Dialog at the edge of reason: addressing spiritual issues within treatment for psychosis Presenter: Ron Unger LCSW

Rough Definitions n Psychosis –Experiences of new perceptions, meanings, and interpretations outside of “reason” or mundane cultural norms, that seem to make things worse n Spirituality (at least when it is positive) –The same thing as above, only it happens in a way that seems to make things better

Psychiatry sees categorical differences n Once a person is diagnosed –Their unusual experience is seen as definitely “illness” or “disorder” –The notion of any positive value to it, any spiritual or transformative potential, is usually dismissed

An Alternative: The Continuum View n Unusual experiences can be seen on a continuum –from definitely helpful or “spiritual” –To definitely problematical n Relationships between experiences and people’s lives can be complex –“hellish” experiences might lead to later breakthroughs

Historical perspective n “Madness” was more a matter of not having the right relationship with spirits or the spiritual –But being in a spontaneous altered state might mean the presence of spiritual ability n If nurtured correctly

“Madness” seen by dogmatic religion as resulting from spiritual wrong or offense against God: Risk is that person will be rejected or punished by society “Madness” seen as not spiritual at all, just a medical problem: Risk is that the meaning of the person’s experience will be ignored & excess medical treatment may occur Complex view: Those apparently “mad” may have both medical and spiritual differences, and may have spiritual insights to offer, especially once any mistakes are overcome The Pendulum Swings, from religious to medical…..

Problems for professionals if psychosis involves spirituality n Neither medical nor psychological professionals could then claim full “expertise” in the area of psychosis –Fear that absence of “expertise” could mean loss of status n Also, lack of understanding how to address spiritual issues within a mental health role

Problems for religious leaders if psychosis involves spirituality n Some experiences may contradict religious teachings or dogma n Would highlight the fact that religious leaders may not know enough to help people who are lost n If psychotic people are seen as partly spiritual, the public may notice that accepted religious or spiritual approaches may be a bit psychotic

Why discuss spiritual issues: n Helpful in therapy to use a person’s own language and metaphors n Spiritual concepts are often less stigmatizing n A spiritual focus encourages professional humility n Better relationships n Spirituality is proven valuable in recovery

Is it worth trying to see a difference? n Between –A spiritual experience with some mental and emotional difficulties –A mental disorder or psychosis with some preoccupation with spiritual issues

How could even an atheist talk about spiritual issues? n Psychosis is best understood from a whole systems, or complexity point of view n Spiritual language and metaphors can be understood as another way of trying to talk about the nature and dynamics of whole systems

Could words that sound delusional just need translation? n Instead of focus on the way the words don’t make sense, or are unscientific –Look for ways to understand them that would make sense to you –Then experiment with speaking about them that way & see what happens

Cultivating Uncertainty & Humility n If we recognize that all maps, concepts etc. are only partially helpful & accurate –Then we can listen to and respect those who see & describe things differently than we do n When we respect both our own views & that of others –We model for our clients how to do the same

Expanding the discussion n Moving from monolog to dialog –Jung’s “archetypal amplification” is one possible method n Rather than suppress “mad” views –Help person experiment with a variety of perspectives –Goal is to induce cognitive flexibility

Body State subsystem Auditory ss. Visual ss. Interacting Cognitive Subsystems, a model by Teasdale & Barnard, based on research on cognitive processing – slide by Isabel Clarke and Donna Rutherford Implicational subsystem Implicational Memory Propositional subsystem Propositional Memory Verbal ss.

Model of the “Renewal Process” n 1. Construct system breaks down –Due to an impairment or trying to solve a problem not solvable within that system n 2. Temporary suspension of constructs –Encounter with the “transliminal” n 3. Construct restructuring –If done under stress, errors are more likely, leading to……

Rely on defective, dissociated, and/or dogmatic constructs: Mystery, or awareness of limits to the constructs, is denied. Lost in the mystery: Since constructs were not adequate, all attempts at constructs are abandoned. But then there is no way to organize or communicate. Attempts at constructs coexist with an awareness of the mystery that surrounds them: Attachment to constructs is tentative, humble, maintains a sense of humor about their limits. Lively. People may “flip” between being lost in the transliminal & relying on rigid & defective constructs

Session 2. The role of Arousal shaded area = anomalous experience/symptoms are more accessible. Level of Arousal Ordinary, alert, concentrated, state of arousal. Low arousal: hypnagogic; attention drifting etc. High Arousal - stress Slide by Isabel Clarke and Donna Rutherford

DIALECTICAL BEHAVIOUR THERAPY: Linehan’s STATES OF MIND applied to PSYCHOSIS Discussion of Ways of coping suggested by this approach – management of arousal and distraction. Slide by Isabel Clarke and Donna Rutherford

Using the model of the renewal process in therapy n Clarify history up to first experience of “psychosis” n Define the life problem that needed resolving n Look at how constructs at that time may have been inadequate n Education on how breakdown in constructs can lead to new insights –And what it’s like to be “in the process” n Explore how to keep access to this process –While better handling the risks

Role of spirituality in recovery n For many, spirituality is key in response to any sort of adversity –Many report spirituality assists in recovery from psychosis n Visionary experience can contain keys to recovery n “Negative symptoms” can sometimes be overcome by opening up to spiritual themes present in the original psychosis

Person perceives problem not solvable within construct system Person enters “renewal process” looking for solution Surrounding society sees renewal process as a threat Surrounding society attempts to suppress renewal process in a way that causes problems for the person

Psychosis and Social Renewal n Rather than suppress the Visionary –A better role for society is: n Protect and Contain the person and the process n Collaborate with the person in selectively drawing from the process n Train people prone to this process in how to navigate it successfully n Our survival may depend on a better relationship with the Visionary