Abstract
The term “psychosis” is used as if it denotes an organic brain abnormality, either known or yet-to-be-discovered. However, I believe its only meaningful use is to describe speech or behavior we do not understand and which frightens us. In this article, I explore how I came to an understanding of how “reality” (which we might also call “meaning” or “clarity” for this purpose) arises in the space between people, as well as how this process can go awry. I offer some objects of attention for implementing these ideas in a clinical context.
Keywords
The word “psychosis”—from the Greek for “abnormal condition of the mind or spirit”—describes any of a number of behaviors; hallucinations and delusions, social impairment, mania, catatonia, among them, that seem to relate to an individual’s ability to perceive reality. For over a century, medicine has sought a brain-based explanation for this seemingly unrelated set of behaviors, with nothing to show. Epidemiological evidence points, however, toward adverse developmental experiences, economic inequality, and/or social disruption as strong predictors. Stress, it is found, is the most reliable immediate antecedent.
The question becomes; how and why would psychosocial stressors explain aberrations in an individual’s relationship with reality? To understand this, we need to expand our understanding of what “mind,” “spirit,” and even “reality,” “knowing,” and “being human” are. As tempting as it is to continue the search for a medical miracle, my own journey has led to a shift in perspective which, while challenging in a completely different way, offers an entirely different kind of miracle as well.
The description of “psychosis,” then, would be “someone behaving or speaking in ways we do not understand, and which frighten us.” It is in the space of as-yet-ungrasped understanding that we have a choice to make between fear and succumbing to the desire to shut jarring perspectives from our worldview, and staying open to new meaning arising. It is learning to enter this space with a person in distress that turns out to be, in my experience, its own reward, and its own form of miracle. I have found that entering this space involves being personally available, without fealty to external authorities, for the idiosyncratic experience of finding new meaning with another human being. Therefore, for this short article, I will focus on my personal journey, through trying to understand psychosis, to the point of focus I now hold in my work and in my life.
I heard words like “psychosis,” “schizophrenia,” and “borderline” applied to people close to me from an early age. The added phrase “born without the ability to love” meant that the other terms meant were not used kindly. I searched for this “ability to love” in myself and, chillingly, could not find it. I knew would have to fool the world into thinking I could love or face the consequences.
Like many others with this problem, I went into show business. I aspired to be a famous director and to make a film that would fix the world. When making my most successful film, a documentary about people living with HIV, I was drawn to go deeper with people in crisis than I felt that cameras would allow; I grew uncomfortable with the camera’s presence, and the feeling that I was stealing people’s stories. I was extremely uncomfortable with the process of becoming known for such a personal film that was not my story. The night the film opened in New York, I looked out from a balcony at a city whose doors were opening to me and asked, “What do I want to do next?” An inner voice said, “I want to go to school, because I don’t know shit.” I felt empty and disconnected at the moment I expected to feel the opposite. I knew how to make something feel true, set to music and projected on a screen, but I wanted to sit in a room with one person in crisis and know that our connection meant something “real.”
I studied psychology at a school that offered “Truth” (“Veritas”) on its seal. I did not aspire to work with psychosis at first, but working in a lab that studied mood disorders as well as labels such as “psychosis” and “schizophrenia” I was gradually drawn to people in deeper crisis. Most important, the people we studied all had traumatic histories that—though systematically ignored—were a sufficient, even better explanation.
This was when I realized, with a shock, that trauma had rippled through my life. Though my childhood had been objectively safe, even privileged, I was confused by feelings of danger that swirled around me. I felt “crazy.” However, trauma had rippled through my family’s generations, from narrow escapes from the wars and pogroms of Eastern Europe, to arriving in the new world and the effects, now evident to me, of dislocation, discrimination, financial turmoil, suicides, as well as physical, emotional, and sexual abuse, I realized that my family’s path had not been the storied penniless-immigrant-to-success story, but one of ceaseless struggle; the effects of which had shown up in family members in forms that earned their labels. I also realized I could not walk away from trauma; the only way through this feeling of “crazy” was to dive straight through the middle; I considered myself fortunate to be doing it in school, rather than a hospital.
Mind: The Gap
I dove into libraries, growing addicted to the feeling that came each time I could say, I “know” something new: a warm, tingling feeling that reminded me of the endorphins rush that comes after exercise, or when looking into friendly eyes. It was a feeling so strong and pleasurable, I realized, that I wanted each new “fact” to remain “true” so that I could hold on to it. The next morning, I would run up the library steps eager for the next “fix.” However, the next day’s fact was as likely to contradict the “fact” that had jolted me the day before, as to support it. I realized that when I say, “I know” I am referring to a feeling and explored the feeling itself.
Alone in the library, I realized I was experiencing a distilled essence of connection. Someone, somewhere, had found this idea meaningful enough to write down—for me. It was not just that it was “true”; It was the feeling of almost touching the person’s hand who wrote it, the feeling of their mind and heart, that had me running back. This concentrated feeling of connection was drug-like in its power, and as with any addiction it offered an end-run around the natural mechanisms of attachment; a more reliable feeling of connection than the fragile and fraught relationships we often find ourselves in.
In the course of employing these ideas professionally, I came to abandon any sense of “truth” versus “lie,” “real” versus “unreal.” I learned instead to ask, “What does it mean to you?” In that spirit, here is my journey to an understanding of psychosis.
Relationships: The Eyes Have It
Human brains are, perhaps more than anything else, relational machines, registering voices before birth and eyes and faces soon after. Without social interaction, infants’ nervous systems fail to self-regulate, and “fail to thrive.” Human sclera are among our most distinctive attributes; while both predators and prey generally opt to conceal their eye direction, humans, at some moment in evolution, found more of an advantage knowing everyone’s eye direction than to conceal their own. Our faces evolved to be preeminent telegraphers of our internal experience.
Though we are born with the capacity for attachment, being fully “human” arises in and through our attachments and relationships. To sustain the miraculous integration of our own perspectives with others that we have come to expect as “normal” requires an exquisite level of real-time processing, and trust. This would be simple if our nervous systems were machine-like recording devices, but we do not perceive the world as it is; we see what we look for. Cells in the eye are primed to quickly detect, analyze, and signal threats such as moving objects. The touch of a tree branch on our shoulder might trigger the image of a person behind us. We might “see” a person down the road, only to find a mannequin on closer view. With confidence, we might laugh off or just quickly forget these misapprehensions.
However, lacking confidence in our own capacity for reality testing, we might wonder where the person had gone, and feel haunted. For people with whom we are interdependent for a fully articulated, three-dimensional view of the world, anything less than complete reliability can be extremely uncomfortable, leading to a need to cutoff views that threaten their own. This is not, I believe, a “cognitive” or “rational” process, but one that is deeply rooted in our dependence on each other’s perspective, and therefore precedes any rational analysis of content. Which is why attachment to ideas may take the place of relationships with people for whom early attachment experiences, or later social experiences, have been traumatic. With luck, we attach to ideas that “work” for us, leading us back to real relationships. However, ideas that revolve around the existence of malevolent forces—that cannot be fought against, and whose existence cannot be disproved—this may be a hard road.
People who grow up looking to the people on whom they depend, only to find fearful or angry eyes, learn that their perceptions and needs are secondary. This can lead to a distrust of others’ perceptions, but perhaps, more important, it can lead to a distrust of their own. What might otherwise be a mutually fulfilling experience of interactive fulfillment becomes furtive attempts at communication that either cease or become increasingly strident or bizarre. The relational fabric becomes stretched, tattered, and torn, with some or all involved labeled “crazy.”
Knowing Together
I took a job running a home for people leaving (and avoiding) psychiatric hospitals. I wondered whether a safe home for people who had not known one, where their perspectives was valued and—most important—from which they would not expelled, might produce better outcomes than I had seen. I declared, “I may have book learning, but I don’t know anything we don’t figure out together,” and focused, not on fixing people, but on simply having relationships. “Your therapist may concerned with what’s inside of you, with the idea that if you do the treatment you will get to have relationships. I say that we are having a relationship, so maybe you’re ok.” I sat with people who were seemingly disconnected from reality, waiting just to meet fleeting moments of eye contact (which always came) with a smile. One said, after long sessions of sitting with her in altered states of consciousness, “you were waiting for me.” I just smiled and nodded, “yes.”
I Think: Therefore I Worry About What You Think
One man claimed that aliens had given him the cure for cancer. He was very insistend, and I felt distressed, torn between a desire to be supportive and not wanting to lie by agreeing. “That’s not my area,” I said. His tone shifted and he asked whether I thought it could have happened. “That’s still not my area,” I said, “but I would like to know is what it would it mean to you if you had the cure for cancer.”
He blurted out, “Well, then people would really like me.” In the silence that followed, I thought back to when I would wanted to be a film director, I also did not imagine anyone who knew liking me, and I tried to fill that empty space with grand acts such as making a film that would save the world in the hope of being liked by strangers. It was no less “crazy.”
“Well that,” I said, “I get.” We sat in silence again. When we spoke, it was about the Red Sox. Would they win the World Series for the first time in 86 years? They did, and we celebrated with a tour of Boston in a borrowed convertible, never speaking of aliens again.
I saw many people who had been told they would be ill and require treatment for the rest of their lives, who walked away from diagnosis and treatment completely. One man said simply, as I drove him to the airport, “You treated me like I was normal when I got here. Eventually I believed you, and now I’m leaving.”
I was increasingly drawn to people on whom others had given up—people who could not express an interest in coming back. I believe, however, that it was never a problem that existed in one individual, and never something that could not have been addressed. The beauty of the work is found in connecting with the most seemingly disconnected. The best outcomes came when it was possible to work with whole families or other significant networks, untying the knots of assumptions, expectations, and traumas in the spaces between us. Working this way is not just effective, and not just intrinsically beautiful, it is a matter of justice; the fact that some of us enjoy the miraculous level of meaning, understanding, and expression that being human affords us obliges us all to offer a hand to those for whom the expectations of being human have become catastrophic.
The Feeling of Meaning Arises
How do we apply these thoughts? I believe that understanding the ways that meaning and clarity arise between us—and how these processes go awry—is a first step toward understanding both what it means to be human, and how to ameliorate the process when it goes awry. Learning to create safe spaces for this tender feeling of meaning to arise; to look for connection and agreement not in words, but in eyes and faces, however, fleetingly the signal might arise. For many, this is instinctive, intuitive, and obvious, but our task as healers is to understand this process on a deeper level. By that I mean, not within any one individual, but between people. This is where the things we look for, and call good, are to be found. Looking for “goodness” or “love,” “reality,” “authenticity,” or “clarity,” “sanity” or “madness” is a fool’s errand when seeking in individuals; they all arise and are to be found in the spaces between us.
The illusion that we can meaningfully exist as humans individually results in feeling alone, grasping at figments of certainty, in the hope of a certain future. It is an illusion that we can be certain about anything in the future other than whom we will enter it with, so it behooves us to trust first in the fundamental unit of human experience: the relationship. It is what we are born to do; anything else is psychotic.
Footnotes
Declaration of Conflicting Interests
The author declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Funding
The author received no financial support for the research, authorship, and/or publication of this article.