A Critique of Psychosis

exploding-brain

Hi Everyone. The following is an academic paper I wrote about Schizophrenia (it is not too dry… I promise!) It proposes an alternative view of the disorder than that which we are most accustomed to in our medical society. I am also open to and WELCOME any feedback, especially from people who have experienced psychosis/ spiritual emergence, or have someone close to them who has gone through this, as I have been in neither position myself. I think this way of holding mental illness is the most humane and harm-reducing way of doing so, considering extreme states are such a mystery in the first place.  Yet I am open to the possibility that I may be romanticizing the experience of psychoses, and that the experience of going through it or being with someone going through it is much harder to navigate than I make it out to be. Enjoy…

A Critique of Medicalized Schizophrenia

For this critique, I would like to focus specifically on Schizophrenia. I will focus primarily on how schizophrenia is situated within a cultural context, and how the context itself may create a lot of the dynamics we associate with the disease. I will do this by examining how schizophrenia is regarded differently across cultures. I assert that schizophrenia is not autonomous, but exists as a relative term in contrast to social constructs. That schizophrenia exists only in its relativity to other things is reflected by its DSM V definition. I wall also explore what is happening neurologically, and question whether this makes sense to explain what is supposedly happening experientially. If it does not make sense, I ask whether a different understanding of what is happening experientially would be more compatible with what we see happening neurologically. I will also address how little we know about the brain/ mind interface, and question whether healthcare professionals are really qualified to make psychiatric decisions. I also want to point out that the term schizophrenia seems to be an umbrella term for everybody not understood by psychologists, and that anybody termed “crazy” is thrown into this general category. The DSM V definition itself is very heterogeneous, and this reflects the large lack of understanding about what is actually happening internally, and what makes schizophrenia distinct from other variants of mental illness. In other words, based on the definition alone, schizophrenia could look so many different ways. Is this list of possible symptoms really the best yardstick to measure pathology? Finally, I will examine the work of R.D. Laing and his hypothesis of schizophrenia as a developmental disorder. I will examine how this contributes to or undermines the classical understanding of schizophrenia.

The main point I want to make is that Schizophrenia is treated by Western medicine as an autonomous, objective, and intrinsic abnormality of the brain and aberration of mental functioning. I believe that schizophrenia is not objectively problematic, but a matter of perspective. Westerners see it in the context of Western cultural values of vocational productivity and contributing to the corporate industrial complex. In that vein, schizophrenics are disabled because they have less incentive and ability to contribute to society in that way. But the question is, could schizophrenia be an asset if the values of our society were different? Is it not the experience of schizophrenia that is problematic, but the cultural imperatives surrounding it that devalue, discredit, and reject it? Sue and Sue (2013) in their work, Counseling the Culturally Diverse, identify the different frameworks used to view disability. There is the: “Moral model (disability results from a moral lapse), medical model (disability is a physical limitation), or minority model (disability results from societal failure to accommodate individual difference)” (p.529). The authors talk about trends over time, including how disability used to be seen through a moral lens in an age when people where more staunchly religious. As science became the forerunning faith, physical and biological explanations were used to explain disability. In this progressing age and in activist communities, more and more we see the use of the Minority Model, which takes a critical look at the culture that contextualizes disability, and questions whether the problem lies in a prejudice culture. Our modern society (including the DSM V) continues to use the Medical Model to analyze schizophrenia, but I would like to criticize this approach from the perspective of the Minority Model.

It is the case that many people with schizophrenia suffer very frightening, paranoid, and distressing experiences from it. We have to ask ourselves, how much of this suffering is due to the content of the hallucinations and delusions itself, and how much is due to how we as a society hold (or fail to hold) this content. Is a snake intrinsically scary? Or is it scary because through stories and religious texts we have been taught to fear it? The stigma we place on the neurodiversity of someone with schizophrenia itself creates many of its distressing and debilitating factors. To describe this eloquently, I turn to Terence McKenna (1994) who spoke about this in a lecture series entitled Eros and Eschaton:

A shaman is someone who swims in the same ocean as the schizophrenic, but the shaman has thousands and thousands of years of sanctioned technique and tradition to draw upon. In a traditional society, if you exhibited “schizophrenic” tendencies, you are immediately drawn out of the pack and put under the care and tutelage of master shamans. You are told: “You are special. Your abilities are very central to the health of our society. You will cure. You will prophesy. You will guide our society in its most fundamental decisions.” Contrast this with what a person exhibiting schizophrenic activity in our society is told. They’re told: “You don’t fit in. You are becoming a problem. You don’t pull your own weight. You are not of equal worth to the rest of us. You are sick. You have to go to the hospital. You have to be locked up.” – You are on a par with prisoners and lost dogs in our society. So that treatment of schizophrenia makes it incurable.

 

I agree with McKenna that our lack of receptivity to the experience of schizophrenia creates much of the problem itself. He goes on to say, “Imagine if you were slightly odd, and the solution were to take you and lock you into a place where everyone was seriously mad. That would drive anyone mad! If you’ve ever been in a madhouse, you know that it’s an environment calculated to make you crazy and to keep you crazy” (1994). It is because of the protocol we take in this culture to deal with schizophrenic people including putting them on antipsychotic meds, putting them on lockdown in mental institutions, and labeling them delusional so that everything they say to try to explain themselves is used against them, that they end up disenfranchised, isolated, in added distress, often on the streets, and often suicidal. These traits we often attribute as symptoms of the disease rather than as consequences of the treatment of such individuals.

At this point it is necessary to name a term used to describe identical experiential phenomenon as psychosis, but with a different interpretation: Spiritual Emergence/ Emergency. This term was coined by psychiatrist and founder of Transpersonal Psychology, Stanislav Grof. He explains it in his 1989 book Spiritual Emergency: When Personal Transformation Becomes a Crisis saying,

In the most general terms, spiritual emergence can be defined as the movement of an individual to a more expanded way of being which involves enhanced emotional and psychosomatic health, greater freedom of personal choices, and a sense of deeper connection with other people, nature and the cosmos. An important part of this development is an increasing awareness of the spiritual dimension in one’s life and in the universal scheme of things. Spiritual development is an innate evolutionary capacity of all human beings. It is a movement towards wholeness or ‘holotropic state’, the discovery of one’s true potential. (p. 5, 1989)

Spiritual emergence speaks to a perspective espoused in most indigenous, shamanic cultures worldwide. Malidoma Patrice Somé, an elder of the Dagara people and teacher of West African Spirituality, in an interview with The Waking Times (2014), described his horror at seeing how people undergoing spiritual crises are treated in mental hospitals in the United States: “I was so shocked. That was the first time I was brought face to face with what is done here to people exhibiting the same symptoms I’ve seen in my village… So this is how the healers who are attempting to be born are treated in this culture. What a loss!” (para. 4). In the shamanic view, mental illness signals the birth of a healer, and it is the role of the community to help the person integrate the incoming energy. To test his theory that the shamanic treatment of someone undergoing spiritual emergence would have the same liberating effect on someone diagnosed as psychotic in the United States, Somé took a young man of eighteen years who had suffered a psychotic break, hallucinations, severe depression, and suicidality for years back to his village. Until that time, the boy had been on medications, in and out of mental hospitals, and his parents had all but given up on him. However, “After eight months [in the village], Alex had become quite normal. He was even able to participate with healers in the business of healing; sitting with them all day long and helping them, assisting them in what they were doing with their clients . . . . He spent about four years in my village. Alex stayed by choice, not because he needed more healing. He felt, much safer in the village than in America” (para. 17). Alex eventually returned to the United States and studied psychology at Harvard.

It is because of the crusade in this culture against mysticism and transpersonal ideology, that the moment anyone expresses supernatural ideation, we see them as delusional, defective, dangerous, sick, and nonsensical. It is then that their extra-sensory-abilities become their worst enemies. Just look at the contrast between the language used to identify their experience between western medical culture, and tribal cultures. In the DSM V, the following terms are used to describe schizophrenia: symptom, delusion, hallucination, and illness. This is in stark contrast to language used to describe identical phenomenon in mystical cultures including extra-sensory ability, psychic power, medicine, seeing, divining, and vision. One perspective assumes that the content of a schizophrenic’s hallucinations are figments of the imagination or of a defective mind and don’t actually exist. In contrast, a shamanic culture asserts that these hallucinations are not mirages of things that are not there, but visions of things that are preeminent, which most people don’t have the sensitivity to see. Anyone treated as though their reality is crazy is bound to feel crazy. To test this claim, simply try the experiment of telling a friend about something you experienced, and having them treat you like you are mad. Then tell them the same story and have them treat you with sincere interest and confidence. Notice the energetic contrast, and the difference in how it makes you fee in relationship to yourself. If one is repeatedly made to feel that she is crazy, this will induce a profound mistrust and confusion in oneself. If “disorganized thoughts” are not symptomatic of the disease itself, they are sure to result from the conventional treatment by healthcare professionals and community alike once one is diagnosed.

Perhaps what we should be inquiring about as healthcare professionals is not whether someone has hallucinations, but about the nature of them. We should ask to find out whether or not they have the potential to be helpful allies and resources. Just because someone sees an angel, should we automatically relegate them to the nonspecific domain of schizophrenia? An angel is a vision that many of the mystics from the great religions around the world experienced, that informed their insight, and made them what the community considered a pious and clairvoyant person, a conduit for the word of God, a role model for mankind, a messiah, etc. We worship such people as Muhammad or Jesus, and yet, an individual in our day and age can have the same visions (or even ones of snakes, blood, insects, things on fire, or other things found in holy scripture) and we pathologize them for having “overvalued ideas” or hallucinations and cast them to the fringes of society. As a therapist, I would wonder not whether a client hears auditory hallucinations, but what the voices say. I would work with the client to help increase their capacity to think for themselves and discriminate between what messages they trust and want to believe, and which ones they don’t find helpful, and would be better off ignoring. This is the exact same discrimination we should take in the physical realm. Human beings can tell us all sorts of things, but our ability to function depends largely on our ability to say, “I don’t trust that person… I don’t think I’ll take their advice.” Or, “I do trust this person, so I think I will listen to them because what they say resonates with me personally.”

What is the difference, really, between “real” life, and hallucinations? A tree, as far as we know, cannot hear, because it does not have ears. Does that mean that I am crazy because I can hear things? Does that mean that sound does not exist? No, it just means that I have the capacity to hear things that trees do not. But what if I was taught that the mere phenomenon of being able to hear was problematic, and that it meant I was crazy? I would be taught to fear and reject every sound that I heard. Every sound would be torture for me because it would isolate me from my tribe, and I would try to bat it down, and silence it. It wouldn’t matter if the sound was music, or if it was the sound of a wolf walking yards away informing me of its presence, or if it was someone telling me they loved me, or someone telling me valuable information… all of it would be “bad!” It would be such a loss to discredit and demonize all of this perception! But on the other hand, if I opened my mind enough to hear these sounds, and then used my sense of discrimination to weed out what I wanted to internalize from sounds I did not want to internalize (like the sound of my mother’s voice telling me I was worthless, for example), I would be empowered.

There was one anthropologist from Stanford named Tanya Luhrmann (2014) who along these lines, conducted a study where she asked schizophrenics from three different countries to describe the voices in their heads. The countries were the United States, Ghana, and India.

Schizophrenics in California reported the most negative feelings about their voices…Only a few patients said they had personal relationships with the voices…Eight could never figure out who was speaking to them, and resorted to giving them abstract names like “Entity.” In Ghana and India, patients’ experiences of schizophrenia were, relatively, more positive. They were more likely to report having intimate—and, they felt, constructive—relationships with the voices in their heads. In Chennai, interviewees rarely used clinical language like “schizophrenia” or “disorder.” Most—13 out of 20—regularly heard the voices of family members. “These voices behaved as relatives do: they gave guidance, but they also scolded,” writes Luhrmann. “Although people did not always like them, they spoke about them as relationships.”

 

The results of this study speak to the importance of treating hallucinations as real, looking into the content of them to understand them rather than relegating them to the field of nonsense, and learning how to relate to these entities in a way that serves the person. From this perspective, what western medicine terms a disability, the mystical, transpersonal, and shamanic traditions term a super-ability that can be utilized as a rich resource when the subject is taught out to read the information. It all comes down to paradigm, perspective, cultural values, and that what we take for granted as “reality.” We cannot confirm with any certainty that what we experience as reality is absolute reality. We can say it is more likely the illusion of reality upheld by a set of social constructs. It is important to question and critically examine the basis of one’s reality before using it as a yardstick to measure and determine pathology.

The DSM V definition for schizophrenia includes diagnostic criteria and features, as well as an elaboration of how it usually appears. The defining diagnostic criteria include delusions, hallucinations, disorganized speech, grossly disorganized or catatonic behavior, and negative symptoms such as diminished emotional expression or avoliton. I have an issue with some of the words used in the DSM definition on the basis that they are relative terms rather than absolute terms, and that they connote a value judgment steeped in cultural context. Some of the words used to differentiate normal functioning from schizophrenic functioning are “appropriate,” “odd,” “abnormal” and “irrelevant”: “Individuals with schizophrenia may display inappropriate affect (e.g. laughing in the absence of an appropriate stimulus)…and may attend to and then interpret irrelevant events or stimuli as meaningful” (p. 101). The terms “inappropriate” and “irrelevant” are a matter of status quo rather than fact. Schizophrenia is also defined in terms of level of functioning, and the DSM reads that schizophrenics may experience, “impaired occupation or social functioning,” and, “avoliton (i.e. reduced drive to pursue goal-oriented behavior)” (p. 100). That level of functioning is criteria in diagnosing someone as mentally ill or disabled speaks to our individualistic, workaholic cultural priorities. For an elaboration of this, I’d like to turn to Nick Walker (2014), who is a neurodivergent professor of somatic psychology and advocate in the neurodiversity movement:

What exactly do we mean by “functioning”? In practice, when people say “high-functioning” and “low-functioning,” they generally seem to be using the term “functioning” to mean “conforming to dominant neurotypical social and cultural norms, standards, and demands.” But do we really want to buy into the assumption that such conformity is the proper “function” of a human being? I propose that instead of rating human beings as “high-functioning” or “low-functioning,” we apply the terms “high-functioning” and “low-functioning” to societies, rating the functioning of a society according to the degree to which it succeeds in supporting and furthering the well-being of all of its members; and the degree to which it can accommodate and integrate diversity, and employ diversity as a creative resource, without attempting to reduce or eliminate it, and without establishing hierarchies of privilege.

 

Walker eloquently analyzes the criteria of being occupationally and socially functional through the lens of the minority model termed by Sue and Sue earlier. He raises the question, what is this operating system offering to mankind? Maybe we should not be asking, how are we serving the system, but is the system serving us given what is evidenced by our experience about what it means to be human. The DSM V definition of schizophrenia involves a lot of comparison between the subject in question and “unaffected” others: “Comparing the individual with unaffected siblings may be helpful” (p.100). This illustrates, once again, that schizophrenia is not an absolute disorder, but a relative one, entirely predicated on how it appears compared to others. But who is to say that our baseline for comparison is “healthy,” anyway?

The DSM subscribes mainly to the Medical Model of disability, turning to brain research to substantiate its concepts of pathology. We may want to examine then, what is happening neurologically during schizophrenia. Many tests have been done, but the results are somewhat inconclusive, as stated in the DSM V entry on Schizophrenia: “Currently, there are no radiological, laboratory, or psychometric tests for the disorder.” The DSM mentions “differences” in brain structure and activity, but does specify how aside from saying that overall brain size is reduced. I think it is important to differentiate between brain scans of individuals who have been tormented by ostracism, isolation, discrimination, stigmatization, abuse, having their human rights violated, being involuntarily medicated, being medicated over long periods of time which can change brain structure and function, and generally being confined in inhumane conditions in mental institutions, and those who are extra-perceptive and live functionally because they have managed to successfully integrate their perceptions. In other words, is the reduced brain size, less grey matter, etc. causational of the hallucinations or visions themselves, or is it due to the deteriorating effect of living in oppression?

I think it is also important to remember that the leading treatment for schizophrenia is antipsychotic medication. I would argue that making decisions on behalf of the brain/ mind relationship is outside the scope of knowledge of modern psychiatrists. Bruce Lipton, a developmental biologist, in an interview with Joe Rogan talks about Iatrogenic illness, which is death caused by medicine itself (either by medication or by physicians). This is the leading cause of death in the United States! Lipton states,

When it comes to anything physical or mechanical, medicine is a miracle maker. You want to transplant a heart, you want to amputate… go to doctors. You want to deal with cancer, Alzheimer’s, diabetes, depression… they have no idea what they are talking about. Because they know the mechanical biology, which gives them the opportunity to work on the body as a vehicle: take out parts, change parts, etc. But how do the parts actually work? There is some missing information (44:44)

 

I think before we start trying to manipulate mental function via the brain, we need to humble ourselves to the fact that we don’t understand the brain/ mind interface. Secondly, if our mind is like a vehicle with which we move through reality, if there was something wrong with our vehicle, wouldn’t we want to fix it? Wouldn’t we want to get in there and get our hands dirty like a mechanic and understand the problem so we could fix it? Instead, antipsychotics are designed to stifle natural brain function and in this way, move us farther away from our operating system. This stifles our ability to understand and repair it.

Finally, I would like to touch briefly on the work on R.D. Laing who had unconventional and revolutionary ideas about the cause of schizophrenia. There is nothing in the DSM hypothesizing the cause of schizophrenia, which further estranges us from an understanding of what it actually is aside from its symptoms. But before I get to Laing, I will explain one of his concepts, which is echoed by other scholars of the mind. Within schizophrenia, there seems to be confusion about what thoughts are one’s own, and what ideas belong to others and are being both transmitted to us, and experienced as one’s own. Malidoma Somé reported in the same article cited earlier (2014) that “what is required in [a spiritual emergence] situation is first to separate the person’s energy from the extraneous foreign energies, by using shamanic practice (what is known as a “sweep”) to clear the latter out of the individual’s aura” (para. 12). There seems to be some ignorance in Western medicine, about this concept, and about the question of where therapy ends, and spirituality begins. I’d like to flesh out this issue by sharing my personal belief about what is happening. Our body and brain are like our vehicle to navigate in the larger landscape. They are our operating system to interface with the universe, which is greater than us. Things can get imprinted onto our operating systems (like beliefs) from personal experiences, or from messages that we were told in childhood. This thus influenced operating system sees larger reality through that multilayered filter. Psychology works on the level of “cleaning the filter” so to speak… helping one clean the dirt off the window panes so he or she can see unobstructedly out into the larger reality, and not be so bogged down by the disempowering messages that were imprinted on his system. For most of us in our individualistic, self-absorbed, self-centered, self-aggrandizing society, all we can see is the dirt. We think “it” is all about us. That is our focus. Or it’s like, because we are told that we are the center of the universe, the light is on inside, and it is dark outside… all we can see is our own reflection, and we can’t see outside. How do we separate our view of our operating system from our view of larger reality? It is easy to get the two confused and think they are one in the same thing. Modern medicine does us no favors by not making this distinction. So, if someone reports seeing a fairy or a dragon, the medical practitioner automatically thinks the problem is with the person’s operating system, and does not consider that it could be an entity from the larger reality. The person may have an imperfect operating system (as we all do,) but their problem may not be as much in the realm of seeing things that are not there as in not being able to trust oneself and one’s intuition, to screen out what it helpful information, from information that is harmful.

This inability to distinguish between what ideas and experiences are one’s own, and what belong to others is the basis of R.D. Laing’s theory about the origin of schizophrenia. He did not talk so much in terms of extraterrestrials or spirits channeling things into our minds, but of people (primarily family members) implanting ideas into our minds. Laing spoke of mystification and double binds. His theory is basically that people can be brought up in a crazy-making way that predisposes them to schizophrenia. A basic tension is created by others telling the subject how he or she feels, which is in conflict with how the person actually feels subjectively. However, the true motivation behind invalidating how the subject feels is masked, and is presented as another issue. The person accepting and internalizing the words of the other regarding the presenting issue is therefore unaware of the internal conflict created by his dissonance with the hidden, unspoken issue. He is confused, but does not know he is confused. He may be happy, but falsely happy, or peaceful, but falsely peaceful. Simultaneously, the other person creates a double-bind where the person cannot affirm or validate themselves without being punished, so they are forced to accept the evaluation of the other person. This happens on both micro levels and macro levels. For example, American soldiers are conditioned to feel great pride for their country and pride for their unit. They are made to believe that they are oversees fighting for freedom. This idea is propagated to distract them from the reality that what they are really doing there is gaining access to valuable resources like oil and opium and wiping out anyone who gets in their way. If soldiers ever have any doubts about murdering men they don’t even know, killing innocent civilians and children, recklessly bombing property, etc. not only are they threatened with getting dishonorably discharged and losing a massive amount of respect and privilege, but they also come up against the contention, “Don’t you love your country? Aren’t you American? Aren’t you proud to be American? Don’t you want freedom?” None of these things any American could argue with, so soldiers agree with them, and they fight in the name of them. But I can’t help feeling like at some level they must know that freedom and patriotism aren’t the real issue. But they dare not admit this to themselves, or let it be conscious. Yet it creates this tension within a person. This is mystification.

This repeated trend of mystification eventually undermines the subject’s ability to discriminate for himself how he feels apart from others. The source of schizophrenia, as Laing identifies it, is in disabling someone’s ability to trust herself, to individuate, to feel safe asserting herself, to fight to protect herself, and to discriminate what are one’s own convictions, from those of others. These variables are all consistent with my hypothesis of schizophrenia (and that of Malidome Somé and other advocates of spiritual emergence, as far as I can tell,) which is that schizophrenia is a matter of being unable to distinguish what is one’s own from what belongs to others, and further, being unable to reject stimulus that one does not personally believe to be true, or that is abusive. Healing from the debilitating strand of psychosis requires in my belief, trusting one’s own experience, and being in a position where one is not punished, discriminated against, or ostracized for doing so. This is in the opposite direction of contemporary medical treatment of schizophrenic patients.

What is interesting about Laing’s theory is that the very thing he has identified as the cause of schizophrenia is exactly the approach modern medicine uses to treat people with schizophrenia: telling clients they are delusional, telling clients they are hallucinating, forcefully sedating them, institutionalizing them, prescribing them meds that distance them further from their minds and disabling their capacity to think for themselves, and using clients’ efforts at explaining themselves to confirm their insanity, and further confining and discrediting them. Laing asserted that usually the hidden agenda in mystification is to maintain the status quo. What is ironic (or not) about the conventional approach to treating schizophrenia is that it seems to be coming from a place of maintaining the status quo. As Nick Walker implied, by not asking how the system could be designed to best accommodate our human nature, we are asking, how can we serve the system to keep it static? The medical model from which physicians operate is in the interest of maintaining itself, and the social hierarchies it upholds. This includes labeling those whose experiences undermine the status quo “sick.”

In conclusion, I think our contemporary, conventional understanding of Schizophrenia is grossly misled. Our approach is based on preserving a system that serves neurotypical people in a capitalist society where the resources are believed to be finite, and access depends on competition and hierarchy. I don’t believe the reality that people with schizophrenia or extrasensory abilities know ascribes to these laws and priorities. That is why they are dysfunctional in our society, and why their reality would completely invalidate and devastate ours. We are all mystified, looking at a diagnostic statistical manual and thinking we are making any sort of constructive difference by pathologizing people based on a list symptoms, that only exist as relative to our status quo. Helping people with so-called schizophrenia would require a complete inversion of the way we think about healthcare. Perhaps it’s not so much about us getting through to them, as them getting through to us.

Leave a Reply