When I was trained to be a mental health therapist, I was taught how to offer therapy for wide variety of psychological problems – but not for psychosis. We were essentially taught that human problems were understandable up until a certain point, but beyond that ….”There Be Dragons!” And these “dragons” could only be addressed by drugs, so people should simply be sent to the psychiatrist and not offered any therapy.
It is now more widely understood that “psychosis” is often an understandable response to life difficulties and trauma, and that therapy can at least often be helpful. But in most locations in countries like the US, training in how to get started in practicing therapy for psychosis is simply not available.
To help remedy that, I’ve put a lot of time into putting together 2 online continuing education courses that people can take anywhere, to get a great start in learning to be effective in helping people recover from “psychotic” difficulties!
Online courses allow people to watch video lectures and demonstrations at their own pace, while also being able to ask questions in writing, and get answers (within a few days) as they go along. The two courses (currently on sale) are:
Just until Wednesday 3/29/17, these courses available for just $29 each, which is a 68% discount off the regular price of $90! (Also until 3/29/17 only, these courses are available for free to non-professionals: see the links at the bottom of this email to access this option.)
Both courses provide both a deeply humanistic view of the difficulties involved in “psychosis” along with practical and understandable “evidence based” approaches to being helpful. And both come with CE credits for most US mental health professionals (more detailed information about CE credits is available at this link.)
Registration gives you lifetime access to the videos and other course materials, you can go back and review them whenever you want.
What follows are descriptions for each course, followed by some testimonials from students: [click to continue…]
I was recently asked to contrast my views on psychosis and recovery with those offered by NAVIGATE, a US government (NIMH) sponsored program aiming to guide early intervention programs for psychosis. This inspired me to inquire into what NAVIGATE does tell people and families about psychosis and recovery. What I found, unfortunately, was quite disturbing.
Navigate presents itself as a very humanistic program, with the goals of “helping people work toward personal goals and recovery. More broadly, the NAVIGATE program helps consumers navigate the road to recovery from an episode of psychosis, including supporting efforts to function well at home, on the job, at school, and in the social world.” The emphasis of the program is broad enough to include “Supported Employment and Education, Individual Resiliency Training (IRT), and Family Education.”
Unfortunately, while these mostly progressive components have value and may help some toward recovery, NAVIGATE includes them alongside a basically toxic collection of blatant misinformation about psychosis which is likely to have the opposite effect.
(I should note that what I write here is based on my review of specific sections of the Navigate Family Education Manual. As far as I know other educational materials produced by this program may be not quite as bad; though it is also possible that they may also be worse. What I do know is that the family manual is terrible enough to suggest the program as a whole is way “off course” from where it should be.)
Early on in my review of that document, I encountered this declaration, prominently made in a text box on page 92:
“Psychosis is nobody’s fault: People do not cause it.”
Wow, really? People “never” contribute anything to causing psychosis? Believing that requires completely ignoring what is now a vast collection of evidence that shows that adverse childhood experiences, including various forms of child abuse, do play a large role in making later psychosis more likely. That isn’t to say that people abusing other people is the only possible cause, but this claim by NAVIGATE that people never have anything to do with causing it is simply inexcusable.
The dishonesty of this statement sets my cynical side to wondering: did child rapists and other abusers of children pay NAVIGATE to so brazenly exonerate them from being blamed for contributing to later experiences of psychosis in so many of their victims?
And providing this sort of misinformation doesn’t just benefit abusers and minimize the importance of fighting child abuse as a way to prevent psychosis; it also makes it more difficult for people who have experienced such abuse to understand what happened to them and to work toward recovery. Even though their extreme experiences may be an understandable reaction to terrible things that happened to them, they are told there is no relationship whatsoever, and that the blame should go to their “psychotic illness.”
When children are abused, they are usually prevented from telling their story. Being forced to keep what happened and all the feelings about it secret then alienates them from others and from themselves. This alienation can later contribute to developing psychotic experience. When professionals tell people that their psychosis has nothing to do with the abuse they experienced, they are contributing to the same process that the abuser began, just “piling on” more alienation, more lies, more abuse.
And even when the psychosis is not a response to experiences of child abuse, it can still be the result of various interpersonal events and personal reactions to those events, a result of various conflicts and misunderstandings. When professionals tell people the psychosis is definitely not the result of any such events, the result is still more alienation that contributes to psychosis and makes recovery more difficult.
So why is NAVIGATE telling this kind of lie? I imagine, if confronted, they might explain that not everyone who becomes psychotic was abused, and they don’t want parents to blame themselves when perhaps they did nothing wrong, and also they don’t want people to blame themselves for becoming psychotic. Isn’t it better, they might ask, when no one feels blamed?
Well, no. It is true that inaccurate or exaggerated forms of blame can be very unhelpful. But placing blame where it belongs is the way we make sense of things, it’s how we learn to get in control of what we are doing and where we are going. Identifying the way others hurt or confused us helps us get a sense we could seek out better relationships in the future, with better outcomes. Identifying our own mistakes also allows us to become responsible for the direction of our life in the future. We are only completely “blameless” for negative outcomes when we are completely helpless, and by telling people that no one’s behavior had anything to do with causing psychosis, a sense of helplessness is conveyed that is actually a huge barrier to recovery.
A better approach is for professionals to be uncertain about what happened to cause the psychosis and what is going on now, and to support everyone in exploring possible viewpoints or understandings, in a way that supports taking personal responsibility for mistakes but also seeks to avoid inaccurate or excess attributions of blame or responsibility.
But when professionals are uncertain, people and their families may come up with a variety of different understandings, and they might not arrive at a certainty that a psychiatric framework best describes what is happening and they might not decide that drugs are critical to making things better. And that, apparently, is not acceptable to NAVIGATE.
So readers of the family education manual are informed, for example, that the duty of mental health workers is to “legitimize the psychiatric disorder” (p. 22). This is framed as something kind and helpful to do for someone – the “symptoms” that are being experienced, we are told, are simply beyond the person’s conscious control, “trying hard” to change things does not work, and so people must be taught to understand them is as part of a “psychiatric disorder.”
I do agree by the way that simply “trying hard” to overcome difficult experiences etc. often fails – but we don’t need the concept of a “psychiatric disorder” to explain why that happens. People often lack understanding of what is happening in their mind, and the things they then try to bring their mind under control not only often fails to work, but actually makes things worse! Trying to control thoughts or voices for example often makes them become more intrusive. And then as things get worse, people try even harder, resulting in escalating problems, creating a vicious circle. It is this vicious circle which then seems so uncontrollable, and is easily framed as illness. But the fact that people’s misguided efforts don’t make things better is not proof that nothing will work. A better approach is to simply notice that life and our minds can be tricky, and people may need help figuring out what does work to manage things, but there usually is a way to do so even if it has not yet been discovered.
What people don’t need is “helpers” persuading them to give up trying to understand themselves or relate to their own experience, and convincing them to see psychiatric frameworks as the only “legitimate” way of comprehending their condition.
But getting back to the NAVIGATE manual: once people have been convinced that the psychiatric diagnosis is “legitimate” then the next step apparently is to convince them it is definitely “biological.”
So people are first informed that “According to the stress-vulnerability model, psychiatric illnesses have a biological basis.” (p. 93). And then “because both biological vulnerability and stress contribute to symptoms, treatment for psychiatric symptoms needs to address both of these factors.” (p. 94).
It is interesting to note that the stress-vulnerability model as first introduced did not describe vulnerability as always biological; it instead described people as possibly having vulnerability due to a number of factors, which might range from something genetic to many other factors, including such things as unresolved childhood trauma to dysfunctional beliefs. The notion was simply that when vulnerability was higher, it would take less current stress to push a person toward psychosis. As such, it was a reasonable and I believe helpful theory. Unfortunately, this reasonable theory was soon distorted by biologically focused propagandists to frame vulnerability as always biological and further, always as something known to be certainly present in everyone who becomes psychotic. The NAVIGATE program is unfortunately choosing to propagate the distorted version of the theory.
One way of challenging this distortion is to simply ask to see the research that shows that there is in fact a type of human being invulnerable to getting psychosis. Of course there isn’t, and since as far as we know anyone could become psychotic when exposed to enough stress etc., then no one’s experience of psychosis can be taken as proof they have a greater degree of biological vulnerability than does anyone else.
And even if a person does have a specific biological vulnerability, there is no proof that treatment needs to “address that factor” as the NAVIGATE document claims. To better understand this point, consider a person with fair skin, which can be understood as a biological vulnerability to sunburn. There is no need to modify the person’s skin to avoid future episodes of sunburn – modifying environmental/lifestyle factors can provide a complete solution. It seems perfectly possible that the same sort of approach could work for any biological vulnerabilities to psychosis.
But there is no room in the NAVIGATE model or educational materials for conceptualizing a rational approach to psychosis without a “biological” treatment. To make sure drugs are prioritized, NAVIGATE even stoops to the old “biochemical imbalance” myth:
“Scientists believe that the symptoms are caused by a chemical imbalance in the brain.” (p. 101). And “Medications reduce biological vulnerability by helping to correct the chemical imbalance in the brain.” (p. 102).
If NAVIGATE had simply informed us that “some” scientists believe that the symptoms of psychosis are caused by a chemical imbalance in the brain, and that many others don’t, then there wouldn’t be much ground for criticism. But instead they try to convince us that a scientific consensus exists around a notion of biochemical imbalances which actually lacks even realistic evidence, and then they frame the drugs as handily “correcting” the problem, even though the actual evidence suggests the drugs create a biologically abnormal state of suppressed dopamine, and that this in turn causes the brain to shrink, etc.
Recovery, as you might recall, is supposed to be the primary aim of the NAVIGATE program. Interestingly though, in the educational materials I reviewed, significant effort seems to go into reducing expectations for recovery! The document speaks of the importance of “imbuing interactions with hope” (p. 5) but then the best possible outcomes they can cite are that “perhaps” as many as 20% might go on to live “relatively symptom free lives” (p. 6) and the possibility that “a small minority of persons with first episode psychosis (perhaps 10-20%) can live successfully even off medication.” (p. 114).
If NAVIGATE is really attempting to help clinicians “imbue interactions with hope” then they might try drawing numbers from, or even referencing, research that provides a bit more room for hope. For example, they might point to the Vermont Study, which found that about 34% of a population of people who had been considered chronic and severe cases were able to be living successfully in the community, off mediation, 20 years later after being helped by a psychosocial approach. Of course, if 34% of a “chronic” population can live successfully off antipsychotics, we would expect that a much higher percentage of people with first episode psychosis would be able to do so. They might also mention research into Open Dialogue, finding that over 80% of people experiencing first time psychosis were living “relatively symptom free” at a 5 year outcome point, with less than 20% taking antipsychotics.
We don’t know where the NAVIGATE authors found their tiny estimates of how many might be able to fully recover and live without drugs. But we do know that the overall effect of minimizing people’s chances for recovery, while also convincing people they are definitely biologically different in a way they can’t manage without drugs, is to discourage belief in the possibility of working toward true and complete recovery.
What is emphasized instead is the possibility of what might be called “recovery but still sick.” The emphasis is on helping people reduce their expectations, so that they will aim only at having some successes in the lives despite continuing to have a biological mental disorder, and will resign themselves to believing they need drugs to correct their “biochemical imbalance.”
I do see lots of value in efforts to help people have a full life despite whatever difficult experiences they might continue to have – and I know that getting support in this way often does help people a lot. But it’s just sad to see what are otherwise good ideas about how to help people being presented mixed in with poisonous lies designed to make people feel more helpless about managing and making sense of difficult experiences, and pushing them toward increased reliance on drugs. People deserve honest and balanced information on these topics that allows them to make informed decisions for themselves, not lies designed to push them in a specific direction.
By writing this blog post, I hope to shame NAVIGATE, and NIMH which has supported it, into correcting their educational materials, so that people experiencing psychosis and their families have a chance to become honestly informed about what is and is not known about the sorts of troubles they are having, about chances for recovery, and what might be helpful and harmful as they try to work toward that recovery.
As we view what many of us perceive to be the wreckage of our political system in the USA, it’s interesting to reflect on what this means in terms of “hearing voices” and “extreme states.”
Last month I attended the Hearing Voices Congress in Paris. A common emphasis in many workshops was on the importance of actually listening to the voices in a friendly way, with an eye to getting to know the emotions and the wants and needs behind the voices, while also getting better at not being taken in by what the voices might literally be saying when that happens to be a lie or something really destructive.
I also heard talk about how it can be really scary to listen to voices, because of the fear that they will gain too much influence, and might get us believing things that aren’t true and taking destructive actions. So it’s understandable that we often feel like it’s the wrong idea to listen, even though listening in the right way is key to healing.
It seems to me the same dynamics apply to a divided nation. We need to learn to listen to and respond in a caring way to the disturbed and disturbing voices within the population, to really engage with them, while also not believing any lies or distortions or letting destructive forces take over. Unfortunately here in the US, we have done too little of this deeper kind of listening, while there has been way too much of the shallower listening to and believing in lies, and soon to be, much destructive action.
So, since we are all “in psychosis” now, maybe it’s even more important to think about how to work through psychosis to some kind of “other side?”
Some of the most promising approaches involve some combination of love, or compassion, and dialogue. I recently had the opportunity to hear Charlie Heriot-Maitland speak about how to combine compassion focused therapy with voice dialogue methods to best reach people troubled by disturbing voices, within an individual or group therapy context.
I have been very impressed with his approach, which seems to get right to the heart of what must happen for healing. He emphasizes first helping people center themselves in a strong and compassionate place, and then doing outreach to the most disturbing voices, in a way that overcomes polarization by exploring the concerns of extreme voice while also not letting them run the show.
If you want to learn more about this approach, you can view this recorded webinar featuring Charlie, on the science and application of the compassion for voices approach:
Charlie of course is focusing on how to help individual voice hearers, not whole nations. But I think some of the same principles apply to national healing: we need to organize first around principles like compassion, wisdom, and strength, within ourselves and our support groups, and then reach out and dialogue with extreme and even overtly destructive voices, individuals and groups. This dialogue can help us find and even ally with what is good in these voices, and reduce the current polarization, while we also hopefully get better at finding ways to resist letting bad ideas “run the show.”
This isn’t easy, on either the individual or collective level. But it does seem to be heading in the right direction, and just getting started in the right direction can sometimes be a very big thing!
As Burning Man nears its 30th anniversary, USA Today has published an article attempting to explain how this still somewhat freakish event came into existence. I enjoyed the article, but as someone involved in the origin story it tells, I believe that an important piece is being left out. This relates to how misguided “mental health treatment” came close to disabling a key organizer of the early Burning Man. This piece is a fascinating tale in itself, but more fascinating when considered as just one example of how a flawed approach to mental health treatment forms a barrier to many forms of cultural evolution and renewal, with oppressive consequences for society as a whole.
It seems to me that we commonly hear sanitized tales of creative accomplishment that leave out the churning chaos that these developments may have emerged from. Then, when people do encounter such chaos or madness, in themselves or others, they see it just as something to be suppressed, rather than something more complex and full of potential as well as hazard. Eventually, the fear of going near such chaos forms a kind of cultural straightjacket, suppressing everyone.
The USA Today article describes, as one of the events leading up to Burning Man, an event I organized where participants were invited to wander about downtown San Francisco acting as “mad” as they liked, knowing they were being watched over by “mental health workers” who were part of the “mental health tour” and who would keep them out of trouble with the public and make everything seem “under control.” While the article reports that the purpose for this event was simply to see how “the public would respond to people who actually were in need,” my actual intention was to create a situation where people did not have to act “sane,” where they could feel free to explore other, more chaotic aspects of their being, and where such exploration would be made safe by the presence of tolerant others who would act as an interface with the often intolerant world we were immersed in.
This was important to me, because I had gone on my own journey through states that could be labeled “mad,” and I was also close to others who had similar experiences, some of whom were getting pulled into a mental health system that focused on suppression of such experiences rather than making it safe to explore them. And one of those people I was close to at the time was John Law, who later became one of the three primary founders of Burning Man, and who also provided critical financing that allowed Burning Man to survive in the years before it pulled in sufficient funds to finance itself.
It is Law’s story I want to focus on here, in particular the story of how psychiatry almost managed to pull him into the role of a chronic mental patient. I believe this story is important because it naturally leads to the question: how many people like him might be making amazing contributions to our world, if they weren’t getting “helped” by being pulled into a system that is focused on suppressing their experience rather than understanding it and seeking to find what is of value within it? Anyway, here’s the story:
At age 16, Law was starting college in Tennessee, financed by a “rehabilitation scholarship” meant to turn him around after a period of juvenile delinquency. He was living in a dorm, away from his family for the first time. He had no clear idea of what he wanted from attending college, though he had chosen forestry as a major. On the social front, he was involved with friends who liked to drink a lot and pop pills like various forms of “speed,” and to get money for all that as well as other needs, he worked as an engraver in a jewelry store.
It wasn’t going very well however. His focus on his education was not strong, as he didn’t have a clear sense of what he wanted to do with his education or with his life. And with all the substance use, and the stress of trying to work a job as well, it seemed impossible to study effectively. His mental state became increasingly foggy.
Then something big happened: a student in the dorm attempted suicide by jumping out of the building. Law isn’t sure if this succeeded or failed, but in the process the window to Law’s dorm room was smashed. This had a big impact on him, and in his foggy state of mind, he began to wonder if it was actually he who had jumped. Then, he began thinking he had actually succeeded in killing himself and was now in hell.
Still carrying those feelings some days later, he went to work as normal. But things weren’t normal. As he watched a co-worker, he saw the man’s fingers appear to multiply till there were 8 or 10 on one hand, and a monocle over his eye used for the engraving work also appeared to multiply; then he looked directly at Law with a clearly demonic leer.
Law’s response was to bolt from his workplace, and to call a cab, requesting to be taken to a mental hospital (or something). He didn’t know what was wrong exactly, but suspected it was something to do with his mind. The cab driver took him to an outpatient facility connected to the university. By that time Law’s thinking had shifted and he was convinced the driver was part of a giant conspiracy against him, but he paid his fare anyway and walked into the building.
There, not knowing how to describe what was happening to him, he explained he had just taken a massive dose of LSD and was having a bad trip. (He had actually not taken hallucinogens in recent months.) Rather than talk to him about his experiences however, or provide any kind of comfort, agency staff simply placed him in a room and told him to wait. After what seemed like a long while, Law got up to leave: but two staff members followed him, forced him to return and then locked him in the room.
Once locked inside the room, there was nothing to do but to watch the clock. It was a big clock, that made a big “click” as each minute passed. Then it stopped dead; Law found that odd. Finally, a doctor entered the room, who looked to Law like a corpse, which made him recoil. The doctor said nothing much, but reached out to take his pulse. As this was happening, Law looked at the time on the doctor’s watch – the exact same time as the time the clock on the wall had stopped! This was too freaky, so Law pulled his hand away.
What followed was foggy – getting sedated, and then shipped to a hospital. Once there, it seemed he was an object for study, and he was convinced the other “patients” were graduate students playing a role so they could better observe him. No one really tried to talk to him though, and he refused to say anything to anyone, at least until one evening a young intern approached him. The intern was very friendly, and talked to him for a long time, until finally Law opened up about his life and family and his experience of being in hell.
But that’s when things went very wrong. Instead of continuing to listen and explore, the intern began explaining to Law that perhaps if he invited Jesus into his life, he might get out of hell! Feeling manipulated, Law yelled and attacked the intern, knocking him down. What followed was restraint and another injection.
This was not the only time Law became violent on the ward – he estimates there were three or four times in total. And while to outsiders his fits of agitation may have seemed simply “crazy,” there was a story he could have told about each one, had anyone cared to ask him.
For example, there was the time he was, with the other patients, watching Walter Cronkite deliver the news. Like many Americans, this was a routine for him long before coming to the hospital, and he very much trusted Cronkite and his sidekick Eric Sevareid to speak objectively about the facts of the day. This evening, the news seemed to be about a “pygmy uprising” in Africa. As Law watched, feeling complete trust in the objectivity of what he was seeing, Sevareid stopped in the middle of his commentary, looked directly at Law, then pointed at him – and his finger came out of the TV set – and he declared “You are in hell!” Law can’t now recall exactly what his response was after that, but it was very agitated and the hospital responded with more restraint and sedation.
Law recalls that the whole hospital experience lasted at least two weeks, probably less than a month. Eventually he stopped hallucinating, perhaps as a result of the drugs, but he was not talking to anyone, and he felt he lacked the mental capacity to form words into sentences. (From a psychiatric perspective, this was cognitive dysfunction and negative symptoms.) Law isn’t clear on why the hospital agreed to release him in this condition, but he suspects that his father pushed for it. His father was a college professor with a long history of standing up to authorities and bureaucrats, and was already skeptical of mental health treatment approaches as they had impacted another family member. (Parents and other relatives cannot always make a difference like this, but in Law’s case, his parent’s willingness and even likely insistence on taking him home was probably pivotal in his recovery.)
Once home, things did not always go smoothly. But Law doesn’t remember anyone insisting he continue to take drugs, and he recalls his mom taking him on long drives, during which he was again vividly hallucinating, probably as the drugs wore off. Law himself was not inclined to talk, and his parents were stressed and his father avoided any talk about what had happened, while his mother talked about it only a little. But his younger sister wanted to talk about everything, and Law started responding to her, and as he did he started coming back to himself.
But this return to himself came with more problems. He didn’t know what to do with the shame of having failed to make good on his scholarship. And his family was not happy when he started reconnecting with the friends with whom he drank and took pills. This came to a head one night and an argument with his dad became physical, and his dad, a former boxer, punched him and knocked him out. Overwhelmed by this event, Law packed up that evening and left home.
That night, camped out by the side of the road, he sobbed and felt his life was ruined. The next morning however the sun came out, and he felt the promise of new beginnings; he decided he was a completely new person! He hitchhiked to Michigan to meet up with my brother Ken, a close pal of his since second grade. A few months later he and Ken hitchhiked to the SF Bay Area to visit me, and then Law decided to relocate there.
The timing of this was great for me, because I had just alienated the one friend who had been close to me during the last couple years when I had been going through my own altered or “extreme states.”
Unfortunately, the first time we became roommates together didn’t work out too well. Law was inspired to recreate something like the Haight Ashbury “crash pads” made famous during the late 60’s, but many of the people he invited in to stay rent-free were a bit difficult to get along with. For example, I recall the guy who decided he would paint a mural on the dining room wall, and who expressed certainty that it would be such a great work of art that the rest of us should be happy to let him eat our food and then clean his dishes for him. When I (among others) critiqued this plan, this guy and his friend threatened to murder me. Soon, there was no one left interested in paying rent, and the whole situation collapsed.
From a mental health system perspective, this housing disaster would be taken as evidence of both grandiosity and poor judgement on the part of Law, evidence that he was still “mentally ill.” From a more open minded developmental perspective though, that same story could be taken as evidence of his emerging creativity and leadership qualities, even if mistakes were being made along the way.
Our second attempt at being roommates, a few months later, was more successful. At the time we were both employed and fitting in enough to get by, but also deeply alienated from conventional society and looking hard for ways to create something really different. For a while, we just talked together and imagined the sorts of things we might like to see happen. Then, I was lucky enough to learn about a rather obscure but innovative institution called “Communiversity,” and Law and I together joined in for the initial meeting of its most famous “class,” the San Francisco Suicide Club. I liked it a lot, but for Law, it was magic: he quickly found his role as a leader first within the Suicide Club, then in the follow-up group the Cacophony Society and eventually, Burning Man.
Interestingly, while Law’s story is told in many places, such as the historical book This is Burning Man and in Law’s own book Tales of the San Francisco Cacophony Society, the part about an encounter with madness and with psychiatry is not included. Mention is made of his record as a juvenile delinquent, but no words about his time as a mental patient. When I asked him about this, he explained that in order to really build a new identity for himself, it always seemed necessary to put everything about madness and psychiatry away, to bury it. Fortunately, he is now willing to be open about this part of his past, and he has approved this story as it is written.
From my point of view, the really sad thing is that so many people who go through experiences like Law’s do not ever manage to break away from psychiatry and build a new identity. They are taught to see their internal chaos as simply “illness” and to focus on fighting it, rather than learning that if approached correctly it can also be a source of creativity and personal and possibly cultural renewal. That’s why I think it is essential that stories like Law’s be told and understood, so we really come to understand madness itself in a completely different way, and to respond to it much differently.
Interestingly, while madness often follows childhood trauma, that was not part of Law’s story. Both his parents were loving, and he related well to siblings and peers. He had a particularly strong role model in his father, who showed courage in standing up against racism and corrupt bureaucracy within the academic world in which he worked. But there were also big contradictions in his life and upbringing that weren’t being addressed. His parents had sent him to Catholic school, where the rigidity he encountered didn’t gel with the independent thinking he had learned from his dad. As he entered high school, he was introduced to various forms of rebellion in the form of drugs etc., but nothing that formed any coherent path to a future existence. By the time he entered college, he had one foot into trying to “make it” by conforming to a society that seemed rigid and meaningless, and one foot into drugs and thoughtless rebellion that also offered no future. Nothing was working.
Further, while Law’s dad was articulate and courageous when confronting obvious corruption, he was not adept at talking about deeper contradictions of the conventional society that he was part of and which he encouraged his son to join. So there really wasn’t a forum within his family or with anyone else he knew at the time for talking about the contradictory pressures he was experiencing. Unfortunately, a bind becomes a double bind when one can’t talk about it. There is no longer any conscious way out of the mess: instead, the existing order has to break down if there is going to be any relief.
For Law, this meant entering “hell.” From the point of view of psychiatry, the problem was that he thought he was in hell when he wasn’t, but from a more humanistic point of view, the problem was that his life was indeed turning into hell. To get out, he first needed to experience that consciously, then he needed to let the fixed beliefs about his life that he had previously identified with “burn away” so that he could resolve the contradictions and find a new path.
From the point of view of many traditional cultures, this is all very understandable. Shamans routinely understood they would have to go through things like experiences of dismemberment and destruction in order to explore new forms of existence and experience. But psychiatry focuses only on the suffering involved in “breakdown” and ignores the possibility of “breakthrough” and renewal that can follow, if only people get the support they need to allow their psyche to reorganize into something new.
When I think of Law’s story, I find the image of the “pygmy rebellion” to be especially interesting. One reason madness can be so terrifying is that parts of our mind with which we were previously barely familiar can be suddenly doing things that throw our whole system out of control. This “rebellion” of the less conscious parts of our mind can be understood to happen as an attempt to free us from the ways we are stuck, but if we then feel too threatened by its actions and just focus on attempts to “put down the rebellion and restore order” then the end result can be getting stuck in struggle, or what Eleanor Longden called a “psychic civil war.”
When Law decided to see mental health “help” he was experiencing profound alienation between his somewhat paralyzed and stuck conscious mind and less conscious parts of his mind, the latter of which were playing terrifying games with his sense of reality, for example “taking over” the image of favorite news announcers to instead make proclamations that were “delusional” if understood literally, but which did accurately describe what was going on in internal reality.
One of my favorite philosophers, Alan Watts, was fond of pointing out that if one’s car goes out of control on a slippery surface, the way to regain control is somewhat counterintuitive: one must turn the steering wheel in the direction of the skid. This is the equivalent of finding something of value within the madness and then going with it, developing it. The mental health system of course does the contrary, it focuses on turning against the skid, attempting to completely suppress the “madness.”
But fortunately for Law, he was able to slip outside the grasp of psychiatry, and then to “turn in the direction of the skid” and to join in rebellion against the established order in a more conscious way.
Law never again had a “psychotic episode.” Instead, he joined with others who had experienced similar bouts of alienation, to experiment with altering their own and other people’s sense of reality, so helping many discover that sense of freedom and play that had earlier emerged as that rebellion inside his own mind.
Interestingly, Law’s allegiance to play and resistance to fixed structures of authority led him to argue that Burning Man should be disbanded once it became large enough to require rules and more established authority. In the last year he participated, 1996, the theme involved an attempt by corporations, allied with Satan, to take over Burning Man itself. The video below captures some of the spirit of that event, and includes an image of Law “fighting back” against the corporate powers by climbing to the top of their headquarters, Helco Tower, setting off a bomb to ignite it, and then escaping via zip line:
Life itself is beset with contradictions. “Revolutions” of various sorts can make room for new life, but they quickly collapse if we don’t do anything to support them, to stabilize the new forms that emerge. Unfortunately though, the very efforts we take to stabilize our lives often turn and threaten to become deadening. An interesting reflection on this process was expressed by the Kafka quote that recently appeared on MIA, “Every revolution evaporates and leaves behind only the slime of a new bureaucracy.”
Opinions now vary as to whether Burning Man continues to be a dynamically growing and vital revolutionary event, or if it has itself become a soulless monster in need of being destroyed so something new can emerge. But leaving that dispute aside, I want to focus on two more basic realities:
First, it seems that no matter how “life supporting” our personal mental structures and identities or our cultural forms and frameworks may be, they do eventually run into problems, they become “soulless” and in need of renewal. Having them break down or burn away can be painful and even dangerous, but this process can also be vital, and may be required so that new life can emerge.
Second, we really need a “health” system that understands and supports this process of breakdown and renewal, rather than attempting to simply suppress it. John F. Kennedy has been quoted as saying that “Those who make peaceful revolution impossible will make violent revolution inevitable.” When we attempt to suppress revolution in the mind, those revolutions just become more chaotic and difficult to understand, and “chronic psychosis” becomes much more likely.
Fortunately, other pathways are possible. Lots will have to change, but telling and reflecting on the stories of those who found such alternative routes is one step toward creating a future where the norm will be for people to be supported in working through their personal revolutions in whatever way makes the most sense for them.
And then maybe, with luck, the very people we learn to help effectively will then turn and help the rest of us find pathways toward a very necessary cultural renewal. That is, their ability to see things differently may eventually help us all find radical alternatives to the current pattern that David Oaks calls “normal people destroying the planet” or “normalgeddon.” That’s the bigger challenge…….
The book “Rethinking Madness: Towards a Paradigm Shift in Our Understanding and Treatment of Psychosis” by Paris Williams is now free, in pdf version, at this website. That’s cool, because the book is a good resource in understanding how psychosis can be understood in a psychological way, and how recovery can be supported. Paris Williams has thought deeply about these issues, and has a good understanding of both the problems and the possible solutions.
I’d like to recommend a documentary show, 52 minutes long, which includes a lot about trauma and psychosis, and includes some interesting bits that relate to the interesting intersection of Compassion Focused Therapy with Voice Dialogue methods. Eleanor Longden and Charlie Heriot-Maitland both appear in the film, and are leaders in these innovative approaches.
The documentary is in German, but with English subtitles. (If you click on the “version” tab at the top of the screen, you can also access a version dubbed into French or with Spanish subtitles.)
In the mainstream, psychological difficulties are seen as “symptoms” of an “illness” or “mental disorder” and based on this the focus is put on suppressing them, either by using drugs, or shock, or by psychological interventions that also aim to “eliminate the problem.”
Unfortunately, this mainstream approach often works poorly, and too often its main effect is to aggravate the problem, or to cause “collateral damage” as critically important parts of the person are suppressed along with the supposed “symptoms.”
But if we want to replace the mainstream approach, we need a coherent alternative view, which realistically frames both the difficulties people experience and suggests better approaches to resolving those problems.
One avenue to this needed reconceptualization was expressed by Jacqui Dillon, who wrote that “When you understand your own ‘symptoms’ as meaningful and essential survival strategies, a more respectful and loving acceptance of yourself begins to emerge.”
I like a lot about that perspective and the shift in attitude it suggests. It helps explain why the traditional approach does so poorly – it’s difficult to heal if we are thinking of essential parts of ourselves as an illness!
There is one possible complication with this perspective though: if we think of disturbing patterns of experience or behavior as being “essential” then we might also feel stuck with them just as they are, with no alternative but just learning to accept and respect them no matter how much trouble they are causing.
One way out of that bind is to think of “symptoms” as meaningful strategies that do fit and are indeed essential in some kinds of situations, but which also are often put into action unconsciously or without much thinking or in mistaken ways. That is, at times they may be truly necessary for our survival, at other times they only seem necessary to some part of our psyche that activates them, while in reality they may be “going too far” and backfiring with destructive effects.
Defining them this way allows for more ambiguity, and suggests that each strategy etc. must be looked at in context, to sort out what really is essential or at least helpful in a given situation from what is well intended but misguided, and may be currently destructive. From that perspective, what we need is not wholesale suppression of what disturbs us, or complete acceptance, but rather an increase in discernment about what strategies are working or not, in particular situations. A strategy that truly was lifesaving during a traumatic situation, for example, may be extremely damaging when carried on into everyday life: but if we can appreciate the way it saved us at one time, we may also be better able to “let it go” in a present that no longer requires it.
To clarify this reconceptualization, what I would like to do now is to outline some of the major categories of psychiatric “symptoms” and describe how they can be reframed as possibly helpful, though often harmful, strategies:
I am sympathetic to these arguments, but I am also concerned they may be too extreme to be practical in a world that could still benefit from a medical specialty focused on mental and emotional problems.
Of course, I don’t mean at all to say that mental and emotional problems are typically “medical” in nature, as I believe they more commonly are simply reactions to difficult events or environments, which can in turn be worked through with some human understanding and non-medical assistance.
But I would propose there are three legitimate roles for a medical profession specializing in issues related to the mind and behavior:
When people are “mad,” they are often insisting that certain things are so, and frequently seem unwilling or incapable of appreciating or learning from other perspectives. Yet when the supposedly “sane” mental health system approaches those who are mad, it typically does the same thing – it insists that its own view of what’s going on is correct, and seems incapable of appreciating or learning from others, whether they be the patient, the family, former users of services, or anyone who understands madness in a different way.
So what’s going on with that?
One way of understanding it is to reflect on the very human tendency to narrow one’s perspective when feeling threatened. When people feel threatened, they tend to narrow their focus down to what they believe may avert the threat, and to shut out other perspectives that seem “wrong,” or that could lead to doom.
That works fine when the threat is relatively straightforward, and a solution can be arrived at which reduces the sense of threat.
But what about when it can’t?
When individuals are facing situations where there seems to be a dire need to solve a problem, yet no solution nor path toward such a solution is apparent, the person naturally enters into a state of conflict. On the one hand there is above mentioned drive to narrow attention in response to the threat, but on the other hand, there is a drive to expand awareness and experiment with unusual ways of looking at things, so as to possibly find a pathway to a solution that otherwise appears impossible.
It may be that it is the collision between the two tendencies, the narrowing of attention to focus on threat, contrasting and conflicting with the expansion of awareness while seeking to control what otherwise appears uncontrollable, that is responsible for the wild states we call psychosis, or madness.
So we see people who seem creative in some ways, often coming up with very imaginative interpretations of reality, yet who also seem very unimaginative and closed minded when it comes to seeing any down side in their point of view or being able to follow how and why others see things differently, or seeing how to negotiate in a world where others do see things so differently.
Those who are “mad” can then seem difficult to communicate with – their attention seems narrowed and entrenched in their point of view. We might say they are stuck in “monological thinking” and have difficulty with dialogue, with really appreciating and reflecting on the views of others and learning from them.
Unfortunately, these difficulties can be so intense that those around the “mad” person typically enter into their own kind of threat response, and narrow their own attention, and become stuck in their own “monological thinking” in an attempt to cope.
In the monologue of the traditional mental health system, a “solution” for the problem of madness is outlined. The mad person is simply experiencing an illness, one that has a name and a clear treatment plan, organized around attempts to suppress that “illness.”
The great thing about having this sense of a “clear path forward” is that it helps professionals and those around the mad person not feel mad themselves. That is, rather than feel there is a problem that urgently needs solved yet for which there is no identified path forward (the bind that could lead to madness), it is now possible to feel there definitely is a path forward – just narrow down one’s thinking and doing to the medical style approach, and no doubt or further reflection or inner conflict is required!
But fortunately, there are better approaches! They are less simple, and involve deliberately accepting uncertainty, and taking some risks, while also attending to safety concerns. These methods emphasize dialogue, and fight back against that tendency for narrow thinking in response to threat. Instead they embody a wisdom that recognizes we all best face complex issues when we are willing to be wide and open enough to hear all the voices, and that “sanity” is most likely to emerge through this sort of dialogical process, when it takes place not just within the “mad” person but also within the social network and treatment team.
The Hearing Voices Network makes really important strides in this direction – emphasizing for example changing relationships with voices rather than defining them as illness or suppressing them. There are now some forms of psychological therapy for “psychosis,” such as the style of CBT for psychosis that I teach (online as well as live) which emphasize relating in a dialogical way. But it is Open Dialogue, and the dialogical practices it has inspired, which have uniquely framed mental health work as being fundamentally about encouraging dialogue, and which often achieve amazing results just by aiming to support dialogue on all levels.
I was inspired to write about this now because I have been publicizing an “online meeting” or webinar with Mary Olson, titled “Introduction to Dialogic Practice.” This meeting has already happened, but you can listen to a recorded version of it at this link. (It may take a couple minutes to get started, so be patient!)
When people are distressed by voices and the impact that hearing voices has on them, it isn’t surprising that their goal often becomes getting rid of the voice and suppressing whatever message might be associated by the voice. The mental health system often takes the same perspective, seeing the voice as itself representing a mental disturbance or disorder, and defining health as no longer having the experience.
But what if attempts to suppress experience in this way are actually likely to increase disturbance or disorder?
I created an 11 minute video which explores how and why problems emerge when people try to suppress experiences such as hearing voices, and which identifies strategies that are much more likely to be helpful. The video is called “Reasons to be wary of attempts to suppress “hallucinatory” experiences” and up until 3/16/16, it’s available as a free preview within the online course CBT for Psychosis.
Just go to this link, and you will find the link to preview this video, as well as some other free previews.
The online course itself is also available for a 67% discount, only $29, up until 3/16/16.
Click this image for more information; 5 CE credits for US professionals, lifetime access to all videos and other materials - $50, or only $25 for people with lived experience of psychosis or family members!
Free Offer: Presentation on “Understanding Psychosis as an Attempt to Solve Problems: Integrating Perspectives on Trauma, Spirituality and Creativity”
Click the link below to access this recording that explores some of the trickiest aspects of "psychosis," and also to receive notices periodically about online courses and webinars that may become available.