February 23 by The Running Son
Psychosis and Spirituality. Finding a Language.
Dept. of Psychiatry
Royal South Hants Hospital
Southampton SO14 0YG.
Psychosis and Spirituality. Finding a Language.
Psychosis and spirituality both inhabit the space where reason breaks down, and mystery takes over. For me as a psychotherapist working with people with psychosis, this encounter poses questions: questions such as; “Why is religious/spiritual preoccupation and subject matter so prominent in psychosis?” “How come they both share a sense of portentiousness and supernatural power, and where does this sense come from?” “How is it that all civilisations but our own have honoured the sacred – are the sacred and spirituality fundamental or expendable?”
As my work as a clinical psychologist working with a psychiatric rehabilitation team led me deeper into empathic encounter with the experience of psychosis, the mystery deepened and the boundaries became more blurred. I already knew from long interest in the spiritual traditions, particularly the Christian contemplative tradition, that the mystical writers enjoined their disciples to beware of terrifying and deceptive experiences that sounded remarkably psychotic. They warned that such experiences were frequently encountered when pursuing the goal of unitive experience of the divine. I now learned that ecstatic experience was a reasonably frequently reported stage in a psychotic breakdown. Peter Chadwick’s book “Borderline” (Chadwick 1992 – discussed below) was for me important corroboration of this observation.
So the questions started to coalesce, and the answer appeared to lie in a psychological conceptualisation that would combine psychosis and spirituality as a unified area of human experience. In attempting this, I am all too aware that spirituality is one of those topics that defy conceptualisation. The illusion of certainty that diagnosis gives to psychosis in some quarters has also been deconstructed (Bentall 1990), leaving both in something of a conceptual quicksand. This is hardly surprising since all the great religious traditions have stressed the paradoxical nature of the truths they pursue; the paradox that I propose to explore in this chapter is the paradoxical relationship between spirituality and psychosis. Far from being at opposite ends of the spectrum of worthwhile human endeavour, I am going to suggest that both represent one way in which human beings can encounter reality, and the same way at that. The difference in the experience, where difference there is, and I will question whether the difference has been exaggerated, comes with the experiencer rather than the experience.
I will start by examining the ideas that William James (1902) had on this subject, as we are only now beginning to catch up with his insights. I will then consider the research evidence for overlap between psychosis and spirituality, founded in the concept of schizotypy, and the crucial role of the spread of cognitive behaviour therapy for psychosis in facilitating the encounter between psychotherapy and the experience of psychosis. As re-examination of the relationship between psychosis and spirituality entails challenging received ideas about spirituality, this is tackled next, leading onto scrutiny of the rigidity of language which has inhibited creative thinking in this field. I then introduce a possible unifying conceptualisation, based on Kelly’s construct theory. I conclude the chapter by arguing that, far from being expendable or an optional extra, the spirituality of connectedness that emerges from this argument, is central to all that we value, and indeed, to our very the survival.
William James (1902) in his series of lectures entitled “Varieties of Religious Experience” succeeded in grasping at this mercurial subject matter in a way that comes over as just as incisive and fresh nearly a century later. He made a number of important points that provide a good foundation for the argument that will follow. He cut through centuries of theological argument at a stroke by founding his definition of religion on experience, as follows: “Religion…….shall mean for us the feelings, acts, and experiences of individual men in their solitude, so far as they apprehend themselves to stand in relation to whatever they may consider the divine.” This definition sits well with the wider term, spirituality, employed in this book. However, it raises the issue of the suitability of individual subjective experience as the subject matter for scientific, and therefore psychological enquiry. In James’ day, following Wundt and others, this was perfectly proper, but has since been trampled underfoot by the success of behaviourism, and is only now resurfacing in the development of methods of enquiry that can deal validly with experience. Heron’s “Sacred Science” is perhaps the most apposite example to the present subject, (Heron 1998).
James distinguished two contrasting attitudes to religious experience, that of the “healthy-minded”, “once-born”, and that of the “the sick soul”, whose spiritual happiness depended on becoming “twice-born”, and for whom “the world is a double-storied mystery”. This phrase uncannily echoes one quoted by the anthropologist Natalie Tobert (Tobert 2001); the phrase “the double house”, used by the Tukano people to describe the natural and the spirit world – an interpretation that it took the anthropologist studying these people (Reichel-Dolmatoff) a couple of years to get to the bottom of, so foreign is it to our culture. The contrast is that for the Tukano, this concept will have been accepted by all, not confined to the “sick soul”.
For the twice-born “there are two lives, the natural and the spiritual, and we must lose the one before we can participate in the other.” P.163. He sees the expansion or blurring of what he terms the “margins of consciousness”, P226, as a crucial entry point into this spiritual state. James lays the groundwork for a model of spirituality which also accommodates psychotic experience when he writes:
“The most important consequence of having a strongly developed ultra-marginal life of this sort is that one’s ordinary fields of consciousness are liable to incursions from it of which the subject does not guess the source, and which, therefore, take for him the form of unaccountable impulses to act, or inhibitions of action, of obsessive ideas, or even of hallucinations of sight or hearing”. (P.229)
This is made more explicit in the often quoted:
“It is evident that from the point of view of their psychological mechanism, the classic mysticism and these lower mysticisms spring from the same mental level, from that great subliminal or transmarginal region of which science is beginning to admit the existence, but of which so little is really known. That region contains every kind of matter: “seraph and snake” abide there side by side.” P.419.
These quotations illustrate James’ recognition that people vary in their constitutional susceptibility to enter into such non-ordinary states of consciousness, which is precisely what Gordon Claridge, and the other researchers in the field of Schizotypy have explored at length (Claridge 1993). This approach normalises the varied incidence of schizotypy in the population, and stresses that, as well as entailing vulnerability to psychotic breakdown, high schizotypy brings advantages such as greater creativity and availability of lateral thinking.
James was also referring obliquely, at the end of the passage quoted above, to the then new study of the unconscious, which has since developed into psychoanalysis. Among the psychanalists (or analytical psychologists), C.G. Jung must be acknowledged as the one to have delved into the realm of the seraphs and the snakes, and to have brought many treasures to the surface. (e.g. see Jung 1963) However, his pioneering work has not led to the widespread practice of psychotherapy among people with psychosis. Such work, and its impact on our notion of spirituality has had to wait until more recent times.
The overlap between psychosis and spirituality has recently been recognised and researched. Mike Jackson tackled the subject with both a broad survey study, that compared the subset of a normal population who reported “spiritual” experiences with a diagnosed sample, and found much overlap, as well as including a fascinating qualitative study in his PhD thesis (Jackson 1991). His work has since become more widely available through published papers and chapters (e.g. Jackson 1997 and 2001). Emmanuelle Peters has similarly compared people involved in New Religious Movements with a clinical sample, finding differences in mood and adjustment, but not in quality of beliefs. (Peters et al 1999 and Peters 2001).
Recognising this overlap between spirituality and psychosis, and its relationship with universal human experience must have implications for the psychotherapist working with people with psychosis. Preoccupation with the spiritual is a characteristic of psychotic thinking. Voices that people hear are frequently attributed to God, the Devil, or other supernatural entities. “Delusions”, particularly grandiose delusions of identity, often involve religious figures, and the characteristic psychotic discourse is suffused with the supernatural, or a sense of spiritual importance. Immediately the therapist is challenged. Usually it is manifestly in the client’s interest to gain a stronger footing in the real world, but who is the therapist to pronounce on deep metaphysical matters? How do you prove who is right and who is wrong in such an area of discourse? Alternatively, the therapist might hold a definition of spirituality which precludes psychosis, so that the client is, by this definition, presenting a “false” spirituality. Again, who is to say?
I consider these issues to be very important, both so that psychotherapists do justice to the rich variety of experience that our psychotic clients present us with, without dismissive or reductionist reactions, and so that we are not sentimental about psychosis. We need to honour the experience, but also help people through the real distress and dysfunction that can accompany psychosis if we are to be any use as therapists. However, taking these issues seriously leads us into uncharted territory. Despite the insights of pioneers such as James, Laing and Grof, there has been reluctance bordering on defensiveness to consider psychosis and spirituality together. As I argue below, the very language we have at our disposal steers us away from such identification. I hope to show that tackling this issue head on leads to new insights into both psychosis and sprituality, and to a better grasp of at least the borderland of the great mystery at the heart of both.
Talking therapy for Psychosis.
The arguments that follow were developed through listening to the experiences of people with psychosis, and striving towards shared meaning making with them. This shared enterprise alerted me to other writers and researchers who were shedding further light on this area of discourse, such as those I have already mentioned;( Peter Chadwick (Chadwick 1992), Mike Jackson (Jackson 1997) and Claridge (1993)). These authors, along with others, collaborated with me in an edited volume (Clarke 2001), whose aim was to shed light on this area.
The timing of this enterprise owes much to the increased availability of talking therapy to people with psychosis through the NHS, which I would attribute to developments in cognitive behaviour therapy for psychosis. When I started working in the NHS, twelve years ago, there was little talking therapy available to people in hospital with chronic psychosis, outside one or two major centres – which certainly did not include Southampton where I was employed. Slow progress or exacerbation of symptoms appear to have blunted enthusiasm for earlier initiatives. The cautious adaptation and application of CBT approaches to psychotic symptoms from the late 1980s onwards has yielded more positive results, probably because the explicit and collaborative nature of the approach allowed for greater groundedness and safety in the therapeutic alliance than the earlier initiatives. The result of this is that this particular talking therapy is now very widely available to people with psychosis, whether of recent onset, or with more chronic forms of the condition. ( e.g.See Chadwick et al 1996 and Kingdon & Turkington 1994).
CBT for psychosis entails a paradigm shift in thinking by challenging the medical model (Bentall 1990 and Boyle 1989). The medical model stresses the distinctness of psychotic from normal experience, through the Present State Examination and the whole aparatus of diagnosis, and sees it as purely pathological. The new psychological understandings stress the continuum with normal cognitive processes, and the comprehensibility of psychotic concerns in the context of the individual’s life (e.g. Chadwick, Birchwood and Trower 1996). I fully embrace this view, and indeed it shapes my clinical practice. However, I wish to take the argument a stage further and emphasise the essential discontinuity between psychotic experience (and spiritual experience involving altered consciousness), and everyday experience, but without reverting to the medical model. I deliberately use the word “everyday” rather than “normal”.
I see psychosis and spirituality as two aspects, or points on a continuum, of the common human experience. I am interested in the way in which they have been so separated by the modes of conceptualisation current in our society. This is reflected in the language we use. My contribution to this debate will therefore be an examination of these modes of conceptualisation and an attempt to develop a means of discourse that is common between the two.
Spiritual Experience and altered consciousness.
There is a growing recognition that the dominance of the materialist scientific world view over the last three or so centuries has seriously stunted and distorted our understanding of the spiritual and religious dimension of life.(e.g. Sheldrake 1990 and Zohar 1990) It has been demanded of religion that it fits into the scientific scheme. This has resulted in “the God of the gaps” phenomenon, and the loss of the appreciation that there are two ways of encountering reality (or two “realities”). This appreciation has been fundamental to every human society from the most primitive until the present age.
I am here referring to a huge debate which is well beyond the scope of this article, but would direct the reader to anthropological research such as that of Felicitatas Goodman (1988) which elaborates the role of altered states of consciousness, or trance in religious ceremony in most societies – surviving in pale shadow in modern church services in the form of incense and repetitive chanting – and to the marginalisation of spiritual/mystical experience in a lot of contemporary religion. Neil Douglas-Klotz traces this marginalisation to the way in which the essentially mystical middle eastern religious traditions of Christianity and Islam have been subjected to the concretising influence of Graeco- Roman culture. He writes:
” Due to this (limited language concerning these states) Western culture developed a massive split between the “inner” psychic and “outer” normative consciousness, as well as splits between cosmology and psychology, body and soul, and humanity and the natural environment.” (Douglas-Klotz 2001)
These splits have led Westerners to seek in oriental traditions something that was once integral to our own, and has, I believe, led to a spiritual hunger in modern society that is fed by consciousness altering drugs.
I am therefore starting my argument from the premise that “spiritual experience”, entered into deliberately as through meditation, mystical practice etc. takes the experiencer into a different relationship to everything, and that, in a less controlled fashion, this is the same space that is stumbled upon in psychosis.
The Nature of Psychotic Experience.
One factor that disguises the overlap between psychotic and mystical experience is the underreporting of the frequent (but not invariable) ecstatic experience at the start of the psychosis. Peter Chadwick (1992) has written eloquently of this from his own experience. Even where it is recognised, and along with it the spiritual dimension of psychosis, as by Grof, Laing etc., the language used distances this insight from the generality of psychotic experience.
I suggest that psychosis, revolution and similar social movements, and profound spiritual experience which is often described as mysticism, follow a common process which encompasses euphoria, bewilderment and horror in a sequence that is actual for some of the time and potential at others. By this I mean that in mysticism, euphoria is an obvious feature; horror a potential that is less generally recognised and thankfully not so often realised (perhaps more often in the fake mysticism of hallucigenic experience). In psychosis the euphoria stage, which is often, but not invariably, present, is not usually talked about. It is mentioned as a possible part of an individual’s prodromal signature in connection with identifying early signs of relapse in Birchwood and Tarrier (1992), but not in its own right. It sometimes features in clinical histories as a time of well-being before breakdown. The bewilderment in psychosis is also a feature of the early onset phase when the world is experienced as confusing, and this is the time when delusion formation takes place, as noted by Chadwick, Birchwood and Trower (1996) in their discussion of “predelusional puzzlement”. In revolution, both the euphoria and the horror stages are usually accessible.
Developing a Language of Comparison.
There is a problem about trying to draw objective and generally accepted conclusions about spiritual, psychotic and revolutionary group experiences, because they are in their nature individual, subjective and difficult to communicate. The language available to discuss these subjects is inadequate and harbours assumptions that hinder comparison. Psychoanalysts talk of the emergence of un- or sub-conscious contents into consciousness (according to school). For the transpersonal psychologists it is called the ‘transpersonal realm’; Grof (e.g. 1990) speaks of ‘non ordinary states of consciousness’. Religious writers have a different set of terms; nirvana; higher states; the divine etc. Metaphors of height exclude psychosis; metaphors of depth, such as subconscious, denigrate the religious experience.
In addition to the problem of the spatial metaphors, frequent and contradictory use of the term ‘reality’ sows confusion. Some religious writers and transpersonal psychotherapists claim a superior grade of reality for the spiritual. This contrasts spiritual with psychotic experience, which, as everyone knows, is about losing touch with reality. Mike Jackson (1991) discusses these confusions in the introduction to his thesis on the subject, and invented his own term; “p-s experiences”, to facilitate comparison across the spectrum. I see as an essential precondition to exploration of this topic, the development of a clear psychological understanding of this area of human experience which embraces both the spiritual, the psychotic and the transpersonal so that group phenomena are included. What follows is an attempt to do this, using Kelly’s personal construct theory as a basis.
Two Sorts of Experience.
I start from the recognition of two possible modes in which a human being can encounter their environment. The most normally accessible of these two modes can be described as ordinary consciousness. The other mode is a less focussed state which renders both psychotic and spiritual experience possible, as well as being the source of creativity and personal growth. Starting from problem focused conscious thought, it is possible to envisage a continuum towards more automatic modes of operation. An example of the latter is the experience of reverie, of letting the mind wander as opposed to focussed thought. Such a state of reverie is easily accessible to all but the most stressed. Most people attain it naturally, whether by listening to music, lying in the bath or on a sunny beach. In this state the elusive solution will drift into the mind of the person who has been straining fruitlessly for weeks. Travelling further along this progression from focussed to less focussed thought, the next distinction is more difficult, as this is where, I would argue, the real discontinuity is encountered.
This is the experience of trying to still and centre the mind, whether in wordless prayer, in meditation, or by participating fully in a relaxation exercise or guided fantasy. A state of reverie is a necessary starting point, but on its own merely leads to daydreaming and unfocussed thoughts. The internal dialogue becomes muted but does not disappear. Switching into a prayer/meditation mode requires a special sort of “attention” which is recognised in Buddhist practice. I find the writings of Simone Weill, an unconventional mystic in the Christian tradition, particularly helpful in elucidating this area. Weill writes of it thus in ‘Gravity and Grace’ (1952) “Absolutely unmixed attention is prayer.” The fact that this is difficult, without considerable practice, and does not appear to come naturally, is my starting point.
A Personal Construct Understanding of the Two Sorts of Experience.
Kelly’s idea of Personal Constructs captures the dichotomy well. (See ‘Inquiring Man’ by Bannister and Fransella (1971) for a good introduction.) Kelly saw the human being encountering the world as a scientist, making hypotheses and predictions based on past experience and any other information that lay to hand. These predictions, or constructs, would be recycled and come to constitute the individual’s unique model of the world, both shaping his/her perceptions and actions, and being constantly modified by feedback born of experience.
Successful living requires a sufficient range of constructs to be able to deal with most situations encountered with relative ease, but with enough flexibility to be able to assimilate the novel situation. When encountering a new situation, the person needs to loosen their construct system sufficiently to accommodate the new material, thereby expanding the system. It is important that this should be followed by a consolidation phase where the constructs are tightened again, or the person will be unable to make valid predictions. Thus, Kelly’s conceptualisation contains within it a natural rhythm of expansion and tightening of constructs, very like breathing. According to this analogy, expansion of the system is compared to breathing out, and consolidation, to breathing in. A well functioning construct system is adaptive as it helps the individual to operate successfully in the world.
Viewed like this it is not surprising that leaving the construct system behind does not come naturally, as it entails moving away from the safety net of construction that the individual has created to operate effectively in the world. It means moving into the unknown. More challengingly, according to this model, as my understanding of myself 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. Laing (1967) writes about this: ” The ‘ego’ is the instrument for living in this world. If the ‘ego’ is broken up, or destroyed ……..then the person may be exposed to other worlds, ‘real’ in different ways from the more familiar territory of dreams, imagination, perception or phantasy. ” William James (1902) puts it thus: “an immense elation and freedom, as the outlines of the confining selfhood melt down.”
These ideas are developed further in my chapter in Clarke 2001
The Advantages of This Model.
What are the advantages of this construct theory model of the contrast between everyday and spiritual/psychotic/transpersonal reality? The only justification for introducing a new mode of conceptualisation is that it explains a wider range of observable phenomena, and I hope to show that this is the case.
The process I have been describing has two stages; the euphoria of encountering unmediated reality, and then the loss of bearings because of having drifted out of reach of the construct system, which people rely on to make sense of their environment. The often cited timelessness of the mystical experience shows that time is one of the parameters lost in this transition. In the case of a mystical experience attained through spiritual practice, (or, as often happens, occuring spontaneously, but within a spiritual context that gives it meaning for the experiencer), managing the transition back to construed reality after the experience generally (but not invariably) occurs naturally and after a short space of time. Where the same state is achieved by taking a drug, the return again normally (but not invariably), occurs when the drug wears off.
In psychosis (and drug or spiritual experiences that go wrong, or shade into psychosis), the orderly return does not happen. The individuals find themselves stranded beyond the reach of their construct system, trying to operate in the world. Not surprisingly this is extraordinarily difficult. The familiar boundaries between people, events, time and space are not accessible as before. Telepathy seems normal. Other people can read, and worse, interfere with, the individual’s thoughts. Coincidences abound – everything is connected and everything is disconnected. Everything is possible and nothing is possible. Where this new reality might be exhilarating for a short while, the sustained experience is terrifying. The desparate sufferer tries to make sense of the unfamiliar environment, clutching at whatever connections come to hand. In this way delusions, which usually have their origin in the early stage of the breakdown, are born. In another dissolution of normal boundaries, internal concerns are experienced as external communication, and the person hears voices. Normal thought is disrupted – or as the psychiatriist would say, disordered.
This model does not deny a physical aspect through some disruption of brain funtioning for these phenomena. In the case of drug taking, there is a simple physical cause, and indeed some ascetic practices such as fasting can create a physical precondition for mystical states in the context of spiritual practice. It offers a complementary psychological understanding of the experience of the person suffering from psychosis as one who is trying to make sense of the world, as all human beings do, but with their usual bearings removed. It is in the tradition of the normalising exposition of psychotic symptoms in Cognitive Therapy for psychosis.
Indeed, emphasising the overlap with spiritual experience brings psychosis in from the cold region of the utterly alien and incomprehensible where it is traditionally relegated. Our society’s particular illiteracy in the area of spiritual experience contributes to the even greater isolation of the person with psychosis. In ‘Recovery from Schizophrenia’ Richard Warner (1985) notes that in societies where experience of the spiritual/psychotic realm is valued, people diagnosed with schizophrenia have a far better prognosis than in modern Western Society.
This conceptualisation might finally have the advantage of bringing spirituality into a clearer focus in the scheme of things. It postulates that the spiritual mode of experiencing is available to all, but more easily accessible to some than others, according to variable schizotypy. Whereas construed thinking has many obvious advantages in terms of precision and predictive power, it inevitably jettisons some of the data. The spiritual mode of apprehension takes in the whole picture – in all its wonder and terror. It holds the key to the added ingredient in the beauty of art, and of perfection in nature; to the excitement of grasping at truth, and the “madness” of falling in love. Without this dimension and colouring life would be dull. Our ancestors recognised and honoured the sacred. They respected its resources of power and “spirit”, and cultivated the relationship with the divine and the beyond. They also sought to construe it in dogma and belief systems, which then collide with our scientific rationalism. Perhaps we need more than ever to grasp the paradoxical nature of the spiritual; to recognise that in this mode of experiencing, two contradictory things can be simultaneously true, so that we can cope with this collision, and reconnect with sacred. Without it, we lose our sense of connectedness with and responsiblity to the whole. Our current danger is that without this sense of connectedness and responsibility, we are destroying the material basis for our life through the recklessness and carelessness of our relationship with the earth. Paradoxically again, I suggest that we need to reconnect with the spiritual in order to safeguard the material, as our future is bound up with both. Psychosis means being lost in this mode of experiencing – but perhaps the rest of us could do to be less divorced from it, and have the humility to respect the experience of those, wherever they are on the schizotypal spectrum, who inhabit more easily this “other” wavelength.
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