Al Galves is a retired psychologist who lives in Las Cruces, New Mexico. He is the author ofLighten Up. Dance With Your Dark Side. You can find him on his website here. His email address is: email@example.com
The health of psychosis:
What about psychosis, the most extreme and bizarre of “mental illnesses”? The key symptoms of psychosis are hallucinations, delusions, disorganized speech and bizarre behavior such as talking to people who don’t appear to be there. What could be the value of that?
I believe that psychosis is a protective and life-affirming move of the psyche in response to extreme desperation, fear, terror about the prospect of having to live in the real world with real human beings. I’m not the only one. Psychologist John Weir Perry spent lots of time with many people who had been diagnosed with schizophrenia. He came to see that state of being as a deeply motivated move by the psyche to reconstitute itself. All of the people he came to know had suffered a severe blow to their self-concept and were experiencing a severe sense of negative self-image. The symptoms of psychosis were a compensating move. In an effort to compensate for a severely debased self-image, the psyche took on the persona of an exalted, powerful figure. Although it can be seen as healthy in the sense that it is more life-affirming than killing oneself or hurting someone else, the discrepancy between the negative self-image in the real world and the exalted figure in the imaginary world sets up an unstable psychic situation full of a sense of unreality and anxiety. Here is Perry’s insight:
“It seems that when the psyche cannot progress further into the next steps of experience so encumbered by this very negative self-image – especially at times of great crises of ebullient falling in love or hurtful falling into rejection – a change is initiated.”
The person’s psychic energy is attracted to the exalted, powerful, capable but unreal, imaginary persona and leaves the higher level, the rational part of the psyche stripped of its usual energy and hence in a state of disorganization.
Perry spent lots of time with a large number (50 or more) of people diagnosed with schizophrenia. He found that their delusions, hallucinations and fantasies had similar themes. People see themselves at the center of things, in a central role, involved in some kind of cosmic conflict, a battle between good and evil, God and the Devil, communism and democracy. They see themselves as having been elevated to divine status, perhaps involved in a sacred marriage with God or spirit. They often feel as if they are being reborn and are participating in the creation of a new society. If they are helped to go through the process, they often find themselves in a more complete, balanced, whole world and are able to come out of it more balanced and whole themselves. Here is Perry again:
“The pre-psychotic make-up, with its assumption of unlovability,…suffers a difficult combination of feelings of crushing insignificance and or superlative prestige-hunger. In other words, the initial tendency of the (exalted, powerful persona) is to prompt the ego to seek out a balm for unacceptability in the form of some absolute mastery. The psychotic process habitually puts this power-oriented form of the self through a transformation that awakens the potentials for relationship and gives them their rightful place in the structure of the personality and in the style of life.”
This makes sense to me. I believe that psychosis is the psyche’s way of protecting itself from having to live in a world full of toxic human beings, a way of avoiding the impossibility of living up to the expectations that have been thrust upon one and of taking on the responsibilities of an adulthood that is way too scary to enter. I’m reminded of psychologist Alice Miller’s dictum that all you have to do create a mentally ill person is two things: first, don’t let them be who they are and, second, when they get angry about that, don’t let them be angry.
Unable and unwilling to live in the real world of real people, the psyche creates its own world and enters into a process of seeking safety, health and wholeness in that imaginary world. I don’t believe people choose this experience. Rather, it is driven by a part of themselves that is much deeper and smarter than their rational side. If they could only use their rational sides, they might kill themselves or others.
I believe all persons who are diagnosed with schizophrenia have been abused, neglected, discounted, dismissed, in some way traumatized in their early lives. It’s significant that the first psychotic break typically occurs just as the person is having to take on the burdens and expectations of adulthood. They are not prepared to do that, are terrified by the prospect, and find a creative way of avoiding it.
In my years as a psychotherapist, I got to know two such persons. One was a woman in her mid-40’s who had experienced every kind of abuse and trauma you can think of. I noticed that, when she was in trouble or applying for some kind of assistance, she was grounded and lucid. She made perfect sense. But when she was in the safety and comfort of my office she would say delusional things. Why would that be? I think she was constantly testing me to see how I would react when she would say things like, “I was christened by the first pope” or “Abraham Lincoln lived from 1968 to 1903.” I would react by saying something like “But the first pope lived 1500 years ago” and she would reply with, “Oh, I mean the pope today.” By doing that, I passed the test because I was willing to stay engaged with her, to play her game, to stay connected with her. One of the functions of the delusions is to push people away. People have been toxic and such persons want to have nothing to do with them, for good reason.
If I knew then what I know now, I would have encouraged her in her fantasy of being important and exalted enough to have been christened by the first pope. And I would have asked her what her relationship with Abraham Lincoln was?
One day, we were sitting in my office. She looked at me and said, “Al, you look tired.” I said, Yes, I am tired.” “You need to talk to the moon more” was her suggestion. This helped me to see that one of the functions of hallucinations and bizarre behavior is to make life interesting. Persons diagnosed with schizophrenia are extremely isolated. They are good at pushing people away and finding ways of distancing themselves. So they need some way of engaging with life that is less dangerous than connecting with real people.
The other person I got to know well was an 18-year-old boy. He also had been abused, neglected and traumatized repeatedly in early life. One day while we were driving in my car he said, “See that guy standing on the corner.” “Yes”, I replied. “He’s reading my thoughts.” Why does he want to read your thoughts?” I asked. “Because I’m important. They want to know what I’m thinking.” This helped me see that one of the functions of the delusions is to help people feel exalted and elevated. As some wise person pointed out, when people’s thoughts are being intercepted, it is usually not by the next door neighbor or the barber but, rather, by the FBI, Homeland Security or Trilateral Commission.
It also came to me that one of the functions of hearing voices is it enables people to avoid taking responsibility for their behavior or thoughts. It isn’t me that is thinking that or urging that behavior. It’s the voices.
So I don’t subscribe to the belief that schizophrenia is caused by chemical imbalances or genetic dynamics. That turns human beings into random organisms who have no control over their behavior. Human beings are not random organisms. They are meaning-making organisms who are born with powerful desires to love the way they want to love, be connected to others of their species and work the way they want to work. When those powerful desires are frustrated and when it appears absolutely impossible for them to satisfy those desires, they become desperate and, in desperation, they retreat into an altered state of being.
The idea that any state of being which can be experienced by a human being is alien, diseased and worthy of being immediately extinguished doesn’t make any sense to me. Human beings have been evolving for more than 30 million years. Any state of being which has survived through the process of natural selection must have some survival value.
The way in which our society treats people who experience the symptoms of schizophrenia is sickening, horrible. We immediately pump them full of powerful antipsychotic drugs. The drugs get in the way of the healing process in which the psyche is engaged and turn people into zombies and chronic mental patients.
What we should do is provide such people with a safe place in which they can live without any pressure to “get better”, “stop saying those things” or “straighten up”. A place in which the staff will just be with them as they go through the healing process in which they are engaged. A staff that will help them go through the experience, make some sense out of it, ultimately learn from it and come out the other side healthier, more balanced and more whole than when it started.
Amazingly, there were places like that in our country in the 1970’s and early 80’s. They were called Soteria houses and they operated in the San Francisco Bay area from 1971 to 1983. A well-done study found that people who were treated in the Soteria house rather than the hospital did significantly better in terms of symptoms, social functioning, employment and relapse. But that model wasn’t in keeping with the biopsychiatric belief system that was taking over psychiatry. And so, they were abandoned.
The bottom line here is that all states of being which are experienced by human beings have survival value and can help the person become healthier. Even though they are painful, bizarre, scary and unwanted, they are there for a reason. Therefore, we would do well to help people pay attention to them, experience them in a safe place and go through them rather than cut them off and extinguish them through the use of drugs and psychosurgery.