The Madness of Carl Jung: a dangerous method

Carl Jung was one of Freud’s earliest supporters and in many respects rivaled him in terms of influence. Some of their interactions provide the basis for the story behind the book and recent movie – A Dangerous Method. Just as Freud did, he famously analyzed himself and while doing so apparently became psychotic. His psychosis was however seen as a way to sanity – a forerunner of 1960s thinking about psychosis. It was also viewed in semi-spiritual terms.

This was all of interest when we came to explore another condition we found in the North Wales hospital records, a condition that made us keenly aware we were playing with fire. Against the background of a major strike in the quarries and mines of North Wales, in the autumn of 1904 and through to the summer of 1905, a preacher called Evan Roberts toured Wales stimulating the Great Revival – and stimulating into madness some of those who gathered in North Wales to hear him preach. There was a spike of admissions to the Asylum for psychoses that looked like schizophrenia or bipolar disorder (see Linden et al 2010).

There is a well-known condition – Jerusalem syndrome, which affects Christians who go to the Holy Land. They go mad, but no-one knows what happens to them because they are sent home to the 4 corners of the globe. But we know what happened in 1905 because our patients had nowhere else to go. What happened was that they recovered and did not become unwell again. Today if recognized, these conditions can be called acute and transient psychoses in Europe and brief reactive psychoses in North America.

If recognized. Today a schizophreniform psychosis is likely to lead to a diagnosis of schizophrenia and treatment with antipsychotics for life. Or if the admission has a manic flavor, North American clinicians are obliged by DSM to diagnose a bipolar disorder, which is a sentence to a life of “mood-stabilizers”.

We ran into trouble with our article on religious psychoses – there were many in North Wales who read the research as critical of religion. Stay away we were warned darkly. This caught us completely by surprise. At the time the paper was being written, Lehman’s Brothers was collapsing and the threat of a Great Depression was very real. We saw the religious fervor of 1905, allied to the stress of a general strike, as producing the kind of conditions that any society can throw up from time to time, and that any of us can generate in our personal lives.

One of currently fashionable ideas is Recovery. We are all supposed to have a recovery orientation. And of course it is helpful always to see the person rather than just the illness, but repeating this mantra is often aspirational rather than useful. These are the patients with psychoses who recover – who need to be recognized.

An important message from the historical record is that these patients recover without drug treatment. The worry today is that they will be slapped on medication and will be unable to get off it because of physical dependence or unhelpful advice from the mental health services that they have schizophrenia or bipolar disorder and need to remain on treatment for life.

These are the patients who now often give clinicians the impression that treatments work well, when in fact they were likely to recover anyway, and the real risk is they will be kept on treatments they don’t need. Is there any harm in staying on an antipsychotic just in case? Well in our data, older patients with acute and transient psychoses are particularly prone to heart attacks and strokes – much more so than younger patients with schizophrenia.

A second message from the modern records is these patients make every effort to have no further contact with the mental health services. If they escape physical dependence on drugs, their clinicians are never likely to see them again. This means that most doctors end up with a misleading impression as to how many patients with psychoses actually recover fully – they underestimate the possibility of recovery.

When the asylums opened in the early nineteenth century, there were few if any cases of schizophrenia. Patients with psychoses who were admitted recovered and asylums were institutions geared toward recovery by giving patients a structured daily routine and opportunities for work on the farm and other activities. They were not the warehouses they later became when schizophrenia emerged. If schizophrenia – chronic psychosis – were to vanish, these brief reactive psychoses would be psychoses that are left. But these schizophreniform psychoses are a disorder that we barely understand. There are vanishingly few case series published to give us even the average age of onset or gender ratio of the patients affected. The biggest studies there are have 40 or so patients. Our databases contain hundreds of cases.

In this mix there may be psychogenic psychoses – mental rather than physical disorders. This may be something like the condition Jung induced in himself that many see he portrayed as a semi-spiritual state or stage of growth. There may be other personality based conditions. Yet other brief psychoses may be more physical in nature but still open to recovery.

These are conditions we need to learn more about because as we shall see in our records it looks like schizophrenia or at least chronicity is vanishing, and we are going to have to re-orient our services much more toward recovery than before.

13 COMMENTS

  1. “This means that most doctors end up with a misleading impression as to how many patients with psychoses actually recover fully – they underestimate the possibility of recovery.”

    When I recovered in 1982, after eight years of drug “treatment”, my psychiatrist wrote for the record that I had had a “spontaneous” remission. He had allowed me to withdraw from the drugs he had prescribed as my symptoms decreased. He was, however, not at all interested in the orthomolecular therapy program based on tissue mineral analysis of a hair sample that I had obtained independently from http://www.arltma.com He would not even say the word orthomolecular, calling it instead “the Hoffer thing”, and of course he made no mention of it in my Veterans Affairs medical records.

    Then he discharged me as a patient with no further appointments scheduled. His behavior, which I now realize is typical of psychopharmacologists may help to explain why so few recoveries are noted. This particular doctor went on to become president of the APA.

    • Some two years ago I was on neuroleptics and got diagnoses of schizophrenia. Since then I went off the neuroleptics and returned to work. Since then the nurses and psychiatrists I’ve seen have often commented that the other psychiatrist and psychologists probably made a misdiagnosis. I know of a woman who has had a diagnosis of psychosis or schizophrenia for years, who by herself went to a low dose of neuroleptics and then told about it to her doctor – the doctor looked at her older data and then said that the schizophrenia was probably a misdiagnosis.

      Heh, perhaps when a patient goes off the drugs, then a doctor can say that the earlier doctors have perhaps made a misdiagnosis. When it’s the same doctor who made the original diagnosis, it’s easier to say that the illness is now in remission.

      • Misdiagnosis is a common scenario. E fuller the one who advocates community treatment orders and the like and says it is all a brain disease as decided the Joanne Greenberg the woman who wrote I never promised you a rose garden was actually wrongly diagnosed and that was the whole reason she was able to recover, as no one with scizophrenia is ever able to recover!!!

        You don’t find real doctors doing such a thing. When a person with terminal cancer recovers they don’t say, actually you never had really bad cancer. They just call it a miracle. At least they admit they had no idea of how it happened. Psychiatrists on the other hand wont admit to miracle cures of schizophrenia, no it was just a mistake. Given the amount of mistakes they make, one questions how they are legally allowed to force treatment onto anyone!!

        • Belinda you are missing the bigger picture. Those who no longer have “schizophrenia” are no longer on meds/drugs. If the patient had followed doctors orders they would still be on the meds/drugs , and still be “schizophrenic”.

          A diagnosis of a broken leg is valid, but a broken leg does not stay a broken leg forever. Where the bones meet in the body , they will grow together again.

          Emotional trouble ( mental illness) does not last forever, the meds/drugs should not be issued forever. The reason the drugs ARE continually given is that doctors can not have their patients feel pain, yet pain is necessary to live life.

  2. Well, Dr. Healy’s heart is in the right place, but he totally mistakes what was going on with Jung. The idea that Jung “went mad” or had a psychotic break just completely misrepresents what Jung was doing with his imagination as a psychological practice. Jung was giving his imagination the freedom to explore itself and this was much more akin to what we call “channelling” or “trance mediumship” than the disorganized state of psychosis. There definitely are overlaps between what Jung was doing and psychosis due to the nature of the psyche and how the psyche functions when the ego does not clamp down on imagination, but they were not even nearly the same process. Jung was doing “waking dreaming” or “active imagination” not psychosis.

    • I’m not so sure about this. His Redbook was just published and I haven’t read it yet, but from what I hear it was something pretty serious that happened to him and it wasn’t active imagination. His family didn’t want it published until just lately because I hear that they thought it would reflect badly on him. I’ve got to get a copy of it and read it to make sure for myself. I’ve done active imagination and waking dreaming and never turned up with what they say happened to Jung.

  3. I think the best way to understand Jung’s “psychosis” is to understand that “psychosis” (as defined by the DSMs) is only one response to an actual experience that takes place in the psyche.

    It could be said that normally, “I” (the ego) see the world through the lens of the rational left brain.

    But under the proper circumstances (extreme stress, for example), the suppressed right brain (or unconscious, or whatever we choose to call it) can break through and present its contents to the hapless ego. In this case, “I” then have to somehow deal with a completely new and dangerously destabilizing world view that can overwhelm, or at least seriously threaten “me,” the individual ego.

    We (the therapists) call it “psychosis” when the ego is actually overwhelmed by the powerful new contents of consciousness, and we call it “recovery” when the new contents are stifled by medication, or the individual successfully assimilates the new contents to consciousness.

    Jung, obviously, was one of the individuals who successfully assimilated the new contents of his right brain/unconscious to consciousness. He met the challenge, and the Red Book is his record of the struggle. He remained in control of himself through the whole process; he did not become psychotic. He then went on to create his theories of archetypes and individuation.

    He gives a fuller account of this process in his autobiography, “Memories, Dreams, Reflections,” which is far more reader-friendly than the Red Book – which Jung plainly says, was written for himself and not for future readers.

      • Stephen wrote:

        > Thanks for the information. Due to your clarification here I probably won’t read the Redbook since I’ve already read “Memories, Dreams, Reflections.” It’s a ttrmendous book and as I read it felt a kindred sprit with Jung.

        Stephen,

        Thanks for your reply. I think a lot of us have that kind of reaction to Jung’s autobiography. I found it the single most helpful book I read during my own spiritual emergence, as the Grofs call it. Jung was the one who convinced me I had to come back to reality, and showed me how to do it. I didn’t find reading his Red Book very helpful, but composing my very own “red book” kept me grounded and out of the hands of the shrinks.

  4. “When the asylums opened in the early nineteenth century, there were few if any cases of schizophrenia.”

    The schizophrenia label wasn’t invented until 1911 so I don’t know what Healy is talking about.

    “And of course it is helpful always to see the person rather than just the illness”

    Just the “illness”?

    I’d love to know what “illnesses” psychiatry has proven exist, other than the thoughts and feelings psychiatry has simply labeled as illness without any demonstrated biological pathology.

    This article was all over the place, darting around from topic to topic, I’ve just re-read it, I still don’t get what the main thing was trying to say is.

  5. I liked some of Jung’s more fanciful theories such as archetypes and shadow aspects, but I was never much for Freud. I actually liked him better after Civilization and its Discontents because I think he finally got it. It’s not that we didn’t get breast feed; Insanity, in all its forms, is reactionary. It’s part of the human condition, and the more social demands, the more insanity tends to flock around. So, your parents have you diagnosed with ADHD. You are labeled and drugged, and your parents are happy because now they can’t be blamed and a title means – normalcy on some level. They blame it. You blame it. The meds stop working, and the cycle starts again. So, you now have a drugged kid, who doesn’t have to take responsibility, and is afraid people will realize he isn’t normal. His parents did. The other kids will learn the association, create stigma, and prove that the first kid isn’t normal, and the whole process begins again. The asylum period, on this side of the pond had two reasons for sudden cures. First, we killed a lot of people. Second, there was no gain in keeping you crazy, and doctors didn’t attempt to reinforce that unacceptable behavior. Insanity was stigmatized, but it wasn’t discussed in polite company, and people learned to work around it the same way a brain injury will reroute a process. In the US, we build our own monsters.