Presenter: Ron Unger

 A view associated with people like R.D. Laing & John Weir Perry  Criticized as “romanticizing madness”  But if we leave this possibility out, might we be “awfulizing madness”?  A more complex view: madness as a possible result of attempts to cope and to heal that may backfire  Better explains diverse antecedents and outcomes?  Balances view of risks and opportunity?

 Often make it more scary  by defining experiences as definitely part of a terrible illness  Puts emphasis on suppression of experience  This may stimulate a “psychic civil war”  Increase in helplessness  “Passive victim of an active illness”  Increase in stigma & isolation  Over-emphasis on stability contributes to rigidity in people and in culture

Interpret voice itself as a threat Hearing a voice Increased emotional arousal hypervigilance, listening harder for more voices Stress Vicious Circle More

Interpret the voice as an effect of stress or as a source of information about aspects of self Hearing a voice Accept the voice as a useful signal of stress, take action that reduces the stress Stress Virtuous Circle Less Less trouble from

 Traumatic situations require, or seem to require, extreme reactions  Extremes are achieved by excluding or pushing away all other possibilities  Black and White thinking,  Dissociation from alternative ways of looking, thinking, and acting that seem threatening  At other times, the person may seem to require exactly the extreme that was shut out previously  “Black” and “White” may flip  Instead of integration of opposites, there is conflict

 The Apparently Normal Part, or ANP  This part wants to move on with daily life, and avoid traumatic memories and/or upsetting emotions  The Emotional Part, or EP  This part is preoccupied with the trauma and/or possible recurrences of the trauma  It is fixated on action systems that were activated at the time of the trauma  It is likely to have “vehement emotion” and emotional reasoning that is not tolerated by the ANP

Positive and negative metabeliefs in PTSD I must stop thinking about it It’s not normal to keep thinking about the trauma I must be weak to respond like this I could lose my mind if I continue to think this way My mind has been damaged by what happened I must go over events to make sense of them It is important not to have gaps in my memory Thinking about threats in the future will help me cope Worry keeps me safe Paying attention to danger will keep me safe Taken from PowerPoint by Dr. Peter Scragg on Metacognitive Therapy

 In “Negative Dissociation” we identify with one part of ourselves, the other part seems to be missing  In “Positive Dissociation” the other part is present, but is seen as intrusive and as causing a disturbance rather than as being a valued part of self  Flashbacks are a form of “positive dissociation”  In more extreme states, intrusions may be seen as completely alien, as a voice, demon, or CIA installed implant

Dialogue, Integration, Orderly Sense of Self Positive Dissociation, Intrusions by what seems not- self, Hallucinations Delusions, Difficult content is present within an ordered view but in disguised form Transliminal, Mystical State, All is present but no sense of order Negative Dissociation, Keeps order by leaving things out Negative Symptoms Positive Symptoms Map of Extreme States

 When people are trying to control something  And there is no direct way to do it  Then they become more likely to see unlikely patterns  Including  seeing images in noise,  perceiving conspiracies, and  believing in superstitions Whitson, J. A., & Galinsky, A. D. (2008). Lacking control increases illusory pattern perception. Science, 322(5898),

 1. Construct system breaks down  Common cause of that: trying to solve a problem not solvable within existing constructs  2. Temporary suspension of constructs  Encounter with the “transliminal”  3. Construct restructuring If done under high stress etc., errors are more likely, leading to getting attached to defective constructs, and/or back into….. Success! If done under low stress and/or with luck etc., the process can result in new vision that enriches the person & possibly the culture.

 There are striking parallel between a fully resolved psychotic process and the metamorphosis of a butterfly:  They both entail an initial stage of profound disintegration.  They both entail eventual reintegration into a form that is much more resourced than the original form. Slide borrowed from Paris Williams, author of “Rethinking Madness”

Rely on defective, dissociated, and/or dogmatic constructs: Mystery, or awareness of limits to the constructs, is denied. Lost in the mystery: Since constructs were not adequate, all attempts at constructs are abandoned. But then there is no way to organize or communicate. Attempts at constructs coexist with an awareness of the mystery that surrounds them: Attachment to constructs is tentative, humble, maintains a sense of humor about their limits. Lively. People may “flip” between being lost in the transliminal & relying on rigid & defective constructs

Dialogue, Integration, Orderly Sense of Self Positive Dissociation, Intrusions by what seems not- self, Hallucinations Delusions, Difficult content is present within an ordered view but in disguised form Transliminal, Mystical State, All is present but no sense of order Negative Dissociation, Keeps order by leaving things out Negative Symptoms Positive Symptoms Map of Extreme States

 All statements are true in some sense, false in some sense, meaningless in some sense,  true and false in some sense, true and meaningless in some sense, false and meaningless in some sense, and true and false and meaningless in some sense  From THE PRINCIPIA DISCORDIA  “Wherein Is Explained Absolutely Everything Worth Knowing About Absolutely Anything”

 Where efforts to make things better are inadvertently making them worse  As things get worse, misguided efforts to make them better often intensify  Leading to an acceleration of difficulties  Both efforts by individuals, and by “helpers” such as the mental health system may be making things worse  Without insight into the vicious circle, it just accelerates  The whole pattern may then be labeled a very serious “biologically based mental illness”

Serious problems, depression Goes into trance and wild ideas to escape problems and depression Acts on trance or wild ideas without using adequate discernment Bad results from person’s own actions & from mental health intervention leads to life going further out of control Vicious Circle Mental health system intervenes in way that is traumatizing, stigmatizing and/or disabling More

Serious problems, depression Uses discretion, though sometimes still goes into trance and wild ideas to escape problems and depression Acts on trance or wild ideas only after using adequate discernment Actions lead to better results, life makes more sense Virtuous Circle Any mental health intervention is normalizing, encourages reflection & discernment Less

 If we recognize that all maps, concepts etc. are only partially helpful & accurate  Then we can listen to and respect those who see & describe things differently than we do  When we respect both our own views & that of others  We model for our clients how to do the same

 Dialogue involves cultivating multiple views  And bringing them into relationship with each other  There is need for dialogue at all levels  Within the person being helped  Between the helper and person  With family and friends  With the wider society or culture  Mental health workers should be trained in how to respectfully address issues framed as spiritual within such dialogue

Slide by Isabel Clarke and Donna Rutherford

 Mental health system role should be:  To protect the person going through extreme states  Help people develop a dialogue with that which disturbs them  Train people prone to extreme states  in how to negotiate these states successfully  And in how to draw on extreme states to support “creative maladjustment” in interaction with social groups  so the best aspects of “mad” or visionary experiences can play a role in social transformation  Our survival may depend on a better relationship with the Visionary