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Posts Tagged ‘psychosis’

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)

assagioli

Even though it’s barely a year since I last republished this sequence, it’s relevance to my sequence on Living in a Mindful Universe is unmistakable, so here it comes again!

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 transcendent 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 basic 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.

titania-l

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.

This 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 remembered dream I have ever noted 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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Given the recent new posts taking another look at psychosis, it seemed worthwhile republishing this sequence from several years ago.

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

The Rogerian Triad

Carl Rogers

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

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

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

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

Smail’s Triad

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

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

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

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

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

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

In the words of Smail (page 213):

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

David Smail

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

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

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

Smail (page 42) feels that there is,

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

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

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

Transferring Ownership

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

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

The Good Samaritan

The Good Samaritan

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

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

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Given the recent new posts taking another look at psychosis, it seemed worthwhile republishing this sequence from several years ago.

The Importance of Motivation

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

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

I.: No.

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

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

P.: Were you surprised it worked?

I.: I was very surprised it worked.

P.: Right.

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

P.: Made sense and gave you relief?

I.: It did give me relief, yeh.

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

The Balance of Pain and Gain

There was also the issue of the pain involved.

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

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

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

The Limitations of Diagnostic Labels

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

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

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

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

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

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

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

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

A Welcome Corrective

A Welcome Corrective

P.: And that was the end of it.

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

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

I.: Yeh.

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

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

Sleep and Food

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

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

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

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

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Given the recent new posts taking another look at psychosis, it seemed worthwhile republishing this sequence from several years ago.

Using Conversation: a Surface Approach

Following on from his comments about trust and the importance of being helped to work on issues in-between sessions, Ian also talked of two main ways he felt he had been helped by the conversations with me. He felt he had learnt how to “bargain” with the voices.

P.: And you feel that [dealing with emotions: see below for more] was a very important aspect of what we were doing together?

I.: And the suggestion that I could bargain with the voices.

P.: Right. So in fact there were then two things. One was the emotions that you got in touch with about the separation from your partner, and there was also it was suggested to you that you could bargain with the voices.

I.: Yeh.

P.: Can you say a bit more about one or other of those? Why you felt they were important?

I.: Well, because I’d tried telling them in the hospital, you know, that I’d been trying to talk to the voices. And they kept discouraging me and said I shouldn’t talk to the voices. I should ignore ’em. And I kept saying `Well, I should talk to them, you know, because I can get in touch with them.’ I’d felt that all along. And you supported it. And told me to talk to the voices, you know. With a bit of confidence.

P.: And what did you say to the voices? What was your approach to them?

I.: I said `I know that you’re unhappy. But I don’t know why you’re unhappy, but I’ll talk to Peter about it. And see if we can’t get to the bottom of it. And I’ll try to make you happy.’

P.: Yeh. And did you ask them if they could do something in return?

I.: Yes, I asked them if they could let me sleep.

P.: Right. And did they?

I.: Yes.

P.: Did they do it straightaway or . . .?

I.: No, it took a coupla nights.

P.: Right. But then after a couple of nights they did give you a break?

I.: Yeh. They give me a break, yeh.

P.: I need to ask you this as well. Did you think that that was actually going to be of any use before you did it?

I.: No, because I didn’t think I could get in contact with the voices so easily. I thought it would take a lot longer, you know? But I found that it happened pretty quickly.

P.: Yeh. It was important was it that it happened quickly?

I.: Yeh.

P.: Do you think you would have had the patience to keep going if it didn’t?

I.: I don’t know.

This I would describe as a surface approach and bargaining in this way has been used by many others as well as Ian. Surface approaches range from recommending that people use earplugs or Walkmans as a distraction from the voices, through reading out loud as a way of disrupting the voices, to examining in detail the experience of the voices in its own right, which is called focusing (see below).

kenmare-reflections2

Using Conversation: a Depth Approach

Ian also mentioned how he had realised that the pain of breaking with his partner had contributed to his experience of the voices.

I.: I knew there was something wrong with me. But I didn’t know what it was. And I knew something was bothering the voices. And I think it was over the split up with my partner, you know, and the pain that that caused.

P.: Yeh. Which you hadn’t dealt with?

I.: Which I hadn’t dealt with. I just pushed it to one side.

P.: So is that why it was important to deal with that then, with that pain?

I.: Yeh.

P.: Can you explain that, rather than me putting the words into your mouth? Why do you think it was important to deal with the pain of that?

I.: Because I hadn’t come to terms with it, you know? I still loved my partner and I was still hoping that somehow we could get together, you know? But I’ve give up that idea now. And I’ve put her in the past.

P.: Right. So, do you feel that that sadness was something that had some kind of effect on the voices or . . .?

I.: Yeh.

P.: What kind of effect do you think it had?

I.: Because I was sad inside and because I was still hanging on, really, they kept plaguing me, you know? They were feeding on my unhappiness. And it was being unhappy that was causing the voices to be unhappy. But having talked about my partner and coming to terms with it and crying and feeling it, you know, and it really hurt and I didn’t want to go on with it at first because I thought it hurt too much but I knew that I had to go on with it, if I wanted to have peace of mind.

P.: Right. And that’s what kept you going was it?

I.: Peace of mind, yeh.

P.: Right. And presumably the fact that the voices did respond to your bargaining earlier on, did give you some hope that if you actually carried doing this process, that they’d leave you alone even more.

I.: Yeh. I thought that if I got it all out in the open, you know? And – er – I was able to think for the first time in eight years.

This is more of a “depth” approach. We were looking at what might lie behind the experience of the voices. Ian discovered that by acknowledging his emotional pain he could dispel the voices. Discounting emotional pain can lead to problems of other kinds as well as voices, but hearing voices is often the result of trauma and therefore connected with emotional pain.

Many people discover that working on what lies behind the voices can help them control the voices. Other people find this too painful and prefer to stick with surface approaches which are nonetheless quite powerful. There is evidence to suggest that distraction is not quite so good in the long run, leaving people with a lower sense of self-efficacy and a greater vulnerability to depression.

Focusing

Focusing, which is still a surface approach, is better if the person can cope with it. Self-efficacy is enhanced and subsequent depression less likely.

Focusing involves turning your attention to the patterns contained in the experiences you are having. When your experience is dominated by threatening and demonic voices, focusing is a scary business. However, if you can make yourself do it, it brings dividends.

The characteristics of the voices (in Ian’s case a bullying male voice) and the specific content (with Ian it was orders such as ‘Get out of bed you lazy bastard’) can help identify why the voices have taken this particular form: Ian’s first breakdown had been in the army when he was under the command of a particularly unpleasant sergeant-major. His army experiences proved important in understanding other aspects of his psychotic experience as well, but that is another and much longer story. So, it was very useful to get this early hint about that.

When they occur, how often, and under what circumstances,  can help us see what triggers them.

My only one session successful intervention was with a someone who heard sadistic voices insisting that he would be tortured if he did not find out where bombs were being planted. Until a couple of years before, his voices, which had been with him 25 years or more, were always friendly and helpful. We tried to work out what had changed. It turned out that about two years ago he had developed a strong interest in the Second World War and was reading avidly and constantly about the Gestapo and the Resistance Movement. We decided between us that he should experiment with desisting from any reading around this subject for the next four weeks and then we would meet against to compare notes.

As he believed the voices were real, and therefore in his view autonomous and beyond his influence, he did not have a great deal of confidence in this approach! He agreed to do it, I believe, in part to prove me wrong. He decided to pursue his other main interest at the time and  to read the National Geographic magazine instead.

He was plainly astonished but delighted when the sadistic voices disappeared and his friendly voices returned.

Focusing can be very effective especially when it is linked to practical action in this way on the basis of what you have learned.

Next time

In the next post we will be looking at some complicating factors.

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Given the recent new posts taking another look at psychosis, it seemed worthwhile republishing this sequence from several years ago.

Some Background Thinking

I thought it was about time I tried to do a post on the work I did for most of my professional life. It could be tricky and might not work out at all.

I have been struggling for ages — at least ten years —  to capture in words the work I used to do. Words like therapist and therapy make me uncomfortable. Even the word counseling implies unequal distributions of wisdom. She who gives counsel is somehow superior to him who receives!

I have come to believe that what I did is best called mind-work. It includes mood-work, belief work and will-work: it should have included ‘soul-care’ but that would have been a step too far for a clinical psychologist’s job description even though ‘psyche’ means ‘soul’ to the Greeks.

Everyone does mind-work up to a point. It’s a bit like cooking though. Almost everyone prepares food at some point in his life but not everyone’s a chef. As a professional mind-worker I was a bit like the chef. I was an expert at the work at the same time as the people who worked with me as clients were experts about their own minds.

Because, to do mind-work, I drew on lots of other disciplines and traditions, including philosophy, psychology, biology, religion (especially Buddhism and the Bahá’í Faith) and the arts, I could sometimes feel like giving myself a fancy title such as psy-culturalist. This captures the richness of the traditions I could draw on and also captures the essential purpose of mind-work which is growth. It also meant I didn’t have to label myself a psychologist with its one-sided implication that I study the mind but don’t work with it, nor did I have to call myself a Clinical Psychologist with its implications of illness and therapy, which are insulting to the client.

Psy-culturalist, as a term, has a similar problem to Clinical Psychology. If we think about gardening, it’s a one-way street. Plants, as a general rule, don’t grow people. Mind-work, though, is both reciprocal and reflexive. I grow you and you grow me and we grow ourselves as well!

In the end then mind-work is a perfectly good description.

Mind-work for the most part involves forming a relationship (much more on that later) that allows words to be used in a process of collaborative conversation (the title of a book chapter I contributed to This Is Madness) to enhance meanings in a way that enables all participants to grow. As I see it every human interaction is an opportunity for mind-work and as many interactions as possible should be used as such. Even the groups of people who traditionally have been seen as experiencing meaningless lives, such as those with a diagnosis of schizophrenia or dementia, are not to be excluded from this meaning-making growth process. My work has mostly been with the former group and what follows discusses some implications of that. For me though, everybody means something and to deny that is to dehumanize us.

Perhaps it is important to clarify something. I use the word mind to cover a wide variety of possibilities. Consciousness is only one of them. Many important processes take place outside the circle of light shed by conscious attention. Mind is also where the body is experienced and shares a two-way relationship with the brain, so the realms of the physical are not excluded. The mind is a node in a sociocultural network and is affected by many wider systems which it maps and responds to in a variety of ways. No mind is an island! There is also strong evidence that the mind can operate independently of the body/brain (See Jenny Wade’s Changes of Mind, Ken Ring’s Lessons from the Light and David Fontana’s Is There an Afterlife? as well as posts on this site about the afterlife hypothesis for more detail about that.)

There are differences that should not be obscured. A psychologist is paid for her mind-work: her client is not. That is one difference which can create an undesirable power-differential if great care is not taken to counteract that tendency. Another difference lies in the fact that the client is the expert, as I have said, in his own mind: the psychologist is the expert when it comes to the nature of the work in some of its aspects. That is the only other difference. Both can grow as a result of the mind-work they do together.

That should be enough to set the scene for the exploration of my way of working that follows.

The Client’s Perspective

In 1996 I interviewed someone who had gone through a series of conversations with me about his voices. He was a former miner and an ex-army man from the Welsh valleys. He was articulate but down-to-earth. What he told me enriched my way of doing things considerably and shed a great deal of light into previously dark places. We made a video together, from which the photo  below is extracted but without showing his face, and he was very keen that it be used to help others understand this kind of problem better. At the time of the videoed interview we had been working together for about six months. There was still a long way to go but much of interest had happened. I will call him Ian to protect his identity.

Perhaps most importantly, he emphasised the role of trust.

P.: And it was in November that we first met, wasn’t it?

I.: Yeh. Jenny [his residential social worker not the author of the book recommended above!] had started talking about you, you know? And it was coming up to the meeting with you. And I can remember going to the meeting with you that first time. And I can remember thinking who’s this bloke asking me all these questions, you know? And I didn’t trust you. But Jen was persistent that I could trust you, so I decided to trust Jenny and to talk to you.

P.: And you actually asked if Jenny could come to sessions, didn’t you?BM & PH

I.: Yeh, I asked if Jenny could come, yeh.

P.: Right. And I think she came about the second or third time you came.

I.: Yeh.

P.: And did you feel more comfortable with her there?

I.: I did, yeh.

P.: And did that make you feel more able to begin to trust me at least personally if not what I was doing?

I.: It took about a month to start to trust you. And that was with Jenny backing you up.

This cannot be stressed too much. Trust takes a long time to build and is easily lost. In Ian’s case Jenny who had worked with him for years and vouched for me assisted the development of trust. In a “delusion” exercise I use in workshops we can see how a period of unsympathetic and confrontational treatment at the hands of other people makes it harder for someone to believe we are not going to be the same. We need to prove our trustworthiness over a period of time. We need to be prepared for hostility at worst and the cold shoulder or evasion at best in the early stages of our relationship. We would be wise not to assume that such behaviour is the result of “paranoia.” It is at least as likely, if not more so, to be a natural reaction to months if not years of other people’s outspoken incredulity.

What also was important to the success of my work with Ian was all the effort Jenny put in in-between times.

I.: It took about a month to start to trust you. And that was with Jenny backing you up.

P.: And that was by being there in the sessions and by talking to you between whiles wasn’t it? You used to have meetings and discussions with her between times.

I.: Inbetweentimes, yeh. And we’d talk about what we’d talked about, you know? And she supported you in what she said.

She helped him remember what I had said or correct his distortions of it. She encouraged him to make use of the suggestions we had come up with. She helped him make sense of what was happening to him in the terms I had described it. Isolated mind-work sessions will achieve little if they are not reinforced and supported by a lot of work in-between.

We will hear much more from Ian in the next post.

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Given the recent post taking another look at psychosis and trauma, it seemed worthwhile republishing this sequence.

The previous post looked at the Grof’s account of Karen’s experience of a spiritual emergency and how it was dealt with. Now we need to look at some of the implications as well as other aspects of their approach.

The Context

I want to open this section with that part of Bahá’u’lláh’s Seven Valleys that has formed the focus of my morning meditations for the last few weeks. I have persisted so long in the hope that I will eventually understand it more fully. I believe that Shoghi Effendi, the great-grandson of Bahá’u’lláh and the one whom ‘Abdu’l-Bahá appointed as His successor, was of the opinion that one needed to read at least ten books by writers who were not Bahá’ís in order to have any hope of understanding a Bahá’í text fully. I may have conveniently chosen to believe that factoid in order to justify my own bookaholic tendencies.

Setting that aside for now, what matters at the moment are the resonances between the words of Bahá’u’lláh and the topic I am exploring more deeply here.

I have touched on how materialistic assumptions about reality will dismiss as rubbish or even pathologise phenomena their paradigm excludes from possibility.

Bahá’u’lláh directly addresses this point (page 33):

God, the Exalted, hath placed these signs in men, to the end that philosophers may not deny the mysteries of the life beyond nor belittle that which hath been promised them. For some hold to reason and deny whatever the reason comprehendeth not, and yet weak minds can never grasp the matters which we have related, but only the Supreme, Divine Intelligence can comprehend them:

How can feeble reason encompass the Qur’án,
Or the spider snare a phoenix in his web?

Our deification of reason has stripped the world we believe in of God and made it difficult, even impossible, in some cases for some people, to entertain the possibility that God in some form does exist, though that would not be as some white-bearded chariot-riding figure in the sky.

This is the Grofs take on this issue (page 247):

A system of thinking that deliberately discards everything that cannot be weighed and measured does not leave any opening for the recognition of creative cosmic intelligence, spiritual realities, or such entities as transpersonal experiences or the collective unconscious. . . . . . While they are clearly incompatible with traditional Newtonian-Cartesian thinking, they are actually in basic resonance with the revolutionary developments in various disciplines of modern science that are often referred to as the new paradigm.

This world-view seriously demeans us (page 248):

Human beings are described as material objects with Newtonian properties, more specifically as highly developed animals and thinking biological machines. . .

We have taken this model or simulation as the truth (ibid.):

In addition, the above description of the nature of reality and of human beings has in the past been generally seen not for what it is – a useful model organising the observations and knowledge available at a certain time in the history of science – but as a definitive and accurate description of reality itself. From a logical point of view, this would be considered a serious confusion of the ‘map’ with the ‘territory.’

This reductionist dogmatism has serious implications for psychosis (page 249):

Since the concept of objective reality and accurate reality testing are the key factors in determining whether the individual is mentally healthy, the scientific understanding of the nature of reality is absolutely critical in this regard. Therefore, any fundamental change in the scientific world-view has to have far-reaching consequences for the definition of psychosis.

A Holographic Approach

They contend that the paradigm is shifting (ibid.:)

. . . The physical universe has come to be viewed as a unified web of paradoxical, statistically determined events in which consciousness and creative intelligence play a critical role. . . This approach has become known as holographic because some of its remarkable features can be demonstrated with use of optical holograms as conceptual tools.

Their explanation of the holographic model is clear and straightforward (page 250):

The information in holographic systems is distributed in such a way that all of it is contained and available in each of its parts. . . .

It’s implications are profound:

If the individual and the brain are not isolated entities but integral parts of a universe with holographic properties – if they are in some way microcosms of a much larger system – then it is conceivable that they can have direct and immediate access to information outside themselves.

This resonates with what Bahá’u’lláh writes in the same section of the Seven Valleys:

Likewise, reflect upon the perfection of man’s creation, and that all these planes and states are folded up and hidden away within him.

Dost thou reckon thyself only a puny form
When within thee the universe is folded?

Then we must labor to destroy the animal condition, till the meaning of humanity shall come to light.

It is crucial for us all as well as for those labelled psychotic that we cease to reduce the mind to a machine. The Grofs spell out the implications for psychosis when we refuse to take the more transcendent perspective (page 252):

The discoveries of the last few decades strongly suggest that the psyche is not limited to postnatal biography and to the Freudian individual unconscious and confirm the perennial truth, found in many mystical traditions, that human beings might be commensurate with all there is. Transpersonal experiences and their extraordinary potential certainly attest to this fact.

. . . In traditional psychiatry, all holotropic experiences have been interpreted as pathological phenomena, in spite of the fact that the alleged disease process has never been identified; this reflects the fact that the old paradigm did not have an adequate explanation for these experiences and was not able to account for them in any other way.

Assuming that we do accept that possibility of a spiritual reality, what follows? They spell it out:

. . . . two important and frequently asked questions are how one can diagnose spiritual emergency and how it is possible to differentiate transformational crises from spiritual emergence and from mental illness.

This is only possible up to a point (page 253):

The psychological symptoms of… organic psychoses are clearly distinguishable from functional psychoses by means of psychiatric examination and psychological tests.

. . . . When the appropriate examinations and tests have excluded the possibility that the problem we are dealing with is organic in nature, the next task is to find out whether the client fits into the category of spiritual emergency – in other words, differentiate this state from functional psychoses. There is no way of establishing absolutely clear criteria for differentiation between spiritual emergency and psychosis or mental disease, since such terms themselves lack objective scientific validity. One should not confuse categories of this kind with such precisely defined disease entities as diabetes mellitus or pernicious anaemia. Functional psychoses are not diseases in a strictly medical sense and cannot be identified with the degree of accuracy that is required in medicine when establishing a differential diagnosis.

What they say next blends nicely with the points made in my recent posts about where the dubious basis of diagnosis takes us (page 256):

Since traditional psychiatry makes no distinction between psychotic reactions and mystical states, not the only crises of spiritual opening but also uncomplicated transpersonal experiences often receive a pathological label.

This has paved the way to dealing with their approach to intervention and their criteria for distinguishing spiritual emergencies that can be helped from other states.

Holotropic Breathwork

Before we look briefly at their attempt to create criteria by which we might distinguish spiritual from purely functional phenomena I want to look at their recommended method for helping people work through inner crises. This method applies what the non-organic origin. This technique they call Holotropic Breathwork.

First they define what they mean by holotropic (page 258):

We use the term holotropic in two different ways – the therapeutic technique we have developed and for the mode of consciousness it induces. The use of the word holotropic in relation to therapy suggests that the goal is to overcome inner fragmentation as well as the sense of separation between the individual and the environment. The relationship between wholeness and healing is reflected in the English language, since both words have the same root.

They then look at its components and their effects (page 259):

The reaction to [a] combination of accelerated reading, music, and introspective focus of attention varies from person to person. After a period of about fifteen minutes to half an hour, most of the participants show strong active response. Some experience a buildup of intense emotions, such as sadness, joy, anger, fear, or sexual arousal.

They feel that this approach unlocks blocks between our awareness and the contents of the unconscious:

. . . .  It seems that the nonordinary state of consciousness induced by holotropic breathing is associated with biochemical changes in the brain that make it possible for the contents of the unconscious to surface, to be consciously experienced, and – if necessary – to be physically expressed. In our bodies and in our psyches we carry imprints of various traumatic events that we have not fully digested and assimilated psychologically. Holographic breathing makes them available, so that we can fully experience them and release the emotions that are associated with them.

As Fontana makes clear in his book Is there an Afterlife?, experience is the most compelling way to confirm the validity of a paradigm of reality, so my experience of continuous conscious breathing in the 70s and 80s gives me a strong sense that what the Grofs are saying about Holotropic Breathwork had validity. My experience in the mid-70s confirms the dramatic power of some of the possible effects: my experience in the mid-80s confirms their sense that the body stores memories to which breathwork can give access. I will not repeat these accounts in full as I have explored them elsewhere. I’ve consigned brief accounts to the footnotes.[1]

They go on to explain the possible advantages of Holotropic Breathwork over alternative therapies (pages 261-263):

The technique of Holotropic Breathwork is extremely simple in comparison with traditional forms of verbal psychotherapy, which emphasise the therapist’s understanding of the process, correct and properly timed interpretations, and work with transference . . . . It has a much less technical emphasis than many of the new experiential methods, such as Gestalt therapy, Rolfing, and bioenergetics. . . . . .

In the holotropic model, the client is seen as the real source of healing and is encouraged to realise that and to develop a sense of mastery and independence.

. . . . . In a certain sense, he or she is ultimately the only real expert because of his or her immediate access to the experiential process that provides all the clues.

Distinguishing Criteria

Below is the table they devised to differentiate between the two categories of spiritual emergence and what they term psychiatric disorder. They explain the purpose of the criteria (page 253):

The task of deciding whether we are dealing with a spiritual emergency in a particular case means in practical terms that we must assess whether the client could benefit from the strategies described in this book or should be treated in traditional ways. This is their table of criteria.

They are certainly not claiming that they have an unerring way of distinguishing between these states, nor that some of those who are placed in the ‘psychiatric’ have no aspects of spiritual emergency in the phenomena they are experiencing. Readers will also know by now that I am a strong advocate of more enlightened ways of managing any such problems than those which are implied in the term ‘traditional.’

Coda

This last post turned out to  be much longer than I planned. I hope it conveys my sense of the value of their approach and of the validity of their concept of a spiritual emergency.

My feeling that their approach is a good one derives largely from my own dramatic experience of what was an almost identical method involving breathwork. In a previous sequence I have dealt with the way the breakthrough I experienced in the 70s had lasting beneficial effects on my my life, first of all in terms of opening my mind so I was able to take advantage of other therapeutic interventions. Perhaps most importantly though in the first instance was the way that the first breakthrough loosened the grip of my previous pattern of anaesthetising myself against earlier grief and pain mostly by cigarettes, gambling and heavy social drinking, so that I could realise that I needed to undertake more mindwork.

I also find it reinforcing of my trust in the basic validity of their perspective that it has led them to draw much the same conclusions as I have about the dangers of materialism and its negative impact upon the way we deal with mental health problems

It doesn’t end my quest though for more evidence to support my sense that psychosis can and often does have a spiritual dimension. Hopefully you will be hearing more on this.

Footnote:

[1] Rebirthing provided the experience that gave me my last major break-through in self-understanding by means of some form of psychotherapy. I heard first about it from a talk I attended on the subject at an alternative therapies fair in Malvern in early 1985. I then bought a book on the subject. The key was breathing:

Jim Leonard saw what the key elements were and refined them into the five elements theory.

The five elements are (1) breathing mechanics, (2) awareness in detail, (3) intentional relaxation, (4) embracing whatever arises, and (5) trusting intuition.  These elements have been defined a little differently in several versions, but are similar in meaning.  Jim Leonard found that if a person persists in the breathing mechanics, then he or she eventually integrates the suppressed emotion.

It was as though what is known as body scanning were linked to a continuous conscious breathing form of meditation. All the subsequent steps (2-5) took place in the context of the breathing.

After three hours I was trembling all over. I was resisting letting go and ‘embracing’ the experience. When I eventually did the quaking literally dissolved in an instant into a dazzling warmth that pervaded my whole body. I knew that I was in the hospital as a child of four, my parents nowhere to be seen, being held down by several adults and chloroformed for the second time in my short life, unable to prevent it – terrified and furious at the same time. I had always known that something like it happened. What was new was that I had vividly re-experienced the critical moment itself, the few seconds before I went unconscious. I remembered also what I had never got close to before, my feelings at the time, and even more than that I knew exactly what I had thought at the time as well.

I knew instantly that I had lost my faith in Christ, and therefore God – where was He right then? Nowhere. And they’d told me He would always look after me. I lost my faith in my family, especially my parents. Where were they? Nowhere to be seen. I obviously couldn’t rely on them. Then like a blaze of light from behind a cloud came the idea: ‘You’ve only yourself to rely on.’

The earlier experience had been more confusing, with no specific experience to explain it by.

Saturday was the day I dynamited my way into my basement. Suddenly, without any warning that I can remember, I was catapulted from my cushioned platform of bored breathing into the underground river of my tears – tears that I had never known existed.

It was an Emily Dickinson moment:

And then a Plank in Reason, broke,
And I dropped down, and down –
And hit a World, at every plunge, . . .

I’m just not as capable of conveying my experience in words as vividly as she did hers.

Drowning is probably the best word to describe how it felt. Yes, of course I could breath, but every breath plunged me deeper into the pain. Somehow I felt safe enough in that room full of unorthodox fellow travellers, pillow pounders and stretched out deep breathers alike, to continue exploring this bizarre dam-breaking flood of feeling, searching for what it meant.

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