Spiritual Issues in Psychosis Presenter Ron Unger LCSW

Spiritual Issues in Psychosis Presenter: Ron Unger LCSW 4 ronunger@gmail. com 541 -513 -1811 Co-Presenter: Michael Cornwall michael. cornwall@att. net

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

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 § Is too quick to judge what 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

Model of the “Renewal Process” § 1. Construct system breaks down § Common cause of that: trying to solve a problem not solvable within existing system § 2. Temporary suspension of constructs § Encounter with the “transliminal” § 3. Construct restructuring § If done under stress etc. , errors are more likely, leading to § Holding on to bad ideas, and/or § Can also be completed successfully, resulting in new vision that enriches the person & possibly the culture!

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, may eventually lead to a better life for the person and may also benefit others

Quotes on 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 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”

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

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 § A spiritual focus encourages professional humility § 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

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 is 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

Exercise § Split into small groups § Explain to each other § What did you hope to get by coming to this seminar? § In what ways are you getting what you wanted? § In what ways are you not getting it, what are your biggest unanswered questions so far?

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.

Model of the “Renewal Process” § 1. Construct system breaks down § Common cause of that: trying to solve a problem not solvable within existing system § 2. Temporary suspension of constructs § Encounter with the “transliminal” § 3. Construct restructuring § If done under stress etc. , errors are more likely, leading to § Holding on to bad ideas, and/or § Can also be completed successfully, resulting in new vision that enriches person & possibly the culture!

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

Qualities of the Transliminal § Numinous § Unbounded - a state without boundaries § Access to propositional knowledge/memory is patchy § Suffused with meaning or meaningless § Self: lost in the whole or supremely important § Emotions: swing between extremes or absent § No means of anticipating or discriminating § Both/and - two contradictory things can be simultaneously valid This slide combines 2 slides by Isabel Clarke

People may “flip” between being lost in the transliminal & relying on rigid & defective constructs Rely on defective, dissociated, and/or dogmatic constructs: Attempts at constructs coexist with an awareness of the mystery that surrounds them: Mystery, or awareness of limits to the constructs, is denied. Attachment to constructs is tentative, humble, maintains a sense of humor about their limits. Lively. 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.

New Integration Propositional Mind split from implicational, Concepts that aren’t related May flip between states or coexisting, un -integrated opposites Old integration, has problems Implicational Mind split from propositional, Relationships that have no concepts

The Transliminal & the Multiplicity of Fear § The transliminal itself can be threatening in two ways § Any possible danger can be seen within it § Preoccupation with it could cause one to miss mundane dangers § Leaving the transliminal can also be threatening § Risk of settling into more limited ways of looking that may be flawed & may impair one’s future § Risk of losing access to mental freedom & transcendence

Developing a working relationship between spirit and form…. Identify with one’s “container” or outward form: see emotion/spirit as illness, something which disturbs the person See Spirit/emotion, and one’s “container” or outward form as both vital aspects of oneself: Don’t wholly identify with either one, both can work together & avoid destroying each other Identify with Spirit/Emotion: See one’s “container” or form as something to be broken or abolished

Session 2. The role of Arousal shaded area = anomalous experience/symptoms are more accessible. Level of Arousal High Arousal - stress Ordinary, alert, concentrated, state of arousal. Low arousal: hypnagogic; attention drifting etc. Slide by Isabel Clarke and Donna Rutherford

DIALECTICAL BEHAVIOUR THERAPY: Linehan’s STATES OF MIND applied to PSYCHOSIS Discussion of Ways of coping suggested by this approach – management of arousal and distraction. Slide by Isabel Clarke and Donna Rutherford

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

Role of spirituality in recovery § For many, spirituality is key in response to any sort of adversity § Many report spirituality assists in recovery from psychosis § Visionary experience can contain keys to recovery § “Negative symptoms” can sometimes be overcome by opening up to spiritual themes present in the original psychosis

Person perceives problem not solvable within construct system Surrounding society attempts to suppress renewal process in a way that causes problems for the person Person enters “renewal process” looking for solution Surrounding society sees renewal process as a threat

A Balanced Approach to Possibly Mad Experiences Madness Runs Rampant: No limits are set on mad ideas or actions, no sorting process to protect against serious errors or dangers Balance Between Openness to Renewal and Caution About Error: Possibility of positive transformation is seen as existing alongside dangers of “madness, ” sorting/helping process exists Rigid Walls Against Everything “Not Normal”: Fear of madness prohibits seeing anything spiritual or positive in “mad” experiences or perspectives

Psychosis and Social Renewal § Rather than suppress the Visionary § A better role for society is: § Protect and contain the person and the process § Collaborate with the person in selectively drawing from the process § Train people prone to this process in how to navigate it successfully § Our survival may depend on a better relationship with the Visionary

Exercise § One person is therapist, the other is a client § Client role plays having a problem related to a spiritual issue § Could include grandiosity, or be persecutory, or both § Therapist attempts to engage with the following qualities § Being curious about the details of the experience, without being quick to draw conclusions § Willing to talk about spiritual particulars and spiritual coping ideas without pretending to be a spiritual expert § Open to talking about what might be positive in the experience, or how it might relate to personal or spiritual growth

Equanimity is important in approaching spiritual or mad experiences Overly avoidant of some aspects of spiritual experience: For example, resists the psychic death that precedes rebirth, fear of seeing sense in which one is insignificant Balance in spiritual experience: Appreciates the gifts in spiritual experience but also able to “let go” at each level to allow for what is deeper Overly grasping toward some aspects of spiritual experience: For example, seeking to be seen as more important or more powerful than others

Voice Hearing Experiences Common Within Spiritual Experience § One study of 3, 000 religious experiences, 7% heard a voice § Hardy, 1979 § Another study, 11% of college students reported that at least once they had heard the voice of God “as a real voice” § Posey & Losch, 1983 § Both of these citations were found in “Hearing Voices” by John Watkins

Rules of Discernment for Voices § These are suggestions John Watkins derived from studying guidance in various spiritual traditions regarding voices § see “Hearing Voices, A Common Human Experience” § Do not actively seek voice hearing experiences § Attempt to ignore the voices § (while looking for deeper sources of truth) § Discuss voice hearing experiences with others § Study the personal effects of the voices § Do not act on voice experiences § (think for yourself about what to do instead of doing something just because a voice commands it)

Both very rigid, and very loose, identities are a setup for voices Everything /Nothing Identity Identify with the transliminal, both expansive and nonattached, immortal, no fixed form Loosely Defined Identity: Some sense of form and boundaries to the identity, but also flexible, has resilience, not so easily threatened Rigidly Defined Identity: Identity is a fixed form, any internal experience contrary to this identity is a threat or an indication that one has died already

No flexibility leads to willpower being overcome by voices, impulses etc. I surrender to a voice or impulse, even when it appears to be persecutory or corrupt: Since I have no real power, I might as well surrender now and get it over with. I do what I can, then I make wise choices about when and how to surrender or let go of the rest: I turn over power only to what is good or once I have done what I can to create what is good. I never surrender to anything, or let go in any way: I must stay in control because I don’t trust anything that is spontaneous. I exhaust myself & get overwhelmed

"Perhaps everything terrible is, in its deepest being, something that needs our love. " § -Rainer Maria Rilke

External World Spontaneous imagination That which one consciously identifies with Impulse Emotion Memories Thought “Inner” Voice Internal representations of others Our culture expects us to define anything that is not “the external world” as part of our wider self, even if we didn’t choose it and it was triggered by the external world.

External World Evil Spirits That which one consciously identifies with Aliens Voice that isn’t part of me… Telepathy Brain Implant Witchcraft Satan Examples of interpretations of inner experiences as being sourced in something other than the self

External World Mental Illness That which one consciously identifies with Chemical Imbalance Misfiring synapses “Symptoms” Neurological Brain Disease “Mental illness” explanations continue the trend of defining experiences as sourced outside the self, but with different names and categories……. notice how the wider self is now polluted with “illness”

Forms of Compassion Worth Increasing: § Compassion from caretakers toward the person § Compassion from others in social network, family etc. toward the person § Person’s ability & willingness to be compassionate towards others § Person’s compassion for self § Person’s compassion for parts of self, § Ability of parts of self to be compassionate toward each other and toward whole self

Exercise § Client identifies an issue which triggers a self critical voice § Client expresses the point of view of the critic, then the point of view of the part of self that is criticized § Can go back and forth on this a few times § Can use different chairs for clarity, or write on paper § Then client shifts into a compassionate perspective § Shares thoughts and feelings both about critic and criticized self, from the compassionate viewpoint

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. . . 4444

Balance of Activation and Soothing I’m spiritually fine, perfect just as I am: I have lots of problems but that’s fine: I don’t need to do a thing to make anything better, I’m invulnerable, perfect, beyond criticism. I work on solving them as best I can, changing course as I learn more, and this process of doing what I can is perfectly acceptable. I’m totally overwhelmed with worry I need to manage and/or change everything, and I can’t possibly do it all

Developing Appropriate Trust in the Spontaneous Mistrust in the spontaneous, or Nature, or Spirit: Because I lack trust, I must rely exclusively on my own efforts or willpower, and so I get overwhelmed. I trust in my own efforts working alongside the spontaneous, or Nature, or Spirit: My own efforts have a role, but I don’t get overwhelmed because I can also find times and places to let go and trust. Blind trust in the spontaneous, or Nature, or Spirit: Since I am so trusting, I make no efforts to sort things out for myself, or to question what pops into my head.

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 “Spirit”

Spirituality – is it about being open, or closed? Sharply Organized, Fixed on One View, Knowledge is Seen as Certain: One side of “psychosis” and also of spirituality Fractal mix of organization & disorganization, knowledge and uncertainty, orientation & disorientation: “Normal” human state Disoriented, Disorganized, No Sense of Having Knowledge: One side of “psychosis” and also of spirituality

§ Photo of a Buddha being attacked by the Taliban, in Bamiyan, Afghanistan

Caught between two fears, two loves Love of Being a Self, Autonomy From Paris Williams, “Rethinking Madness” Love of Other, Connection

Exercise § Small groups § Identify what seems be the very most important things you learned or became more aware of today § Identify at least a few questions that this has raised for you § Someone write them down for your group § We will then attempt to answer as many as we can § Most of your questions you will have to work on yourself, with further study, observation & contemplation!