In the immediately preceding post, I wrote that:
Where do all the distortions that are common to what we see as psychosis come from? That’s the question I took on in a short series of PowerPoint slides that I created this morning. In these slides, I suggest that these distortions come about out of attempts to resolve two kinds of stress. One type is stress that can result when we are over-estimating the level of external threat, and the second is stress that can result when we under-estimate such threat and so are vulnerable to jarring encounters that we hadn’t anticipated.
I will be using these slides in presentations I do, where I will be able to explain the concepts in more detail. But I just thought I would post them here, to see how much sense they might make to you standing on their own. [Note: there is an option to look at the slides in full screen, and you may have to pick that mode to see all of the slides.]
I realized later that these issues needed more explanation than was offered, so I am adding a lot more explanation below. Let me know if it helps, or still seems too unclear!
What I was trying to do was to address a sort of confusion that all human beings face when confronted with severe stress and trauma, and that has to do with a bind caused by the stress that is usually not articulated. The bind is as follows:
Let us use the example of a major betrayal of interpersonal trust.
One danger after such a betrayal occurs, of course, is that the person may then have a difficulty trusting people. One way to cope with this is to see the betrayal as highly localized, to see it as just an exception in a generally trustworthy world. This allows one to again feel comfortable, to calm one’s emotions and to again relate positively with people.
One problem though with that coping method is that then one may fail to learn necessary lessons from the betrayal, and one will be highly vulnerable to having it happen again. A person who becomes sensitive to that possibility may develop a bias the other way, toward the belief that “paranoia makes me safe,” toward being very suspicious and aware of the possibility of betrayal in a huge number of situations. In fact, the person might even go from just noticing the possibility of betrayal, to assuming it is already happening “just to be on the safe side.” This allows the person to assure his or her self that there are no pending betrayals that have not been spotted, that one is not being “fooled again.” The issue here is also self-comforting, but at a level different than that in the prior paragraph.
The problem is that the two types of self-comforting are not compatible. If one tries to reduce the impact of the betrayal on one’s ability to trust by seeing it as highly localized, then it is much harder to reassure oneself that one won’t be betrayed again. But if one tries to increase one’s ability to reassure oneself that the betrayal won’t happen again, by becoming more suspicious or paranoid, then one’s ability to be comfortable with other people will shrink.
Wikipedia currently defines a double bind in the following way:
A double bind is a dilemma in communication in which an individual (or group) receives two or more conflicting messages, with one message negating the other. This creates a situation in which a successful response to one message results in a failed response to the other, so that the person will be automatically wrong regardless of response. The nature of a double bind is that the person cannot confront the inherent dilemma, and therefore can neither comment on the conflict, nor resolve it, nor opt out of the situation.
If the person can clearly see a bind, then it is not a double bind, because it can be faced squarely, and articulated clearly to self and others. So a person who recognizes the bind with regards to self-comforting may just “get it” that peace must be made with fundamental interpersonal uncertainty, and may find a way to make such peace. But a person who doesn’t recognize the bind, and who tries too hard to reassure his or her self that the problem has been solved, can “spin out” in either or both of the two sorts of vicious circles that I diagrammed in the slides I linked to.
It is interesting that in childhood mammals appear programmed to respond to harm associated with caretakers by minimizing it, so that the bonds and the trust can continue. This is based on a sort of programmed-in gamble that the mammal will be better off trusting the caretaker, despite any harm, rather than going on its own. But in young adulthood, this programming fades away, as now the individual must now develop his or her own balance regarding how much and when to trust. It is problems that occur at this stage that seem to lead, in an immediate way, to psychosis. My understanding is that many earlier events and conditions, ranging from biological problems like responses to infections, probably genetics and epigenetics, attachment problems, and childhood trauma, may add to vulnerability, but it is actual events in early adulthood that tip a person into actual psychosis. And since vulnerability is not determinism, it is also possible that later events and understandings derived from them can tip a person back out of psychosis.
Again, if a person can see the bind, then they can face it squarely, and this sort of facing the bind directly is I think a key part of recovery from psychosis. So I believe it is helpful when we as therapists can see the binds our clients are in, so we can understand our clients better and eventually help those clients understand their binds, face them squarely, and make progress toward recovery.
In the slides I linked to, I then tried to go a little further than the bind explained above, and touch on another bind that occurs once a person becomes aware that his or her own perceptions and evaluations are unreliable.
One might try to “think one’s way out” of the confusion, by trying to be more conscious of how everything is being perceived and evaluated, to try and spot mistakes. But this can be overwhelmingly laborious, and if one’s thinking is already biased, it may not work anyway.
To avoid being overwhelmed with such labor, and to allow the possibility of something fresh and new, one might pull back from questioning perceptions and beliefs, and just let them arise spontaneously, as one does while dreaming. But then new problems can arise, as without questioning, misperceptions and misunderstandings, otherwise known as hallucinations and delusions, can proliferate.
A person who is aware of this bind also becomes aware of the fundamental uncertainties in knowledge, in one’s helplessness to have rock-bottom certainty. And with this awareness of uncertainty, it becomes possible to take a fresh look at what is happening using one’s best judgment, which involves both spontaneous perception and intuition balanced with rational questioning to sort through inconsistencies as best is possible. This “fresh look” offers no guarantees, but can get a person unstuck from ways of looking at things and beliefs that were causing trouble.
I was reminded by Marian’s comment on my previous post that what appear to be distorted views in psychosis, whether paranoid or grandiose, often have some truth to them, or can be seen as true from a metaphorical perspective. I think, if we want our clients to be able to take a fresh look at reality, and to face the reality of the bind which means that real certainty is impossible, then we have to be willing to do that ourselves as well, and to meet our clients in this zone. Of course, we can’t really do that when we are totally sure that it is they who are psychotic and we who are sane – instead, I think it helps to note that even while it may seem obvious that in some respects they are misguided, we can also stay open to the possibility that there may be equally important respects in which we are misguided, and be open to taking that fresh look. Who knows what we may discover together when we are willing to do that.