Presenter: Ron Unger4ronunger@gmail.com1-541-513-1811

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?

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

Interpret voice itself as a threat

Hearing a voice

Increased emotional arousal hypervigilance, listening harder for more voices

StressVicious Circle

More

Interpret the voice as an effect of stress or as a source of information about aspects of self

Hearing a voice

Accept the voice as a useful signal of stress, take action that reduces the stress

StressVirtuous Circle

Less

Less trouble from

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

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

• 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 todanger will keep me safe

Taken from PowerPoint by Dr. Peter Scragg on Metacognitive Therapy

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

Negative Symptoms Positive Symptoms

Map of Extreme States

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.

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.

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”

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.

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.

People may “flip” between being lost in the transliminal & relying on rigid & defective constructs

Negative Symptoms Positive Symptoms

Map of Extreme States

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”

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”

Serious problems, depression

Goes into trance and wild ideas to escape problems and depression

Acts on trance or wild ideas without using

adequate discernment

Bad results from person’s own

actions & from mental health

intervention leads to life going further out

of control

Vicious Circle

Mental health system intervenes in way that is traumatizing, stigmatizing and/or disabling

More

Serious problems, depression

Uses discretion, though

sometimes still goes into trance and wild ideas to escape problems and depression

Acts on trance or wild ideas

only after using adequate

discernment

Actions lead to better results,

life makes more sense

Virtuous Circle

Any mental health

intervention is normalizing, encourages reflection & discernment

Less

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

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

reasonable mind

Ordinary thinking

Shared reality.

wiseMind –in touch With both

in the presentin control

emotion mind

or open to other ways

of experiencing

Non-shared reality

Shared and Non-shared Reality

Slide by Isabel Clarke and Donna Rutherford

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

Has [more]fears and insecurities

Attempts to cope by not

thinking about the “what ifs”

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

Fears intrude anyway in the

form of perceptions of

threat happening in the present (“what

if” quality is lost)

Vicious Circle

Has [less]fears and insecurities

Considers “what ifs” to a modest degree, without taking them too

seriously

Use of better judgment

results in better life outcomes, ability to put

threats in perspective Due to habit of

facing fears, able to evaluate whether threat is occurring in the

present in a reasonably

balanced way

Virtuous Circle

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

“Psychotic Symptom” Example of a sense in which is it a solution:

Example of a problemit causes:

Grandiosity Raises self esteem Induces problems in relating to others, supports bad decisions

Paranoia Creates sense of confidence that threats are being seen & faced

Life limited & stressed by seeing threats that don’t exist

Hearing a self critical voice

Self critical perspectives are explored within the context of a familiar relationship

May become demoralized due to excess self criticism & distraction from external reality

Flat affect, not showing much emotion

Avoids escalating emotions or communicating confusing emotion to others

Fails to connect emotionally with others and even with self

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

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

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)

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.

• 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 mesolve problems

Taken from PowerPoint by Dr. Peter Scragg on Metacognitive Therapy

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….

"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