Addressing Spiritual Issues Within Bipolar and Psychosis Presenter

Addressing Spiritual Issues Within “Bipolar” and “Psychosis” Presenter: Ron Unger LCSW 4 ronunger@gmail. com 541 -513 -1811

Rough Definitions § Psychosis § Experiences of new perceptions, meanings, and interpretations outside of “reason” or mundane cultural norms, about matters of deep importance, § that seem to make things worse § Spirituality (at least when it is positive) § The same thing as above, § only it happens in a way that seems to make things better

Rough Definitions § Bipolar Disorder involves § radical emotional changes and mood swings, from extended episodes of feeling abnormally euphoric, optimistic, and energetic to periods of feeling sad, hopeless, guilty, and sometimes suicidal. § Periods of Spiritual Crisis and Transformation can involve those same dynamics § Spiritual experiences typically appear special in their degree of profundity and meaning for the individual, and seem to go beyond mundane consensual reality § (Jackson 2001) § The “going beyond” can seem positive or negative, and can alternate

Psychiatry sees categorical differences § Once a person is diagnosed § Their unusual experience is seen as definitely “illness” or “disorder” § The notion of any positive value to it, any spiritual or transformative potential, is usually dismissed

Framing perspectives as “mad” when they vary from cultural norms § Can label as pathology something that might be a movement toward cultural or spiritual innovation § Ignores the possibility that the culture itself may in some sense be “mad” or destructive § And that innovations may be necessary to correct it § Even innovations that may be disturbing at least at first

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 low stress etc. , more likely to result in new vision that enriches the person & possibly the culture! If done under high stress etc. , errors are more likely, leading to getting attached to defective constructs, and/or back into…. .

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

Problems with Common Mental Health Approaches § Make it more scary § by defining experiences as definitely part of a terrible illness § § § Don’t teach the person relevant skills Often isolate the person Focus on trying to stop the process Often stimulate a “psychic civil war” If discussion of spirituality is allowed at all, it is seen as secondary to the illness model

Better Mental Health Approaches § Recognize both the risks and possible benefits of anomalous experiences and perspectives § Are open to different ways of talking about these experiences § Acknowledge the normality of going out of our minds § Teach relevant skills § Focus on opportunities for connection, shared meaning, compassion § Are open to the idea that the overall process may be transformative § That is, it may eventually lead to a better life for the person and may also benefit others

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 bad or mad, may be highly contested § Wars are fought over what approach to spirituality is correct

The Known & the Unknown § “There are knowns; there are things 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 also unknowns – the ones 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

Being Curious & Open Minded About Possible Meanings of Expressions: § 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”

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

Historical perspective § “Madness” was more a matter of not having the right relationship with spirits or the spiritual § But being in a spontaneous altered state, even if out of control and floundering, might mean the presence of spiritual ability and gifts § If nurtured correctly

The Pendulum Swings, from religious to medical…. . “Madness” seen by dogmatic religion as resulting from spiritual wrong or offense against God: Risk is that person will be rejected or punished by society Complex view: Those apparently “mad” may have both biological and spiritual differences, and may have spiritual insights to offer, especially once any mistakes are overcome “Madness” seen as not spiritual at all, just a medical problem: Risk is that the meaning of the person’s experience will be ignored & excess medical treatment may occur

Problems for professionals if psychosis involves spirituality § Neither medical nor psychological professionals could then claim full “expertise” in the area of psychosis § Fear that absence of “expertise” could mean loss of status § Also, lack of understanding how to address spiritual issues within a mental health role § Or how to address issues generally in a non-dogmatic way

Problems for religious leaders if psychosis involves spirituality § Many experiences that contradict religious teachings or dogma might then be seen as at least partly spiritual and possibly valid § Religious leaders who don’t know how to help people with “psychotic” experiences might then be seen as lacking spiritual competence § If psychotic experiences are seen as partly spiritual, people may then question whether accepted religious practices may be at least somewhat psychotic

Problems when Religious Explanations are Too Dominant or Extreme § May be excess blame to the person § Problems framed as “sin” § Mysterious entities may be blamed § Believing the problem is a “demon” may not be helpful § Possibly useful mental health ways of framing the problem, and mental health treatments, may be discouraged § For example, people may be encouraged to discontinue medication when they are not ready to do so

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

Recovery & Spirituality: difficulties § Disapproval of staff expressing interest in spirituality from other staff § Staff find peoples’ religious concerns hard to handle. § People on the ward are afraid to talk about spirituality because it is regarded as a symptom. § Staff who try to convert service users to their “religion”: § other staff do not feel confident to tackle this abuse of vulnerable individuals. Slide by Isabel Clarke

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

How could even an atheist talk about spiritual issues? § Within science, psychosis is best understood from a whole systems, or complexity point of view § Spiritual language and metaphors can be understood as another way of trying to talk about the nature and dynamics of whole systems § Self organization, emergence, critical states, etc. § And about the unknown, and one’s relationship to it

“The Spirit Speaks Poetically but the Man Understands It Literally” John Perceval as cited in Bateson, 1961, p. 271

Finding a balance with metaphorical expressions Religiosity: seeing possible spiritual expressions or metaphors as being literally & concretely true. Voices and other mental phenomena are seen as physically real. Awareness of different types of existence and reality: Voices and other inner phenomena are seen as that, and are given neither excess nor inadequate significance. Metaphors are seen as metaphors, etc. Stuck in the Mundane: possible spiritual expressions or metaphors are seen as either untrue or of no importance. Voices & other mental phenomena are seen as either irrelevant or sick.

Could words that sound delusional just need translation? § Instead of focus on the way the words don’t make sense, or are unscientific § Look for ways to understand them that would make some sense § As metaphor, or touching on a meaningful psychological process § Then experiment with speaking about them that way & see what happens

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

Balancing identifying with, and distancing from, Divinity I am God – Grandiose, can’t relate well to others because they aren’t equal to me. I am not God in some sense, but also I am God or at least close to God in some sense: I can experience both oneness with the Divine in some sense and human humility, I can relate to others. I am completely other than God: I am a weak suffering being of little value, I don’t have enough sense of my value to relate well to others.

The Relativity of Madness § To be mad is to be “disturbed, and/or to be disturbing to others” § But if we find those who are mad to be “disturbing” doesn’t that imply we are “disturbed? ” § Perhaps unnecessarily? § And if those who are mad are “disturbed” isn’t it possible that it is we who have played some part in “disturbing” them? § Recognizing such possibilities is part of developing a healthy professional humility

Religious Trauma Syndrome § Happens when: § People feel blamed & guilty because a recommended religious approach didn’t cure an emotional problem § People are taught they have to be exactly a certain way to be acceptable – feeds perfectionism, rigidity § Religion is used to justify, or to give power to people who practice, emotional, physical & or sexual abuse § Teachings leave people feeling more stuck, guilty, afraid of concepts like hell or Satan § Dependency is created, make people fear making their own decisions § People become isolated in religious communities, then fear losing all support if they turn against the teachings

Role Play Exercise § “Client” is a young person having difficulties for the last 8 months that have been labeled schizoaffective disorder, § Is asking therapist’s opinion: § is this really a mental health problem? § or is it really a spiritual revelation like the voices say that it is, and as it sometimes seems to be to the person themselves? § Client: Really try to challenge therapist to provide a “clear answer”! § And maybe ask therapist about his or her own beliefs about spirituality and what is spiritually possible

Expanding the discussion § Moving from monolog to dialog § Jung’s “archetypal amplification” is one possible method § Rather than suppress “mad” views § Help person experiment with a variety of perspectives § Goal is to induce cognitive flexibility § This may be possible even working within a dogmatic religious frame

Possible relationships between trauma and spirituality Overly vulnerable after trauma: I cannot rely on anything to keep me safe. Previous knowledge has been shown to be inadequate. I am in permanent crisis. Uncertain yet finding spiritual safety in uncertainty: I cannot rely on any “thing” to keep me safe. But I can trust the process of doing my best, then letting go in each moment. Overly reliant special beliefs after trauma: Through my new spiritual/magical method, I can now be invulnerable to the kinds of threat that happened before.

Threat relations Conflicts of Emotions blocks Anger blo ck s Anxiety Sadness ks c blo Each emotion can have a variety of defensive behaviours and memories Slide by Paul Gilbert

Threat Relations Slide by Paul Gilbert Conflicts of Strategies blocks Dominant blo ck s Care. Seeking Submissive ks c blo Each strategy can have a variety of forms, functions and behaviours and memories

Conflict around Affect: “Bipolar” § Restricting positive affect and excitement, or depression, is one strategy § Depressed mood is associated with better “analytical rumination” § Which may be helpful in solving complex life problems § Empty or dark moods can help create the space where something new can emerge § Removing limits from positive affect or excitement, or mania, is another strategy § Can lead to persistence in a given direction that can lead to breakthroughs

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.

Interacting Cognitive Subsystems, a model by Teasdale & Barnard, based on research on cognitive processing – slide by Isabel Clarke and Donna Rutherford Implicational subsystem Implicational Memory Body State subsystem Auditory ss. Visual ss. Propositional subsystem Propositional Memory Verbal ss.

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 low stress etc. , more likely to result in new vision that enriches the person & possibly the culture! If done under high stress etc. , errors are more likely, leading to getting attached to defective constructs, and/or back into…. .

Stages in the experience § Not all stages experienced by everyone. § First: ecstatic – unitive § When prolonged - becomes frightening § Mind is no longer private § Open to any influence or “insertion” § Loss of the construct “safe/dangerous” - danger can come from anywhere. § The boundary between inner and outer is lost. This slide combines 3 slides by Isabel Clarke