PSYCHOSIS AND SPIRITUALITY: Exploring the new frontier

What is the relationship between psychosis and spirituality? Are they distinct constructs? Can one be reduced to the other? Indeed, are these constructs valid at all? James (1902) questioned the relationship between spiritual experience (discovering seraphs) and psychosis (discovering snakes in the realms beyond the 'ordinary' sphere of consciousness), an exploration continued one hundred years later in this interdisciplinary collection of papers. This book admirably seeks to investigate, re-conceptualise and re-map the shifting boundaries of this territory, for which varied 'neutral' terms are used: 'unusual experiences', the transliminal, the borderline, 'p-s experiences' and 'unconstrued' experience. The 'new frontier' lies not so much in reflecting upon the constructs of and distinctions/ similarities between psychosis and spirituality, but in incorporating models of 'adaptive psychosis' into clinical models and intervention procedures. This collection assimilates a wide range of perspectives and levels of analysis, including neurophysiology (Peter Fenwick), anthropology (Natalie Tobert), postmodernism (Richard House), phenomenalism (Chris Clarke) as well as Clinical Psychology (Isabel Clarke) and Psychiatry (David Kingdon). From this plethora of orientations, despite some contradictions, convergent themes emerge. Key is the deconstruction of Western concepts of psychosis and spirituality, relinquishing the hold of dualistic approaches in favour of continuum models of consciousness. These are based on the assumption that different forms of cognition exist with which to apprehend 'reality', and that a variety of intrapersonal and interpersonal variables (such as personality, ego strength and social support) mediate ones experiences and access to these 'cognitive modes'. Seeking to instigate a 'conceptual revolution', Natalie Tobert, Neil Douglas-Klotz and Richard House each explore the constructs of psychosis and spirituality, their culture bound basis, exclusivity and validity. Tobert expounds the social construction of conscious experience and the plurality of frameworks for understanding human existence, which influence what is construed as 'mental illness' and what experiences of consciousness are culturally endorsed, i.e. labelled as 'normal' or even adaptive. Hence, the constructs of 'reality', spirituality and psychosis are mutable, varying from culture to culture. Neil Douglas-Klotz considers the way that presumptions about the nature of reality are embedded in language itself, setting limits to our understanding and underlying the way we categorise and conceptualise. He argues that Western language is paralysed by the dualisms of inner-outer and mind-spirit, while the symbolic and multivalent nature of Middle Eastern Semitic language, enabling paradox, shifts in category and non-linear conceptualisations, is more amenable to describing and modelling non-ordinary states of consciousness. From an anti-psychiatrist, postmodernist stance, Richard House, argues that diagnoses of psychosis are not scientific facts, but theory-laden representations, cultural products determined by the prevailing Zeitgeist. House seeks to challenge arbitrary culture bound definitions, and create space for concepts of healthy self to evolve. These three authors together question the validity of Western clinical and lay conceptualisations of spirituality and psychosis, showing how these terms and our understanding of consciousness and self are partly linguistic, social and cultural constructions or symbols, challenging the idea that psychoses are clearly identifiable disease syndromes. Peter Fenwick and Chris Clarke underpin such issues by identifying problems with reductionistic, Cartesian, materialistic approaches to the understanding of consciousness. Clarke seeks to fuse the perspectives of phenomenalism, modern science (quantum physics and physiology) and psychological analysis to provide a philosophical perspective that can account for 'non-consensual experience'. In phenomenalism 'reality' is disclosed directly through experience itself, rather than through a priori categories (Merleau-Ponty, Heidegger). Clarke makes analogies with quantum mechanics, where 'objective', consensual reality emerges from a probabilistic network of overlapping perspectives (either regions of space-time or beings-in-the-world). In this model unusual experiences are not 'right' or 'wrong', based on any a priori categories, rather they are merely less probable, less experienced, or less consensually validated aspects of reality. The papers summarised thus far encourage the relinquishing of conceptual monoliths and encourage a flexible consideration of existing and evolving psychological models of non-consensual experience. Fenwick proposes that the ability to experience mystical states is an aspect of normal brain function. He draws parallels between positive mystical experiences, psychosis and temporal lobe epilepsy, proposing that right temporal lobe functioning as well as large frontal and thalamic components are associated with both psychosis and mystical experience. Peter Chadwick, addresses the level of 'meaning' through an autobiographical account of a 'mystico-psychotic crisis'. He argues that both 'supersanity' and 'insanity' have a common function, reconfiguring a personality that requires change. Both may be termed 'borderline experiences', with a positive and a negative borderline. Chadwick suggests that mystical experiences are available to all, but certain personality types may be more prone to experience them. Gordon Claridge explores psychosis as a personality continuum, from 'normality' to schizophrenia/ manic-depression, which he calls 'schizotypy'. In this model, psychotic traits are not pathological in themselves, but merely represent personality variation. Hence, certain personalities are more likely to have or report perceptions, thoughts and beliefs that are outside the range of everyday experience. One mechanism postulated to account for this is 'cognitive disinhibition', where there is a breakdown of the stimulus-barrier that normally excludes information form awareness. Mobile thresholds enable a supersensitivity of perception, thinking and affect. Which may be manifested through 'unhealthy' or 'healthy psychoticism' (such as creativity). Isabel Clarke's discontinuity model suggests another mechanism for shifts modes of cognition. This revolves around the operation of two meaning making systems: the propositional subsystem (verbally coded and categorising) and the implicational subsystem (coded in the other sensory modalities, holistic and emotional). Clarke suggests that both these systems act in synchrony in everyday thought, operating within a construct system that acts as a filter, restricting our experience of everyday reality. However, in spiritual/ psychotic states, the implicational system may dominate, and the construct system may be transcended (unconstrued experience). Mike Jackson empirically explores issues with a comparative case study, revealing phenomenological parallels between 'non-extreme' 'p-s experiences' labelled 'psychotic' and 'benign spiritual'. Jackson found no clear demarcations between these groups in the content of experiences, but a difference in the subsequent processing of experiences. The group diagnosed with a psychotic disorder initially found experiences to be overwhelming and isolating, in contrast to the undiagnosed group who found experiences constructive to personal development. Emmanuelle Peters focuses on delusions as the 'basic characteristic of madness'. She cites a large body of work demonstrating the irrationality of so-called normal individuals, suggesting no clear-cut divisions between normality and delusional thinking. Peters argues that the form of experience is more diagnostically important than the content and that the major difference between spiritual and psychotic experiences lies in interpretation and behavioural and emotional consequences. Are both psychosis and spirituality outcomes of the same tendency, a fluid personality-experiential configuration? It is suggested (Clarke, Chadwick, Claridge) that whether this tendency manifests itself as a 'psychotic' or 'spiritual' experience depends upon interaction with variables such as social support, cultural norms and evaluation, self-system dynamics and additional biological predispositions. Peters stresses the importance of psychological factors such as coping style and cognitive flexibility, as well as socio-cultural contexts, such as living alone, psychosocial stressors, religious affiliation and emotional support. Hence, a second prominent theme of this book questions the importance of the self-system and navigation or control of unusual experiences. Is the psychotic drowning in the same water in which the mystic swims? Isabel Clarke suggests that a key distinguishing variable is well foundedness of self, or ego-strength. Tobert argues that schizophrenia is a fragmented experience, whilst mystical experience is controlled, suggesting that the nature of an 'unusual experience' depends upon stability of personality. A careful consideration of these issues avoids the pitfalls of romanticising psychosis or pathologising spiritual experience, enabling the beginnings of a complex interactive systems model of experiences of consciousness to be constructed. This book seeks to develop both conceptual and practical tools for exploring the psychosis-spirituality interface, potentially challenging practices and interactions in clinical practice. Nigel Mills discusses the clinical implications of mindfulness techniques for working with experiences of fragmentation accompanying 'psychoses'. Mills focuses on a case study working with Tai Chi as a compliment to verbal therapy with a young man diagnosed with 'schizophrenia'. A kinaesthetic/ sensory way to begin reintegrating a dissociated self, by accessing a part of self that is centred, calm and embodied. This exploration of a 'safe self', argues Mills, makes it possible to explore interpersonal and emotional aspects of self without being dominated by them. David Kingdon, Ron Siddle and Shanaya Rathod work with the cognitive behavioural therapy approach, describing how this can be applied and adapted to working with specifically religious concerns. The acceptance of unusual behaviour and experience e.g. glossolalia or hearing the voice of God can be labelled as normal in a religious context. However, one of the main criteria for 'religious delusions', distinguishing between culturally appropriate and non-appropriate religious beliefs, can be difficult when 'delusions' are not extreme. This is exacerbated when the therapist has a different religious background/perspective to the experient. Kingdon et al. suggest that explorations of the nature and impact of the religious experiences rather than their 'correctness' is advisable, and highlight the ethical dilemmas involved in 'thought policing' and the infringement of religious freedom. Overall, this collection offers a variety of insights (theoretical and applied) into understanding non-conventional experience, seeking to escape assumptions inherent in the scientific realist picture focused upon finding malfunction. As Isabel Clarke concludes, the purpose of this book to open up this area to exploration, to encourage pursuit of the burgeoning research questions. Indeed, this collection raises more questions than it brings answers, portraying the importance and value of the search for a deeper understanding of the dimensions of 'p-s experiences'. However, the book focuses rather heavily on the schizotypal model. There is a lack of integration with or consideration of transpersonal research and developmental models of consciousness. Different chapters address different aspects of a vast ocean of experiences of consciousness beyond the 'consensual', which tend to be treated with an element of equivalence. The multi-dimensionality of these experiences requires further consideration, as do the mechanisms of 'epistemological flexibility' which enable adaptive responses to non-consensual experience. By focusing on the construct of spirituality from continuum models, this book makes an important, nascent contribution to the integration of the concept of 'adaptive unusual experiences' with mainstream models in clinical psychology. It succinctly synthesises a range of perspectives, emerging with a coherent approach to this complex area. This enables beliefs and assumptions of researchers to be questioned, awareness to be heightened, and insights to be gained. This book is an important stimulus to synthesising various models of human consciousness with clinical practice.