Posts Tagged ‘psychology’

O thou who art attracted by the Fragrances of God!

. . .  I read thy poem, which contained new significances and beautiful words. My heart was dilated by its eloquent sense. I prayed God to make thee utter more beautiful compositions than this.

(Tablets of ‘Abdu’l-Bahá)

It may seem strange resurrecting a post on poetry from 2009 amidst sequences on psychosis. If you are interested to know you’ll need to patience to read on almost to the end!

The BBC Poetry Season currently unfolding is causing me to reflect on why I think poetry matters.

There may be a clue for me in how my interest shifted, when I left the Catholic Church, from poetry to novels as my favourite reading matter. It’s true that my disillusion with religion was influenced by poetry as well: one of my favourite poets at the time was Byron. Others, though were Wordsworth, Coleridge, George Herbert, the Tennyson of In Memoriam and Gerard Manley Hopkins — a spiritually troubled bunch maybe but not exactly godless.

Even though I spent another decade teaching English Literature, my love for poetry remained prematurely buried: occasionally I could hear its finger nails scraping at the coffin lid but put it down to rats behind the skirting boards.

When my career change came and I took up with Psychology you would have thought that would be the end of it. The undead in the coffin should have given up the ghost and turned into a corpse. But strangely enough it didn’t. I threw myself enthusiastically into my new calling and was two years into my degree course while working at a day centre for the so-called ‘mentally ill,’ before I had a strange dream to remind me that my love for poetry might be buried but it wasn’t dead.

I can’t now recall all the details but the key moment in the dream was when my car broke down. I clambered out to look under the bonnet to see what was wrong. (This was at a time when I often had to cook the spark plugs in the oven in the morning before the car would start, so at this stage it would’ve been tempting to dismiss the dream as simply revisiting a prosaic daytime anxiety.) When I lifted the bonnet though everything changed. Instead of the engine there was the most beautiful golden horn — the instrument not the sharp pointed weapon of the rhinoceros.

When I woke I knew that something needed explaining here. What on earth was a golden horn doing under the bonnet of my car in place of the engine?

To cut a long story short, the chain of associations led me from music, creativity and song through the horn of plenty as a pun to Yeats‘ moving poem A Prayer for my Daughter.

It’s certain that fine women eat
A crazy salad with their meat
Whereby the Horn of Plenty is undone.

(lines 33-32)

(Before dismissing this as sexist, it’s important to take into account that there is a particular emphasis on the word ‘fine’ here which, in the context about his worries concerning his daughter’s future, is partly to do with being made proud by beauty and unconcerned about defects of character.)

There is more, fuelled by his experiences with Maude Gonne who was a bit of a fanatic:

Have I not seen the loveliest woman born
Out of the mouth of Plenty’s horn,
Because of her opinionated mind
Barter that horn and every good
By quiet natures understood
For an old bellows full of angry wind.

(lines 60-65)

There were obvious surface implications here which I had to consider and weren’t excluded by the main message I finally took away from the dream. It was asking me how I might have undone the Horn of Plenty in some way, perhaps by disowning something important to me that the dream was trying to remind me of. What might an ‘opinionated mind’ have to do with it? What were the good things understood by ‘quiet natures’? And what, if anything, was my ‘old bellows full of angry wind’?

The bottom line for me was that the dream was telling me in no uncertain terms that I had sold out poetry (‘song’) for prose, heart for intellect (‘the opinionated mind’), and intuition for reason and most of all was emphasising that this choice was ‘breaking down,’ that perhaps even the car (an ‘old bellows’?), symbol of a mechanical approach, was the wrong vehicle to be relying on so exclusively.

Discounting, in existential therapy, cuts both ways. You don’t solve the kind of discount I was making by throwing away the car of prosaic mechanical psychology and picking up the horn of poetry and blowing it for all your worth in everybody’s ears. You find a way of balancing both, of integrating them at a higher level of understanding which dissolves their apparent incompatibility. You can’t drive a horn to work or play a haunting melody with an engine but you might need to find the right place for both of these in a complete life..

Interestingly my work with ‘psychosis’ helped me do precisely that.

The psychotic experience, looked at from this angle, is all metaphor. Hallucinations are imagery taken literally: delusions are stories mistaken for plain truth. Both hallucinations and delusions are rooted in reality in the same way that poetry and dreams are, and they point towards truths that we might otherwise ignore or cannot otherwise express. They only become dangerous when we unreflectingly act them out in ways that you would never act out a poem and most people do not act out dreams because their motor system has been shut down in sleep.

The great power of poetry is to articulate for us and convey to us the otherwise inexpressible aspects of experience that cry out to be integrated if we are not to die spiritually, emotionally and intuitively. I was rescued by my dream from continuing to disown the creative force of poetry. Reintegrating poetry into my life was a critical step, not only in becoming a better clinician than I would otherwise have been by the aid of psychology alone, but it also led me to a greater openness to the spirituality of Buddhism than I would otherwise have been capable of, which in turn led me to the Baha’i Faith whose poetic and mystical writings  were easier for me to absorb than would have otherwise been the case.

In a very real sense I owe the rich texture of my present life at least in part — and it is a significant part — to poetry.

Yeats wrote:

. . . many a poor man that has roved,
Loved and thought himself beloved,
From a glad kindness cannot take his eyes.

(lines 38-40)

And in the Bahá’í Writings we are told:

A kindly tongue is the lodestone of the hearts of men. It is the bread of the spirit, it clotheth the words with meaning, it is the fountain of the light of wisdom and understanding….

(Gleanings from the Writings of Bahá’u’lláh: CXXXII)

They both seem to be speaking of the same appealing quality in their different ways.

That’s why it is so good to know that the BBC is seeking to bring the creative and transformative power of poetry to people who might otherwise be tempted to ignore it.

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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)


Because my current sequence of posts refers to the Kellys and their thought-provoking text Irreducible Mind, it seemed a good idea to republish this sequence from March 2013. This is the last of the three parts.

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).

Separating the Mirror from its Reflections

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 (page 87):

Supernormal 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 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 [conscious] from the latent [subliminal: unconscious] 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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Ringstone Symbol

. . . . the mind is the power of the human spirit. Spirit is the lamp; mind is the light which shines from the lamp. Spirit is the tree, and the mind is the fruit. Mind is the perfection of the spirit, and is its essential quality, as the sun’s rays are the essential necessity of the sun.

(Selected Writings of ‘Abdu’l-Bahá: page 316-317)

Because my next sequence of posts will be referring to the Kellys and their thought-provoking text Irreducible Mind, it seemed a good idea to republish this sequence from March 2013. The three parts will appear over the next four days finishing on Wednesday.

I began studying psychology in 1976, long before I became a Bahá’í, and completed my clinical training in July 1982, at least four months before I met even a mention of the Faith in the following November.

Never once in my entire experience of being taught psychology did I ever hear of Frederick William Henry Myers. The closest encounter I ever had of this kind was with William James. He was mentioned in asides with a dismissive and grudging kind of respect. The implication was that he was an amazing thinker for his time but nowadays very much old hat. I gave him a quick glance and moved on.

Looking back now I realise I was robbed.

FWH Myers

FWH Myers (1843-1901)

When I decided to become a Bahá’í at the beginning of December that same year, after a lightening conversion, my friends thought I was nuts, and when I met the quote from ‘Abdu’l-Bahá which you’ll find at the top of this post, I was thunderstruck. It ran completely counter to all I had been taught and all I had found in any psychology I had ever read. I really struggled to integrate that insight into my world-view.

The context included ideas such as Manifestations of God (symbolised by the stars in the picture at the head of the post), a spiritual realm (represented by the left hand line), and a link between that spiritual realm and our material one (the line that joins the left hand to the right hand line). If accepting the idea of God was a huge challenge for a former atheist, taking on board the concept of a soul was an even bigger one. At least the Bahá’í concept of God was definitely not the one I most certainly did not and could never believe in: it still seems such an unwarranted gift for beings like us to have an immortal soul though, considering how badly we behave most of the time. It took me four years at least of hard study and deep reflection to even begin to get my head around this stuff. (The poem I posted on 21 March, after this post was written, gives a sense of where I was starting from.)

It is plain to me now though how this situation came about. Kelly and Kelly capture it neatly and clearly in the introduction to their brave, thorough and well-researched book, Irreducible Mind (pages xvii-xviii):

[William] James’s person-centered and synoptic approach was soon largely abandoned . . . in favour of a much narrower conception of scientific psychology. Deeply rooted in earlier 19th-century thought, this approach advocated deliberate emulation of the presuppositions and methods – and thus, it was hoped, the stunning success – of the “hard” sciences especially physics. . . . Psychology was no longer to be the science of mental life, as James had defined it. Rather it was to be the science of behaviour, “a purely objective experimental branch of natural science”. It should “never use the terms consciousness, mental states, mind, content, introspectively verifiable, imagery, and the like.”

And, sadly, in some senses nothing much has changed. Psychology is still, for the most part, pursuing the Holy Grail of a complete materialistic explanation for every aspect of consciousness and the working of the mind. It’s obviously all in the brain, isn’t it (page xx)?

The empirical connection between mind and brain seems to most observers to be growing ever tighter and more detailed as our scientific understanding of the brain advances. In light of the successes already in hand, it may not seem unreasonable to assume as a working hypothesis that this process can continue indefinitely without encountering any insuperable obstacles, and that properties of minds will ultimately be fully explained by those brains. For most contemporary scientists, however, this useful working hypothesis has become something more like an established fact, or even an unquestionable axiom.

This is a dogma and as such can only be protected by ignoring or discounting as invalid all evidence that points in a different direction. Edward Kelly argues for a different approach in his introduction, believing as the co-authors demonstrate in this massive tome that there is a wealth of evidence to undermine this a priori belief (page xxii):

First and perhaps foremost is an attitude of humility in relation to the present state of scientific knowledge. . . . Second, we emphasise that science consists at bottom of certain attitudes and procedures, rather than any fixed set of beliefs. The most basic attitude is that facts have primacy over theories and that belief should therefore always remain modifiable in response to the empirical data.

Francis Bacon

Francis Bacon (1561-1626)

He quotes Francis Bacon (ibid.):

“The world is not to be narrowed till it will go into the understanding . . . but the understanding is to be expanded and opened till it can take in the image of the world as it is in fact.”

The Kellys try and practice what they preach, as their book demonstrates (page xxv):

Our own empiricism is thus thorough-going and radical, in the sense that we are willing to look at all relevant facts and not just those that seem compatible, actually or potentially, with current mainstream theory. Indeed, if anything it is precisely those observations that seem to conflict with current theory that should command the most urgent attention.

Their first chapter, to which I may return in a later post, takes a critical look at the current mainstream position. I want to start instead with their second chapter that looks in detail at the work of Myers. I want to do justice to a deep and creative thinker whom I was induced to neglect during my formal training, much to the detriment of my practice for a significant number of years.

I am plucking a quote from the middle of Emily Kelly’s chapter on Myers’s approach (page 76) because the last sentence cuts to the core of the challenge constituted by his position and the evidence that mainstream ‘scientists’ ignore:

This notion of something within us being conscious, even though it is not accessible to our ordinary awareness, is an exceedingly difficult one for most of us to accept, since it is so at variance with our usual assumption that the self of which we are aware comprises the totality of what we are as conscious mental beings. Nevertheless, it is essential to keep in mind Myers’s new and enlarged conception of consciousness if one is to understand his theory of human personality as something far more extensive than our waking self.

And perhaps it needs to be said in advance, in order to soften the shock for some readers, that he is not just talking about the kind of unconscious processes we all accept as definite, such as those which keep our hearts beating, or as probable, such as the projection of past experiences onto the present. He takes seriously not just what lies underneath our minds so to speak, the stuff that many dreams are made of, but also what soars above them, such as mystical states.

Emily Kelly’s preamble:

Before we look in more detail at what his exact position was in the next post, it might be useful to quote from Emily Kelly’s preamble. She puts her finger on the most significant loss incurred when psychology went pseudo-scientific (page 50):

All elements of the universe are not only inextricably related, but they all function according to the same basic, deterministic principles of cause-and-effect and are all, in the final analysis, of the same basic essence or nature. . . . The attempt to transform psychology into a science, however, raised some unique problems. The phenomena of psychology are unlike those of any of the physical sciences in that they are, above all else, mental. (Ibid.)

The pioneers of this approach were far too sure of themselves (page 54):

. . . . For many in the first generation of scientific psychology, the thoroughgoing unilateral dependence of mind on brain was “a practical certainty.”

The basic issue had been resolved (page 58):

. . . . For [T.H.]Huxley as for many other 19th-century scientists, the exact nature of the dependence of psychical processes on physical ones with an open – though unresolvable – question; the general dependence of mind on matter was a resolved – and thus closed – question. (page 58)

I almost winced when I read her pointed explanation of how psychology had traded in the mind to buy itself a place among the sciences (page 59):

Scientists instrumental in the development of 19th-century psychology thus in general had chosen to conceptualise science primarily not as a method with which to confront basic questions posed by contradictory aspects of human experience, but as a doctrine to which psychology, if it is to be a science, must conform. (page 59)

LEAD Technologies Inc. V1.01

Lotus/I-Ching (From this Website)

She paves the way for a key component of Myers’s approach in her quote from Mill (page 62):

John Stuart Mill had been the leader and exemplar of mid 19th– century liberal thinkers who believed that the cause of knowledge is best served, not by partisans, but by “those who take something from both sides of the great controversies, and make out that neither extreme is right, nor wholly wrong.” (page 62)

In the next post on Tuesday we’ll be taking a closer look at Myers’s approach.

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Talking to Ian

Talking to Ian

There is now overwhelming evidence that psychological approaches can be very helpful for people who experience psychosis. However, there remains a wide variation in what is available in different places. Even the most successful approaches, such as early intervention and family work, are often not available, and nine out of ten of those who could benefit have no access to CBT. There is a pressing need for all services to come up to the standard of the best and to offer people genuine choices. Perhaps most importantly, we need a culture change in services such that the psychological understanding described in this report informs every conversation and every decision.

(From Understanding Psychosis and Schizophrenia published by the British Psychological Society – page 93)

At the end of the previous post in this sequence, I shared an example from my own experience that confirms the idea that psychosis might be a way of protecting oneself from what one experiences as even greater pain and terror. Here is another example before we move forward.

Ian’s Story

My experience in 1993 with another client, Ian, who did not want to be shown in full in the video we made at the time, pointed in this same direction (see a previous sequence of posts for a more detailed account). He was an ex-soldier whose traumatic experiences in the army, riding on the back of a difficult childhood and a recent intense and distressing relationship with a woman who had a serious drink problem, had led to a deeply disturbing psychotic experience involving persecutory voices. In many ways he made good progress and for almost a year he kept moving forwards.

It is perhaps worth quoting an extract from a videoed interview with him that exactly explains what for him were key components of the effectiveness of what I call collaborative conversation. In his explanation we find references to the recent reactivating trauma (his abandonment of the woman he was living with and the guilt that ensued), the way that avoidance of the feelings this triggered led to persecuting voices, and how facing the feelings defused the voices.

At the point we pick up on the conversation after a question about how the easing of the voices had helped, he had learnt how to negotiate with the voices to give him breaks from their constant harassment: J. was his care worker where he was living.

I.: Because I’d got time to think about it. And I was thinking about different things, you know? And different things from the past that needed to be talked about. And I could remember things from the past, you know and the thoughts just kept coming into my head of different things. `I must mention that to Pete.’ That’s what I kept thinking.

P.: I know this sounds a very stupid question, but in terms of when you then came and talked about them, what was valuable about just talking about them?

I.: Because it made it real. When I was ill, it didn’t seem real. You know what I mean? My memory didn’t seem real. It was like a dream. And it was as if I’d never done anything. But talking to you reminded me that I’d actually done these things, you know? And that it was memory. And that I’d actually done the things. It was reality.

P.: And how did knowing that it was reality prove so helpful? What did it do?

I.: Well, it proved the voices wrong for a start.

P.: Ah. Why? Were they saying that they were real and your memories weren’t?

I.: Yeh. It proved the voices were wrong. And that my memory was right. And talking to you fetched it out into the open. . . . . .

P.: It sounds as though being able to think about things and about the past or about what’s happening to you now was a very important thing that began to happen.

I.: Yeh. It was very important. Getting in touch with reality. And finding out what things were real. And what things wasn’t real.. . .  I needed to think about getting well. And what it was going to be like without the voices. And what it was going to be like without going in and out of hospital all the time. And I needed to think about it. And I couldn’t think about it when the voices were talking to me.

P.: Do you think that when we were talking about things it was only a question of remembering and then realising that the memories were real or were you also doing something else with the memories once you got them remembered?

I.: I was putting ’em in order. I was sorting ’em out. Things from the past that shouldn’t haunt me no longer. That I could put in the past and leave there, you know? I had to talk about ’em. I had to think about ’em. I had to feel about it, yeh. I thought it would never stop, you know. . .  It wasn’t easy

J.: You actually hurt a lot, didn’t you?

I.: Yeh. I hurt so much that I thought it wasn’t worth being well, you know? . . .

J.: We tried hard to put the good things in the now, didn’t we? You started to feel them more as well, didn’t you?

I.: Yeh.

J.: Tell me if I’m not getting this right. My belief was that you were feeling all these bad things that hurt. When we went and did something that was pleasant and you realised that you could enjoy that more now it helped you to realise that feelings could be good as well as bad.

I.: Yeh. I thought feeling was all bad. But feeling – like I feel good now – I feel really good now . . . (Pause)

P.: Are you saying that you’ve come to realise – it’s like not being anaesthetised – anaesthetic stops you feeling pain but it also stops you feeling anything else as well – and now it’s like you’re no longer under anaesthetic so you can feel very bad . . .

I.: Yeh.

P.: . . . but you can also feel very good. Is that a price worth paying? Sometimes feeling bad, is that a price worth paying for quite often feeling good?

I.: Yes. ‘Tis a price worth paying. Getting your feelings back is a painful thing, you know? And it really hurts. Makes you cry. But once you done your crying and you’ve realised that that’s real, you know, then you come to terms with it. You can put it in the past without worrying about it.

P.: What do you think is the effect of that on the voices?

I.: Well, they got no worries. So, they leave me alone.

P.: Do you think they fed on the worry and pain and distress you were keeping under?

I.: Yeh. They kept feeding on my suppression, you know? . . . They kept getting worse and worse until it got unreal.

P.: Yeh. There were certain things that you had done that really you felt very bad about, weren’t there?

I.: Yeh.

P.: That you felt really guilty about. In a sense you had never quite faced up to that perhaps?[1] The loss, the grief, the pain, you’d not faced up to. Am I right that these were all different bad feelings you had?

I.: Yeh. I felt bad about L. [his ex-partner] you know? I felt really bad about her. And I thought I’d done her wrong. And that’s why I was ill. The voices fed on it, you know?

P.: Do you think you actually deserved to be ill?

I.: No. Nobody deserves to be ill.

To show us the limits of what can be done, and how psychosis can seem preferable to raw reality, it was then that we discovered that there were two anniversary effects that triggered a resurgence of the hostile voices: these related to two traumatic army experiences whose pain and guilt he was never able re-experience and integrate, preferring instead for the voices to get worse at that time of year. We realised that the guilt at what he felt he had done to his ex-partner, the trigger to the hospital admission that led to my involvement, had been reactivating an earlier and far deeper sense of guilt. An increase in the intensity of the voices was in this case the lesser of two evils for him, even though it risked relapse and consequent hospitalisation sometimes.

Further Implications

It was experiences like these that convinced me that the medical model had to be complemented, or maybe even superceded, in some way.

In explaining his model, Shields, whose work I examined earlier in this sequence, is not discounting the role of biology (ibid):

However, this hypothesis does not view these psychological processes as operating independently of biological factors; these psychological and existential factors work closely with the structural or functional integrity of the brain in producing psychotic episodes.

Graph of the Model that states Psychosis is on a continuum with Normal Functioning (Source: The route to psychosis by Dr Emmanuelle Peters)

Graph of the Model that states Psychosis is on a continuum with Normal Functioning (Source: The route to psychosis by Dr Emmanuelle Peters)

He is singing from the same hymn sheet as Bethany L. Leonhardt et al in arguing that there is a continuum (page 146):

. . . 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. . . .

They go on to make a particularly subtle but potentially crucial point (pages 146-7:

This hypothesis can explain another aspect of psychosis: psychotic individuals do not choose realistic explanations for their experiences (Freeman et al., 2004). If the explanations chosen by psychotic individuals were more realistic, then the problem of reality would continue to intrude on an individual that cannot deal with reality.

This possibility paves the way towards explaining why some people with psychotic experiences are desperate to be helped to get rid of them while others work hard to hold onto them against every attempt to persuade them otherwise (page 147):

Psychotic breaks that do not entirely allow psychotic individuals to avoid dealing with the issues that prompted their psychosis would leave these individuals no way to avoid reality – though they desire to. Therefore, individuals in this state would want to rid themselves of reality and their experience however necessary – if their psychosis is, indeed, an attempted escape from an unbearable reality. Alternatively, for psychotic breaks that do truly allow individuals to avoid dealing with the issues that prompted their psychosis, these individuals would cling to their psychosis with certainty, as their psychosis is what permits them to cope with the crushing distress that prompted their episode.

The implications of this would explain why the drugs prescribed prove to have a positive effect of any kind at all (page 150):

This paper’s hypothesis – that psychosis might function as a mechanism for coping with existential distress – explains the efficacy of antipsychotic drugs by their ability to help a patient avoid existentially distressing issues. . . . . After a lengthy review of the evidence for and against the dopamine hypothesis, one psychiatrist proposed that antipsychotics primarily work not by modifying dopamine but instead by inducing neurocognitive suppression, which diminishes the severity of psychotic symptoms (Moncrieff, 2009).

This leads to another disturbing conclusion (page 151):

However, if the hypothesis outlined herein is true, the nature of the antipsychotic cure is temporary rather than permanent; the individual still has not dealt with the issues that prompted their psychotic break. This temporary nature may explain why antipsychotics increase the chronicity of psychosis: antipsychotics are simply another measure in avoiding the same issues that need resolved.

Shields recognises that his hypothesis is not without its weaknesses (page 152):

[One] limitation of this hypothesis is that many individuals undergo existential crises without having a psychotic break. However, it may be that individuals who do not have a psychotic break do not attempt to avoid the existential issues they are facing; instead, they may accept these issues or deal with them. Again, though, this is speculation, and it does not easily lead to predictions for further research. A final possible limitation of this hypothesis is that it implicitly assumes that psychosis is a unitary phenomenon, potentially manifest in differing ways, but some argue that a single concept of psychosis ought to be abandoned for a pentagonal model (Os & Kapur, 2009; White, Harvey, Opler, & Lindenmayer, 1997).

Rethink said cognitive behavioural therapy could help cut long-term costs of care (for source of image see link)

Rethink said cognitive behavioural therapy could help cut long-term costs of care (for source of image see link)So what?

So what?

What for me is of compelling interest in the arguments these papers put forward has two aspects.

The first is that they all seek to confirm in one way or the other that psychosis is a meaningful response to experience.

The second follows on from that. If psychosis is a meaningful response to experience, then it needs to be explored in the light of that experience if the person is to move on. Shields favours some form of existential therapy but admits that he lacks the evidence to support his preference. The study he would like to see run has not happened yet (page 153):

In a randomized trial of treatment for psychotic individuals, those treated with existential psychotherapy – especially a type of existential psychotherapy that provides an ontological ground for the resolution of existential issues, such as the one provided by Bretherton (2006) – should have significantly better outcomes than those treated with biological methods.

I also am drawn to existential therapy, and it influenced my own approach, not least because of the emphasis it places upon developing the capacity to think about one’s thinking (metacognition), something widely recognised as a problem for people with psychotic experiences.

I am aware as well that there is a great deal of scepticism about the efficacy of Cognitive Behaviour Therapy for schizophrenia, partly because its implementation has been half-hearted, to put it mildly, but also because it may not be the optimal response in every case. I am not convinced by any one-size-fits-all model.

I need to explore all this more deeply still, but I know what I feel is likely to be the case.

These writers are right, despite all caveats. Psychosis is a response to extreme experience that cries out to be worked with in a way that helps the person come to terms with what for them is unendurable.

I know from my own experience that this is not going to be easy. Some people would choose not to go down that road at all, just as there are those who would rather take painkillers forever than begin to use exercise to help their bodies heal. But I also know that if our society and its institutions gave far more support than they do to this model (in fact they all too often rubbish it at least implicitly) far more people would be empowered to use it and leave the real and imagined terrors of the psychotic state behind.

I also recognise that more needs to be done to fashion and test the best psychotherapeutic approach to these issues. But that is no reason for failing to do anything on a larger scale to remedy this deficiency.


[1] I may have been missing the crucial point that links suppression of painful feeling with increasing loss of contact with reality and the ascendancy of the voices. This pertains to the difficulty he had explaining what the point of talking about memories was.

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Graph of the Model that states Psychosis is Distinct for Normal Functioning (Source: The route to psychosis by Dr Emmanuelle Peters)

Graph of the Model that states Psychosis is Distinct from Normal Functioning (Source: The route to psychosis by Dr Emmanuelle Peters)

The British Psychological Society (BPS) has stated that ‘clients and the general public are negatively affected by the continued and continuous medicalisation of their natural and normal responses to their experiences; responses which undoubtedly have distressing consequences … but which do not reflect illnesses so much as normal individual variation… This misses the relational context of problems and the undeniable social causation of many such problems’. The BPS Division of Clinical Psychology (DCP) has explicitly criticised the current systems of psychiatric diagnosis such as DSM–5 and ICD–10. It has suggested that we need ‘a paradigm shift in relation to the experiences that these diagnoses refer to, towards a conceptual system not based on a ‘disease’ model’.

(From Understanding Psychosis and Schizophrenia published by the BPS – page 28)

What has this to do with EMS?

EMS stands for Everybody Means Something. My work as a clinical psychologist was with people who were experiencing what our culture calls a psychosis. When I started work in the NHS most people felt that these experiences were meaningless. I disagreed. I found myself using those three words as a kind of mantra to remind myself of my conviction. It was a no-brainer to use them as the title for my blog.

Various experiences reinforced my scepticism about the medical model with its prevailing assumption that such experiences are largely biologically determined. I came increasingly to believe it was significantly incomplete, possibly seriously flawed.

Before I move onto psychosis in particular there is a story from my earlier experiences in clinical psychology, which served to reinforce my scepticism and which clearly illustrates how this default assumption can operate as a potentially damaging blinker.

Laura had been given a diagnosis of endogenous depression, ie one that was not explicable in terms of her life situation. She used to believe that her parents were more or less perfect. The work we were doing became very stuck and seemed to be going nowhere.

We had plateaued on bleak and distressing terrain, more tolerable than her previous habitat but too unwelcoming to live on comfortably for the rest of her life, and yet with no detectable path towards more hospitable ground.

Frustrated by the protracted lack of movement, I began to see discharge as a very attractive option. I discussed this with my peer supervision group. We decided that I should continue with the processes of exploration but make sure that I did not continue my habit of stepping in relatively early to rescue her in sessions from her frequent experiences of intense distress. I continued to see her, having agreed with Laura that I would allow her to sink right into the “heart of darkness” in order to explore it more fully and understand it more clearly. The very next session, when we first put this plan into action, after I had left her alone in her silence for something like half an hour, Laura came to a powerful realisation at the heart of a very intense darkness. She said: “I think my mother threw me away even before I was born.”

This paved the way for deeper and more fruitful explorations of the reality of her childhood, the nature of which I will come back to later in this sequence of posts.

Since I started this blog almost eight years ago now, my interests have ranged widely across many topics, and psychosis has only featured in a relatively small number of posts. Decluttering has triggered me back into my fascination with ‘psychosis’ as the recent posts on out-of-the-ordinary-experiences illustrates.

When I trawled through my backlog of journals I found no other article dealing with that topic. On the web as a whole my most important find is a book edited by Isabel Clarke titled Spirituality & Psychosis which touches on it in places. I will need to buy a copy of that and read it carefully before I can even begin to comment, but the Chapter headings and their authors on the Google version certainly whetted my appetite. How could I resist a book dealing with two of my favourite obessions?

I have found a few other titles on related themes via the British Psychological Society website and it is on three key papers from among those that I wish to focus now.

Graph of the Model that states Psychosis is on a continuum with Normal Functioning (Source: The route to psychosis by Dr Emmanuelle Peters)

Graph of the Model that states Psychosis is on a continuum with Normal Functioning (Source: The route to psychosis by Dr Emmanuelle Peters)

We’re on a Continuum

Bethany L. Leonhardt et al, right from the beginning of their article[1] arguing that psychosis is understandable as a human experience (page 36), ask us to regard the symptoms of psychosis ‘as part an active meaning-making process, regardless of whether or not that meaning is adaptive.’

They explore how the use of literature, particularly novels, can help those who work with people who are having psychotic experiences tune into their predicament more empathetically. As a result of their use of this method, they offer some interesting perspectives.

For example, (page 47) they ‘suggest that exposure to novels and related literary genres may help prevent therapists from surrendering to the view that psychosis is not understandable as anything other than a collection of abstract symptoms or from infantilizing patients by offering of paternalistic direction or protection from life demands.’

As we have seen in the previous sequence on out-of-the-ordinary experiences (OOEs), the attitudes of others has a powerful effect upon how well or how badly a person is able to deal with their bizarre and often frightening experiences. An assumption that what people have experienced is meaningless is at best patronising and at worst confrontational and undermining. One of my own early observations was that most of the clients I saw were expecting me to dismiss everything they were saying, either by ignoring it, refusing to discuss it in any way that resembles their own terms or by frankly rubbishing and pathologising it. They seemed both surprised and relieved when I did my best to engage with them in an attempt to understand it, which is of course not the same as endorsing everything they told me as objectively true. It was though a way of taking what they said seriously and respectfully. For a fuller explanation of my approach click on the posts listed below.

On the occasions where I was unable to sustain this at a sufficiently high level I risked damaging the relationship. I can remember one such occasion. A client was convinced that the devil was plotting against him and kept bringing forward the evidence he thought proved it. My approach clearly aroused his suspicions as to my beliefs about the devil, and he repeatedly pushed me to disclose what my own beliefs were. After several repetitions of this over a number of sessions I concluded that my holding back was blocking further progress. I made the mistake of letting him know that I thought that the devil had no objective existence but was a metaphor to explain evil. He discontinued therapy at that point.

In retrospect I realised that I could have given a more authentic response from a deeper level of my thinking and stated that, while for practical purposes in my own life I did not operate on the assumption that the devil existed, I had to admit that there was no way I could dogmatically state or absolutely prove that he didn’t: agnosticism on that point would have been a better and perhaps more honest answer. Though I may have failed this client, I learnt something very helpful for future interactions.

Equally importantly, Leonhardt et (ibid) ‘acknowledge that our views largely draw on the idea that psychosis can be understood as existing along the continuum of human experience. Our use of novels and related literary genres indeed seems predicated on the idea that individuals experiencing psychosis are not inherently different from anyone else, and that some of the strangest and most bewildering experiences can be made sense of while reading literature and engaging in other reflective activities.’

This ability to find ways of empathically recognising that psychosis is a point on a dimension we all share in some way is a key requirement of a true understanding of what psychosis is in my view.

Next time I will explore the role of trauma in the formation of psychosis.

Related Posts

An Approach to Psychosis (1/6): Mind-Work & Trust
An Approach to Psychosis (2/6): Surfaces & Depths
An Approach to Psychosis (3/6): Complicating Factors
An Approach to Psychosis (4/6): The Mind-Work Process (a)
An Approach to Psychosis (5/6): The Mind-Work Process (b)
An Approach to Psychosis (6/6): Fitting It All Together


[1] The article was published in the American Journal of Psychotherapy, Vol. 69, No. 1, 2015.

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A relevant blast from the past in the light of yesterday’s post.

Forget about jam and Jerusalem. Marmalade and meditation is the real deal.

Bruce made a significant comment on my review of Iain McGilchrist‘s book about the need for a proper balance between the way the two halves of our brain work together, the left with its word-dependent logic and the right with its creative intuition:

At the time I “found” McGilchrist’s book I was reading concurrently a history of Greek philosophers, a narrative of the development of the “western mind” and a quirky travelogue of discovery of “the psyche of Persia we really don’t know”, searching for something I wasn’t sure existed – a unified view, a coherence that McGilchrist just dropped into my lap . . . .  Best of all, when I put the book down, I find myself more inclined to seek out a wetlands forage for watercress than a newscheck on the internet!

When I read it I felt a twinge of envy at the idea of foraging for watercress in a wetlands habitat. It was only fleeting though. My connection with nature has always tended to be passive rather than active. My interest in gardens, for example, extends only as far as sitting in them with immense pleasure: any actual gardening tends to result in injury or accidental damage. I end up lacerated by thorns or by cutting the trimmer cable in half. This takes the edge of any slight pleasure I might have felt and tips me well over the cliff into aversion.

So, I came to feel, perhaps with a slight sense of smug complacency, that the impact on me of McGilchrist’s insights, though considerable, might extend no further than a bit of meditation laced with poetry. And those who have been following this blog will testify there’s been a lot of poetry recently. I never thought I’d sink to practicalities.

Until, that is, a friend of ours gave my wife a hefty bag of plums. It looked like there were millions of them and they were very small. My wife mentioned something about making jam so I made some excuse about needing to answer a load of emails and disappeared into my study. I was there for what felt like several hours and thought the whole thing would have blown over by the time I came downstairs to make a cup of coffee.

As even Basil Fawlty at his most obtuse would have realised, making coffee requires going into the kitchen, and going into the kitchen, when jam making is in the air, is not a smart move for those who don’t want to make jam. As soon as I walked in I knew I had made a fundamental error. There on the table was a mountain of plums piled carefully in a massive bowl. Within seconds – I’m still not sure how it happened – I was back on my computer looking for recipes for plum jam. One of the drawbacks of Google is that you can find exactly what you don’t want if you make the mistake of looking for it. And I did.

Initially I emailed three of the recipes to my wife and came back downstairs to continue making the coffee.

‘Have you got the recipes, love?’ my wife asked quietly.

“I’ve emailed them to you,’ I said defensively.

‘Couldn’t you print one off?’ came the response.

It was at that point I knew the game was up.

. . . . . . . . . . . . . .

What I didn’t yet realise was how fulfilling the making of plum jam would be. And how my decision to resume regular and disciplined meditation two months previously had made it possible for me to take pleasure in exactly the kind of fiddly repetitive task that would have driven me to complete distraction just a few short weeks ago. Meditation had enabled me to maintain focus far better, accept the repetition in good spirit, notice with genuine surprise and pleasure the way each rounded fruit was subtly different from the last one and learn by stealth rather than conscious effort how to become more efficient and dextrous at getting every last piece of flesh off even the tiniest the stone. Preparing the plums in this way became a form of meditation in itself, a spiritual discipline that changed my consciousness, heightened my awareness and developed new skills. It changed me in a way that generalises to many things I do from emptying the dishwasher to replying to emails.

And it paved the way for making marmalade. My favourite form of jam.

But before I come onto that perhaps I’d better explain why I started to meditate again so much in earnest.

Sam Harris meditation pic

Meditation from Article by Sam Harris


It’s true that I have always done some meditation ever since I first learnt at the London Buddhist Society in the early 70s. But it had been a long time since I had done so with the discipline of those early days. It’s also true that for some years the emphasis psychology now places on mindfulness rekindled my interest a little. But I had of late been much more interested in reading about it than really doing it. And the McGilchrist book, while it drew me back to music and poetry, left my pattern of meditation very much as it found it.

In truth, I felt I was far too busy to make the time for anything more than a perfunctory gesture at the task. I had far more important things to do and I raced around doing them until the warnings from my interactions with the world became too strong for me to ignore.

First, in spite of my lip-service to mindfulness, I became so ungrounded by the pace I was keeping up, that I spilt coffee on my lap top and destroyed it. That jolted me more than a little but I still did not fully wake up to my need to change something radically until, late at night a month later, in a haze of fatigue, with my whole close family in the car, convinced I was already on the dual carriageway which was in fact still half a mile down the road, I moved out to pass the slow moving car and trailer ahead of me. I was alerted to my mistake when I saw, with initial incredulity, the headlights of an oncoming car heading straight for me in the distance. I pulled back inside with time to spare more by good luck than good judgement. What shocked me most about this incident was that fatigue had warped my perception of reality so much that what I believed about where I was completely overrode the cues telling me otherwise that were plainly there for me to see and respond to.

I remembered the story about a well-known Bahá’í, Dorothy Baker, who had a serious and almost fatal car-accident on a steep mountain road.

She mused aloud to a friend: ‘I wonder what God is trying to tell me.’

To which the reply came: ‘Dorothy, you drive too fast!’

The same kind of answer came to me in a flash, in the aftermath of this near collision: ‘Pete, you’re driving yourself too fast.’

Carl Jung used to say something like, ‘When life has a message for you, it first of all taps you gently on the shoulder, may be more than once. Then, if you don’t notice, it will slap you in the face. If you still don’t pay attention it will bang you hard in the head.’ This moment was my bang in the head.

It became clear to me that I had to take meditation seriously, slow down and trust that I would still be able to do all that was truly important to do.

So, at the start of every day since then, for half an hour at least, I have practised a form of meditation. (I won’t bore you with the details here but for anyone interested I’ve posted the basic model, as used in a group exercise, at this link Turning the Mirror to Heaven. It also explains how the method can be used alone.)

Initially I found it almost impossible to step back from a very disempowering belief. I believed that making time to meditate, and then using the calm I had generated to slow down my pace of work, would in fact make the whole situation much worse by leaving a trail of neglected tasks in my wake for others to trip over.

And it’s true I’ve had to decline some requests to take on more than I could do, and that was hard. But to my astonishment, almost all the major projects I’ve taken on continue to progress, though it still is hard to trust that the pace is fast enough – but as far as I know there’s no great harm done (‘yet’ says the voice I have to fight every time I meditate or do things mindfully).

And the strangest thing of all is that there has been time to make my own marmalade. I never thought I’d see the day when I would take pleasure in slicing orange peel into thin strips as though I had all the time in the world, my enjoyment marred by only the faintest suspicion that in doing so I must be neglecting something more important.

So my present unprecedented state of mind seems to be thanks to marmalade, McGilchrist and meditation. I still find myself wondering quite often, though, how long it will be before life pricks this bubble too. Some people are never satisfied.

Oh and, by the way, we gave a jar of plum jam to the friend who’d set this whole jam thing going and to my surprise she seemed to love it. Perhaps she was just being polite.

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Dr Penny Sartori (for source of image see link)

It is more than two years since I posted this short sequence. Given my recent sharing of Sharon Rawlette’s review, it seemed a good time to republish it.

I recently read yet another book about NDEs –  The Wisdom of Near-Death Experiences: How Understanding NDEs Can Help Us Live More Fully by Dr Penny Sartori.

Much of it covered very familiar ground and I won’t be dwelling on those aspects in detail here as I have dealt with such things as the basic elements and the implications for consciousness elsewhere. I want to look at what the book seems to add to our understanding of this contentious area of investigation.

Some of what she writes simply adds to my understanding of aspects which have been well-researched already. For example, previous studies, such as those of Ken Ring, have rightly emphasised the impact that an NDE can have on someone’s subsequent pattern of life, often radically altering a person’s priorities, shifting them from the material towards the moral/spiritual. What Sartori includes is some concrete evidence that supports the idea, which writers such as Eben Alexander put forward, that genuine knowledge beyond the person’s previous capacity can be acquired during an NDE. One example (Kindle location 325) describes a presentation at an NDE conference of the NDE experienced by someone called Rajaa:

During the conference a video recording of an interview with Rajaa’s university professor was broadcast. He stated how puzzled he was about Rajaa’s level of knowledge of quantum physics. The knowledge and understanding that she has cannot be acquired by attending an accelerated course or reading lots of books about quantum physics. What I found particularly intriguing was that he said that not even he understood some of what Rajaa was writing about but her work had since been confirmed by recent papers that had been published in physics journals.

Because she is a nurse by profession she is particularly interested in the clinical implications of the NDE. This gives her treatment of the subject a specially valuable slant.

She gives a clear account of the challenges the experience can present in its aftermath. She feels that ‘six major challenges that the NDErs [are] faced with’ have been identified (697). She lists them as (698):

• Processing a radical shift in reality
• Accepting the return to life
• Sharing the experience
• Integrating new spiritual values with earthly expectations
• Adjusting to heightened sensitivities and supernatural gifts
• Finding and living one’s purpose.

As will become clear later the attitude of important others is of particular significance in helping people comes to terms with these challenges. NDEs may be particularly testing for children (1464):

Connecting with unconditional transcendent love, then returning to life was confusing for many childhood NDErs. Many children reported that they wanted to return to where they were and would even attempt suicide to get there. Suicide in this case is not a means of self-harm but a means to return to that wonderful place of love.


In her own practice as a nurse she was challenged by the way that clinical teams managed death and dying and by accounts of NDEs that she met en route. She watched as four members of staff, intent on saving the life of an elderly woman who was certain to die soon, mounted a massively invasive mechanical campaign to prevent the inevitable, only to prolong her suffering to no useful purpose whatsoever.

She decided to embark upon her own investigation of NDEs. It was a demanding exercise to undertake given her duties as a nurse at the time (2605-8):

After the first year I had interviewed 243 patients but only two reported an NDE (0.8 per cent) and two reported an OBE (0.8 per cent). . . . . So by the by the end of the five years, out of 39 patients who survived cardiac arrest, seven reported an NDE (17.9 per cent). . . . . in total, during the five years, 15 patients reported an NDE and there were eight reports of OBE-type experiences.

She argues strongly against NDEs as some form of wish fulfilment, partly on the grounds that these experiences do not conform to expectations and are sometimes decidedly unpleasant. One ‘was so terrifying for the patient that I had to terminate the interview.’ She adds (2725):

Such experiences are hardly the outcome of wish fulfilment. Further to this, some patients met dead relatives they did not expect to see and some had unexpected reactions from these relatives while others did not experience what they had expected. It seems that expectations were not met and some unexpected factors arose.

She quotes Bruce Greyson’s pithy summary of the situation as far as systematic investigation is concerned (2786):

It is interesting to note Professor Bruce Greyson’s comment: ‘Why is it that scientists who have done the most near-death research believe the mind is not exclusively housed in the brain, whereas those who regard NDEs as hallucinations by and large have not conducted any studies of the phenomena at all?’

She dismisses the contention that NDEs are drug induced on the basis of considerable evidence to the contrary, for example (2807-9):

Interestingly, when drug administration is considered in the hallucination group, out of the 12 patients who reported bizarre hallucinations, 11 (almost 92 per cent) of them received both painkilling and sedative drugs. This appears to suggest that drugs greatly contribute to confusional, bizarre hallucinations . . . . which are in stark contrast to the clear, lucid, well-structured NDEs that were reported. 


For source of image see link

She then moves into an area of particular practical interest to me given my involvement in NHS Chaplaincy.

She begins by explaining that, in general (2967), ‘spiritual aspects of patient care are an area which is greatly lacking for many reasons, such as lack of confidence or experience, or lack of continuity of care, but probably the biggest factor is excessive workloads and resultant lack of time and nurses.’  She is clear that (2970) ‘addressing spiritual needs of patients and treating patients holistically has the potential to accelerate healing and recovery, reduce medication and resources required and so reduce the hospital stay’ and that (2973) ‘[c]aring for patients’ spiritual needs could also prompt healthcare workers to explore their own spiritual needs.’

She makes the same point (2977) as the recent Horizon programme on the placebo effect also demonstrated experimentally, ‘Drawing on the latest research of the effect of positive emotions on health, it has been shown how feelings of wellbeing and love can greatly enhance recovery and healing.’

What has this to do with NDEs? Quite a great deal as it turns out. First of all these experiences are usually wrongly categorised (2987):

NDEs are often misdiagnosed as post-traumatic stress or a dissociative disorder, despite the literature warning against this, and they are categorized into conventional diagnostic illnesses that are not appropriate for NDEs.

There is widespread ignorance amongst health staff which adversely affects the care they provide (3003):

Despite NDEs being highly popularized in the media, healthcare workers still lack the knowledge to provide the level of care that these patients require.

She argues for the importance of a more understanding approach (3032):

Caregivers should not discredit NDE/end-of-life experiences because they are at variance with their own worldview but should encourage the person to use it in a positive way and see it as a gift. Although as nurses we are trained to ‘correct’ hallucinations, it is most important that NDEs are not treated in this way but listened to.

She unpacks why this matters (3040):

NDEs are still regarded by some people as hallucinations and many try to explain them away as being due to drugs or lack of oxygen. This is not a criticism; when NDEs are taken at surface value these appear to be very rational, plausible explanations – in fact, these were my own initial reactions to NDEs. Research in the clinical area is now showing these factors to be inadequate explanations and such a response can be detrimental to the NDEr understanding and integrating their experience.

This can lead to long term negative consequences as the patient retreats into silence about the whole experience, questions his or her rationality and suffers from a feeling of alienation.

The next post will go into more detail about what the book reveals of the implications and the aftermath of an NDE.

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