Psychosis and Psychosis and SpiritualitySpirituality

Isabel ClarkeIsabel ClarkeConsultant Clinical PsychologistConsultant Clinical Psychologist

Southern Health Foundation NHS TrustSouthern Health Foundation NHS Trust

Spiritual Crisis Network Director.Spiritual Crisis Network Director.

Some Questions Some Questions

What are the characteristics of spiritual What are the characteristics of spiritual experience ?experience ?

What are the characteristics of psychotic What are the characteristics of psychotic experience ?experience ?

Two WaysofExperiencing

-

The other one!

Characteristics of the other way of Characteristics of the other way of experiencingexperiencing

Metaphor come to lifeMetaphor come to life

Dissolution of boundariesDissolution of boundaries

Cosmic significance – terrible or wonderfulCosmic significance – terrible or wonderful

Confusion about the selfConfusion about the self

Coincidence rules OKCoincidence rules OK

Threat (cosmic)Threat (cosmic)

Link with traumaLink with trauma

O the mind, mind has mountains; O the mind, mind has mountains; cliffs of fallcliffs of fall

Frightful, sheer, no-man-fathomed. Frightful, sheer, no-man-fathomed. Hold them cheapHold them cheap

May who ne’er hung there.May who ne’er hung there.

Gerald Manley Hopkins (from ‘No worst, there Gerald Manley Hopkins (from ‘No worst, there is none, pitched past pitch of grief’)is none, pitched past pitch of grief’)

Travel into the strange places of Travel into the strange places of the mindthe mind

Not mind safely locked inside the skull; Not mind safely locked inside the skull;

No!: mind that envelopes us; No!: mind that envelopes us;

Mind that is sea we swim in Mind that is sea we swim in

Travel across the threshold – the Travel across the threshold – the Transliminal – but never to let go of Transliminal – but never to let go of Ariadne’s thread!Ariadne’s thread!

Spirituality and RelationshipSpirituality and Relationship

As people, we make sense only within our As people, we make sense only within our context of relationship –we are held in a context of relationship –we are held in a web of relationshipweb of relationshipImportant others; our family; our social Important others; our family; our social group; ethnic group etc. group; ethnic group etc. Spirituality is about relationship with that Spirituality is about relationship with that which is beyond; with the whole – the which is beyond; with the whole – the widest circle of the webwidest circle of the webAt times of breakdown, that wider context At times of breakdown, that wider context becomes importantbecomes important

Different types of experience: Different types of experience: psychosis and spirituality revisited.psychosis and spirituality revisited.

Mental health breakdown is a common human experienceMental health breakdown is a common human experienceComes from a combination ofComes from a combination of Individual vulnerability/sensitivityIndividual vulnerability/sensitivity Life circumstances – losses etc.Life circumstances – losses etc. Leading to unmanageable feelingsLeading to unmanageable feelings It often happens at times of transitionIt often happens at times of transition

For some – the other dimension, across the threshold opens For some – the other dimension, across the threshold opens up up A way out of the impasse ?A way out of the impasse ?Creative. Transformational ?Creative. Transformational ?Disorienting. Terrifying ?Disorienting. Terrifying ?A journey into territory where there are no maps, no A journey into territory where there are no maps, no guarantees.guarantees.

What is going on here? The levels of processing What is going on here? The levels of processing problemproblem

Being human is difficult because our brains have 2 Being human is difficult because our brains have 2 main circuits – they work together most of the time, main circuits – they work together most of the time, but not always.but not always.There is one direct, sensory driven type of processing There is one direct, sensory driven type of processing and a more elaborate and conceptual one.and a more elaborate and conceptual one.The same distinction can be found in the memory.The same distinction can be found in the memory.Direct processing is emotional and characterised by Direct processing is emotional and characterised by high arousal.high arousal.The other one filters our view to make it more The other one filters our view to make it more manageablemanageableThe direct processing system is the default system – The direct processing system is the default system – the one that dominates if the other gets disconnected the one that dominates if the other gets disconnected – in which case we lose that filter – and land up – in which case we lose that filter – and land up ACROSS THE THRESHOLD –THE TRANSLIMINALACROSS THE THRESHOLD –THE TRANSLIMINAL

Getting a scientific grip on the Getting a scientific grip on the transliminaltransliminal

The split between realities comes from the The split between realities comes from the split in us!split in us!Interacting Cognitive Subsystems provides a Interacting Cognitive Subsystems provides a way of making sense of this ‘crack’way of making sense of this ‘crack’..(Teasdale & (Teasdale & Barnard 1993).Barnard 1993).

An information processing model of cognitionAn information processing model of cognition Developed through extensive research into memory and Developed through extensive research into memory and

limitations on processing.limitations on processing. A way into understanding the “Head/Heart split in people.A way into understanding the “Head/Heart split in people.

Linehan’s STATES OF MIND Linehan’s STATES OF MIND (from Dialectical (from Dialectical Behaviour Therapy) – Maps onto Interacting Cognitive SubsystemsBehaviour Therapy) – Maps onto Interacting Cognitive Subsystems

REASONABLE

MIND(Propositionalsubsystem)

EMOTION

MIND

(Implicational subsystem)

IN THE PRESENTIN CONTROL

WISE

MIND

WISE

MIND

BodyState

subsystem

Auditoryss.

Visualss.

Interacting Cognitive Subsystems.

Implicational subsystem

ImplicationalMemory

Propositional subsystem

PropositionalMemory

Verbalss.

Important Features of this modelImportant Features of this model

Our subjective experience is the result of two Our subjective experience is the result of two overall meaning making systems interacting – overall meaning making systems interacting – neither is in control.neither is in control.

Each has a different character, corresponding to Each has a different character, corresponding to “head” and “heart”.“head” and “heart”.

The IMPLICATIONAL Subsystem manages The IMPLICATIONAL Subsystem manages emotion – and therefore relationship.emotion – and therefore relationship.

The verbal, logical, PROPOSITIONAL ss. gives The verbal, logical, PROPOSITIONAL ss. gives us our sense of individual self.us our sense of individual self.

Two Ways of KnowingTwo Ways of Knowing

Good everyday functioning = good Good everyday functioning = good communication between communication between implicational/relational and propositionalimplicational/relational and propositionalAt high and at low arousal, the At high and at low arousal, the implicational ss becomes dominantimplicational ss becomes dominantThis gives us a different quality of This gives us a different quality of experience – one that can be either valued experience – one that can be either valued and sought after, or shunned and fearedand sought after, or shunned and feared

A Challenging Model of the MindA Challenging Model of the Mind

The human being is a balancing act as the two The human being is a balancing act as the two organising systems pass control back and forth: organising systems pass control back and forth: there is no boss.there is no boss.The mind is simultaneously individual, and The mind is simultaneously individual, and reaches beyond the individual, when the reaches beyond the individual, when the implicational ss. is dominant.implicational ss. is dominant.This constant switch between logic and emotion This constant switch between logic and emotion gives us human fallibilitygives us human fallibilityThe self sufficient, billiard ball, mind is an illusionThe self sufficient, billiard ball, mind is an illusionIn our implicational/relational mode we are a part In our implicational/relational mode we are a part of the whole.of the whole.

‘‘That’s How the Light gets in’ That’s How the Light gets in’ (and the dark)(and the dark)

The Relational part of our mind is embedded in The Relational part of our mind is embedded in relationship; in the whole (the older part) relationship; in the whole (the older part) The newer, self conscious, part holds our individualityThe newer, self conscious, part holds our individualityTemporary control passing backwards and forwards Temporary control passing backwards and forwards between the two organising ss is experienced as between the two organising ss is experienced as normalitynormalityWhen the ‘relational’ takes over for any length of time, When the ‘relational’ takes over for any length of time, the character of experience changesthe character of experience changesThe person is no longer grounded in their individuality – The person is no longer grounded in their individuality – boundaries dissolve – they are open to any influences – boundaries dissolve – they are open to any influences – positive and negative.positive and negative.

The Everyday The TransliminalThe Everyday The TransliminalOrdinaryOrdinary

Clear limitsClear limits

Access to full memory Access to full memory and learningand learning

Precise meanings Precise meanings availableavailable

Separation between Separation between peoplepeople

Clear sense of selfClear sense of self

Emotions moderated Emotions moderated and groundedand grounded

A logic of ‘Either/OrA logic of ‘Either/Or

NuminousNuminousBoundaries dissolveBoundaries dissolveAccess to propositional Access to propositional knowledge/memory is knowledge/memory is patchypatchySuffused with meaning Suffused with meaning or meaninglessor meaninglessSelf: lost in the whole Self: lost in the whole or supremely importantor supremely importantEmotions: swing Emotions: swing between extremes or between extremes or absentabsentA logic of ‘Both/And’A logic of ‘Both/And’

Managing the thresholdManaging the threshold

Awareness of vulnerability – of openness to transliminal Awareness of vulnerability – of openness to transliminal experienceexperienceGrounding when the experience is overwhelming. Grounding when the experience is overwhelming. Grounding activity. Grounding food.Grounding activity. Grounding food.Mindfulness to manage the thresholdMindfulness to manage the thresholdChallenge of facing unshared reality mindfully – both Challenge of facing unshared reality mindfully – both pleasant and unpleasantpleasant and unpleasantTransliminal state of mind = most accessible at high and Transliminal state of mind = most accessible at high and low arousal low arousal Managing arousal – breathing control to reduce arousal; Managing arousal – breathing control to reduce arousal; mindful activity in the present to prevent it slipping.mindful activity in the present to prevent it slipping.

Web of RelationshipsWeb of Relationships

Self asexperienced

in relationshipwith primary

caregiver

Sense ofvalue comes

from rel. withthe spiritual

primarycare-giver

In Rel. with wider

group etc.

In Rel. withearth:

non humansetc.

Unpacking the WebUnpacking the Web

We learn about ourselves from the way the We learn about ourselves from the way the important people around us treat us from important people around us treat us from babyhood on.babyhood on.

The function of emotions is the organisation of The function of emotions is the organisation of relationship: relationship with others, but also relationship: relationship with others, but also our relationship with ourselves.our relationship with ourselves.

Emotions communicate directly between people, Emotions communicate directly between people, bypassing the verbal-logical (they are catching).bypassing the verbal-logical (they are catching).

Looking Beyond the Individual – to Looking Beyond the Individual – to understand Spiritualityunderstand Spirituality

We are defined by relationships that go We are defined by relationships that go beyond our current human bondsbeyond our current human bondsThese include relationship with our These include relationship with our ancestors and those who will come after ancestors and those who will come after ususMoving out to relationship with our group, Moving out to relationship with our group, nation, other peoples, humanitynation, other peoples, humanityOur relationship with the non human Our relationship with the non human creatures is deep and significant for uscreatures is deep and significant for us

Further dimensions of relationshipFurther dimensions of relationship

Relationship with place, with the earth, our Relationship with place, with the earth, our planetplanet

Relationship with that which is deepest and Relationship with that which is deepest and furthest – which is beyond our naming capacity, furthest – which is beyond our naming capacity, but is sometimes called God, Goddess, Spirit but is sometimes called God, Goddess, Spirit etc.etc.

Relationship is something we experience – so it Relationship is something we experience – so it can be beyond propositional knowledge – we can be beyond propositional knowledge – we can feel more than we know.can feel more than we know.

Psychosis, Spiritual Crisis and Psychosis, Spiritual Crisis and RelationshipRelationship

Psychosis can be seen as getting lost on the Psychosis can be seen as getting lost on the wrong side of the threshold – the place of wrong side of the threshold – the place of relationshiprelationshipBut we need our propositional to manage But we need our propositional to manage immediate human relationships – and life in immediate human relationships – and life in generalgeneralIt is no accident that it is those people diagnosed It is no accident that it is those people diagnosed as psychotic who are often most concerned with as psychotic who are often most concerned with the spiritualthe spiritualI suggest we need to respect their connection I suggest we need to respect their connection with that valued part of human experience – with that valued part of human experience – while developing ‘threshold management’while developing ‘threshold management’

Psychosis – Potential for Psychosis – Potential for TransformationTransformation

Traditions such as Psychosynthesis and Spiritual Traditions such as Psychosynthesis and Spiritual Emergence/Emergency recognize the transformational Emergence/Emergency recognize the transformational potential of the transliminal.potential of the transliminal.

Meeting and integrating shadow - an aspect of Meeting and integrating shadow - an aspect of transformationtransformation

These traditions tend to distinguish between ‘psychosis’ These traditions tend to distinguish between ‘psychosis’ and transformational crisesand transformational crises

More and more this is seen as a false dichotomy – Spiritual More and more this is seen as a false dichotomy – Spiritual Crisis Network (.org.uk)Crisis Network (.org.uk)

Mike Jackson’s Problem Solving – problem solving model, Mike Jackson’s Problem Solving – problem solving model, encompassing potential and dangers.encompassing potential and dangers.

Role of stigma in trapping people.Role of stigma in trapping people.

Taking Experience Seriously in Taking Experience Seriously in Psychosis/Spiritual CrisisPsychosis/Spiritual Crisis

Acknowledging that psychosis feels differentAcknowledging that psychosis feels differentNormalising the difference in quality of Normalising the difference in quality of experience as well as the continuityexperience as well as the continuityPositive side as well as vulnerabilityPositive side as well as vulnerability

• Helping people to manage the threshold – Helping people to manage the threshold – mindfulness is keymindfulness is keySensitivity and openness to anomalous Sensitivity and openness to anomalous experience – continuum with normality: Gordon experience – continuum with normality: Gordon Claridge’s Schizotypy research.Claridge’s Schizotypy research.Understanding the role of emotion – the feeling Understanding the role of emotion – the feeling is real even though the ‘story’ can be suspect.is real even though the ‘story’ can be suspect.

Evidence for a new normalisationEvidence for a new normalisationSchizotypy – a dimension of experience: Gordon Schizotypy – a dimension of experience: Gordon Claridge.Claridge.Mike Jackson’s research on the overlap between Mike Jackson’s research on the overlap between psychotic and spiritual experience.psychotic and spiritual experience.Emmanuelle Peter’s research on New Religious Emmanuelle Peter’s research on New Religious Movements.Movements.Caroline Brett’s research: having a context for Caroline Brett’s research: having a context for anomalous experiences makes the difference betweenanomalous experiences makes the difference between whether they result in diagnosable mental health whether they result in diagnosable mental health

difficultiesdifficulties whether the anomalies/symptoms are short lived whether the anomalies/symptoms are short lived

or persistor persist. (and now Heriot Maitland). (and now Heriot Maitland)Wider sources of evidence – e.g.Cross cultural Wider sources of evidence – e.g.Cross cultural perspectives; anthropology. Richard Warner: Recovery perspectives; anthropology. Richard Warner: Recovery from Schizophrenia.from Schizophrenia.

The ‘What is Real and What is Not’ programmeThe ‘What is Real and What is Not’ programme

A way of working with psychosis that normalises the spiritual A way of working with psychosis that normalises the spiritual dimension.dimension.

Validating the person’s experience, and helping them to Validating the person’s experience, and helping them to manage the threshold between the two ways of manage the threshold between the two ways of experiencing.experiencing.

Mobilising and nurturing strengthsMobilising and nurturing strengths

Persuasion to join “shared reality” – need to be honest Persuasion to join “shared reality” – need to be honest about the risks.about the risks.

““Sensitivity” – normalisation based on Claridge’s work on Sensitivity” – normalisation based on Claridge’s work on schizotypy.schizotypy.

The person’s important context of relationships needs The person’s important context of relationships needs attending to – a lifeline.attending to – a lifeline.

Creative expression Creative expression

Session 2. The role of ArousalSession 2. The role of Arousal shaded area = anomalous experience/symptoms are more accessible.shaded area = anomalous experience/symptoms are more accessible.

Level of Level of ArousalArousal

Ordinary, alert, concentrated, state of arousal.Ordinary, alert, concentrated, state of arousal.

Low arousal: hypnagogic; attention drifting etc.Low arousal: hypnagogic; attention drifting etc.

High Arousal - stress

Contact details, References and Web Contact details, References and Web

addressesaddresses Isabel.Clarke@hantspt-sw.nhs.ukIsabel.Clarke@hantspt-sw.nhs.ukAMH Woodhaven, Calmore, Totton SO40 2TA.AMH Woodhaven, Calmore, Totton SO40 2TA.

Clarke, I. (Ed.) (2010)Clarke, I. (Ed.) (2010) Psychosis and Spirituality: consolidating the new Psychosis and Spirituality: consolidating the new paradigm.paradigm. Chichester: Wiley Chichester: WileyClarke, I. ( 2008) Clarke, I. ( 2008) Madness, Mystery and the Survival of GodMadness, Mystery and the Survival of God. . Winchester:'O'Books.Winchester:'O'Books.Clarke, I. & Wilson, H.Eds. (2008)Clarke, I. & Wilson, H.Eds. (2008) Cognitive Behaviour Therapy for Acute Cognitive Behaviour Therapy for Acute Inpatient Mental Health Units; working with clients, staff and the milieu.Inpatient Mental Health Units; working with clients, staff and the milieu. London: Routledge.London: Routledge.Durrant, C., Clarke, I., Tolland, A. & Wilson, H. (2007) Designing a CBT Durrant, C., Clarke, I., Tolland, A. & Wilson, H. (2007) Designing a CBT Service for an Acute In-patient Setting: A pilotService for an Acute In-patient Setting: A pilot evaluation study. evaluation study. Clinical Clinical Psychology and PsychotherapyPsychology and Psychotherapy. 14, 117-125. . 14, 117-125. Wilson, H, Clarke, I & Phillips,R.,(in submission) Wilson, H, Clarke, I & Phillips,R.,(in submission) Evaluation of an Inpatient Evaluation of an Inpatient Group CBT for Psychosis Program Designed to Increase Effective Coping Group CBT for Psychosis Program Designed to Increase Effective Coping and Address the Stigma of Diagnosis and Address the Stigma of Diagnosis Psychosis.Psychosis.

www.isabelclarke.orgwww.isabelclarke.orgwww.SpiritualCrisisNetwork.org.ukwww.SpiritualCrisisNetwork.org.uk