Going mad involves breaking away from, or losing touch with, group norms and ideas about reality. This routinely leads many to even extreme levels of distress and disability, so I am among those who continue to think that promoting whatever might help people “recover” from this distress and disability is vitally important.
That’s why I get involved in projects like producing the upcoming webinar, “Recovery-Oriented Cognitive Therapy: Resiliency, Recovery, & Flourishing,” that will happen on 12/12/17. In this webinar, Paul Grant and Ellen Inverso will present approaches they have researched and developed that can often help even severely “institutionalized” people return to an active, “sane” life. If only more professionals could learn and practice these methods, we’d have many fewer people permanently disconnected from productive lives, or permanently alienated from society.
But is being productive and connected to the group norms of our society really the highest goal we should be talking about?
I think it’s more complex than that.
One way of understanding psychosis is that it often comes out of what some call “efforts at adaptation” — that is, psychosis results from efforts (consciously, or more often not consciously) to transform oneself and one’s mind in a way that might resolve problems that were not getting solved within one’s previous “sane” way of being in the world.
So I think we might better talk about what is needed as “transformation and recovery.”
Just “recovering” one’s previous way of functioning is not so likely to work, because usually something wasn’t working prior to the psychosis. It was that which set off the psychosis, and if that isn’t changed, any “recovery” may not be worth much, as the problems, and so the need to transform, will likely still be present, and will tend to cause other problems or even set off another psychotic episode.
What are the problems that cause people to need to enter a process of transformation? A damaged sense of identity caused by trauma can be one of them. But sometimes the problems are more cultural, the person is more sensitive than most to cultural contradictions and conflicts, and needs to reconcile some of those to go on. Or they might be something else, perhaps even something more biological — for example psychosis is more common after brain damage, and it might be that the person needs to transform in some way to deal with the way their brain is functioning differently.
The key thing to understand is that psychosis involves not just a defect in the person, but an attempt to reorganize to address problems. Like any attempt to reorganize, success is not guaranteed, and some attempts to reorganize may cause way more problems than they solve, but people can also learn from failures if they are given the space to sort things out. (Those of you more interested in how psychosis can be understood as an attempt to solve problems, and how that relates to trauma, spirituality and creativity, might be interested in a recording of a talk I gave on that, available at this link.)
Of course, a lot of people will say it is “romanticizing madness” to point out any connection between psychosis and creativity.
I do see a lot of difference between being lost in psychosis and being successfully creative, but I think we also need to avoid “awfulizing psychosis” as we do when we fail to notice what’s common between psychosis and creativity. Successful creativity, like psychosis, involves a process of pulling away from the “normal,” of experimenting with various sorts of transformation, and then of bringing something back, or “recovering.” It’s just that when the person does this without needing obvious help, the parallel with psychosis is often not obvious. And when people are experimenting only with more superficial forms of transformation, they are less likely to get lost in any important way, and so it may then be much easier to manage any “recovery.”
Support for the notion that creativity is facilitated by social disconnection came recently in a study reported on in this Newsweek article. That shouldn’t be too surprising: it’s hard to come up with anything really new when one is also following the path of “the herd.” But being successful with one’s creativity also involves that social reconnection or recovery piece.
So I think the bigger picture is that people need to be both given the space to disconnect from the established order, and to reconnect in a way that allows them to bring something back from their process of transformation. This would accomplish two objectives:
• It would allow people some space to experiment with the deep changes they might need to make to resolve the problems that pushed them into psychosis, rather than trying to immediately pull them back to their previous mindset that was likely not working for them, and
• It would benefit our society as a whole, as culture would be enriched by allowing people support as they went into the creative process in a deeper way
Will Hall, on his show Madness Radio, routinely asks the question, “What does it mean to be called crazy in a crazy world?”
I recently read the preface to Will’s book Outside Mental Health: Voices and Visions of Madness and I noticed that in his writing there he answered a related question, which could be stated as, “What does it mean to recover when the world is mad?”
Here’s what he wrote:
“The stronger I became in reality, and the more I became capable and my “functioning” improved, the more something unexpected happened. My altered states and different mental experiences that got called “psychosis” did not go away. They became more real. I found more and more reason to believe in the truth of my “symptoms.” I wasn’t recovering from “madness.” Something far more mysterious was happening. The hospitals and the threat of my label have faded. Today I am less isolated, more in control, and less terrified than I was that day when a team of doctors gathered around a consulting table to pronounce me schizophrenic. But my most “florid” symptoms of that time, my unusual beliefs, my conversations with voices, my paranoia, my contemplation of suicide, my silent inward withdrawal, my perception of prophetic omens… all of that remains. Professionals made their case for my severe mental illness diagnosis by presenting symptoms as evidence, but that evidence is all still part of me today, even as I live outside any psychiatric care or treatment. I am doing something completely different from what medical and mass media narratives say I should be doing: I am regaining my wellbeing in the world while at the same time losing touch more and more with “reality.” My madness is leading me somewhere that is more real than what everyone seems to say is real. I’m leaving behind not just the doctors’ diagnosis, but also the mechanistic, soulless, and “objective” reality that gave rise to it. I have begun to arrive somewhere very far outside mental health indeed.
“TODAY I WILL MEET SOMEONE FOR THE FIRST TIME. I make breakfast, and last night’s dream rings in my imagination: I was with my brother, we were playing together outside.
“As I recall the strange atmosphere of the dream, I break a single egg into a bowl, and look down. I see two yolks there, fused together, both from the same shell. I arrive at my counseling office, and the woman I meet says why she has come to see me. She tells me her birth was traumatic. She tells me that her twin sister died when she was born, and, she says, her sister is still haunting her. Psychiatrists haven’t helped; they labeled her delusional. I sit listening to this anguished woman talk about her twin sister. I recall the dream about my brother from the night before, and I remember the egg I broke this morning. I know that it is only the habit of what we call “real” that makes us think there are two people in this room, instead of there being one person here, meeting themselves for the first time.”
I very much share with Will his aversion to the “soulless objective reality” that is so often accepted without question in our culture, though sometimes I slip into that cultural trance anyway.
But then I get reminders that there is more to look at, more to consider. An example: just before I read the above excerpt, my partner remarked, while cracking an egg, that it had a double yolk! Sure I could take that as “just a coincidence” but I could also take it as a direct message, from “the universe,” that I should be paying attention to Will’s words and recalling that there is more to existence than the often lifeless theories we often use to conceptualize it.
This brings me to another possible meaning for the term “recovery.” It could be used to mean not just recovery of our connection to the people and ways of thinking that are considered “sane” within our culture, but also as possibly meaning “recovering” our connection to vital elements that are left out of our culture!
So “transformation and recovery” can mean transforming in a way that allows for connection to those missing elements. In my way of thinking, people like Will Hall are models for how it is possible to “recover” in both ways at once: to connect well with both “conventional reality” and with elements that are usually left out. This of course is the traditional role of the shaman, the person who moves between worlds.
I’m not suggesting that everyone who experiences psychosis will want to be something like a cultural pioneer, a prophet, or a shaman. Many will be only too happy to make whatever minimal changes they must make in themselves to simply return to conventional society, aiming only at very conventional notions of success! But for others, a psychotic episode is just an initiation into questioning socially constructed realities and seeing other possibilities. Success for them is defined not as staying anchored in “this world” or way of looking at things, but in traveling to other worlds or views, coming back to this one to share and connect, then traveling again, etc. I hope we eventually create a mental health system which can understand and embrace this process, a mental health system open not just to recovery, but also to transformation and appreciative of the importance of that in our collective life.
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.