Psychosis and Spirituality Journey with no map.

1. Psychosis and Spirituality Journey with no map. Isabel Clarke Consultant Clinical Psychologist.

2. The Wood Where Things Have No Names(Alice Through the Looking Glass)

3. 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

5. 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

7. Everything is connected – synchronicities Metaphor comes to life Cosmic significance – terrible or wonderful Confusion about the self

9. Threat (cosmic) Link with trauma. Link with transition times.

11. 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!

12. 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?

13. 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

14. 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.

15. Interacting Cognitive Subsystems. Body State subsystem Implicational subsystem Auditory ss. Implicational Memory Visual ss. Verbal ss. Propositional subsystem Propositional Memory

16. Linehan’s STATES OF MIND (from Dialectical Behaviour Therapy) – Maps onto Interacting Cognitive Subsystems EMOTION MIND (Implicational subsystem) REASONABLE MIND (Propositional subsystem) WISE MIND IN THE PRESENT IN CONTROL

17. 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.

18. 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

19. The Everyday The Transliminal 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 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’

20. 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.

21. ‘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.

22. Web of Relationships In Rel. with earth: non humans etc. In Rel. with wider group etc. primary care-giver Self as experienced in relationship with primary caregiver Sense of value comes from rel. with the spiritual

23. 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).

24. 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.

25. 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’

26. 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.

27. 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.

28. 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!

29. 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.

30. 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.

31. 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.

32. 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

33. Session 2. The role of Arousal shaded area = anomalous experience/symptoms are more accessible. HighArousal - stress

35. 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