≡ Menu

If you are new to this site, Questions and Answers about Recovery can be a good place to start!

Distinguishing Dissociative Disorders from Psychotic Disorders: Compounding Alienation

Stories organize us, and “bad stories” organize us in destructive ways. In this post I will address one example: the story told about how skilled mental health professionals can distinguish between dissociative disorders, with their roots in trauma, and psychotic disorders, which are understood to be definitely illnesses of the brain.

Why do professionals attempt to make such a distinction? The idea is that people with dissociative disorders need to be offered caring and skillful therapy which addresses their traumatic past and their fragmented response to it, so they can reorganize in a more integrated way. It is thought that such a psychological approach would be useless for those with psychotic disorders, as their problems are understood to be based in their diseased brains, with drugs being required to control the malfunctions.

If professionals really could reliably distinguish those whose problems came from difficult experiences and who could be helped by therapy and self-understanding, from those whose problems were more organic and who could not be helped in a psychological way, then focusing on making such a distinction would be a useful approach. But if their faith in their ability to do this is really a delusion, then what they are really doing is defining everyone on the “psychotic” side of the distinction as being beyond human understanding and help, and so inflicting another blow on those already severely troubled.

It is well known that people dissociate when all of the person’s mind cannot bear facing what happened directly. Later, parts of the person that did not face the experience may be unable to integrate with the parts that did: each feels alien to the other.

It’s what happens next that may be crucial in separating those who will be recognized as having a dissociative disorder from those who will be seen as having a psychotic disorder.

If the person recognizes the “alien” parts of themselves as being just parts of themselves, even if they seem to be disturbing or even “different personalities,” then they have a good chance of seeing themselves, and of having professionals see them, as having PTSD or a dissociative disorder. But if they see the “alien” parts of themselves as being literally aliens, or demons, or CIA agents talking to them through a brain implant, then they will likely be diagnosed as psychotic.

It’s important to notice what’s happening here: it’s the person who feels more strongly alienated from parts of themselves who is likely to make the “psychotic” interpretation about what those parts are — and then it’s that person who will be seen by the mental health system as having a disorder that is understandable only as brain dysfunction.

We might imagine the following exchange:

Person: “I have an alien inside me.”

Mental health professional: “No, what you have inside you is a defective brain, this is brain pathology or illness.”

When we are alienated from someone, we may fail to cooperate with them and actually battle with them, but at least we notice they are a living being. When people are alienated from thoughts, feelings, and parts of themselves, or characters inside themselves, they may fail to work with those parts or integrate them into their identity, but at least they relate to those parts as something alive. What professionals do when they pathologize parts of people or their experiences is to dehumanize them, to see them not as something living that can be related to, but as something that should be exterminated. This is where the alienation becomes compounded.

What’s missing in the professional’s response is an acknowledgment that what the person may have inside them is a very human response to very difficult experiences, and the brain may be simply responding to those experiences. By failing to admit that possibility, recovery becomes more difficult. If the person accepts the professional’s explanation, they may feel no longer inhabited by an alien, but now they are inhabited by pathology, and one that can be expected to be lifelong and requiring lifelong efforts toward ongoing extermination.

Professionals vary of course in when they start seeing evidence of “brain pathology,” versus when they are open to seeing a problem as psychological.

  • Some will still identify any report of voice hearing as evidence of brain pathology, with no consideration of the possibility that voices could be dissociative.
  • Some imagine they can use certain criteria to distinguish “dissociative voices” from “psychotic voices” — even though research shows there is no reliable basis for making such a distinction.
  • Some claim that if a voice is dissociative, then the person will be able to talk to it, while a person cannot talk to a psychotic voice.

The alternative hypothesis is that professionals are simply failing to recognize that alienation exists on a spectrum, and these professionals are mistaking differences in degree of alienation for a categorical distinction that does not exist.

It’s common for example for people to be told that dissociative voices are experienced as “inside” the person, while psychotic voices are experienced as “outside” the person.  But these experiences are really on a spectrum, and, it turns out, a very tricky spectrum.

For the purposes of this discussion, let’s say that a person is just dissociative, and not psychotic, if they perceive all the voices they hear (that others don’t) as part of their larger self, while defining someone as “psychotic” if they perceive voices they hear as something other than themselves. (Looked at this way, being “psychotic” is not distinguished from a dissociative problem, but seen as a possible complication that might occur, or a further degree of alienation.)

The tricky issue is that many people who are just dissociative in the sense defined above, actually hear the voices of the other parts of themselves as though they were coming from outside of themselves, from somewhere else in the room for example. They may also “see” parts of themselves as outside of themselves, though they are aware this is just a mental experience and so they are not psychotic. Meanwhile, many people who are “psychotic” in the sense defined above, hear their voices or many of their voices as located inside themselves, though they believe it is not part of themselves — as in the case where they believe that a demon or brain implant has gotten inside of them.

This makes more sense if we think of multiple spectrums: there’s the spectrum of how much a person is alienated from a voice or how much they see it as not themselves, and then there is the spectrum of how much it seems at any given point to be physically inside themselves.

The idea that professionals can define voices as more “psychotic” if people find themselves unable to talk to them also ignores the possibility of a spectrum; it ignores the possibility that inability to talk may be another function of the degree of alienation. We all know, for example, that when people are feeling very alienated from fellow human beings, they often find they are unable to talk with them. Many of us find for example that we can’t talk with people who are too different politically — or even if we are willing to talk, those others will not talk to us!

People in the hearing voices movement, and therapists working with psychosis, commonly find at the outset that people cannot talk to their voices, but with some work, such talk becomes possible, and helpful.

This work is not seen as possible, however, when the person’s initial inability to talk to the voices, and inability to see the voices as part of themselves that can be related to, is interpreted as evidence that the voices are just brain pathology. There is a notion that “one cannot talk to a disease” and so the professional’s interpretation that the voice is brain pathology becomes part of the problem in communication, or compounds it.

I should point out that “dissociation,” like anxiety or depressed mood, is not entirely a bad thing. There are times it is helpful, and some degree of it is part of healthy human functioning. People in the hearing voices network point out that hearing voices — a particular kind of dissociative experience — can also be part of healthy human functioning, though people can also have various kinds of problems with these experiences. Some of those problems reach the level of what is called psychosis — being seriously “out of touch with reality” and/or severely disorganized. But these problems can all potentially be addressed and resolved, by helping people relate to what they are experiencing rather than pathologizing it.

There are now lots of people who have publicly described their journey from being quite truly lost in psychosis, and fully meeting the diagnostic criteria for “schizophrenia,” and who then, as they got more insight, shifted to having experiences that looked something more like a dissociative disorder, and then eventually shifted to not being “disordered” at all. Eleanor Longden is a well-known example. When she was fully “psychotic” she was fully convinced that her voices emanated from physically real beings outside of her who could harm her and her family if she did not obey their commands, and her reasoning process was so bad that at one point she was ready to drill holes into her head to get the voices out, with no insight into the fact she would likely kill herself in the process. Later, she came to recognize the voices as split-off parts of herself, and as she reconciled with those parts, she healed. She tells her story eloquently in her Ted talk and in more detail in this longer version.

I work as a therapist specializing in therapy for psychosis, and while I am not always successful, I have been fortunate enough to help people make similar journeys toward healing.

These are complex issues, and this post only touches on the subject. I have been working to make education on this subject more available, in particular in the form of my online course Working with Trauma, Dissociation, and Psychosis:  CBT and Other Approaches to Understanding and Recovery, which comes with 6 CE credits for most US professionals.

In the bigger picture, alienation and dissociation is something that happens not just within people, but within and between social groups, tribes, nations, etc. Seeing the “alien other” as just something pathological, something to be exterminated, is not working very well. We need more attention to approaches that recognize the life and the validity in the alien other, and which help people and social groups assert their own needs while also finding ways to recognize and reconcile with the deeper needs of the other. There is reason for hope, so let’s do what we can to nurture the possibilities!

Innovative Approaches to Psychosis on YouTube

In the last few years I’ve been working with ISPS-US to produce videos of webinar presentations on a variety of innovative approaches to psychosis, approaches which break out of the usual routine in order to give people a real chance at recovery!

I’ve arranged to have presentations on a wide  a wide variety of methods, including

  • Open Dialogue
  • the Hearing Voices Network
  • Shamanism
  • Psychodynamic therapy
  • CBT therapy
  • Compassion focused therapy,
  • Slow psychiatry

I recently put all these videos up on one channel, making them easy for you to find or link to!  You can check out that channel (and subscribe!) at

Below is one of the most popular videos, in which Charlie Heriot-Maitland describes the process of helping people heal by developing compassion for themselves and also for their voices:

What Are the Down Sides of Antipsychotics? A Visual Summary…..

The possible benefits of the drugs called “antipsychotics” are pretty easy to comprehend – there is the possibility of a quick calming of what are often chaotic and distressing states of mind, and the risk that chaos will return if the drugs are stopped.

The down sides of the drugs are less easy to grasp. So often they never really figure into treatment decisions.

A new infographic aims to correct that, by summing up those possible down sides in one image:

For those interested, a list of references supporting the infographic are available, as follows:

[continue reading…]

A Wider Perspective on “Psychosis”

In an article published online by the Journal of Humanistic Psychology on 3/7/18, I argue that the mainstream view of “psychosis” is way too narrow, and I outline the evidence supporting a wider perspective, and reasons to believe such a view would allow us to be much more effective in our attempts at helping people.

Here’s the abstract for the article:

“Evidence that psychosis always has a biological cause appears lacking, while evidence that it can be a reaction to life events appears increasingly strong. A broader approach may therefore be required, one allowing for the possibility of psychosis emerging, independently of biological causes, when a person’s understandable attempts to solve difficult problems inadvertently create more problems. Efforts by helpers to simplistically explain or suppress psychosis may also then backfire and increase difficulties. Restoring balance may require accepting and integrating psychotic experiences, neither overvaluing them nor dismissing them as being without value. Some methods of working toward this goal are identified and discussed.”

This article is part of a part of a 20 author, invited Journal of Humanistic Psychology  2018 special edition on extreme states that’s titled-“Humanistic Perspectives on Understanding and Responding to Extreme States.” edited by my friend and colleague Michael Cornwall.  These articles are currently being published online and the hard copy edition of the journal will be out later this year.  I expect there will be lots of great articles in this edition!

Payment is required to view the published version of my article, but I’m sharing below the draft submitted to the journal:

A tale is commonly told of science narrowing in on an understanding of psychotic disorders such as schizophrenia – they are an illness of the brain, caused by genetic risk factors, biochemical imbalances (Deacon, 2013), and faulty circuits amongst neurons (Insel, 2010). Psychoeducational materials confidently inform families that “people do not cause it” (Glynn, 2014) – that is, it is not caused by interpersonal experience or personal mistakes.

But do the narrower views of psychosis really follow from evidence, or do they rest more on prejudice? [continue reading…]

Promoting Healing After Psychosis

What does it mean to heal after a psychotic episode? Is it just about trying to “get back to normality” and to suppress any further “psychosis” – or does something deeper need to happen?

I have written previously about how psychosis is often due to something like a revolution happening within a person – a revolution that occurs usually because the existing way the person is organized is in some manner not functioning well, or is oppressive.

It’s commonly known that just putting down a revolt and forcing a return to a prior oppressive “normality” will be unlikely to lead to long term peace and stability.  Instead, there will have to be some kind of a shift or transformation in the governing system so that the conditions that led to the revolution no longer exist.  Isn’t it likely that the same sort of thing applies in the case of revolt within the mind?

In 1996, Sean Blackwell had his own experience of psychosis within an apparent bipolar episode, and it seemed obvious to him that the episode was an attempt by his psyche to accomplish something quite profound. Rather than being an illness, Sean has always considered his break-down as a critical break-through in his own personal development. In 2011, he authored the book “Am I Bipolar or Waking Up?” while also producing numerous YouTube videos which explore the connection between psychotic episodes and psychological transformation. This entire creative process has led Sean to speaking with hundreds of people who have experienced psychosis which they found to be somehow meaningful.

However, modern forms of treatment don’t provide much space for people to explore altered states or “revolutionary” ways of functioning to see what might be positive in them: instead, action is taken to bring people back to some simulation of “normality” as quickly as possible. Once that happens, most people are understandably frightened of going back into an altered state, which is likely to both disrupt their life and bring on more intrusive “treatment.” Unfortunately, this can lead to being stuck in a kind of limbo state, with the person’s psyche still struggling to transform, but with the conscious mind firmly opposed to any further dangerous disruption of stability.

For years, Sean wrestled with the question of how to help people complete their healing journey in a way that would be sufficiently safe. He eventually turned to Holotropic Breathwork, which is a powerful therapeutic process originally developed in the 1970’s by Dr. Stanislav Grof and his late wife, Christina. While breathwork facilitators certified by Grof Transpersonal Training generally avoid using this method with people who have had a history of psychosis, Sean has found that for many people with such histories, holotropic breathwork can be both very effective and reasonably safe, provided that it is performed in a highly secure, private retreat setting.

In a webinar that occurred on 3/2/18, Sean shared the details of his retreat program, with a focus on how modifications to the standard holotropic breathwork format have led to increasingly positive results. Two of Sean’s clients share their experiences of healing — their shift to living a life free of both psychotic symptoms and psychiatric medications. You can watch a recording of this presentation at

Another source of information about this approach is this article from Moni Kettler which goes into detail regarding her initial healing process with Sean: )

It does make sense to me that we be cautious about any kind of exploratory practice that might send someone who has been “psychotic” into another “psychotic episode,” or another period of being lost and confused.  But I think we should also beware the risk of trying to be too stable and “normal” after psychosis, the risk of avoiding the transformative work that might need to happen for that person.  In other words, we need to avoid what Sandra Bloom calls “risky risk avoidance,” where avoiding risk at one level creates more risk at another.  I applaud people like Sean, who are trying to find a balance, attending to safety issues while also finding ways for people to take reasonable risks in their development and healing.

When Minds Crack, the Light Might Get In: A Spiritual Perspective on Mental and Emotional Breakdown

One of the most damaging aspects of the mainstream understanding of “mental health” difficulties is that they are conceptualized as a problem separate from the bigger and deeper problem of how we make sense of our lives as a whole, and how we find meaning, or spiritual questions.

I was recently asked to address the intersection of spirituality and mental health in a talk at the Unitarian Church in Vancouver BC. What follows is roughly a transcript of that talk, in which I question that split and outline a very different, and integrated, approach to understanding. (Or if you want, you could also watch or listen to this video of me rehearsing the talk):

To start off, let’s consider a story of a man who isolates himself and then stops eating for over a month. He starts seeing and hearing things, and a demon suggests to him he should jump off a cliff and suggests that instead of dying, he would get special powers. He doesn’t jump though, and he does eventually come back around people. But sometime later he goes into a place of worship and starts yelling at people he thinks shouldn’t be there and he’s trying to throw them out.

Now if you know our mental health system, you know this guy’s experience and behavior are very likely going to get him diagnosed with a psychotic disorder.
But what I just described is also what we have been told was the experience and behavior of Jesus when he went into the desert, fasted, was tempted by Satan, and then later threw the money changers out of the temple. He definitely wasn’t behaving normally for a Jewish person of his time.

That’s just one example: there are lots of ways that mental health crisis and intense spiritual experiences can look very similar. So an important question is, what should we make of that resemblance?I’ll briefly outline 3 approaches to answering that question that people sometimes try:

  • One is to say that any resemblance is misleading, and that spirituality and mental problems are two very different things, and that we should turn to experts to help us tell them apart.
  • A second approach is the one Richard Dawkins took in his book “The God Delusion”: just dismiss all of spirituality as mental dysfunction!
  • A third approach is to see it as more complex or possibly mixed, with useful spiritual experiences often emerging at times of crisis and breakdown. From this perspective, we would expect to often see truly spiritual and helpful experiences coexisting with some degree of error and confusion.

Out of these three, the approach that is dominant in our culture is to believe that experts like psychiatrists can tell if something is really a spiritual experience or just “mental illness.” But if you check out how exactly they do that, you might see some problems with their method!

Essentially what they do is to say that if a person’s experience is seriously disruptive, and if it is not normal in the person’s culture, then it is illness. But this implies that anyone who is experiencing something really new and disruptive to the culture, like Jesus or any kind of prophet, is at risk of being identified as ill. So there’s a danger that psychiatry will become a force used to suppress spiritual or cultural innovation.

A second problem is that psychiatry’s categorization of experience is very black and white. Once someone’s odd experience is categorized as being a result of mental illness, it’s then seen as worthless and meaningless, just something to be suppressed with drugs. But what about if someone’s experience is mixed, and they have some degree of spiritual revelation along with their mental and emotional troubles? In that case, what is the effect of refusing to see any possible value in what they are experiencing?

If you ask a lot of mental health professionals, they will say it’s a good thing to refuse to see anything positive in the experience of people who seem for example to be psychotic. They will say that it is “romanticizing psychosis” to see anything positive in psychosis. We are told to just see it as illness, having nothing to do with spirituality, even if the individual sees the experience as being all about spirituality.

I work with people who are experiencing what we call “psychosis” most every day. So I know how awful things can get. But while I do believe it is not a good idea to romanticize psychosis and to refuse to notice what’s bad about it, I would say it’s also not a good idea to refuse to notice what might be positive or spiritually important within people’s experience, and by doing so to “awfulize” psychotic experiences.

The method that I use most in my therapy practice is called CBT for psychosis. One of the most fundamental parts of this method is to aim at balanced thinking. Madness is typically about being unbalanced, so it’s definitely doesn’t help when professionals themselves have an unbalanced understanding of what is going on – as they do when they “awfulize” or “pathologize” confusing experiences.

One of the worst things that can happen when we awfulize experiences is we set off a vicious circle where people get more scared of their experiences, and then that fear and avoidance of their experience makes their mental disorder worse.

It’s interesting to reflect a bit on the way trying to reject experiences we think we shouldn’t have, and being grasping of experiences we do want to have, affects mental health in general.

When we don’t want to have an experience, we often inadvertently make ourselves have more of it.

For example if we really don’t want to feel anxious, then if we do start to feel a little anxious anyway we are likely to also feel anxious about the fact that we are starting to feel anxious, and the anxiety will begin to snowball. Or if we really don’t want to feel depressed, then we are likely to get more depressed in response to noticing that we are having some depressed feelings, and that can also snowball.

Grasping at positive feelings can also cause problems. When we just want to feel good, we might start pushing away any feeling or thought related to self-criticism or a need to slow ourselves down. This can make us carried away with ourselves, and get impulsive or even manic, in a way that can also snowball.

Now I want to contrast the unbalanced states I have just described with the perspective of the 19th century Polish rabbi Simcha Bunem. His idea was that it is helpful to have something like two pockets.

  • In one’s right hand pocket can be a statement like “For my sake was this world created.” Or even as I heard it once, “I am one with the universe, I am the Divine, I am everything.” That’s pretty grandiose, but also carries a truth about our essential oneness.
  • In one’s left-hand pocket can be a statement like “I am but a speck of dust, existing for but a moment in time.” That’s pretty humbling or even depressing, but also true in a sense.

The rabbi’s idea was that when feeling low or depressed, one might reach in the right-hand pocket and feel uplifted, while when feeling high and mighty and carried away with oneself, one might reach in the left-hand pocket and access some humility.

One thing I really like about that story is that it is about having access to, and finding spiritual value in, extreme states of consciousness. Because both those statements are extreme – but the rabbi is talking about accessing them both in a healthy and balanced, and a non-grasping way. We might say the rabbi is “bipolar” in a spiritually informed sense.

Tom Wootton is a modern guy who talks about the same kind of possibility, for example in his YouTube videos about what he calls being “bipolar in order.” Tom is a guy who was diagnosed with bipolar disorder, who then tried being a Buddhist monk for a while, and eventually learned to accept his extremes as being of spiritual value, as long as he kept them in perspective as just part of a bigger picture.

It’s actually not that uncommon that people will first experience extreme states of consciousness in an unbalanced way, and get lost and confused, and only later, if they are lucky and have help, learn to integrate those extremes in a balanced way like the rabbi did.

That’s my own experience. When I was a kid, I suffered lots of abuse, both at home and outside of home where I was severely bullied. Then, by the time I reached 17 years old, the abuse and bullying had ended. But inside I still felt crushed.

So, like many in my situation, I started experimenting with ways to make myself feel better. It started with using psychedelic drugs but quickly went beyond that, as I started thinking of myself as a completely new being with new ways of thinking and seeing. I would often see myself as God, able to recreate the world by seeing it differently. (Unlike some people who think they are God, I was open to the idea that other people were also really God. But since they weren’t aware of it like I was, they were more like insects or robots compared to me.)

During this time, I rejected the usual ways of making sense, so I often talked or even wrote letters in ways that made no or very little sense to others. Sometimes it was also very scary to me as I also struggled to make sense to myself.

One thing that helped though, and that gave me some perspective on what I was going through, was reading the ideas of radical mental health writers like RD Laing, and mystical literature like the writings of William Blake and Alan Watts and books like The Cloud of Unknowing. And, over the course of a few years I also almost always had at least one person I could talk to who saw something meaningful in my experience.

A big fear I had at the time was that all important others would see me as just mentally ill, with my efforts to redefine myself seen as meaningless aspects of a disease rather than as the most precious aspects of my spiritual self, struggling to survive. Fortunately for me, that never happened.

Eventually I found more people who took an interest in my wild perspectives. And as they showed more interest in me I started showing more interest in making sense to them, and eventually I no longer came across as crazy. So I never did get forced into any psychiatric treatment. And now I can look back at that time as being when I made lots of spiritual discoveries that really set the foundation for my successful adult life.

But later several my younger siblings started experiencing their own wild mental states. Unlike me they did get sent to mental hospitals and told their experiences were due to illness, and where no interest was shown in what might be positive in their experiences. It was seeing that mistreatment of family members and of some friends that got me interested in becoming a therapist and in trying to pioneer better ways of helping people with these kinds of challenges.

I believe that if we really want to get better at helping people, we need to do a couple things:

  • One is to get better at wrapping our minds around all the research that is now showing that adverse experiences and trauma typically plays a crucial role in throwing people into the states we call mental illness.
  • A second is noticing how trauma throws us into the zone where we face the big spiritual questions. This means recognizing that trauma and mental health and spirituality are all very related.

Most of us know the saying that it’s very difficult for a rich man to enter the kingdom of heaven. Often, we take that to be referring just to monetary riches. But being rich can also be seen as having a life free of trauma and serious losses. Because when things go well for us, we may just rely on those things, and relying on things gets in the way of spirit. Trauma on the other hand cracks open a hole in our lives and in our minds.

Psychiatrist Sandra Bloom is one who is good at describing how trauma disturbs our frame of reference, and brings into question our beliefs about self, world, causality and higher purpose.

There is a saying that there are some things you just can’t unsee. You can’t go back to totally mundane ways of seeing the world after very dark things happen. People have to access something spiritual, or something that could be called spiritual, in order to integrate the existence of darkness without being overwhelmed.

It’s also important to recognize that the effects of trauma are not all just at the time of trauma.

For example, my story is like that of a lot of traumatized young people. At the time when I was abused I just lived with a damaged sense of myself and the world. But when I got old enough to question my identity, I rejected most everything I learned about myself and the world and tried to reinvent it all. That could be described as a dangerous attempt to heal. I think of it as a process more like vomiting, expelling something that is messed up, or like a revolution, rather than as an illness.

What happened to me could be described as my mind having cracked open. Lots of bad things can happen, and bad ideas can get in, when things open up like that. But it’s also possible that the light, or something new and positive, can also get in at that time.

Joseph Campbell liked to say that the mystic swims in the same ocean in which the psychotic flounders. It’s in this floundering that people grasp onto fixed ideas to try to save themselves.

At times like this, people are sometimes grabbing very strongly onto really bad ideas. And then the mental health system comes along and says what they should really grab onto is the idea that they are just mentally ill. What might work better?

To stay with the Joseph Campbell metaphor, is it possible we could assist people as they learn to swim instead of flounder? That is, can we help people move toward the kind of balance that the rabbi in the earlier example demonstrated?

I definitely think so.

To accomplish that, we who want to be helpers have to also work on being more balanced. We need to be less certain we know what’s going on or that our way is completely correct. That allows us to be curious about how there might be something positive or spiritual in someone else’s confusing experience. And when we model being less certain, we set an example for those whose task is to possibly find some value in their own experiences while also being curious about where they might be making mistakes that require correction.

I would propose we do best when we are always searching for spiritual truth and sanity, but never too sure that we have it. In Taoism they say the way that can be spoken is not the true way. Just as in many spiritual traditions, any image of God or the Divine is understood to be not the true one.

We need rather a living interest in an ongoing process of discovery of the Way or of the Divine as we engage with each other. The terrible thing about modern psychiatric ideas about mental illness is that we are taught to lose interest in that kind of engagement. The diagnosed person’s views and experience are framed as just meaningless symptoms of an illness.

What I’m suggesting would work better is engagement and dialogue with those who seem crazy, and for each of us to engage and dialogue with the parts of ourselves that seem crazy. We can do this with the understanding that even though those people or those voices within us may be misguided in many ways, they may perhaps have a part of the truth that we don’t have, and if we talk together in an open minded way we might all learn something.

Another way dialogue with apparently insane people or insane parts of ourselves can be helpful is a little paradoxical. When I was going through my wild experiences, I was very impressed by a William Blake quote: “The fool who persists in his folly will become wise.” Sometimes it’s our encounter with the opposite of the truth that becomes an enlightening experience.

For example I knew a guy who had the habit of just believing and acting on whatever a voice, that he believed to be a spiritual being, told him. Finally the voice stated “I am just telling you all this so you will learn to be less gullible!” It was a backwards way of encouraging him to have critical thinking.

And often people can learn to find value in what initially seem to be very negative experiences. One guy was disturbed for years by voices who would make him feel vulnerable. And so he focused on fighting them, which really didn’t work. But later he realized he had spent years denying any feelings of vulnerability, and that he had the option instead of using the voices as a reminder that he did have vulnerability and that was part of life. So now the voices were something helpful instead of something he had to fight.

Now a lot of this stuff can get pretty tricky. But you don’t need to know all the tricks to be able to be helpful to people having the kind of experiences I’ve been talking about.

  • One thing you can do is just be more open to talking to people about confusing or disturbing experiences, while keeping in mind that there may be some meaning in these experiences, and something of value mixed in with any confusion or errors.
  • A second thing you can do is advocate for reshaping our mental health system so that it will support people in working through these experiences rather than just framing it all as pathology to be suppressed.
  • A third thing you can do is support people having access to peer groups like hearing voices groups, where alternative views can be explored in an open-minded way.

At the end of my talk, I thanked those in the church for being willing to consider this point of view – there aren’t that many churches that are open to considering the possible intersection between mental health crisis and spiritual breakthroughs!
I might also have thanked Leonard Cohen for his recognition of the way the light comes through the cracks in everything:

Or earlier, Rumi: ““The wound is the place where the Light enters you.” None of these ideas are entirely new, but we always need to introduce them again, because they are always being forgotten……..

From “Recovery” to “Transformation and Recovery”

Going mad involves breaking away from, or losing touch with, group norms and ideas about reality. This routinely leads many to even extreme levels of distress and disability, so I am among those who continue to think that promoting whatever might help people “recover” from this distress and disability is vitally important.

That’s why I get involved in projects like producing the the webinar,

that happened on 12/12/17. In this webinar, Paul Grant and Ellen Inverso  present approaches they have researched and developed that can often help even severely “institutionalized” people return to an active “sane” life. If only more professionals could learn and practice these methods, we’d have many fewer people permanently disconnected from productive lives, or permanently alienated from society.

But is being productive and connected to the group norms of our society really the highest goal we should be talking about?

I think it’s more complex than that.

One way of understanding psychosis is that it often comes out of what some call “efforts at adaptation” – that is, psychosis results from efforts (consciously, or more often not consciously) to transform oneself and one’s mind in a way that might resolve problems that were not getting solved within one’s previous “sane” way of being in the world.

So I think we might better talk about what is needed as “transformation and recovery.”

Just “recovering” one’s previous way of functioning is not so likely to work, because usually something wasn’t working prior to the psychosis. It was that which set off the psychosis, and if that isn’t changed, any “recovery” may not be worth much, as the problems, and so the need to transform, will likely still be present, and will tend to cause other problems or even set off another psychotic episode.

What are the problems that cause people to need to enter a process of transformation? A damaged sense of identity caused by trauma can be one of them. But sometimes the problems are more cultural, the person is more sensitive than most to cultural contradictions and conflicts, and needs to reconcile some of those to go on. Or they might be something else, perhaps even something more biological – for example psychosis is more common after brain damage, and it might be that the person needs to transform in some way to deal with the way their brain is functioning differently.

The key thing to understand is that psychosis involves not just a defect in the person, but an attempt to reorganize to address problems. Like any attempt to reorganize, success is not guaranteed, and some attempts to reorganize may cause way more problems than they solve, but people can also learn from failures if they are given the space to sort things out. (Those of you more interested in how psychosis can be understood as an attempt to solve problems, and how that relates to trauma, spirituality and creativity, might be interested in a recording of a talk I gave on that, available at this link.)

Of course, a lot of people will say it is “romanticizing madness” to point out any connection between psychosis and creativity.

I do see a lot of difference between being lost in psychosis and being successfully creative, but I think we also need to avoid “awfulizing psychosis” as we do when we fail to notice what’s common between psychosis and creativity. Successful creativity, like psychosis, involves a process of pulling away from the “normal,” of experimenting with various sorts of transformation, and then of bringing something back, or “recovering.” It’s just that when the person does this without needing obvious help, the parallel with psychosis is often not obvious. And when people are experimenting only with more superficial forms of transformation, they are less likely to get lost in any important way, and so it may then be much easier to manage any “recovery.”

Support for the notion that creativity is facilitated by social disconnection came recently in a study reported on in this Newsweek article. That shouldn’t be too surprising: it’s hard to come up with anything really new when one is also following the path of “the herd.” But being successful with one’s creativity also involves that social reconnection or recovery piece

So I think the bigger picture is that people need to be both given the space to disconnect from the established order, and to reconnect in a way that allows them to bring something back from their process of transformation. This would accomplish two objectives:
• It would allow people some space to experiment with the deep changes they might need to make to resolve the problems that pushed them into psychosis, rather than trying to immediately pull them back to their previous mindset that was likely not working for them, and
• It would benefit our society as a whole, as culture would be enriched by allowing people support as they went into the creative process in a deeper way

Will Hall, on his show Madness Radio, routinely asks the question, “What does it mean to be called crazy in a crazy world?”

I recently read the preface to Will’s book Outside Mental Health: Voices and Visions of Madness and I noticed that in his writing there he answered a related question, which could be stated as, “what does it mean to recover when the world is mad?”

Here’s what he wrote:

“The stronger I became in reality, and the more I became capable and my “functioning” improved, the more something unexpected happened. My altered states and different mental experiences that got called “psychosis” did not go away. They became more real. I found more and more reason to believe in the truth of my “symptoms.” I wasn’t recovering from “madness.” Something far more mysterious was happening. The hospitals and the threat of my label have faded. Today I am less isolated, more in control, and less terrified than I was that day when a team of doctors gathered around a consulting table to pronounce me schizophrenic. But my most “florid” symptoms of that time, my unusual beliefs, my conversations with voices, my paranoia, my contemplation of suicide, my silent inward withdrawal, my perception of prophetic omens… all of that remains. Professionals made their case for my severe mental illness diagnosis by presenting symptoms as evidence, but that evidence is all still part of me today, even as I live outside any psychiatric care or treatment. I am doing something completely different from what medical and mass media narratives say I should be doing: I am regaining my wellbeing in the world while at the same time losing touch more and more with “reality.” My madness is leading me somewhere that is more real than what everyone seems to say is real. I’m leaving behind not just the doctors’ diagnosis, but also the mechanistic, soulless, and “objective” reality that gave rise to it. I have begun to arrive somewhere very far outside mental health indeed.

“TODAY I WILL MEET SOMEONE FOR THE FIRST TIME. I make breakfast, and last night’s dream rings in my imagination: I was with my brother, we were playing together outside.

“As I recall the strange atmosphere of the dream, I break a single egg into a bowl, and look down. I see two yolks there, fused together, both from the same shell. I arrive at my counseling office, and the woman I meet says why she has come to see me. She tells me her birth was traumatic. She tells me that her twin sister died when she was born, and, she says, her sister is still haunting her. Psychiatrists haven’t helped; they labeled her delusional. I sit listening to this anguished woman talk about her twin sister. I recall the dream about my brother from the night before, and I remember the egg I broke this morning. I know that it is only the habit of what we call “real” that makes us think there are two people in this room, instead of there being one person here, meeting themselves for the first time.”

I very much share with Will his aversion to the “soulless objective reality” that is so often accepted without question in our culture, though sometimes I slip into that cultural trance anyway.

But then I get reminders that there is more to look at, more to consider. An example: just before I read the above excerpt, my partner remarked, while cracking an egg, that it had a double yolk! Sure I could take that as “just a coincidence” but I could also take it as a direct message, from “the universe,” that I should be paying attention to Will’s words and recalling that there is more to existence than the often lifeless theories we often use to conceptualize it.

This brings me to another possible meaning for the term “recovery.” It could be used to mean, not just recovery of our connection to the people and ways of thinking that are considered “sane” within our culture, but also as possibly meaning “recovering” our connection to vital elements that are left out of our culture!

So “transformation and recovery” can mean transforming in a way that allows for connection to those missing elements. In my way of thinking, people like Will Hall are models for how it is possible to “recover” in both ways at once: to connect well with both “conventional reality” and with elements that are usually left out. This of course is the traditional role of the shaman, the person who moves between worlds.

I’m not suggesting that everyone who experiences psychosis will want to be something like a cultural pioneer, a prophet, or a shaman. Many will be only too happy to make whatever minimal changes they must make in themselves to simply return to conventional society, aiming only at very conventional notions of success! But for others, a psychotic episode is just an initiation into questioning socially constructed realities and seeing other possibilities. Success for them is defined not as staying anchored in “this world” or way of looking at things, but in traveling to other worlds or views, coming back to this one to share and connect, then traveling again, etc. I hope we eventually create a mental health system which can understand and embrace this process, a mental health system open not just to recovery, but also to transformation and appreciative of the importance of that in our collective life.

More Rest Leads to Less Psychosis

A recent study showed that just a brief internet-based CBT intervention aimed at improving sleep was also effective in reducing paranoia and hallucinations.  (You can access an article about the study at this link and the full academic article at this link.)

This finding adds to evidence suggesting that educating people how to improve their sleep should be a basic part of helping people with “psychosis.”

This idea isn’t new, but hasn’t been taken seriously enough.  One might say, it’s so basic that it gets overlooked (especially by people who are sure psychosis is definitely the result of a special “illness” rather than perhaps just life problems that aren’t being dealt with adequately.)

A classic book on the psychodynamic approach to psychosis, “Psychotherapy of Schizophrenia,”suggests reminding people they have the option of “just resting” if they can’t sleep, and that 8 hours of resting is probably worth 5 hours of sleep.

I encourage something like the “just resting” approach, but I also suggest people try to meditate as they rest.  For example, a person might simply focus on the breath and then gently bring their attention back to the breath every time they get distracted.  People sometimes complain that this type of meditation is boring, and it’s especially hard to do this kind of meditation while lying down without falling asleep – but in this case, that’s not a bad thing!

One of the things that often keeps people awake, once they have gotten “keyed up,” is simply worrying about whether they will sleep or not.  Worry itself is activation and can prevent sleep.  So what I suggest is that people tell themselves they will either get into a good and restful meditative state – if they are awake enough to carry out the meditation successfully – or they will fall asleep, and it really doesn’t matter which happens!  In either case, they will get a decent amount of rest.

One site that has quite a bit on mindfulness to improve sleep is nosleeplessnights.

Anyway, I hope if you have any kind of difficulties with sleep, that you try out some of these ideas!

Expanding the Conversation: Talks on Hearing Voices, Oppression and Recovery

The Hearing Voices Congress of 2017 is over, but it’s not too late to listen to some of the key talks that happened there!


Other keynotes:
* Marty Hadge
* Akiko Hart
* Barry Floyd
* David Walker
* Val Resh

Check these out to hear some amazing stories, told with insight into some of the deeper issues we all face!

Many of these videos touch on issues of culture and cultural oppression, and intersections in identity, and how that all affects the altered states of mind that get called “psychosis.”

These are issues that will also be addressed at the ISPS-US Conference in Portland Oregon November 17-19, 2017, where the theme is “Psychosis in Context: Exploring Intersections in Diverse Identities and Extreme States.”  Note that Gogo Ekhaya Esima, featured above, will be a keynote speaker there where she will give a longer talk.  (Early bird discounts for this conference are only good till 9/17).

[continue reading…]

Has Anyone Ever Fully Recovered From “Schizophrenia?”

When someone recently asked this on Quora, the first answer they received was the typical perspective offered by our mental health system.  It was stated that schizophrenia is a chronic biological illness, and that no cure exists.  The only hope offered was that many people with “the illness” can “lead productive and fulfilling lives with the proper treatment.”

I believe that answer to be horribly wrong in two respects.

  • First, it contains assertions not based on facts, and it suggests for example that schizophrenia is a “real illness” definitely based on biological differences and that people diagnosed with schizophrenia are only ever able to lead productive fulfilling lives if they continue to receive the “proper treatment.”
  • Second, since hope has been found to be one of the keys to recovery, and since this answer reduces any hope for full recovery, it functions as a kind of dark, self-fulfilling prophecy that impedes recovery.

So I offered the following answer:

The answer [to the question of whether anyone can fully recover from schizophrenia] is clearly yes. While it’s popular to say that schizophrenia is a biological illness, there is in fact no biological test for it, it is diagnosed when people talk and behave in certain ways for a period of time. And when researchers follow people who are diagnosed that way, they find that a great many of them no longer meet the criteria for the disorder when followed up later, and many of them have even very successful lives.

To give just one example: Daniel Fisher. Over a five year period, he was treated for schizophrenia, with drugs and a few hospitalizations. He then worked on recovery, became a psychiatrist, and eventually a national leader in the recovery movement. He got married, had kids, had a good life, etc. He did not continue to take drugs or to have the sorts of problems associated with “schizophrenia” and so he would meet any reasonable criteria for full recovery. He has written about his experience, and I recently reviewed his book “Heartbeats of Hope: The Empowerment Way to Recover”

I think it’s worth noting that when recovery is discussed in the mainstream mental health system, it is discussed usually in terms of working to regain a valued life despite continued illness.  I do believe that focus can be important, but as I argued in my article Moving Beyond Clinical Recovery AND Personal Recovery: Reclaiming the Possibility of Full Recovery,  it is only one side of the possibility of full recovery, which also involves getting to a place where nothing that might seem to be an “illness” remains.

For more thoughts about full recovery, and the possible role of mental health treatments in accomplishing it (or possibly getting in the way), see Questions and Answers About Recovery.