Hemingway, the FBI, Paranoia, & the Concept of “Mental Illness”
July 7, 2011Trying too hard to recover may make it less likely
September 5, 2011I just finished reading a book called “Madness, Mystery and the Survival of God” by Isabel Clarke.
Isabel Clarke is a psychological therapist, at home in her work with the experience of people diagnosed with psychosis and other severe mental health problems. Familiarity with their experience, together with a knowledge of the spiritual literature and of research into the processing capacity of the brain, led to her central conclusion:that psychosis and spiritual experience both inhabit that other reality – a reality that is integral and vital for all humans.
While our culture tends to value both creativity and spirituality, at least the forms of it that have “made it” into acceptability, it tends to deny that either are risky or that less valued experiences, such as psychosis, might be very closely related to the more valued states. But Clarke makes a good argument that the relationship is very close indeed: spirituality and creativity result from what might be seen as successful forays into, or opening up to, the “transliminal,” while “madness” results from getting lost in it or overwhelmed by it.
As for what the “transliminal” is, she sees it as just the way the world looks when we view it in a way dominated by one of our two primary “cognitive subsystems.” Normally, we draw from both the propositional subsystem – that dominated by either/or logic – and from the implicational subsystem, which uses a “both/and” logic, and is more involved in affect, association, and the “unconscious.” Normally, we synchronize the operation of both these two subsystems in a way that leaves us not even aware there are two different systems. But when they become desynchronized, the implicational system dominates without a sense of containment or interpretation from the propositional.
Some know how to visit the transliminal, then come back enriched by the experience, while others get lost in the experience and are seen as “mad.” Of course, some have both experiences – sometimes being successfully creative or spiritual, at other times being lost.
I would add that when people appear “lost” it is partly the deficit of those around the person and of the culture, that doesn’t know how to relate to them, to contain and define their experience.
Clarke works as a therapist in an inpatient setting, and she finds it helpful to teach her model to the people there, even though the time is just brief. She finds that it really helps reduce stigma, it avoids battles about whether or not someone is really “mentally ill,” it acknowledges that there is something potentially valid in people’s experience while also challenging them to find better ways to contain and communicate about it.
11 Comments
Thank you – a very perceptive review that a friend alerted me to – you have definitely ‘got’ the argument of the book, and have similar concerns looking at the other headings!
A brilliant read, it makes one look at Psychosis very differently. I would strongly recommend this book. Thank you for the posting.
this gives me some hope of recovery.
Hello Ron:
I’ve been browsing your pages here, and gleaning a lot of info, as well as checking out some links.
My 20 year old daughter is currently under court ordered detainment in a mental health facility. This is the second time in 2 months. The first time was after she left Florida for AZ, and I had to drive 2200 miles to collect her and bring her home. She refused to take the meds or seek treatment when we got home, and since she is an adult, I could do nothing, so here we are, two months later, and she was picked up by a police officer early one morning while lying in the street and refusing to move.
This brings me to the crux of the issue for my family at this present time. My daughter has not reached a point where she understands that she has a problem. She is balking at medication, but she is being forcefully medicated. I am her medical proxy at this time, and so ordered it, out of fear for her life.
The medication is helping. She was very sleepy today, but coherent, and not agitated making odd hand gestures and refusing to speak as she was yesterday. Her mind is not racing.
I don’t like to think of a lifetime of meds for her. It horrifies me. However, it is necessary at this time.
My question to those who suffer from “Schizophrenia” is, what was the defining moment that led you to understand you had a problem, and needed help?
My mother was a lifetime Schizophrenic who never learned to live life-she was joyless and merely existed-on medication.
My 26 year old nephew was hospitalized 2 years ago for 6 weeks for the same symptoms. It took that long to get him stabilized and for him to understand that he needed help. He is on four different meds today. He is happily married, and leads a normal life. He sees his Psychiatrist weekly, and takes his meds.
This is my family history, and as noted, everyone who sufferes from mental illness is different, and has individual needs.
My fear is, if she won’t acknowledge that her paranoia and delusions are just that, she will end up like my mother, not my nephew. I would really appreciate hearing from anyone about what brought them to their defining moment of acceptance that they had a problem. What made you seek treatment? Why did you decide you needed help?
Thank you so much.
Sharon
Hi Sharon,
I think one strategy that might be helpful is to avoid insisting that the problem is “mental illness” and instead just have discussions about what is happening, and what different people’s hopes and fears are. This avoids a really polarized discussion where a person has to choose between being either completely correct in their views, or be defined as mentally incompetent. Instead, specific issues and incidents can be focused on with all parties admitting their uncertainties, being curious about the other’s point of view, and looking to understand problems from multiple perspectives.
The key difference with this kind of dialogue is that it makes it easier for a person to admit to having problems in some kind, if things are being looked at in a way that is not black and white. One of the things that contributes to psychosis is black and white thinking, for example a person often either ignores his or her fears or decides they are completely true, rather than being able to take a middle ground and acknowledging them as fears, possibly true but also very possibly not true. It is very tempting for others around the person to respond with their own black and white thinking – “your views are completely mad!” – rather than being willing to think in shades of grey, but this is likely to add to the crisis.
Of course, what I am proposing is not easy, and not guaranteed of success, but I think it increases chances for success. When professionals are willing to take this approach, as they are particularly in areas that practice Open Dialogue treatment, and also to some extent within CBT for psychosis, then outcomes tend to be better. Such approaches might succeed without antipsychotic medication (and usually do in the case of Open Dialogue) but the idea of medication can also be introduced in a balanced way if necessary, and because things are being discussed in a non black and white way, it is more likely that over medication or over reliance on medication will also be avoided.
I recently had the opportunity to follow someone closely throughout 3 weeks of unmedicated “psychosis”, and to then witness what the drugs did to the person in question. My intention wasn’t to do therapy with the person, but to simply get her out of the locked ward where she was kept for the first 4 weeks. Nevertheless, if it’s doing therapy, or whatever the intention, I think the most important thing if one wants to help is to establish trust. I wouldn’t have trusted anybody who had tried to tell me I was “mentally ill”, “delusional”, “hallucinating”, etc., and since I myself was given the chance to explore the meaning with my own “madness”, which resulted in the realization that there was no such thing as meaningless madness, that whatever it was I had experienced, there was a meaning to it, I had no difficulty listening without judging, and believing that there was truth to whatever “weird” things the person mentioned above told me. Once trust was established — which didn’t even take much time or effort, although there was a whole lot of what gets called “paranoia” involved — I started to introduce the person to the idea that maybe not all of her beliefs were to be taken literally, although they, without doubt, and in the light of her life experiences, certainly were meaningful enough, and I also, and this was the most difficult part of it, started to put some pressure on the person, trying to make her understand that she would have to swallow her pride and play the mh system’s dirty game if she wanted to get out of the locked ward, and eventually out of hospital: “Yes, I’m mentally ill. Yes, I need your drugs. Thank you!” At first, the reaction was what gets called “word salad” circling around the terms “justice”, “integrity”, and “dignity”. Anyway, and in spite of occasional “word salad”, and “delusions”, she made headway. Once the drugs entered the picture — usually it doesn’t take 3 weeks for someone to get forcibly drugged, but she had made a complaint that was partly upheld: the hospital had failed to “motivate” her sufficiently before they wanted to drug her forcibly –, all that changed was that she had difficulty concentrating and expressing herself, her “delusions” etc. included: “improvement”, in the eyes of the mh system. I, on the other hand, was shocked. She had clearly become much less capable of thinking coherently (!) about her experience. Deterioration, in my eyes. Luckily we found a “solution” to the “drug problem”, she’s making headway again, and hopefully will be discharged soon.
This experience confirmed to me that what the drugs bring about is a slowing down of thought processes, and consequently a slowing down of the expression of these. This can only be seen as “improvement” if the thought processes we’re talking about are seen as a manifestation of meaningless madness. If they’re seen as meaningful, and also necessary in order to work out what is going on emotionally, what the drugs bring about is deterioration, and, except for one or two sleeping pills to get a good night’s sleep, ought to be avoided altogether.
Hi Marian,
I think you do a good job of summarizing a lot of the problems with the medical model of “madness” as well as the drug approach, at least for many people. I’m glad you were available to give this person someone to talk to with a different perspective.
Ron, there was another thing that my regular visits to the locked ward — and this was my first experience with a locked ward irl — brought to my awareness on a much deeper level than all the theorizing about it I of course had done before, and that was how these places indeed are “schizophrenia factories”, to use Will Hall’s beautiful term, how they are creating madness. They lock you up, you can’t leave, the windows can’t be opened, the door to your room can be locked from the outside, but not from the inside, then you’re threatened with “treatment” you don’t want, you experience as painful and a punishment, and then you’re actually “treated” = punished, while you’re totally powerless. The effect on the person I mention above — and I imagine on most people in this situation: she got even more stressed out and scared than she was before, and in her confusion, while trying to make sense of what was happening, she concluded that she must have committed one or the other crime, that the place must be either a prison or a forensic ward, and that it all was part of the conspiracy against her by the people she believed she’d hurt in the past, and who now were seeking revenge. So, in the beginning, like most people in distress extremely confused and having a difficult time controlling her reactions, she asked the staff questions about these things: “Is this a forensic ward?” etc. And the staff of course went: “Ah, look, more symptoms, more delusions, more paranoia!” A reaction that had her become even more frightened and confused. A vicious circle that is just so difficult to break. You have no idea — or well, probably you have — how much time and energy I spent alone doing my damnedest to explain these dynamics to her, and thus counteract its effect on her. Time and energy that could have been spent in a much more constructive way, had the surroundings been supportive instead of, well, abusive. And, geez!, did witnessing this going on close-up irl make me angry! Nobody would expect anyone to stay calm and in control under such pressure. It’s only “the mentally ill” who are expected to put up with this insanity (!). So twisted. I admire the strength of the person in question who, although driven into a corner time and again, did never once act out violently in self-defence. All she did, and I really love that, is that she once asked a nurse: “How do you sleep at night?”
Marion, that’s a great description of some of the vicious circles involved in forced treatment. I think it is people’s fear of what is happening inside the diagnosed person that makes the system act in “crazy” ways: then, because people fear being seen as over-reacting or as not being helpful, they attempt to identify any critique of their actions as part of the “illness” of the person whom they were afraid of to start with. This, as you point out, makes things even more difficult for the person who has been diagnosed, often leading to the diagnosed person becoming more disturbed and disturbing, leading to more fear on the part of the “helpers” and even more unhelpful responses.
As long as the “madness” is seen as only existing within the person originally diagnosed, there is little hope to escape from these vicious circles. When all can admit their perspective is limited and thus they may be in some senses “mad” or in error, then people can start listening to each other, and movement toward healing can occur.
I’m glad you were able to help this one person have some perspective on the parts of the disturbance that were in those around her rather than within her, which probably helped her be more thoughtful in her responses as well as more hopeful. Now if we could just change the system so people were less likely to have to face such unhelpful “help” as that provided by this locked ward!
I discovered this website while looking for a book review of Isabel Clarke’s book. I have only just discovered that people are looking at psychosis from an alternative and spiritual point of view. My sister is hearing voices after the birth of her daughter. Medication does not seem to be working all that well. I am wondering how I can help and support her. However, some of the things the voices tell her don’t seem to be too different from the internal suggestions I had after the birth of my son when I had severe depression. The difference seems to just be that she is hearing the voices as if someone is talking to her whereas I heard my inner voice telling me things I didn’t want to hear. I am hoping my sister will get some psychotherapy as this helped me with depression although it was a slow process. I will try to explore this website more to see if there are any useful things I can print out for her. I don’t want to undermine what the professionals are trying to do to help her cope with life, but she hasn’t had much relief from the voices or really managed to stabilise her condition. She has only managed a few months out of hospital in the last two years. Any suggestions or encouragement. I love her very much and know she is at core a very strong person. I think she can get better or at least learn to cope with life while living with the condition.
I hear your concern about not wanting to “undermine what the professionals are trying to do” but this can get tricky, as professionals only sometimes truly help, other times they inadvertently make things worse, and they may not want to recognize that.
It is true that voices often just seem to be expressing difficult emotional states, and that when a person is more alienated from their own emotions, they come through sounding like they are coming from someone else. Therapy would be a good idea, especially if the therapist can be someone who knows about voices. A hearing voices group might help, or reading coping ideas coming out of the hearing voices movement such as http://rufusmay.com/index.php?option=com_content&task=view&id=85&Itemid=9 or a self help book like http://www.amazon.com/Think-Youre-Crazy-Again-Cognitive/dp/158391837X