Transcript isps-dialog-at-the-edge-of-reason1

Dialog at the edge of
reason: addressing
spiritual issues within
treatment for
psychosis
Presenter:
Ron Unger LCSW
[email protected]
541-513-1811
Rough Definitions

Psychosis
– Experiences of new perceptions, meanings,
and interpretations outside of “reason” or
mundane cultural norms, that seem to
make things worse

Spirituality (at least when it is positive)
– The same thing as above, only it happens
in a way that seems to make things better
Psychiatry sees categorical
differences

Once a person is diagnosed
– Their unusual experience is seen as
definitely “illness” or “disorder”
– The notion of any positive value to it, any
spiritual or transformative potential, is
usually dismissed
An Alternative:
The Continuum View

Unusual experiences can be seen on a
continuum
– from definitely helpful or “spiritual”
– To definitely problematical

Relationships between experiences and
people’s lives can be complex
– “hellish” experiences might lead to later
breakthroughs
Historical perspective

“Madness” was more a matter of not
having the right relationship with spirits
or the spiritual
– But being in a spontaneous altered state
might mean the presence of spiritual ability

If nurtured correctly
The Pendulum Swings, from religious to medical…..
“Madness”
seen by
dogmatic
religion as
resulting from
spiritual wrong
or offense
against God:
Risk is that
person will be
rejected or
punished by
society
Complex view:
Those apparently
“mad” may have
both medical and
spiritual
differences, and
may have
spiritual insights
to offer,
especially once
any mistakes are
overcome
“Madness” seen
as not spiritual
at all, just a
medical
problem:
Risk is that the
meaning of the
person’s
experience will be
ignored & excess
medical treatment
may occur
Problems for professionals if
psychosis involves spirituality

Neither medical nor psychological
professionals could then claim full
“expertise” in the area of psychosis
– Fear that absence of “expertise” could
mean loss of status

Also, lack of understanding how to
address spiritual issues within a mental
health role
Problems for religious leaders if
psychosis involves spirituality
Some experiences may contradict
religious teachings or dogma
 Would highlight the fact that religious
leaders may not know enough to help
people who are lost
 If psychotic people are seen as partly
spiritual, the public may notice that
accepted religious or spiritual
approaches may be a bit psychotic

Why discuss spiritual issues:
Helpful in therapy to use a person’s own
language and metaphors
 Spiritual concepts are often less
stigmatizing
 A spiritual focus encourages professional
humility
 Better relationships
 Spirituality is proven valuable in recovery

Is it worth trying to see a
difference?

Between
– A spiritual experience with some mental
and emotional difficulties
– A mental disorder or psychosis with some
preoccupation with spiritual issues
How could even an atheist
talk about spiritual issues?
Psychosis is best understood from a
whole systems, or complexity point of
view
 Spiritual language and metaphors can
be understood as another way of trying
to talk about the nature and dynamics
of whole systems

Could words that sound delusional
just need translation?

Instead of focus on the way the words
don’t make sense, or are unscientific
– Look for ways to understand them that
would make sense to you
– Then experiment with speaking about
them that way & see what happens
Cultivating Uncertainty &
Humility

If we recognize that all maps, concepts
etc. are only partially helpful & accurate
– Then we can listen to and respect those
who see & describe things differently than
we do

When we respect both our own views &
that of others
– We model for our clients how to do the
same
Expanding the discussion

Moving from monolog to dialog
– Jung’s “archetypal amplification” is one
possible method

Rather than suppress “mad” views
– Help person experiment with a variety of
perspectives
– Goal is to induce cognitive flexibility
Interacting Cognitive Subsystems, a model by
Teasdale & Barnard, based on research on cognitive processing –
slide by Isabel Clarke and Donna Rutherford
Implicational
subsystem
Implicational
Memory
Body
State
subsystem
Auditory
ss.
Visual
ss.
Propositional subsystem
Propositional
Memory
Verbal
ss.
Model of the “Renewal Process”

1. Construct system breaks down
– Due to an impairment or trying to solve a
problem not solvable within that system

2. Temporary suspension of constructs
– Encounter with the “transliminal”

3. Construct restructuring
– If done under stress, errors are more
likely, leading to……
New Integration
Propositional
Mind split from
implicational
May flip
between
states or
coexisting,
un-integrated
opposites
Old integration, has
problems
Implicational
Mind split from
propositional
People may “flip” between being lost in the transliminal & relying
on rigid & defective constructs
Rely on
defective,
dissociated,
and/or
dogmatic
constructs:
Attempts at
constructs
coexist with an
awareness of the
mystery that
surrounds them:
Mystery, or
awareness of
limits to the
constructs, is
denied.
Attachment to
constructs is
tentative, humble,
maintains a sense
of humor about
their limits. Lively.
Lost in the
mystery:
Since constructs
were not
adequate, all
attempts at
constructs are
abandoned.
But then there is
no way to
organize or
communicate.
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.
Slide by Isabel Clarke and Donna Rutherford
DIALECTICAL BEHAVIOUR THERAPY: Linehan’s
STATES OF MIND applied to PSYCHOSIS
Shared and Non-shared Reality
reasonable mind
Ordinary thinking
Shared reality.
wise
Mind –
in touch
With both
emotion mind
or open to other ways
of experiencing
Non-shared reality
in the present
in control
Discussion of Ways of coping suggested by this approach –
management of arousal and distraction.
Slide by Isabel Clarke and Donna Rutherford
Using the model of the
renewal process in therapy




Clarify history up to first experience of
“psychosis”
Define the life problem that needed
resolving
Look at how constructs at that time may
have been inadequate
Education on how breakdown in constructs
can lead to new insights
– And what it’s like to be “in the process”

Explore how to keep access to this process
– While better handling the risks
Role of spirituality in recovery

For many, spirituality is key in response
to any sort of adversity
– Many report spirituality assists in recovery
from psychosis
Visionary experience can contain keys
to recovery
 “Negative symptoms” can sometimes be
overcome by opening up to spiritual
themes present in the original psychosis

Person perceives
problem not
solvable within
construct system
Surrounding
society
attempts to
suppress
renewal
process in a
way that
causes
problems for
the person
Person enters
“renewal
process” looking
for solution
Surrounding
society sees
renewal
process as a
threat
Psychosis and Social Renewal

Rather than suppress the Visionary
– A better role for society is:




Protect and Contain the person and the process
Collaborate with the person in selectively
drawing from the process
Train people prone to this process in how to
navigate it successfully
Our survival may depend on a better
relationship with the Visionary