Process Oriented Approaches to Altered and Extreme States of Consciousness


My colleague John Herold has an interesting image he uses to communicate the conventional mental health approach to disturbing mental states: it is that of a fire extinguisher being applied to a fire.

If we think of disturbing states as an illness, then it makes sense that we focus on trying to eliminate them or to “put them out.” Of what use is an illness?

But what if these states are something more than that? A key alternative idea is that disturbing states represent something important that is trying to emerge, something that has been missing from our dominant mental states. We may not know yet how to integrate it, but the possibility of getting to know it better, of making peace with it, and finding value in it, exists.

I believe it makes more sense to conceptualize “psychosis” as something like a revolution in the mind, than as an illness. And as John F. Kennedy famously said, “Those who make peaceful revolution impossible will make violent revolution inevitable.” It follows then that if we want to make “psychosis” less disturbing, we need to focus less on suppression, and more on actually facilitating altered states of consciousness and integrating them into our lives!

That’s the approach taken in Process Oriented Psychology, also known as Process Work.

When John Herold went to see a Process Work counselor, they talked about how John’s  experience of extreme states had been too intense and had been disruptive in his life, and had led to hospitalization, something that John wanted to avoid in the future. But they also talked about how these states had value. The counselor then compared John’s experience with drinking an entire bottle of Tabasco sauce all at once. Why not instead, the counselor suggested, “try being just a little psychotic all the time?”

That strategy turned out to work great: applying it allowed John to make peace within his mind. In fact, it worked so well that John became inspired to get a master’s in Process Work and to begin teaching about it.

Conventional mental health approaches tend to be deadening — this isn’t surprising given that suppressing part of the psyche is their goal. Not so Process Work: it is always lively and playful, often playing specifically with that which has been disturbing. No mental state is taken as having the whole truth: instead, it is always possible to take any state to its “edge” and then over the edge, into something else. It’s an approach that very much values diverse mental states.

Another aspect of conventional mental health approaches is their tendency to assume that “reality” is a given, and that the goal should be to have everyone be in touch with it in the same way. “Consensus reality,” where everything can be divided up and measured, is the only kind of reality that is valued.

In contrast, Process Work sees reality as having a number of different dimensions, with some value in being in touch with different dimensions at different times.

“Dreamland” for example can be seen as a level of reality, or a way of being in touch with an aspect of reality. In process work, “dreaming” is not just something we do at night, but something that comes up in body sensations and symptoms, in fantasies, in visions and voices, etc. These experiences are “not real” from the perspective of consensus reality, but are completely real on their own terms.

Another level of reality is that of “essence”: this relates to the non-dual aspect of reality.  At this level we can experience that we are all one consciousness, that there is no observer separate from the observed, and that all of reality can be experienced as right here right now.

This relates to my experience, as many of the most powerful events that shaped me did not take place in “consensus reality.”

One such event occurred when I was 17 years old, when I took LSD for the first time.  I had the experience of going to another dimension, where I met some beings who told me I did not have to continue to be who I had been, that I could be a completely new person. This sounded great to me, because I did not like my self up to that point — it was too much shaped by fear, defined by people who had abused me. So I went with the new identity!

For the next 15 years or so, I continued to see my origin as more related to that “dreamland” event of becoming a new being, than it was to my “consensus reality” experience of growing up with abuse. I also focused very much on “essence level” reality, as that gave me a point of origin quite other from my childhood, and helped me continue to escape from feeling vulnerable.

This continued until various events, combined with my increasing awareness of the costs of denying my basic human vulnerability, pushed me to face my past and the dimensions of experience that I had disowned. This was at first shocking and very disruptive, and it seemed I was at risk of losing my sense of safety and being stuck in the trauma that I had previously avoided — at least until I got help in integrating from some competent therapists, one of whom had training in process work.

In Process Work, everyone is understood to have a “primary process” or a kind of functioning with which they identify, and also the possibility of having a “secondary process” which may disturb, or offer an alternative to, the primary process. When the contrast between the primary and secondary process is very sharp, there is the possibility of something they call a “process inversion” in which the two switch, and what was the person’s primary process now seems to be completely missing.

From this point of view, what happened to me when I was 17 was that I crossed over from what had been a primary process highly affected by trauma and abuse, to a secondary process of being someone who was fresh and unaffected by abuse. This was a “process inversion” because my past identity became missing, and I could not or would not relate to the person I had been. Turning to face my childhood trauma 15 years later threatened me with another such inversion, but after some rocky times I found ways to become more fluid and able to draw from both identities: the one who had been crushed by abuse, and the one who had never been touched by it.

An important aspect of Process Work is that nothing is pathologized; every part of the person, every kind of experience, is seen as having value. A process worker would see value both in my crossing over into being someone who never had a childhood, and also crossing back into reclaiming a very disturbing past. People may, as I did, get stuck in some parts of their experience and need help finding a way to be more fluid so they can also relate to other parts, but there is nothing that needs to be suppressed or gotten rid of.

Want to know more about this approach? Then I suggest watching the video below, a very lively, recently recorded presentation by John Herold, who knows a lot more about Process Work than I do! In this presentation, he covers deep and complex topics with amazing clarity and humor, and he speaks informed not just by theory but with perspective drawn from learning to manage his own extreme states. After you watch it, please let us know what you think!


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.


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  1. Hi Ron, Pleased to read this. I read your paper today and I actually felt quite liberated, even simply hearing this sort of opinion. My feeling is that this is an extremely interesting possible remedy, but I do stress that it may be difficult to make other practitioners see the merit, as with most forward looking thing (this ahead of the crowd). I think these kind of theories fall in a similar vein to that of R.D Laing even. Thank you for writing this post. Especially interesting is your quote “something important that is trying to emerge, something that has been missing from our dominant mental states” . I think you will find your theory is accepted very intuitively with people who suffer distress, including myself.

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    • I’m glad you found the article liberating! I hope you watch the video too, I think you will find it much more helpful. And I know it is hard to get practitioners to change, but I think it is worthwhile to keep chipping away at it, just getting a few to change can make a big difference to the people those practitioners work with. And once enough change, the balance may shift and the current model of mostly mistreatment may come to be seen as the monstrosity that it is.

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  2. Great article Ron, l like the counselor comment “try being just a little psychotic all the time.” Sums up the human condition really, as we walk around pretending that we know reality because we can name and number what we think we perceive.

    While, simultaneously not being able to think or say in word’s ‘how’ we walk and talk. All we can do is describe ‘what’ we do when performing the two quintessential behaviors that make us human.

    As postmodernism suggests, we are all trapped in the 3rd person dichotomy of our mind’s. And l suggest that using word’s like extreme state simply maintains our consensus reality illusions of Self knowing by our ‘memory’ of literacy & numeracy skill.

    Socrates did not write because he was suspicious of how word’s imprison self-knowing by creating ‘static’ impressions of our reality, with word’s like ‘my brain’ my heart etc.

    And the sad truth is that we human’s who label ourselves ‘normal’ know little more about our human nature, than word’s and numbers.

    In my experience psychotic experience is a dissolution of this third person dichotomy of mind, inflicted by the subconscious nature of our nervous system structure and function.

    Learning something about how our nervous system orchestrates the bio-energetic phenomena of experience we call mind, can lead to better self-regulation, by shifting attention to bodily sensations that help recognise the charge/discharge patterns of those 100 million cells that compose the organic nature of our brain.

    The simple advice that out of the contemplative era known as the ‘axial-age’ was know thyself, for a very solid reason, we don’t.

    “Seeing they see not and no ‘wise’ perceive.” The Prophet.

    “We are all in a post-hypnotic trance induced in early infancy.” R. D. Laing

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  3. Hi, Good comment. You could almost be speaking about something a psychiatrist had supplanted in your conscience.
    I think this post is mainly about minimising. It’s about taking your feelings, your general day to day feelings and saying that ‘this is normal, because i am indeed a human being’. Can you see where i’m coming from?

    We are all human, and I feel sure the people writing on this site see that every emotion is ‘natural’. Maybe there is a ‘third dimension’, maybe you can run with this. I’m thinking you have more mundane indicators which are making you unhappy, & possibly circumspect about this post.

    Money is one problem for most, which distorts our vision and our relative happiness & contentment.

    Good luck.

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    • You are indeed a human being, Legal Chic. But my comment is about ‘how’ we do being human.

      Third dimension, is a creative word formulation, but are you made of words?

      Try saying “l am” Followed by your name & contemplate how you have said “l am these word’s?” And is this figure of speech a true sense of being human?

      Or is it simply a product of memory?

      Look at your hand & notice the thought word ‘fingers’ then move your fingers & feel the sensations of motion, while asking yourself whether the ‘word’ fingers is the reality of your fingers?

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  4. Nice one Ron (and John).

    I know that when I was in hospital there was a talk given by the people from the Hearing Voices Network. Staff ensured that certain patients (those hearing voices) were restricted from attending. Seemed strange to me at the time, and I copped a mouthful from staff when I tried to introduce one guy who I thought might be interested in what the person had to say. So they only want people hearing voices to hear the voices they want them to hear lol.

    Speaking of which

    This passes and you will not be hearing any voices of opposition to psychiatric abuses from our country. Not if the only people who can provide information to the UN without being detained without charge for years are our Politicians. No talking about the delousing program people. I wouldnt want to be an Aboriginal person in this country.

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    • Lots of professionals were trained to think that talking with people about their “psychotic” experiences would just make them worse, so if they believed that, it’s not surprising that they would think that people who hear voices shouldn’t go to a hearing voices group. But it’s also so ridiculous – it shows the impact of bad ideas, that can make the whole mental health system quite mad, and not in a good way.

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      • I think it also shows the insecurity of many of those trained in and committed to (sorry, bad choice of words there!) the current system. I believe most of them KNOW on some level that they are missing something big, and if someone went to a “hearing voices” group and got better, it would point out to them the thing they are trying so desperately not to admit – they really don’t know what they are talking about, and their way of “helping” doesn’t really help the way they’ve been told it should.

        It reminds me of a group of volunteers who went into schools in Oregon and read to the elementary school kids. They did nothing but read to the kids, and have the kids read to them, and give the kids two books a month if they participated. The volunteer training was something like 4 hours. And kids reading levels went up immediately to the point that a study showed that the program made the difference between meeting the reading benchmarks and not meeting them for an average child. The educators were astounded, and started asking the people who ran the program what their method was, how they did it, what was their “secret.” The leader explained that they just read to kids, nothing more. The educators could not accept this. It bothered them no end that a layperson simply taking the time to interact with a child around reading would be sufficient to teach them to read, and were sure there was some “trick” the program was holding back that would explain these (to them) unexpected results. They’d spent all this time learning all these “educational methods,” and the study showed their educational methods to be of little to no value in terms of teaching kids to read – an average untrained person could do the job with only 4 hours of very general training.

        I think the same fear exists for psychiatrists/psychologists/therapists. If peer support can create positive change, it means their own years of training were misleading or maybe even worthless, and it’s even possible their actions were making things worse. It takes a courageous person of integrity to allow such an observation to really impact their view of the world.

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        • Is it fear or ignorance, Steve? Perhaps a combination of both, as we seek a sense of conscious certainty, to appease a subconscious need to feel secure?

          11 of years of drug free self-regulation began with an acceptance that l knew nothing more about my own reality, than word’s.

          While the history of Process work involved the term ‘felt-sense’ & the paradox of traumatic experience, in my opinion is a fear-terror flight into the mind, in an attempt to escape sensations/feelings in the body.

          My existential (the experience of experience) advice to Legal Chic, is an example of the process of ‘realizing’ how we are raised to live in heads, through our early life adaptation to literacy & numeracy skill.

          Process work, in my opinion, involves a self- balancing of thought & felt sense. Through an a shift in attention to the ‘environment’ within our body. Hence, the notion that ‘word’ recognition is not a recognition of reality, and we are not our Mind.

          It simply feels like we are our Mind, through the repetitious process of habit formation. Growing to normal adulthood with no memory of the effort involved in our first attempts to form the sound of words, like our name.

          Hence, R. D. Laing said: we are all in a post-hypnotic trance induced in early infancy.

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        • Hi Steve, I agree with you that much of what is taught in standard approaches is either not helpful or is actually detrimental, but I don’t think that all attempts to educate people in how to help is useless – a good example is the Open Dialogue program, which relies a lot on education, though part of what they educate is also humility and staying uncertain! I think we need to work on sorting out what is helpful and what isn’t.

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          • Right, if what we are teaching is living with uncertainty, maintaining humility, being flexible, and empowering the client, I can agree that such things are helpful. What I’m objecting to is the idea that some workbook can teach you steps to follow that will help anyone with a particular set of “symptoms,” as people are all different and have different needs and motivations and reasons for their anxiety or whatever, and thinking that there is some formulaic way to address this that works for everyone is at best misleading, and can be quite dangerous.

            But I think I’m preaching to the choir at this point.

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          • Yes, the idea that one approach will help everyone should be declared quite dead! But I think there is value in having a diversity of approaches, then people can find something that fits for them at a given time and place.
            Steve, I wonder if you watched any of the video? If you did, can you see how someone like John might be more ready to help someone after learning something like Process Work?

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  5. For time being, we do not know what is psyche/psychosis/depression, because phenomenology, the essence of the psyche was destroyed by ECONOMY, the main god of materialists, by scientism, by theology/spiritualism, and by apollonian ego hegemony. Now, all we have is the false empiricism and scientism which is a curse and DSM is a way to understate the value of human beings. People are trained by materialism and they can see worth only in the flesh reality, it is a curse of apollonian ego era.

    Everyone should read James Hillman, Re -visioning psychology to understand the phenomeological value/the role of the psychosis. The meaning of the psyche.
    Laing, Szasz, they were not phenomenologists, Szasz was a great critic, but he was a nihilist, the same with Liang, he was also a spiritualist.

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  6. I largely agree with this approach / theory about “extreme states” or “psychosis.” Thanks for sharing. Today’s “mental health professionals” believe in, not “consensus reality,” but the DSM as reality. And they totally deny the spiritual, “dreamland,” and “essence” levels of reality. The problem with this is the psychiatrists’ DSM “reality” is based upon scientific fraud and it’s an “invalid” belief system, meaning it’s not based upon reality.

    I, too, experienced the feeling of oneness with all, or as you call it, the “essence” level of reality. And the concept of a oneness with all is really cool, and has amazing potential. I tend to believe it may be how humanity is supposed to evolve. It’s about living in a mutually respectful world where all work collectively together to make a better world for all. It’s about living within a humanity based in love, as opposed to fear, as our current leaders rule the world. And it strikes me that when so many people experience the same type of alternate reality, there’s likely something real about it.

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    • Thanks Someone Else. I look forward to seeing more people who work in mental health be able to talk about some of these other levels of reality in a coherent way – people feel a lot less crazy when they understand that others have been having similar experiences since as long as we have records!

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        • Hi BigPicture, sorry if you were waiting for a response, I didn’t think of anything to add to what you already said, at least nothing without making a longer post than I might be ready to do! I think you make some good points, many of them along the lines of what Alan Watts used to talk about when he said that sometimes you have to go out of your mind, to get back to your senses.

          And I agree about the post hypnotic trance thing. Going into at least a different kind of trance gives you at least the awareness that some other kind of processing is possible, even though it doesn’t tell you what “being truly awake” might be…..

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          • Truly awake? Aware that language throws a veil over reality & we should learn to be ok with an inability to ascribe words to experience?

            Beware the scribes, said a wise Jesus the Christ. A word (Christ) that originally meant ‘anointed’ even though many now associate the word with Savior, from a supernatural perspective.

            Although, if we do learn to not ascribe words to experiences of awe, would we come to a feeling for the wisdom of the ages story, in a supra-normal way?

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