I came across this article in my wanderings earlier this evening. It's very lengthy, so I won't include it all (a link to the full article will be provided) but it also offers some different perspectives on working with and understanding individuals who have undergone psychotic experiences. In particular, there's a lot of background as related to communication styles and methods of interpretation. It may be helpful to those who are attempting to understand their own experience, family and friends, or even for exploring the therapeutic treatment that fits you best.

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<font size=4>THE PSYCHOTIC IMAGINATION</font>
by Dharmavidya David Brazier

INTRODUCTION
Nobody is completely mad. Nobody is completely sane. On the stage of each of our lives are many players, and all of them are crazy in their own particular way.

Generally we are inclined to define madness in terms of failure to adhere to consensual reality. DSM IIIR defines psychosis as "gross impairment in reality testing and the creation of a new reality.. delusions or hallucinations (without insight into their pathological nature)" (p.404). The consensus about reality, however, shifts from culture to culture and from one period of history to another, and indeed, from circumstance to circumstance. The conventions by which we live are themselves full of contradictions. Furthermore, all of us depart from consensual reality as soon as we fall asleep and there are none of us who do not harbour phantasies which, if acted out in the "real" world, would not be considered mad by many people.

As therapist's we come into contact with many people whose views of the world are different from our own, and different from those of the people around them. Often such people wonder if they are mad, in which case they almost certainly are not. Some are quite sure that only they are sane, in which case they are almost certainly mad.

The first step we must take in learning to tap into our own psychotic imagination is to recognise that madness is a paradoxical and relative phenomenon. Those who come to be publicly declared mad are not, in most cases, fundamentally different from anyone else. Generally it is a case of their particular madness having ceased to work in the social context in which they live and their communications about it having become incomprehensible to those around them.

None of this should, however, lead us to believe that madness is a benign condition which should not worry us at all. Our imaginations are capable of transporting us to the heights of ecstasy and the pits of despair, to creativity and to destruction. It is surely our fear of the tempests which may blow within each of us which leads us commonly to try to draw a hard and fast line between ourselves and those who can be classified as "mad".

To aspire to be a therapist is equally surely to be willing to entertain the possibility that there is no such line, for a therapist is one who ventures into the other world, the world of the client. We will never be able to do this without the aid of our own psychotic imagination.

JUNG
One of the first modern therapists to begin to take mad people seriously was Carl Jung. "I could never be satisfied with the idea that all that the patients produced, especially the schizophrenics, was nonsense and chaotic gibberish. On the contrary I soon convinced myself that their productions meant something which could be understood, if only one were able to find out what it was. In 1901, I started my association experiments with normal test persons in order to create a normal basis for comparison. I found then that the experiments were almost regularly disturbed by psychic factors beyond the control of consciousness. I called them complexes. No sooner had I established this fact than I applied my discoveries to cases of hysteria and schizophrenia. In both I found an inordinate amount of disturbance, which meant that the unconscious in these conditions is not only opposed to consciousness but also has an extraordinary energic charge. While with neurotics the complexes consist of split off contents, which are systematically arranged, and for this reason are easily understandable, with schizophrenics the unconscious proves to be not only unmanageable and autonomous, but highly unsystematic, disordered, and even chaotic. Moreover, it has a peculiar dreamlike quality, with associations and bizarre ideas such as are found in dreams. In my attempts to understand the contents of schizophrenic psychoses, I was considerably helped by Freud's book on dream interpretation which had just appeared (1900). By 1905, I had acquired so much reliable knowledge about the psychology of schizophrenia .. that I was able to write two papers about it. (These) had practically no influence at all, since nobody was interested....

At the beginning, I felt completely at a loss in understanding the associations of ideas which I could observe daily with my patients. I did not know then that all the time I had the key to the mystery in my pocket, inasmuch as I could not help seeing the often striking parallelism between the patient's delusions and mythological motifs. But for a long time I did not dare to assume any relationship between mythological formations and individual morbid delusions. Moreover, my knowledge of folklore, mythology, and primitive psychology was regrettably deficient, so that I was slow in discovering how common these parallels were. (Jung 1953, Collected Works, vol 18, pp353-4)

CONSCIOUS AND UNCONSCIOUS
What is the unconscious? The unconscious is whatever part of the mind is kept out of view. It is both the source of spontaneity and creativity on the one hand, and, on the other, the repository of all memories which are either too shameful to be exposed or too at odds with our conceptions of ourselves to be admitted.

It is apparent that the unconscious operates according to different principles from the conscious mind. The conscious mind is much concerned with:
- Categorizing
- Defining and limiting, exclusion
- Logic, deduction, consistency
- Causality
- Dualistic reasoning - true/false either/or dichotomies
- Temporal sequences, history
- Objectivity

whereas the unconscious mind seems to work more by
- Association of ideas, including puns
- Intuition and imagination
- Metaphor
- Acausal relationships
- Holistic impressions - inclusive, both/and,
- Timeless, achronistic connections
- Subjectivity

The unconscious is, it seems, the more "natural" part of the mind whereas the conscious is the more "artificial" part. The conscious works things out and tries to get things done whereas the unconscious just plays, imagines, desires and fears. "It is essential to abandon the overvaluation of being conscious before it becomes possible to form any correct view of the origin of what is mental, the unconscious must be assumed to be the general basis of psychical life. The unconscious is the larger sphere, which includes within it the smaller sphere of the conscious. Everything conscious has an unconscious preliminary stage. The unconscious is the true psychical reality; in its innermost nature it is as much unknown to us as the reality of the external world, and it is as incompletely presented by the data of consciousness as is the external world by our sense organs" (Freud 1900/1976, p.773).

Freud asserted that the unconscious mind is governed by the "pleasure principle" whereas the conscious mind is governed by the "reality principle". This is a useful distinction. We can immediately see that a person needs both in order to function effectively but that the two may, nonetheless, be in conflict with each other. Psychotherapy has traditionally relied a good deal upon methods for accessing the unconscious such as hypnosis, free association of ideas, dream analysis, transference analysis and reflection upon the seeming irrationalities of daily life.

Each of us, however, has reason to want to keep some things out of consciousness. In order to achieve this we operate a kind of self-censorship. However, the situation is doubly complicated because clearly enough we must not only deceive ourselves about the mental contents we do not wish to acknowledge, we must also deceive ourselves about the fact that we are deceiving ourselves. The censorship is therefore operated unconsciously and takes the form of "defense mechanisms" which are commonly listed as:
- Displacement
- Dissociation
- Suppression
- Repression
- Reaction formation
- Denial
- Projection and
- Splitting

It is worth noting that Freud's original term which gets translated as "defense" actually meant "warding off". We have a wide range of ways of warding off what we do not want to accept. We ward off problems which are insoluble. We ward off what we believe is shameful. We ward off whatever is painful. But this does not mean that the painful contents of our minds cease to exist. The most extreme form of warding off is catatonia. In this state the person become unable to do anything at all. A kind of catatonia is encountered in refugees. A person whose whole world has been taken away from them may simply sit down and enter a state of total helplessness. This is, in a way, rather like the way a defeated animal will roll over on its back into a totally defenceless position, the last chance of survival.

MADNESS
Most of us succeed most of the time in keeping our particular madnesses out of public view. When a person becomes overtly mad, this may be attributed to a failure to keep the irrational part from over-whelming him or her. Such a collapse may have been triggered by a particularly acute stress. Factors which may play a part in creating the conditions within which a psychotic condition or episode may occur include:
- Drug induced states
- Terror
- Extreme physical stress
- Grief
- Genetic-temperamental factors
- Emotional neglect or abuse
- Sexual abuse
- Guilt

There are many theories about the origins of madness. There is quite a bit of evidence that some people may be genetically vulnerable to schizophrenia, or some forms of it. It seems unlikely, however, that this is the whole explanation of its onset.

Ronnie Laing suggested that psychosis may be a rational response to an insane situation and Gregory Bateson (1973) suggested the "double bind theory" as a means of explaining how this works. Melanie Klein saw psychosis as regression to the blind, uncontrollable "furies" of the new-born infant. Jung saw it as an invasion of consciousness by archetypal forces around which a massive complex may be constellated. John Rowan and Jacob Moreno have each written about sub-personality approaches to understanding mental disturbance while Paul Federn and Eric Berne each wrote about psychosis in terms of the development of different ego states. All these theories have something to recommend them. Rather than look for a single explanation, we are probably best to consider psychosis as a multi-faceted pattern of phenomena. Each theory tells us something about it from a particular view-point. Sometimes one theory will be more useful, sometimes another. This paper draws on a wide range of schools of thought.

The sorts of signs which are commonly taken as indicators of madness are a combination of several of the following:
- Failure to form meaningful or lasting relationships
- Failure to sustain such social institutions as employment, marriage etc.
- Communication which is intermittently bizarre
- Delusions, hallucinations and voices
- Highly idiosyncratic ideas about taboo subjects such as sex, anger, religion, contamination, food, death, power etc.
- Absence of emotions and of normal social responsiveness
- Suspicion (paranoia)
- Ideas of extreme self-importance

All these "symptoms" are characteristics which are not unknown to us in our own lives. Madness may therefore be considered to be a matter of degree rather than a difference of kind. There is a tendency to think that once a person has become mad they will always be so. This is not true. Chronic and acute psychosis should be distinguished. The chronic form seems to be largely a product of the way society treats people who have had a "breakdown". Recovery rates from schizophrenia, for instance, are much higher in third world than in industrialized countries (Barham & Hayward 1990; WHO 1979).

...

PSYCHO-DYNAMIC MODELS
When we try to understand psychotic speech and imagery by reference to possible underlying psychodynamics, therefore, we may consider any of the following:
- That it is the manifestation of a powerful complex which over-rides other concerns;
- That it is like wakeful dreaming, and so may be worked with in the same way as dream material;
- That it is like a defense mechanism, that it serves to ward off something unbearable such as a terrible guilt or knowledge that one loved in vain;
- That it is a symbol for an unresolved issue, such as a humiliation or a grief;
- That it is a compensation for or escape from low status, as when people whose lives are full of drudgery convince themselves they are royalty or celebrities
- That it is the inflation of the personality by identification with archetypal ideas
- That it is the projection of aspects of the personality which cannot be accepted onto the outside world, as when we cope with our own suppressed rage by seeing enemies on all sides;
- That it is displacement of uncomfortable emotions onto an easier target, as when the person says "The BBC is killing me" and means "My parents pay no attention to me but just watch TV all the time". The TV is blamed in order to avoid blaming the parents.
- That it is representative of an inner dialogue between different parts of the ego or material introjected by parts of the ego or with ego states which have been split off.
- That it represents a contamination of one ego state by another.

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PHENOMENOLOGICAL METHODS

As phenomenologists, our way of appreciating the world of psychosis may thus include:
* Adopting a positive mental attitude toward the person, no matter how strangely he presents himself. Since we will, at first, probably have some difficulty in communicating efficiently verbally, the subliminal messages we give out are even more important than usual.
* Maintaining a warm and attentive manner toward the person, taking care not to alarm, and listening carefully to what is said without mentally classifying it into mad and sane components.
* Noticing the manner in which things are said and paying careful attention to body language and behaviour. The psychotic person does not recognise the normal conventions about communication and the acting out of significant meanings may therefore be more obvious.
* Using our own imagination to conjure up the world of the client. The therapist working with the "snake woman" should soon be able to "see" the snake present in the consulting room, as it is for the client.
* Inviting the client to express herself in whatever media seem useful. Many psychotic people find it easier to convey things pictorially than verbally. Toys and other symbolic objects may be useful. Sometimes it is possible to use dramatic methods and though there are also pitfalls in using this very powerful approach and it is not for the inexperienced.
* Responding to any sign of emotional expression appreciatively no matter whether the emotion is one which is normally welcome of unwelcome.
* Making reflective responses to the implied feelings rather than to the literal content, eg "That sounds frightening, like you are being intruded on" to the client who believes gas is coming through the walls.
* Translating images back into metaphors.
* Assuming the imagined figures have something important to say in their own right and encouraging interaction with them. This is a matter of letting the phenomenon speak for itself. Clients will generally resist this initially but one can return to the idea.
* Respecting that the client's behaviour serves a need even when it is not yet apparent what that need is. Sometimes it is rational to be irrational. We are not good phenomenologists if we assume that we know best what is right for the client. Our aim is to understand the phenomenon in its terms rather than ours.

...

PRACTICAL POINTS
The following are simple practical points to be borne in mind when communicating with a person who is psychotic. Many of them apply with equal force to communicating with any client:
1. This person has probably been through experiences which are terrifying. Create trust and safety.
2. He has also probably been humiliated, experienced a lot of failure and been treated as of no account many times. Treat the person with the utmost respect.
3. He/she will have come to distrust his natural emotions and may have further lost touch with them as a result of drug regimes. He/she will need help recognising ordinary emotional reactions and believing they are normal.
4. Any emotion is better than no emotion.
5. The ordinary world may seem dull and uninteresting compared with the drama of being mad. The "recovering" psychotic client may experience grief about losing his delusions and hallucinations.
6. Achieving understanding is a slow process. Be patient.

CONCLUSION
Psychosis is a process of the imagination akin to dreaming in which the person is overwhelmed by images which are compelling to a degree which takes precedence over input from the environment. Such imagery serves a purpose for the person's psychological development which may not at first be apparent but which generally has to do with coming to terms with difficult or even insoluble dilemmas in life. As such it may be regarded as an extreme form of phenomena with which we are all familiar even though the task of unravelling may be complicated in the particular case. The methods of the psychodynamic and phenomenological therapies include a wide range of approaches which may be useful. Fundamentally, however, it may be of greatest importance for the therapist to learn to recognise and use his or her own "madness" and to work at coming to terms oneself with the existential dilemmas in which the psychotic client has become enmeshed.

FINAL WORD
I would like to give the final word on this occasion to Jung: That is how mental illness looks from the psychological side. The series of apparently meaningless happenings, the so-called 'absurdities', suddenly take on meaning. We understand the method in the madness, and the insane patient suddenly becomes more human to us. Here is a person like ourselves, beset by common human problems, no longer merely a cerebral machine thrown out of gear... we recognize insanity to be simply an unusual reaction to emotional problems which are in no wise foreign to ourselves. (CW3, p.165).

Source: The Psychotic Imagination