1. Isabel Clarke Consultant Clinical Psychologist
Bringing psychosis in from the cold. Seeing anomalous experiencing in the wider context of human cognition .
Isabel Clarke
Consultant Clinical Psychologist

3. What I propose to cover
Looking at psychosis and spirituality in the same frame, as one potential of human experience.
Research that supports this perspective.
A model of brain architecture to underpin this perspective.
Implications of looking at human beings in this way.
Implications for clinical practice will be the subject of my second talk.

4. Questions to ask of Psychology
Mental breakdown: what is going on?
How can people be better supported through it?
Where does spirituality fit within psychological science?
Psychotic experiences: what is going on here?
Euphoria followed by catastrophe ????

5. Making Connections Early breakdown Revolution and social movements
Overwhelming sense of connection – spiritual literature
Followed by fear
Revolution and social movements
Euphoric, everything possible stage
Followed by terror, brutal dictatorship and repression
Stepping out of individuality – a sought after experience

6. Evidence for normalization of anomalous experiencing
Mike Jackson’s research on the overlap between psychotic and spiritual experience.
Emmanuelle Peter’s research on New Religious Movements.
Schizotypy – a dimension of experience: Gordon Claridge. High Schizotypy = positives as well as negatives
Wider sources of evidence – e.g.Cross-cultural perspectives; anthropology. Richard Warner: Recovery from Schizophrenia.

7. More recent research
Caroline Brett’s AANEX makes it possible to measure anomalous experiences phenomenologically – get away from symptom language
Research that demonstrates: having a context for anomalous experiences makes the difference between
whether they result in diagnosable mental health difficulties
whether the anomalies/symptoms are short lived or persist.
Caroline Brett, Heriot-Maitland and others.

8. What this points to
An area where experience becomes anomalous – spiritual/psychotic/ THE TRANSLIMINAL
This challenges the idea of psychosis as ‘just’ an illness and symptoms as things to be got rid of at all costs.
Powerful evidence: how the experience is made sense of impacts peoples’ lives
Health services do not come well out of this
Time for a new perspective!

9. Psychosis – Potential for Transformation
Traditions such as Psychosynthesis and Spiritual Emergence/Emergency recognize the transformational potential of the transliminal.
Jung: Meeting and integrating shadow - an aspect of transformation
These traditions tend to distinguish between ‘psychosis’ and transformational crises
More and more this is seen as a false dichotomy – Spiritual Crisis Network (.uk)
Mike Jackson’s Problem Solving Model, encompassing potential and dangers.
Role of stigma in trapping people.

10. Two Ways of Knowing – Introducing the Transliminal
The breeze at dawn has secrets to tell you.
Don’t go back to sleep.
You must ask for what you really want.
People are going back and forth across the doorsill
Where the two worlds touch.
The door is round and open.
Rumi, translated by John Moyne & Coleman Barks in ‘Open Secret’ (Threshold books).

11. What is going on here? The levels of processing problem
Being human is difficult because our brains have 2 main circuits – they work together most of the time, but not always.
There is one direct, sensory driven type of processing and a more elaborate and conceptual one.
The same distinction can be found in the memory.
Direct processing is emotional and characterised by high arousal.
The other one filters our view to make it more manageable
The direct processing system is the default system – the one that dominates if the other gets disconnected – in which case we lose that filter – and land up
ACROSS THE THRESHOLD –THE TRANSLIMINAL

12. Getting a scientific grip on the transliminal
The split between realities comes from the split in us!
Interacting Cognitive Subsystems provides a way of making sense of this ‘crack’.(Teasdale & Barnard 1993).
An information processing model of cognition
Developed through extensive research into memory and limitations on processing.
A way into understanding the “Head/Heart split in people.
Having reviewed these trends within the cultural map of therapy, I will return to the central challenge faced in attempting to facilitate change where the patterns to be changed are rooted in early or major trauma, and are deep seated, or where psychopathology is severe, as with serious psychosis.
The split between thought and feeling underlies the logic of CBT. Behaviour, and so the course of life and relationship tends to be governed by feelings and habitual patterns (schemas). If these can be thought about, with the facilitation of therapy, they can be changed. It was then noted that the relationship between thought and feeling operated differently in different situations. Under high threat/high arousal/ high emotion, the reaction was automatic and not reflected upon at all (hot cognition). For revision to happen – it had to be appraised coolly.
Different CBT therapist-researchers have come up with a bewildering variety of ways into the levels of processing split - which I will not bore you with. Instead, I will bewilder you with Interacting Cognitive Subsystems, which provides a neat explanatory framework across these areas (I suggest).

13. Different Circuits in the Brain (Adapted from DBT)
REASONABLE
MIND
EMOTION
MIND
WISE
MIND
Reasonable
Mind Memory
Emotion
Mind Memory
Though L does not refer to it specifically, the ICS split maps onto the basic DBT model of the mind, as follows: The idea of a shifting balance is central to DBT, so that the self is seen as moving between the minds. Wise mind is the same as the two central ss. in ICS working smoothly together; reasonable mind dominance suggests an avoidance of the emotional (because the physical state of arousal produced by memories is anticipated as too unpleasant). Emotional Mind is where the implicational is dominant, and a loop can be set up that excludes current reflection, and so revision of past patterns – whether of depressive rumination or impulsive action.
IN THE PRESENT
IN CONTROL 13

14. Interacting Cognitive Subsystems.
Body
State
subsystem
Implicational
subsystem
Auditory
ss.
Implicational
Memory
Visual
ss.
This is a diagram of some of the processing subsystems in the brain, according to Teasdale and Barnard - based on research on cognitive processing. .
I am going to concentrate on the two large ones here - p and i.
p = verbal based logical reasoning - with a verbally coded memory store.
i = holistic, overall meaning processing. Direct connections with sense modalities (in contrast to p) and a memory store coded in every sensory modality - vivid and immediate. The connection with emotional response made possible by the direct connection with state of bodily arousal.
For complete processing, for “construing” in a Kellyan sense, you need both working in close communication. Because the systems are distinct, it is possible for this communication to become overloaded or skewed in some way.
This helps to explain a lot of what goes wrong for human beings.
Propositional
subsystem
Verbal
ss.
Propositional
Memory

15. Important Features of this model
Our subjective experience is the result of two overall meaning making systems interacting – neither is in control.
Each has a different character, corresponding to “head” and “heart”.
The IMPLICATIONAL Subsystem manages emotion – and therefore relationship.
The verbal, logical, PROPOSITIONAL ss. gives us our sense of individual self. 15

16. Two Ways of Knowing
Good everyday functioning = good communication between the main organizing systems
At high and at low arousal, the implicational ss becomes dominant
This gives us a different quality of experience – the transliminal
More often, the two are working together, adding something to ordinary experience – e.g. where we get that sense of the sacred, the supernatural.
This suggests that some things are precisely knowable, and others are not – though they can be experienced. I think ICS gives us a neat way into this, so I am going to return to the 2 central organising subsystems.
Our everyday mode of being and knowing is achieved by smooth communication between these two higher order subsystems.
However, as we have seen, they can become desynchronised in certain circumstances. It could be that when this happens, and the relational subsystem is in the ascendant, we have access to a quality of experience that goes beyond the personal and appears to offer relationship with the whole. This could be identified with a transpersonal, or spiritual quality of experience – but also the psychotic.

17. A Challenging Model of the Mind
The human being is a balancing act as the two organising systems pass control back and forth: there is no boss.
The mind is simultaneously individual, and reaches beyond the individual, when the implicational ss. is dominant.
This constant switch between logic and emotion gives us human fallibility
The self sufficient, billiard ball, mind is an illusion
In our implicational/relational mode we are a part of the whole – and the nature of our experience changes.

18. Being Human is a Precarious State
Mental health breakdown is a common human experience
Comes from a combination of
Individual vulnerability/sensitivity
Life circumstances – losses, trauma etc.
Times of transition
Leading to unmanageable feelings
Important relationships are vital to hold us together – including the one with ourselves.
These can suffer in breakdown – or breakdown can occur because they have suffered
Therapy is about healing that crucial relationship between you and you!

19. We are not who we think we are
We are not who we think we are! We constantly move between being self conscious individuals ……and existing in a web of relationship

20. Web of Relationships Sense of value comes from rel. with the spiritual
In Rel. with
earth:
non humans
etc.
In Rel. with
wider
group etc.
primary
care-giver
Self as
experienced
in relationship
with primary
caregiver
16 I would go further and suggest a theory of mind that says we create and our created by our relationships, and by the quality of our relationships; I see the individual as held in a web of relationship.
ICS, by suggesting that the verbal and emotional parts of our cognitive organisation work in partnership, opens the possibility of a theory of mind that holds two potentialities; one for the purely individual experience, and the other where human beings are organised in the context of relationship. In this way, the individual mind is not self sufficient, but makes sense within a web of relationship which both creates and is created by experience and action in relationship. The quality of those relationships shapes us in the core of our being.
Clearly, the person's early caregiver relationships, which influence all later intimate partnerships, are important, but the web extends wider; to the social group; the tribe or nation; the ancestors and those who will come after us; the non human creatures with which we share the planet, and to the planet itself. This model provides a way of understanding that "ground of being" that has been cited, or the mystery of the ultimate; of God (however designated) as the widest and deepest relationship of the web. This suggests a way into a universal human experience, but not one that can be precisely designated – it remains a mystery.
Sense of
value comes
from rel. with
the spiritual

21. Spirituality and Relationship
As people, we make sense only within our context of relationship –we are held in a web of relationship
Important others; our family; our social group; ethnic group etc.
Spirituality is about relationship with that which is beyond; with the whole – the widest circle of the web
At times of change, transition - and breakdown - that wider context becomes important

22. Beyond time and certainty
Emotional knowledge tells us about relationship – not reasoning – we can feel more than we can precisely know
Relationship operates across the boundaries of the self and across time – bereavement encounters.
Beyond certainty!

23. How do you cross the threshold?
In a small way, in ‘spiritual’ etc. moments. Seriously across the threshold:
Times of transition
Trauma loosens the boundary, softens the walls
Illness and loss
Physical privation – lack of food, sleep, isolation
Mind altering substances
All apply equally to spiritual practice, the saints, and vulnerability to psychosis!

24. Knowing which side you are on The Everyday The Transliminal
Ordinary
Clear limits
Access to full memory and learning
Precise meanings available
Separation between people
Clear sense of self
Emotions moderated and grounded
A logic of ‘Either/Or
Numinous
Boundaries dissolve
Access to propositional knowledge/memory is patchy
Suffused with meaning or meaningless
Self: lost in the whole or supremely important
Emotions: swing between extremes or absent
A logic of ‘Both/And’

25. Openness/Vulnerability - a spectrum
Times of transition and loss ‘wake up’ earlier trauma
People find ways to cope when things are unbearable – for some that coping is to cross the threshold – into another dimension.
This is easier for some people than for others – the ‘schizotypy’ spectrum - openness to anomalous experience – on a continuum with normality
People high on the schizotypy spectrum are more sensitive and “open”.
Leading to the need to regulate stimulation.
This can lead into an avoidance cycle; social isolation and withdrawal = the other ‘reality’ takes over – helped by stigma.
Positive side as well as vulnerability

26. Psychic phenomena and openness
Loss of boundaries = openness both to other parts within the self and perhaps to other minds
Loss of time dimension – pre-cognition
Interchangeability of psychic contents – past lives, telepathy etc.
Voices. Possession – invasion from within or without ? Distinctions lose their meaning

27. Part of a trend?
Richard Bentall, Mary Boyle and others: questioning the validity of the construct of Schizophrenia
Questioning of the biological illness idea – evidence for the role of trauma and past adversity
Read, Mosher etc. Stigma and an illness conceptualization
Whittaker and others: overselling of medication
Joanna Moncrieff: misselling of medication

28. Contact details, References and Web addresses
Clarke, I. (Ed.) (2010) Psychosis and Spirituality: consolidating the new paradigm. Chichester: Wiley
Clarke, I. ( 2008) Madness, Mystery and the Survival of God. Winchester:'O'Books.
Clarke, I. & Wilson, H.Eds. (2008) Cognitive Behaviour Therapy for Acute Inpatient Mental Health Units; working with clients, staff and the milieu. London: Routledge.