“Unshrinking Psychosis”: A brief book review

I recently finished reading the book “Unshrinking Psychosis: Understanding and Healing the Wounded Soul” by John Watkins. I found it to be a wise and well informed exploration by a true expert on the states of mind called “psychosis.”

While much of what is currently written about psychosis defines it as a condition caused by defective brains and brain chemistry, Watkins correctly notes that scientific research finds that only a minority of people diagnosed with schizophrenia show brain abnormalities, and it is dogmatic thinking, not science, that leads to the obsessive search for exclusively biological causes of psychosis. Meanwhile, overlooked, is a huge collection of evidence about the psychological forces that drive some people into psychosis, and about the kinds of dynamics that sometimes bring them out of it.

Watkins writes about all the hard questions in psychosis, with great chapters exploring the roots of psychosis in experience and development, the connections between psychosis and the dreaming mind psychosis and the mind on psychedelic drugs, spiritual issues and possible positive reorganization within psychosis, and when it makes sense to use, or not use, antipsychotic medications.

He also provides a good historical overview of the recurring role of ignorance in the treatment of psychosis, for example quoting Jung about how even in his training, the main art taught to psychiatric students seemed to be “how not to listen to their patients.” Watkins explains that seeing humanity in the expressions of individuals experiencing psychosis is itself frightening, since the psychosis provides a mirror for the uncertain chaos that resides just below the surface in all of us. By sharing many stories of people who have been psychotic, then recovered and took the time to explain their experiences, Watkins shows us that these experiences are understandable if we take the time and find the courage to take a look.

The one important area where I had some disagreement with Watkins concerned the relationship between psychotic and psycho-spiritual crisis. While Watkins admitted to some ambiguity, he favored the notion that it does make sense to distinguish some psychotic-like experiences as “genuine” spiritual experiences, while others should be seen as just psychotic. He suggests that one way to tell if an experience is genuinely spiritual is if it leads eventually to a positive impact on the life of the person and those around the person, though he acknowledges a misinterpreted spiritual experience might lead to a negative impact. It seems to me that there really are no good criteria for distinguishing between a misinterpreted, potentially positive “spiritual” experience and a purely psychotic experience, and making such distinctions could cause us to overlook the possible spiritual or constructive implications of the experience of those who otherwise might be put in the category of “just psychotic.”

While some might see a psychosis that has a clear organic cause to be “just psychosis” without spiritual implications, I don’t believe that is warranted either. It is perfectly possible that experiences with clear physical causes can lead to profound spiritual experiences; examples could include those brought on by psychedelic drugs, by fasting, by near death experiences or stroke, etc. The initiating cause may be physical, but the experience overall may be very deep and have profound implications. Also, I don’t buy the notion that we can say that some “spiritual insights” are clearly not spiritual at all just because they are bizarre or contradictory. Lots of observers have noted that the deepest spiritual truths cannot really be put into words and involve paradoxes and contradictions, and even mainstream spiritual or religious practices appear bizarre to outsiders – eating the flesh and drinking the blood of someone who died 2000 years ago? Instead, I think it is more helpful to just keep an open mind, to not try to categorize any particular experiences as “not spiritual” but instead to help the person in crisis also keep an open mind and look for interpretations of their experience that will help them eventually have a positive impact on themselves and others.

Whatever my differences with Watkins, I was left impressed by his ability to convey an understanding of this difficult area of human experience. I encourage those interested to check it out for themselves.