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Posts Tagged ‘collaborative conversation’

PTSD and war

Before we plunge further in from where we got to last time, I need to look briefly at what is known about the impact of war trauma on those affected by killing other human beings. This will help clarify just how disabling the effects of Ian’s experiences were likely to be on someone who was already undoubtedly very vulnerable.

There was an in-depth look at this in a television documentary in the wake of the Falklands War. The programme adduced a wealth of evidence that most human beings have a powerful and deep-seated aversion to killing other people. Approximately 98% of us are to varying degrees averse. For example, there were soldiers in the days of muzzle-loading muskets, who died with their muskets in their hands, the barrel full of undischarged ammunition balls. They had faked reloading without firing, so reluctant were they to risk killing anyone. Others, using rifles, were known to aim to miss or to wound slightly rather than to kill.

There are two outliers, representing about 1% in each case, who have no such inhibitions. One such exception is, not surprisingly, the psychopath. The other exception, which is very surprising, is an otherwise morally and emotionally normal individual who has no compunction about killing.

Psychologists, to their shame, devised training methods, using probable battle scenarios, that made rapid and automatic shooting to kill seem easy and unproblematic. These scenarios were practiced repeatedly until the lethal reaction was instinctive. What no one predicted was how traumatic many soldiers found it, to be confronted in battle with the consequence of their training: a dead soldier they had killed without a moment’s thought. As with Ian, the post-traumatic reactions were often devastating, with guilt and horror as key components of flashbacks and nightmares. In his case the signs of trauma were the unrelenting voices, a waking nightmare in effect.

Some of the horror of this is captured in Keith Douglas’s poem of the Second World War, How to Kill.

keyesdouglas

Keith Douglas

Under the parabola of a ball,
a child turning into a man,
I looked into the air too long.
The ball fell in my hand, it sang
in the closed fist: Open Open
Behold a gift designed to kill.

Now in my dial of glass appears
the soldier who is going to die.
He smiles, and moves about in ways
his mother knows, habits of his.
The wires touch his face: I cry
NOW. Death, like a familiar, hears

And look, has made a man of dust
of a man of flesh. This sorcery
I do. Being damned, I am amused
to see the centre of love diffused
and the wave of love travel into vacancy.
How easy it is to make a ghost.

The weightless mosquito touches
her tiny shadow on the stone,
and with how like, how infinite
a lightness, man and shadow meet.
They fuse. A shadow is a man
when the mosquito death approaches.

This is an equally disturbing but different kind of trauma from the kind captured in Wilfred Owen’s poems, such as Dulce et Decorum Est.

The intense guilt Ian harboured about his army experiences was too hard to bear and he had buried it. However, his subsequent guilt over throwing his alcoholic partner out of the house because her drinking was consuming his income from three jobs and he couldn’t cope any longer, reactivated the earlier even more intense guilt, because he thought she might die on the street, meaning that he might in a sense have killed her.

During the first period of therapy he felt that he was dealing only with his guilt about her, and that this was the main problem in terms of his voices. This was hard enough. Only later did he come to realise, by the impact of an anniversary effect I’ll come to in the next post, that the far darker army experiences, that he hadn’t yet dealt with, lay still active in this respect underneath.

What use is religious practice here?

There is much evidence that faith and religion are beneficial to mental (and physical) health. They reduce amongst other difficulties: depression, anxiety, suicide, & psychosis. The protectors they provide include: greater meaning and purpose, higher self-esteem, social support, less loneliness and more hope. (Harold Koenig at al. in Religion and Health’ Chapter 15)

My focus now will be on two aspects: reflection and consultation. Buddhism offers the most obvious example of powerful reflective processes. There is also a wealth of information that suggests most strongly that the 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.

It is the special combination of both these processes that is unique to the Bahá’í Faith as far as I am aware, though variations of each alone can be found in other either religious or educational/therapeutic contexts.

After I qualified and became a member of the Bahá’í community, fully integrating my understanding and practice of these processes into my clinical repertoire took a couple of years. I came to feel the benefits of that were considerable.

These weren’t the only factors I tried to accommodate. The hardest to digest was the belief that the mind is not dependent upon the brain. I have dealt with that in detail elsewhere.

The easiest was the notion that not only is the spiritual core of all religions essentially the same, but also humanity is in essence one: we are all part of the human family and all interconnected, not just at a material level but at a spiritual one as well. This is relevant here. This concept of unity not only serves to dispel any residual sense we might have that someone with a diagnosis of schizophrenia is somehow a different kind of being from us, but it also clarified that being inwardly divided, as many of us are, is not only a betrayal of our own essential inner oneness but an obstacle to our connecting with others, not just as a therapist but in any relationship. Similarly a community that is at odds with itself with find it hard to connect with everyone on a harmonious basis. I will be returning to that point.

My shorthand description of reflection is to say that it involves separating consciousness from its contents. Consultation, in similarly brisk terms, is the dispassionate comparison of notes, with the emphasis here on the word ‘dispassionate.’

Reflection

In discussing the nature and power of reflection I usually start with Peter Koestenbaum’s book, New Image of the Person: Theory and Practice of Clinical Philosophy.

Reflection, he says (page 99): ‘. . . releases consciousness from its objects and gives us the opportunity to experience our conscious inwardness in all its purity.’ I will look more closely at exactly what this might mean in a moment. Before we move on from his take on the matter, what he says at another point is even more intriguing (page 49): ‘The name Western Civilisation has given to . . . the extreme inward region of consciousness is God.’

I am quoting this upfront so that, if you find what I’m going to say from a faith perspective hard to accept, this might help.

In earlier posts I have discussed how psychosis is a very rigid and inflexible state of mind. I believe it is simply at the end of a continuum along which we all are placed. We all to some degree at times overvalue our beliefs, our perceptions, our simulation of reality. This can bring about a degree of attachment to them that makes us inflexible and highly resistant to contradictory evidence or different perspectives. This does not create a huge problem if our take on reality is not also destructive or frightening or both.

Fixity in the face of often extremely unpleasant phenomena causes an unacceptable and virtually inescapable amount of distress to the sufferer and of anxiety in his friends and family. The distress is what brings the sufferer to the attention of the psychiatric services. Psychiatry then applies the label schizophrenia. This label, in my view, mixes up the content of the experiences with the person’s relationship to those experiences in what can be a most unhelpful way.

Just as it is important to separate our perceptions (voices, visions and other internally generated experiences in other sensory modalities) from our understanding (beliefs, models, assumptions, meaning systems etc), it is crucial also to separate out, from the nature of these experiences in themselves, this loss of perspective and flexibility which I am calling fixity.

I have examined elsewhere on this blog the various ways that this fixity can be dispelled. Here I plan to focus simply on reflection. This is not because they are irrelevant. One, which I term disowning, by which I meant discounting or suppressing uncomfortable contents of consciousness such as pain, grief or guilt, was something Ian described in in the process of our shared reflections: he saw himself as increasingly ‘recognising’ his feelings rather than ‘repressing’ them.

My focus though will be on how reflection enables us to contain unpleasant material in consciousness, giving us time to think about and explore it, prior to integrating it.

Bahá’u’lláh, the Founder of the Bahá’í Faith, in the Kitáb-i-Íqán (Book of Certitude) quoted a hadith from the Islamic tradition: ‘One hour’s reflection is preferable to 70 years’ pious worship.’

‘Abdu’l-Bahá

His son ‘Abdu’l-Bahá, explored this in a talk he gave at a Friends’ Meeting House in London in 1913. He spoke of reflection, meditation and contemplation as virtually equivalent concepts. He went on to explain their power (Paris Talks – pages 174-176):

This faculty of meditation frees man from the animal nature, discerns the reality of things, puts man in touch with God. . . .

Through this faculty man enters into the very Kingdom of God. . .

The meditative faculty is akin to the mirror; if you put it before earthly objects it will reflect them. Therefore if the spirit of man is contemplating earthly subjects he will be informed of these. . . .

What he says for me maps onto Koestenbaum but in more directly spiritual terms. It explains why reflection, also connected with meditation and contemplation, is so powerful from a Bahá’í point of view.

The mirror analogy along with Bahá’u’lláh’s various references to the human heart as a mirror, led me to ask: what are the possible similarities between consciousness and a mirror?

Basically, a mirror is NOT what is reflected in it. In the same way, consciousness is not its contents. We are not what we think, feel, sense, plan, intend, remember, imagine and so on. This is also known as Disidentification in Psychosynthesis. In Jessica Davidson’s very brief summary, the affirmation exercise this form of therapy uses reads like this:

I have a body and sensations, but I am not my body and sensations. I have feelings and emotions, but I am not my feelings and emotions. I have a mind and thoughts, but I am not my mind and thoughts. I am I, a centre of Pure Awareness and Power.

Less controversially for most people I suspect, I would prefer to affirm that I have sensations, but these change from moment to moment so I cannot be my sensations. I am the capacity to sense. And so on with feelings, thoughts, plans, memories and imaginings, including our ideas about ourselves and what or who we are. Assagioli’s final affirmation was, as I remember, ‘I am a centre of pure consciousness and will.’

Reflection enables us to find meaning in what we are tempted to call ‘madness.’ It gives us the freedom to examine it even if only in our own minds. Psychosis is almost always meaningfully rooted in a client’s experience.

How might reflection help us find meaning?

Reflection helps counteract the fixity of attachment to the contents of consciousness that characterises what is called the ‘psychotic’ experience. The crucial stepping back relates not just to the experiences themselves, such as visions and voices, but to the explanations the sufferer has created for the experiences, which then cease to be delusional.

What Ian thought was just schizophrenia had meaning. Understanding and integrating that meaning released him from his voices. To understand his psychotic experiences he had to neither suppress them nor surrender to them: he had to contain them so he could examine them.

Recognising that they were simply the contents of his consciousness enabled him to step back, experience and think about them. They no longer had power over him.

I will sharing some of his thoughts on this in the final post.

Consultation

But there is one step further we can go.

When Ian loosened his identification with his experiences, he was able not just to think about them, he could also compare notes with others about what they might mean: he could consult in a Bahá’í sense of that undervalued word.

The Bahá’í International Community, which represents the Faith at the United Nations, quotes Bahá’u’lláh on consultation (The Prosperity of Humankind Section III): ‘In all things it is necessary to consult. The maturity of the gift of understanding is made manifest through consultation.’

What might He mean by that. Paul Lample in his excellent book Revelation and Social Reality puts forward his view: (page 199):

Consultation is the method of Bahá’í discourse that allows decisions to be made from the bottom up and enacted, to the extent possible, through rational, dispassionate, and just means, while minimising personal machinations, argumentation, or self-interested manipulation.’

Key words and phrases here are: ‘from the bottom up’ which I take to mean not imposed in some condescending fashion by those who feel superior; ‘dispassionate’ meaning objective and detached (something I’ll come back to in more detail in the next and last post); and ‘minimising . . . manipulation,’ so no ulterior motives or advantage seeking creep in.

Later he adds further illumination (page 215):

[C]onsultation is the tool that enables a collective investigation of reality in order to search for truth and achieve a consensus of understanding in order to determine the best practical course of action to follow.… [C]onsultation serves to assess needs, apply principles, and make judgements in a manner suited to a particular context.’

The key concept here is the ‘collective investigation of reality.’ This means that all parties involved in consultation are comparing notes, sharing perspectives, without undue attachment to their own point of view and not in an attempt to win an argument but with a sincere striving to understand reality better.

Just as the client needs to reflect, so does the ‘therapist.’ It is a two way street. And the therapist needs to model what she wants the client to learn: reflection. If she does not consultation is not possible. She must be as detached from her conclusions as she wants the client to be. If both client and therapist can reflect together as equals they are genuinely consulting. They can achieve a higher level of understanding, a better simulation of reality, together, than they ever could alone.

We are now ready to explore the impact of these processes on Ian and to examine some other important factors and considerations. More of that next time.

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The Changeling

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.

Thinkung thro CulturesThinking Through Others

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’;

heartsurgeryWe can ignore this dimension at our peril: whether we intend it or not our ‘less conscious selves’ can be triggered big time.

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.

Talking to Ian

Talking to Ian

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.

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VoicesIn 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.

Background

In 1988 a young woman persuaded her GP to refer her to me. She had carried a diagnosis of schizophrenia since she was 16. Before that she had had a twelve year history of sexual abuse at the hands of her father which went undisclosed and unnoticed at the time. She wanted to talk about the abuse to someone. An OT and I saw her together, with some trepidation. After all, psychosis and psychotherapy weren’t supposed to mix.

I allayed my fears with an article that argued that, although ‘schizophrenia,’ a label that is increasingly questioned nowadays, was not in itself amenable to a `talking cure’, people with this diagnosis could benefit from counselling for other problems. We plunged in.

It took more than a year for her to begin to describe the abuse, so painful was it for her. She could focus on it for no more than ten minutes in each hour at first. After that she became overwhelmed with terrifying hallucinations of her father, hallucinations which impinged upon all her senses – smell, touch, hearing, taste and vision. The only way she learned to determine afterwards that he had not really been there was to observe that she had no marks upon her body. Generally it would take the rest of the session to help her regain control of her own mind.

As the months went by she could bear to reveal more of her painful story, though always in small instalments. Her fears about telling it diminished, but, at the time of writing, she still had not really come to terms with the emotional pain and the anger. She did not wish me to share any of the particulars of her story.

She was able, eventually, to break free of an abusive marriage. She gained greater control over other hallucinations.

What set me wondering was how working on the trauma was releasing her from what were supposed to be the virtually autonomous symptoms of an illness process. Her experience did not seem to gel with the theory.

I was given confidence to pursue it further by the work of Paul Chadwick and the advice of Max Birchwood, though the road I eventually followed developed some distinct characteristics of its own. I would like to share some of these.

I would also like to share some of the experiences of three other people who have agreed to let me tell their stories, at least in part, and who have also helped reshape my thinking along the way. I think in doing so they have also reshaped me. Perhaps therapy should always also change the therapist, but I was not taught to think so in my official training.

Inquiry in ACtionTheory

The phrase `collaborative conversation’ is derived from a paper by Anderson and Swim (1993) where it is used of the student/teacher relationship. They state of the learning process that: `. . .new meaning and change evolve through . . . a conversational, process.’ They add: `Everything (knowledge, meaning, beliefs, feelings) is . . . a product of . . a community of persons and relationships.’ Both the phrase and the assumptions which lie behind it have helped formulate the concept of `collaborative conversation’ as presented here.

The concept of Bahá’í consultation has been even more influential. A succinct statement of its purpose also conveys a great deal about its methods and assumptions: `the adversarial method, . . [is]. . fundamentally harmful to [the] purpose [of consultation]: [which] is, arriving at a consensus about the truth of a given situation and the wisest choice of action among the options open at any given moment’ (Bahá’í International Community: 1995. Cf also Kolstoe). It is a process of non-adversarial decision-making which assumes that: (a) no one person can formulate anywhere near an adequate representation of the truth, (b) groups of people, if they pool their perspectives in a collaborative fashion, formulate increasingly accurate but never foolproof approximations to the truth, and (c) today’s formulation, no matter how useful, may be out-of-date by tomorrow. This means that client and therapist play out their roles on a more equal basis — delusions are not located only in the client. More of this below!

Reason (1988) in a book called Human Inquiry in Action refers to `critical subjectivity’. This is a state and process in which what we believe is subjected to the corrective influence of other beliefs through a process of discussion. It requires that `we do not suppress our primary subjective experience; nor do we allow ourselves to be overwhelmed and swept along by it; rather we raise it to consciousness and use it as part of the inquiry process’. . . .`[A]ll co-operative inquiry at its best works to enhance . . . experience towards a critical subjectivity . . . . .’ There is a dynamic relation in this method between experience, group reflection and action plans leading to different and informative experiences.

Heron, in a discussion of validity in the same book, states: `. . .the agreement sought between inquirers is not total unanimity., but the illumination of a common area of inquiry by differing individual perspectives.’ These factors are also characteristic of the process of collaborative conversation in a clinical context. It still operates even-handedly in that no one’s subjectivity is to be suppressed and no one is to be engulfed by his/her subjectivity either, if at all possible.

Thinkung thro CulturesShweder too, in his stimulating book Thinking Through Cultures, is liberating in his approach. He is looking at the assumptions of hard-line scientists who believe only what can be derived directly from observation: I will call them positivists for short! He elaborates the case that although positivists may think God is dead and therefore there is no God, it does not necessarily follow that there are no gods. Nor should we enthrone our own god above every one else’s. Shweder builds on this position.

Science is as subject to these strictures as any other belief system.

He argues that the ideas we have about reality shape our experience of reality: this is equally true for scientists, mystics, the so-called mentally ill and poets. Reality, though indispensable, is in itself inaccessible. Accordingly, it is a core aphorism for the position advocated here (page 66) `that the objective world is incapable of being represented completely if represented from any one point of view, and incapable of being represented intelligibly if represented from all points of view at once.’  His `doctrine’ is (page 68) `the relativistic idea of multiple objective worlds, and its commandment is participation in the never-ending process of overcoming partial views’.

Practice

An illustration of this `doctrine’ at work in the context of clinical collaborative conversation might help here.

Louise was an articulate woman who has been hearing distressing voices for nearly two years in the context of a painful divorce at the end of a self-denying marriage. She had intermittent contact with the psychiatric services prior to that. Part of her experience of voices involved a young girl of about seven who, Louise felt, was about to be murdered by a man whose voice she heard threatening the little girl. She flickered between being an observer and being the little girl. She sometimes suspected, sometimes was convinced, that she had been the little girl in a previous life. Sometimes she settled for believing the little girl was someone else who had been, or was going to be, murdered. She drew upon some kind of metaphysical or supernatural explanation to account for her experience in either case.

The positivist temptation was to use a cognitive approach to test out whether her belief in ghosts or reincarnation could be shaken. This is not necessary. In my view, these kinds of beliefs are to be respected. Many people who hold to them firmly, survive perfectly well outside the psychiatric system. It is not in these beliefs that the problem lies.

I prefer to seek to arouse a person’s curiosity about why those experiences should be coming their way. Why should she have been distracted by experiences of such a kind at all? If reincarnation is true, why, out of all the lives she must inevitably have lived in the past, had this one surfaced to torment her? Why this ghost out of all the invisible millions thronging around her? I attempt to stimulate inquiry into the personal meaning of these experiences.

Those who came to me had taken their experiences of this kind very personally indeed. They did not distance themselves from them at all. These phenomena call 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.

More of that next Monday.

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