. . . . psychotic symptoms exist on a continuum even in healthy individuals (Stefanis et al., 2002). This, too, seems to be explicable if psychosis is a way to cope with existential distress – as psychosis would be quantitatively, rather than qualitatively, different from normal.
(Psychosis as Coping by Grant S Shields – page 146 in Existential Analysis 25.1: January 2014)
There is growing interest in the idea of that ‘psychotic’ crises can sometimes be part of, or related to spiritual crises, and many people feel that their crises have contributed to spiritual growth. A number of clinical psychologists have also explored the interface between psychosis and spirituality. Some believe that at least some ‘psychotic’ episodes can be transformative crises that contain the potential for personal, including spiritual, growth. Many people who believe that there is a spiritual element to their experiences find support from others with similar beliefs invaluable, for example within faith communities.
In the last post I began to look at a paper (pages 41-49, from the British Journal of Clinical Psychology – 2012 – 51, 37-53) by Charles Heriot-Maitland, Matthew Knight and Emmanuelle Peters on the subject of what they call Out-of-the-Ordinary-Experiences or OOEs.
Where their findings became even more intriguing from my point of view was when their discussion used terminology with clear spiritual implications that are held in common across NDEs, mystical states and meditative practices. They write:
Another subjective phenomenon reported by both [clinical] and [nonclinical] participants was the sensation of ego loss, what essentially seemed to be a breakdown of the normal psychological relationships between mind-body and/or self-others.
A fear reaction was frequently reported and ‘is likely to have largely come from the unfamiliarity of [the] experience . . . . It is possible that more prolonged absorption was caused by the emotionally fulfilling roll of the OOE in a psychological problem-solving process.’
This was followed in their report by more of a spiritual nature concerning the discovery of deeper meaning:
This symbolic, deeper meaning perhaps reflects the quality of awareness that is not filtered or confined by the conceptual boundaries of ordinary day-to-day experience… If the ego breaks down, then it may be that perception of the world becomes unbounded and limitless . . . .
This, in their view, paves the way for a shift in consciousness:
Following on from the previous theme, which conveys an awareness that is free from the influences of a ‘conditioned’ conceptual framework, this theme suggests the implementation of a new conceptual framework, or a new way of looking at the world.
Where their work maps onto that of Jenny Wade is in the idea that, when our old models of reality cease to work in new situations, a state of uncomfortable dissonance is created that leads to a breakthrough to new levels of understanding:
It could be that the initial psychological crisis arose in many participants due to an inadequacy of their existing conceptual framework in making sense of their emotional experience. . . . . . It may be that a new way of thinking was the necessary, adaptive ‘solution’ to the crisis; that the old conceptual framework had to be replaced by a new one for the emotional experience to become integrated.
Wade’s model maps closely onto Dabrowski’s Theory of Positive Disintegration in key respects. She analyses, in a more close-grained fashion than Dabrowski, which kind of conflict and discomfort spurs us to move up from the comfort zone of our present level of consciousness to the next step up the ladder of awareness. Dabrowski, as I have explored elsewhere, correlates this most strongly with an intensity best described as suffering.
The next point the paper makes is crucial:
[T]he fact that, apart from existential questioning, there has been no notable difference up to this point in the OOEs of [clinical] and [non-clinical] groups implies that this problem-solving process is neither pathological nor indicative of clinical psychosis.
The real issue lies somewhere else altogether. They explain in a particularly important passage:
More of the [nonclinical] participants received validating/accepting responses from others, and more of the [clinical] group received invalidating responses, as these quotes illustrate:
‘[I] relayed this experience to psychiatrists in the [hospital] and was sent for EEG tests, was told that I was hallucinating – this guy just didn’t listen to, just obviously haven’t heard anything really that I’d said . . .’
‘Somebody came up to me and said “well, you know, we really need to hear from you. That’s a very powerful message to people, and they need to hear that message.” And that did matter to me.’
For the individual who is, perhaps, already slightly hesitant about how best to incorporate their experience into their social worlds, the difference between these two social interactions could be immense.
All non-clinical participants demonstrated some prior understanding or interest in their OOEs, which are generally described as ‘life-enhancing.’ Furthermore, ‘These life-enhancing qualities, which were reported by the majority of participants, add further support to the psychological problem-solving hypothesis. Not only did the OOEs provide many participants with relief from emotional suffering, but they also added a dimension that enriched other life domains. . . . . The medical (illness) explanation clearly presented barriers to similar reflections in the clinical population . . .’
The blame for why some people’s experiences are eventually experienced as dark, negative and ultimately inescapable seems to lie with the negative approach adopted by others, especially the medical profession:
More [non-clinical] than [clinical] participants viewed their experience as a temporary stage or process. . . . . . [I]f the causes and subjective nature of OOEs are no different between [non-clinical] and [clinical] groups, then it seems misleading for professionals to inform one group that their OOEs signal ‘the end,’ [ie they are stuck with them] while the other group continue with their (enhanced) lives.’
This has echoes for me of how the reaction of others determines how the experiencer responds to distressing NDEs, which also has an impact on their future mental well-being. Nancy Evans Bush writes (Dancing Past the Dark: Kindle reference 2502-05):
Experiencers have told many sad stories of going to a professional for help in understanding their NDE, only to find themselves caught up in the medical model, pathologized by a diagnostic label and the NDE dismissed as meaningless. . . . . . . People have also told of being dismissed by their rabbi or pastor as well, for in a secular society much awareness of deep spiritual process is lost or distorted, even within religious institutions themselves.
Stephanie Beards and Helen Fisher, in a 2014 paper (Social Psychiatry Psychiatric Epidemiology 49: 1541–1544), shed further light on the dynamics of this. They write (page 1542):
It has been proposed that negative core schemas [ingrained patterns of thought or behaviour that affect experience] are formed early in life and may result from adverse experiences in childhood. If an individual experiences further trauma later in life, these schemas could become (re)activated, leading to emotional changes which may not only cause the development of psychotic experiences, but alter the appraisal of these anomalous occurrences, further increasing distress, and preventing a benign explanation from being concluded.
Even so, such experiences do not need to cast a shadow over the rest of a person’s life. The experiences themselves, as the current British Journal of Clinical Psychology study demonstrates, are not significantly different between the two groups, nor are the potential explanations they develop. Nearly all participants gave some acknowledgement of the link between psychotic and spiritual experience.
Because the OOEs of all participants seemed, at some level, to fulfil a psychological purpose, they were interpreted as being a part of an adaptive psychological problem-solving process, which frequently involved the breakdown of conceptual ego boundaries, and the formation of a new conceptual outlook.
However, regarding group differences (my emphases), they write:
[T]here was a sense that [non-clinical] participants were better able to incorporate their OOEs into their personal and social world. This was partly due to more [non-clinical] participants having prior conceptual knowledge of, and in some cases, open attitudes towards, there OOEs; however, the more prominent reason seem to be that more [non-clinical] participants received validation and acceptance from others.
The saddest point of all perhaps is this:
It would seem that the more OOEs are associated with clinical psychosis, the less chance people have of recognising their desirability, transiency, and psychological benefits, and the more chance they have of detrimental clinical consequences.
They draw some very strong conclusions from this:
An important clinical implication is that psychotic experiences should be normalised, and people with psychosis should be helped to re-connect the meaning of their OOEs with the genuine emotional and existential concerns that preceded them. . . . . . However, the current findings suggest that the argument for normalisation goes far deeper than just its clinical usefulness; they imply that a more ‘radical normalisation’ approach is needed, when normalising OOEs becomes an intrinsic formulation and treatment principle.
During my decluttering, I also came across a number of journals which describe current approaches to creating psychological descriptions of a patient’s problems, known as formulations in psychobabble. Nowhere, for any patient group, did I find reference to any kind of spiritual dimension, though the word ‘cultural’ was thrown in from time to time, and might have concealed an entrance through which such considerations could possibly have infiltrated the consultation process.
When it comes to psychosis, where the default first-line treatment is medication rather than therapy (or meditation), there is an additional problem:
Unlike antipsychotic drugs, which can suppress the emotional expression, this approach [of accepting the validity of the emotions underlying the OOEs] would validate and encourage the emotional expression, whilst working on building a more helpful conceptualisation or narrative about the emotional concerns.’
The authors do not regard their paper as definitive. They are all to aware of its possible limitations, shown, for example, by their reference to methodological caveats concerning small sample size and possible confounding variables not having been picked up at screening and thereafter controlled for.
I do not think those caveats constitute reasons for ignoring or minimising the significance of their findings, but rather they should be a motivating factor for the generation of further work on this issue. In the meantime, even in advance of further findings, we should be spurred to introduce into the clinical setting a far greater sensitivity to the emotional and spiritual meaning of such experiences.
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