In 1995 I apparently gave a long talk to some meeting or other, after which the content of my talk was published by the BPS Psychotherapy Section. I have no memory whatsoever of giving any talk but I do remember writing the article. It seems worth publishing on this blog, with some updates in terms of one of the practical examples, a much shorter version of the original article as it complements with useful background the Approach to Psychosis sequence I republished some time back: I’ve also tried to reduce the psychobabble, though maybe not enough for everyone’s taste! I’ve included in addition references to later research that sheds further light on, for example, neuroplasticity and the relationship between trauma and psychotic experiences. This is the second of five instalments.
At the end of the last post I explained that those who came to me had taken their psychotic experiences very personally indeed. They did not distance themselves from them at all. These phenomena called into question the fabric of their selfhood. It is this threat that must be addressed if the person is to grow. Many people hear voices and experience apparently supernatural events without becoming engulfed by them. Those who cannot so distance themselves fail because too much of their inner being resonates to the vibrations of the voices. It is that part of their inscape that has to be explored.
Louise, whose experiences I described last time, responded to the curiosity I sought to evoke with a slightly bewildered kind of interest. She became more questioning of her family and her childhood. She did not relinquish one jot of her conviction that the hallucinatory child she was experiencing, and the man who threatened her, had or would have some real existence outside her own mind. And why should she?
Shweder, in his excellent exploration, Thinking Through Cultures, argues strongly against the assumption of superiority that can underlie positivist approaches to the reality of others and advocates `transcendence without superiority, scorn, or cynicism’. Transcendence does not necessarily destroy what it replaces, anymore than Einstein can be said to have abolished Newton!
Shweder builds on his premises (page 97):
Cultural psychology assumes that intentional persons change and are changed by the concrete particulars of their own mentally constituted forms of life.
He claims a new aim has been defined for psychologists (page 100):
That aim for cultural psychology is to conceive imaginatively of . . . . intentional worlds and . . . . intentional persons interpenetrating each other’s identities or setting the conditions for each other’s existence and development, while jointly undergoing change through social interaction.
I believe all participants in any form of therapeutic conversation, good or bad, can testify that their identities interpenetrate, at least to a modest degree. This is not achieved by language alone or even mainly. Partners in this kind of dialogue come to occupy a common or shared space which is constructed as much by what is done as by what is said.
The degree to which they can set the condition’s for each other’s existence is limited by many factors, including the shortness of time, the environmental conditions prevailing and the degree to which the exercise of power is restrained. To put someone on a Section marks a momentous escalation in the use of power. Milieu treatment also is well above the snowline on the Everest of power.
By comparison with these collaborative conversation seems to pale almost into insignificance. It gains though by its capacity to prolong its influence over far greater expanses of time, albeit less intensively, and it can enlist the far more willing participation of those engaged in it. This willingness is in itself a potent catalyst for change within the context of this pattern of social interaction.
Our Less Conscious Selves
Shweder outlines four interpretations, in the anthropological context, of the phrase `thinking through others’, all of which can enrich our clinical practice. He describes thinking through others (pages 108-110) in the sense of:
(a) `using the . . . self-consciousness of another . . . person — his or her . . . articulated conception of things — as a means to heighten awareness of our less conscious selves’;
One fairly simple example from my own experience should serve to illustrate this convincingly.
Mary, whom I describe in more detail below, is tormented constantly by voices. She is a young girl who is visually handicapped and has a long history of hospitalisation for surgery, starting in early childhood. According to her own account, her first admission was for surgery at the age of three or four. Her parents claimed that neither of them could stay with her, she says. She remained in hospital for several weeks, consoled only by visits of a fairly brief duration.
As a result of my conversations with her, I had to have early recourse to my supervision group. Within the first few weeks of seeing her, I was already experiencing reactivations of my own early hospitalisations (for more background see links). They were much less traumatic than hers appear to have been. One took place at the age of three for a tonsillectomy and the second at the age of four for the removal of an abscess in my ear. They were of relatively short duration. In both cases my parents could not stay there with me for reasons of contemporary hospital policy, which were unintelligible to me at the time.
While I was familiar with that history and had worked on it in my own therapy I was not aware of the hook her story had lodged in me. At least not until I brought up the situation in my supervision. The undertow of feeling that was threatening to carry me away concerned my feelings of abandonment and my passionate desire not to abandon this young girl whose story seemed genuinely tragic in comparison with my own more mundane circumstances. I was all too familiar with my own pain and imagined it horrendously magnified in her.
My awareness of my less conscious self was heightened to an almost paralyzing and definitely aversive degree. I wanted to be relieved of any responsibility for her at the same time and for the same reasons as rendered me incapable of contemplating withdrawing my commitment! In my experience, people whose selves have been overwhelmed by voices frequently rattle the cage of my own demons.
I can well understand why medication seems, to those people who have the power to prescribe, such a reasonable response to such extremes of suffering, especially if it triggers their own subliminal stuff. Incidentally, I believe that some drugs can sometimes be helpful but that they are used too often, too soon and in too large a quantity. They are also far too frequently used in a way that implies they are all we need.
Discovering the Real
The next interpretation of thinking through others described by Shweder is (b) `getting the other straight, of proving a systematic account of the internal logic of the intentional world constructed by the other’ for `strong and persistent’ feelings `must after all be based on something real, which it may perhaps be possible to discover.’ In simpler terms, there must be some intelligible reason for even the strangest experiences.
Incidentally, this perspective was crucial to my starting this blog: everybody means something is an affirmation of what I believe to be a fact: if we try hard enough everyone’s subjective reality, no matter how bizarre, can make sense to us as their attempt to make sense of their very different experience. This is not the same as agreeing with it, of course.
It needs a longer illustration here to convey the relevance of this. I could have produced a snappy vignette which seemed to prove that I do exactly what I am describing here. I prefer to give you enough background to enable you to decide for yourselves, bearing in mind that what I now think I was doing evolved as an idea in stages over time through the experiences I shall be describing.
Ian was a 50 year old man with an eight year history of being tormented by voices telling him to kill himself and fly with them to far-off places. Describing his experience of the voices he said:
I was living in a dream world. I’d got the voices nearly all the time. They were so loud that I couldn’t hold a conversation. And I couldn’t listen to the radio. They just blocked everything out. The voices were plaguing me so much that if I tried to think about something they’d side-track me. And I’d start thinking about what they were saying to me, and start thinking about doing something about it. I couldn’t think in a straight line. It was just going round and round in circles. They used to wake me up at night. They got loud when I was ill. I thought they were spirits, come from the spirit world for me. I didn’t think that I was going to hurt myself by jumping under a train. I thought it would just be a few seconds of confusion and then it would be all over. I didn’t mind if being dead was just black and nothingness. And if it was flying with the voices all round the world, I didn’t mind that neither. It was better’n what I had.
He was on medication when I first saw him:
It wasn’t having any effect at all. I was on quite a high dosage. I was on 100 mgms of Haldol a week, and 600 mgms a day of Chlorpromazine.
His view of his future was bleak:
Just the voices, and hospital, really, and medication. That’s all there was in life. I couldn’t see any point in any thing. And I couldn’t see any point in doing anything else. I thought it was just schizophrenia. 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. So that jumping under a train was looking very attractive.
Thursday’s post will go into more detail of what then took place.