Presenter: Ron Unger 4ronunger@gmail 1-541-513-1811

1. Understanding Psychosis as an Attempt to Solve Problems:Integrating Perspectives on Trauma, Spirituality and Creativity Presenter: Ron Unger 4ronunger@gmail.com 1-541-513-1811

2. Psychosis as a healing process? • A view associated with people like R.D. Laing & John Weir Perry • Criticized as “romanticizing madness” • But if we leave this possibility out, might we be “awfulizing madness”? • A more complex view: madness as a possible result of attempts to cope and to heal that may backfire • Better explains diverse antecedents and outcomes? • Balances view of risks and opportunity?

3. Problems with Approaches Oriented Around Suppression of “Symptoms” of “Illness” • Often make it more scary • by defining experiences as definitely part of a terrible illness • Puts emphasis on suppression of experience • This may stimulate a “psychic civil war” • Increase in helplessness • “Passive victim of an active illness” • Increase in stigma & isolation • Over-emphasis on stability contributes to rigidity in people and in culture

4. More Vicious Circle Stress Increased emotional arousal hypervigilance, listening harder for more voices Hearing a voice Interpret voice itself as a threat

5. Less Virtuous Circle Stress Accept the voice as a useful signal of stress, take action that reduces the stress Less trouble from Hearing a voice Interpret the voice as an effect of stress or as a source of information about aspects of self

6. Stability: A “false god” of the mental health system?

7. Personal Story

8. “Madness” that leads to fun, changes seen as positive, and notable cultural influence – how different is it from madness that just causes trouble and is labeled “sick?”

9. Why does trauma cause dissociation? • Traumatic situations require, or seem to require, extreme reactions • Extremes are achieved by excluding or pushing away all other possibilities • Black and White thinking, • Dissociation from alternative ways of looking, thinking, and acting that seem threatening • At other times, the person may seem to require exactly the extreme that was shut out previously • “Black” and “White” may flip • Instead of integration of opposites, there is conflict

10. The most common, or Primary, Structural Dissociation • The Apparently Normal Part, or ANP • This part wants to move on with daily life, and avoid traumatic memories and/or upsetting emotions • The Emotional Part, or EP • This part is preoccupied with the trauma and/or possible recurrences of the trauma • It is fixated on action systems that were activated at the time of the trauma • It is likely to have “vehement emotion” and emotional reasoning that is not tolerated by the ANP

11. Positive and negative metabeliefs inPTSD • I must stop thinking about it • It’s not normal to keep thinking about the trauma • I must be weak to respond like this • I could lose my mind if I continue to think this way • My mind has been damaged by what happened • I must go over events to make sense of them • It is important not to have gaps in my memory • Thinking about threats in the future will help me cope • Worry keeps me safe • Paying attention to danger will keep me safe Taken from PowerPoint by Dr. Peter Scragg on Metacognitive Therapy

12. “Negative Dissociation” vs “Positive Dissociation” or “Disorderly Association” • In “Negative Dissociation” we identify with one part of ourselves, the other part seems to be missing • In “Positive Dissociation” the other part is present, but is seen as intrusive and as causing a disturbance rather than as being a valued part of self • Flashbacks are a form of “positive dissociation” • In more extreme states, intrusions may be seen as completely alien, as a voice, demon, or CIA installed implant

13. Map of Extreme States Narrow self expanded self Negative Symptoms Positive Symptoms

14. Becoming more “open minded” when no solution is apparent • When people are trying to control something • And there is no direct way to do it • Then they become more likely to see unlikely patterns • Including • seeing images in noise, • perceiving conspiracies, and • believing in superstitions Whitson, J. A., & Galinsky, A. D. (2008). Lacking control increases illusory pattern perception. Science, 322(5898), 115-117.

15. The “Renewal Process” • 1. Construct system breaks down • Common cause of that: trying to solve a problem not solvable within existing constructs • 2. Temporary suspension of constructs • Encounter with the “transliminal” • 3. Construct restructuring If done under high stress etc., errors are more likely, leading to getting attached to defective constructs, and/or back into….. • Success! If done under low stress and/or with luck etc., the process can result in new vision that enriches the person & possibly the culture.

16. The Metamorphosis of Madness • There are striking parallel between a fully resolved psychotic process and the metamorphosis of a butterfly: • They both entail an initial stage of profound disintegration. • They both entail eventual reintegration into a form that is much more resourced than the original form. Slide borrowed from Paris Williams, author of “Rethinking Madness”

17. People may “flip” between being lost in the transliminal & relying on rigid & defective constructs Attempts at constructs coexist with an awareness of the mystery that surrounds them: Attachment to constructs is tentative, humble, maintains a sense of humor about their limits. Lively. Rely on defective, dissociated, and/or dogmatic constructs: Mystery, or awareness of limits to the constructs, is denied. Lost in the mystery: Since constructs were not adequate, all attempts at constructs are abandoned. But then there is no way to organize or communicate.

18. Map of Extreme States Narrow self expanded self Negative Symptoms Positive Symptoms

19. Being Curious and Open Minded About Possible Meanings: • All statements are true in some sense, false in some sense, meaningless in some sense, • true and false in some sense, true and meaningless in some sense, false and meaningless in some sense, and true and false and meaningless in some sense • From THE PRINCIPIA DISCORDIA • “Wherein Is Explained Absolutely Everything Worth Knowing About Absolutely Anything”

20. Watch Out for Vicious Circles: • Where efforts to make things better are inadvertently making them worse • As things get worse, misguided efforts to make them better often intensify • Leading to an acceleration of difficulties • Both efforts by individuals, and by “helpers” such as the mental health system may be making things worse • Without insight into the vicious circle, it just accelerates • The whole pattern may then be labeled a very serious “biologically based mental illness”

21. More Vicious Circle Serious problems, depression Bad results from person’s own actions & from mental health intervention leads to life going further out of control Goes into trance and wild ideas to escape problems and depression Mental health system intervenes in way that is traumatizing, stigmatizing and/or disabling Acts on trance or wild ideas without using adequate discernment

22. Less Virtuous Circle Serious problems, depression Uses discretion, though sometimes still goes into trance and wild ideas to escape problems and depression Actions lead to better results, life makes more sense Any mental health intervention is normalizing, encourages reflection & discernment Acts on trance or wild ideas only after using adequate discernment

23. Cultivating Uncertainty & Humility • If we recognize that all maps, concepts etc. are only partially helpful & accurate • Then we can listen to and respect those who see & describe things differently than we do • When we respect both our own views & that of others • We model for our clients how to do the same

24. Dialogue as an approach to complexity & uncertainty • Dialogue involves cultivating multiple views • And bringing them into relationship with each other • There is need for dialogue at all levels • Within the person being helped • Between the helper and person • With family and friends • With the wider society or culture • Mental health workers should be trained in how to respectfully address issues framed as spiritual within such dialogue

25. DIALECTICAL BEHAVIOUR THERAPY: Linehan’s STATES OF MIND applied to PSYCHOSIS Slide by Isabel Clarke and Donna Rutherford

26. Toward a “Transformation Friendly” Mental Health System • Mental health system role should be: • To protect the person going through extreme states • Help people develop a dialogue with that which disturbs them • Train people prone to extreme states • in how to negotiate these states successfully • And in how to draw on extreme states to support “creative maladjustment” in interaction with social groups • so the best aspects of “mad” or visionary experiences can play a role in social transformation • Our survival may depend on a better relationship with the Visionary

27. Vicious Circle Has [more]fears and insecurities Person copes by either acting on sense of threat, leading to life chaos, or by trying not to think about it, which prevents seeing the “what if” quality Attempts to cope by not thinking about the “what ifs” Fears intrude anyway in the form of perceptions of threat happening in the present (“what if” quality is lost)

28. Virtuous Circle Has [less]fears and insecurities Use of better judgment results in better life outcomes, ability to put threats in perspective Considers “what ifs” to a modest degree, without taking them too seriously Due to habit of facing fears, able to evaluate whether threat is occurring in the present in a reasonably balanced way

29. Changing the Relationship Between the “Mad” and Society • Social efforts to suppress madness have • Often been very destructive • Have often increased the problem, by increasing the division between mad persons & perspectives and “sane” ones • Indigenous people often took a different approach • Saw risk in “abnormal” experiences but also possibility • Would support and train people to handle the risks better while continuing to explore new visions

31. A Complex Web of Events and Reactions to Events • Some reactions may seem to make sense at the time • But then make problems worse later • Or if the reaction continues when no longer needed • Other reactions may seem to make things worse at the time • But in the long run, can lead to positive changes

32. If we see what is going on as an attempt at transformation, • then we can join with the person in finding a way to complete that successfully • Transformation involves changing ourselves and the way we relate to the problem • Usually this involves both • setting limits with the “problem” • And finding something of value within it

33. Mad Pride! • Finding value in rebellion, mental diversity, extreme states • Even though these things • Often cause distress as well • And people often need help with them • “Madness” may be helpful in 2 ways • Sometimes what is seen as “mad” actually has a value that others have not seen • Sometimes it is more a case of “the fool who persists in his folly will become wise” (William Blake)

34. Depressive Disorders and Dissociation • EP sees a threatening problem, withdraws energy from other areas to focus on the problem • Which results in depression • ANP doesn’t see the original problem, sees depression as the problem, tries to resume normal activity • EP sees this as a distraction from the problem, resists, etc.

35. Positive and negative metabeliefs indepression • I cannot control my depressive thoughts • My depressive thoughts are a sign I’m losing my mind • My depressive thoughts control me • I am defective/abnormal for thinking like this • Rumination helps me cope • If I analyze why I feel this way I’ll find answers • Rumination helps me understand my depression • Rumination helps me solve problems Taken from PowerPoint by Dr. Peter Scragg on Metacognitive Therapy

36. Being “manic” is often an over-correction for being depressed • Just looking at the “bright side” of things • Not taking any costs into account • Blocking out any self-criticism • Restricting awareness of the need for rest or any limits to personal energy • This can lead to • Anxiety, when awareness of the dark side of manic thinking and behavior threatens to intrude • Or depression, when awareness of the dark side takes over • But depression is painful and destructive in its own way, so person may turn to mania again for relief….

38. Is it “crazy” to value “psychotic” experiences? • "My voices are the sanest part of me, the madness is not listening to their pain“- Dolly Sen • "My voices gave me the security of belief, even though what I believed was terrifying" - Jo Twist • "Accepting my voices meant I could finally begin to accept myself" – Jacqui Dillon