Transpersonal Psychotherapy
In class, we learned the difference between spiritual emergency and schizophrenic break. But is the difference only noticeable because we are viewing the situation from a Western perspective? Did indigenous shamans view spiritual crisis and schizophrenic fracture in the same manner? R.D. Laing and Michel Foucault both agreed that schizophrenics could be healed if a client was given a nurturing healthy environment to experience their psychotic break, allowing them to pass through it. The healing methods described by Foucault and Laing are very similar to the one’s mentioned in class concerning the methods to heal someone through a spiritual emergency. If we look at madness through the lens of Western Christian religion, maybe it is not as different as it is made out to be. According to Foucault, “Christ did not merely choose to be surrounded by lunatics; he himself chose to pass in their eyes for a madman, thus experiencing, in his incarnation, all the suffering of human misfortune” (p.80). This puts forth the questions who is mad and who is sane? What actions make you crazy and what one’s make you normal?
What is Madness?
Today, we have a distorted view of what is rational in the Western world. How is it that we have come to accept modern ideas like war in the name of democracy as rational but we view a person talking to himself on the sidewalk as psychotic? We assume that that our society is normal, even though we live where murder, rape, war, and other such horrors are considered routine because they are on the news everyday. Yet, we believe that, if someone behaves in a harmless nonconforming manner, they are crazy and should be put away from the rest of society. We believe that these people are mad because, for the last 100 years, psychiatrists have told us that they are. Since psychiatrist are the Western high priests of judging who is sane and who is not, we take their word as gold. Foucault writes the following about madness:
Madness is precisely at the point of contact between the oneiric and the erroneous; it traverses, in its variations, the surface on which they meet, the surface which both joins and separates them. With error, madness shares non-truth, and arbitrariness in affirmation or negation; from the dream, madness borrows the flow of images and the colorful presence of hallucinations. But while error is merely non-truth, while the dream neither affirms nor judges, madness fills the void of error images, and links hallucinations by affirmation of the false. In a sense, it is thus plenitude, joining to the figures of night the powers of day, to the form of fantasy the activity of walking mind; it links the dark content with the forms of light. (106)
Can psychiatrist and psychology truly tell who is insane? Laing and Foucault believe that those in the medical profession are ill equipped to make that judgment without more investigation. Can this theory be proven?
The Rosenhan Experiment
Rosenhan wanted to test R.D. Laing’s theory of what constituted normality or mental illness. The research test that took place in 1972 is known today as the Rosenhan Experiment. Rosenhan sent himself and eight healthy colleagues into well-known psychiatric institutions across the United States. They told the psychiatric officials in the institutions that they heard an unclear voice saying he words “empty”, “hollow” and “thud”. Beyond hearing these words, they acted completely normal. Against their will, all of them were committed to the psychiatric institutions. Rosenhan instructed the pseudo-patients to behave completely normal once admitted. Even though the mentally healthy pseudo-patients behaved normal and even kept detailed notes of the tests they were asked to perform, they were held for months. No psychiatrists or nurses ever looked at the notes the pseudo-patients were writing. Only when the pseudo-patients admitted to being crazy and pretended to take their medication were they eventually released. In an interview, Rosenhan says, “I told friends, I told my family, I can get out when I can get out. That’s all. I’ll be there for a couple of days and I’ll get out. Nobody knew I’d be there for two months. The only way out was to point out that they’re [the psychiatrists were] correct. They had said I was insane, I am insane; but I am getting better. That was an affirmation of their view of me” (Wikipedia).
Once the results of this test were published, the psychiatric facilities became angry with Rosenhan. He agreed to work with one particular institution over a three-month period of time. The staff was asked to evaluate all incoming patients to determine whether or not the patient was one of Rosenhan’s pseudo-patients (he falsely informed them that he would be sending in his test subjects to recreate the results of the first experiment). Of the 193 genuine patients seeking psychiatric care at this particular institution, the staff identified 41 as impostors and 42 as suspicious.
These two experiments proved that it was often difficult to correctly diagnose anyone coming into a psychiatric facility and that staff often had a tendency to misdiagnose a healthy person because they were looking for signs that the person was unhealthy rather than assuming the person was healthy. One unforeseen response was that the misdiagnosed and admitted pseudo-patients were able to carefully critique and evaluate the care they were receiving without the staff being aware of the observations, allowing Rosenhan and others to openly and intelligently criticize the psychiatric community.
It is no doubt that these experiments supported the idea that the Western world needed to deinstitutionalize mental health care. There had been many class action suits against institutions in the U.S. and the anti-psychiatry movement in the 1960s and some were beginning to see the cost savings of community mental health programs established to help people with disabilities to live on their own with some supervision. Although this did not achieve Laing’s vision of psychological care in “community households” where people can work through their emotional difficulties together and with psychotherapists (not through medical treatment and behavior modification techniques that often caused more harm than good), some progress was made in the psychiatric field, with many doctors and researchers now looking for scientific and biological clues for mental illness.
One unfortunate result of deinstitutionalization is that many of the mentally ill patients ended up homeless or in the prison system. Many of these people would have been better served if they had been in some form of institution because they were incapable of taking care of themselves and, since there was an across-the-board decision to revamp the mental health care system, these people were often overlooked.
R.D. Laing
Both Laing and Foucault felt that the psychological institutions of the 1950s and 1960s were unhelpful and even harmful in the treatment of schizophrenia. I can find no evidence to dispute their theory. The Rosenhan Experiment confirms that the institutions were misdiagnosing patients and putting them into an unhealthy environment, with little chance for recovery. Foucault’s theory included communist political views, something Laing’s theory left out. So why is Laing and his ideas so overlooked in today’s psychology? There seems to be two reasons for Laing’s demise. The first reason is that Laing could never overcome his own personal battle with substance abuse. Severe alcoholism finally unraveled his life, leading to his disbarment, and his untimely death. The second reason is a large campaign pushed by the American psychiatric community to discredit all of Laing’s theories.
It has been well documented that the U.S. pharmaceutical companies fund the American psychiatric community directly and indirectly. According to Mihal Andrel, in 2008, U.S. pharmaceutical companies made 235.4 billion dollars and spent 24.4% on advertising and 13.4% on research. Much of this advertising money goes to discredit non-pharmaceutical psychological treatments. The discrediting of Laing is less apparent in Western socialist countries because socialized medicine eliminates the possibility for medical companies to make overly high profits. England did take away Laing’s psychiatric license for practicing while intoxicated and sexual misconduct. He has only himself to blame for allowing this to overshadow his theories on schizophrenia. The important thing to remember is that after forty years Laing’s care homes for schizophrenics still run today throughout Europe. If these homes were not efficient, would they still be in use?
Brant Cortright gives different criteria for spiritual emergency than he does for schizophrenia. He also gives a separate criterion that includes both elements of spiritual emergency and psychosis. According to Cortright, “In provocative contributions to this field, Lukoff (1985) and Nelson (1990) propose criteria in which spiritual and psychosis experience co-exist” (P.171). Laing also believed it was at this early spiritual stage of schizophrenia when a person is having their first or second breaks that a true healing could take place. He contemplated that the healing could only take place if the client was given a contained nurturing environment to pass through their schizophrenic dilemma.
Cortright says that a person having a spiritual emergency needs grounding, special diet, exercise (movement), bodywork, sleep, and sometimes medication to pass through the experience to a healthier mental state. Laing had a very similar list for schizophrenics to pass through a schizophrenic break. His Philadelphia Association Community Houses in London today offer the schizophrenic residents their own rooms in a large home where they can come and go. The homes offer around-the-clock support and all of the treatments that Cortright mentions for spiritual emergency, even medication.
I believe that we, as therapists, wish to discredit Laing because of unseen psychology establishment pressure and we feel let down that, as a therapist, he was unable to overcome his own psychological demons. I have heard the same discrediting at CIIS of Foucault’s brilliant theories because he was unable to stop his sadomasochistic lifestyle that eventually led to his death. The problem is, when we discredit a therapist for not living up to our standards, their theories also suffer, becoming fixed in time—lifeless.
Many CIIS students believe that Laing had schizophrenia care homes where he and other therapist experimented with LSD. That’s all they know about his theories and are reluctant to hear anything else—he is discredited. Nobody knows or cares that his theories and schizophrenic care homes evolved until his death and still continue to develop today. Only when we can admit to ourselves that we, too, are fragile beings with our own set of psychological hardships, is it possible to see Laing and Foucault as brilliant minds with human faults.
A Healing Environment
What is a healing environment for someone suffering from schizophrenia? Unlike Laing, I believe that it must be a contained capsule similar to what Cortright mentioned in his class lecture. Most care homes for schizophrenics allow the clients to come and go at their free will. The center where I am about do my practicum says that the center is the schizophrenic client’s home and that we must try to be there for them without being intruders. The problem I see with this center and Laing’s home care centers are that the clients go out and self medicate on various drugs and are exposed to a harsh world; when they are out in society, they experience hardships that people suffering from schizophrenia or a spiritual emergency are mentally unprepared to handle. I witnessed a great example of this today at the center. A client took a walk downtown from the center with a social worker. They were stopped by two undercover police officers and questioned callously. The social worker was not searched but the schizophrenic client was. Then, the police left as suddenly as they had appeared. The client, already suffering from acute paranoia, was traumatized by the episode and needed to be taken to a mental health institution for stronger medication.
I think that schizophrenic care homes would have much better results with clients if they safely contained clients from the outer world in a healthy environment. The problem is when people hear containment they think of being locked up in mental facility similar to the one in the film, One Flew Over the Cuckoo’s Nest. Cortright writes the following about a safe container:
If it is at all possible, it is a great help to have a sanctuary, a retreat from the ordinary world in which to experience the profound conscious changes that are occurring. It is preferable that this not be a hospital or some other clinical, sterile environment. Ideally this safe haven should be comfortable and quiet, warm and home-like with soft lighting, and connected to nature. Such ideal settings are not often available, in which case the person’s home may need to be good enough. (174)
It is hard to believe that a schizophrenic suffering their first or second break would not benefit and pass through their psychotic break in such a loving supportive environment as the one Cortright just described. Unfortunately, none of Laing’s homes ever offered a safe container separate from the outside world. During the early 1970s, psychology wanted to get as far away from institutional model of mental health as it could and Laing was no exception. The home that I am doing practicum in offers each client their own room, cafeteria-style cooked meals, and a shared living room with a giant television. The house smells, is dirty by my standards, has only cold linoleum floors and fluorescent lighting. The main problem is that these care homes lack financial backing and run off limited governmental handouts. The lack of funds also puts most of these care homes in low income downtown areas, far from any kind of nature.
Nature Heals
Cortright says that nature is an important component to the healing of a spiritual emergency. It is my opinion that these same principles can be applied to the healing of schizophrenia. In my first experiences with schizophrenic patients in practicum, I witnessed the power of nature and the environment in healing. When I arrived for training at the center, I saw a group patients watching television in the living room, all with void expressions and very little awareness of anything other than the T.V. screen flickering. By contrast, in the director’s office, I saw several photographs of people smiling on the beach, carrying surfboards or out in the ocean, surfing. I thought it might be staff at the center and asked if they took surf lessons or something. I was shocked when the director told me that it was a group of patients, many of them still at the center and undoubtedly part of the group of expressionless television viewers I just witnessed. I was shocked. They were active, reacting with nature and responding to the experience. They looked healthy. It reminded me of the organization, Surfers Healing; they use surfing to reach many children with autism and report the same kinds of evidence of healing. I am not even sure if the director was aware of the change in the patients that was apparent in the photographs but I hope to explore this once I become more familiar with the center and the structure of the care provided there.
Another experience I had was while watching the film, Grey Gardens, the 1975 documentary about Edith Ewing Bouvier and Edith Bouvier Beale, aunt and first cousin of Jacqueline Kennedy Onassis. It was about a mother and daughter living in a run down 25-room mansion. The mother and daughter dressed as though they were in the 1920s. As the film progresse, you begin to see that, in the 1920s, they were both very wealthy high society beauties. Now, all the wealth was gone and the house was in shambles and surrounded by a thick grove of trees.
The daughter, a former beauty queen, poet, scholar, and dancer had obviously suffered a schizophrenic break in her late twenties. She still suffered from a little paranoia and some delusions but overall was still very mentally sharp and held conversation with no problem. Her mother who seemed to have a good spirit about her had supported her daughter. The daughter was contained by an overgrown encapsulating garden that resembled a small forest even though it was smack dab in the middle of Nantucket Sound. It seemed to me that the garden had acted as a barrier from the outside world and created a nurturing environment for her to pass through a schizophrenic break to some extent.
It is important to note that a container for anyone experiencing a mental emergency is important because the out society we live in is ill. This brings us back to Laing’s theory that we live in a world of murder, hate, rape, and genocide, yet we consider a person talking to him or herself insane. Theodore Roszak see the decline of the worlds health a direct result of mental illness. Roszak writes:
When the Earth hurts, who responds? The answer is, I believe, that each of us now experiences in some way—physically, psychotically, economically, or politically—the pain of the Earth. The news about environmental degradation is hard to avoid, anyone who walks, breathes, looks, or listens knows that the air, the water, and the soil are being contaminated and that nonhuman species are disappearing at alarming rates. Yet the great majority of us, in this country and in much of the Western world, seem to be living our lives as if this were not so. Because we experience the self as separate from the Earth, we feel either overwhelmed by or removed from what we learn about environmental deterioration; we become helpless or indifferent in the face of it, and unable to respond except with numbness and denial. (161)
What chances does a person suffering a schizophrenic break have of recovering in a world that is unraveling? Can a schizophrenic find a safe container in this society?
Conclusion
I believe that Laing and Foucault theories on schizophrenia need to be looked at with a fresh set of eyes. Freud theories suffered a similar discrediting during the 1970s and 1980s but are having a renaissance today. Perhaps a similar resurgence will happen for Laing and Foucault theories. Cortright’s transpersonal approach to spiritual emergency seems to compliment Laing’s theory on schizophrenic care. Roszak seems to back both Laing and Cortright’s theory of the healing effects of nature on society and spiritual emergency with psychotic features. I feel that by using an integral approach that includes similar theories we can heal schizophrenia in its early stages. Laing and Foucault laid the groundwork fifty-years-ago. Since then transpersonal and ecopsychological approaches have appeared on the psychology seen. When these theories are blended together we end up with a powerful psychotherapeutic tool.
Work Cited
Andrel, M. (2008). Big Paramedical Spends More on Advertising than Research. ZME Science. Retrieved April 12, 2009, from http://www.zmescience.com/big-pharma-spends-more-on-advertising-than-research.
Cortright, B. (1997). Psychotherapy and Spirit. New York, State University of New York Press.
Foucault, M. (1965). Madness and Civilization. New York, Vintage Books.
Laing, R.D. (1969). The Divided Self. London, Penguin Books.
Roszak, T, Gomes, M. & Kanner, A.D. (1995). Ecopsychology: restoring the earth healing the mind. San Francisco, Sierra Club Books.