This pandemic seems like such an obvious opening for western industrialized cultures to wake up and recognize the impact of structural inequalities and traumatic experiences on our individual and collective well-being. Yet our mainstream media and professional journals, fed by guild and corporate priorities, continue to emphasize the risk of mental illnesses that inherently exist within individuals, or are just waiting to emerge. A large focus of their narrative centers around risk assessment. I see risk assessment, used to net and guide us into the treatment streams most valued by those invested in separating us, a dangerous toxin clothed in care. Even authentic compassionate caring that is nourished by fearful assumptions is transmuted into othering, such as calls for “saving” the most “vulnerable,” whilst the most “vulnerable” have been excluded from contributing.
As Victor Hugo wrote in Les Miserables, “not being heard is no reason for silence.” If the voices of the majority are muted or silenced, that heightens the message of domination. We don’t need a war on mental illness, we need collective peacemaking that centers on the experiences of those who have been most harmed by systemic devaluation and “othering.” This includes our natural environment.
Our scarcity driven systems invest in separating and dividing us. We don’t need guild-driven narrators to distribute more tools for assessing individual pathology. This is a moment when collective fear can drive us into more binary narratives that sacrifice lives and futures. It is also a moment that human and environmental justice can pull us together to co-construct new narratives. We can form a movement around the common ground of being human in our surviving planet. Our biggest risk is allowing this existential crisis to melt away.
Turning towards one another gives us a chance to listen and connect, to restore basic justice that has been so obscured by dominance narratives. We must begin to listen to voices that are gasping to breathe. I naively thought that our global interconnection was now undeniable. But, more and more I see those invested in anachronistic narratives storm the media in a “scientific” blitz spinning messages which reassure some and profit only the few. We are provided campaigns to prevent suicide instead of calls for collective action to address the very conditions that lead people to see no other alternative. It’s time that we unite to co-construct alternatives to the current corrupt and barren narratives. For this we need to uproot racism, classism, sexism, heterosexism, ableism, and all the other strains of separation and systemic dominance.
Those who envision enhancing our current “safety nets” often have not seen themselves in those whom they seek to “protect.” To do that we all must move into changing our relationships with our fears. Holding ever more tightly to familiar narratives that separate, label, detain, and “treat,” will reinforce the nooses choking us all. Truly sustainable nets are co-created when those voices we haven’t heard, those bodies we have feared and used, are centered and finally fully participate in weaving our futures.
Let’s tune in, listen, participate!
On May 7th there was an international conversation with a select panel on a Mad in America, An Urgent Conversation: “Mental Health is Our Common Wealth. Fear and Grief are not mental illnesses and they never were.” If you missed it, you can still listen to the recording:
Join us as we read books about psychosis and extreme states. What can we learn from each other?
Each month we will read a different book and discuss it over a special Book Club listserv. At the end of the month, we will have a Zoom Q & A with the Author. Books can be purchased in the ISPS-US bookstore to help ISPS-US financially (a portion of your Amazon.com purchase goes to ISPS-US without additional cost to you).
This month (May) we are reading Hearing Voices, Living Fully: Living with the Voices in my Head by Claire Bien:
When Claire Bien first began hearing voices, they were infrequent, benign and seemingly just curious about her life and the world around her. But the more attention Claire paid, the more frequently they began to speak, and the darker their intentions became…
Despite escalating paranoia, an initial diagnosis of Schizophreniform Disorder and taking medication with debilitating side effects, Claire learned to face her demons and manage her condition without the need for long-term medication. In this gripping memoir, Claire recounts with eloquence her most troubled times. She explains how she managed to regain control over her mind and her life even while intermittently hearing voices, through self-guided and professional therapy and with the support of family and friends. Challenging a purely medical understanding of hearing voices, Claire advocates for an end to the stigma of those who experience auditory verbal hallucinations, and a change of thinking from the professionals who treat the condition.
When you purchase a ticket, you will be added to the listserv and given the Zoom link to the Q & A which will happen on Sunday May 31st at 7pm EST.
Upon request, copies of the chapter of the book are available while people are waiting for their book to arrive. Discussion starts May 1st, and continues throughout the month.
A donation of $10-40 is suggested, and your donation supports ISPS-US. Sign up on Eventbrite.
While the experience of psychosis can be highly distressing, many who recover report that the treatment was often worse than the psychosis itself. What is it that goes so wrong with treatment, and what could we do to improve efforts aimed at helping?
In a webinar titled “What Hurts & What Helps in Treatment for Psychosis: Insider Perspectives” (see below for the recording) two “experts by experience” reflected on their own experiences of treatment and on what eventually worked better. They also discuss attempts to get professionals to be more open to learning from the experience of those who have undergone treatment.
About the presenters:
Brenda Froyen is a motivated teacher/educator in language didactics and children’s literature. Besides her passion for education she is active in the field of mental health care, organizing conferences and giving lectures and workshops based on her own experience as a patient. Her writing skills have resulted in several books including Psychotic mum: an inside story, editorials in newspapers, and in the website www.psychosenet.be, one of the pioneer projects concerning E-health care in Belgium. For three years she was part of the Belgian Superior Health Council who formulated advice on the DSM5. Brenda is constantly looking for new ways and initiatives to improve the quality of mental health care and education: two fields that have a lot more in common than one might think.
Dmitriy Gutkovich is an activist for those with hearing voices lived experience. In addition to facilitating weekly groups for those with lived experience, Dmitriy sits on the boards of HVN NYC, HVN USA, and the NYC Peer Workforce Coalition, and is chair of the ISPS-US Experts-by-Experience Committee. His main projects include celebrating the stories of those with lived experience, and creating a forum where those with lived experience can share their tools and strategies for improving quality-of-life. He is also a loving husband and hard-working professional.
“hallucinations,” defined as sensations that don’t seem to have any physical cause, and
“delusions,” defined as beliefs that don’t agree with others in one’s culture and/or with physical reality.
Thanks to the revolutionary impact of the Hearing Voices Movement, many people around the world are now able to think of the experience of the first phenomena, “hallucinations,” as something much broader than just as part of a “psychosis.” In fact, even the term “hallucination” has been questioned, with less medicalized terms like “hearing voices” and “seeing visions” proposed instead. And it has been asserted that hearing voices itself should never be defined as an illness. Instead, hearing voices is conceptualized as a human variation, like being left handed or gay. It is understood that people may have problems with the voices and may need help figuring out how to relate to them, but once the relationship has been improved, the experience may change to something that is overall benign or even beneficial to the person.
Unfortunately, less attention has been brought to that other key component of psychosis, the “delusions.” And yet, the need for a revolution in how they are approached may be just as intense.
Sometimes, revolutions start with changes in understanding. One area to begin with might be the notion of a firm distinction between hallucinations and delusions. Hallucinations are understood as disorders of perception, while delusions are understood as disorders of conception: but in practice conception plays a big role in perception, and vice versa. For example, consider the difference between thinking that an external force is controlling one’s thoughts (classified as a delusion) and “hearing” thoughts that seem to be coming from outside one’s mind (classified as a hallucination.) Are these two really that different? Or are they better thought of as on a continuum, with some experiences in the middle and not easily classified as one or the other?
In hearing voices groups, the lack of a clear distinction between perceiving a different reality, and conceptualizing or believing in a different reality, is often understood, and so alternative ways of relating to “unshared beliefs” have been developed alongside alternative ways of relating to voices. But these alternative approaches to working with troublesome beliefs have not received as much publicity as have approaches to hearing voices.
One example of a person working to change that is Rufus May. At age 18, Rufus became convinced that he was a spy and that a device had been planted in his chest. His beliefs were treated in the conventional way by the mental health system: he was diagnosed with “schizophrenia,” hospitalized, and drugged. But Rufus decided not to believe in the diagnosis and the drugs, and he eventually found his own way to regain control of his life. Then, using undercover skills which he had previously just fantasized, he infiltrated the mental health system, keeping his psychiatric history secret as he completed his training as a psychologist.
With his training complete, Rufus shifted to being open about his history, and became an effective advocate and educator for alternative approaches. And while some of his efforts have been around alternative approaches to hearing voices, he has also written very coherently about alternative approaches to working with difficult beliefs. for example in his article Accepting Alternative Realities. He also explored that topic in a recent webinar, Believe It or Not! Ways of Working with “Delusions” or “Unusual Beliefs” (See the link at the end of this post.)
One reason I believe Rufus is a great teacher on this topic is due to the degree of flexibility, creativity, and respect for people that he brings to the work.
A key issue with “delusions” is that people are often holding beliefs in a rigid manner: this tends to prompt those around the person to become unhelpfully rigid in return. In conventional mental health treatment, this rigidity involves insisting that the person “get insight” into the “fact” that their belief is a delusion and is a sign of the presence of a “mental illness” like “schizophrenia.” This rigidity is maintained despite evidence that many ideas about “schizophrenia” may be as untrue as any “delusion,” and despite extensive evidence that confronting any strongly held belief in a rigid way tends to make the person holding the belief dig in and defend it more.
I’ve been practicing CBT for psychosis for many years, and CBT does have some ways to approach “unshared beliefs” in a less rigid way. But there is still a tendency in much CBT literature to emphasize attempting to change the belief seen as troublesome. That is sometimes possible, and work around reconsidering beliefs can be important, but it is also sometimes not possible or not the most helpful approach.
In many cases, it can be more helpful to work on things like understanding the life experience that led to the belief, exploring the possibility of living successfully even while continuing to have the belief, and/or looking at the belief as a possibly metaphorical message about something that needs attention, and then shifting the focus to that area.
A couple years ago I had a chance to hear Aaron Beck, a key founder of CBT, speak about his understanding of how to approach apparent “delusions.” It may be common for older people to be rigid in their views, but I was pleased to find that Beck, then age 97, was advocating for a more creative direction. He was asked for example how he might respond to a man who was claiming to have been roasted in an oven. Beck said first he would acknowledge the man’s story, and be curious about what that experience was like, how it felt etc. Then he would ask about other times in the man’s life when he may have felt that way, and then inquire about whether anything currently was making him feel something similar. In other words, he was saying it might make more sense to follow the vein of emotional content to where it might connect with the man’s past or current issues and distress, which then could be addressed directly. That could be way more effective than simply trying to change beliefs.
Too often in conventional mental health treatment, once people express a belief that seems “insane,” there is just an effort to suppress the belief, rather than to really understand where the person might be coming from, and what their most important concerns might be.
Another example Beck gave involved a man who told hospital staff that his psychiatrist was a threat, and revealed that he wanted to shoot the psychiatrist. In a conventional setting, this would be seen as a sign of the worsening of a dangerous psychosis, and an increase in antipsychotic drugs, by force if necessary, would have been seen as the solution. But in this case, the psychiatrist had been trained to proceed with more sensitivity and flexibility, so instead of treating it as a symptom, he asked the patient, “why do you want to shoot me?” The patient responded, “because you are planning to shoot me!” “But,” the doctor explained, “I don’t even own a gun!” “Well,” said the patient, “you use your drugs like a gun.” The doctor thought about it and said, “I wonder if you are feeling you have very little control? That must be frustrating. But I know you must have lots you want to do outside of here and I want to help you get out so you can do that!” This made sense to the person and they started to work together.
In the hearing voices movement, it is often pointed out that the voices may be “poor communicators” and that working things out with them may require considering alternative interpretations of what they are saying, until a more constructive meaning emerges. For example, a voice that tells someone “you need to die” may be better understood as a part of the person saying that “something is wrong, you need to change something” or “you need to let something about you die.” Once the message is properly understood, it becomes something helpful rather than destructive. The voice hearer can learn to be like the parent who hears the child say “I hate you” but is able to infer that the child needs some love and a nap, rather than taking the statement literally.
One interesting thing about “delusions” is that people can be disturbed by their own beliefs: that is, they can find themselves falling into a belief, but sense there is something wrong with the it at the same time. At that point, they are like the voice hearer who hears a message that seems disturbing, but which they are also starting to believe.
A key skill people need to learn is discernment: sorting out what might be a valid message in the belief or in what the voice is saying, while dismissing what might be exaggeration or a too literal interpretation. This allows them to resolve the situation by believing the helpful part of the message, while disregarding the rest.
At other times people are not at all disturbed by their belief, but their having the belief does become disturbing to others. At that point, the person with the belief is, in relation to us, like the voice is in relation to the voice hearer. The person is saying something, and we must decide how to respond to it. Do we see them as the enemy, and someone whose views simply need to be suppressed? Or do we consider the possibility that while the person may be a poor communicator, there may be some valid message in what they are trying to communicate, even if we can’t agree with all of it?
To develop an adequate approach to difficult beliefs, it is also important to think more broadly about the nature and function of beliefs in general, and to understand how all humans tend to “behave irrationally” around their beliefs when those beliefs become important to their world view and their identity.
Beliefs are often a tribal kind of thing: people may believe something to fit in with others, not because of logic. Having a tendency to do so may benefit individuals in an evolutionary sense, because it makes the individual more likely to get along with others in their social group. (This works, of course, only when the belief is not so destructive as to lead to the extinction of the entire group: it remains to be seen for example how the “tribal belief” in the non-existence of the climate crisis, popular in many quarters, will affect the evolutionary viability of humanity.)
Curiously, psychiatry identifies only untrue beliefs held by one or at most a few people who are at odds with their culture as having mental health problems, and doesn’t consider the possibility that beliefs held by larger groups or even entire cultures may be even more of a problem – even though the dangerousness of a belief tends to increase the more people endorse it!
(If psychiatry were more able to recognize the “pathology” of widely held beliefs, it might for example be more able to reflect on the damage done by beliefs it has itself promoted, such as the one about how “mental disorders” are caused by “biochemical imbalances.”)
But, one might ask, if people often hold beliefs just to fit in with their group or tribe, why do some individuals seem to go their own way and choose beliefs that put them at odds with their community?
One answer may be that when a person’s life does not seem to them to be working out, they may be motivated to try on different beliefs, sometimes desperately grabbing on to whatever seems to offer some chance at inner coherence amid chaos and disruption. Once a belief that seem to help restore internal order is found, the person may be reluctant to let go of it, even when that puts them at odds with their culture and gets them labeled “psychotic.”
It is also true that evolution would never work if there were not genetic variations, and cultural beliefs can never evolve unless we have people trying on different perspectives. Much variation in belief may be just a part of human diversity, and not a problem that needs to be solved. A skilled approach to working with beliefs involves both toleration of differences in perspective, with an awareness of a variety of possible things that can be tried when a belief is causing problems that do not seem to be tolerable, either to the person or to others with whom they must interact.
There’s a lot more that could be said about this topic: this post just scratches the surface. To go a little deeper into it, consider viewing the “Believe It or Not” webinar:
Topics covered include
understanding the protective function of beliefs,
understanding how they may be linked to past life events,
ways to be with someone with different beliefs, and
if someone is motivated to hold their beliefs more lightly how we might help them with this.
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 explored in a webinar “Messages, Meaning and Ancestral Maps: Spiritual Frameworks for Extreme States.” A link to a recording of that talk is below.
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).
“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).
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’.
is committed to increasing access to effective psychological therapies for
people distressed by hearing voices.
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.”
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
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 https://openmindedonline.com/portfolio/engaging-with-voices-videos/
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’.
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:
Clarke, I. ( 2008) Madness, Mystery and the Survival of God.
Clarke, I. (Ed.) (2010) Psychosis and Spirituality:
consolidating the new paradigm. Chichester: Wiley
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.