When we try to understand why we emotionally suffer, we can look to the ever-growing, reliable knowledge that traumatic, overt emotional wounds of commission can surely cause our emotional suffering via depression, anxiety and even extreme states.
John Read’s groundbreaking research on the impact of traumatic childhood adversity in the genesis of psychosis, leads the way in refuting psychiatry’s disease model.
That disease-based model instead points to underlying genetic and neurological processes that both cause and sustain psychosis. It’s hugely important that research is showing that trauma is finally being broadly understood as a reason why almost all people become psychotic.
But in my experience of 35 years as a therapist while serving people in emotional suffering and/or extreme states, I’ve seen that there can also be a lack of awareness by mental health professionals, and even those of us in the reform movement chronicled here on MIA, about emotional wounds of omission that go unseen, wounds that have no guarantee of ever being clearly seen, let alone completely understood. Those wounds are caused by our intrinsic needs for empathy, compassion and love, not being met.
I’d like to encourage a dialogue about those wounds of omission with this essay.
I believe that our social-Darwinism-based and patriarchal/corporate mass market culture uses the emotional currencies of guilt, shame, fear and anger to motivate us, and by doing so, emotionally wounds us in many ways we aren’t easily aware of.
We are all vulnerable to being injured covertly from our culture by our needs for empathy, compassion and love not being sufficiently met in our daily lives. These needs certainly are greatest when we are children. If we don’t get enough empathy, compassion and love from our family, friends and social group as we’re growing up, we may be unable to negotiate the huge developmental milestone of young adult autonomy and self-support without becoming psychotic, even if we’ve had no overt trauma happen to us our entire lives until then.
As rebel psychiatrist RD Laing noted, our “normal ego” is in fact “that false self competently adjusted to our alienated social reality.” Laing advocated the caregiver response of love and compassion as the antidote to reverse the suffering of those in madness.
In this essay, I’ll mainly be drawing on my years of specializing in serving people in extreme states from a hybrid neo-Jungian and Laingian perspective, one that also relies on the caregiver giving empathy, compassion and love as the best practices response to others in extreme states. By exploring the etiology of psychosis from a heart-centered, transpersonal/depth psychology perspective, and from Laingian-social-impact perspective, we can find subtle contributing factors that are very important.
My followup 2002 doctoral research on the medication-free, first-episode psychosis program called Diabasis House showed that there was a therapeutic “way” of caregivers being with people in extreme states that relied on empathy, compassion and loving receptivity instead of the clinical detachment that is part of the disease model of care. This humanistic and heart-centered “way” of caregiver response to residents was the key beneficial variable in the successful treatment outcomes for almost 80 residents.
Writing this now may challenge both the conventional wisdom of the disease model of psychiatry, and the perhaps over-determined, overt trauma causation approach to the etiology of psychosis that has been so widely embraced here on MIA. In my view, all of our intra-psychic, personal and familial experiences and relationships occur in the often extremely toxic and stressful emotional crucible that our dysfunctional culture provides for all of us regardless of social class. Indeed, in my 28 years serving in an urban public mental health system, the ever- present effects of violence, poverty, racism and community fragmentation counted hugely in the suffering of all.
Our culture’s widespread “survival of the fittest” ethos has reduced the social contract in 2016 to a struggle for wealth, power and dominance that pits us against each other in fierce competition. Is it fair to say that in that competitive environment, the healing balms of love and serenity are rarely the consistent, normal portions we receive from others or from ourselves throughout the day?
If not, then what is our daily bread?
Fear, shame, guilt, despair and anger take up so much of the emotional space in the collective and solitary rooms we live in. Those painful emotions are the emotional currency of a culture that long ago lost its way from the ideals of altruism and justice. Such invisible injuries to our spirits and souls may come at us every hour of the day. We may become numb to their impact on us and not even be able to identify our huge unmet needs for empathy and compassion.
When the collective daily life of us all is a constant dog-eat-dog contest for success and status, is there ever enough time and energy for seeking and finding an abundance of love and nurturing peace of mind?
The destructive, modern-nation-state chaos that threatens us all with conventional and nuclear war, racism, environmental and economic disaster, terrorism, poverty, and loss of personal freedom has created an often loveless, dystopian world that is no longer imaginary. It feels like a hybrid blend has been created, one that draws on what both Orwell and Huxley prophetically imagined.
Signs of the times now include that one in 4 women are prescribed a psychiatric medication and countless toddlers, children and teens are medicated too.
In this atmosphere of social alienation and almost universal personal malaise, I’ve frequently been in rooms, over the past decades, with families and mental health professional people who earnestly wonder why some young adults they love and care about break down and crash, become psychotic or severely depressed, without ever having had an abusively raised voice or raised hand against them in their personal histories. No history of overt trauma. The recognizable, overt traumatic wounds of commission that could have caused the young adult’s madness or despair or terror were not present.
But still they have crumbled under an invisible weight.
Since I don’t believe they are victims of neuropsychiatric brain disease syndromes, I believe that they are casualties of the invisible wounds of omission that our culture inflicts on them and all of us. In my experience with these younger people who have become psychotic, without overt trauma, I came to see that not getting a minimum requirement of empathy, compassion and love was sufficient cause for their becoming psychotic.
They may have had very good hearted, non-abusive parents but those parents were often overwhelmed by the societal demands on them, demands that forced them to stumble through the door at night, emotionally exhausted after commuting and working long hours. It’s no surprise the warm empathy, compassion and love for their children—and for themselves—had long been in desperately short supply.
A plant needs the perfect combination of nutrients and sun and water to bloom in the spring. It needs these things sustained over the summer to bring forth fruit in the season of harvest. We too need an abundance of love and safety and praise to grow up strongly and to flourish.
Without them in abundance we wither or spasm in pain.
We all long to be heard in a way that our precious words are lovingly welcomed by the ears we want opened to us; our eyes long to be seen into by eyes that adore us and glow with love for us. We want to be lovingly held with arms that hold us with tender and fierce devotion.
Where do parents, siblings, relatives, teachers and caregivers find the easily accessible aquifers of love and serenity to renew themselves in the socially arid 24 hours we all travel through that make up a typical day?
The good news is that those fountainheads of sustenance exist closer than we may imagine. We don’t have to spend all our time looking at our failed culture’s faulty design. Let’s instead take time to try and receive the healing balms we need from ourselves and each other.
It sometimes happens that people in an extreme state process will respond quite dramatically to a transfusion of empathy and compassion as highlighted in the two examples shared below. In most instances, a gradual process of healing and integration takes place over time, if people are provided the crucial relationship with a caregiver or loved ones where the transformative essence of empathy and compassion is consistently present.
Recently I was with a young adult without a trauma history who’d been hospitalized before but who hadn’t spoken a complete sentence in months, and yet started talking in complete sentences midway through our first hour together. For almost all that time, I sat quietly and looked at them with an open heart of caring, not a single thought about diagnosis clouding my mind or eyes, my eyes instead looking at them with warm delight. And then, the first sentence. A well-formed sentence that began our relationship in words exchanged, that has grown into conversations at times that sound completely normal.
Another young adult with no trauma history recently came to see me after spending a month in one of the most prestigious private psychiatric hospitals in the country. Their parents had read some of my articles on madinamerica.com and decided to bring the young person to see me. After a few minutes of quiet time sitting alone together, I said how sorry I was that the young person had been and was still suffering.
In response a floodgate of emotion and words came pouring out, keening wails of despair and fear, words grasping for meaning as I sat with my eyes in tears at the raw human emotion being shared with me. After 45 minutes, when I didn’t say a word but listened with my heart wide open, the emotional outpouring subsided. The young person then said, “Thank you Michael for caring and listening to me. I was in that hospital for a month and never spoke a word of this to anyone there. I did not believe I could trust them.”
I’m 70 now and still see people in extreme states every week. I have hope that the young people coming up now will create a future where the cultural wounds of omission that can be so hurtful are gone, and there will be a future society where those needs are met.
Mad in America hosts blogs by a diverse group of writers. These posts are designed to serve as a public forum for a discussion—broadly speaking—of psychiatry and its treatments. The opinions expressed are the writers’ own.