Psychosis, spirituality and beyond - finding your way and helping others

1. Psychosis, spirituality and beyond - finding your way and helping others Isabel Clarke Consultant Clinical Psychologist

2. THE RATIONALITY ASSUMPTION

3. THE BILLIARD BALL MIND ASSUMPTION

4. Different Circuits in the Brain (Adapted from DBT) EMOTION MIND REASONABLE MIND WISE MIND Reasonable Mind Memory Emotion Mind Memory IN THE PRESENT IN CONTROL

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

6. 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 accessed at high or low 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

8. 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. Rumi, translated by John Moyne & Coleman Barks in ‘Open Secret’ (Threshold books). Two Ways of Knowing – Introducing the Transliminal

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

10. We are not who we think we are!We constantly move between being self conscious individuals……and existing in a web of relationship

11. 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

12. 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 change, transition - and breakdown - that wider context becomes important

13. Beyond time and certainty Emotional knowledge tells us about relationship – not reasoning – we can feel more than we can precisely know Relationship operates across the boundaries of the self and across time – bereavement encounters. Beyond certainty!

14. How do you cross the threshold? In a small way, in ‘spiritual’ etc. moments. Seriously across the threshold: • Times of transition • Trauma loosens the boundary, softens the walls • Illness and loss • Physical privation – lack of food, sleep, isolation • Mind altering substances All apply equally to spiritual practice, the saints, and vulnerability to psychosis!

15. Knowing which side you are onThe 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 Boundaries dissolve 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’

16. Openness/Vulnerability - a spectrum • Times of transition and loss ‘wake up’ earlier trauma • People find ways to cope when things are unbearable – for some that coping is to cross the threshold – into another dimension. • This is easier for some people than for others – the ‘schizotypy’ spectrum - openness to anomalous experience – on a continuum with normality • People high on the schizotypy spectrum are more sensitive and “open”. • Leading to the need to regulate stimulation. • This can lead into an avoidance cycle; social isolation and withdrawal = the other ‘reality’ takes over – helped by stigma. • Positive side as well as vulnerability

17. Managing the threshold Awareness of vulnerability – of openness to transliminal experience Grounding when the experience is overwhelming. Grounding activity. Grounding food. Sleep. Other people – even when not on a wavelength 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.

18. The role of Arousalshaded area = anomalous experience/symptoms are more accessible. HighArousal - stress

20. A therapeutic approach using this model Validate the experience as their experience Validate the emotion (as opposed to ‘the story’) Sit lightly to explanations – all explanations, including medical and CBT ones! Model sitting with uncertainty, recognizing mystery ‘Shared’ and ‘Unshared’ reality – a way of talking about this Helping the person to take control of their ‘unshared reality’ is key – how to close off openness to invasion – from within or without

21. Understanding and taking charge of the Threshold • Brainstorm the factors leading to vulnerability • Lack of sleep, food, stress, isolation • Pressure of events – life transitions • Effect of past trauma and adversity • Drugs, alcohol • Spiritual practice – with vulnerability/to excess • Choice – you can take charge – you do not have to shut it down completely • Motivation to use coping strategies in order to take charge

22. Psychosis – Potential for Transformation Traditions such as Psychosynthesis and Spiritual Emergence/Emergency recognize the transformational potential of the transliminal. Jung: Meeting and integrating shadow - an aspect of transformation These traditions tend to distinguish between ‘psychosis’ and transformational crises More and more this is seen as a false dichotomy – Spiritual Crisis Network (.uk) Mike Jackson’s Problem Solving Model, encompassing potential and dangers. Role of stigma in trapping people.

23. Evidence for normalization of anomalous experiencing Mike Jackson’s research on the overlap between psychotic and spiritual experience. Emmanuelle Peter’s research on New Religious Movements. Schizotypy – a dimension of experience: Gordon Claridge. High Schizotypy = positives as well as negatives Wider sources of evidence – e.g.Cross-cultural perspectives; anthropology. Richard Warner: Recovery from Schizophrenia.

24. More recent research • Caroline Brett’s AANEX makes it possible to measure anomalous experiences phenomenologically – get away from symptom language • Research that demonstrates: 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. • Caroline Brett, Heriot-Maitland and others. Qualitative research

25. Contact details, References and Web addresses • isabel@scispirit.com • Araci, D & Clarke, I (2016): Investigating the efficacy of a whole team, psychologically informed, acute mental health service approach, Journal of Mental Health, DOI: 10.3109/09638237.2016.1139065 • 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. Clarke, I. (2015) Spirituality: a new way into understanding psychosis.in  E.M.J. Morris, L.C.Johns & J.E.Oliver Eds. Acceptance and Commitment Therapy and Mindfulness for Psychosis. Chichester: Wiley-Blackwell.P.160-171. • www.isabelclarke.org • www.SpiritualCrisisNetwork.uk