Psychosis and Spirituality
Journey with no map.
Isabel Clarke
Consultant Clinical Psychologist.
The Wood Where Things Have No Names
(Alice Through the Looking Glass)
The doorsill where the two
worlds touch
The breeze at dawn has secrets to tell you
Don’t go back to sleep
You must ask for what you really want
Don’t go back to sleep
People are going back and forth across the doorsill where the two
worlds touch
The door is round and open
Don’t go back to sleep
Where is the door? There are no walls around me
I won’t go back to sleep.
Rumi 1207 - 1273
Experience across the
Threshold
Meaningful
But what does it mean?
“Where is the door? There are no walls
around me” – things merge. Dissolution
of boundaries
Everything is connected – synchronicities
Metaphor comes to life
Cosmic significance – terrible or wonderful
Confusion about the self
Threat (cosmic)
Link with trauma.
Link with transition times.
Travel into the strange places of
the mind
Not mind safely locked inside the skull;
No!: mind that envelopes us;
Mind that is sea we swim in
Where inner and outer are one
Travel across the threshold – the Transliminal –
but never to let go of Ariadne’s thread!
Different People, Different
Journeys
Mental health breakdown is a common human experience
• Comes from a combination of
– Individual vulnerability/sensitivity
– Life circumstances – loss of relationship, of role etc
– Leading to unmanageable feelings
– It often happens at times of transition
• Why can some people manage to adust to difficult
transitions
• Whereas other people find themselves in a different
dimension?
• How is it that for some people this experience is creative
and transformative?
• Whereas for others it is the opposite?
• What can we learn about this other dimension – and
how can this help us to stand beside the journier?
What is going on here? The
levels of processing problem
• Being human is difficult because our brains have 2
main circuits – they work together most of the time,
but not always.
• There is one direct, sensory driven type of processing
and a more elaborate and conceptual one.
• The same distinction can be found in the memory.
• Direct processing is emotional and characterised by
high arousal.
• The other one filters our view to make it more
manageable
• The direct processing system is the default system –
the one that dominates if the other gets disconnected
– in which case we lose that filter – and land up
ACROSS THE THRESHOLD –THE TRANSLIMINAL
Getting a scientific grip on the
transliminal
The split between realities: the two
worlds, comes from the split in us!
• Interacting Cognitive Subsystems
provides a way of making sense of this
‘crack’.(Teasdale & Barnard 1993).
– An information processing model of cognition
– Developed through extensive research into memory
and limitations on processing.
– A way into understanding the “Head/Heart split in
people.
Interacting Cognitive Subsystems.
Body
State
subsystem
Implicational
subsystem
Implicational
Memory
Auditory
ss.
Visual
ss.
Propositional subsystem
Propositional
Memory
Verbal
ss.
Linehan’s STATES OF MIND (from Dialectical Behaviour Therapy)
– Maps onto Interacting Cognitive Subsystems
REASONABLE WISE
MIND
(Propositional
subsystem)
EMOTION
MIND
MIND
(Implicational
subsystem)
IN THE PRESENT
IN CONTROL
Important Features of this model
• Our subjective experience is the result of two
overall meaning making systems interacting –
neither is in control.
• Each has a different character, corresponding to
“head” and “heart”.
• The IMPLICATIONAL Subsystem manages
emotion – and therefore relationship.
• The verbal, logical, PROPOSITIONAL ss. gives
us our sense of individual self.
Two Ways of Knowing
• Good everyday functioning = good
communication between
implicational/relational and propositional
• At high and at low arousal, the
implicational ss becomes dominant
• This gives us a different quality of
experience – one that can be either valued
and sought after, or shunned and feared
The Everyday
• Ordinary
• Clear limits
• Access to full memory
and learning
• Precise meanings
available
• Separation between
people
• Clear sense of self
• Emotions moderated and
grounded
• A logic of ‘Either/Or
The Transliminal
• Numinous
• Unbounded
• Access to propositional
knowledge/memory is
patchy
• Suffused with meaning or
meaningless
• Boundary between self
and others dissolves
• Self: lost in the whole or
supremely important
• Emotions: swing between
extremes or absent
• A logic of ‘Both/And’
A Challenging Model of the Mind
• The human being is a balancing act as the two
organising systems pass control back and forth: there is
no boss.
• The mind is simultaneously individual, and reaches
beyond the individual, when the implicational ss. is
dominant.
• This constant switch between logic and emotion gives us
human fallibility
• The self sufficient, billiard ball, mind is an illusion
• In our implicational/relational mode we are a part of the
whole.
‘That’s How the Light gets in’
(and the dark)
• The Relational part of our mind is embedded in
relationship; in the whole (the older part)
• The newer, self conscious, part holds our individuality
• Temporary control passing backwards and forwards
between the two organising ss is experienced as
normality
• When the ‘relational’ takes over for any length of time,
the character of experience changes
• The person is no longer grounded in their individuality –
boundaries dissolve – they are open to any influences –
positive and negative.
Web of Relationships
In Rel. with
earth:
non humans
etc.
primary
care-giver
In Rel. with
wider
group etc.
Self as
experienced
in relationship
with primary
caregiver
Sense of
value comes
from rel. with
the spiritual
Unpacking the Web
• We learn about ourselves from the way the
important people around us treat us from
babyhood on.
• The function of emotions is the organisation of
relationship: relationship with others, but also
our relationship with ourselves.
• Emotions communicate directly between people,
bypassing the verbal-logical (they are catching).
Looking Beyond the Individual – to
understand Spirituality
• We are defined by relationships that go beyond our
current human bonds
• These include relationship with our ancestors and those
who will come after us
• Moving out to relationship with our group, nation, other
peoples, humanity
• Our relationship with the non human creatures is deep
and significant for us
• Relationship with place, with the earth, our planet
• Relationship with that which is deepest and furthest –
which is beyond our naming capacity, but is sometimes
called God, Goddess, Spirit etc.
• Relationship is something we experience – so it can be
beyond propositional knowledge – we can feel more than
we know.
Psychosis and Relationship
• Psychosis might be about getting lost on the
wrong side of the threshold – the place of
relationship
• But we need our propositional to manage
immediate human relationships – and life in
general
• It is no accident that it is those people diagnosed
as psychotic who are often most concerned with
the spiritual
• I suggest we need to respect their connection
with that valued part of human experience –
while developing ‘threshold management’
Taking Experience Seriously in
Psychosis
• Acknowledging that psychosis feels different
• Normalising the difference in quality of
experience as well as the continuity
• Positive side as well as vulnerability
• Helping people to manage the threshold –
mindfulness is key
• Sensitivity and openness to anomalous
experience – continuum with normality: Gordon
Claridge’s Schizotypy research.
• Understanding the role of emotion – the feeling
is real even though the ‘story’ can be suspect.
Evidence for a new normalisation
• Schizotypy – a dimension of experience: Gordon
Claridge.
• Mike Jackson’s research on the overlap between
psychotic and spiritual experience.
• Emmanuelle Peter’s research on New Religious
Movements.
• Caroline Brett’s research: having a context for
anomalous experiences makes the difference between
– whether they result in diagnosable mental health
difficulties
– whether the anomalies/symptoms are short lived
or persist. (and now Heriot Maitland)
• Wider sources of evidence – e.g.Cross cultural
perspectives; anthropology. Richard Warner: Recovery
from Schizophrenia.
What does this say about the possible
transpersonal dimension of psychosis?
• Taking experience seriously – experience of possession
• Experience of cross generational healing
• On the other hand – the transliminal is governed by a
logic of both – and……?
• When the relational ss. is dominant the propositional ss,
and with it precise knowing, is temporarily out of reach
• Interchange of psychic contents becomes possible
(conjecture)
• Human beings always strive to make sense of things –
whether they have the necessary data or not!
Psychosis – Potential for
Transformation
• Traditions such as Psychosynthesis and Spiritual
Emergence/Emergency recognize the transformational
potential of the transliminal.
• They tend to distinguish between ‘psychosis’ and
transformational crises
• More and more this is seen as a false dichotomy –
Spiritual Crisis Network (.org.uk)
• Mike Jackson’s Problem Solving – Paradigm Shifting
model, encompassing potential and dangers, to follow .
• Role of stigma in trapping people.
Helping People to Manage the threshold
• Awareness of vulnerability – of openness to transliminal
experience
• Grounding when the experience is overwhelming.
Grounding activity. Grounding food.
• Mindfulness to manage the threshold
• Challenge of facing unshared reality mindfully – both
pleasant and unpleasant
• Transliminal state of mind = most accessible at high and
low arousal
• Managing arousal – breathing control to reduce arousal;
mindful activity in the present to prevent it slipping.
The What is Real and What is Not
Programme – designed to combat stigma
First : Form an Alliance.
• Validate their reality
• Introduce the idea that their reality is only one way of looking at it:
• shared and unshared reality (negotiate the language).
• The individual’s experience is taken seriously and valued – at the
same time as working on a better relationship to shared experience
• It is possible to get away from illness language – and arguments
about diagnosis
Normalising openness to unshared reality – idea of the schizotypy
spectrum
• Advantages and disadvantages of openness to unshared reality
• – e.g. of people who have used unshared reality positively.
Characteristics of unshared reality.
• Idea of the line/ the threshold.
• Importance of being able to manage the line
• Motivational aspect – pros and cons.
Coping skills to manage the line
• When is unshared reality most powerful; in charge?
• Arousal as a means of being in control;
• Stress management
• Being alert and concentrated – watch out for drifting
states
• Grounding in the present
• Wise mind and mindfulness
• Focusing/mindfulness v. distraction
Session 2. The role of Arousal
shaded area = anomalous
experience/symptoms are more accessible.
Level of
Arousal
High Arousal - stress
Ordinary, alert, concentrated, state of arousal.
Low arousal: hypnagogic; attention drifting etc.
Contact details, References and Web
addresses
• Isabel.Clarke@southernhealth.nhs.uk
• AMH Woodhaven, Calmore, Totton SO40 2TA.
• Clarke, I. (Ed.) (2010) Psychosis and Spirituality:
consolidating the new paradigm. Chichester: Wiley
• Clarke, I. ( 2008) Madness, Mystery and the Survival of
God. Winchester:'O'Books.
• Clarke, I. & Wilson, H.Eds. (2008) Cognitive Behaviour
Therapy for Acute Inpatient Mental Health Units; working
with clients, staff and the milieu. London: Routledge.
• www.SpiritualCrisisNetwork.org.uk
• www.isabelclarke.org