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Dialog at the edge Dialog at the edge of reason: of reason: addressing addressing
spiritual issues spiritual issues within treatment within treatment
for psychosisfor psychosisPresenter: Ron Unger LCSW
Rough DefinitionsRough Definitions
PsychosisPsychosis– Experiences of new perceptions, Experiences of new perceptions,
meanings, and interpretations outside meanings, and interpretations outside of “reason” or mundane cultural of “reason” or mundane cultural norms, that seem to make things norms, that seem to make things worseworse
Spirituality (at least when it is Spirituality (at least when it is positive)positive)– The same thing as above, only it The same thing as above, only it
happens in a way that seems to make happens in a way that seems to make things betterthings better
Psychiatry sees Psychiatry sees categorical differencescategorical differences
Once a person is diagnosedOnce a person is diagnosed– Their unusual experience is seen as Their unusual experience is seen as
definitely “illness” or “disorder”definitely “illness” or “disorder”– The notion of any positive value to it, The notion of any positive value to it,
any spiritual or transformative any spiritual or transformative potential, is usually dismissedpotential, is usually dismissed
An Alternative: An Alternative: The Continuum ViewThe Continuum View
Unusual experiences can be seen Unusual experiences can be seen on a continuum on a continuum – from definitely helpful or “spiritual”from definitely helpful or “spiritual”– To definitely problematicalTo definitely problematical
Relationships between experiences Relationships between experiences and people’s lives can be complexand people’s lives can be complex– ““hellish” experiences might lead to hellish” experiences might lead to
later breakthroughslater breakthroughs
Historical perspectiveHistorical perspective
““Madness” was more a matter of Madness” was more a matter of not having the right relationship not having the right relationship with spirits or the spiritualwith spirits or the spiritual– But being in a spontaneous altered But being in a spontaneous altered
state might mean the presence of state might mean the presence of spiritual abilityspiritual ability
If nurtured correctlyIf 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 Problems for professionals if psychosis involves if psychosis involves
spiritualityspirituality
Neither medical nor psychological Neither medical nor psychological professionals could then claim full professionals could then claim full “expertise” in the area of psychosis“expertise” in the area of psychosis– Fear that absence of “expertise” could Fear that absence of “expertise” could
mean loss of statusmean loss of status Also, lack of understanding how to Also, lack of understanding how to
address spiritual issues within a address spiritual issues within a mental health rolemental health role
Problems for religious Problems for religious leaders if psychosis leaders if psychosis involves spiritualityinvolves spirituality
Some experiences may contradict Some experiences may contradict religious teachings or dogmareligious teachings or dogma
Would highlight the fact that religious Would highlight the fact that religious leaders may not know enough to help leaders may not know enough to help people who are lostpeople who are lost
If psychotic people are seen as partly If psychotic people are seen as partly spiritual, the public may notice that spiritual, the public may notice that accepted religious or spiritual accepted religious or spiritual approaches may be a bit psychoticapproaches may be a bit psychotic
Why discuss spiritual Why discuss spiritual issues:issues:
Helpful in therapy to use a person’s own Helpful in therapy to use a person’s own language and metaphorslanguage and metaphors
Spiritual concepts are often less Spiritual concepts are often less stigmatizingstigmatizing
A spiritual focus encourages professional A spiritual focus encourages professional humilityhumility
Better relationshipsBetter relationships Spirituality is proven valuable in recoverySpirituality is proven valuable in recovery
Is it worth trying to see a Is it worth trying to see a difference?difference?
BetweenBetween– A spiritual experience with some A spiritual experience with some
mental and emotional difficultiesmental and emotional difficulties– A mental disorder or psychosis with A mental disorder or psychosis with
some preoccupation with spiritual some preoccupation with spiritual issuesissues
How could even an atheist How could even an atheist talk about spiritual issues?talk about spiritual issues?
Psychosis is best understood from Psychosis is best understood from a whole systems, or complexity a whole systems, or complexity point of viewpoint of view
Spiritual language and metaphors Spiritual language and metaphors can be understood as another way can be understood as another way of trying to talk about the nature of trying to talk about the nature and dynamics of whole systemsand dynamics of whole systems
Could words that sound Could words that sound delusional just need delusional just need
translation?translation?
Instead of focus on the way the Instead of focus on the way the words don’t make sense, or are words don’t make sense, or are unscientificunscientific– Look for ways to understand them Look for ways to understand them
that would make sense to youthat would make sense to you– Then experiment with speaking about Then experiment with speaking about
them that way & see what happensthem that way & see what happens
Cultivating Uncertainty & Cultivating Uncertainty & HumilityHumility
If we recognize that all maps, concepts If we recognize that all maps, concepts etc. are only partially helpful & accurateetc. are only partially helpful & accurate– Then we can listen to and respect those Then we can listen to and respect those
who see & describe things differently than who see & describe things differently than we dowe do
When we respect both our own views & When we respect both our own views & that of othersthat of others– We model for our clients how to do the We model for our clients how to do the
samesame
Expanding the discussionExpanding the discussion
Moving from monolog to dialogMoving from monolog to dialog– Jung’s “archetypal amplification” is Jung’s “archetypal amplification” is
one possible methodone possible method Rather than suppress “mad” viewsRather than suppress “mad” views
– Help person experiment with a Help person experiment with a variety of perspectivesvariety of perspectives
– Goal is to induce cognitive flexibilityGoal is to induce cognitive flexibility
BodyState
subsystem
Auditoryss.
Visualss.
Interacting Cognitive Subsystems, a model by Teasdale & Barnard, based on research on cognitive processing – slide by Isabel Clarke and Donna Rutherford
Implicational subsystem
ImplicationalMemory
Propositional subsystem
PropositionalMemory
Verbalss.
Model of the “Renewal Model of the “Renewal Process”Process”
1. Construct system breaks down1. Construct system breaks down– Due to an impairment or trying to solve a Due to an impairment or trying to solve a
problem not solvable within that systemproblem not solvable within that system 2. Temporary suspension of 2. Temporary suspension of
constructsconstructs– Encounter with the “transliminal”Encounter with the “transliminal”
3. Construct restructuring3. Construct restructuring– If done under stress, errors are more If done under stress, errors are more
likely, leading to……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 ArousalSession 2. The role of Arousal shaded area = anomalous experience/symptoms are more shaded area = anomalous experience/symptoms are more
accessible.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: DIALECTICAL BEHAVIOUR THERAPY: Linehan’s STATES OF MIND applied to Linehan’s STATES OF MIND applied to
PSYCHOSISPSYCHOSIS
reasonable mind
Ordinary thinking
Shared reality.
wiseMind –in touch With both
in the presentin control
emotion mind
or open to other ways
of experiencing
Non-shared reality
Shared and Non-shared Reality
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 Using the model of the renewal process in renewal process in
therapytherapy Clarify history up to first experience of Clarify history up to first experience of
“psychosis”“psychosis” Define the life problem that needed Define the life problem that needed
resolvingresolving Look at how constructs at that time Look at how constructs at that time
may have been inadequatemay have been inadequate Education on how breakdown in Education on how breakdown in
constructs can lead to new insightsconstructs can lead to new insights– And what it’s like to be “in the process”And what it’s like to be “in the process”
Explore how to keep access to this Explore how to keep access to this processprocess– While better handling the risksWhile better handling the risks
Role of spirituality in Role of spirituality in recoveryrecovery
For many, spirituality is key in response For many, spirituality is key in response to any sort of adversityto any sort of adversity– Many report spirituality assists in recovery Many report spirituality assists in recovery
from psychosisfrom psychosis Visionary experience can contain keys Visionary experience can contain keys
to recoveryto recovery ““Negative symptoms” can sometimes Negative symptoms” can sometimes
be overcome by opening up to spiritual be overcome by opening up to spiritual themes present in the original psychosisthemes 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 Psychosis and Social RenewalRenewal
Rather than suppress the VisionaryRather than suppress the Visionary– A better role for society is:A better role for society is:
Protect and Contain the person and the Protect and Contain the person and the processprocess
Collaborate with the person in selectively Collaborate with the person in selectively drawing from the processdrawing from the process
Train people prone to this process in how to Train people prone to this process in how to navigate it successfullynavigate it successfully
Our survival may depend on a better Our survival may depend on a better relationship with the Visionaryrelationship with the Visionary
