Understanding Psychosis as a Healing Process: Integrating Perspectives on Trauma, Spirituality, and Creativity

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. Mental Health, and Life • Life involves being out of balance, far from equilibrium • To have the force to keep moving • But also requires many types of balance • To coordinate that movement • A one-sided preoccupation with “stability” is not compatible with being truly alive • Stability is best balanced with an openness to change, to creativity, to “Spirit”

8. Personal Story

9. “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?”

10. 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

11. 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

12. 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

13. “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

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

15. 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.

16. 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.

17. 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”

18. 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.

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

20. 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”

21. 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”

22. 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

23. 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

24. 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

25. 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

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

27. 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

28. 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

29. Is it worth trying to see a difference? • Between • A spiritual experience with some mental and emotional difficulties • A mental disorder or psychosis with some preoccupation with spiritual issues

30. One attempt to distinguish a visionary spiritual experience (VSE) from psychosis (Lukoff, 2005) • The VSE typically includes ecstatic mood, a sense of newly gained knowledge, and delusions with spiritual themes • Unlike psychotic disorders, VSEs have • good pre-episode functioning, • acute onset of symptoms during a period of three months or less, • [a] stressful precipitant to the psychotic episode, • [and] a positive, exploratory attitude toward the experience" • Further, there must be no significant risk for homicidal or suicidal behavior in a VSE. • Note that the experience of Mohamad, who contemplated suicide when first contacted by the angel, or Abraham, who contemplated killing his son, could have been ruled out under these criteria • These criteria may be helpful in predicting who is more likely to do well with a non-medical or more spiritual approach, but these predications lack any certainty

31. The Continuum View • Unusual experiences can be seen on a continuum • from definitely helpful or “spiritual” • To definitely problematical • Relationships between experiences and people’s lives can be complex • “hellish” experiences might lead to later breakthroughs

32. Which Experiences Promote Growth, Which are Pathological? • Distinction is mostly related to: • Context in which they occur • Manner in which they are approached • Ability to integrate them into everyday life • Grof, 1985, as cited in Watkins, 2008 • Note that it is not just the person, but the attitudes and behavior of those close to them, that determine whether or not the conditions exist for anomalous experiences to promote growth

33. Distinguishing "Mystical Experiences with Psychotic Features," from "Psychotic Disorders with Mystical Features." • The act of making such a distinction can itself affect the outcome • When it is determined that a condition is “really psychosis” then it is likely there will be • Reduced hope for a positive outcome • Little or no effort to understand the person’s anomalous experiences • Definitely a lack of effort to see possible good in the person’s anomalous experiences • Increased effort to suppress those experiences • neglect of spiritual issues that could relate to recovery

34. Distinctions in Cause • Contrast • Confusion caused by a disruption of an established order as a person embarked on a quest for something “spiritual,” with • Confusion caused by trauma, or a disruption of the brain caused by substances, sleep loss, or some biological process • But • Any disruption of normal process raises spiritual questions and can open up a person to a spiritual reorganization, and • Sometimes brain disturbances by substances, sleep loss, stressful or painful experiences, isolation etc. are sought out as part of a deliberate spiritual quest

36. An Alternative to Differential Diagnosis: • Attempt to understand, and to look for positive elements, within everyone’s experience • Give everyone a chance to improve without anti-psychotic medication • When we fail to help someone work through their experience in a positive • consider the possibility our efforts may have been flawed • rather than simply assume that the person “really had a psychotic illness instead of a spiritual process”

37. Discussion: • Are there key arguments for a categorical distinction between spiritual emergence and psychosis that haven’t yet been mentioned? • Does the notion of a continuum between the spiritual and the psychotic raise questions for you that haven’t yet been addressed? • Let’s discuss this in small groups, then bring your key points back to the bigger group.

38. The value of framing it as a transformative process • 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

39. Using the model of the renewal process in therapy • Clarify history up to first experience of “psychosis” • Define the life problem that needed resolving • Look at how constructs at that time may have been inadequate • Education on how breakdown in constructs can lead to new insights • And what it’s like to be “in the process” • Explore how to keep access to this process • While better handling the risks

40. Why discuss spiritual issues within mental health treatment: • Helpful in communication to use a person’s own language and metaphors • Spiritual concepts are often less stigmatizing • Spiritual seeking is often a key part of the human response to trauma • A spiritual focus encourages professional humility • Willingness to discuss spirituality leads to better relationships • Spirituality is proven valuable in recovery

41. 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)

42. The Meaning of Madness – an “Essentially Contested Concept” • Madness itself often involves contesting all kinds of conventional meaning • And discovering new sources of meaning • Which may then be contested by self and/or others • Spirituality involves the discovery of profound meanings • But whether such discoveries are “correct” or themselves mad, may be highly contested • Wars are fought over what approach to spirituality is correct

43. From “The entropic brain: a theory of conscious states informed by neuroimaging research with psychedelic drugs” Front Hum Neurosci. 2014; 8: 20. Published online Feb 3, 2014.

44. Into the Cool Into the Cool is a scientific tour de force showing how evolution, ecology, economics and life itself are organized by energy flow and the laws of thermodynamics. There are natural, animate and inanimate systems like hurricanes and life whose complexity are not the result of conscious human design, nor of divine caprice, nor of repeated, computer-like functions. The common key to all organized systems is how they control their energy flow. Scientists, theologians, and philosophers have all sought to answer the questions of why we are here and where we are going. Finding this natural basis of life has proved elusive, but in the eloquent and creative Into the Cool Eric D. Schneider and Dorion Sagan look for answers in a surprising place: the second law of thermodynamics... 

45. The Abyss, and the Promise, of Madness • Trauma leads to people becoming more rigid in some ways • Becoming more of a fixed thing, less an open process • chronic stress generates more myelin-producing cells and fewer neurons than normal • http://newscenter.berkeley.edu/2014/02/11/chronic-stress-predisposes-brain-to-mental-illness/ • Fixed responses may help with specific traumatic situations, but lead to disability in other situations • Attempts to reverse this vulnerability by “opening up” may lead to a sense of non-being, a sense of the abyss • Which itself may be seen as a new threat

46. 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 activity • 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….

47. God, and the Integration of Positive and Negative Affect • “God” can be understood as Mystery, both Terrible and Wonderful • Faith in God can mean simply understanding that there are always these two sides • “Satan,” the Trickster, gets us caught on one side or the other • Attached to some mundane “good,” relying on it for our security rather than relying on the whole, or God • Caught in some negative state and fearing it is the whole, losing our faith that there is always something more within mystery • Being caught in one extreme mood or another involves being tricked

48. A “Bipolar” View of Mood Swings • Mood swings can be both • A result of failing to appreciate God, or the whole • A part of the process of discovering God, or the whole, or spiritual opening • Mania can be part of spiritual discovery • Depression can be part of spiritual emptying, opening the space for discovery • Can help to change one’s relationships to mood swings • Accept them • Be open to learning from them • Don’t take them too seriously

49. The Known & the Unknown • “There are known knowns; there are things we know we know.We also know there are known unknowns; that is to say, we know there are some things we do not know.But there are also unknown unknowns – the ones we don’t know we don’t know.” • —Former United States Secretary of Defense, Donald Rumsfeld • "It ain't what you don't know that gets you into trouble. It's what you think you know that just ain't so“ – Josh Billings

50. What I am suggesting is that the very demand to understand the mystery of existence is destructive. Just leave the mystery alone. ~ UG Krishnamurti