The Psychotic Imagination

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.

...

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

"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. "

I have to admit, that is pretty much right. I tried to joke about this to my husband by saying recently: "You sane people are boring. What do you do all day? Nobody to talk to, nothing interesting to look at."

Seems that the delusions and hallucinations are so normal to some of us now, that losing them is what becomes awkward.

Interesting read, thanks for sharing this.

A thought in a similar vein...

One of the "symptoms" of schizophrenia is apathy or disinterest. Naturally, the people making those assessments are typically, the people standing outside of the experience. What they may not see (or be willing to see) is that the experience is very intense and after a white-knuckled ride on the world's tallest rollercoaster, the monkeybars do tend to look rather blase.

Psychosis can also expose people to intense realizations. It may allow us to see that our self-perceptions are limited -- the world is much bigger and connected in ways we had not seen before. Go ahead, try getting excited about washing the dishes after you've hung out with angels, demons and gods. Try to convince me that paying down my mortgage is the most crucially important decision I could ever make, or that the model of the car I buy, or the clothes I wear, or the drink I drink, or who I choose to spend my time with is an accurate reflection of who I am and my worth as a human being. I'm not that interested. It's just an image. It's not real.

And yet, I make the effort -- to be accepted, to reassure my family, to "look" normal. Still, I'm often far more content to sit with my own thoughts and if you try to engage me in meaningless conversation, I just might give you a blank stare before I catch myself and remember to pretend that the matching set of dishware you picked up at Walmart at 10% off that matches the exact shade of red as that streak in your dining room blinds is something to get excited about.

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One of the "symptoms" of schizophrenia is apathy or disinterest

</div></font></blockquote><font class="post"> I've been accused of this.... though, certainly never meant to be that way.....

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Naturally, the people making those assessments are typically, the people standing outside of the experience. What they may not see (or be willing to see) is that the experience is very intense and after a white-knuckled ride on the world's tallest rollercoaster, the monkeybars do tend to look rather blase.


</div></font></blockquote><font class="post"> s'pose having ones life threatened when barely being alive but a few years, and then other paradoxical situations that confuse one when around healthy societal norms..... can seem like a roller coaster ride for sure...... I can say I'm never bored- on the good side--

however, on the not so good side-- most times feel awfully alone .......

mandy
edited for typo

That was very interesting and I am still trying to digest it. I'll have to read it again when I am more alert... and again... and again LOL

I found this part speaks volumes:

"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."

I have life experiences far from the norm of most people which has resulted in severe PTSD and more. It isn't really probable that I could have experienced the terrors I have seen and still remain "normal". It all gets very confusing as to what is abnormal in my life and what is a "normal" response.

Hello Yoda, Mandy and BasketCase...
Your words of feeling different and isolated struck a chord with me. I recall coming across a link at one point in time that really resonated with me titled "Listening to Survivors of Exteme Experiences". I do recall a time when I felt that there was no other human being who could possibly identify with my experience if only because I'd never encountered or heard of another human being who had been through such an experience. I was wrong, but nonetheless, that's the way I felt then. It was very helpful for me to begin finding other people who I felt could understand and empathize with my experience. For the large part, that meant other people who had been through an experience that was the same or similar to mine.

There was also a time when I very much wanted my family members to fulfil those roles but they didn't seem to want to or be capable of doing so. Although I felt hurt and rejected at the time I later came to understand that my experiences had both hurt and impacted them. In some instances, it brought up a lot of personal fears that they couldn't deal with. In other instances, it brought up pain -- it hurt them to know that I was hurting. In still other instances, it brought up shame or guilt -- they felt badly that they hadn't been capable of "being there" for me during a time of crisis, because they didn't understand what was going on or were too frightened to try and understand.

I think this is where friends, peers, and professionals can become valuable allies. Because they're somewhat removed from the situation, they may not feel personally impacted by your experience. I was very fortunate to have two very good friends who sincerely cared about me and offered a great deal of emotional support and acceptance. I was also fortunate to slowly find other people who had been through similar experiences. In addition, I did a great deal of research on my own and this also brought insight and reassurance.

Meanwhile, the following can serve as a resource for those who may find themselves in the position of listening. It's not an easy position to be in and some people are naturally more skilled than others. Note that no one who has been through such an experience should ever feel that they are obligated to listen. Depending on where you're at in your own recovery, it might be too painful, or bring up strong emotions that you find difficult to cope with. We should give what we're capable of giving in that moment. Sometimes, it's a lot and sometimes it's nothing at all. It is okay to take care of ourselves too.

Meanwhile, the article...

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Listening to Survivors of Extreme Experiences: Guidelines for Friends and Family
by Al Siebert, Ph.D., author of The Survivor Personality

<center>"Sorrows are halved and joys are doubled when shared with a friend."</center>

More than once after a survivor has talked with me, the person's family has said, "What did he tell you? He's never talked to us about it." The following guidelines show how to be a good friend and a good listener with people who have survived distressing experiences.

Emotional recovery takes time. A person's healing process will be helped or hampered depending on the emotional maturity and listening skills of friends and family. The following guidelines show how to listen well.
[*] Don't ask a person to open up unless you can handle honest answers. When vietnam combat veterans returned home they found that very few people had the emotional strength to listen to their stories. Don't open someone up and then "chicken out" if they tell you about experiences, memories, or feelings you can't handle. Survivors of traumatic experiences will usually talk to a person who has the emotional strength to listen.
[*] Coach the person to develop a temporary coping plan. Simple everyday activities help stabilize a person experiencing the turmoil of grief and loss.
[*] Give the person lots of time. When a survivor is willing to talk to you, it is important to allow him or her plenty of time to talk. Don't interrupt to share your feelings about your experiences. Plan to listen for hours. Expect some follow-up sessions. When people open themselves up to experience and express strong emotional experiences, additional details and feelings may flood into their minds in the days that follow. It is typical for survivors to have weeks and months of emotional turmoil.
[*] Encourage the person to write about their feelings in a personal journal.
[*] Be an active listener. Ask about feelings. Ask for details. Ask questions when you feel puzzled about facts or incidents.
[*] Remain quiet if he or she starts crying. Don't tell people to not feel what they are feeling. It may help to touch or hold the person if it feels right to both of you. Don't suggest a better way to look at it. Leave his or her thoughts and feelings alone. Your quiet presence is more useful than anything else you can do. Let nature do the work.
[*] Listen with empathy but minimize sympathy. It is easier for survivors to express their feelings if they don't have to put up with sympathy statements such as "What a horrible experience!" or "You poor soul!" Survivors of distressing experiences talk more easily to a person with calm concern. Control your imagination and resist letting the person's feelings become your feelings. Don't make the survivor have to handle your emotional reactions as well as his or her own. If you need emotional support, seek it elsewhere.
[*] Ask if he or she sees anything positive in the situation. This is the basis for what Victor Frankl called logotherapy. Do not assume that a survivor will be experiencing deep grief or that they are suppressing it if they don't seem to feel it. Some resilient people quickly reach emotional peace with their loss. (Note: Resist trying to rescue people in a victim pattern. This is their practiced way of handling life's adversities. Relax and let them do it their way.)
[*] Later on, inquire to see if the survivor is finding any value in the experience. Many people are made stronger by distressing experiences. Spiritual growth is often prompted by emotional pain. The same extreme distresses that cause emotional trauma for some people lead to others becoming stronger. Gently inquire to see if the person is discovering new inner strengths and new life purpose.

Al Siebert has studied mental health for over thirty years. He is author of The Survivor Personality: Why Some People Are Stronger, Smarter, and More Skillful at Handling Life's Difficulties...and How You Can Be, Too.


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"you sane people are boring." hehe, no wonder i'm so depressed..... i was in this forum by curiosity. i had been misdiagnosed as schizophrenic and psychotic at one point many years ago. hope you don't mind my mingling with your experiences. although i've never hallucinated, i like hallucinations. i guess, i used my imagination to pretend that i took lad, so i can escape reality. lol. hey, it's fun. i have a psychedelic christmas and i like psychedelic art a lot. oh, so trippy.

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spiritual_emergency said:

Listening to Survivors of Extreme Experiences: Guidelines for Friends and Family
by Al Siebert, Ph.D., author of The Survivor Personality

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My therapist could use this.

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spiritual_emergency said:
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The following guidelines show how to listen well.
[*] Don't ask a person to open up unless you can handle honest answers. When vietnam combat veterans returned home they found that very few people had the emotional strength to listen to their stories. Don't open someone up and then "chicken out" if they tell you about experiences, memories, or feelings you can't handle. Survivors of traumatic experiences will usually talk to a person who has the emotional strength to listen.
[*] Coach the person to develop a temporary coping plan. Simple everyday activities help stabilize a person experiencing the turmoil of grief and loss.
[*] Give the person lots of time. When a survivor is willing to talk to you, it is important to allow him or her plenty of time to talk. Don't interrupt to share your feelings about your experiences. Plan to listen for hours. Expect some follow-up sessions. When people open themselves up to experience and express strong emotional experiences, additional details and feelings may flood into their minds in the days that follow. It is typical for survivors to have weeks and months of emotional turmoil.
[*] Encourage the person to write about their feelings in a personal journal.
[*] Be an active listener. Ask about feelings. Ask for details. Ask questions when you feel puzzled about facts or incidents.
[*] Remain quiet if he or she starts crying. Don't tell people to not feel what they are feeling. It may help to touch or hold the person if it feels right to both of you. Don't suggest a better way to look at it. Leave his or her thoughts and feelings alone. Your quiet presence is more useful than anything else you can do. Let nature do the work.
[*] Listen with empathy but minimize sympathy. It is easier for survivors to express their feelings if they don't have to put up with sympathy statements such as "What a horrible experience!" or "You poor soul!" Survivors of distressing experiences talk more easily to a person with calm concern. Control your imagination and resist letting the person's feelings become your feelings. Don't make the survivor have to handle your emotional reactions as well as his or her own. If you need emotional support, seek it elsewhere.
[*] Ask if he or she sees anything positive in the situation. This is the basis for what Victor Frankl called logotherapy. Do not assume that a survivor will be experiencing deep grief or that they are suppressing it if they don't seem to feel it. Some resilient people quickly reach emotional peace with their loss. (Note: Resist trying to rescue people in a victim pattern. This is their practiced way of handling life's adversities. Relax and let them do it their way.)
[*] Later on, inquire to see if the survivor is finding any value in the experience. Many people are made stronger by distressing experiences. Spiritual growth is often prompted by emotional pain. The same extreme distresses that cause emotional trauma for some people lead to others becoming stronger. Gently inquire to see if the person is discovering new inner strengths and new life purpose.

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</div></font></blockquote><font class="post">

Good advice -- if advice is ever good. But from the point of view of someone who needs help, how is he or she to find someone who meets these criteria?

How is it possible to lead someone who doesn't already understand these points to adopt them in interacting with a needful person?

<blockquote>
pachyderm: Good advice -- if advice is ever good. But from the point of view of someone who needs help, how is he or she to find someone who meets these criteria?

There are probably two essentials factors a therapeutic relationship must contain: the first is skill, the second is fit. Therapists (I'm referring here to the full range from the counselor to the psychiatrist) come in many shapes, sizes and skill levels. Some of them are absolutely horrible and their fellow therapists know as much; others are exceptionally skilled. Most are somewhere in between those two extremes. I've occasionally joked that finding a good therapist is a bit like going on a number of blind (and very expensive) dates. Trouble is, even if a therapist is skilled, that doesn't mean they'll "fit" and "fit" is probably as important as skill--maybe even more so.

Just as in the dating and mating department, some people get lucky, they find a good fit early in the game. Others have to try and try again. It can get discouraging and as always, it's expensive. We can try to discern a good fit as based on therapist's reputation but an initial interview is probably going to be necessary as well. Usually, we'll have to pay for that interview, although I did run across one therapist's website who will give you one hour for free as an introductory interview. I imagine a therapist like that is too busy to accept more patients.

How is it possible to lead someone who doesn't already understand these points to adopt them in interacting with a needful person?

You could always print out the above, hand it to your current or potential therapist, and say, "This is what I need/What I'm looking for." Some therapists might be offended, others might appreciate the opportunity to honestly talk about your relationship and how it can be improved. Ideally, a therapeutic relationship goes both ways--you learn something from the therapist and the therapist learns something from you.

However, as I've also noted elsewhere, it can be helpful to pull together a support team. That team could include a therapist but it will also include family, friends, and peers. Hopefully, someone in that entire team would be able to address your need to feel that your experience has been heard and understood. That person may not be your therapist!

I didn't work professionally with anyone, but I did find meaning in the work of professionals such as Maureen Roberts, Anne Baring, R.D. Laing, Clarissa Pinkola Estes, John Weir Perry, Carl Jung, etc. A therapeutic relationship doesn't have to be one in which you sit opposite each other in a cozy office somewhere, rather, it's a relationship with anyone or anything that helps. My relationships with friends, peers, family members, books, websites, music, tonglen, and Silence were also therapeutic.

That said, I would honestly have to say that I didn't feel heard or understood in probably 95% of my relationships with other people. We have to find a way to come to terms with that, hopefully in a manner that won't leave us feeling victimized. When it comes to schizophrenia or psychosis, we're already talking about an experience that is relatively rare, it only affects 1-2% of the population. That means roughly 98% of the population cannot personally identify with it. As we go along we get better at identifying where the good listeners might be found. We learn to shut-up in the vicinty of those who can't and we also learn to respect that the most important listener is probably ourselves. What others hear only validates our own experience. I concede that if can feel invalidating to not be heard.

I do not discuss my personal experience with most of my friends, family members or casual acqaintances. They don't understand; they have no similar experience they can draw from in order to understand my own. I do discuss it in more general terms with those who may have gone through a similar experience. Every once in a very rare while, I'll connect with another human being whose experience is very similar to my own and that's always therapeutic--even if they're not a therapist.

See also: Choosing a Competent Caregiver

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spiritual_emergency said:
Therapists (I'm referring here to the full range from the counselor to the psychiatrist) come in many shapes, sizes and skill levels. Some of them are absolutely horrible and their fellow therapists know as much; others are exceptionally skilled.

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The trouble is that someone who is emotionally damaged and with poor self-confidence, which most people seeking such help will be, has a hard time telling a good one from a bad. And I have found essentially no correlation between good therapists and professional credentials. One such credentialled person was a horrible disaster for me. And I am coming to believe (partly with the aid of some authors I have read) that the vast majority of the mental health establishment is off the track as to what causes the kind of distress I have experienced -- and they don't know it.
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I didn't work professionally with anyone, but I did find meaning in the work of professionals such as Maureen Roberts, Anne Baring, R.D. Laing, Clarissa Pinkola Estes, John Weir Perry, Carl Jung, etc. A therapeutic relationship doesn't have to be one in which you sit opposite each other in a cozy office somewhere, rather, it's a relationship with anyone or anything that helps. My relationships with friends, peers, family members, books, websites, music, tonglen, and Silence were also therapeutic.

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The list of helpers I have found include a few of yours, and others, including "survivors." These have been mostly via books.

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See also: Choosing a Competent Caregiver


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I am going to investigate this.

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spiritual_emergency said:
See also: Choosing a Competent Caregiver


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I found a broken link on the last page. Apparently the author is no longer accepting e-mail about such things.

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pachyderm: The trouble is that someone who is emotionally damaged and with poor self-confidence, which most people seeking such help will be, has a hard time telling a good one from a bad. And I have found essentially no correlation between good therapists and professional credentials. One such credentialled person was a horrible disaster for me. And I am coming to believe (partly with the aid of some authors I have read) that the vast majority of the mental health establishment is off the track as to what causes the kind of distress I have experienced -- and they don't know it.

Regretably, I agree with you. I say "regretably" because I recognize that in this culture, the therapeutic route is the route most likely taken but I suspect that many therapists--in spite of their best intentions--are doing far more harm than good. Still, where else would I recommend that someone go--to a shaman? to a priest? to a guru? This culture long ago lost their connections to such people; we replaced them with psychotherapists and so, that's where we feel compelled to go and compelled to send others.

Not long ago, Phil made a post somewhere in which he expressed his anger that these people, these "experts" who are supposed to be helping him, are not helping him. I wanted to respond, but then the thread disappeared and my own life was keeping me very busy and I didn't have time to dig through the archives. Yet, I was pleased in a way to see his anger because with that comes the realization that you have to help yourself. Until we hit that point we can sincerely believe that others possess that which we need and this keeps us in a passive role.

There is a wonderful article by a woman named Judi Chamberlain that captures this realization very well. It's called, Confessions of a Non-Compliant Patient...

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A famous comedian once said, "I've been rich, and I've been poor, and believe me, rich is better." Well, I've been a good patient, and I've been a bad patient, and believe me, being a good patient helps to get you out of the hospital, but being a bad patient helps to get you back to real life.

Being a patient was the most devastating experience of my life. At a time when I was already fragile, already vulnerable, being labeled and treated only confirmed to me that I was worthless. It was clear that my thoughts , feelings, and opinions counted for little. I was presumed not to be able to take care of myself, not to be able to make decisions in my own best interest, and to need mental health professionals to run my life for me. For this total disregard of my wishes and feelings, I was expected to be appreciative and grateful. In fact, anything less was tacked as a further symptom of my illness, as one more indication that I truly needed more of the same.

I tried hard to be a good patient. I saw what happened to bad patients: they were the ones in the seclusion rooms, the ones who got sent to the worst wards, the ones who had been in the hospital for years, or who had come back again and again. I was determined not to be like them. So I gritted my teeth and told the staff what they wanted to hear. I told them I appreciated their help. I told them I was glad to be in the safe environment of the hospital. I said that I knew I was sick, and that I wanted to get better. In short, I lied. I didn't cry and scream and tell them that I hated them and their hospital and their drugs and their diagnoses, even though that was what I was really feeling. I'd learned where that kind of thing got me - that's how I ended up in the state hospital in the first place. I'd been a bad patient, and this was where it had gotten me. My diagnosis was chronic schizophrenia, my prognosis was that I'd spend my life going in and out of hospitals.

I'd been so outraged during my first few hospitalizations, in the psychiatric ward of a large general hospital, and in a couple of supposedly prestigious private psychiatric hospitals. I hated the regimentation, the requirement that I take drugs that slowed my body and my mind, the lack of fresh air and exercise, the way we were followed everywhere. So I complained, I protested, I even tried running away. And where had it gotten me? Behind the thick walls and barred windows and locked doors of a "hospital" that was far more of a prison that the ones I'd been trying to escape from. The implicit message was clear: this was what happened to bad patients.

I learned to hide my feelings, especially negative ones. The very first day in the state hospital, I received a valuable piece of advice. Feeling frightened, abandoned, and alone, I started to cry in the day room. Another patient came and sat beside me, leaned over and whispered, "Don't do that. They'll think you're depressed." So I learned to cry only at night, in my bed, under the covers without making a sound.

My only aim during my two-month stay in the state hospital (probably the longest two months of my life) was to get out. If that meant being a good patient, if that meant playing the game, telling them what they wanted to hear, then so be it. At the same time, I was consumed with the clear conviction that there was something fundamentally wrong here. Who were these people that had taken such total control of our lives? Why were they the experts on what we should do, how we should live? Why was the ugliness, and even the brutality, of what was happening to us overlooked and ignored? Why had the world turned its back on us?

So I became a good patient outwardly, while inside I nurtured a secret rebellion that was no less real for being hidden. I used to imagine a future in which an army of former patients marched on the hospital, emptied it of patients and staff, and then burned all the buildings to the ground. In my fantasy, we joined hands and danced around this bonfire of oppression. You see, in my heart I was already a very, very bad patient!

Source: Confessions of a Non-Compliant Patient


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If you haven't already, I would encourage you to read that article in its entirety. Truth is, no one knows you like you know yourself. No one can identify with your struggles, your hardships, your pain, like you can. I think that many of us--even those who have been deemed the most ill, the most incurable, the most hopeless--have greater insight into what ails us than has been considered. No one will be more motivated than you to find the healing you need. In that seeking, you may find that which might be helpful to others--this is the fulcrum that drives peer-based support. To share what helped me with others because as you (and Phil) have noted, the vast majority of those who are supposed to be capable of helping seem to be out of the loop. They don't know what they're doing, but they don't want to admit it.

Professional therapy is probably the best resource we have going for us, but the truly skilled are few and far between. Carl Jung is dead; John Weir Perry, R.D. Laing, Loren Mosher, Harry Stack Sullivan -- also dead. Jaakko Seikkula is in Finland, which is great, I suppose... if you're a Finnish schizophrenic. The reality is, it's discouraging but it's still up to us to make the best of our personal situation. The words of the dead or the distant might be all we have to guide us, but that will have to do.

> Judi Chamberlain

A well-recognized name from the past!

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spiritual_emergency said:

Meanwhile, the following can serve as a resource for those who may find themselves in the position of listening...

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Listening to Survivors of Extreme Experiences: Guidelines for Friends and Family
by Al Siebert, Ph.D., author of The Survivor Personality...

Al Siebert has studied mental health for over thirty years. He is author of The Survivor Personality: Why Some People Are Stronger, Smarter, and More Skillful at Handling Life's Difficulties...and How You Can Be, Too.


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Where did that article come from? At the moment the link that you provided produces "The site you are attempting to access is temporarily unavailable."