Finding Meaning in States Some Call Mad

When we relate with each other, a key thing we long for is to have the other see meaning in our experience, while we notice and reflect on the meaning in theirs.

But when people are seen to be “mad” or “psychotic” or “crazy,” they are typically told that their experience makes no sense, and their best option is to take pills in an attempt to make that experience stop.

When people’s experience seems extreme, it may be difficult to find meaning in it even when people around the person do make an effort. One reason for that may be the shallowness of our culture, which has difficulty connecting to anything too far from the “norm.”

Spiritual traditions, though, do contain clues about how to understand extreme experiences and extreme states of consciousness.

That’s a subject Caroline Maze-Carlton will explore in a webinar “Messages, Meaning and Ancestral Maps: Spiritual Frameworks for Extreme States.” This will take place on Friday 10/11/19, noon EDT.

Assimilation, genocide, and systems of oppression such as anti-Semitism and Islamophobia have left many disconnected from ancestral traditions, spiritual tools and texts.  When encountering extreme states of being such as Voices and Visions, the pharmaceutical model of chemical imbalance often steps into claim space in this cultural vacuum.  However, for many, Western medicalized approaches are neither sufficient nor culturally competent.  This Webinar will explore ways in which we can re-claim spiritual tools and wisdom traditions and be in open dialogue with our ancestors as we navigate extreme states of being.  Caroline will draw on over a decade of direct experience supporting others with altered states of consciousness in diverse settings from peer respites to forensic psychiatric units, as well as her personal lived experience as both psychiatric patient and student of Abrahamic traditions and Buddhist sutras.

About the presenter:

Caroline Mazel-Carlton is a ritual-weaver and sacred space holder in the Jewish Renewal lineage of Rabbi Zalman Schachter-Shalomi.  She is a student of the ALEPH Jewish seminary and recently completed the Yad B’Yad program in Muslim-Jewish collaboration and leadership.  She has traveled the globe in her role of Director of Training for the Wildflower Alliance (home of the Western Mass Recovery Learning Community) supporting systems change and alternatives to the conventional mental health system.  Her passion for re-claiming Jewish identity and tradition through a feminist lens extends to the roller derby community where she is known as Mazel Tov Cocktail (#18).

To register, go to Note that while donations are requested of those who are not members on ISPS, no one will be turned away for lack of funds.

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Don’t React – Choose How to Relate to Distressing Voices!

“Don’t React – Choose How to Relate to Distressing Voices!”  is the subject of a webinar that was presented by Dr. Mark Hayward on 6/20/19. (See the link to the complete recording below.)

This webinar presents a very practical way to help people start experimenting with different ways of relating to voices they might be having trouble with. I encourage people to check it out!

“There has recently been a shift from conceptualizing a voice as a sensory stimulus that the hearer holds beliefs about, to a voice as a person-like stimulus which the hearer has a relationship with. Understanding voice hearing experiences within relational frameworks has resulted in the development of psychological therapies that focus upon the experience of relating to and with distressing voices. This webinar explores lessons learnt from the development, experience and evaluation of one of these therapies – Relating Therapy. These lessons are located within the broader context of other relationally-based therapies that seek to support recovery through the use of digital enhancement (Avatar Therapy) and dynamic interaction with voices (Talking With Voices).”

About the presenter:  Mark Hayward has worked as a Clinical Psychologist within NHS mental health services for the past 20 years. His roles combine clinical (Lead for the Sussex Voices Clinic), research (Director of Research for Sussex Partnership NHS Foundation Trust) and teaching (Honorary Senior Research Fellow at the University of Sussex).

His research activities have focused primarily on the exploration of voice hearing within relational frameworks – acknowledging the voice as an interpersonal ‘other’ and researching differing aspects of the relationships that people can develop with their voices. These relationships have been central to the development and evaluation of new forms of individual and group therapy that can facilitate acceptance of self and voices through the use of assertiveness and mindfulness training. His books include the CBT self-help book ‘Overcoming Distressing Voices’, and the research monograph ‘Psychological Approaches to Understanding and Treating Auditory Hallucinations’.

Mark is committed to increasing access to effective psychological therapies for people distressed by hearing voices.

You can download the PowerPoint slides associated with this presentation at

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Recovery Versus Mad Pride: Exploring the Contradictions

I’ve been intrigued by the way the battle against mental health system oppression has drawn on two important and powerful ideas – which happen to contradict each other!

One is the idea that people can “recover” from mental health problems.  Asserting the possibility of recovery has been key to fighting back against the oppressive belief that certain people will always be “mentally ill” and will need to resign themselves to a limited life as a mental patient, etc.

The second idea is that people may not have to change to be OK and valuable – that people can even be proud of what has been called madness!  Mad pride helps people fight back against the oppressive notion that one has to be “normal” to be acceptable, and that mental diversity means illness.

But, if one is perfectly OK as one is, then there is no need for recovery.  In fact, if one is already quite OK,  then the suggestion that one should work on recovery can itself be oppressive – like offering “reparative therapy” for gay people.

On the other hand, if one’s mental state and current beliefs are causing lots of problems that are keeping one stuck, then being encouraged to be proud of that mental state can become a barrier to changing or recovering and so can deepen or prolong problems and oppression. 

Contradictions like those outlined above can lead to battles between activists about how to move forward.  They can also lead to battles, and confusion, within people who are trying to find the best way to deal with their own “mad” states. 

What I want to show is that it’s possible to embrace both “recovery” and “mad pride” despite the contradictions.  But to do so, we need to be aware of both the advantages, and of the “down” or “shadow” side of each of these notions.

Let’s start by looking at the concept of recovery.

Compared to mad pride, recovery has been much more widely embraced.  It has even been embraced by much or most of the mental health system – though often what is embraced is just the word itself, and not the possible reality!  But because of its popularity, it has also been more widely critiqued, and some have even advocated that we stop using the word altogether.   

One common critique is that the word “recovery” implies that one must have been ill in the first place, and so this word should not be used when the problem never was an “illness.”  However, people do “recover” from many things that aren’t an illness:  we recover our balance, we recover from injuries, we even recover from the down side of events that were overall positive, as in “I’ve finally recovered from that wild party I attended last night!”  Krista Mackinnon, in her “Recovering Our Families” course, emphasizes that all humans are constantly recovering from all sorts of things, and so “recovery” is not something unique to those who have been psychiatrically labeled.

A stronger critique of the notion of recovery points out that recovery involves going back to something, while many prefer to see their life as going forward.  John Herold for example talks about wanting to move toward “discovery” and not “recovery.”  I agree with that up to a point, but I also notice that we often have to go back to something we had possessed previously in order to move forward overall.  For example, if I used to know how to face people and maintain friendships, but then I seemed to have lost that ability during an emotional crisis, I may want to recover the skills and habits I had before so that I can then get on with my life and move into that wider process of discovery.

Then there’s the problem of the word being co-opted to mean something much less than real recovery.  Lots of mental health programs use the recovery word, but their practices remain targeted towards lifelong drugging and containment of the person, with “recovery” apparently meaning only getting to where the person won’t be in crisis so much.  I understand why that sort of use of the word “recovery” makes people want to vomit, but I would rather work on reclaiming the word, rather than giving it up.  The US government can call a nuclear missile a “Peacekeeper” but that doesn’t mean we need to quit using the word “peace.”  I think our best strategy is to continue to emphasize the true meaning of recovery and to contrast truly recovery-oriented treatment with that which is not.

Adding complexity to discussions of recovery is the distinction between “clinical recovery,” or no longer experiencing “symptoms,” versus “personal recovery” which has been defined as “recovering a life worth living.” 

Interestingly, within standard care, “personal recovery” is often framed as the proper goal because of a belief that “clinical recovery” is not possible.  In other words, it is believed that the person will always have symptoms and will always be less than healthy than others because of that, but they may still learn to “recover a life worth living” despite continuing to be ill.  (Of course, this notion that they are still ill can be used to convince people to stay on their drugs, which makes this interpretation popular amongst those who embrace the medical model but who still want to offer some appearance of hope.)

But there is a deeper and more valid reason to focus on personal recovery rather than clinical.  That’s because the experiences that the mental health system called “symptoms” may not be a problem at all once the person learns to live with them.  Hearing voices for example may be benign or even helpful once the person learns to relate to them differently.  And once experiences no longer cause problems, there is no longer a need for drugs or any kind of treatment to manage them.    

Of course, it’s the idea that people don’t need to change, and that their differences may be OK or even something quite valuable, that is basic to that idea that sometimes seems in opposition to recovery:  mad pride. 

“You are only given a little spark of madness.  You mustn’t lose it.” Robin Williams

From a radical mad pride perspective, there is only mental diversity, and not any mental problems, disorders, or illnesses.  People do best when they accept and become proud of themselves as they are rather than try to change.  If people have problems, or seem to be disabled in some way, it’s just because society has failed to accommodate their differences, and so it’s society that needs to change.

But what are the problems with this kind of radical mad pride perspective? 

One issue is that if I am suffering in some way, while believing that there is nothing wrong with me but only problems with others, and if it’s also true that I don’t have the power to make others change, then I am stuck with my suffering.  Working on recovery from a problem may not require accepting that one is ill, but it at least requires accepting that something needs to be changed; but pride is the opposite of believing in a need for change.

Another problem is the adversarial relationships that a radical mad pride perspective can create with others.  If I for example demand that others change their attitudes and start accepting me just as I am and if I demand that they change in other ways to accommodate my differentness, while I insist that I am perfectly fine as I am and don’t need to change anything, I may just piss people off.  I’m certainly not likely to be effective at winning friends and forming peaceful relationships, since good relationships tend to be built when people are willing to change at least some to accommodate each other, at least when they are able to do so.

On the other hand, the notion of radically accepting ourselves just as we are can often seem to be the very core of peace of mind and mental healing.  So it can all seem quite complex.

How can all this be best resolved?  Or, how can we take what is best about mad pride, and what is best about recovery, without getting caught up in the shadow side of each?

I think it may help to take a step back, and look in more general terms at how we can resolve other kinds of contradictions.

It’s not uncommon that things are opposites, but we find ourselves needing both.  Breathing in for example is a good thing, but so is breathing out, even though that’s the opposite.  Our ability to open up to people and trust is a good thing, but so at certain times is our ability to close up and distrust. 

Mental health issues can be notoriously complex.  People can go through terrifying, bewildering experiences that may also have a very important positive side.  Or, experiences may seem to be quite positive, but then lead to something very detrimental. 

It’s also possible that an experience we want to recover from at one point may be something that later we wish to regain.  In my own life I can identify times I have worked to recover from “madness” and to regain my ability to integrate with normality, and then also times when it seemed more important to turn around and work to recover from that normality trance, so I could reclaim what I had discovered when I first went “out of my mind.” 

One metaphor for madness is that of revolution.  Revolution overthrows the existing order – then anything is possible, which is both great, and terrible.  Revolution is both something to be proud of, when it is necessary and when it works out well, and it is something to recover from, so that order can be restored. 

When we over-value sanity, we stick with an existing order in rigid ways that can be oppressive.  When we over-value madness, or revolts against sanity, we can get lost in disorder.  Life though works best at the edge of chaos and order, so it may require both rebellion against order and efforts to recover order.

One way to map relations between polarities, where neither polar opposite provides a full answer, is to use what is called a polarity management map.  These maps make overt what is positive and negative about each polarity, and suggest that each polarity is the solution for the problems caused by the other.    

Below is a polarity management map about recovery versus mad pride.  It suggests that there is no final answer to resolving the tensions between mad pride and recovery, or between madness and sanity generally.  Rather, whenever we emphasize the positive of one side, we will also sooner or later encounter its negative, and then may have to shift to the opposite side. 

If we follow this line of thinking, it follows that there are no final answers as to when a focus on change and recovery is best, versus when it might be better to instead be proud of one’s current state and perspective, even if it is somewhat “mad.”  Instead, we will be more open to exploring what might fit or seem healthy, or not, in any given situation.  And we will be open to the possibility that whatever we choose now, we will later be called upon to choose the opposite.

When we are too sure that our side is right, that “God is on our side,” we end up at war with our opposite.  People who are too sure that their current mental view or version of sanity is correct will go to war against that which opposes it, be they voices or other people who are seen mentally wrong  But going to war just makes everything more extreme, and prevents the “peaceful revolutions” that are possible when people realize that their current polarity is just one side of a more complex picture.

Modern humans are not, of course, the first to struggle with these issues.  Spiritual traditions going back to ancient times wrestle with how to relate to the limits of any existing order, and how to find value in what is outside of that order, or “outside of our minds.”  While these traditions are not perfect, and have too many times been bent to completely corrupt and oppressive purposes, they also contain reminders that we humans do our best not when we stay confined within a mundane “sanity” but rather when we allow ourselves, at least at times, to open up to what goes beyond.

What would mental health treatment look like if it balanced an awareness of the need for “recovery” with an awareness that people also sometimes need to go “out of their minds” to resolve problems that they haven’t been able to solve otherwise, or maybe that their entire culture has not been able to face and resolve?

To explore some possible answers to that question, I recently put together a new online course, “Addressing Spiritual Issues Within Treatment for Psychosis and Bipolar.”  This course outlines some radically different ways of conceptualizing the mental states that get called “psychosis” and “bipolar” and reviews ways professionals can shift from pretending to “know it all” to being helpful to people as they face some of the bigger mysteries together.  In the course, I try to strike a balanced position that avoids both “romanticizing” extreme states and the more common mistake of “awfulizing” or “pathologizing” them. 

This course comes with 6 CE for most US professionals. Through this link, it is available for $49.99 (an 68% discount.)  Use the link to get more information, or to register. Note that if you do pay, 50% of the proceeds goes directly to ISPS-US to help fund its activities.

A few more thoughts:

One other possibly helpful metaphor for madness is that of wilderness.

It can be disturbing when young people wander off into the wilderness.  What if they become lost, and need to be rescued?  Sometimes people do need to be rescued.  But a society too sure that the wilderness is nothing but bad will seek to prevent young people from ever wandering off, won’t recognize when people are doing OK in their explorations and don’t need to be rescued, and/or will even seek to destroy the wilderness so that everything can be “civilized” – aka, sane.

But any society cuts itself off from the wilderness, and/or declares war on what is wild, only at its own peril.  Certainly, modern civilization or “normality” has declared war on the wild, and it does often seem that it is winning.  But that “winning” is a most terrible thing, and puts us all in danger!

Rather than winning, we need to focus more on finding a dynamic balance, or peaceful coexistence.  The peaceful coexistence between recovery and mad pride that I have proposed is just one example of that. 

Emerson said that “People wish to be settled; only as far as they are unsettled is there any hope for them.”  It’s time that we define mental health not as some settled “sanity” but as the unsettled and possibly playful dialogue that results when we value both madness and sanity, and when we explore together with those whom we wish to help rather than impose our own version of some settled, and dead, “correct answer.”

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Helping People To Constructively Engage With Voices

When people have problems with voices, the most common recommendation they are given is to try to avoid them – to take drugs to make them stop, to simply ignore them, to use distraction, or similar approaches.

But these strategies often don’t work. Or even if they do seem to work, they may themselves cause other kinds of problems that may not be acceptable. So what else can people try?

One possibility is to try the opposite of avoidance: to deliberately engage with the voices!

But this sounds scary or wrong to some people. Won’t engaging with the voices make people take them too seriously or see them as more real than they are? Might that lead to people getting even more lost in the world of voices, and so more distressed?

While the mind is tricky and things can always go wrong, we now know that it is possible for people to engage with voices in ways that make things better. Specifically, when the engagement is done with creativity and compassion, the result can be a positive change in the relationship with voices, leading to much greater peace of mind.

But how can people learn how to facilitate this sort of constructive engagement?

Fortunately, Charlie Heriot-Maitland (known for producing the Compassion for Voices video), Rufus May, and Elisabeth Svanholmer have just made available a free series of videos, in which they offer practical ideas about how to do just that. These videos cover topics such as how to:

  • Prepare to engage with voices
  • Identify and nurture the compassionate self and engage with voices from that perspective
  • Change the power balance with voices
  • Identify the function of voices
  • Work with voices that don’t seem to want to engage
  • Map out voices
  • Engage constructively with voices that sound like an abusive person from the past
  • Marital arts exercises that can help in work with voices

This is the first video in the series:

You can access the rest of the series at

I spoke to Rufus May, one of those involved in making these videos, and asked him what inspired he and his colleagues to do this. He answered that:

“We know there is a growing interest in this approach and we wanted to make some accessible resources. In the Bradford Hearing Voices group I volunteer with, I might facilitate a dialogue with a group member’s voice and then encourage them to regularly engage with their voice or voices. In this way group members have found they have been able to improve the relationship they have with their voices.

“People ask me, how can you talk with someone’s voice? I sometimes joke ‘I‘ve got a special microphone!’ But the truth is we ask someone to ask their voice questions and then report the answers the voice is giving them. We have found if we use good communication skills such as empathy and non-judgemental questions the voice sometimes begins to respond in a different way.”

I asked Rufus for an example of this:

“Through a facilitated dialogue with a person’s voice that was being quite harsh and critical towards the person, we established the voice wanted the person to be more assertive with people in their social network. The person went on to consult with the voice on who to be more assertive with and when she became more assertive the voice seemed to relax and become more constructive.

“We have also found if people compromise with their voices the voices often behave in a less controlling way. So finding out if the voices like certain types of music or food or drink and listening to the music the voice likes or consuming the food the voice likes can role model to the voices a more respectful collaborative relationship.”

I asked Rufus where these engaging approaches have come from:

“In many traditional cultures consulting with voices is something that has been done for 100s of years. The original Hearing Voices research carried out by Romme and Escher in the 80s in Holland found many voice hearers who had never used mental health services negotiated and engaged with their voices.

“The challenge is how to talk with voices that are hostile and controlling. This means we as communities need to support voice hearers to become more confident in being assertive with their voices and then learning how to engage in a power with style of relationship, rather than power over.

“Hearing Voices groups can be good spaces to learn this ‘living with voices’ approach. We have also found tools like Nonviolent communication and mindfulness and compassionate mind exercises helpful in supporting this process.

We have tried to make short films that demonstrate how you can engage voices and find ways to learn from them. The three of us myself, Elisabeth and Charlie have used both role-play and some demonstrations of mapping out and talking with Elisabeth’s voices.

“We don’t want engaging with voices to become a therapy that only highly trained professionals can used. While we welcome therapists using these approaches, we also want people who hear voices, and their friends and family to know about dialoguing and creative ways to understand and engage with voices.”

I think that last point Rufus makes is really important! It’s helpful when mental health professionals can offer certain kinds of assistance, but it can be even better when people learn how to help themselves and each other. That’s what really creates a healthy society. So I hope lots of you take an interest in this approach and do check out the video series, which again is available at

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Starting with Immediate Experience: A Presentation by Isabel Clarke

What would it look like if mental health providers were trained to be both deeply humanistic, AND very efficient at helping people identify and cope with the issues at the core of whatever their difficulties might be, including psychosis?

It might look like the approach developed by Isabel Clarke and Hazel Nicholls, which they call “Comprehend, Cope and Connect (CCC).”   CCC starts from the perspective of the immediate experience of the individual -‘what it feels like to be me, now’. This approach to mental health difficulties brings together the impact of past trauma and adversity on present coping (comprehend), and utilizes the latest in mindfulness and compassion-focused approaches to manage change (cope and connect).

In the presentation linked to below, Isabel Clarke focuses on using this approach with people whose experiences might be described as “psychosis.”  Isabel brings a uniquely deep and yet practical understanding to this topic.  On the one hand, she has thought deeply about the nature of psychosis, and she has written several inspiring and insightful books and articles on the intersection of spirituality and psychosis.  On the other hand, she has extensive experience working in acute care settings where making a direct an immediate impact is essential, and this has pushed her to develop an approach capable of accomplishing that objective.

“Simple and yet powerful, this impressive body of work has transformed practice wherever it has been introduced. Mental health practitioners should all be aware of it.” said Dr Lucy Johnstone, consultant clinical psychologist and author of ‘Formulation in psychology and psychotherapy’.

Comprehend, Cope, Connect: An Experience Based Approach to Psychosis & Other Mental Health Challenges

About the presenter:

Isabel Clarke’s work spans two areas: psychosis and spirituality, and clinical psychology. Both draw on the research based Interacting Cognitive Subsystems model of cognition, and both seek to bring spirituality into center stage, founding it in cognitive and other research and theory, and regarding it as a central part of what it means to be human.

Recently Isabel has been developing Comprehend, Cope and Connect (CCC –  previously known as Emotion Focused Formulation Approach, EFFA) in the diverse contexts of Acute, Primary Care and Culture Free Adaptation.  See  “ICS Underpinning 3rd Wave CBT”  and the following book for more details:

Clarke, I. & Nicholls, H. (2018) Third Wave CBT Integration for Individuals and Teams: Comprehend, Cope and Connect.  London & NY: Routledge.

Other books by Isabel Clarke:

Clarke, I. (2013) Spirituality: a new way into understanding psychosis. In E.M.J. Morris, L.C.Johns & J.E.Oliver Eds. Acceptance and Commitment Therapy and Mindfulness for Psychosis. Chichester: Wiley-Blackwell.P.160-171.

Clarke, I. ( 2008) Madness, Mystery and the Survival of God. Winchester:’O’Books.

Clarke, I. (Ed.)  (2010) Psychosis and Spirituality:  consolidating the new paradigm.  Chichester: Wiley

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Meeting Review & Response: Life, Liberty and the Pursuit of Wholeness


People don’t like to think that Freud was right when he described them – us – as walking pinball machines of contradiction, our paths the sum-total of the many forces within us that amplify and cancel each other.  Nor do they – we – want to think of psychic distress/anomaly as a continuum-in-flux, a wide umbrella under which we stand with those who disturb and inspire us.  But then, there’s so much that we don’t want to think about, unless we are moved through dialogue with others to transcend ourselves.  The title of this year’s ISPS-US annual meeting, “Life, Liberty and the Pursuit of Wholeness,” points to the fact that the conference did its job in multiple dimensions, by capturing not only the content of the event, but its process as well.  Here was a group of people striving to generate vitality, freedom and wholeness through talking about vitality, freedom and wholeness.  As such, the meeting hovered within that nexus of education and transformation that constitutes true learning, as a conference should but often fails to do.  

Given that there’s something un-summarizable about the ISPS-US conference experience, I wouldn’t even be emboldened to try were it not that the dialogue had already been started, by Peter Simons, of the MIA-UMB news team.  His MIA overview of the conference,“Filling the Crack in the Liberty Bell,”has subtly functioned as something of an agent provocateur among our group, and for this reason, seemed to me to call for an answer.  Its narrative arc which, in drawing upon the conference’s use of the Liberty Bell as a symbol, moves from crack to bell, did not do justice to what I see as our imperfect, tension-filled, iconic cast mass of copper and tin, arsenic and gold and silver and …air.  Unwittingly, Simon’s account worked to reinforce a schism, an us-vs-them divide between practitioners and their patients that in fact had no last word here.  Rather, to my mind, the conference itself strove to embody integration above all, and what Berta Britz, our keynoter, described following Friere as “the invention of unity in diversity.”  As she reminded us, “sameness is not a prerequisite for unity.”  

There is, indeed, a problem embedded in the tension between the expert by experience and the professional, but our whole reason for being as an organization is to transcend this divide, even as we acknowledge it, recognizing the opportunities for healing that arise when we challenge this distinction rather than reify it.  I’d be tempted to diagnose Simon’s synopsis as too-much-crack-and-too-little-bell syndrome, except that I find diagnosing in general according to our standard sets of categories to be often less than useful, and since what I want to do is to highlight the inseparability of bell and crack, of metal and glowing vein.

It’s important to emphasize that wholeness is not something we have, but something we pursue, if we’re lucky, throughout our lives.  And the primary path of pursuit is through talking and especially listening, listening to ourselves via listening to each other, failing to understand ourselves and each other, having the humility to admit that we’ve failed and the courage to try again.  Admittedly, I did not attend several of the sessions to which Simon refers in his essay, so I cannot speak to their usefulness, their transcendent aspirations or lack thereof.  But I felt the pursuit of wholeness everywhere I turned on that November weekend; There wasBrian Kohler, attempting to anchor our appreciation of the transformative mutuality that characterizes a healing psychotherapeutic relationship, showing us that this quest has a long history within the disciplines of psyche.  Noel Hunter invited us to untangle the twisted threads that bind extreme states to trauma.  Jim Gorney moved some in his audience to tears by speaking about his efforts to reach a tortured soul in his practice across a bridge made, literally, of music, and speaking of music, John Thor Cornelius and Charlotte Jevins bemoaned a failure on the part of organized psychiatry to recognize the experiential surround of the so-called “first break schizophrenic,” just as, in an observation often attributed to Nietzsche, “those who were seen dancing were thought to be insane by those who could not hear the music.”  John and Charlotte were there to offer an alternative way to evaluate and engage that did not turn complex individuals into chronic “mental patients,” by teaching practitioners to hear the music that forms the context of each patient’s unique life. Bert Karon’s insights have been formative for an entire generation of clinicians who are devoted to listening to what their patients are trying to tell them so that they can speak to the deep hurts that otherwise grow into psychic fissures between what one is not supposed to know and what one knows, between the desires to remember and forget, between who one is and the fear of becoming.  There were Mark Richardson, Robin Belcher-Timme & Joseph Lesko, straining to listen within the godforsaken landscape of prison walls to people who were told by every aspect of their lives that their stories were not worth hearing, that their strengths were not worth noticing, let alone valuing.  I understood Berta Britz’s entire talk as an effort not to vilify those who had misunderstood her by allowing fear to close their ears, nor to forgive them, but to see their impulses to objectify and pathologize as voices within her as well as outside of her, as the echoes of a family history of trauma and terror which had been planted in her mind by parents too afraid to hear themselves and a culture that reinforced their impulses to destroy curiosity and memory.  There was Francoise Davoine, showing us how she allowed herself to bring her own ghosts to meet those of the people who came to her with theirs.  Her presentation highlighted our shared nature as beings-in-context, inherently meaning-making historians and memoirists of broken generations.  There were our experts-by-experience, telling their stories of suffering and liberation, sharing with us the schisms between themselves and themselves, between themselves and the world, and, by sharing, transcending, and bringing their audiences with them as they went.  There were family members, who spoke of terror and hope, of the ways in which the struggles of their relatives became in some respects their own.  Those were the liberty-bells I heard ringing throughout the conference, in which the cracks neither muted nor extinguished the force of the music they made.

Were there times when listening stopped, when meanings were imposed, when objectification, power and denial had their say as well?  Of course there were.  Those forces were everywhere too, but they existed within the contexts of life stories, and of the efforts of each of us to listen and be moved.  That, more than anything, is what the conference was for.  There were descriptions of encounters with systems of intransigence, of the sort that rob so many of hope, but there was also a sense that the reception offered by gatherings such as ours, as we listened to these terrible encounters, showed how even in darkness, connection was possible.  Our collective presence was a testament to the fact that the denials of experience, the failures to listen, the fears of understanding and the misuses of power might be addressed through empathy, growth and collective action.

I have devoted a good part of my life to learning (and of course to being in) psychoanalysis, and have come to believe that the power of listening is the power of revolution, so I found it fitting that I had the opportunity to hear so many stories of striving, integration and development in the city built upon those foundations.  As Adam Phillips says in his preface to Equals, “calling psychoanalysis a talking cure has obscured the sense in which it is a listening cure (and the senses in which it is not a cure at all).  Being listened to can enable one to bear – and even to enjoy – listening to oneself and others; which democracy itself depends upon.  Whether or not the whole notion of equality was invented to make it possible for people to listen to each other, or vice versa, listening is privileged in democratic societies.”  In that regard, ISPS showed itself to be striving towards democracy in Philadelphia this fall, and I’m grateful that I had the chance to be there, and to listen.

Nancy Burke

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Finding Meaning in “Madness”

When someone is “mad” or “psychotic,” should the people around them try to make sense of their experience and of what they are saying? Or should the person be taken to professionals who will listen only in order to diagnose and then prescribe treatments aimed at suppressing or eliminating experiences that are understood to be meaningless?

In the mainstream of mental health treatment in the US, the latter approach is dominant. But what does it mean to be “treated” by people who won’t try to understand you?

When I was a young man having experiences that were “extreme” and arguably quite “mad” or “psychotic,” one of my worst fears was that the people around me would give up on the idea of finding any significance in what I was communicating, and that they would decide to see it as something that simply couldn’t, or even shouldn’t, be understood.

Fortunately I always seemed to keep some contact with at least one person who saw some significance or meaning in what I had to share, and after awhile, I made more sense of it myself and had a better time communicating with others. Now I work as a therapist, helping others explore the significance of their own “mad” experiences.

I was recently interviewed on the topic of “Finding Meaning in Psychosis.” You can check out that interview here:

Thanks to Stacy Duffy for being the interviewer! Also thanks to everyone at Psychosis Summit who contributed to making this happen. (There are 20 additional interviews with a wide variety of perspectives and innovative approaches to psychosis at the Psychosis Summit website, )

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From Body to Mind: Emotions and Art as Proto-languages

Dorothea Leicher, LCSW, NCPsyA, CCDP

ISPS-US 10th Annual Meeting, Rockville, MD 2009

The workshop is based on the clinical experience of the presenter, supported by research/theories from biology, psychology, philosophy and social work, and her realization that her experience of “truth” was based on aesthetic experiences.

This realization led the presenter to recognize the importance of economic criteria in aesthetics (cv. “elegantia”): Art emerges as medium to model energy and change in complex systems. This is necessary to prepare the organism for future outcomes and/or strategies to maximize positive outcomes. The presenter’s work in substance abuse relapse prevention led to these ideas. They also proved useful in work with depressive self-sabotage and repetition compulsion. While traditionally art has often seemed “immeasurable” , this workshop makes the argument that art has a very important mathematical function to orient us in a complex statistical environment: Good object relations protect us from Disraeli’s trap (“there are lies, damn lies and statistics”).

The workshop builds on the theory that language is rooted in gesture (which shares “movement” with “e-motion”). It shows parallels between our orientation in physical space and (sublimated) social, emotional or aesthetic “spaces”. Breakdowns, (e.g. how the ability to represent space can be functionally destroyed during acute psychotic phases) provide support for the validity of these links. Additionally, we review parallels in the organization of color, sound and sign-language to illustrate first abstractions as part of language development. The workshop outlines the role of kinesis in symbolization and the perception of “meaning” and extend to Fonagy’s research on factors fostering attachment. The importance of social relationships in the evaluation of “truth” and heuristic assessment of complex systems are discussed in the context of clinical repetition compulsion and our current social crisis.

The goal of the workshop is to show language evolving in a series of increasingly differentiated proto-languages. Effective communication (creating conviction) evolves as sampling and consistency evaluation of various of these proto-languages (with a side-note on hypnosis). Transference becomes a special subset in language development. This theory will lead to process-oriented techniques for client engagement which incorporate elements of hypnosis.

Note: We are in the process of migrating our audio and video recording of past conferences, and the free audio files will be posted here on the blog. They will be posted as presenters can be reached and give permission for their recordings to be posted. Remaining ones will be available for sale soon. Also check out our YouTube channel  for free videos. Other videos will be available for sale soon too.

-Karen Stern, Executive Director

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When Psychiatry Aggravates Psychosis by Focusing on Childhood Traumata and Ignoring Key Current Problems

Nathaniel Lehrman, MD

ISPS-US 10th Annual Meeting, Rockville, MD 2009

Current or recent traumatic experiences have long been recognized as major causes of psychosis, but it is widely maintained that one cannot  understand psychosis without exploring childhood traumata.  When that exploration diverts attention from important current situations, tragedy can follow.

Note: We are in the process of migrating our audio and video recording of past conferences, and the free audio files will be posted here on the blog. This is the first one. They will be posted as presenters can be reached and give permission for their recordings to be posted. Remaining ones will be available for sale soon. Also check out our YouTube channel  for free videos. Other videos will be available for sale soon too.

-Karen Stern, Executive Director

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Don’t forget to submit your proposal for the 17th Annual Meeting of ISPS-US.

Have you submitted your proposal yet? Now is the time!

The Call for Proposals is now open for the ISPS-US 17th Annual Meeting/Conference:
Life, Liberty and the Pursuit of Wholeness in Extreme States
November 9-11, 2018
Philadelphia, PA


Deadline for Proposals: May 21, 2018

More information about the Annual Meeting
Call for Proposals Requirements
Submit a Proposal
Examples of Learning Objectives
Hotel Information

As we gather together in this historic city of Philadelphia, we are aware that one of the central symbols of what is best in our country is the Liberty Bell, cracked and yet whole, stifled and yet resonant, emblematic of failure and of hope alike. When we look at the available resources for those who are struggling with psychosis and other anomalous experiences, we can both celebrate the supportive network of services, research and relationships that fill the spaces between us and bemoan the cracks in our communities and in our system of care, through which so many still fall.

In this, the ISPS-US 17th Annual Meeting, we welcome presentations that aim to fill the gaps — to bridge the divide between where we are now and where we need to go, to connect people with optimal services, to bring us closer to one another through empathy and wisdom, and to make the spaces between us more liberating and alive. Join ISPS-US for a weekend of inspiration, support, and possibility as we work to transform the cracks in our communities, our continuum of care, and our understanding into fertile spaces where hope can thrive. Philadelphia, here we come!

We welcome proposals for presentations, papers, panel discussions, and creative or alternative formats focused on psychological and social approaches to psychosis or extreme mental states. We encourage interactive and experiential formats. A variety of perspectives and topics are welcome and we are interested in representing a diversity of voices. All professional disciplines, experts by experience, and family members are encouraged to submit proposals. Please share your knowledge, experience, energy, and hope.

Keynote Speaker: Berta Britz, MSW, ACSW, CPS

Berta Britz offers consultation and training through Berta Britz Consulting. Recipient of the 2016 Intervoice Inspiration Award, Berta is on the board of HVN-USA. Her ministry, “Hearing Voices and Healing,” is under the care of Central Philadelphia Monthly Meeting. Berta uses the liberation she experienced in the International Hearing Voices community and in Montgomery County Hearing Voices Network Taking Back Our Power Hearing Voices Groups to inform her collaboration for understanding the experience of living and working with anomalous beliefs and voices and growing compassionate communities. Her deepest passion is for creating spaces that welcome young people growing into their fullest selves.

Honoree: Krista MacKinnon

Krista MacKinnon is the Director of Families Healing Together, an online resource for families struggling with emotional distress. After working in the mental health system for fifteen years Krista, who was also a patient herself, understands deeply that families deserve access to a community that supports a recovery mindset. Deeply fascinated by exploring the intersection of wisdom and technology, Krista leverages tools of the internet age to create an online community that both supports and inspires. Krista is a mom of three, a Canadian expatriate to Costa Rica and California, and a lifelong student of yoga and breathwork.


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