Presenter: Ron Unger LCSW4ronunger@gmail.com541-513-1811

Co-Presenter: Michael Cornwallmichael.cornwall@att.net

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

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

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

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!

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

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

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

“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

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”

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

“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

“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

“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

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

The Pendulum Swings, from religious to medical…..

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

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

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

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

Between A spiritual experience with some mental

and emotional difficulties A mental disorder or psychosis with some

preoccupation with 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

Religiosity: seeing possible spiritual expressions or metaphors as being literally & concretely true.

Voices and other mental phenomena are seen as physically real.

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.

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.

Finding a balance with metaphorical expressions

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

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

I am God –

Grandiose, can’t relate well to others because they aren’t equal to me.

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.

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.

Balancing identifying with, and distancing from, Divinity

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

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

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.

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.

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.

Possible relationships between trauma and spirituality

Conflicts of EmotionsConflicts of Emotions

AngerAnger AnxietyAnxiety

SadnessSadness

blocks

blocksblocksblocks

blocksblocks

Each emotion can have a variety of Each emotion can have a variety of defensive behaviours and memories defensive behaviours and memories

Slide by Paul Gilbert

Conflicts of StrategiesConflicts of Strategies

DominantDominant SubmissiveSubmissive

Care-Care-SeekingSeeking

blocks

blocksblocksblocks

blocksblocks

Each strategy can have a variety of Each strategy can have a variety of forms, functions and behaviours and forms, functions and behaviours and

memoriesmemories

Slide by Paul Gilbert

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?

BodyState

subsystem

Auditoryss.

Visualss.

Interacting Cognitive Subsystems, a model by Teasdale & Barnard, based on research on cognitive processing – slide by Isabel Clarke and Donna Rutherford

Implicational subsystem

ImplicationalMemory

Propositional subsystem

PropositionalMemory

Verbalss.

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!

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

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

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

May flip between states or

coexisting, un-integrated

opposites

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

Identify with one’s “container” or outward form:

see emotion/spirit as illness, something which disturbs the person

Identify with Spirit/Emotion:

See one’s “container” or form as something to be broken or abolished

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

Developing a working relationship between spirit and form….

Level of Arousal

Ordinary, alert, concentrated, state of arousal.

Low arousal: hypnagogic; attention drifting etc.

High Arousal - stress

Slide by Isabel Clarke and Donna Rutherford

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

Discussion of Ways of coping suggested by this approach – management of arousal and distraction.

Slide by Isabel Clarke and Donna Rutherford

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

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

Person enters “renewal

process” looking for solution

Surrounding society sees

renewal process as a

threat

Surrounding society

attempts to suppress renewal

process in a way that causes

problems for the person

Madness Runs Rampant:

No limits are set on mad ideas or actions, no sorting process to protect against serious errors or dangers

Rigid Walls Against Everything “Not Normal”:

Fear of madness prohibits seeing anything spiritual or positive in “mad” experiences or perspectives

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

A Balanced Approach to Possibly Mad Experiences

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

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

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

Overly grasping toward some aspects of spiritual experience:

For example, seeking to be seen as more important or more powerful than others

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

Equanimity is important in approaching spiritual or mad experiences

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

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)

Everything /Nothing Identity

Identify with the transliminal, both expansive and non-attached, immortal, no fixed form

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

Loosely Defined Identity:

Some sense of form and boundaries to the identity, but also flexible, has resilience, not so easily threatened

Both very rigid, and very loose, identities are a setup for voices

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 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

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.

No flexibility leads to willpower being overcome by voices, impulses etc.

"Perhaps everything terrible is,

in its deepest being,

something that needs our love."

-Rainer Maria Rilke

That which one

consciously identifies

with

Impulse

Emotion

“Inner” Voice

Thought

External World

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.

Memories

Spontaneous imagination

That which one

consciously identifies

with

Evil Spirits

Aliens

Witchcraft

Brain Implant

External World

Satan

Examples of interpretations of inner experiences as being sourced in something other than the self

TelepathyVoice that isn’t part of me…

That which one

consciously identifies

with

Mental Illness

Chemical Imbalance

External World

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”

Misfiring synapses

“Symptoms”

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

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

444444 44

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I’m spiritually fine, perfect just as I am:

I don’t need to do a thing to make anything better, I’m invulnerable, perfect, beyond criticism.

I’m totally overwhelmed with worry

I need to manage and/or change everything, and I can’t possibly do it all

I have lots of problems but that’s fine:

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.

Balance of Activation and Soothing

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.

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.

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.

Developing Appropriate Trust in the Spontaneous

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”

Sharply Organized, Fixed on One View, Knowledge is Seen as Certain:

One side of “psychosis” and also of spirituality

Disoriented, Disorganized, No Sense of Having Knowledge:

One side of “psychosis” and also of spirituality

Fractal mix of organization & disorganization, knowledge and uncertainty, orientation & disorientation:

“Normal” human state

Spirituality – is it about being open, or closed?

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

Love of Being a Self, Autonomy

Love of Other, Connection

From Paris Williams, “Rethinking Madness”

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!