Irreducible Mind – a review (3/3): the self & the Self

What is the dust which obscures the mirror? It is attachment to the world, avarice, envy, love of luxury and comfort, haughtiness and self-desire; this is the dust which prevents reflection of the rays of the Sun of Reality in the mirror. The natural emotions are blameworthy and are like rust which deprives the heart of the bounties of God.

(‘Abdu’l-Bahá: Promulgation of Universal Peace – page 244)

In the previous two posts I’ve been moaning about how I was robbed when my training in psychology steered me away from the work of thinkers such as FWH Myers as though they had the plague. What I probably need to do to redress the balance is mention how much I was influenced by thinkers who were deeply influenced by Myers. In one case I know that for certain because I still have Roberto Assagioli‘s introductory text on psychosynthesis, which I read in 1976 and which cites Myers in the list of references at the end of Chapter I. Another was a seminal book I borrowed but never bought, so it is impossible to say whether the influence was direct and acknowledged: this was Peter Koestenbaum’s New Images of the Person.

Assagioli explained in his book the importance of what he calls a ‘disidentification exercise’ (page 22):

After having discovered [various elements of our personality], we have to take possession of them and acquire control over them. The most effective method by which we can achieve this is that of disidentification. This is based on a fundamental psychological principle which may be formulated as follows:

We are dominated by everything with which our self becomes identified. We can dominate and control everything from which we disidentify ourselves.

(For the psychosynthesis disidentification exercise see the following link.)

Then, in another exciting moment, I came upon Koestenbaum’s ideas about reflection six years after I had read Assagioli. Reflection is the ‘capacity to separate consciousness from its contents’ (Koestenbaum: 1979). We can step back, inspect and think about our experiences. We become capable of changing our relationship with them and altering their meanings for us. It is like a mirror learning to see that it is not the same as what is reflected in it. So here was a writer in the existentialist tradition speaking in almost the same terms as psychosynthesis. I had practised Assagioli’s exercise for a long period after reading his book. Now I was triggered into resuming the practice again by what Koestenbaum had written.

I came across Koestenbaum’s book just before I discovered the existence of the Bahá’í Faith (for a fuller account see link). It helped me take what I had found in Assagioli and fuse it with what I had found in the Faith and create an experiential exercise to express that understanding in action in a way that helped me immensely to adjust to spiritual concepts which until that point had been completely alien to me for decades – all my adult life in fact. The Baha’i Writings talk about certain key powers of the soul: loving, knowing and willing as well as introducing me to the idea of the heart, the core of our being, as a mirror. I pulled this into my version of the exercise (see below). What I didn’t realise until later was that Assagioli had corresponded with ‘Abdu’l-Bahá and had therefore to some degree been influenced by Bahá’í thought. (See Disidentification exercise for the final version that I used myself rather than this one I revised to share for the use of others).

How amazing then to find Emily Kelly, in the book Irreducible Mind, quoting Myers quoting Thomas Reid, an 18th century philosopher (page 74):

The conviction which every man has of his identity . . . needs no aid of philosophy to strengthen it; and no philosophy can weaken it.… I am not thought, I am not action, I am not feeling; I am something that thinks, and acts, and suffers. My thoughts and actions and feelings change every moment…; But that Self or I, to which they belong, is permanent…

What I regret therefore now is that the usefulness of this exercise did not make me trace it back to its source and find out more of what Myers thought about this and many other things of great importance to me. So, better late than never, that is what I am about to do now.

Myers’s the self and the Self

The disidentification exercise rattled the cage of my previous ideas about who I was in essence. While I didn’t quite buy into Assagioli’s other ideas about consciousness at that time I felt, both intuitively and from the experiences I was having, that his idea was completely right that there is some form of pure consciousness underpinning our identity.

So, as good a place as any to pick up the thread of Myers’s thinking again is with his ideas of the self and the Self. There are some problems to grapple with before we can move on. Emily Kelly writes (page 83):

These ‘concepts central to his theory’ are undoubtedly difficult, but despite some inconsistency in his usage or spelling Myers was quite clear in his intent to distinguish between a subliminal ‘self’ (a personality alternate or in addition to the normal waking one) and a Subliminal ‘Self’ or ‘Individuality’ (which is his real ‘unifying theoretical principle’). In this book we will try to keep this distinction clear in our readers minds by using the term ‘subliminal consciousness’ to refer to any conscious psychological processes occurring outside ordinary awareness; the term “subliminal self” (lower case) to refer to ‘any chain of memory sufficiently continuous, and embracing sufficient particulars, to acquire what is popularly called a “character” of its own;’ and the term ‘Individuality’ or “’Subliminal Self” (upper case) to refer to the underlying larger Self.

Myers believed that the evidence in favour of supraliminal experiences, used here by me in the sense of things that leak through the membrane from above, is strong enough to warrant serious consideration and he distinguishes between that and subliminal experiences that come, as it were, from underneath (see diagram and footnote at the bottom of the post)[1] (page 87):

Supernormal [ie supraliminal in my sense] processes such as telepathy do seem to occur more frequently while either the recipient or the agent (or both) is asleep, in the states between sleeping and waking, in a state of ill health, or dying; and subliminal [unconscious in my use of terms] functioning in general emerges more readily during altered states of consciousness such as hypnosis, hysteria, or even ordinary distraction.

He felt that we needed to find some way of reliably tapping into these levels of consciousness (page 91)

The primary methodological challenge to psychology, therefore, lies in developing methods, or ‘artifices,’ for extending observations of the contents or capacities of mind beyond the visible portion of the psychological spectrum, just as the physical sciences have developed artificial means of extending sensory perception beyond ordinary limits.

Midsummer Night’s Dream

Thin Partitions

He also has much that is interesting and valuable to say about the implications of a proper understanding of these upper and lower thresholds, especially when they are too porous, for both genius and mental health (page 98):

When there is ‘a lack of liminal stability, an excessive permeability, if I may say so, of the psychical diaphragm that separates the empirical [supraliminal: conscious in my usage] from the latent [subliminal: unconscious in my usage] faculties and man,’ then there may be either an expansion of consciousness (an ‘uprush’ of latent material from the subliminal into the supraliminal) or, conversely, a narrowing of consciousness (a ‘downdraught’ from the supraliminal into the subliminal). The former is genius, the latter is hysteria.

His use of supra- and subliminal is slightly confusing here but the main point is that genius expands what we are aware of, and more comes above the threshold, whereas hysteria narrows our experience so that less comes into consciousness. This is partly clarified by Kelly explaining (page 99):

In short, Myers believed that hysteria, when viewed as a psychological phenomenon, gives ‘striking’ support to ‘my own principal thesis’, namely, that all personality is a filtering or narrowing of the field of consciousness from a larger Self, the rest of which remains latent and capable of emerging only under the appropriate conditions.

Even the expanded consciousness of genius, in this view, is still filtering a lot out – in fact, it still leaves most of potential consciousness untapped.

There is in addition a common quality of excessive porousness which explains why, in Shakespeare’s phrase, the ‘lunatic . . . . . and the poet are of imagination all compact.’ Myers’s view is that (page 100):

Because genius and madness both involve similar psychological mechanisms – namely, a permeability of the psychological boundary – it is to be expected that they might frequently occur in the same person; but any nervous disorders that accompany genius signal, not dissolution, but a ‘perturbation which masks evolution.’

For Myers dreams, though they may indeed be common and frequently discounted, they are nonetheless important sources of data (pages 102-103):

Myers argued [that] dreams provide a readily available means of studying the ‘language’ of the subliminal, a language that may underlie other, less common forms of automatism or subliminal processes. . . . Myers’s model of mind predicts that that if sleep is a state of consciousness in which subliminal processes take over from supraliminal ones, then sleep should facilitate subliminal functioning, not only in the organic or ‘infrared’ region, but also in the “ultraviolet” range of the psychological spectrum, such as the emergence of telepathic impressions in dreams.

This has certainly been my own experience. A post I wrote two years ago will perhaps serve to illustrate that for those who are interested. My dream of the hearth, recounted there, was, incidentally, the only dream I have ever had in which I experienced the presence of God, another reason for my attaching such great importance to it.

An important related topic he also addresses is that of ‘hallucinations.’ People tend to be quite closed minded on this topic, seeing visions and voices as the sign of a mind gone wrong. This is quite unhelpful. There is a mass of evidence that I may come back to some time to indicate that ‘hallucinations’ range from the darkly destructive to the life enhancing and it important to pay close attention to the details of them and the circumstances under which they occur before coming to any conclusion about them. Our society’s default position, the result of exactly the backward step under discussion here that both psychology and psychiatry took in the name of pseudo-science, is harmful rather than helpful quite often (I have explored a more positive approach on this blog – see the six links to An Approach to Psychosis). Pim van Lommel’s research into NDEs replicates the same kind of pattern in that patients whose families and friends were unsympathetic took much longer to integrate their experiences and found it a more painful process than those who were met with support and understanding. He summarises this (page 51):

When someone first tries to disclose the NDE, the other person’s reaction is absolutely crucial. If this initial reaction is negative or skeptical, the process of accepting and integrating the NDE typically presents far greater problems than if this initial reaction is positive, sympathetic, or neutral. Evidence has shown that positive responses facilitate and accelerate the integration process. In fact, without the possibility of communication, the process of coming to terms with the NDE often fails to get under way at all.

We tend to underestimate the frequency of ‘hallucinations’ in the ‘normal’ population, something the Myers was already aware of (page 108):

One of the most important accomplishments of Myers, Guerney, and their colleagues in psychical research was in demonstrating the previously suspected, but as it turns out not infrequent, occurrence of hallucinations in normal, healthy individuals.

Not all them should be dismissed as fantasy (page 109):

These studies and surveys also demonstrated that such hallucinations are not always purely subjective in origin. Some, in fact, are veridical – that is, they involve seeing, hearing, or otherwise sensing some event happening at a physically remote location. . . . . Using their own figures for the frequency with which people recall having hallucinations in a waking, healthy state, together with statistics regarding the incidence of death in the United Kingdom, they concluded that hallucinations coinciding with a death happened too frequently to be attributable to chance.

All in all, Myers’s mould-breaking approach to the mind and to the problems of consciousness is refreshing to say the least, and maps onto my own long-standing interests in spirituality, creativity and ‘psychosis.’ It was icing on the cake to find what he said about science and religion, a point to savour and a good note to end this post on (page 113) :

On the one hand, . . . he believed that science could ‘prove the preamble of all religions’ – namely, that the universe extends far beyond the perceptible material world. On the other hand., religion could contribute to ‘the expansion of Science herself until she can satisfy those questions which the human heart will rightly ask, but to which Religion alone has thus far attempted an answer.’

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[1] Unfortunately, Myers uses supraliminal to mean anything that crosses any threshold into consciousness, whether from above or below. This is a perfectly legitimate usage but it then leaves us no straightforward word to describe what lies above us and beyond our upper threshold. I have preferred to use subliminal to mean what lies beneath the lower threshold and supraliminal for what lies beyond our upper threshold, and conscious to describe what crosses either of the thresholds into our awareness. Quotes from or about Myers tend to follow his usage.

The Threshold Issue

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An Angle on Suffering (3/3): the nature of choice

Had the life and growth of the child in the womb been confined to that condition, then the existence of the child in the womb would have proved utterly abortive and unintelligible; as would the life of this world, were its deeds, actions and their results not to appear in the world to come.

(‘Abdu’l-Bahá inBahá’í World Faith: page 393)

In the previous two posts, I have been looking at Dabrowski’s Theory of Personal Disintegration (TPD) most particularly for what it has to say about suffering.

Both TPD and a rich and interesting approach to psychotherapy – Acceptance and Commitment Therapy (ACT) – owe much to existentialism. Mendaglio acknowledges his debt in the last chapter of the book he edited on this subject (page 251):

However, there is a great deal of similarity between existential psychology and the theory of positive disintegration. Both emphasise similar key concepts such as values, autonomy, authenticity, and existential emotions such as anxiety and depression. A more fundamental similarity is seen in the philosophical underpinnings of TPD, which is in large measure existentialism.

In spite of my own immense debt to existentialist thinking, only rivalled by my debts to Buddhism and to the Bahá’í Faith, I have certain reservations about Dabrowski’s take on the degree of choice we are able to exercise.

Crucial Caveats

His take on suffering is truly inspiring. Care needs to be taken though that we do not adopt this view in a way that assumes that those who are crushed by their sufferings are somehow to blame.

It is true that his model presupposes that each of us will probably meet a challenging choice point sometime in our lives, where we can either cling to the familiar comfortable half-truths that have failed us or strive to rise about them to higher levels of understanding. It is also true that he feels that many of us are capable of choosing the second option, if we only would.

However, not everyone is so lucky. I include here a brief summary of the life history of Ian – the man whose interview I have quoted extensively in the first three posts on An Approach to Psychosis.

His history shows very clearly that he could only make the second choice at times and then meet the pain and work through it to alleviate his tormenting voices. At other times the voices were preferable to experiencing the guilt and he chose what we might call madness rather than lucidity. Given the horrors he had faced it was clear that he should not be thought a failure. I would probably have done the same had I gone through what he had experienced in his life, from his earliest days.

Dabrowski seems to feel that our capacity to choose is genetically determined. Mendaglio explains (page 250):\

Dabrowski . . . . postulated the existence of a third factor of development, representing a powerful autonomous inner force which is rooted in the biological endowment of individuals.

It seems to me that it would have taken a truly exceptional individual to make the choice to experience Ian’s level of pain in order to progress. If that does not seem quite convincing, there is another case history I would like to share very briefly.

Among the sequence of posts related to mental health there is a poem called ‘Voices.’ The woman upon whose experiences that poem is based, was brutally abused by her father, sexually, and by her mother, physically, from her earliest years through her mid-teens.

She came to us to work on her father’s abuse. We developed a safe way of working which involved starting with 15 minutes exploring how things had been since we last met. Then we moved on to 15-20 minutes of carefully calibrated work on the abuse. Then the last half hour of the session was spent helping her regain her ordinary state after mind after the work on her early experiences had intensified her hallucinations.

After almost a year of this work things seemed to be going well. Then came the unexpected. She found herself in a building that closely resembled the building strongly connected with the worst episode of abuse she had experienced at the hands of her father. Just being there was more than she could cope with. She became retraumatised in a way we none of us could have anticipated or prevented. The next time we met she could not stop sobbing.

We discussed what she might do. There were two main options.

She could, if she wished, continue on her current low levels of medication and move into a social services hostel where she would be well supported while we continued our work together, or she could be admitted onto the ward and given higher levels of medication in order to tranquillise her out of all awareness of her pain.

She chose the second option and I could not blame her in any way for doing so. It would be a betrayal of the word’s meaning to suppose she had any real choice at that point but to remain psychotic while the medication kicked in rather than deal with the toxic emotions in which she felt herself to be drowning.

It is when I consider these kinds of situation at my current level of understanding of his theory, that I feel it could leave the door open to destructive attitudes.

He believes, if I have understood him correctly, that some people’s genetic endowment is so robust they will ultimately choose the harder option regardless of the environment in which they grew up. Most of us are in the middle and with an environment that is not too extreme we will do quite well. The endowment of some is so poor, he seems to be saying, that it requires an optimal environment if they are to choose to grow even in a modest way.

This approach, if I have got it right, has two problems. The first, which is less central to the theme of this post, is that it is perhaps unduly deterministic because of the power that is given to inherited ‘endowment’ to determine the life course of any individual. The second problem is more relevant to current considerations in this post, though related to the first point. By placing such a determining role upon heredity, the force of the environment may be unduly discounted.

I am not claiming that he attaches no importance to environment. In fact, education for example is much emphasised in his work and he is clearly aware that limited societies will be limiting most people’s development – and he would include the greedy materialism of Western cultures in that equation. I’m not sure where he would place the impact of natural disasters in his scheme of things.

He may though be minimising the crushing impact of such experiences as the two people I worked with had undergone, in the second case throughout almost all her formative years. Could a strong genetic endowment have endured such hardship and come through significantly less damaged? If you feel so, you may end up not so much thinking ‘There, but for the grace of God, go I!’ but more ‘They broke because they were weak.’ Empathy, which Dobrawski values so much, would be impaired because we can start to define people as essentially different from us, not quite part of the same superior species.

More Complexities

This is a truly complex area to consider though, and I will have to restrict myself at this point to a very brief examination of one approach to it which does justice to that complexity.

‘Abdu’l-Bahá, in his description of the various components of our character, suggests that what we inherit is a source of either strength or weakness (Some Answered Questions: page 213):

The variety of inherited qualities comes from strength and weakness of constitution—that is to say, when the two parents are weak, the children will be weak; if they are strong, the children will be robust. . . . . . For example, you see that children born from a weak and feeble father and mother will naturally have a feeble constitution and weak nerves; they will be afflicted and will have neither patience, nor endurance, nor resolution, nor perseverance, and will be hasty; for the children inherit the weakness and debility of their parents.

However, this is not quite the end of the matter. He does not conclude from this that moral qualities, good or bad, stem directly from the inherited temperament of an individual (pages 214-215):

But this is not so, for capacity is of two kinds: natural capacity and acquired capacity. The first, which is the creation of God, is purely good—in the creation of God there is no evil; but the acquired capacity has become the cause of the appearance of evil. For example, God has created all men in such a manner and has given them such a constitution and such capacities that they are benefited by sugar and honey and harmed and destroyed by poison. This nature and constitution is innate, and God has given it equally to all mankind. But man begins little by little to accustom himself to poison by taking a small quantity each day, and gradually increasing it, until he reaches such a point that he cannot live without a gram of opium every day. The natural capacities are thus completely perverted. Observe how much the natural capacity and constitution can be changed, until by different habits and training they become entirely perverted. One does not criticize vicious people because of their innate capacities and nature, but rather for their acquired capacities and nature.

Our habits and choices have a crucial part to play. Due weight though has also to be given to the power of upbringing and the environment (Selections from the Writings of ‘Abdu’l-Bahá, Sec. 95, pp. 124–25):

It is not, however, permissible to strike a child, or vilify him, for the child’s character will be totally perverted if he be subjected to blows or verbal abuse.

This theme is taken up most powerfully by the central body of the Bahá’í Faith ((Universal House of Justice: April 2000):

In the current state of society, children face a cruel fate. Millions and millions in country after country are dislocated socially. Children find themselves alienated by parents and other adults whether they live in conditions of wealth or poverty. This alienation has its roots in a selfishness that is born of materialism that is at the core of the godlessness seizing the hearts of people everywhere. The social dislocation of children in our time is a sure mark of a society in decline; this condition is not, however, confined to any race, class, nation or economic condition–it cuts across them all. It grieves our hearts to realise that in so many parts of the world children are employed as soldiers, exploited as labourers, sold into virtual slavery, forced into prostitution, made the objects of pornography, abandoned by parents centred on their own desires, and subjected to other forms of victimisation too numerous to mention. Many such horrors are inflicted by the parents themselves upon their own children. The spiritual and psychological damage defies estimation.

This position allows for the fact that we need to take responsibility for our own development while at the same time acknowledging that we may be too damaged by the ‘slings and arrows of outrageous’ upbringing to do so to any great extent without a huge amount of help from other people. And most of us are the other people who need to exert ourselves to protect all children and nurture every damaged adult who crosses our path to the very best of our ability. Maybe Dabrowski is also saying this, but I haven’t read it yet. Even so his thought-provoking message is well worth studying.

In the end though, as the quote at the beginning of this post suggests, any consideration of suffering that fails to include a reality beyond the material leaves us appalled at what would seem the pointless horror of the pain humanity endures not only from nature but also from its own hands. I may have to come back to this topic yet again.

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An Approach to Psychosis: Fitting It All Together (6/6)

Some years ago I posted a series of attempts to describe my work in the NHS as I experienced it. Since then I have been also attempting to use poems to approach the same experiences from a different angle. Because my poems tend to come from a darker place than my prose it seemed only right to publish the poems alongside the more positive feel of the republished mind-work posts. It felt as though that would be more balanced, more true to the experience as a whole. So, what I am doing is following up a prose post with a poem after a day or two, but they need to be read together to get a more complete picture of what was involved in the work I did. Above all else I would hope to convey the reality of this area of experience more completely by tackling it this way, and do more justice to the courage of those who suffered. They are stronger than we realise for bearing the unbearable so bravely. 

Only Our Simulations to Go  On

At best we never achieve more than a simulation of reality. Even something as apparently clear-cut and concrete as colour is no exception.

To see how Visual Illusions work – go to link

What we perceive as red is really nothing more than a wavelength of light and our experience of red is a coded response that has been allocated quite arbitrarily. We could just as well have experienced the “red “ wavelength as blue! More abstract things are of course even more liable to be the product of construction and elaboration in the brain-mind system which habitually fills in the gaps in experience as best it can to make sense of it all. For present purposes three aspects of this simulation concern us most: experiences, beliefs and flexibility.

Experiences are the raw material of the mind. They are what we access of the inner and outer worlds through our senses, albeit modified by the interpretive activity of the brain. Experiences range from mainstream to the extremely idiosyncratic. Dreams are about as idiosyncratic as experience gets for most of us unless we are placed in strange, extreme and possibly frightening circumstances. For some people however dreams seem to become part of their waking reality.

Beliefs are the ideas we form usually on the basis of experience. We often make heavy emotional investments in our important ideas. These then colour experience in turn and can even distort it at the time it happens or in memory. Again beliefs range from the conventional to the extremely unusual. Even the most middle of the road person can find their way of looking at the world morphing into strange and frightening shapes as a result of such things as prolonged isolation.

Experience suggests that most people manage to negotiate their way through the world without too much of a problem on the basis of the models of the world they have developed. Many people whose experiences and beliefs are well outside the usual run of the mill rub along quite well. There are relatively small numbers of people whose beliefs and experiences are not only unusual but also very troubling. These are often the people mind-workers have to deal with. The majority of them have only short-lived difficulties.

Much of my work, before I retired, was with those who are stuck in their difficulties. Their experiences are unusual, troublesome and intractable. It is in helping people deal with this intractability that the model of mind-work I am proposing here is most useful.

Steering between Rigidity and Chaos

Most of us live somewhere between rigidity and chaos. Our models of the worlds are sufficiently malleable to respond flexibly to the shifts and changes of the world around us. If systems of thinking are too unstable or unformed we will be unable to make sense of our world and make reasonable responses to it. If they are too fixed and too compelling we cannot adapt when circumstances require it. The antidote to such unhelpful fixity is the flexibility which comes from reflection, relatedness and relativity.

Complete fixity, which often though not always in psychosis results from the kind of high emotional investment and simplification of thinking that feelings such as terror can induce, makes therapeutic work of the kind I am describing difficult. Someone who believes that their survival is in doubt is unlikely to see too much point in a leisurely exploration of their inscape! If the terror, or whatever is driving the investment that is creating the fixity, can be somewhat reduced, then conversation becomes possible. I suspect that medication, where it works, achieves its effect by calming someone down.

Increasing our Leverage

Once conversation is possible two powerful tools, implied in all that has been said above, become available. First, some space can be created between consciousness and its contents, and secondly there is a chance for more than one mind to be brought to bear upon the experiences. The space can be used for people to compare notes as equals – as two human beings, both with imperfect simulations of reality at their disposal, exchanging ideas about what is going on, with no one’s version being arbitrarily privileged from the start. There is a wealth of information that suggests most strongly that this process of collaborative conversation (Andersen and Swim), of consultation in the Bahá’í sense (see John Kolstoe), of inquiry (see Senge), of interthinking, can achieve remarkable results: Neil Mercer talks of the crucial function of language and says:

it enables human brains to combine their intellects into a mega-brain, a problem-solving device whose power can be greater than that of its individual components. With language we are able not only to share or exchange information, but also to work together on it. We are able not only to influence the actions of other people, but also to alter their understandings. . . . . Language does not only enable us to interact, it enables us to interthink.

I’d like to slightly alter the wording of one sentence there to capture the essence of what I think I’m describing:

We are able not only to influence the actions of one another, but also to alter one another’s understandings.

I feel that the conditions that I have sought to describe in this sequence of posts go a long way towards making effective interthinking possible. Effective interthinking and mind-work are closely related activities. Neither can happen at their best and most constructive in the absence of good relationships, reflection, relativity and relatedness.

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Patients in Adversity (4/5): Voices

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An Approach to Psychosis: the Mind-Work Process (4/6)

Some years ago I posted a series of attempts to describe my work in the NHS as I experienced it. Since then I have been also attempting to use poems to approach the same experiences from a different angle. Because my poems tend to come from a darker place than my prose it seemed only right to publish the poems alongside the more positive feel of the republished mind-work posts. It felt as though that would be more balanced, more true to the experience as a whole. So, what I am doing is following up a prose post with a poem after a day or two, but they need to be read together to get a more complete picture of what was involved in the work I did. Above all else I would hope to convey the reality of this area of experience more completely by tackling it this way, and do more justice to the courage of those who suffered. They are stronger than we realise for bearing the unbearable so bravely.

Many people have grappled with defining what mind-workers ought to do. Two “orts” emerge as favourites: rapport, as described by Carl Rogers, and support, as outlined by David Smail. My idea of the mind-working process starts from but does not end there. We will also have to consider other factors of crucial importance if the client is going to be able to take over and keep going the process of transformation for himself. These factors will be described in more detail in the next post: I’ll be using terms rooted in existential therapy but the key underlying concept is present in a strong form in my Faith tradition.

The Rogerian Triad

Carl Rogers

First there is the old faithful – the so-called Therapeutic Triad! I have used the word ‘therapist’ here because it is the one Rogers chooses. I’ve mentioned my doubts about the word in an earlier post of this sequence.

The Therapeutic Triad of Carl Rogers consists of genuineness (or congruence), empathy and warmth (or unconditional positive regard). Though it is very well known it perhaps needs a brief comment here. Carl Rogers in 1957 described the core conditions required of the mind-worker. To be genuine the therapist must be “freely and deeply ” herself. The therapist must also find herself experiencing “a warm acceptance of each aspect of the client’s experience as being a part of that client” if she is to experience “unconditional positive regard.” Empathy is “to sense the client’s private world as if it were your own.” For this to be effective the client must perceive “the acceptance and empathy which the therapist experiences for him.”

This triad can be summarised as Rapport, one of the “orts” which the mind-worker must bring to the mind-work to make the existential processes possible. This is what the mind-worker brings to the relationship but does not expect the client to apply to his own life.

(Incidentally, I will be using “he” or “we” for a client and “she” for a mind-worker in order to be politically correct, to avoid awkward constructions such as “(s)he” or him/her and to increase the likelihood of our reading at least some of these words from a client’s perspective.) If these qualities were not seen by the client to be present the mind-work would never get going. Rapport may often do no more than make change possible.

Smail’s Triad

Then there is the relatively new one on the block which takes things a bit further.This other “ort”, which can be labeled “Support”, is the Smail Triad, which he introduces in his book “How To Survive Without Psychotherapy” (1996). This is less widely known and will need a bit more introduction. It consists of Encouragement, Solidarity (or Comfort) and Clarification.

Warmth and Encouragement are related but not identical. Encouragement is essential. Smail defines this as:

. . . any kind of influence brought to bear by the therapist on the patient (sic) to try actively to make a difference to the factors that are causing him or her distress.

(A feature of so-called “psychosis” is passivity in the face of experience: encouragement is therefore very important in this context. Also such people have typically been facing deeply discouraging experiences for many years.) By encouragement the mind-worker responds positively to the efforts of her client to apply what he has discovered in mind-work. Praise is, for me, a key component.

Solidarity is, according to Smail, “one of the most potently therapeutic experiences to be had,” even though in itself it changes nothing. It is derived from sharing your deepest fears and most shameful secrets with a ‘valued other’ who does not immediately heap blame or scorn upon you, but who instead listens patiently and sympathetically to what you have to say.

It is something one human being gives to another by uncritically and supportively, but not blindly, standing beside him in his difficulties. It should but perhaps does not go without saying that this does not mean leaping in and drowning in there with him.

In the words of Smail (page 213):

Solidarity with others is both one of the most significant and, all things considered, the most available forms of power for ‘ordinary’ people.

David Smail

For people with a label of psychosis it is significantly less available and we should not underestimate the corrosive effects of that unavailability upon a person’s well-being. Solidarity is also what stops the praise and encouragement from being experienced as patronising. The mind-worker stands alongside, not above, the client. To feel that we are not alone in our troubles and that some one appreciates our efforts has a power to keep us going and bring about success that should not be underestimated.

Though Solidarity and Empathy have much in common they also are not the same thing. Solidarity involves standing with somebody as he struggles to act. Though it implies the mind-worker knows how the client feels, solidarity also implies action whereas empathy might only sit nearby and commiserate with how difficult it must feel.

Clarification is also crucial. People in distress are often confused. Simple questions and straightforward feedback are often all that is needed to dispel the fog. Sometimes another map of the world needs to be gradually introduced, again as a colleague and fellow human being, not as a superior being from her pedestal.

Smail (page 42) feels that there is,

. . . in principle at least, not a great deal of difficulty in arriving at an acceptable account of how people come to be as they are and what are the origins of their distress. Where difficulties do arise is in knowing what is to be done with this information. The idea that ‘insight’ leads automatically to cure, while figuring largely in many patients’ expectations, has long been recognised to be problematic by therapists.

The glib assumption, that to be clear is to be able to change, places an unrealistic degree of responsibility upon the client. Part of Smail’s solution is to emphasise solidarity and encouragement: the rest of what he stresses may be summarised under the idea of taking proper account of the power of environment in creating and alleviating difficulties. The extent to which an oppressive environment cannot be changed sets limits on the degree of change we can bring about.

For me, the physical environment within which the mind functions can be both outside (society, unemployment, lack of cash, poor housing etc) and inside (brain structure, chemistry, hormones etc) the individual. The degree to which these variables can operate effectively to bring about change is affected by environment, but that is a topic too large for present consideration.

Transferring Ownership

The process of clarification provides us with the easiest bridge from the “orts” to the factors we mentioned earlier which enable the client to keep the transformation process going because the client has to have more ownership of clarification than of the other qualities in these groups of three.

Support, even in the context of a good rapport, can only make change possible but it doesn’t tell us how to make sure it will happen in the first place and then continue in the right direction in the absence of the mind-worker. These qualities do not become the instruments the client will use himself to bring about change nor are they the results of changes taking place. They are composed of the essential prerequisites that make positive change processes possible within a relationship. With the possible exception of clarification, if the client lacks them, he does not need to develop them if he does not wish to. However, he needs to sense most of them in the mind-worker.

The Good Samaritan

It perhaps goes without saying that most of these characteristics of the relationship, such as warmth, empathy, honesty, encouragement and solidarity are also emphasised in many spiritual traditions as essential to a proper relationship with other people. The golden rule, which recommends that we treat others as we would ourselves wish to be treated, occurs over and over again across the world transcending barriers of language and culture.

The characteristics I will be discussing in the next post helped me combine practical insights specifically drawn from the Bahá’í Faith with the processes of therapeutic practice. They are key to someone’s being able to carry on the work after the mind-worker has gone.

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An Approach to Psychosis: Complicating Factors (3/6)

Some years ago I posted a series of attempts to describe my work in the NHS as I experienced it. Since then I have been also attempting to use poems to approach the same experiences from a different angle. Because my poems tend to come from a darker place than my prose it seemed only right to publish the poems alongside the more positive feel of the republished mind-work posts. It felt as though that would be more balanced, more true to the experience as a whole. So, what I am doing is following up a prose post with a poem after a day or two, but they need to be read together to get a more complete picture of what was involved in the work I did. Above all else I would hope to convey the reality of this area of experience more completely by tackling it this way, and do more justice to the courage of those who suffered. They are stronger than we realise for bearing the unbearable so bravely.

The Importance of Motivation

What perhaps is also worth mentioning is that if Ian had not been desperate to get rid of the voices he probably would not have bothered doing anything I suggested.

P.: What I’m picking up is that, initially, you didn’t have much trust in me and you wondered what on earth I was up to. You didn’t really believe in what I was suggesting you should do.

I.: No.

P.: So, in a sense, why do you think you tried it? And why do you think you stuck with it?

I.: Desperate. I wanted to get better, you see? I didn’t want to go on the way I was going. So, I was desperate. So, I tried what you were telling me to do. It was worth a try. It was something I hadn’t tried before. And it was something new, you know? And it worked.

P.: Were you surprised it worked?

I.: I was very surprised it worked.

P.: Right.

I.: It seemed so simple. All that eight years, you know? All the trouble, all the Sections [i.e. compulsory detentions under the Mental Health Act 1983], and all the rest of it, and all the time in hospital and all the talking didn’t count for nothing. Then all of a sudden it just seemed to click! And it come together.

P.: Made sense and gave you relief?

I.: It did give me relief, yeh.

It made very little sense to him beforehand. This is true for a great many people. The more engulfed they are by their experiences the less sense a mind-work approach makes to them. Only desperation or an equivalent motivation will drive them to try what we suggest to them. In Ian’s case we were lucky that he got some results before he gave up trying.

The Balance of Pain and Gain

There was also the issue of the pain involved.

P.: So you think that the pain you experienced as a result of sorting this out was a price worth paying for now having sorted it out?

I.: Yes. It was well worth paying. I didn’t think so at the time. I wanted to stop it, you know? Because it hurt too much.

This was not true later. When he was dying some years later of emphysema and heart failure, I visited him in the hospice and asked him the same question. We had worked on other deeper pain by then. He had changed his mind. The pain was not worth the gain he said then. He had learned to manage the voices by dealing with the pain when they got too bad and he had learned to manage the pain of difficult anniversaries by allowing the voices to surface again more strongly. The torment of the voices at those times was preferable to the pain, anguish and guilt he would otherwise experience. This makes it imperative to consider carefully whether we have the person’s informed consent before we use the depth approach.

The Limitations of Diagnostic Labels

Also interesting is the point he made that the problems he discovered were different from what he thought they would be.

I.:. . . . the questions you asked were painful. And I didn’t want to answer them.

P.: And you didn’t see the point of answering them either, did you?

I.: No, I didn’t see the point in answering them because I didn’t recognise myself that the problem lay there. But once I could see where the problem was I could bargain with the voices.

P.: Yeh. And you had to know where the problem lay, roughly before you could bargain with them?

I.: And talking to you showed me where the problem was. So, I was able to deal with the voices in a positive way.

P.: But before you had gone through this whole process there was no way you would have realised that the problems were what they turned out to be.

I.: No. I thought it was just schizophrenia.

A Welcome Corrective

P.: And that was the end of it.

I.: And that was the end of it. I was schizophrenic and that was it. And I had nothing to look forward to except hospital and more medication. And I couldn’t stand the thought of that, you know? So that jumping under a train was looking very attractive. But it doesn’t look attractive now.

P.: Because life seems to have more to offer?

I.: Yeh.

Nonetheless in our subsequent conversations he oscillated between talking about his thoughts/feelings/voices and his illness.

What perhaps matters most is not whether these ways of describing a problem are true or false but whether they are useful or useless to the person at the time. Psychosis is too complex a phenomenon to be successfully explained in our present state of knowledge. My problem with the medical model is not that it is always completely wrong but that it is all too often offered as the only explanation when other explanations would be more useful to the person concerned.

Sleep and Food

Naturally, there are other factors that have a part to play in psychotic experiences and a person’s capacity to cope effectively with them. For example, Ian talked of his need for sleep and food.

He said, ‘Now I come back off the holiday. I was quite well for about a couple of weeks . . ..: . . . and then I went downhill very quickly because [the voices] wouldn’t let me sleep and I stopped eating. And I got very weak, you know. And the voices become louder and more persistent. And I started to believe them.’

We probably all know how important sufficient sleep and good food is for mental health, especially for people suffering from this type of problem. The physical and social environment is also extremely important. However, I am not attempting here a comprehensive list of such factors. That would be too ambitious. I’m trying to give a sense of what constitutes an optimal approach for someone seeking to use conversations to help those who are struggling with these potentially disabling phenomena we call psychosis. The recovery model as a whole package depends upon many other things also being in place such as, where needed, social support, training, education, a spiritual perspective and work.

Perhaps next time we should look more closely at the ingredients of collaborative conversation.

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