Where have all the prophets gone? (Part Two) 06/19/2012Posted by ALT in Philosophy/Spirituality, Psychosis.
Tags: collective unconscious, dry bones, Ezekiel, Far Side of Madness, John Perry, prophet, psychosis, schizophrenia, visionary
[read Part One here]
(New International Version)
The hand of the Lord was on me, and he brought me out by the Spirit of the Lord and set me in the middle of a valley; it was full of bones. 2 He led me back and forth among them, and I saw a great many bones on the floor of the valley, bones that were very dry. 3 He asked me, “Son of man, can these bones live?”
I said, “Sovereign Lord, you alone know. ”
4 Then he said to me, “Prophesy to these bones and say to them, ‘Dry bones, hear the word of the Lord! 5 This is what the Sovereign Lord says to these bones: I will make breath [in Hebrew, the word also means “spirit”]enter you, and you will come to life. 6 I will attach tendons to you and make flesh come upon you and cover you with skin; I will put breath [spirit] in you, and you will come to life. Then you will know that I am the Lord. ’”
7 So I prophesied as I was commanded. And as I was prophesying, there was a noise, a rattling sound, and the bones came together, bone to bone. 8 I looked, and tendons and flesh appeared on them and skin covered them, but there was no breath in them.
9 Then he said to me, “Prophesy to the breath; prophesy, son of man, and say to it, ‘This is what the Sovereign Lord says: Come, breath [spirit], from the four winds and breathe into these slain, that they may live.’” 10 So I prophesied as he commanded me, and breath entered them; they came to life and stood up on their feet—a vast army.
11 Then he said to me: “Son of man, these bones are the people of Israel. They say, ‘Our bones are dried up and our hope is gone; we are cut off.’ 12 Therefore prophesy and say to them: ‘This is what the Sovereign Lord says: My people, I am going to open your graves and bring you up from them; I will bring you back to the land of Israel. 13 Then you, my people, will know that I am the Lord, when I open your graves and bring you up from them. 14 I will put my Spirit in you and you will live, and I will settle you in your own land. Then you will know that I the Lord have spoken, and I have done it, declares the Lord. ’”
This was the text for the sermon I heard at the church of my childhood, a few weeks ago. I had never encountered this story before, and it floored me.
What powerful imagery, and how relevant to our times! A valley of dry bones, the people dead and desiccated, no breath to enliven them… until the Spirit reclaims them. And I was struck – thunderstruck, really — by the fact that Ezekiel’s vision bears a striking resemblance to the visions experienced by many during a so-called “psychotic episode”: death and destruction, an Apocalypse, the voice of God, a rebirth.
In The Far Side of Madness, John Perry proposes a series of interrelated archetypal images/ideas that consistently make an appearance in the psychotic process (though not necessarily in a linear fashion):
A. Center – A location is established at a world center or cosmic axis
B. Death – Themes of dismemberment or sacrifice
C. Return to beginnings
D. Cosmic Conflict – a battle between good and evil
E. Threat of Opposite
F. Apotheosis - direct communication or identification with God
G. Sacred Marriage
H. New Birth
I. New Society/a New Age
J. Quadrated World – a fourfold structure of the world or cosmos
(from John Weir Perry’s Far Side of Madness)
Perry illustrates, with numerous case studies, the amazing regularity with which these features appear in psychotic processes. Ezekiel’s vision contains many of them: death (dismemberment), cosmic conflict, apotheosis, new birth (the bones and flesh made alive), and quadrated world (breath “from the four winds”). The book of Ezekiel, an account of Ezekiel’s seven visions from God, contains them all.
The idea that some [not all] psychotic processes are spiritual in nature, and serve (in part)* to convey a message from the divine, is an old one. In fact, in many traditional cultures, it was and is the dominant interpretation of these experiences.
But in our culture, the idea that psychosis/the visionary process has value for the individual experiencing it and the community to which he belongs is downright revolutionary!
On the micro level — the individual — it is valuable as
a self-healing process – one in which, specifically, the pathological complexes dissolve themselves. The whole schizophrenic turmoil is really a self-organising, healing experience.
-John Weir Perry, in this interview
But there is an analog at the macro level, the level of the community, that is equally important:
Our new understanding shows that the process of re-connection to the Unconscious [psychosis]… is nonetheless made up of the same stuff as seers, visionaries, cultural reformers and prophets go through. They also experience much of the same content, except that in their case it is specifically concerned, first and foremost, with the culture itself.
Any kind of therapy that deals with the psyche at this deeper level of the collective unconscious, one comes to the inevitable realisation that we are not going along in our psychic life, you know, just in a realm of interpersonal relationships. A very powerful culture such as ours projects huge patterns, huge conflicts and turmoils, and we all experience them, although we may not be conscious of their inner meaning at all.
In this sense, Humankind is still enormously alienated; the point is, it doesn’t happen just in Washington and Moscow – it happens within the psyche of the whole people…
This brings up the question of myth-form. You see, the big problems facing society are perceived in symbolic, mythic expression, and for this reason their resolution takes place on the symbolic, mythic level as well. If there’s work going on in a culture to reorganise itself, then it’s a process that must occur on both levels simultaneously: individuals will go through their personal visions, and collective spokesmen will express collective visions, which get worked out and implemented on a cultural level.
- John Weir Perry, in this interview**; emphasis added
Where have all the prophets gone?
Does this culture have problems of epic proportions facing it? I would say: YES. Are we in need of reorganization, a drastic reordering of priorities, some serious soul-searching? Again, my opinion – YES.
And is it possible that somewhere in the vast expanse of humankind exists a visionary, one who will journey across an archetypal landscape and bring back to us a spiritual message, a breath of life to the dry bones of our culture of death?
Will we listen?
Or will we label (as psychotic) and medicate (with “anti-psychotics”) until that voice grows silent?
* They also serve as a process of self -reorganization, psychic re-invention.
** More from John Perry on these ideas in this excellent video interview, recently uploaded to YouTube (!):
Psychosis as a plastic process 05/10/2012Posted by ALT in Psychosis.
Tags: Dr. Paris Williams, neuroplasticity, psychosis, recovery, Rethinking Madness, schizophrenia, stroke
Neuroplasticity – the idea that our brain is constantly changing, rearranging itself, adapting to the environment it is presented with and optimizing performance based on ever-changing stimuli, that it is, in short, a living thing – is finally getting some attention. Though the concept has been around for, literally, centuries, mainstream neuroscience, stuck in its Cartesian ways, has been doggedly insisting that the brain is like a machine, with specified parts that function in an unchanging way. “Once brain-damaged, always brain-damaged,” they say. [Hmm… sounds familiar, doesn’t it?]
Never mind this couldn’t possibly be true.
This article describes just two of countless examples of a damaged brain reorganizing itself, regaining (or re-developing, to be more accurate) the lost functions in the process. First, we read about Cheryl, who suffered complete loss of her vestibular function. The vestibular function controls balance – without it, she felt like she was perpetually falling. This went on for almost 10 years before a neuroplasticity-based therapy helped her regain almost all of it. [Incidentally, this brain damage was the “side effect” of a drug she was prescribed after a routine surgery.]
Next, there is Pedro, who suffered a stroke so severe it left him unable to speak and with half of his body paralyzed. Through tremendous effort, Pedro and his son George designed a rehabilitation program that allowed him to slowly, ever-so-slowly re-learn nearly all of the skills he had lost. After a year, he was able to resume his job and worked their happily until retirement. After his death, doctors did an autopsy of Pedro’s brain, only to discover a massive legion that had never healed – yet he had regained all of his lost functions. His brain must have reogranized itself, redistrbuting the lost functions to areas unhurt by the lesion.
Doesn’t sound like something your standard machine could do. Which most neuroscientists these days are begrudgingly conceding.
Of course, there are those desparate few who cling to the old ideas (Cartesian doctrine dies hard)…
[Lots more to be learned about neuroplasticity from this book, which I have just finished devouring and highly recommend.]
The Brain is Plastic, not Elastic
Note that the term is neuroplasticity. Not neuroelasticity. What’s the difference?
Something that is elastic can be stretched, but it will always come back to its original shape. Like a rubber band.
Something that is plastic can also be stretched, but it then maintains its new shape. And though you could manipulate it to return it to a semblance of the old shape, it would not be exactly the same… it never could be.
I imagine that the brain activity is like Play-Doh… if you start out with a package of Play-Doh that is a square, and you then make a ball of it, it is possible to get back to a square. But it won’t be the same square as you had to begin with… Even when a patient with a neurological or psychological problem is ‘cured,’ that cure never returns the patient’s brain to its preexisting state.
- Neuroscientist Alvaro Pascual-Leone, in the book The Brain that Changes Itself [emphasis added]
If the brain is plastic, the brain’s processes are plastic, too
Research has already shown this to be true for some processes. Take, for example, memory. Every time we recall an event, our brain literally rebuilds the memory.
I can recall vividly the party for my eighth birthday. I can almost taste the Baskin-Robbins ice cream cake and summon the thrill of tearing wrapping paper off boxes of Legos. This memory is embedded deep in my brain as a circuit of connected cells that I will likely have forever. Yet the science of reconsolidation suggests that the memory is less stable and trustworthy than it appears. Whenever I remember the party, I re-create the memory and alter its map of neural connections. Some details are reinforced—my current hunger makes me focus on the ice cream—while others get erased, like the face of a friend whose name I can no longer conjure. The memory is less like a movie, a permanent emulsion of chemicals on celluloid, and more like a play—subtly different each time it’s performed. In my brain, a network of cells is constantly being reconsolidated, rewritten, remade.
- Neuroscience journalist Jonah Lehrer, in this article (a very, very good read!)
Which brings me to my main point:
Psychosis is a plastic process
It seems that one of the fundamental premises of mainstream psychiatry is that the goal of treatment is to return the patient to the state of mind he or she was in before the psychotic break. “Get back to normal,” they say.
Not only would this truly be impossible (given that the brain is more like Play-Doh than a rubber band), but it may, in fact, be counterproductive to aim for it. Psychosis can better be viewed as a transformative process, out of which a healthier human is born, “weller than well,” as they say.
In the new book Rethinking Madness, psychiatric survivor and clinician Dr. Paris Williams eloquently illuminates the point:
In the life sciences, it is common to think of living organisms as existing in a state of homeostasis, which is an organism’s resistance to change and its ability to maintain a stable internal environment. Mainstream psychology and psychiatry evidently draw from this model when attempting to return a psychotic individual to a state that is as close to his or her pre-psychotic state as possible. It has been suggested, however, that it is actually more accurate to consider organisms to be living in a homeodynamic state rather than a homeostatic one. The term homeodynamic suggests that “once a new stressor is encountered, the organism never returns to its previous dynamic state, but establishes a new dynamic balance appropriate to this newly integrated experience” …
In the context of psychosis, then, this concept suggests that it may be terribly problematic to attempt to return someone to their pre-psychotic condition rather than to support them in integrating their anomalous experiences as they move into an altogether new way of being in the world, an idea that is in very close accord with the recovery research. … [therefore] my working definition for full recovery is: “The condition of having achieved a homeodynamic balance in which the overall distress (and not necessarily the anomaly) of one’s subjective experiences is the same or less than that which preceded the psychosis.”
-Dr. Paris Williams in Rethinking Madness: Towards a Paradigm Shift in our Understanding and Treatment of Madness [emphasis added]
Ultimately, it’s up to each one of us to define “recovery” and “wellness” for ourselves – but I kind of like what Dr. Williams has done with the terms.
Click here to read a preview of the book Rethinking Madness.
DSM-5 conflicts of interest hit mainstream media; protestors rally, but is it for the right reasons? 03/14/2012Posted by ALT in DSM-5, Mental Health Policy and Inititatives, Patient Rights and Advocacy.
Tags: APA, conflict of interest, DSM-5, John Perry, mental health, Occupy the APA, psychiatry, psychosis, schizophrenia
I’m no journalist.
I did write for my high school newspaper (I can recall a particularly riveting article about different styles of shoes!), but these days I’m strictly a blogger, cavalierly inserting humor, my own biased opinion, and all manner of distractions and sidetracks into my “articles.”
Nevertheless, this ABC news article from yesterday (“DSM-5 Under Fire for Financial Conflicts of Interest”) follows the exact argument I put forward in my little piece entitled “For the DSM-5 Task Force, Being Greasy Never Been So Easy!” Whoa, did I inadvertently produce some journalism here?
I have to admit, I liked my title better.
Ok, ALT; stop patting yourself on the back!
Done. Now let’s dig in.
The ABC story was fueled by the publication of an academic analysis of the conflicts of interest of the various DSM-5 committees, conducted by the same researcher (Lisa Cosgrove) who published a similar analysis in the days of DSM-IV development.
As I wrote awhile ago, it’s practically a conflict-of-interest OLYMPICS! Cosgrove found that about ¾ of the work groups have a majority of members with major ties to the pharmaceutical industry. Some standout groups include:
- Mood Disorders Group: 67% of members report ties to industry
- Psychotic Disorders: 83%
- Sleep/Wake Disorders: 100%
Moreover, when comparing the figures from the DSM-5 to her previous analysis of the DSM-IV workgroups, Cosgrove has found that in about half the work groups, conflicts of interests have only gotten worse.
[click to enlarge]
It appears that the APA thought transparency alone would be a solution to their metastisizing “conflict of interest” problem.
Well, they’re wrong. We can clearly see the giant, throbbing tumor now, but the fact is it’s still there.
The whole point of disclosing conflicts of interest is determining whether someone is unencumbered enough to participate in a decision-making/fact-finding process. For this to be in any way legitimate, there must be some threshold where the person’s conflicts of interest are too great, where they are removed from the process. But the APA apparently has no limit.
Oh, sure, they say something about “no more than $10,000/year directly from the pharmaceutical industry and no more than $50,000 in pharma stock options” … but with major gaps in their disclosure policy and no dollar amounts made public, how can we be sure this is any less of an empty gesture than the rest of their carefully choreographed “transparency” dance?
DSM detractors say the darndest things…
A wave of protest against the DSM has been building over the past few months, but I’m not sure that I’ll be able to unite with the mainstream (or “middle way”) DSM protesters. Here’s why:
Middle way protestors are against the DSM-5 in particular, criticizing the development process, the addition of so-called “unscientific diagnoses,” financial conflicts of interest of the developers, etc.
The idea being that we simply need a better process for creating this thing. And that the botched development of the DSM-5, which will result in flaws that could’ve been avoided with more rigorous procedures, is a risky business because it might turn the tide of public opinion against the very institution of the DSM; which would be terrible because we need some kind of DSM in order to treat mental illness at all. The DSM detractors quoted in this article all seem to fall into that camp; Allen Frances, David Elkins, and Cosgrove herself.
But there’s another camp, which I and many others belong to. Instead of being against the DSM-5 in particular, we’re against the institution of the DSM, period. Instead of arguing that the DSM-5 is marginalizing, stigmatizing, unscientific, we argue that the practice of diagnosing people itself is all of these things and worst of all… dehumanizing!
In ABC’s coverage, only the “middle way” DSM detractors are represented. And I find myself feeling a little piqued by what they have to say. For example:
Dr. Allen Frances, who chaired the revisions committee for DSM-4, said the new additions would “radically and recklessly” expand the boundaries of psychiatry.
“They’re at the boundary of normality,” said Frances, who is professor emeritus of psychiatry at Duke University. “And these days, most diagnostic decisions are not made by psychiatrists trained to distinguish between the two [normality and mental illness, presumably]…”
- From ABC News article “DSM-5 Under Fire for Financial Conflicts of Interest”
The boundary of normality? He speaks as if he knows exactly where that is! And that the DSM-IV catalogs “diseases” that fall well beyond it.
I beg to differ.
Take so-called “schizophrenia,” or psychosis, for example. As John Perry so nicely puts it:
In my opinion, the real pathology in psychosis does not reside in the “mental content,” the images and the symbolic sequences. All of that appears to be a natural psychic process, present and working in all of us. This is normal madness, so to speak. The schizophrenic “disorder” lies rather in the ego, which suffers from a constricted consciousness… The problem of the prepsychotic state is how to discover the impassioned life, and nature has its own answer in the form of a turbulent ordeal, a trial by immersion in the source of the passions – that is, a psychosis.
- John Perry, in The Far Side of Madness
[If you liked that quote and have some time on your hands, read this!]
From Perry’s point of view, psychosis is often a naturally transformative and healing process, somewhat like childbirth. If there is such a thing as a “boundary of normality” (which I doubt), it falls well within it. Psychosis is the “normal” response of a psyche needing to heal.
Here’s another rather disturbing quote from the middle camp:
“My best hope would be for the APA to respond in a substantive way to the concerns we’ve raised. They have an opportunity here to make a correction that would give the appearance, if not the reality of developing a diagnostic instrument that’s objective and has integrity.”
- Lisa Cosgrove, in the ABC News article DSM-5 Under Fire for Financial Conflicts of Interest; emphasis added
A semblance of objectivity and integrity – not necessarily the real thing – is her best hope for the DSM committee??
Way to aim high!
Should all the DSM-V detractors put aside their differences and join together to protest the DSM-V, or are the two camps far enough apart that their protests really can’t align?
As you ponder, consider this: a large DSM-5 protest (Occupy the APA) is planned for May 5th in Philadelphia at the site of the APA convention. The middle way camp will necessarily be inside the convention (most of them belong to the APA, after all), while the rest of us will be standing outside, barred from entry.
It appears that more than mere distance separates our two camps.
Thoughts from John Perry on psychosis as vision, schizophrenia as process, and healing as the natural result 01/30/2012Posted by ALT in Philosophy/Spirituality, Treatments.
Tags: Diabasis, healing, John Perry, Jung, Loren Mosher, psychosis, schizophrenia, Soteria House
I’m sure most of you are already familiar with the work of Dr. Loren Mosher at Soteria House (if not, this is my favorite article about it).
His is the most famous of these un-medicated, peer support-based treatment approaches for first break (or not) schizophrenia. It also happens to be the best documented, scientifically; and what excellent documentation it is! 85-90% of “acute sufferers” were able to return to the community and did not suffer relapse.
But, as I have been delighted to learn recently, his is by no means the only iteration of this treatment model. Another pioneer in this field – a friend and contemporary of Mosher’s, in fact – was the Jungian John Weir Perry. His treatment center, called Diabasis, operated in San Francisco in the 70s. Heavily influenced by Jungian approaches to psychosis (Perry did study with him in Switzerland) and Chinese philosophy, Diabasis was a place for schizophrenics to process their internal Apocalypse with the loving support of the laypeople staffed by the project. Medication was, for the most part, avoided, as were restraints and coercion of any kind.
Today I stumbled upon an extensive and fascinating interview with John Weir Perry about the nature of psychosis and “schizophrenia” and the approach of Diabasis to these phenomena. I’ve pasted a few of my favorite excerpts below, but you can also download the entire thing here.
On Diabasis and the healing nature of a supportive, home-like environment:
One has to let the visionary process unfold itself spontaneously.
Under these conditions, to our surprise, we found that our clients got into a clear space very quickly! We had started out with the notion that we would surely be in for a lot of bedlam with all this “madness” going on, but actually the opposite was true! People would come in just a crazy as could be on the first day or two, but they’d settle down very soon into a state of coherency and clarity… The calming effect of a supportive environment is truly amazing!
Now throughout all this there was nothing scheduled, nothing mandatory. It was all informal… You see, we wanted them to be in this house of their own free will. They had to realise their own desire to belong in the house, and they did.
So this whole approach is essentially one of releasing, rather than suppression. We allowed everything and encouraged its expression — not towards chaos, but toward communication! Communication tends to order.
Schizophrenia as a self-healing process:
“Schizophrenia” is a self-healing process – one in which, specifically, the pathological complexes dissolve themselves. The whole schizophrenic turmoil is really a self-organising, healing experience. It’s like a molten state. Everything seems to be made of free energy, an inner free play of imagery through which the alienated psyche spontaneously re-organises itself – in such a way that the conscious ego is brought back into communication with the unconscious again…
It [psychosis] is like the mythological image in a perfect stained-glass window being smashed, and all the bits and pieces being scattered. The effect is very colourful, but it’s very hard to discern how the pieces belong to each other. Any attempt to make sense of it is an exercise in abstraction from the actual experience. The important thing is to find the process running through it all.
“Chronic schizophrenia” – a cultural construct:
[Interviewer:] So are you saying that the reason we have so-called “chronic schizophrenia” in our society, – where a person is medicated, distressed or hospitalized for decades – is really cultural? A society which refuses to understand the healing nature of the phenomenon?
Yes, it seems so. Of course, there are some unusual cases where the individual simply can’t handle the impact of all this unconscious content, or doesn’t know what to do with it, and freaks out. But from my experience at Diabasis, I’ve seen so many people go the other way that I really do feel “chronic schizophrenia” is created by society’s negative response to what is actually a perfectly natural and healthy process.
Goal of Perry’s treatment approach:
The tendency [amongst first break schizophrenics]… is to concretise all the symbolic stuff and believe there are enemies out there, and that the walls are wired, that there are people with guns at the window, and subversive political parties trying to do things, or that one is being watched because one is the head of some organisation and everybody knows it. All of that is a mistaken, “concretistic” tendency to take too literally things whose correct meaning is actually symbolic.
So yes, the therapeutic goal is to achieve that attitude which perceives the symbolic nature of the ideation which belongs to the inner reality. Now, the inner reality is real! It’s very important to grant it that reality, but not to get the two realities mixed up. That’s the trick! Actually, for most people it’s surprisingly easy…
The average person tends to go along with the inner journey and to realise – well, they do need to be reminded – but once they’re reminded, they tend to quickly perceive that it is a spiritual test, or a symbolic test, and not the actual end of the actual world.
Again, the full interview with Perry is available here.
If you’re intrigued by Diabasis and would like to know more, Perry wrote a book called The Far Side of Madness about the program. Additionally, Michael Cornwall over at Mad In America is blogging about his experience with the program. I suggest you check out what he has to say about it as well!