Psychosis and
Spirituality
Isabel Clarke
Consultant Clinical Psychologist
Southern Health Foundation NHS Trust
Outline of the Session
Introduce the idea of 2 ways of
experiencing
Leading into a psychological
understanding of spirituality – using
Interacting Cognitive Subsystems
(Teasdale & Barnard 1993).
Leading into a new way of understanding
the human being
Applying this clinically: The ‘What is Real
Programme’
Some Questions
What are the characteristics of spiritual
experience ?
What are the characteristics of psychotic
experience ?
Two Ways
of
Experiencing
The other
one!
Characteristics of the other way of
experiencing
Metaphor come to life
Dissolution of boundaries
Cosmic significance – terrible or wonderful
Confusion about the self
Coincidence rules OK
Threat (cosmic)
Link with trauma
O the mind, mind has mountains;
cliffs of fall
Frightful, sheer, no-manfathomed. Hold them cheap
May who ne’er hung there.
Gerald Manley Hopkins (from ‘No worst,
there is none, pitched past pitch of grief’)
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
Travel across the threshold – the
Transliminal – but never to let go of
Ariadne’s thread!
Spirituality and Relationship
As people, we make sense only within our
context of relationship –we are held in a
web of relationship
Important others; our family; our social
group; ethnic group etc.
Spirituality is about relationship with that
which is beyond; with the whole – the
widest circle of the web
At times of breakdown, that wider context
becomes important
Different types of experience:
psychosis and spirituality revisited.
Mental health breakdown is a common human experience
Comes from a combination of
 Individual vulnerability/sensitivity
 Life circumstances – losses 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 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
EMOTION
MIND
MIND
(Propositional
(Implicational
subsystem)
subsystem)
WISE
MIND
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
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.
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
Self: lost in the whole
or supremely important
Emotions: swing
between extremes or
absent
A logic of ‘Both/And’
Managing 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.
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
Further dimensions of relationship
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 become diagnosable mental health
difficulties and whether the anomalies/symptoms are
short lived or persist.
(New chapters by Brett and Jackson in Psychosis and
Spirituality: consolidating the new paradigm – along with
new qualitative research)
Wider sources of evidence – e.g.Cross cultural
perspectives; anthropology. Richard Warner: Recovery
from Schizophrenia.
The What is Real and What is Not
Programme
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.
Making sense of the experience
Discussion:
Why do people click into/get lost in unshared reality/the
transliminal?
Discussion of Different meanings for the experience
Meaning for the individual
Place in their life – what was happening in their life when
it all started?
Address and validate the emotion – that is reliable.
'Problem Solving' idea – Mike Jackson’s research.
Touching on the transformative potential of the
transliminal.
A way of working with psychosis that normalises the
spiritual dimension.
Validating the person’s experience, and helping them to
manage the threshold between the two ways of
experiencing.
Mobilising and nurturing strengths
Persuasion to join “shared reality” – need to be honest
about the risks.
“Sensitivity” – normalisation based on Claridge’s work on
schizotypy.
The person’s important context of relationships needs
attending to – a lifeline.
Creative expression
Helping someone get their bearings by mapping
the 2 states.
These sorts of experiences can be very confusing and
disorienting – it helps it someone can come up with a
map.
Explain that there are 2 states, and some people are
more open than others
Find a way of describing this that works for your client
(e.g. ‘Your Reality’ and ‘Shared Reality’
Draw out two columns
Sort out the person’s story into the two – being very
tactful where you are suggesting that it lies in the nonshared side – hint: Non-shared reality has a ‘both-and’
logic – 2 incompatible things can be true at the same
time!
This can be used as a framework for future sessions.
Contact details, References and Web
addresses
Isabel.Clarke@hantspt-sw.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.
Durrant, C., Clarke, I., Tolland, A. & Wilson, H. (2007) Designing a CBT
Service for an Acute In-patient Setting: A pilot evaluation study. Clinical
Psychology and Psychotherapy. 14, 117-125.
Wilson, H, Clarke, I & Phillips,R.,(in submission) Evaluation of an Inpatient
Group CBT for Psychosis Program Designed to Increase Effective Coping
and Address the Stigma of Diagnosis Psychosis.
www.isabelclarke.org
www.SpiritualCrisisNetwork.org.uk