Remembering A Medication-Free Madness Sanctuary

Michael Cornwall, PhD
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In my last blog entry, I described how the I-Ward first episode madness sanctuary came into being and how I ended up working there as a therapist for over three years.

As you read now about my time there, I would again like to ask you to keep in mind the question I posed in my first two blog entries- “If Madness isn’t what Psychiatry says it is, then what is it?”  Because on I-Ward, madness was not believed to be anything like what psychiatry imagined it to be.

At the end of this post, you will find a list of references that support an alternative understanding of madness and how best to respond to someone in that madness process. For scientific data on this approach, please see the Agnews study, the Soteria research, and other medication-free results. John Bola has written several articles summarizing this literature, and one of his articles a few years ago set off a firestorm of debate in the academic psychiatric community and in the pages of the New York Times because it challenged the practice of prescribing antipsychotics as a matter of course during first- and early-episode psychosis.

Also, the recent Open-dialogue research in northern Finland, which involves minimizing use of neuropletics, and a process that involves defining madness as a process that should be responded to as a meaningful life crisis,  shows similarly remarkable first-episode results. Schizophrenia diagnosis rates have plummeted in northern Finland as a result of the Open-Dialogue program, as cited in Robert Whitaker’s Anatomy of an Epidemic.

The program leaders in Finland describe madness almost exactly as R.D. Laing described madness and the psychosis-inducing family almost 50 years ago in a partially NIMH- funded study of 25 families with a mad member in Great Britain! The Open-dialogue leaders say: “Psychosis does not live in the head. It lives in the in-between of family members, and the in-between of people. It is in the relationship, and the one who is psychotic makes the bad condition visible. He or she ‘wears the symptoms’ and has the burden to carry them.”

Here is the story of I-Ward, a 20 Bed, Medication and Diagnosis Free, First Episode Madness Sanctuary.

In 1975, Contra Costa County Hospital I-Ward founder Dr. Stanley Mayerson was emboldened by the California state hospital Agnews project. This was a gold-standard, NIMH funded double-blind study, where the longer-term outcomes for the unmedicated patients (first and earlyi-episode madness) that they were seen by someas seriously challenging the validity of the schizophrenia diagnostic category itself. The much, much lower follow-up re-hospitalization rate of the randomly assigned placebo group vs. those who got Thorazine pointed to the efficacy of non-medication treatment of first and early- episode psychosis.

Mayerson designed I-Ward based mainly on a vanguard definition of madness that was formulated at the Esalen Institute and demonstrated on the Agnews project where he had worked.

I-Ward founder Mayerson, who also focused greatly on the role of the ‘identified patient’ in the family therapy we did there, had actively been part of an Esalen Institute initiative on ‘Alternative Approaches to Psychosis,’ which was led by Esalen Co-founder Richard Price.

Price had been through his own madness ordeals, forced hospitalizations and shock treatments and wanted Esalen to be a refuge and force for developing an alternative vision and response to madness. That Esalen activity grew and became responsible for the design and implementation of the Agnews Project.

The Esalen initiative on madness was a remarkable, decades long series of gatherings- some for up to 2 months in length! Last month I co-led an Esalen workshop called- “An Integrative Approach To Psychosis,” in an attempt to revive that venerable tradition that had gone dormant for some years.

Attending those earlier invited, closed symposia were more than a few veritable giants in the field of western psychology, philosophy and anthropology. These historic multidisciplinary explorations about madness held at Esalen drew Gregory Bateson and Erik Erikson, Fritz Perls, Joseph Campbell, John Weir Perry, Abraham Maslow, Alan Watts; Michael Harner, Stan Grof, Claudio Naranjo, Allen Ginsburg, Jullian Silverman, R.D. Laing and more.

The syncretistic, alternative vision of the very nature of madness and how best and humanely to respond to those in a madness process that partially evolved out of that brain trust at Esalen, sees madness as a very complex and multi-dimensional subjective, somatic, familial, archetypal, trauma influenced and social/cultural bound experience that is not a form of bio-medical pathology.

Early onset madness came to be seen as a purposive, necessary healing crisis that is often a rite of passage into young adult hood. Madness occurring later in life was seen as an attempt to integrate earlier wounds or a response to overwhelming adult trauma and loss. Both passages of madness were seen as needing a heart centered, non-pathologizing  response by care givers,

Every form of modern madness was also held to be an experience of the ancient archetypal mystery that has been marveled at and feared throughout human history, as described in Plato’s Phaedrus, in the Bible and by C.G. Jung, Anton Boisen, John Weir Perry, and also by the writings on shamanic initiation by M. Eliade.

Madness in our lifetime was also viewed through the historical lens of seminal writers such as Michele Foucault, Gregory Bateson and R.D. Laing- who believed our post modern culture was itself a fragmented, often heartless wasteland which was the inescapable, toxic Petrie dish in which record numbers of young adults were required to become mad in order to move into an authentic and fuller life.

Their young, ‘leaving home’ madness was seen by the Esalen thinkers as an effort to free themselves from the injuries inflicted by the dog eat dog social Darwinism and soul killing materialism that permeates our  largely loveless social environment, that has caused the socially embedded nuclear family to become the wounding crucible of our culture.

Our culture itself was seen as being self-destructively mad and actively endangering human survival on earth.. In this view, the modern family itself is the primary but unwitting vehicle for inflicting the madness inducing wounds of the broader culture’s traumatic impact on childhood development.

Feminism was another important influence in the evolving, alternative vision of madness that was discussed at  Esalen. The feminist critique of culture dialed the historical microscope further back to look at the over-arching myth our culture lives by and through. From the perspective of the effects of the patriarchal mono myth that reifies guilt, shame and fear of punishment as core values we are effected by every moment, madness was also seen as a rebellious outburst of polytheistic pagan energy, a Dionysian and Aphrodite led revolt against the oppression of the sacred feminine and sexuality.

Madness itself was seen as a vehicle for revolutionary cultural change because it supplied needed visionary content that pushed the edges of understanding and contained numinous elements from beyond consensual consciousness. For John Perry and Joesph Campbell especially, madness was seen as an ancient source of inspiration and a contributor to the evolving, emerging myth form that was challenging patriarchy.

Through the visionary, shamanic and prophetic content of madness that often involved themes of world renewal and a messianic vision of a healed and peaceful earth, the mad among us were seen as possible harbingers of change at the level of the development of a new myth form itself. Campbell and Perry pointed to the emerging myth motif that appears repeatedly in modern people’s madness as being centered on a compelling concern for the earth, our sacred home that has been likened to Gaia, a living organism that births all life.

The recent publication of Jung’s ‘Red Book’ shows how his visionary madness did bring enriching content for the culture in addition to being the emotional and symbolic record of his own transformative madness. He said it contained the prima materia for his lifetime’s work.

The work of my friend David Lukoff and the Esalen based work of Stan Grof also support the claims of the field of Transpersonal Psychology that madness can be a rich personal transformation, even an initiatory spirtual emergency at one level that also brings valuable, numinous material into the broader culture.

I was already a true believer in this Esalen style, comprehensive version/vision of madness cited above before I got  to I-Ward, so it was like finally finding my tribe when I got there in 1980.

But there is always a risk involved in feeling one is part of a vanguard movement. In the 60’s and 70’s many of us felt that we were part of a naturally occurring cycle of revolution that would overthrow the capitalist, war making patriarchal system. We made many mistakes, the largest to my mind was demonizing those who we opposed. Those who aspire to hold the purist vanguard truths often find themselves inflated and acting from arrogance and without compassion.

So, the feet of clay of some of the pioneers in the alternative madness revolution were starting to show as I walked through the wide open, never locked double doors onto the I-Ward madness sanctuary for the first time.

The building was a single story, free standing old TB ward that was on the edge of the hospital grounds, with a miles of open hillside behind it and it had a wonderful redwood grove overshadowing the building.

As I entered that amazing zone, the hair on the back of my neck stood on end because there was a palpable energy filling the air I had never felt before.

It mainly was being generated by the several young men and women I saw moving about who were fully ramping up in their first ever madness experience. The strangely almost electric buzz in the air was buoyed up also by the several young men and women who were into their second or third week of madness as I would soon learn.

They also were of wild and shiny eyes and, like the newcomers, were expressing unbridled emotion and displaying bodily movements and using metaphorical speech that was out of the ordinary, but not as intensely as those that had just arrived that in the past few days.

The last group of young men and women residing there that made up the contingent of 20 souls were still mad, but were a lot less mad. They could easily be mistaken for staff. Everyone wore their own casual clothes of mostly Levis and short sleeved shirts.

The program director came out and met me, and when we sat together, he seemed nervous as he asked me a very surprising job interview question. He started by saying that the staff had just recently had a training by one of R.D. Laing’s close associates from Kingsley Hall in London who had exhorted the I-Ward staff to be willing to have sex with the residents if necessary, in order to prove that all the trappings of the colonial oppressors of our corrupt culture had been cast aside.

So the director asked me if I agreed with Laing’s co-worker that we should have sex with the mad young people there. I could see it was a serious question for him that he felt he had to ask me. Although it felt quite surreal, I found myself answering,- “No, I don’t believe it ever is right to have sex with people we are serving.”

He seemed relieved and after a few more questions I was offered the job.

How far, I then realized, was I from the world of the high end private psychiatric hospital where I still worked. The bearded, wild haired I-Ward director sported several hoop earrings of various sizes and wore a leather pouch across his chest. His fellow psychiatrists at the private hospital usually wore camel hair coats and Armani suits and even I had managed a tweed sport jacket and affected a briar pipe in a self conscious and now laughable attempt to fit in as a young intern still in graduate school.

But I immediately felt at home on I-Ward. Madness was palpably in the air and so was a loving, receptive acceptance of it that felt viscerally right to me.

In many ways I-Ward was more radical than both Mosher’s Soteria and Perry’s Diabasis, the other SF Bay Area med-free sanctuaries that were seen by us as competition for who provided the best model of responding to madness.

We served everyone who came to psychiatric emergency who was mad for the first and sometimes second time. There was a larger locked ward on the hospital grounds where medication and restraints were used for people who had been in the system for a longer time. We wanted to divert and prevent any new mad people from being in the system.

Within minutes of someone’s first contact with the system, one of us would walk down the hill and after a brief intake, bring them up to the sanctuary. Unklike Soteria and Diabasis, we took all comers- no matter how violent, wild, suicidal or out of comtrol. Our resident population was very ethnically diverse as were the staff.

Although I-Ward was open for 8 years and served vastly more young mad people than any other alternative program that has ever existed in the United States- easily more than many times the amount of Soteria and Diabasis combined, it is almost unknown about today because there was no research component built into the program design as at Soteria.

On I-Ward we did not believe in a mental illness paradigm of human emotional suffering and madness and the diagnostic labeling that supports the medical model. So we were opposed to testing anyone to see what their symptoms and functioning were when they arrived using the standard tests that we felt were de-humanizing and that objectified people.

From our revolutionary perspective, I-Ward was a pirate ship or a Trojan Horse, or perhaps the leaven that would transform the whole system around us, but we didn’t want to prove it’s value by putting the mad people we sheltered there through the seeming degradation ceremony of measuring their subjective madness with qualitative, medical model designed testing.

As part of a county mental health system we were required to have a diagnosis for every person to receive public insurance payment, but since we didn’t believe in mental illness, diagnosis or schizophrenia, and because we knew that if people were given sanctuary when first mad- they didn’t have to earn the 6 month schizophrenia label, we just diagnosed everyone with brief reactive psychosis.

But we  described madness to residents, family and loved ones as a process of growth and individuation-  a necessary developmental crisis of dramatic separation from the family. Again, this seems quite similar to the current Open-dialogue approach.

Two weeks after my memorable job interview I took a leap of faith and left my job at the high end private psychiatric hospital and reported for work at I-Ward. But they wouldn’t let me work! They instead just required me to be there with no responsibilities for over a  week. That was their way of seeing how the mad residents related to me and how I related to them. It was unnerving. I was afraid I wouldn’t be kept on, and would be dismissed, without a job to return to at the private hospital.

Until finally one day I was met by a somber senior staff person as I arrived at work. He pronounced- “We have decided that you are able to be entrusted to… do the work!”

The work. That is what they called this way of being with mad people.

He told me that the first person I was to work with who had just arrived from our psychiatric emergency unit down the hill was alone in the back dayroom. I asked who it was and he just said- “Go find out.”

I walked back to the dayroom and standing on a table about three feet off the ground was a totally nude beautiful young woman in an ecstatic transport! Her arms were were outstretched to the heavens and her face was a mask of radiant ecstasy as she chanted over and over in a quavering, almost sobbing voice- “Glorious, Glorious, Glorius!”

I was so stunned I didn’t know what to do. In my 2 weeks of job probation until that day, I had never seen anyone on I-Ward this completely gripped or possessed by madness.

I remember now introducing myself which felt pretty stupid, like someone interrupting Saint Theresa who I remembered seeing paintings of, that looked very similar when she was in mystical transport.

The young woman finally looked down at me kindly with such sweet kindness, that I again was at a loss to account for her nudity and saint-like demeanor.

I ushered her to her nearby room where she wrapped herself in a blanket and sat and continued to more softly now repeat- “Glorius, Glorius, Glorius.”

Writing this now, 32 years later, I still am moved and humbled by the incredible power and at times terrible beauty of madness I was fortunate to have witnessed that day in the young mother that I came to know so well over the next many weeks.

But her divine light filled consciousness was soon to shift to the other pole. Within a day I remember meeting with her as she explained that the glorius spirit of god resided in the right side of her body and directed her right hand, but that satan was in and controlled her left hand and half of her body.

She extended her left hand to me and as she did her face was transformed into a mask of almost snarling malevolence and her voice became guttural as she rasped- “In this hand is the evil of satan..”

She then tried without prompting from me to shift back to her light and love filled right side and easily was able to do it.

She was not frightened by this back and forth shift of darkness and light. I must say that I was. It was so uncanny to witness this and to feel  responsible for her life and her healing. There had been a suicide of a heavily medicated young woman at the private hospital while I worked there and just before I started on I-Ward there had been a suicide by a young un-medicated man on I-Ward.

But the young mother in my care was meant to survive her dramatic journey through madness.

We were always expected to convene a large meeting of family members and close friends of every young mad person on I-Ward within 24 hours of their arriving there- much like the current Open-dialogue practice.

The young mother’s husband and parents and siblings attended my first ever family meeting. I must say that what I witnessed there has sadly been my experience to varying degrees in every family where a young adult has gone mad in 30 years of specializing in serving people in madness processes.

On I-Ward I soon came up with my own litmus test that every family where a young adult becomes mad has sadly not passed- the apple of my eye test. Does at least one parent look at and express the feelings I have for my own daughter- that she is the apple of their eye?  Do they insist that they will move mountains to get help for their precious son or daughter out of a strong passion that has juice, energy and won’t stand for less than the best.

Freud said that nothing is more important for the healthy development of a child than the loving, protective presence of their father. At least one parent needs to be there and hold the child in their heart as the apple of their eye. Even then the lack of the other parent’s love can be a big enough wound that the developmental hurdle of young adulthood requires madness to occur.

There was a measurable lack of emotional warmth in the nuclear family of the young mother.

There was a palpable sense of subjective isolation existing between them all as we sat togrether.

No one but her overwhelmed young husband leaned forward in their chairs to offer concern and emotional caring. I realized that I was witnessing the emotional wasteland Laing had described in the families he researched.

There was a subtle mystification of experience in the communication between family members that Laing said resulted in the identified patient not being able to trust their own mistrust.

In other words, people were not communicating directly, but through confusing half-truths, through statements that both blamed and praised her at the same time, contradictory signals of incongruous facial expressions such as smiling when being hostile were happening.

This madness inducing situation Gregory Bateson described as a double bind, which leaves the recipient not knowing which of the mixed messages they are getting they should respond to. It is a contributing factor to the sense of being isolated and unable to connect with family members authentically.

I believed that my work in meeting with the family of the young mother was to help untangle these family communications so that she could start to know where she stood with her parents especially. I don’t know that I ever really succeeded in my freshman family therapist efforts.

Looking back now I believe it was the caring connection with me and other staff she connected with that made for a space or crucible for her psyche to do it’s own re-organization, using the rocket fuel of un-medicated madness to surge up emotion and the imagery that gave form to the emotion.

I believe that procees of being held emotionally, in warm human hearted connection ultimately allowed her to resolve the dark/light polarities- the good mother/bad mother judgements she was tormenting her self with before she got mad.

Emotion is the core of madness and medication stills it and stops the needed power of emotion to carry the psyche’s mission forward. She would rage for over an hour at times in our padded, unlocked room where we would hold people lovingly when they were out of control.

We used no restraints and every time after long periods of wild raging people would wind down and end up cuddling into the sometimes 2 or 3 staff needed to hold them. They would then softly start to cry and sometimes sob in a deep regrression of safely being held by strong and loving parental figures.

The young mother left I-Ward after about 2 months and I wondered for several years what ever became of her. Then one day I received a phone call from her at the clinic where I then worked asking me for a referral for a family member who had a problem. I came up with some phone numbers for her and then asked her how she had been since I had last seen her.

She answered matter of factly as if I should have known- “Oh Michael, didn’t you know, I got all of mine out on I-Ward!”

It was my priviledge to serve many other people on I-Ward in the next 3 years. It made a believer out of me in people getting what they need when they need it.

One more I-Ward story must be told here though, because it is what I remember most from those years on the sanctuary.

I was working the pm shift and was sitting outside a young person’s room in a chair in a vigil as we did when someone was feeling suicidal. The lights were dim in the long hallway stretching down towrds the entrance. I saw a young woman come out of her room looking to be frightened, as nightime often stirs fears that day would hold at bay as I knew well from my own season of madness.

She was approached at once by one of the very kind women staff who put her arm lovingly around the frightened young woman’s shoulder. The older woman leaned her head over and smiled warmly at the young woman, speaking words of comfort that I could not hear at the distance.

Suddenly a golden light surrounded them both. I shook my head as if to rouse myself from a dream I was slipping into. But I wasn’t slipping into a dream. Some would say I was hallucinating. but I don’t beleive I was, because the light somehow held an emotion in it that hung there in the air around them. It was a light of love that seemed ancient, old, very rare. It vibrated and my heart was shaking with a feeling that took my bretah away. It was the light of the sanctuary, the ancient healing light that hovers over and in sanctuaries where the mysteries of madness and healing occur and have occured ever since we became human.

Research references and reading suggestions-

Bateson, G. 1956- Towards a theory of schizophrenia
Bateson, G. 1972- Steps to an ecology of mind
Boisen, A. 1936- The exploration of the inner world
Bola, J. 1998- Evaluation of treatment in early episode acute psychosis
Bola, J and Mosher, L. 2003- Treatment of acute psychosis without neuroleptics
Bower, B. 2001- Back from the brink: psychological treatments for schizophrenia
Breggin, P. 1994- Should the use of neuroleptics be severely limited
Burton, A. 1961- Psychotherapy of the psychoses
Campbell, J. 1984- The way of the animal powers
Ciompi, L. 1995- Alternatives to the hospital for acute psychiatric treatment
Dabrowski, J. 1964- Positive disintegration
Dallet, J. 1988- When the spirits come back
Duerr, M. 1996- Hearing voices
Eliade, M. 1954- The myth of the eternal return
Eliade, M. 1974- Shamanism
Fisher, D. B. 1994- Health care reform based on an empowerment model of recovery
Fortuna, J. 1995- The Windhorse program for recovery
Foucault, M. 1965- Madness and civilization
Fromm-Reichman, F. 1948- Notes on the development of treatment of schizophrenics by psychoanalyitic psychotherapy
Goffman, E. 1961- Asylums
Greely, A. 1974- Ecstasy: a way of knowing
Grof, S. 1989- Spiritual emergency
Gunderson, J and Mosher, L.- 1975- Psychotherapy of schizophrenia
Haley, J. 1997- Leaving home: the therapy of disturbed young people
Harding, C. The Vermont longitudinal study
Harner, M. 1980- The way of the shaman

Henderson J. 1997- The spiritual foundations of madness- an interview with John Weir Perry
Jung, C.G. 1953- Forward in J.W. Perry – the self in psychotic process
Jung, C.G. 1965- Memories, dreams, reflections
Jung, C.G. 2010- The red book
Karon, B. 1981- The psychotherapy of schizophrenia: the treatment of choice
Kuhn, T. 1962- The structure of scientific revolutions
Laing, R.D. 1959- The divided self
Laing, R.D. 1964- Sanity, madness and the family
Lukoff, D. 1985- The diagnosis of mystical experience with psychotic features
Menninger, K. 1959- Towards a unitary concept of mental illness
Mindell, A. 1988- City shadows: psychological interventions in psychiatry
Morrisey, M. 1988- Exploring burch house
Mosher, L. 2004- Soteria
Pao, P. Therapeutic empathy and the treatment of schizophrenics
Perry, J. 1953- The self in psychotic process
Perry, J. 1962- The reconstittutive process in the psychopathology of the self
Perry, J. 1974- The far side of madness
Perry, J. 1976- Roots of renewal in myth and madness
Perry, J. 1986- Spiritual emergence and renewal
Perry, J. 1999- Trials of the visionary mind
Rappaport, M. 1978- Are there schizophrenics for whom drugs may be unnecessary or contraindicated- the agnews project reasearch
Scheff, T. 1975- Labelling madness
Seikkula, J. 2003- Open dialogue approach
Szasz, T. 1974- The myth of mental illness
Sullivan, H.S.- Schizophrenia as a human process
Whitaker, R. 2002- Mad in america
Whitaker, R. 2010- Anatomy of an epidemic

 

 

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22 COMMENTS

  1. you wrote, “In other words, people were not communicating directly, but through confusing half-truths, through statements that both blamed and praised her at the same time, contradictory signals of incongruous facial expressions such as smiling when being hostile were happening.”

    Yuk

    This reminds me of something about my own family.

    It makes getting angry with them, and breaking away, very difficult

  2. I was intrigued, Michael, by your description of the woman with a malevolent left-hand side and a benevolent right hand side. As a bipolar meyself, I had been reading about some Australian research that found in comparative studies that bipolars tend to focus on one hemisphere at a time, whilst non bipolars switch frequently between the hemispheres. It is posited that activity predominantly located on the left hand side of the brain would lead to manic, narcissistic, psychopathic behaviour, unmediated by the ironically labelled “devil’s advocate” of the right hemisphere, which gives a more socially aware second opinion of bizarre ideas dreamt up by the left brain. I found the article quite feasible until I reached the part where they were recommending cold compresses to be applied to the right or left ear, respectively, to mitigate mania or depression.

    • Thank you John. In my experience, during un-medicated madness, the psyche almost always creates symbolic imagery and at times even somatic manifestations of contrasting archetypal polarities that move towards reconciliation and unity if the necessary and sufficient conditions are met for that emotional and symbolic content to be received with acceptance and caring by another person or persons.

      The madness process iself can be one of blending the polar emotional/affective archetypal opposites that are expressed symbolically and that are constellated as powerful agents to bring about a renewal or transformnation of the pre-madness, constricted state of the person’s emotional truth and soul.

      The contending emotionally felt motifs possible in madness of male and female, good and evil, life and death, rage and ecstacy, terror and serenity, sorrow and joy, light and dark, all emerge dramatically in a very natural and an almost predictable way.

      These opposites can be viscerally felt by the person and expressed symbolically via word, somatic expression, art etc.-again if there is the needed container of the caring, receptive other or others to receive it all.

      The net effect of the emotional/symbolic opposites constellating and then integrating, as stated by the young woman who said- “I got all of mine out on I-Ward”-can be that the perosn comes out and through this initatory process- “Weller than well” as Karl Menninger famously said.

      She and so many others I have known became able after their madness process to enjoy the highs and lows and all the broad range of human emotions that were previously bottled up inside until madness burst forth and revealed their ever changing, flowing emotional truths.

      For me, fully experiencing, naming, claiming and expressing- in other words, fully living our emotional truths is reclaiming our sacred human birthright

  3. Too bad I-Ward couldn’t have stayed that way. It eventually turned into the usual psychiatric ward of oppression. I didn’t learn my chops through formal educational philosophy. Back in the 60’s and 70’s I volunteered at the local free clinic. Usually, someone experiencing a “bad trip” could be best helped by just being with the person. Making a human connection and holding that connection through their experience. It wasn’t magic. Then when I started helping people with psychiatric experiences, I found that the same thing applied and I have been able to help many others though making and holding that human connection and just being with them.

    • I know you have helped a great many people Pat by being with them in that open hearted way. Often training to be a mental health professional detracts from that universally needed, receptive human connection being provided because of the distancing role maintained by the therapist.

      When someone wrongly assumes they are somehow the expert on the person’s life that they want to help, then the helful connection you have for so long made happen by just being with the person in distress, won’t happen.

  4. Such a good posting Michael. It was wonderful to learn more about I-Ward and the work that was done there. I assume, sadly, that they are no longer in operation?

    There was much in the contents here that resonated for me. As you know, my own experience was literally a textbook case of Perry’s “psychotic-visionary episode” which I was fortunate to go through on my own, without medication, doctors, or hospitals. In the years since, years of sharing my story and hearing the stories of others, the one theme that seems to consistently arise is a event or series thereof that significantly challenges an individual’s sense of self-identity to the extent that the ego collapses.

    It has become politically incorrect to ever imply that family environment plays a role in psychosis although it has certainly been my experience that it can. That’s far from the only triggering event however — romantic relationships gone awry, failure to meet a self or other imposed challenge, sleep deprivation, medication reactions, experimental recreational drug use. There seem to be a multitude of causes to psychosis that too often, are interpreted with one label and addressed with only one form of treatment.

    @Michael: On I-Ward I soon came up with my own litmus test that every family where a young adult becomes mad has sadly not passed- the apple of my eye test. Does at least one parent look at and express the feelings I have for my own daughter- that she is the apple of their eye? Do they insist that they will move mountains to get help for their precious son or daughter out of a strong passion that has juice, energy and won’t stand for less than the best.

    I have encountered that as well — most commonly in parents who, when presented with evidence of superior recovery rates via programs such as Diabasis and Open Dialogue, adamantly refuse to educate themselves. They have their own ideas of what madness is and they’re not willing to alter them, even if it might improve the odds that their child will recover.

    I’ve also encountered many parents who are desperate for anything that will help their child because they do love them so very dearly. There, the sadness is that so few options are available to them. I can encourage them to educate themselves, to do their best to patch together a Diabasis, Soteria or Open Dialogue approach using whatever local resources their finances will allow. It’s an immense challenge that many have struggled to do; some have found success. How much easier it would be if these kinds of programs were actually available within our own communities.

    *sigh*

    Terrific piece, Michael. I know I’ll be back to read it several times over.

    ~ Namaste

  5. Thank you Tessa. I again encourage everyone to click on your spiritual_emergency name/link above to gain from the huge resource you have put together there about alternative approaches to madness.
    I agree completley with your point about all the ways that madness can be triggered. I do think that even people who may have a madness experience later in life that isn’t a drug or medication reaction may have been vulnerable in part from early family traumas and unmet needs for nurturance. Sudden losses of jobs, relationships and loved one’s deaths in adulthood hit us harder if we have been through significant trauma before.

    The I-Ward program was disbanded in 1984 as the growing power and practices of the medical model took over the county mental health system.

    I’m still working to get another sanctuary open as you know.

    Bless you and your valuable healing work. You have helped allot of people.
    Michael

  6. @Michael: I do think that even people who may have a madness experience later in life that isn’t a drug or medication reaction may have been vulnerable in part from early family traumas and unmet needs for nurturance.

    Absolutely. I had a mother who was not perfect, but she loved her children. That was not the case with my birth father who my mother left the night he put hangman’s nooses around the necks of my sisters and I. Apparently, it wasn’t the first time he’d threatened to kill us, or her.

    Years later, I began to go “crazy” when she died and that old trauma emerged, demanding to be dealt with less the absence of the protective and loving mother. One of my first “symptoms” was a curious fascination with a card in the tarot: The Hanged Man. lol! There’s an example of that symbolic, metaphoric communication that emerges in one whose ego has collapsed and they have been plunged, in pieces, into the depths.

    Seikkula states it well: “All of us could have psychotic problems. It’s an answer to a very difficult life situation. It’s in a way, a kind of metaphorical way to speak of things that beforehand did not have anywhere they could be spoken of.”

  7. Thank you again Tessa. Yes, life events can create madness even in mature adulthood. You were plunged into the depths as a full adult because of overwhelming events or ‘a very difficult life situation’ as Seikkula says above.

    The too daunting developmental hurdle of young adulthood is for some, the most frequent “difficult life situation” that is the occasion for madness.
    I just saw the excellent film- “A Dangerous Method” which shows how Jung also, like you, was plunged into the depths of visionary madness by overwelming life events when he was a 38 year old adult.
    His calling to a larger self knowledge that made him break with Freud, and ended up happening via madness, meant that his madness was not just caused by the loss of his bond with Freud, but I believe was what his soul demanded for him to realize his initiated status as an urban shaman and wounded healer.

    Looking back Tessa, if you could have avoided your madness and never have gone through the suffering that has given you your hard won knowledge, would you? I wouldn’t. Although I wouldn’t wish it happening on anyone.

  8. @Michael: Looking back Tessa, if you could have avoided your madness and never have gone through the suffering that has given you your hard won knowledge, would you? I wouldn’t.

    Funny. That same question came up elsewhere in the past few days. I commented that it was a redundant question because whatever was, was. We couldn’t make those things un-happen, even if we wanted too so, instead, we had to learn to make the best of what had happened. I think part of recovery is coming to terms with that.

    Meantime, just a few months ago, I was going to walk away from this part of my life, and I more or less did. Then, I felt pulled back and when I slipped into this skin once more, it felt comfortable, it felt right, it felt part of who I am and what I do. I realized I can’t walk away — it’s become such an integral part of who I am.

    ALL of my life experiences have shaped who I am right in this moment, and I feel good about this person I have become.

    Music of the Hour: http://www.youtube.com/watch?v=8bg9yzMoIpg

  9. Michael, What a wonderous post. As I consider starting a blog here I am inspired by yours and others. We may just be creating a blogesphere of renewed spirit for ideas long dormant. I am optimistic that just as blind termites are able to construct magical castle so we are constructing a polyverse to supplant the mad, medical universe of today. Our consumer/survivor movement has been fashioning such a new world for 30+ years. The beauty of Open Dialogue is that it usually allows the person to receive help in the natural environment. At times though people will need sanctuary from their natural environment. That is where an I-Ward, Soteria, peer-respite can assist.

    • Thank you Dan! I sure hope you do start blogging here soon, and that everyone listens to your powerful and inspiring interview with Will Hall on the Madness Radio link on the home page of this site.

      I love what you say about us creating a blogsphere of renewed spirit of ideas long dormant! This site is special in that unique way that feels very promising.

      I-Ward served people from all economic backgrounds, many were victims of discrimination because of their ethnicity in their home community. Many lived in urban war zones of constant violence, trauma and drug addiction.

      So, as I mentioned, we did not shun anyone for being violent, suicidal, homicidal or drug addicted if they were also mad.

      I know there is a growing hope in the US that the Open Dialogue approach will meet the totally unmet needs of people in first episode madness, to offer a humane alternative to the 99% of first episode mad people who now get locked wards and meds.

      Because the majority of young people in the US live in urban environments in fragmented, chaotic nuclear family systems so much differently than do those in northern Finland, I would estimate that perhaps only 15 or 20% of first episode young adults in the US could be served via an Open-dialog in-home intervention, as you mention during their initial madness.

      I gratefully remember when you and Laurie Ahern flew out to help us try and get another sanctuary like I-ward opened in the bay area. We came close, but weak willed politicians and awful NIMBYism ended up killing the project that we had secured $900,000 start up money for!
      Today I’m visiting Jana Jacobs and the wonderful peer respite house in Santa Cruz.

      How I am grateful for it being there.

      But it is not a front end sytem diversion program like I-Ward was.

      The tragic truth is Dan that there is no place like I-Ward in the entire US unless you count Soteria Alaska.

      An old friend who worked at Soteria San Jose reminded me recently that they never could have comtained any of the severely acting out people we served on I-ward.

      They never could have, because of their set up and lack of staff helped the young woman I described above who, when she was raging needed 3 peopele to hold her from harming herself or others. She badly bit a well meaning, but careless staff person on the neck when she was in the dark, satanic, energy as she called it. She badly scalded a staff with hot coffee, who agian naively tried to get too close when they shouldn’t have.

      Unmedicated madness can be a form of un-civilized wildness as you know.

      People like her sometimes went running out the unlocked doors naked down through the streets of town!

      Until there are industrial strength medication and restraint free sanctuaries like I-Ward right next to every psych emergency at every hospital in the US, countless numbers of young mad people are stiil going to be entering the system to only have their potentally life renewing and transforming, purposive madness aborted- they will most likely then be dependent on meds indefinitely and years of precious life will be wasted until they hopefully will fully recover like you and I have dear friend Dan.

  10. Michael – I am so inspired by your strength of vision and the stories you carry around from revolutionary times before the rise of Biopsychiatry. Reading these words I can’t help but feel like you’re laying the groundwork for the next wave of the revolution, and I’m so looking forward to being a part of it with you. There is so much in these words but I want to reflect back to you how important I think this part of the story is:

    “Feminism was another important influence in the evolving, alternative vision of madness that was discussed at Esalen. The feminist critique of culture dialed the historical microscope further back to look at the over-arching myth our culture lives by and through. From the perspective of the effects of the patriarchal mono myth that reifies guilt, shame and fear of punishment as core values we are effected by every moment, madness was also seen as a rebellious outburst of polytheistic pagan energy, a Dionysian and Aphrodite led revolt against the oppression of the sacred feminine and sexuality.”

    As an older father figure in the movement (with your white beard and articulateness and the powerful wisdom that can only come from decades on the front lines), I think it’s incredibly important that you do everything you can to empower women who stand next to you in our struggle. As much as some elements amidst the culture of Esalen and the Human Potential Movement attempted to learn lessons from the Feminist Movement, they fell WAY short of actually putting those lessons into practice, and the results are embarrassing clear.

    This time around, the women lead! Mad love my brother!

    • Thank you dear friend Sascha! Your leadership and the strong presence of women Like Jacks and Danni in the Icarus and Occupy generation make me feel both confident in the future but also inspired to push myself to do more of what you urge- to hold those values of the sacred feminine even more dear.

      That gentle, receptive way of being with mad people that I try to practice and talk about doesn’t require professional training to do. We all can do it when we open our hearts and arms to those who suffer.

      But isn’t psychiatry itself a form of the patriarchy? A poweful institution that makes all the same mistakes that men have made in the same ways in dominating the less strident, kind and human hearted among us into submission.

      The nurturing impulses of mothers have been scorned by fathers who bully and push around everyone in their path-we men push around other nations, our own children and our beloved birth giving mates- as well as the living feminine anima of our souls.

      I’ll stand with you until doomsday brother to stop that real madness.

  11. Michael, your experiential narrative was so powerful. I have to admit that while I was reading your blog I was touching into those dark and mysterious places, those potentials in myself and perhaps all of us. A place where madness could make more sense than reality. You helped me feel viscerally the powerful energy that is available in psychoses. I could see how, with lots of compassionate acceptance and a strong supportive team, this almost electrified energy could be a crucible for deeply transformative work.

    I also wondered how a sanctuary might help those who are severely depressed or paralyzed with anxiety? How would I-Ward or Soteria or Diabasis look if that fire were missing in its guests? Would the transformative work be different and how so?

    Really looking forward to future blogs!

    • Thank you dear friend Jen!

      If I understand your great question about sanctuaries being available for people having severe depression and anxiety who aren’t in a madness process, I would say that the standard approach for severe depression which is traditional psychiatric hosptitalization if suicide is a pronouced risk, often is traumatic and depressing in itself.

      If a person doesn’t meet the risk criteria for being in the hospital,then community modalities such as therapy and support groups are provided. That community model so often does not provide enough support and human contact.

      But I know many of the people who were suffering from panic attacks and/or depression that I worked with in clinics on little or no meds, would have benefitted greatly from a holistic retreat center, a sanctuary where they could stay to more intentionally and dramatically resolve the underlying causes of their depression and anxiety/fear.

      That deep, archetypal soul work with depression and panic/anxiety is just as potentially transformative and life enriching as going through a madness process.

      I can’t imagine the ancient healing temples of Greece or the shamanic Native American healers discriminating between whose type of suffering was more desserving of comapassion and assistance.

      When a love giving, spiritual orientation is held by the care givers, then every sufferer is seen as a child of the divine.

      So, in any sanctuary it would be especially valuable if the staff had the same heart centered values that we held on I-Ward, and if it was in a natural setting where the healing effects of the outdoors were present.

      Many of the people we served on I-Ward had strong elements of depression in their madness process as well as panic and at times abject terror. I certainly did during my madness process that I describe in my Initatory Madness blog entry here.

      It all is incredible suffering whether one is mad or not.

      I envision a time where no one has to suffer alone in fear and panic, depression and grief, or in madness. I know you are working towards that day too!

  12. It’s very easy to blame the family. What exactly do you know of the family, beyond your self-created “apple of the eye” litmus test? How do you know what this family has gone through prior to seeing the woman admitted? I doubt that Open Dialogue would be as successful as it supposedly is if it took an adversarial view of the family. Without my knowing the details, perhaps this woman’s lengthy erratic behavior confused and tested her family to the breaking point. Perhaps some of the family members did not agree on the treatment program. Perhaps they resented having a psychiatrist present. How do you know what was going on? Now, if you look at the woman’s breakdown in a positive light, that she is undergoing a spiritual transformation, that there is nothing pathological about her, then why blame the family as the young woman is a product of this family. Would psychiatry blame Jesus Christ’s family? By today’s DSM criteria, he would be schizophrenic.

    • You are welcome Darby.
      Your awesome work on our history as Director of historical projects at New York OMH and your extensive oral history work and your work with Peter Statsny-“Lost Cases, Recovered Lives: Suitcases From a State Hospital Attic”- make up such an enormous contribution that gives us proof that the wrong practices of the past happened and must not be repeated.

      The much quoted Santayana phrase-
      “Those who do not learn from history are doomed to repeat it”- can not be forgotten by us because of the revising of history that has systematically been done by psychiatry at times.