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Posts Tagged ‘schizophrenia’

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Given that there is clear evidence that a head injury or smoking skunk can damage the brain’s ability to filter out unwanted information, it is relatively easy to demonstrate that, at least on some occasions this decrement can contribute to the experience of psychosis.

For example, Shields claims (Psychosis as Coping), on the basis of evidence he adduces, that one difference commonly observed in psychotic individuals is a functional reduction in activity in the lateral pre-frontal cortex. As he puts it ‘impairing the lPFC entails a diminished ability to avoid dealing with unwanted thoughts and memories.’

That is not the same, of course, as demonstrating that it is causative. What I was hoping to find at some point are studies that demonstrate whether or not psychosis occurs in the absence of comparable damage to the brain’s ability to filter, and whether or not such damage is a significant contributor if present. I am frustrated at present by my inability to gain access to the necessary material.

It took five weeks before I received my copy of Exploring Frontiers of the Mind-Brain Relationship – Mindfulness in Behavioral Health edited by Alexander Moreira-Almeida and Franklin Santana Santos. It is mostly somewhat disappointing in terms of this issue. I’ve shared a couple of faintly useful ideas from it so far (see previous post for examples). However, there is an extremely useful section of a chapter by Mario Beauregard which I’ll be quoting from in the next post, as well as additional insights from Peter Fenwick and Penny Sartori.

Primary sources are almost impossible to access as I no longer subscribe to academic sources. I hope to resolve this problem as soon as I have time. In the meantime and in full awareness that compelling evidence may be lacking, what have I got to go on?

The main sources of information are Psychosis and Spirituality and Irreducible Mind, the latter not focusing on psychosis specifically.

psychosis-spiritualityPsychosis and Spirituality continued

In the first source Isabel Clarke (Chapters 9 and 20) and Gordon Claridge (Chapter 7) are the clearest proponents of the psychosis/transliminality link.

She sees three aspects to transliminality (page 103) ‘which embraces both the spiritual and psychotic’ and ‘extends to the interpersonal, so that group phenomena, and the collective unconscious are included. All live beyond the limen, the threshold or boundary of the individual self.’

Our ordinary method of construing reality, which she refers to as ‘the construct system’ is transcended (pages 105-06) so ‘[i]t means moving into the unknown. Challengingly, according to this model, as my understanding of the self is essentially a construction, I lose touch with this when I pass beyond the horizon, along with other constructs, and thereby lose the means of making predictions.’

She quotes Hemsley as noting that psychotic experience can be explained by: ‘the failure to relate current sensory input to stored regularities’ and adds ‘The neurophysiological substrate of high schizotypy, implying easier accessibility of the transliminal, is described in the schizotypy literature thus: “The positive schizotypal nervous system has been described as an ‘open nervous system […] where excitatory mechanisms are high and inhibitory processes low” (McCreery and Claridge, 1996).’

She unpacks further the implications for the self (page 110):

I have already mentioned that the construct of self is among the concepts to be lost in the transition, which can lead to an exhilarating feeling of unity and interconnectedness, as well as the bewilderment of loss of self. . . . . I would argue that the characteristic themes of psychotic material, whether in the form of voices or delusions, concern issues of self worth, acceptability, sexuality and personal significance, which are all relevant to understanding the self.

It is obvious how the themes she highlights here relate to the impact of trauma, especially in the form of sexual abuse.

In her later chapter she explores other aspects of this dynamic, which can be both positive and negative (page 249):

[A] reconceptualisation [of psychosis] recognises opening to the transliminal as a part of the journey of life which can be problematic but has great potential. Such openings can compromise normal functioning; they can bring the individual face-to-face with unresolved issues and be acutely frightening and distressing; however, they can also present the opportunity to break out of a mould that had become constricting and embrace a fuller way of being, through opening the self to the whole.

This, she feels, would be an important counterbalance to our society’s left-brain overemphasis, to use McGilchrist’s language here. She writes (page 251):

I am suggesting that we need that connectedness with the whole, but not to expect to grasp it with our intellect and ability to manipulate the environment, as it is literally beyond this grasp. This un-graspability has led to its marginalisation in a technical era. Perhaps we need that connectedness that takes us beyond the individual, towards other humans, other species, and yet wider, within the whole. We need the mystery, the unknowable, to feel at home in the world, with our fellow human and non-human creatures, and with our natural environment; to connect with whatever source of sacredness envelops all of this. . . . . Perhaps our subjective sense of separateness is more illusory than we would like to think.

While I resonate emotionally to this rhetoric, it is evidence I’m looking for here, and I am finding none.

Before we move on to Chadwick’s perspective it is worth quoting Natalie Tobert (page 46) She quotes the psychiatrist Barett as suggesting that ‘patients with schizophrenia are in a state of ‘suspended liminality.” Barett suggests that psychiatric institutions may ‘freeze liminality into a permanent state.’ This maps onto my discussion in an earlier sequence of how important it is to have an accepting environment if a positive journey towards integration and healing is to be facilitated.

Chadwick shares Clarke’s sense of there being a mixture of positive and negative (page 67):

This openness to without and within can have advantages for inside, sensitivity and creativity and also for access to spiritual experiences but on an everyday level such ‘skinlessness’ undoubtedly is a burden – and a fear-inducing burden at that.

We have already seen in an earlier post that he believes, as Thalbourne does, that the subliminal content that crosses through to consciousness is both spiritual and personal in nature (page 82). The presence of spiritual content is not inevitable though:

. . . . . . . other questions lurk here. Not all, perhaps relatively few, people who suffer clinical psychosis also report experiences of a positive, spiritual kind.

I sense that here we again are meeting two sources of experience, thankfully not conflated: the ‘without,’ by which I presume he means the extrasensory transcendent dimension, and the ‘within,’ our brain generated subliminal signals. He seems to relate creativity to inner stimuli.

He feels that the quality of early experience might be a factor here (page 84):

Where nourishing as opposed to abusive early experience obtained, the same biological susceptibility to transliminality, the break with ordinary reality could be much less threatening, even psychologically rewarding.

What I am uneasy about here is the use of transliminality to refer to both inner and outer sources of experience. I am going to stick to my guns here and state that filtering operates within the brain and a spectrum/bandwidth model applies to whatever comes from outside the brain.

The closest I have been able to get to the original work by Thalbourne and Delin on this issue is the reference they themselves make in 1999 to their 1994 paper (Transliminality: its Relation to Dream Life, Religiosity and Mystical Experience in The International Journal of the Psychology of Religion 9:1). They write (page 45):

. . . evidence was presented that there exists a common thread underlying creative personality, mystical experience, psychopathology (both schizotypal and manic-depressive), and belief in the paranormal. This common factor was named transliminality and was tentatively defined as ‘a largely involuntary susceptibility to, and awareness of, large volumes of inwardly generated psychological phenomena of an ideational and affective kind’ (page 25).

I’m sorry this is a bit of a hall of mirrors – a reference within a reference – but it’s the best I can do right now. It is extremely useful though in confirming that they are speaking exclusively of ‘inwardly generated’ material, suggesting that for them this would be a filtering not a spectrum/bandwidth issue. For me, it still begs the question then of what exactly is the status of mystical experience. If it is inwardly generated, is it therefore imaginary rather than objectively valid and externally existent?

Their later comments in this paper suggest that they are very much inclined to believe there is no external reality, even though their conclusions are none the less intriguing and make no distinction, except for intensity, between religious and psychotic upsurges from the subliminal[1] (pages 58-59):

. . . atheists are lowest in degree of transliminality, followed by agnostics. Christian theists have a level that is close to that for the sample as a whole, but non-Christian theists has the highest levels of transliminality of all. We suggest that belief in God may derive partly from external sources [i.e. socio-cultural] and partly from within the person. Atheists and agnostics tend to reject external authority and find little evidence within themselves to persuade them of the existence of a deity. Christian theists appear not to have much inner experience suggestive of a God but may rely more on tradition and authority. Non-Christian theists, however, may be basing their belief predominantly on inner experience, their high degree of transliminality providing them with the food for their conclusion that a deity exists.

. . . . Clearly, the outpourings produced by high transliminality are often enough taken to be not almost but actually miraculous, or to derive from the Godhead itself. Perhaps in some cases they do!

Returning to Chadwick, even with negative early experiences he does not rule out the possibility of input leaking from the transpersonal (page 87):

If we were to try to confront how the same formulation might also account for spiritual or mystical experience, then we might logically be forced to consider that the psychotic person’s skinlessess (or transliminality) could even extend to what in conventional terms would be called the supernatural.

This is where I need to find a reason why what has created a greater leakage across the filtering processes of the brain would also cause a retuning to a wider bandwidth, giving access to externally valid transpersonal experiences. It seems improbable that damage enhances receptivity in this way, although, if the brain tends to block rather than permit information flow, maybe a damaged brain will paradoxically become a better transceiver. If we are simply talking about the process by which the brain’s own subliminal contents are filtered, there is of course, no such problem for a materialist: it’s all imagination anyway and if you damage the filter you’ll obviously get more stuff coming through. I don’t think the writers of this book though would be happy with that position: they mean something more than imagination when they use the word spiritual.

Returning to Chadwick’s point once more, it could of course in that context be dark rather than uplifting material that leaks in through the cracks.

A problem for me at present is that none of this is backed up by clear and compelling proof that what they are defining as spiritual is true and transcendent. At best, it is mostly hypothetical, ambiguous, anecdotal or, frankly, even metaphorical.

Even so, Chadwick’s own personal experience warrants inclusion here. I personally am convinced of its authenticity, but am aware that a sceptic would find reasons to dismiss it as at best anecdotal.

This is a slightly abbreviated account of his experiences with sounds that could be heard accompanying his thoughts (page 71):

There was only one brief crisis in my recovery period that is worthy of note, particularly in the context of this volume. It is important for the reader to realise that the rappings I referred to that began in Charing Cross were actually audible to other people. They were not hallucinations. I have them at times to this day and even our cats can hear them and orient their heads quickly to the source. They particularly come from a wood and metal.

In September 1981, two years after the [psychotic] episode, I was living in a basement flat in Perham Road… with my future wife Jill… The rapping began again over a period of a couple of weeks…. Jill could hear them and would flee the kitchen when they built up. They were now frequently tapping ‘Yes’ to the thought that I should rush out and throw myself under a lorry.

At times like this, one sees and fully realises how useless the attitude of sceptics in the field of the paranormal can be. In that situation, a sceptic would not have had the faintest idea what to do. It seemed to me that as the rappings began to really gallop, science and psychology were of no use to me now. I asked Jill if you could find my Bible and when she brought it to me I sat at the kitchen table… and began to read. It seemed to me that I really needed to call upon a Higher Power to defeat what was definitely looking like a manifestation of The Demonic. . . . . .

As I started to read the New Testament the timing of the rappings started, very slightly at first, to go awry… By the second page, their timing was definitely ‘off,’ by the third they were ‘missing thoughts’ and not tapping at all to some things that crossed my mind. By the fourth and fifth pages, their timing was totally haywire, it was like the sound of machine that was completely malfunctioning… Then very suddenly they stopped completely. The kitchen was quiet.

My sense is that much more systematic research needs to be done in this area. There is little institutional support for this even yet, I suspect. This may suggest that not only are spiritual experiences in the context of psychosis likely to be discounted, but also they will be rare in a culture that devalues any such experiences in general. The priority of the brain as a product of evolution is physical survival, as many writers point out. Spiritual dimensions are tuned out as irrelevant. Opening up such channels against the grain of a culture such as ours is almost impossible for most people.

filter-spectrum-v2

Given that this is the level we seem to be working at, what hypothesis seems best?

At the end of my sequence on Shelley I made reference to three possible routes that the transcendent might take into consciousness:

  1. a seed in the soil of an artist’s subconscious (subliminal in the diagram),
  2. a reflection in the mirror of his consciousness (when reflection has separated it from the clutter of its contents), or
  3. a light from the lamp of his mind (assuming we accept that mind is independent of the brain, which is simply a transceiver that can pick up even the subtlest waves if it is tuned correctly, which it usually isn’t).

Even though the focus there was on creativity, this can be blended up to a point with the problem raised in my earlier diagram as my notes in brackets indicate.

It is time now to revisit Irreducible Mind in the next post.

Footnote:

[1] They feel that the frequency of religious content in psychosis is to do with the prevalence of religious ideas in American society.

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For many years it was believed that psychotic symptoms were discontinuous from `normal’ psychological functioning. This position is becoming increasingly untenable in the light of research evidence that positive psychotic symptoms can be understood with reference to normal psychological processes. This paper will outline the evidence from current psychological conceptualizations that psychotic symptoms are closely related to a person’s psychological functioning and that they are therefore amenable to psychological intervention (Yusupoff et al., 1996). Current psychological conceptualizations of hallucinations and delusions hold that the content of these symptoms contain material which is personally relevant to the individual. Indeed, this personal relevance is critical to the understanding of, and cognitive interventions with psychotic symptoms.

(From An Interacting Cognitive Subsystems Model of Relapse and the Course of Psychosis by Andrew Gumley, Craig A. White and Kevin Power – page 262)

In the previous post I began to outline a picture of the kind of traumatic life experiences which can give rise to psychosis.

There’s more to add to the list of factors.

Additional Factors

Many who experience psychosis also, for example, according to Murphy at al (Modelling the co-occurrence of psychosis-like experiences and childhood sexual abuse), have experienced heightened levels of social deprivation, discrimination and isolation even beyond the age of 16. Additionally, members of the group with no history of Childhood Sexual Abuse were more likely to have experienced Childhood Physical Abuse, PTSD, social isolation and neurotic disorder. Interestingly, members of this class were also more likely to be male.

This profile seemed to indicate that, in the absence of Childhood Sexual Abuse, individuals who experienced psychosis were likely to endure a wide range of other traumatic experiences. It seemed that the composition of this class, particularly in terms of sex, suggested that, while psychosis may be a phenomenon highly associated with traumatic experience and adversity, the precise nature of this trauma and adversity may be dependent upon the sex of the individual. The Child Sexual Abuse-only class was more likely to be female and was characterised by elevated probabilities of childhood physical abuse and adult sexual trauma, neurotic disorder and cannabis consumption.

It may be worth spending sometime teasing out the exact level of risk of psychosis represented by trauma.

Longden and Read (The Role of Social Adversity in the Etiology of Psychosis – page 7) focus on two substantial meta-analyses (ie collated data from a number of well validated studies). The first screened 736 articles, retaining 41 of the best designed. When results were pooled, individuals with a history of childhood trauma (child sexual abuse, physical abuse, emotional abuse, neglect, bullying, parental death) were shown to be 2.8 times more likely to develop psychotic symptoms than those who had not. The second meta-analysis retained 25 studies from a search result of 1104, and found that rates of childhood adversity (including child sexual abuse, physical abuse, emotional abuse, neglect, witnessing domestic violence, and loss events) were 3.6 times greater in people diagnosed with schizophrenia relative to “healthy controls.”

It is important that we make sure we are not being misled into attributing cause when we have only correlation. By this I mean that just because, when I am holding my key to either open or lock my front door, the light goes on, I should not jump to the conclusion that my door key is switching the light on. I need to understand that my mere presence with no key is enough to trigger the motion sensor. The key is a confounding variable that needs to be eliminated, for example by leaving the house without locking the door one night. I’d be wise not to go further than strictly necessary to prove the point though.

Longden and Read (pages 7-8) deal extensively with this problem:

Large-scale population studies have shown that associations between adversity and psychotic experience remain significant when controlling for possible confounders, including: family history of psychosis and other mental health problems (which negates the notion that psychosis only occurs in those genetically predisposed), age, sex, ethnicity, marital status, exposure to discrimination, other psychiatric diagnoses, education level, neuroticism, and substance use. Furthermore, the association has repeatedly demonstrated a dose-response relationship; that is, the likelihood of psychosis increases relative to the extent of adversity exposure.

 

Lucretia by Rembrandt

Lucretia by Rembrandt (For source of image, see link)

Even this does not end the list of factors (ibid.):

Despite much emphasis on childhood abuse, this is by no means the only environmental adversity associated with psychosis. Other cited factors (Larkin & Morrison, 2006; Read, 2013a; Scott, Chant, Andrews, Martin, & McGrath, 2007) include discrimination, witnessing domestic violence, prenatal stress, war trauma, torture, adulthood rape and physical assault, excessive marijuana use in adolescence (in some instances this may represent attempts to self-medicate posttraumatic symptoms . . . ), and disturbed attachment relationships with one’s caregivers, including abandonment, being the result of an unwanted pregnancy, being raised in institutional care, dysfunctional parenting (often intergenerational), and parental death or separation. Another factor receiving significant attention is poverty and inequality . . .

Longden and Read feel (page 9): ‘that erroneous reports of sexual victimization are no different between patients diagnosed with schizophrenia and the general population,’ so we have as much reason to believe a patient diagnosed with schizophrenia as anyone else, and we have already established in the first post of this sequence that this level of credibility is basically compelling.

The Brain

Now is the time to return to a closer examination of the role of the brain in all this.

Longden and Read describe what they intimidatingly label (page 12) ‘the traumagenic neurodevelopmental (TN) model of psychosis’ by which they mean how, during our formative years, trauma can affect the brain in ways that make psychosis more likely. They argue that there are similarities between abnormalities in the brains of abused children and those of adult patients with psychosis.

A key point is this: ‘A major premise of the TN model is that the heightened stress sensitivity consistently found in patients with psychosis is not necessarily inherited, but caused by formative exposure to abuse and neglect.’ This is key because it moves the debate away from genes to life experience.

They give various examples of the research including (pages 20-21):

A . . . study with 45 individuals considered at clinical high risk for psychosis found significant positive associations between trauma exposure (psychological and/or physical bullying, emotional neglect, emotional abuse, physical abuse, Childhood Sexual Abuse) and feelings of being watched or followed, as well as false beliefs about power or status. . .

An equally important finding is the relationship between psychotic content and precipitating trauma (ibid.):

Comparable work with 41 patients experiencing a first episode of psychosis found that attributes of stressful events in the year preceding psychosis onset were significantly associated with core themes of both delusions and hallucinations.

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

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

Implications for Therapy

How might this realisation help?

Murphy et al (Modelling the co-occurrence of psychosis-like experiences and childhood sexual abuse) feel that:

. . . . identifying and evaluating trauma specificity in the onset and maintenance of psychological distress may aid clinicians and service users alike, in

(1) clarifying sources of distress and

(2) understanding symptom content and expression, while enhancing treatment design and efficacy also.

They emphasise that point that ‘symptoms of psychosis are often characterised by content that can be meaningfully attributed to past personally significant experiences.’

Longden and Read (page 22) feel that their evidence points in this same direction and  ‘reinforces a standpoint formed in the earliest days of psychiatry and that has gathered a striking momentum in the past two decades; that it is no longer a scientifically or morally tenable position to view psychosis as a purely biogenetic disease.’

This has clear implications for the approach we should adopt. They remind us that the British Psychological Society ([BPS] Division of Clinical Psychology) recently published a report emphasizing the utility of psychotherapeutic approaches to psychosis. The executive summary opens with the observation that “Hearing voices or feeling paranoid are common experiences which can often be a reaction to trauma, abuse or deprivation. Calling them symptoms of . . . psychosis or schizophrenia is only one way of thinking about them, with advantages and disadvantages” (BPS, 2014, p. 6)

Unfortunately the evidence I find in what I read now suggests that the situation that confronted someone I worked with in the 1990s may not have changed much. She wrote me as follows, after she moved to another city:

Today I saw my new CPN. He’s called D, and I’m feeling very upset as a result of our meeting. I’d be able to give you a ten foot long list of insensitive things he said, if I wanted to! His main objection was that I’m not out there working, earning money and contributing to the country. He said he’s going to phone the DRO tomorrow and get her to come out and see me to assess me for a job. . . . D was also very heavy-handed in his approach to “disability”. He said there’s people much worse off than I am and they’re using their abilities to the benefit of other people. I think one of the worst things that anyone can say to someone who’s got my kind of disability is that there are people worse off than they are. It has to come from the individuals themselves to say that sort of thing. I’ve applied to do a BA at the Open University — D wasn’t even satisfied with that, because it won’t lead to a “practical skill.” He questioned the intensity of my voices, the fact that I’m not sleeping . . . and he also physically tried to stop me rocking. I’m feeling really upset by it all.

[Later] My new CPN is . . . . refreshingly gentle and unassertive, but he’s only here for another couple of weeks. It’s very unsettling all this changing around, because I can’t work consistently with them, and by the time I feel ready to talk in confidence it’s time for them to move on to another post. I think it will be like this for the next six months until the permanent CPN comes back from maternity leave.

ThriveLayard and others certainly do not think things have changed for the better. It is an indictment of our society’s approach to mental health that effective treatment for many forms of mental problem is not sufficiently available to meet the need. Writing in 2014, Layard and Clark’s in their book – Thrive – draw this forcefully to our attention. The data the authors use to prove their case include the fact that (page 381):

. . . while over 90% of diabetes sufferers receive treatment for their condition, under a third of adults with diagnosable mental illness do so. This is largely because good evidence-based psychological therapy is not readily available

If anything things have got worse in the intervening period. The value of talking therapy for psychosis is clearly not sufficiently well recognised to guarantee that it will be funded and, if funded, that it will be safeguarded and prioritised. In the few areas seeking to provide some form of psychological support, Health Care Commissioners, even while knowing that CBT for psychosis should be available in 12 session packages, in itself a minimum requirement, frequently fund only six sessions or less. If this policy were followed for the prescription of antibiotics or the provision of cancer treatment there would be a national outcry.

Part of the reason for this blindness is the still prevailing implicit conviction that psychosis is basically a biological problem and is best treated with drugs not psychotherapy. Hopefully this sequence of posts will go some way to adding momentum to the increasingly powerful wave of dissent from this conveniently short-term cost-saving point of view.

In fact, it doesn’t save any costs at all in the long-term. With even the minimum basic intervention of CBT mounted early enough, sufficient benefits would accrue for enough patients to save the costs of relapse and readmission further down the road.

Beyond this though, in my view, we need more widely effective forms of ‘talking cures’ before we will see really major benefits long-term. But better half a loaf than none at this point.

So, having dealt at some length with the relatively straightforward issue of trauma and psychosis I plan to embark in the next sequence of posts on the trickier issue of thresholds of consciousness and psychosis. Wish me luck!

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

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

As human beings we are constantly making sense of our world. Sometimes the conclusions we come to are frightening, and sometimes we’re mistaken. Sometimes we see or hear things that aren’t there. Sometimes our judgements are affected by our past experiences – if we’ve survived bullying, abuse or racism, for example, it might be difficult to trust people and we might understandably become a bit paranoid. Sometimes – for example when we’ve drunk alcohol or taken drugs, or sometimes even when we haven’t – the way our brain is functioning can affect our judgement. But in each case, we are actively making sense of our world. Recent research into ‘psychotic’ experiences has found that often this sense-making or interpretation of events (‘cognitive factors’ in technical language) can play an important role.

(From Understanding Psychosis and Schizophrenia published by the British Psychological Society – page 47)

The Purpose of Psychosis

Longden and Read’s thorough exploration of the relationship between psychosis and trauma, which was the focus of my last post, paves the way for a crucial insight, which currently carries too little weight with professionals dizzy from spending too long going round in psychiatric circles (page 10): ‘the conceptualisation of the psychological aftermath of adversity (including complex experiences like hearing voices, or extremely paranoid beliefs) as a meaningful way of responding to, or coping with, distressing and overwhelming events.’

This idea we have already met in my earlier post on out-of-the-ordinary experiences (OOEs). Charles Herriot-Maitland et al contend that there seems to be some direct relevance of OOEs to the context of participants’ existential questioning. From this, it could be interpreted that the OOE actually emerged as a direct expression of, or indeed solution to, some kind of psychological crisis.’

To build on this understanding and to place it in a more ‘normal’ context to reinforce that psychotic experience may simply be at one end of a normal continuum, I want to pick up on my work with Laura again, the lady who thought that her mother had thrown her away the day she was born. Admittedly her diagnosis was endogenous depression (ie deep sadness with no obvious cause), but that may not rule out any relevance to our current concerns as we will see.

She initially had no sense that life had given her any reason to be depressed. She was an articulate lady who gave clear descriptions of her history, which included a basically contented childhood, and of her current feelings, which were often suicidal, though she did not understand why.

However, some part of her mind knew perfectly well where the problem really lay and recognized its exact nature. This awareness broke through in the metaphorical form of her dreams, a psychotic experience we all share at night whether we remember them or not.

One day, she spoke of a recurrent dream she was having. With variations, it was of being in a room with Hitler’s SS. They wanted information from her and were preparing to torture her.  Before the torture could begin she invariably woke in terror. Following the model I used for my own dreams I asked her to give me a full description of every aspect of her situation in the dream. She described not only the people, but also the size and shape of the room and the kind of furniture that was in it.

An Interrogation Room

An Interrogation Room

Naturally, we focused at first on the people, but, apart from the obvious link of her having been brought up in the aftermath of World War Two, there were no links with the SS officers who were threatening her. The room did not trigger any useful insights either. We were beginning to wonder whether this was simply a childhood nightmare of the war come back to haunt her, when I asked about her associations to the furniture. We were both instantly shocked by her first answer. It was exactly the same as the furniture in the kitchen of the house in which she had grown up.

It would not be right for me to go into any detail about where this led. I imagine everyone can see that the picture she had persuaded herself was real, of a contented childhood, was very wide of the mark. That she had no vivid memory of any one dramatically traumatic incident was because there were none to remember: her whole childhood, as we then gradually came to understand it, had been a subtle form of emotional starvation and neglect successfully disguised for her at least as normal parenting.

The key point for present purposes is that the bizarre and frightening dream contained a vital key to her greater self-understanding. My question is, ‘Why cannot a psychotic experience be the same?’ There may be reasons in terms of brain deficits why terrifying leaks from the subliminal mind create a waking dream, but there is evidence that such deficits are the result of the underlying trauma itself, as we have seen in the discussion of damage to the lateral prefrontal cortex, which can no longer act as an effective filter.

Many other people have been struggling to articulate similar perspectives.

Shields, for example, in his paper Psychosis as Coping, which I referred to earlier in the discussion of drugs, makes a similar case (page 143):

This paper proposes that . . . . one sees psychotic episodes for what they may be: a mechanism for coping with existential distress – a way of being that allows an individual to escape existential realities when that individual cannot avoid these things otherwise. . . . .

Escaping the Intolerable

He goes on to clarify what he means (page 145):

. . . if existential distress becomes unavoidable but unmanageable . . . . a psychotic episode can function as a dissociative mechanism for avoiding that distress.

My own work over 35 years confirms this perspective. In 1988 a young woman persuaded her GP to refer her to me. She had carried a diagnosis of schizophrenia since she was 16. Before that she had had a twelve year history of sexual abuse at the hands of her father which went undisclosed and unnoticed at the time. She wanted to talk about the abuse to someone. An OT and I saw her together, with some trepidation. After all, psychosis and psychotherapy weren’t supposed to mix in those days. I’m not sure yet how different it is now.

Voices

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

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

As the months went by she could bear to reveal more of her painful story, though always in small instalments. Her fears about telling it diminished, but she still had not really come to terms with the emotional pain and the anger. For reasons of confidentiality I cannot share any of the particulars of her story. She was able, eventually, to break free of an abusive marriage. She gained greater control over other hallucinations.

However, one day, as our work continued and she became gradually more able to tolerate working on the memories, she was readmitted back into hospital. When I next met with her she explained what had happened.

She had ended up in a place that reminded her of one of the worst experiences of abuse. She was overwhelmed by all the original pain and terror. In my jargon, she had been re-traumatised.

We discussed her options. She could either remain in hospital on high doses of medication until the impact of this faded, or she could move to a residential facility with the close support of staff she trusted to work on these feelings and memories with the minimum of medication. She thought about this as she sat there, her eyes full of tears on the edge of uncontrollable sobbing. She chose to stay in hospital rather than have to face these feelings anymore.

In the next post I will be looking at where all this leaves us.

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

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

Some psychologists are reaching the conclusion that psychosis is often no more and no less than a natural reaction to traumatic events. For example one recent paper suggested that ‘there is growing evidence that the experiences service users report … are, in many cases, a natural reaction to the abuses they have been subjected to. There is abuse and there are the effects of abuse. There is no additional ‘psychosis’ that needs explaining’.

(From Understanding Psychosis and Schizophrenia published by the British Psychological Society – page 42)

The Impact of Trauma

Eleanor Longden and John Read take a long hard look at the evidence for the involvement of trauma in the incidence of psychosis, and look carefully at the implications of that in their article The Role of Social Adversity in the Etiology of Psychosis[1]. A degree of patience will be required here as some quotes are a bit technical. Hopefully your patience will be rewarded by the insights gained. Later posts in this sequence will return to easier terrain!

They are not impressed by the proponents of mainstream thinking (page 6):

Neither the NIMH nor the UK’s National Health Service (NHS, 2014) websites cite the considerable research that implicates traumatic or adverse events as causes of psychosis.

So, while the increased presence of voices that argue against the view that dismisses psychosis as a self-contained abnormality is encouraging, there is still a long way to go. Moreover, it’s of critical importance that we shift the consensus towards normalising psychosis. Exactly what I mean by that will become clear as I go along.

They quote rigorous analyses of multiple studies (meta-analyses in the jargon) that demonstrate beyond dispute in their view that (page 7) ‘individuals with a history of childhood trauma (child sexual abuse, physical abuse, emotional abuse, neglect, bullying, parental death) were shown to be 2.8 times more likely to develop psychotic symptoms than those who had not.’ They also explain that (pages 7-8):

Large-scale population studies have shown that associations between adversity and psychotic experience remain significant when controlling for possible confounders, including: family history of psychosis and other mental health problems (which negates the notion that psychosis only occurs in those genetically predisposed), age, sex, ethnicity, marital status, exposure to discrimination, other psychiatric diagnoses, education level, neuroticism, and substance use.

Moreover they feel the evidence proves that ‘the likelihood of psychosis increases relative to the extent of adversity exposure.’

They explain in detail why they think that patients’ accounts of abuse and trauma cannot be dismissed as deluded fabrications. Patient testimonies, in their view, hold up as well as those provided by people without any diagnosis.

Prefrontal Cortex (for source of image see link)

Prefrontal Cortex (for source of image see link)

Shields, in a paper[2] I will be discussing in more detail later adds head injuries into the mix in a particularly interesting way (Pages 148-9:

One classic and commonly discussed risk factor for psychosis is a head injury (Symonds, 1937). Although there are conflicting data (cf. David & Prince, 2005), there is good reason to believe that a traumatic brain injury does indeed predispose individuals to psychosis (Molloy, Conroy, Cotter, & Cannon, 2011). However, why and how traumatic brain injuries bring about the occurrence of psychosis is unknown. This paper proposes that this predisposition is due to damage of the lateral prefrontal cortex (lPFC) or connectivity to it. The lPFC is responsible for suppressing unwanted thoughts and memories (Anderson et al., 2004). A consequence of this is that impairing the lPFC entails a diminished ability to avoid dealing with unwanted thoughts and memories. Therefore, an individual who has incurred a head injury that damaged or impaired his or her lPFC cannot avoid dealing with unwanted thoughts or issues to the same degree that a healthy individual can. Because of that, when faced with existentially distressing issues, an individual with an injured lPFC who chooses to try to avoid these issues would suffer psychotic breaks when a healthy individual faced with the same issues would not – as the weight of these issues would not press down as hard on healthy individuals who can repress them.

Shields also has an unusual take on the idea that drug use is one of the causes of psychosis (page 149):

Drug use – particularly cannabis use– is associated with an increased risk of developing psychosis (Moore et al., 2007). [My] hypothesis, however, notes that drug use is often an attempt by an individual to escape from reality. Rather than drug use being the cause of psychosis, then, drug use would be a symptom of an inability to deal with reality as it is – which is a clear precursor to psychosis on this view.

Longden and Reid, to come back to their perspective, also give short shrift to the genetic argument and quote a powerful piece of evidence to support their scepticism (page 11):

A particularly shocking demonstration of the limitations of the genetic argument is an epidemiological analysis of the prevalence and incidence of schizophrenia in Nazi Germany, wherein it is estimated between 220,000 and 269,500 citizens with the diagnosis were forcibly sterilized or murdered by the Nazi regime (Read & Masson, 2013; Torrey & Yolken, 2010). Contrary to everything that is known about genetic, heritable conditions, the rates of schizophrenia diagnoses in Germany did not diminish after the war but increased. The analysis showed this atrocity provided proof against the very reasoning used to instigate it.

Because they are convinced by the evidence suggesting that trauma is a major trigger of psychosis they can make a telling point against simplistic claims that genes lead to defective brains that make you psychotic. They write (page 12):

To assume that brain differences exist in a social vacuum, and are solely and causally responsible for schizophrenia, has the same logic as suggesting neural changes during bereavement are the causes of sadness rather than the loved one’s loss.

They continue by describing an explanatory model that states clearly that trauma as the child grows damages the brain in ways that are likely to create psychotic experiences (ibid):

The traumagenic neurodevelopmental (TN) model of psychosis (Read, Perry, Moskowitz, & Connolly, 2001) synthesises biological and psychological research to emphasise the similarities between structural and functional abnormalities in the brains of abused children and those of adult patients with psychosis (which, correspondingly, reflect the differences between patients with psychosis and healthy adults, and traumatised and non-traumatised children). A major premise of the TN model is that the heightened stress sensitivity consistently found in patients with psychosis is not necessarily inherited, but caused by formative exposure to abuse and neglect.

They discuss in more technical detail than it is appropriate to include here exactly what kind of damage has been done to the brain. In a later sequence of posts I will be unpacking a powerful explanatory model (Mike Jackson in Psychosis and Spirituality – pages 139-153), which attempts to pinpoint, from a psychological rather than a biological point of view, the issue of exactly why the trajectory of some people’s experience of psychosis is quite positive while that of others is so negative.

Longden and Reid then move on to discussing the problems surrounding the currently preferred treatment, which is based on the idea that excess brain dopamine or dopamine sensitivity is the cause of psychosis (page 15):

. . . . the dopamine hypothesis was crafted from indirect evidence—the seemingly beneficial sedative effects of neuroleptics. On discovering their main mode of action was blocking dopamine receptors, the argument developed that schizophrenia itself must therefore result from dopamine overactivity. Thus rather than designing a therapeutic agent to treat a disorder, a disorder was hypothesised to fit the drug; and, as pointed out by Jackson (1986), is as logically tenable as claiming headaches are induced by a lack of aspirin.

They do not deny that dopamine could well be implicated in reactions to stress. They do though feel that the efficacy of medication has been falsely explained and possibly overstated, especially as (page 17) ‘long-term medication use may lead to some of the neurological anomalies traditionally ascribed to psychosis itself (Moncrieff & Leo, 2010; Smieskova et al., 2009).’ These anomalies include shrinkage of the frontal lobes.

Grant S Shields, in a paper[3] to which we will be returning shortly, suggests their scepticism is warranted (page 42):

[B]iological treatments of psychosis are somewhat ineffective: the efficacy of antipsychotic drugs to reduce psychotic symptoms and prevent relapse is only 41% (Leucht, Arbter et al., 2009; Leucht, Corves et al., 2009).

If medication is at best only a partial solution[4] with potentially damaging side-effects, where do we go next. The authors of this paper argue for Compassion Focused Therapy but admit the evidence-base supporting its use is thin up till now. This needn’t stop us looking more closely at why some form of psychotherapy could well work.

Next time I will be looking at what the purpose of a psychotic experience might be.

References

[1] This can be found in the American Journal of Psychotherapy, Vol. 70, No. 1, 2016

[2] To be found in Existential Analysis 25.1: January 2014.

[3] To be found in Existential Analysis 25.1: January 2014.

[4] For a passionate personal picture of what being medicated in this way does see Joshua Gliddon’s article in the Guardian.

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

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

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

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

What has this to do with EMS?

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

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

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

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

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

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

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

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

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

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

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

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

We’re on a Continuum

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

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

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

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

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

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

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

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

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

Related Posts

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

References:

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

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A particularly shocking demonstration of the limitations of the genetic argument is an epidemiological analysis of the prevalence and incidence of schizophrenia in Nazi Germany, wherein it is estimated between 220,000 and 269,500 citizens with the diagnosis were forcibly sterilized or murdered by the Nazi regime (Read & Masson, 2013; Torrey & Yolken, 2010). Contrary to everything that is known about genetic, heritable conditions, the rates of schizophrenia diagnoses in Germany did not diminish after the war but increased. The analysis showed this atrocity provided proof against the very reasoning used to instigate it.

(The Role of Social Adversity in the Etiology of Psychosis by
Eleanor Longden and John Read – page 11)

schwartzSome time ago on this blog I addressed the issue of neuroplasticity. I shared my frustration at how the neuroscientific community’s resistance to the idea that the mature brain could change had been a damaging doctrine for decades.

As I wrote in 2012, even if you only date the start of a belief in neuroplasticity at 1962 – and there is some evidence it could fairly be backdated earlier than that – 34 years seems a long time to wait for such a clinically vital concept to surface into general practice.

I can testify to that from personal experience. From when I first studied psychology in 1975 until I qualified as a clinical psychologist in 1982, the conventional wisdom was that the adult brain had virtually no capacity to change itself. I cannot exactly remember when it became respectable to doubt that dogma, but I am fairly sure it was well into the 90s. And even then it was a qualified scepticism only. We were into the new century before I became aware of the wide-ranging and radical possibilities that people like Schwartz have written about.

It is horrifying to contemplate the human cost of such resolute intransigence in the face of compelling data.

I have expressed equal frustration, if not more, at the obdurate dogmatism with which mainstream materialistic science denies validity to spiritual experiences of almost any kind.

Not even once in my entire experience of being taught psychology did I ever hear of Frederick William Henry Myers, a resolute explorer of the borderland between mind and spirit. The closest encounter I ever had of this kind was with William James. He was mentioned in asides with a dismissive and grudging kind of respect. The implication was that he was an amazing thinker for his time but nowadays very much old hat. I gave him a quick glance and moved on.

Looking back now I realise I was robbed.

Irreducible MindKelly and Kelly capture it neatly and clearly in the introduction to their brave, thorough and well-researched book, Irreducible Mind (pages xvii-xviii):

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

And, sadly, in some senses nothing much has changed. Too many psychologists are still, for the most part, pursuing the Holy Grail of a complete materialistic explanation for every aspect of consciousness and the working of the mind.

I have a comparable, perhaps even greater, sense of frustration about a similarly destructive dogmatism that bedevils the clinical/psychiatric approach to so-called psychotic experiences. This is far more damaging, for reasons that will become clear in a moment, than the a priori rubbishing of psi or near death experiences, unhealthy as that undoubtedly is.

My recent decluttering process triggered the feeling all over again. I’ve been sorting through back issues of my psychology journals. In the process, I found one article of particular interest on this theme. Sadly it was the only one I found in the dozens of journals I have checked through for items of interest before deciding whether to discard them. (As I later discovered through trawling the web and my British Psychological Society website in particular, there are others sailing against the hitherto prevailing current of dogmatic biodeterminism, but they are still the exception rather than the rule. The BPS as a body, to its credit, is getting on board as well, as quotes I use in later posts will testify.)

The journal[1] was dated 2012 and contained a paper by Charles Heriot-Maitland, Matthew Knight and Emmanuelle Peters on the subject of what they call Out-of-the-Ordinary-Experiences or OOEs. The focus of the study was to use a phenomenological interview process that enabled them to compare the experiences of two small groups of people, one group who had been diagnosed as psychotic, labelled the clinical (C) group, and other who had not, labelled the non-clinical (NC) group.

Their operating assumption from the start was that voice-hearing prevalence, which runs at 10-15%, (page 38) ‘suggests that OOEs do not inevitably lead to psychiatric conditions, and that people can experience psychotic-like phenomena whilst continuing to function effectively.’

They also refer to two other pieces of research from this sparsely populated field of investigation.

First of all, they quote Brett et al (2007) as finding that ‘while [their Diagnosed] group were more likely to appraise their experiences as external and caused by other people, the [Undiagnosed] group made more psychological, spiritual and normalising appraisals, and reported higher perceived understanding from others. . . . . They . . . did find trauma levels in both groups to be higher than in the general population.’

Jackson and Fulford (1997), which they describe as the only known published qualitative study of clinical and nonclinical populations with OOEs, also found that psychotic-like experiences were triggered in both groups by intense stress in the context of existential crises, and that the subsequent group distinction depended on ‘the way in which psychotic phenomena are embedded in the values and beliefs of the person concerned.’

Later work has expanded on this. For instance, Eleanor Longden and John Read in their review of the evidence concerning the role of social adversity in the etiology of psychosis (American Journal of Psychotherapy, Vol. 70, No. 1, 2016: pages 21-22) summarise a wealth of data that suggests that, not only is trauma a clear factor in the incidence of psychosis, but also psychotic experiences relate strongly to the nature of the trauma experienced. For example, work with 41 patients experiencing a first episode of psychosis found that attributes of stressful events in the year preceding psychosis onset were significantly associated with core themes of both delusions and hallucinations (Raune, Bebbington, Dunn, & Kuipers, 2006).

Where the OOE work is particularly significant is in the emphasis it places on the potentially positive function of the psychotic experience in and of itself, a rare perspective indeed. Even a paper on the existential approach (Grant S Shields – Existential Analysis 25.1: January 2014 – page 143) takes a somewhat darker view of such experiences, seeing psychosis as ‘a mechanism for coping with existential distress – a way of being that allows an individual to escape existential realities when that individual cannot avoid these things otherwise.’ I will be returning to a more detailed consideration of his valuable but different position in a later post.

ooe-table

Later in this sequence I will refer back to other thinking and data that expand on the relationship between levels of consciousness or understanding, and the stress caused by experiences that challenge the models of reality we have so far developed. I’ll just focus in the reminder of this first post in the sequence on the basics of what this study found (pages 41-49). Please bear in mind as you read that we should do our best to see the experiences labelled ‘psychotic’ not as some alien state remote from anything we might ever have to undergo ourselves, but as simply part of a continuum, a dimension, along which we all are placed and therefore could at some point also be thrust to a similar extreme, given the wrong circumstances. I’ll be retiring to they theme in a later sequence as well.

Nearly all participants in both groups reported a period of emotional suffering before their first OOE. There was a sense, therefore, that the first OOE was a direct expression of emotional concerns at the time. For details of what some of the OOEs were like, see the table above.

A process of existential questioning came into the mix. Similar to the emotional suffering, there also seemed to be some direct relevance of OOEs to the context of participants’ existential questioning. From this, it could be interpreted that the OOE actually emerged as a direct expression of, or indeed solution to, some kind of psychological crisis.

Isolation, which was reported equally across both groups, was either caused by intentional social withdrawal, or by private pre-occupation with other activities. It may therefore be that isolation has more of a causal role in triggering the experience itself, perhaps because it encourages introspective focus on the kinds of emotional and/or existential concerns mentioned above.

At first I thought the authors might be operating on an implicit assumption that isolation is generally undesirable, but revised that view in the light of the paper as a whole.

One of their most striking findings was the powerful language used by participants to describe the emotionally fulfilling and euphoric qualities of their experiences.

Next Monday I’ll be looking more directly at the spiritual implications of this.

Footnote:

[1] British Journal of Clinical Psychology (2012) 51, pages 37-52.

 

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Cliff

Cliff

. . . . 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.

(Selected Writings of ‘Abdu’l-Bahá,Section 36)

In preparation for a couple of posts later this week it seemed a good idea to republish this sequence.

A Community of Selves?

I have pondered this issue over many decades. It seems that the person who is writing this now may not be the same person who did the first draft years ago. I am not, of course, referring to my body even though it may have replaced most of its cells in that time, as cell replacement does not seem necessarily to entail self-replacement. As the brain, if not driven to new learning, tends to lose cells rather than grow new ones, the brain I’m using now may be significantly smaller than it was when I wrote the first draft, but will be otherwise the same, I should not be greatly changed as a result.

It is the person that I have my doubts about. I have had to select one of my selves to edit this post at this point, and I had to trust that the me who did so would not be too out of step with the me who originally wrote it!

That the self is vast there is no doubt. According to Bahá’u’lláh it contains the universe enfolded. Other spiritually oriented people generally share the same view. One poet, who was a Jesuit priest, wrote:

O the mind, mind has mountains; cliffs of fall
Frightful, sheer, no-man-fathomed.

(G.M. Hopkins, Poems Oxford Edition page 107).

R.S. Thomas, also a priest, wrote that:

Wordsworth turned from the great hills
of the north to the precipice
of his own mind.

(Later Poems page 99).

But size does not of necessity entail multiplicity.

For source of image see link

For source of image see link

The Great Brain Robbery

I have already gone over in detail the implications of meditation and the Third ‘I’ and the threebrain models.

That can all seem a bit dramatic – a bit like the Great Brain Robbery.

It goes something like this.

Lots of people, when they’re explaining the value of mindfulness and meditation, describe the body as our car. So, if I think I’m the driver of this car, in full control, I’m deluded. I’ve been car-jacked.

Yes, my centre of awareness is in the driving seat, hands on the wheel and feet on the pedals, but every seat in the car is taken by a presence that’s holding a gun to my head. Directly behind me is Johnny Fear, known to his friends as Mr Rabbit. On my left is Jimmy Rage, the ‘auld croc.’ Back left is Sissy Thinker, who thinks she’s the brains of the outfit.

In the worst case scenario, I can hear an occasional thud and grunt from the boot of the car where they have locked my True Self, tightly bound and gagged. What he knows but I don’t is that their guns are loaded with blanks. They’re all bluff and thunder but no lightning at all.

When Sissy Thinker has bought into an ideology that sees almost everyone except her gang as a sworn enemy and unbeliever, Jimmy Rage takes control of the car and goes on a killing spree. Either that, or Mr Rabbit grabs the wheel, slams his foot on the accelerator and makes a run for it.

As we’ve looked at those issues in enough detail already, I’ll focus now on how to understand another aspect of the complexity of our interior in less loaded terms, more to do with our cultural conditioning than our evolutionary and instinctual heritage.

The Bahá’í Perspective

To get us going, what might be the beginnings of a Bahá’í perspective on all this?

Bahá’u’lláh wrote (GleaningsCXII):

No two men can be found who may be said to be outwardly and inwardly united.

There are many passages in the Bahá’í Writings that explain various ways in which each of us can experience or be subject to divisions within, to a point at which one part of us is even in conflict with another. Such conflicts have implications for our relationships with others but it is not my purpose to consider those in detail now.

The focus of this post is the community of selves within each of us. Where is the evidence that we are more than one self?

The above quotation from Bahá’u’lláh describes us as not inwardly united, which implies that we may be inwardly divided. Bahá’u’lláh also talks of the self but in ways that conflict. For example, we are enjoined to flee the self as a prison[1] on the one hand, and to turn our sight towards it, on the other, and see Bahá’u’lláh as God standing within us[2]. We clearly cannot be talking about the same self in each case. ‘Abdu’l-Bahá and Shoghi Effendi develop this idea in many places[3].

Furthermore ‘Abdu’l-Bahá describes character as coming in three kinds – innate, inherited and acquired: there is also natural capacity and acquired capacity.[4]

There is in addition the question of divine attributes (Bahá’u’lláh, Gleanings XXVII):

Upon the reality of man… He hath focussed the radiance of all of His names and attributes… and made it a mirror of His own self.

This multitude of varied attributes is hard to reconcile into one concept of God let alone integrate into a single self as the unwavering centre of a unified consciousness![5]

If the Bahá’í picture suggests at least a family of selves, what does the Western world think? I shall draw for the most part on psychology in the profile that follows.

For source of image see link.

For source of image see link.

The Psychological Perspective

The layman seems typically to value consistency, which, in effect, means singleness. In psychology too the assumption has sometimes been that there really is a unity, accounting for differences and inconsistencies within the same person by variations of the trait perspective. However a vast body of theory, clinical practice and research has accumulated which calls this assumption gravely into question. Split brain research and resulting theories[6], clinical experiences with multiple personalities[7] and the auditory hallucinations of people with a diagnosis of schizophrenia[8], as well as psychoanalytic theory (Freud and Jung especially) and its offspring[9] are useful starting points in getting our bearings.

For instance, Berne, the founding father of Transactional Analysis, saw us as beings organised into at least three different semi-autonomous and incompletely conscious subselves. These he called the Parent, the Adult and the Child[10]. The extent to which these subselves are in harmonious cooperation is one of the determinants of well-being.

A model of therapy often used in coordination with Transactional Analysis is the Gestalt Therapy of Fritz Perls[11] whose most fundamental tenet is that we are divided beings seeking to become whole. His therapy is a form of consultation between conflicting aspects of the person.

Split-brain research strongly suggests that the left and right halves of the brain function in distinct ways. If they become surgically or traumatically disconnected then the patient can be shown to process reality in simultaneous but conflicting ways. Radical developments in academic psychology and its research take the view that no such thing as personality in the traditional sense exists. We are constructed from our social experience. Roles and the internalised descriptions of others produce an illusion of solid selfness. However, rather as with the proverbial onion, once you take these layers away is there nothing left above and beyond these disparate and ephemeral imaginings!

Amartya Sen, in Identity and Violence, expresses his view that our multiple identities are inescapable and to be celebrated (page 172) partly at least because there is the danger of intolerant extremism once we ‘think of [our]selves only as Hindus or only as Muslims (who must unleash vengeance on “the other community”) and as absolutely nothing else: not Indians, not subcontinentals, not Asians, not members of a shared human race.’

Next time we’ll look at some implications of these possibilities.

Notes:

  1. Bahá’u’lláh, Hidden Words (Persian) no. 40.
  2. Bahá’u’lláh, Hidden Words (Arabic) no. 13.
  3. See ‘Abdu’l-Bahá, Some Answered Questions chapter 64, and Shoghi Effendi in Living the Life 28.
  4. See ‘Abdu’l-Bahá, Some Answered Questions chapter 56.
  5. See the Long Healing Prayer for a concentrated exposure to this problem.
  6. See N. Ornstein. Multiminds: A New Way to Look at Human Behaviour. Boston: Houghton Miffin, 1986.
  7. See A. Crabtree. Multiple Man: Explorations in Possession And multiple Personality. London: Grafton Books, 1988.
  8. See L.S. Benjamin . “Is Chronicity a Function of the Relationship Between the Person and Auditory Illusion?” Schizophrenia Bulletin (1989) 15: 291-310.
  9. See E. Berne. “Games People Play”. Harmondsworth: Penguin, 1964; and R. Assagioli. Psychosynthesis: A Collection of Basic Writings. 3d. ed. London: Turnstone, 1975.
  10. For a full and very intelligible description, see S. Woolams and M. Brown. TA: The Total Handbook of Transactional Analysis. New York: Prentice-Hall, 1979, pp. 9-40.

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