PSYCHOSIS

Please cite all information taken from this chapter of my website in the following manner:

(Schmid, Gary Bruno (Year): Psychosis. www.mind-body.info (Month). Paragraph Heading, Subsection)

Prologue

This is perhaps the most controversial page of my website. The problem of psychosis encompasses not only the cut and dried facts of medical research, but also the heated passions of individual experiences. From the perspective of psychiatry alone, there are numerous, sometimes even contradictory attitudes toward what psychosis "really" is and where it "truly" comes from. Psychologists and psychotherapists are no less at difference about their views. Then we have the whole range of social opinions and religious beliefs about what psychosis is and how it should be treated.

On the one hand, psychosis is one of the greatest maladies society has to face, destroying individual lives, misleading the innocent, and encompassing giant costs at the burden of a nation. On the other hand, there is the attitude that the concept of psychosis is a logical construct of naive rationalism, that there is no such thing as psychosis; what clinicians denounce as psychosis is in truth a spiritual reality, a so-called "spiritual crisis"; after all, without visions, hallucinations, and the hearing voices etc., the Bible and Koran would seem to reduce to monologues of questionable historical or literary value. Unfortunately, the scientific community has, in the past at least, not been too shy to resort to such brutal methods as euthanasia and forced sterilisation to attack the issue of mental illness, thus fueling the fire of denial of psychosis as a mental disturbance.

These issues cannot be solved here! Maybe there even is no "real, true" solution to the problem of psychosis. What this chapter can offer, however, is a forum for discussion allowing different perspectives for view. In the following introduction, I outline my own, personal, perspective on the problem of psychosis. (See also my comments on Psychiatry in the Chapter CONSCIOUSNESS.)

-----------------------

Introduction

What is psychosis?

In everyday language, a person is said to be psychotic when the things they do or the things they believe can't be grasped by others and can't be put into a context meaningful to others. Then others say that the behavior or beliefs of this person are crazy or insane, and that this person themself is crazy or insane. People encountering a psychotic person face two major problems blocking communication: an easy problem and a hard problem. The easy problem is trying to understand what this person is doing or what he or she believes or claims to experience. The hard problem is trying to understand why this person behaves the way he or she does or why this person has such strange thoughts, feelings, sensations or anticipations.

In clinical terms, psychosis can be defined most generally as «a weakened or distorted relationship to or attitude toward collective reality». Depending upon a clinician's field of specialization, clinic or research, he or she develops a particular understanding of the phenomenon psychosis. Here I differentiate between a phenomenological and a functional understanding of psychosis. (See my presentation below.) My personal approach understands psychosis as a «functional disturbance» at the bioneurological level. It is based upon two related, empirically-founded hypotheses stemming from the domains of chaos and quantum theory.

Before delving into details, it is helpful to consider a simple metaphor:

Mental awareness is composed of many different perceptive and apperceptive experiences or, figuratively speaking, of countless pieces of a picture puzzle comprising an overall mental impression. I hypothesize that mind-brain processes and the corresponding qualitative experiences of the individual are - figuratively speaking - also put together like the pieces of a mental puzzle. However, in the "psychosis picture puzzle", each individual piece may sparkle and shine, but, the overall composition makes little or no sense, it is weakened or distorted: The puzzle pieces comprising the afflicted person's impressions are individually experienced, separately, that is, not recognizably as belonging together as in the case of the nonpsychotic person.

Scientifically, I speak in the case of psychosis of «linear information processing in the mind-brain», because the normal, nonlinear networking involving biochemical and bioelectrical feedback loops between certain regions of the brain or between certain neuronal ensembles seem to be weaker during psychotic as compared to the remitted ("healthy/normal") states of mentation. Borrowing terms from the science of consciousness, I can call this a problem of «binding». In other words, I hypothesize that

Psychosis is a consequence of disturbance to the ("normal") nonlinear information processing ("hand-shaking") between various cell ensembles in the mind-brain. This results in pathologies of associated coherence and synchronization also called «binding» in the mind-brain: Afferent and efferent signals, in particular, those corresponding to the usual sensory and apperceptual channels become confusingly disorganised in psychosis (Schmid, 1997a), (Schmid, 1997b).

This hypothesis can be augmented with a second hypothesis, namely, that the «psychosis binding problem» has formal parallels to certain nonlocal effects which have long been proven to exist in atomic physics in connection with a phenomenon called «quantum communication»:

«Binding» is sustained by quantum correlations playing an orchestrating role of instantaneous synchronisation of brain processes over widely separated regions of the brain. A qualitative «mental state of ego-awareness» leading to an unambiguous ego-identity might be synonymous with the synchronization resulting from a quantitative «highly coherent, local quantum brain state». (This justifies the use of the dyadic concept «mind-brain».)

The first hypothesis has been derived from empirical evidence and experience with persons suffering from psychosis, namely, EEG-measurements (Schmid & Dünki, 1996), (Dünki et al., 1996), (Schmid & Koukkou, 1997), (Dünki & Schmid, 1998), (Dünki, Schmid, & Stassen, 2000) and Phantasy Therapy (Schmid, Eisenhut, Dämpfle, Frei, & Ito, 1997), (Schmid et al., 2000), (Schmid, 2001a), (Schmid et al., 2002). I emphasize in passing that Phantasy Therapy - see the corresponding chapter in this website - has been gradually developed and optimized over a period of several years of hands-on clinical experience with psychotic persons in psychotherepeutic groups employing direct feedback from the patients themselves. This experience has led to the evidence-based Binding Hypothesis mentioned above and not the other way around: Phantasy Therapy is not the product of any theoretical concept nor is it dependent upon one or another psychiatric, psychological, or psychotherapeutic school of thought.

The second hypothesis is based upon theoretical considerations following from medical reports on the phenomenon of psychogenic death (death by imagination - see (Schmid, 2002), (Schmid, 2001b)).

Literature

-----------------------

Psychosis Therapy: A New Approach

This presentation introduces a mind-body-social approach to psychosis therapy with an emphasis upon the special treatment of psychotic patients in general psychiatry. Since there are so many different ways to understand the phenomenon of psychosis, the presentation begins with a clarifying Introduction motivated by the question: "What is psychosis?", followed by the proposal of an evidence-based psychosis hypothesis. The Objective is to put this hypothesis to work by laying the theoretical foundations of a corresponding psychosis therapy. This leads to the presentation of a practical Method called «Phantasy Therapy» for the group psychotherapy of acute psychotic patients. (See the corresponding chapter in this website.) The Results gathered from hands-on experience with this depth-psychologically oriented therapy form practiced in our clinic since 1995 attest to the method's quality assurance in both stationary and ambulatory settings. I Conclude that the mental «binding problem» associated with psychosis - see heading "What is psychosis?" above - may be effectively treated by optimizing «therapeutic presence». The idea is to enhance the cognitive-emotional-sensorial-intuitive encounter between therapist and patient («pacing»). This can help the patient rediscover our common objective reality within his or her phantasy under the empathic, vigilant guidance («leading») of the therapist. «Phantasy Therapy» is one way to do this by integrating elements from psycho-, movement/dance-, art- and music-therapies.

Go to Presentation

Literature

Table 1: Summary of the Two Sequential Sessions of Phantasy Therapy

-----------------------

Spiritual Crisis

NOVALIS spoke about a «sublime hyponchondria» and thereby meant a «creative illness» from which the afflicted arises with a new philosophical insight and transformed personality (Ellenberger, 1973, p. 306). Such an illness was often the prerequisite for the calling as shaman or medicine man of natural cultures. Here, ethnologists often speak of a «wounded healer». In this same sense, ELLENBERGER refers to the father of psychophysics: Gustav Theodor FECHNER (1801-1887), the philosopher and nihilist: Friedrich NIETZSCHE (1844-1900), the father of psychoanalysis: Sigmund FREUD (1856-1939), and the "discoverer" of the unconscious: Carl Gustav JUNG (1875-1961), as "wounded healers". According to ELLENBERGER (Ellenberger, 1973, p. 611), a «creative illness» generally follows a period of intense preoccupation with a basic idea, and the search for a particular truth. It is a polymorphic state which can take on the form of a psychosomatic disturbance (FECHNER), neurosis (FREUD), depression (NIETZSCHE), and even a psychosis (JUNG). Regardless of the particular nature of the symptoms, they are always experienced by the afflicted as painful, if not as agony or torture. It is not uncommon for the afflicted to suffer alternating episodes of improvement and relapse. Nevertheless, the "wounded healer" never loses sight of his or her basic idea and never wanders beyond the context of their overall search. The «creative illness» seldom interferes gravely with the normal occupational and family life of the afflicted. But even if he or she can more or less fulfill their basic social obligations, the "wounded healer" is almost exclusively preoccuppied with themself throughout the entire "initiation" process. He or she suffers from a feeling of exteme isolation, even if the afflicted one does have a mentor who accompanies him or her throughout their difficult "test" (like the shaman apprentice always has his master). The end of the trial and illness is often sudden and unexpected, and is accompanied by a period of exhaltation. The "wounded healer" leaves his «creative illness» behind with a permanent transformation of his or her personality, and the conviction of having discovered a great truth or a new spiritual reality. In this sense, one may also call a «creative illness» a "spiritual crisis".

The above discussion shows that a so-called "spiritual crisis" may indeed involve a psychosis. The question to be explored here is now: To what extent might a psychosis actually be a "spiritual crisis"?

-----------------------

Literature

Dünki, R. M., & Schmid, G. B. (1998). Unfolding dimension and the search for functional markers in the human electroencephalogram. Physical Review E, 57(2), 1-8.

Dünki, R. M., Schmid, G. B., Scheidegger, P., Stassen, H. H., Bomben, G., & Propping, P. (1996). Reliable Computer-Assisted Classification of the EEG: EEG Variants in Index Cases and Their First Degrees Relatives. American Journal of Medical Genetics (Neuropsychiatric Genetics), 67, 1-8.

Dünki, R. M., Schmid, G. B., & Stassen, H. H. (2000). Intraindividual specificity and stability of Human EEG: Comparing a Linear vs. a Nonlinear Approach. Methods of Information in Medicine, 39, 78-82.

Ellenberger, H. F. (1973). Die Entdeckung des Unbewussten (G. Theusner-Stampa, Trans. Vol. 1 & 2). Bern, Stuttgart, Wien: Verlag Hans Huber. The English title is: The Discovery of the Unconscious. The History and Evolution of Dynamic Psychiatry (Basic Books Inc.) New York.

Schmid, G. B. (1997a). Chaostheoretische Betrachtungen zu Psychiatrie, Psychologie und Psychotherapie. Teil 1: Die Sechs Grundeigenschaften des Chaos und eine Prozess-Orientierte Psychiatrie (POPSY). Forschende Komplementärmedizin / Research in Complementary Medicine, 4(3), 146-163.

Schmid, G. B. (1997b). Chaostheoretische Betrachtungen zu Psychiatrie, Psychologie und Psychotherapie. Teil 2: Neue Hypothese zur Natur der Psychose. Forschende Komplementärmedizin / Research in Complementary Medicine, 4(4), 194-208.

Schmid, G. B. (2000). Tod durch Vorstellungskraft: Das Geheimnis psychogener Todesfälle (1. ed.). Wien-New York: Springer-Verlag.

Schmid, G. B. (2001a). Die Bedeutung Benedettis für die Therapie der Schizophrenie. Zu Ehren von Gaetano Benedetti. Forum für Kunsttherapie, 1/2, 3-19.

Schmid, G. B. (2001b). Tod durch Vorstellungskraft: Das Geheimnis psychogener Todesfälle (2. ed.). Augsburg: Bechtermünz.

Schmid, G. B. (2002). Psychosis Therapy with a New Approach: Special Treatment of Psychotic Patients in General Psychiatry. Manuscript ready for submission.

Schmid, G. B., & Dünki, R. M. (1996). Indications of nonlinearity, intraindividual specificity and stability of human EEG. The unfolding dimension. Physica D, 93, 165-190.

Schmid, G. B., Eisenhut, R., Dämpfle, S., Frei, K., & Ito, K. (1997). Phantasietherapie: In der Phantasie die Realität wieder finden. Tandem, 2, 21-23.

Schmid, G. B., Eisenhut, R., Rausch, A., Ito, K., Dämpfle, S., Frei, K., & Giacometti Bickel, G. (2000). Phantasietherapie: In der Phantasie die Realität wieder finden. «Das praktische Gerüst». Forum für Kunsttherapie, 2, 34-49.

Schmid, G. B., Eisenhut, R., Rausch, A., Ito, K., Dämpfle, S., Frei, K., & Giacometti Bickel, G. (2002). Phantasy Therapy in Psychiatry: Rediscovering Reality in Fantasy. A Special Treatment for In- and Outpatients in General Psychiatry. Forschende Komplementär Medizin, accepted for publication.

Schmid, G. B., & Koukkou, M. (1997). Die Dimensionale Komplexität des EEG in psychotischen und remittierten Zuständen. In G. Schiepek & W. Tschacher (Eds.), Selbstorganisation in Psychologie und Psychiatrie (pp. 151-170). Braunschweig: Vieweg.

-----------------------

I need your help!

Do you have published research results relevant to the phenomenon of psychosis or have you had a true first-hand experience relevant to the theme of psychosis which you feel important enough to share with others? If so, please send me an e-mail describing it in detail! If it's interesting enough, I'll share it with other readers in my Data Bank on this home page and may even publish it in the next version of my book! Thanx!

Send me PUBLISHED RESEARCH RESULTS (in English or German) about the phenomenon of psychosis to mind@mind-body.info with the comment "Psychosis Research".

Send me TRUE STORIES (in English or German) about first-hand psychotic experiences to mind@mind-body.info with the comment "Psychosis Experience".

With each true, first-hand story please include the following information:

Your name in full
Your complete home address and e-mail address
Your telephone number
The exact source of your story and any necessary background information which may be important to understanding the full impact of your experience
Your expressed agreement allowing me to tell your story further (orally, in print, online etc.).
Your anonymity is guaranteed! (If you would like me to explicitly mention you by name in quoting your story online or in print, please send me per post ("snail mail") a signed statement to this effect at my business address: Trittligasse 2 / CH-8001 Zürich / Switzerland.)

Thank you for your interest and your help!

-----------------------

(Last revision: 04. May 2002)