Feeds:
Posts
Comments

Posts Tagged ‘psychosis’

It seems a good idea to republish this sequence from almost six years ago to complement the current sequence on transcending the crocodile within and providing more detailed background to its thinking. This is the fourth of six.

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.

Advertisements

Read Full Post »

It seems a good idea to republish this sequence from almost six years ago to complement the current sequence on transcending the crocodile within and providing more detailed background to its thinking. This is the third of six.

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.

Read Full Post »

It seems a good idea to republish this sequence from almost six years ago to complement the current sequence on transcending the crocodile within and providing more detailed background to its thinking. This is the second of six.

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.

Read Full Post »

It seems a good idea to republish this sequence from almost six years ago to complement the current sequence on transcending the crocodile within and providing more detailed background to its thinking. This is the first of six.

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.

Read Full Post »

Heart to heart

Humanity’s crying need . . . . . calls, rather, for a fundamental change of consciousness, for a wholehearted embrace of Bahá’u’lláh’s teaching that the time has come when each human being on earth must learn to accept responsibility for the welfare of the entire human family.

(From a message of the Universal House of Justice to all those gathered on Mount Carmel to mark the completion of the project there on 24th May 2001)

This seems worth republishing at this point, given its relevance to nature as an issue in the current sequence.

I had a recent deep discussion with an old friend (of course, I mean old in the sense of ‘known a long time.’) We are close in many ways. We share a similar sense of humour and many core values. However, we are hugely different in our interests – hers practical, mine theoretical – and temperament – she, extravert: me, introvert.

She was completely unable to understand how I could combine a deep love of nature with a completely passive attitude to gardening.

I gave into the temptation to react, which generally involves treading on dangerous ground and attempted to point out that she similarly fails to understand why I spend so much time and energy reading and writing, even though she values some of the ideas that come out of all that effort.

I referred to her passion as horticulture. It’s then that the concept of ‘hearticulture’ came to me in a flash, as a good way of contrasting our intense enthusiasms.

This idea has had a long gestation period though.

First of all there was the slogan used many years ago in the Bahá’í community ‘Uniting the World: one heart at a time’ with the logo that accompanied it (see picture at the head of this post). I used to joke that this meant we were involved in heart-to-heart resuscitation.

Then there was the idea of ‘psy-culturalist’ which I coined in my discussion of my approach to mind-work, more specifically working with those who were experiencing distressing and abusive voices and the delusions that sometimes accompanied them. I wrote:

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!

Flowers near the Shrine

Flowers near the Shrine of the Báb

Thirdly, there was all my pondering on the issue of the ‘understanding heart.’ In that process I attempted to unpack some of the implications of a key image in the Bahá’í Writings: the heart as a garden. I wrote:

The garden image implies that many of the processes that promote spiritual development have a far slower pace than either light or fire would suggest. The image is also powerfully suggestive of how the processes of spiritual growth are an interaction between what we do and what is accomplished by infinitely greater powers that work invisibly on the garden of the heart over long periods of time. It takes only a few seconds to plant a seed, it takes some degree of patience then to nurture and protect it, but by far the greater determinants of what happens in the end come from the soil, the weather and the sun.

When, for example, I read a passage of Scripture I am sowing seeds. When I perform acts of kindness as a result I water that seed. My heart’s garden then benefits with flowers and fruit because of the rich nutrients of the spiritual soil and the energising power of the divine sun. By analogy, these fruits yield further seeds that I can plant if I have the wisdom and caring to do so, and my heart will benefit even further.

I know that the term ‘hearticulture’ could still be seen as one-sided. I’m the gardener and you’re the garden. But in terms of the Bahá’í perspective that would be missing a crucial point: I need to tend my heart, you need to tend yours and we can both help each other in this process. We both can help each other develop a growth mindset, to borrow Carol Dweck’s terminology.

Once we begin to see what this means, every interaction with another human being, or even with an animal, insect or plant, becomes an opportunity to facilitate our growth and the growth of the being with whom we are interacting. And, what’s just as or even more important, they can facilitate ours.

That heart is an anagram of earth just makes the metaphor even more appealing. I have come to realize that hearticulture is my true passion. Everything I do is influenced, perhaps even entirely reducible, to that purpose. I want to understand myself and others better, that’s true, but not just for its own sake, but for the purpose of growth. And if our hearts grow, so will the earth as a whole benefit. When our hearts shrink, the world dies a little. If all our hearts should shrivel completely, the world as we know it would be utterly destroyed. We would wreak such havoc that Hiroshima and Nagasaki would be utterly dwarfed by the consequences.

Basically, I have to learn how to expand my heartfelt sense of connectedness so that it embraces the whole earth. I believe that’s what we all need to learn. I want to learn it too, and as fast as I can, but I have discovered over the years that the metaphor of gardening applies here also in a way. I cannot grow faster than the laws of nature and the limitations of my own being allow. To paraphrase a Bahá’í pamphlet on making the equality of men and women a reality, hearticulture will also take love, patience and the passage of frustratingly long spans of time.

But that is not a reason not to persist in the attempt.

Read Full Post »

After all this whinging about what Peterson has written it’s about time I tried to explain what it all looks like to me.

What do I think?

I’m not sure yet whether all I have said undermines his basic argument.

I am still struggling to articulate exactly how I would develop a model to bring it closer to what I experience as reality. In a way, I am grateful to him for having pushed me to think more deeply about this issue, even though I am uneasy about a basic aspect of his model.

Anyhow this is how my thinking goes so far. And in case any of you need to know I’m handing over the writing of this to my right-brain, which, when I have the patience to listen to it on such matters, is almost always right.

First things first. I firmly believe that labels, dichotomies and categories, when employed in the social or cultural field are almost always not only false, but potentially fatal. I am not saying this as a reward to my right-brain for having had the patience to let my left-brain bang on about everything it’s read on the subject for the last ten years. My left-brain believes it too, but can’t always act on it in the heat of the moment. It’s so much easier to slap a sticky label over the complexity of social experience: it makes deciding what to do so much quicker and easier.

So, you can see why I’m so uncomfortable when I feel that Peterson, in spite of all the good things he says, seems to be happily dwelling in the land of opposites. If he was distancing himself from the categorising tendency he ascribes to our interpretation of the world, instead of seeming to be contentedly identifying with it, I’d be more inclined to agree with him. Yes, he sees its limitations, but seems to feel that it is an inescapable feature of our perception of the world, one which we have to be aware of, and adapt to, even if we need to soften its hard edges, if we are to function wisely in the world.

He seems to have decided, perhaps not consciously, to live in the left-brain world of, to use McGilchrist’s words I quoted earlier, ‘language, logic and linearity.’ He doesn’t seem to entertain, at least in the first half of the book, the possibility that we could give more space in our perspective to the paradoxical and ambiguous take on the world of the right-hemisphere as McGilchrist describes it. This suggests to me that the part of his analysis, which contrasts chaos and order so definitively, is buying into the left-brain’s perceptual bias in favour of categories.

He does eventually produce an admission of the dangerous weakness of the left-brain approach (page 217):

The capacity of the rational mind to deceive, manipulate, scheme, trick, falsify, minimise, mislead, betray, prevaricate, deny, omit, rationalise, bias, exaggerate and obscure is so endless, so remarkable, centuries of prescientific thought, concentrating on clarifying the nature of moral endeavour, regarded it as positively demonic. This is not because of rationality itself, as a process. That process can produce clarity and progress. It is because rationality is subject to the single worst temptation – to raise what it knows now to the status of an absolute.

However, he reverts, in my view, to overstating the value of words again later (page 281):

The past can be redeemed, when reduced by precise language to its essence. The present can flow by without robbing the future if its realities are spoken out clearly. With careful thought and language, the singular, stellar destiny that justifies existence can be extracted from the multitude of murky and unpleasant futures that are far more likely to manifest themselves of their own accord.

An ‘essence’ or ‘stellar destiny’ of any kind is more elusive than that. Peterson’s lack of coherence in the presentation of his ideas sometimes allows him to believe that he can have his cake and eat it too. Believing language can accurately capture the essence of experience is one of the things that can lead to our succumbing to the temptation of believing that what we know is the absolute truth.

Again I need to acknowledge that an earlier discussion on genuine conversation (pages 253-56) illustrates how we can enhance our understanding by the use of words, rather in the same manner as I would argue can be done by consultation, in the Bahá’í sense of that word.

In addition, I must add that what the right-brain would see as beautiful, if we let it, comes to seem scary rather than promising when the left-brain dominates with too little restraint. As McGilchrist puts it: ‘This is much like the problem of the analytic versus holistic understanding of what a metaphor is: to one hemisphere a perhaps beautiful, but ultimately irrelevant, lie; to the other the only path to truth.’

Only when we refuse to categorise, and can rise to the challenge of absorbing the blending of parts that is reality, can we have any hope of accessing the truth. Not a possibility Peterson seems to recognise. Without linguistic analysis, he claims (page 282): ‘Everything will bleed into everything else. This makes the world too complex to be managed.’

I feel the right-brain can make a better fist of grasping the blended complexity of reality than he allows for. Einstein, after all, describes how he sensed the truths that he was groping for, at first as almost kinaesthetic shapes in his mind or as a kind of music: ‘If… I were not a physicist, I would probably be a musician. I often think in music.’

In consequence, I even think that not just our social world, but developments in modern post-Newtonian science are forcing us to accept this as a fundamental characteristic of reality. Flux, unpredictability and ambiguity confront us the more deeply we seek to penetrate below the surface of our world. Machado captures this brilliantly when he says: ‘cambian la mar y el monte y el ojo que los mira’ (sea and mountain change, as does the eye that sees them’ – quoted in Xon de Ros The Poetry of Antonio Machado, page 5). If we refuse to let the way we see change, we will never see the world as it is, only as we think it should be. Seeing the world more as it is may be scary, but it’s not chaos, and it need not be dangerous.

One thinker quotes convincing evidence to confirm that this fluidity and chaos underpins not just quantum matter but our biology as well. Jonah Lehrer writes in Proust was a Neuroscientist (page 47):

Molecular biology, confronted with the unruliness of life, is also forced to accept chaos. Just as physics discovered the indeterminate quantum world – a discovery that erased classical notions about the fixed reality of time and space – so biology is uncovering the unknowable mess at its core. Life is built on an edifice randomness.

It seems we can’t escape it.

What needs to change is our attitude to what our analytical mind, with its fixation on the maps it already has, finds disturbing. If we can trust our flexible right-brain intuitions more, what is new to us will feel less scary, and we will also tune in earlier to subtle shifts in the familiar, which are telegraphing imminent change, in a way that will help us deal with it more effectively. What I am striving for a lot of the time is to let my right-brain lead when I have to process complexity. After that, I need to integrate what it shows me into my left-brain maps without distorting or discounting anything essential.

Much of our way of seeing, when we use the categorising tendency that Peterson both critiques and yet accepts as somehow inevitable, creates avoidable problems, even becomes toxic, lethal. More of that in a moment.

I am not convinced that replacing categories with dimensions will in the end be a completely satisfactory way of interpreting the world. For a start it’s hard to use the difference between the known and the unknown as ends of a dimension anymore than to see it as indicating two categories.

I have concluded, as I explained earlier, that knowing/unknowing are not identical, as Peterson seems to think, with chaos and order, which I am also saying may not be so easily distinguished either. This is because knowing and not knowing are characteristics of consciousness. The diagram on the left attempts to express that relationship.

The dotted line around the edge of the known indicates my sense that the boundary, if there is one, is at best fluid. How do we deal with the forgotten – what was once known, is now not consciously remembered and yet almost certainly subliminally influences how we see the world and how we react to it?

The dark area around the outer circle is meant to represent where physical consciousness of any kind ends – death if you like. Even this needs a dotted line, I think, given my belief that physical consciousness is not all there is. As I have explored that at length elsewhere, I’ve decided not to go there in this sequence which is already long enough, and I have to keep my left-brain quiet long enough to finish even this much.

If we accept for now that thinking in terms of dimensions is legitimate, there are at least two categories of dimension active here, within the zones, if that is the right word, of knowing and unknowing. One concerns perceived reality, which stretches along a dimension relating to order and disorder between the extremes of order on the one hand, which can become tyranny, and on the other of chaos, which can be creative. The other dimension concerns the preference pattern of the mind that interacts with those perceived possibilities: among many other possibilities, in addition to the holistic and analytical I’ve already touched on, there will be risk-takers and risk avoiders, as Peterson makes clear he is aware towards the end of his book. Please hold in mind my fundamental scepticism about the need to accept that we have to split reality up, either in terms of order/disorder or degrees of risk taking, whether as dimensions or categories. Let’s accept for now that they hold good up to a point.

A risk-taker will delight in what they experience as the excitement of what the risk-avoider will see as the dangers of chaos, and conversely will feel stifled by the perceived order a risk-avoider thrives in.

It is important to note that perception is indeed an unavoidable mediator of all these interactions between reality and consciousness. I don’t think Peterson attaches sufficient importance to the flexibility of perception, and even fails to consider the possibility of its using dimensions rather than discrete categories. Nowhere that I’ve read so far does he deal with the possibility that we could potentially transcend even dimensional thinking when it is necessary to do so, either because it ceases to be useful or becomes potentially dangerous. Left-brain perception is his default mode, just as much as it is that of our culture. The rich potential of right-brain perception, in spite of the value he clearly sets on myths (reduced though to his left-brain interpretations of his selection from them), doesn’t really feature.

Why should we exert ourselves to go against our left-brain tendencies? They’ve lifted us out of the middle ages. Why can’t they lift us further?

That’s a complex issue, parts of which I’ve addressed at length elsewhere on this blog in terms of altruism, compassion and civilisation building.

In the light of the various references I quoted in the earlier two posts in the context of why human beings can perpetrate such evil, I’m going to focus briefly on why labelling, a left-brain temptation with emotional consequences, is so toxic.

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

I have worked for more than thirty years in mental health. I have seen at close quarters the costs and benefits of diagnostic labels. Yes, getting the label of schizophrenia will open the door to the benefits system and give you access at least to some form of drug treatment. But drugs are a double-edged sword as I have discussed before. One edge can, if the patient is lucky, cut through the tormenting ropes woven around the mind by derogatory voices, but the other edge all too often clouds any clarity of thought and stupefies the mind. The diagnosis also carries, as so many labels do, a heavy weight of social stigma, which all too often more than outweighs any benefits. It’s far better, in my view, to look at the person as a whole, and tackle the more complex question of what these so-called psychotic experiences mean, and where their roots are in the felt life of the person.

Other labels are often at least as bad if not worse: abnormal, disabled, backward, black, unclean, alien, outsider, mad, cockroach, sewer rat, immigrant – the list is potentially endless.

If we see ourselves as in the normal, able, white, clean, insider, sane, human, legitimate citizen category, we can smugly comfort ourselves that we deserve all the good things we have whereas these people don’t and perhaps even couldn’t. It’s very cosy. It gives us no motivation to change anything. It even justifies to us in our own minds taking steps to protect what we are and what we have from ‘contamination’ or destruction, even if that means harming other people perceived as coming from any of those completely false categories. It wouldn’t take long, given the right circumstances, to tipple over into enthusiastic eugenics or even forms of genocide. We can see these toxic options unfolding around us even now.

Using only our left-brain analytic mind it is hard for us to experience the world except in such categorising ways. Yet, experiencing the world holistically is exactly what we have to do, especially in terms of our perceptions of our fellow human beings, and also the life-world around us. Labels won’t work if we’re going to survive. We are interconnected. In fact we are in essence one family, even one huge multi-minded entity. Only by operationalising this insight can we transcend this problem. And I think, from the evidence I’ve quoted earlier in this sequence, it’s not just Bahá’ís that see it this way.

View of the Terraces above the Shrine of the Báb on Mount Carmel, Haifa

We believe that this will not be an easy vision to bring into reality. The Universal House of Justice, our central body, wrote in a letter to Bahá’ís of Iran (2 March 2013 – my emphasis):

The rejection of deeply ingrained prejudices and a growing sense of world citizenship are among the signs of [a] heightened awareness. Yet, however promising the rise in collective consciousness may be, it should be seen as only the first step of a process that will take decades—nay, centuries—to unfold. For the principle of the oneness of humankind, as proclaimed by Bahá’u’lláh, asks not merely for cooperation among people and nations. It calls for a complete reconceptualization of the relationships that sustain society.

The bar is raised very high, as the Universal House of Justice explained to all those gathered on Mount Carmel to mark the completion of the Shrine and Terraces project there on 24th May 2001:

Humanity’s crying need will not be met by a struggle among competing ambitions or by protest against one or another of the countless wrongs afflicting a desperate age. It calls, rather, for a fundamental change of consciousness, for a wholehearted embrace of Bahá’u’lláh’s teaching that the time has come when each human being on earth must learn to accept responsibility for the welfare of the entire human family. Commitment to this revolutionizing principle will increasingly empower individual believers and Bahá’í institutions alike in awakening others to the Day of God and to the latent spiritual and moral capacities that can change this world into another world.

Not for nothing do they describe it as the work of centuries, and Paul Lample, clarifying this is not just the work of the Bahá’í community, writes (Revelation and Social Reality – page 48):

Generation after generation of believers will strive to translate the teachings into a new social reality… It is not a project in which Baha’is engage apart from the rest of humanity.

The diagram at the bottom of this post seeks to represent the magnitude of the task we face, moving as we must from the self-centred and short-term processing our bodies are programmed for, to the transcendent vision of our ultimate goal, far in the future though it may be, of a united humanity working together in harmony.

We acknowledge that religion has been and sometimes still is an obstacle in the path. ‘Abdu’l-Bahá, anticipating by at least six decades Robert Wright’s caveat quoted in the first post, made it quite clear that ‘religion must be conducive to love and unity among mankind; for if it be the cause of enmity and strife, the absence of religion is preferable.’ (Promulgation of Universal Peacepage 128).

Treading this long and difficult road will involve resolving conflicts within us as well as between us. Most of us are still divided selves, as Bahá’u’lláh indicated (Tablets of Bahá’u’lláh – page 163):

No two men can be found who may be said to be outwardly and inwardly united. The evidences of discord and malice are apparent everywhere, though all were made for harmony and union. The Great Being saith: O well-beloved ones! The tabernacle of unity hath been raised; regard ye not one another as strangers. Ye are the fruits of one tree, and the leaves of one branch.

And the way forward, we believe, lies in recognising a higher and inspiring source of value that will help us lift our game in a way that can be sustained over centuries. For us that is God (From Selected Writings of ‘Abdu’l-Bahá – page 76):

Let all be set free from the multiple identities that were born of passion and desire, and in the oneness of their love for God find a new way of life.

For others, such as Rifkin, it is awareness of the supreme importance of preserving our planetary homeland.

Whatever the source of our inspiration, it has to bring the warring selves within us into harmony before we can create a truly peaceful world. Whatever the value is that we find, it has to be a very powerfully motivating one, but essentially benign nonetheless. It must not replicate the self-righteous crusading we can still see around us, which believes that if you are not for us we can kill you.

A commonly used phrase captures an important aspect of this vision: unity in diversity. It allows for perceived differences within an essential unity, but does not fossilise them or make them an excuse for discrimination.

I am fairly sure that Peterson would not disagree, at least, with this sense of our common humanity, and the imperative need confronting us to recognise and act upon it. Because he comes from a Christian perspective, I’m sure he would recognise the importance of God as well.

I hope I have not been attacking a straw man in all this. Even if I have, I hope I managed to avoid placing him in a separate category of human being from my more enlightened self. In many ways he seems to have thought more deeply than I have about whole aspects of this problem, and I owe him a debt of gratitude for forcing me to think more deeply about my own model of the world.

Oh, and in case you hadn’t realised, his book, 12 Rules for Life, though its over-assertive and somewhat divisive in tone, confusingly organised, very left-brain in most of its language and at times testingly macho in style, has flashes of insight that might make it worth reading despite all I’ve said, even though I abandoned it before finishing the last chapter. Before going out and buying a copy it might be worth reading someone who has had the patience to wade through far more of Peterson’s prose than I did and probed more deeply into the problems and challenges his perspective creates. Nathan J. Robinson concludes at the end of a long critique:

. . . since Jordan Peterson does indeed have a good claim to being the most influential intellectual in the Western world, we need to think seriously about what has gone wrong. What have we done to end up with this man? His success is our failure, and while it’s easy to scoff at him, it’s more important to inquire into how we got to this point. He is a symptom. He shows a culture bereft of ideas, a politics without inspiration or principle. Jordan Peterson may not be the intellectual we want. But he is probably the intellectual we deserve.

‘You finished now?’ I hear my right-brain snap. ‘Can we get back to the poetry again please?’

‘I guess so,’ my left-brain sighs wearily. ‘This last lot was all your idea though!’ it growls, trying to fight back, but in the end can’t be bothered. ‘I’m too tired to argue after scribbling your stuff down for so long. I’m not doing this again though. Take my word for it.’

My right-brain smiles quietly, thinks ‘Fat chance!’ but says nothing.

Read Full Post »

Video May 1993

In the main video interview transcript, an extract from which features at the beginning of the first post in this sequence, there is a very important passage focusing on one aspect of the impact of consultation on a key aspect of Ian’s difficulty with the voices. It concerns his memories of what he had done that made him feel so guilty.

I.: Well, 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.

P.: It was memory not imagination?

I.: That’s right. 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.

In a later video interview in September the following year, Ian explained that he felt as though talking helped get the feelings he had repressed ‘out into the open.’ He was in effect able to consult about them. Reflection had paved the way towards his being able to think about the feelings and begin to feel them. Talking about them brought them more fully into the open and enabled him to make better sense of them. The voices on the other hand fed on his habit of suppressing his feelings.

The September interview also explained how we had refined our understanding of his pattern of suppression. If he began to feel low, slightly depressed, he’d switch off his feelings which then brought the voices back.

But I must not make this process sound too simple. Yes, it is true that learning to reflect can pave the way both to a better understanding of our own mind and heart as well as potentially enabling us to share our discoveries with someone else and compare notes in a consultative fashion. But the transition is not necessarily automatic.

Video September 1994

The Importance of Trust

Take this extract from the May 1993 video. Jenny was his care worker.

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

I.: Yeh. Jenny 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 . . .

P.: Right.

I.: . . . and to talk to you.

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

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.

P.: And that was by being there in the sessions and by talking to you between whiles . . .

I.: With Jenny.

P.: . . . betweentimes.

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

This extract testifies to how hard Ian found it to trust me. If it had not been for the fact that he had been living for some time, since his discharge from hospital, in a social services home specialising in the care of people with serious mental health problems, and if he had not had the time to build up a trust relationship with his care worker, Jenny, over that period, on an almost daily basis, who knows how long it would have taken him to trust me enough to work with me, or whether he would ever have been able to trust me enough at all, given we met only once a week. A sense of trust is not easy for someone who has been abused and a sense of safety is not easy for someone who has been traumatised. Ian had experienced both abuse and trauma.

After the May interview, the field of consultation had expanded beyond his Thursday meetings with me and his regular conversations with Jenny to include a Voicework Group, which had been set up at his instigation. He felt strongly that these opportunities for consultation were as important for him as his medication. Without Jenny, though, building sufficient trust to do effective work it would have taken far longer to reach this point, though he felt it would have happened in the end even so. I’m not so sure on that as he was.

Detachment

There is one quality that has been implicit in much that I’ve said so far. It is both the fruit of even the early stages of reflection and the soil from which a further ability to reflect more deeply springs. It is also an essential prerequisite of consultation. Those who are too attached to their own perspective will always find it hard to consult. I am speaking of the quality of detachment. Its power goes even further than this. Bahá’u’lláh, the Founder of the Bahá’í Faith, wrote (Arabic Hidden Words No 68 – my emphases):

Know ye not why We created you all from the same dust? That no one should exalt himself over the other. Ponder at all times in your hearts how ye were created. Since We have created you all from one same substance it is incumbent on you to be even as one soul, to walk with the same feet, eat with the same mouth and dwell in the same land, that from your inmost being, by your deeds and actions, the signs of oneness and the essence of detachment may be made manifest.’

If we are divided against ourselves we are also going to be in conflict with others. If we can, by a process of reflection, become both more detached and more integrated, we can transcend both our inner conflicts and our conflicts with others.

‘Abdu’l-Bahá describes this possibility in the following words (Selections from the Writings of ‘Abdu’l-Bahá 1978 – page 76):

. . . .all souls [must] become as one soul, and all hearts as one heart. Let all be set free from the multiple identities that were born of passion and desire, and in the oneness of their love for God find a new way of life.

Even if we do not believe in a God but at least have faith in the essential oneness of all humanity, this will help remedy our current conflicted state, wherein we are at war with ourselves as well as with others. This is Bahá’u’lláh’s description of the challenge we face compared with the reality most of us are blind to (Gleanings from the Writings of Bahá’u’lláh = CXII):

No two men can be found who may be said to be outwardly and inwardly united. The evidences of discord and malice are apparent everywhere, though all were made for harmony and union. The Great Being saith: O well-beloved ones! The tabernacle of unity hath been raised; regard ye not one another as strangers. Ye are the fruits of one tree, and the leaves of one branch.

This is another two way street. As individuals in harmony with ourselves we become more able to love and care for others, and as communities in harmony with one another we become more able to support and care for our fellow human beings.

Such levels of detachment, reflection and consultation are not easy to reach and are even harder to sustain, but the effort of attempting to do so is amply rewarded. Usually the effort is more than compensated for by the benefits gained.

Crucial Caveats

However, it would be too simplistic to suggest that people struggling with challenges as monumental as those Ian had to battle with can always achieve these benefits in a sustainable way. I am not arguing that reflection and consultation are always possible for people in such extreme distress.

Many of the contexts in which a person struggling with psychosis is placed seem neither safe not trustworthy. Sometimes the contents of a client’s consciousness prove so terrifying or distressing they cannot feel safe dealing with them nor trust their ability to manage them.

There came a point where the lady with the history of abuse chose mind-numbing medication rather than deal with the worst of her experiences.

After almost a year of our work together things seemed to be going well. Then came the unexpected. She found herself in a building that closely resembled the building strongly connected with the worst episode of abuse she had experienced at the hands of her father. Just being there was more than she could cope with. She became retraumatised in a way we none of us could have anticipated or prevented. The next time we met she could not stop sobbing.

We discussed what she might do. There were two main options.

She could, if she wished, continue on her current low levels of medication and move into a social services hostel where she would be well supported while we continued our work together, or she could be admitted onto the ward and given higher levels of medication in order to tranquillise her out of all awareness of her pain.

She chose the second option and I could not blame her in any way for doing so. It would be a betrayal of the word’s meaning to suppose she had any real choice at that point but to remain psychotic while the medication kicked in rather than deal with the toxic emotions in which she felt herself to be drowning.

Ian did the same when it came to his memories of slaughter from his army days. It was in June that he experienced a devastating return of the voices that led to his hospitalisation. Further exploration discovered a link between a traumatic army experience, which had occurred at that time of year, and an overwhelming reactivation of the voice-inducing guilt – far stronger than anything he had experienced in connection with his breach with his alcoholic partner. Each year after that he preferred to allow himself to become psychotic rather than attempt to process the intolerable guilt. He chose increased medication and admission to hospital till the anniversary effect was over, when he would be discharged to resume a relatively normal life until the next anniversary.

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

A Genuine Help

What I am contending from my decades working with ‘psychosis’ in the NHS is that my CBT training was made more effective by my spiritual practice and the facilitation of those twin skills: reflection and consultation. The meanings achieved as a result facilitated flexibility and personal integration, as against the distressing rigidity and disturbing inner and outer conflict of the psychotic experience.

Hopefully one day these conclusions from personal practice will be validated in systematic studies.

An additional point to mention is that this is not just a model for psychosis. Take Laura for example, with her diagnosis of endogenous depression, ie one that her doctor felt 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.

Effective group supervision provides a context where fruitful consultation can take place and better decisions about the most fruitful line of action can be made. 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. Laura and I consulted carefully and jointly agreed 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.” Thankfully consultation had helped me manage to avoid doing something similar by discharging her before we had resolved the causes of her depression.

This paved the way for deeper and more fruitful explorations of the reality of her childhood, continuing to use the same reflective and consultative process I have been describing in this sequence of posts.

Ian’s Last Word on the Matter

P.: Is there anything else that you feel that you want to say that I haven’t brought out by the questions I’ve asked you?

I.: No, except that the pain, you know, 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 . . .

I.: Yeh.

P.: . . . 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.: Yeh. 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.

P.: Yeh. 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.

I need to add here, though, to put all this fully into context, that I visited him in the hospice when he was dying of emphysema and other complications consequent upon what he knew was his self-damaging habit of heavy smoking. He was well aware of the implications of the injury to his lungs caused by the bomb blast that led to his being discharged from the army on health grounds.

I sat by his bed watching him breath in oxygen from the cylinder at his bedside. When he had taken in sufficient oxygen, I felt moved to ask him the question I had asked once before during our therapeutic relationship.

‘In the light of all you know now, were the gains you made worth the pain you had to go through?’

‘No,’ was the answer he gave. ‘They weren’t in the end.’

As he did not spell out exactly why not, I did not feel it right to press him for his reasons. Even so, his answer taught me a lot, not least how difficult it is to be sure you have obtained fully informed consent before embarking on any intervention.

I’ll leave it there until the New Year, and pause my posts until then as I did last year. I wish all my readers well over this festive season.

Read Full Post »

Older Posts »