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Schizophrenia

What to do in a spiritual emergency

Last month I organized an event on ‘what to do in a spiritual emergency’ –you can see videos of the talks here. Three of my friends spoke bravely and lucidly about their own experiences – psychotherapist and film-maker Anna Beckmann, poet and transformational coach Louisa Tomlinson, and Tai-Chi teacher Anthony Fidler – and Dr Tim Read, a wonderfully wise and compassionate psychiatrist, gave us his perspective.

I wrote about this topic in The Art of Losing Control, and it’s become particularly important to me after the mini-crisis I had last year, following my ayahuasca retreat. A friend referred to it as a ‘breakdown’ this week, which didn’t feel quite right, because it was also something beautiful and healing.

So what does ‘spiritual emergency’ mean exactly, and what can we do when they occur?

There is an overlap between spiritual / religious / ecstatic experiences, and psychosis. Psychiatry has historically viewed all religious experiences as pathological, labelling them ‘hysteria’, ‘ego-regression’ or ‘psychosis’ and ignoring any positive aspects. That’s partly because psychiatrists have tended to be anti-religious secular materialists, battling the church for authority over the care of souls.

However, some psychologists (and a few psychiatrists) have suggested an experience can be both spiritual and quasi-psychotic. This ‘transpersonal’ perspective was put forward by psychologists and thinkers like Frederic Myers, William James, Carl Jung, Aldous Huxley, Ram Dass and Stanislaf Grof – who coined the term ‘Spiritual Emergency’ and brought out an excellent anthology with that title in 1980.

A spiritual emergency involves the sudden collapse of one’s habitual ego and customary sense of reality, and an opening to a different reality (which one could call the subconscious, or the archetypal layer, or the dream-world, or alternatively the Self or God – it’s a movement both downwards and upwards). It can involve a powerful sense of connection to all things, perhaps a transcending of time, space and matter, and a deep sense of meaning and awe. And it can also be extremely messy, painful, terrifying and dangerous, and have psychosis-like features like mania, ego-inflation, insomnia, voices, visions, ontological uncertainty and emotional disturbance. But unlike a psychotic illness, it can be a transition to growth, if handled sensitively.

Anthony told us: ‘It’s easy to get an idea of the life journey as a tidy evolution. But there’s another way humans grow, through revolution. The personality structure that’s evolved through childhood builds up like a building. And at some point in life it can be healthy for that to collapse. It can be a moment of growth, a journey forwards. But it doesn’t look like that. It looks like a piece of shit.’

Anna told us of her experience in her twenties:  ‘It was the most horrifying experience I ever had, and also the most awesome.’ Louisa said: ‘A spiritual emergency is when there’s an opening between the two worlds – the spiritual and the material – but it happens without maps or guides. What could be a successful integration into a larger self and reality becomes instead intensely terrifying, a failed initiation, which instead of leading to transformation, leads to fragmentation and sometimes to annihilation.’

What are the triggers?

Both Anna and Louisa spoke of how unresolved trauma was a trigger for their spiritual emergencies. For me too, the turbulence I felt after my ayahuasca retreat was partly a resurfacing of trauma from my late teens and early 20s. Trauma seems to create an ego structure that is more prone to what Tim Read calls ‘high archetypal penetrance’ (HAP) states – the subconscious and the transpersonal or spiritual dimension gets through the cracks easier.

There may also be a genetic predisposition to altered states – you might have some genes in your family that predispose you to schizophrenia, or bipolar disorder, which make you schizotypal without necessarily developing into a psychotic disorder. One notes that in some cultures, shamanism is considered an inherited ability, as are psychic powers – a tendency to absorption or dissociation gets passed through the genes, and this can lead to creativity and insight as well as disturbance, eccentricity and illness.

More immediate triggers include being physically isolated from one’s friends and family. My crisis occurred when I was in South America, Lou’s when she was alone in Dartmoor, Anna’s when she was in New York, Anthony’s when he was in China. Tim has written about a near-crisis he had while travelling in India. Such crises can occur at moments of difficult transition – going to university, say, or breaking up from a long-term relationship.

And then there are triggers like not eating or sleeping properly, or going on a spiritual retreat, or taking drugs. Tim says he has often encountered people who’ve had spiritual crises after attending spiritual retreats – he writes about this in his excellent book Walking Shadows: Archtypes and Psyche in Crisis and Growth, and notes that retreats often shift people’s egos but fail to help them integrate their experience in the days and weeks afterwards.

What does a spiritual emergency feel like?

Both Lou, Anthony and Anna spoke of a feeling of ego dissolution accompanied by physical dissolution – they felt they went out of their bodies, and the material world seems to dissolve. I had a similar experience on ayahuasca, as many do. It is terrifying, because you don’t know if you’ll come back, so I can’t imagine what it’s like to experience that for several days or weeks. But I wonder, too, if this dissolution of the ego and material reality is an insight into the actual nature of things – Buddhists say we perceive the world as made up of separate solid things (me, the table) where actually there is a continuum of energy. Buddhist monks try to get to a state where you go beyond the perception of solid things. But it is terrifying if that happens when you’re not ready for it.

The Rebel Powers That Do Thee Assay by Charles Sims

There’s also a collapse of boundaries – between the self and other people (can you read my thoughts, can I pick up your feelings and thoughts?); between you and the world (‘I can control traffic lights or even world events with my mind, it’s all connected to me’); between dream and reality. Anthony suggests we have at least two types of consciousness – a movie camera that projects waking reality, and a movie camera that projects our dreams. And in psychotic episodes, these two movies overlap, so the mythical movie of the dream-world gets superimposed on reality. Both Anna, Lou and Anthony had strong archetypal aspects to their experiences – religious imagery, messages, a sense of cosmic significance to their thoughts and acts. There can be intense surges of energy, powerful gusts of emotion, lights, visions, voices.

And there’s a deep ontological uncertainty. Anthony says he didn’t know if he was dead, or in some sort of altered bardo state. That was the same for me – for a week, I couldn’t work out if I was dreaming or in the afterlife. In Tim’s book, some of his case studies also don’t know if they’re dead or in heaven. It’s common on powerful psychedelic experiences to think you’re either dead or about to die. The ego interprets its dissolution as actual death. You find yourself still conscious and in some reality, but you can’t take anything for granted about how it works. In psychological terms, it’s a profound de-automatization. Your habitual automatic expectations of reality are dissolved. I would get on a plane and wonder if it would really take off or not, as if I somehow had to will it to take off (it was my dream – I was making it all happen).

What helps?

In his book, Tim Read emphasizes the importance of ‘set, setting and integration’ for navigating this sort of spiritual turbulence. This is also one of the main conclusions of my book, The Art of Losing Control.

Set refers to the mind-set one brings to the moment. In ecstatic states of consciousness – like psychedelic consciousness – our mind becomes extremely sensitive. It can swing from euphoria to terror in a moment. So you need to foster certain attitudes, above all mindfulness. Don’t worry about the past or future, focus on what is happening now. We need to try to remember ‘I’m in a spiritual crisis’ or ‘I’m tripping’ rather than get swept away by the powerful thoughts and sensations. Feel whatever you’re feeling, and observe it without attachment or aversion.

The breath is very important for this. It grounds us in the present moment, it relaxes our emotions, and it connects us to our body. Lou speaks of the ‘silvery chord of my breath’ being the only thing that connected her to her body and to physical reality. Someone once said we’re spiritual beings having an in-the-body experience – we need to connect to the body, enjoy this sensual material reality (nature is good for this too, so are hugs). It was also hugely important for me, in moments of panic, to breathe slowly, and remind myself ‘this will pass’.

A second important attitude is humility – not giving way to ego-inflation and Messianic grandiosity. Anthony says: ‘If you think you’re Jesus or the Buddha, that’s OK. But you’re also this person. And if I’m the Buddha, so are you.’ You have a glimpse of the infinite Self within you. But it’s within everyone, not just you. Relax. Don’t take yourself or the experience too seriously. You’re not controlling the universe. Have a sense of playfulness. Anthony talks about having an open and curious attitude to one’s experience – what does it feel like? How does this reality behave?

Third, we need to take care of ourselves. Yes, you’re the infinite cosmos, but you’re also this particular being in this particular body. Have patience and compassion for your ego and body. Look out for yourself – make sure you eat and sleep, don’t put your body in danger. Be polite, pay for things, even if you think it’s all a dream. Self-compassion is the key – even when I felt very alone and frightened, I rooted for myself. I was on my side, no matter how much the volatility swept away my tidy life-plans.

Painting by the sectioned artist Louis Wain

Secondly, setting is crucial. It helps if you have loving, understanding friends to support you while you are ‘transitioning’. When I came back from South America, I couldn’t tell what was real, I could barely understand conversations, and luckily my friends were there for me, and weren’t freaked out, because they’d had similar experiences (Lou is one of my best friends).  I loved getting hugs from my friends, I loved stroking my brother’s dog and cat, I loved sitting by his fire – I grounded myself in love and touch. Getting out into nature was also really healing for me. I avoided seeing people who wouldn’t get what I was going through.

Third, integration is very important. I came back to this reality within a week or so, but worked on the integration for several months, and am still working on it. I started seeing a therapist who is open to the transpersonal perspective. I found a community where I could practice meditation with others. There are also communities like the Spiritual Crisis Network and the Hearing Voices Network which offer support.

Sadly, western psychiatry is often the worst setting or integration process for this sort of experience. As Tim told us, most psychiatry is meaningless – it doesn’t accept that these sorts of experiences could have meaning, could be a stage in a person’s growth. Tim writes: ‘the medical intervention often serves to entrench stasis and impede growth’. Anna really wanted support during her crisis, but was terrified of being locked up and treated as totally mad. She was lucky, probably, not to be sectioned – most secure psychiatric wards are horrible, harsh, loveless and soulless places. Tim, who led the Emergency Psychiatry Service at Royal London Hospital, writes: ‘It is one of the great tragedies of psychiatry that our most vulnerable people are placed in the most unsuitable settings.’

And western culture is also rather an inhospitable and even hostile setting for such experiences – we don’t talk about them, and we see messy breakdowns as awful, shameful and frightening, something to hide away, rather than potentially something painful but wonderful, like giving birth!

However, just as there is a risk of materialist fundamentalism, there is also a risk of religious or spiritual fundamentalism – Anna talks about how she would feel these ecstatic experiences and hunger for them, but she came to see this was a way of bypassing her pain. We can use our spiritual experiences as ways of not dealing with this reality, this body, this life with all its messiness. Tim Read writes about one case study of spiritual narcissism, a young man who focused so exclusively on his spiritual experiences that he lost the capacity to negotiate this world. We need to balance our life in this world with our yearning for the transcendent, so we don’t become a ‘total space-cadet’ as one ayahuasca facilitator put it to me. We also need to be open to ambiguity and uncertainty, to sometimes not knowing precisely where we are on the path.

None of this is meant to deny that there are psychiatric illnesses which are mainly physical in origin, and which are not transitions to higher selves. I also know that, for some people, psychiatric medication is helpful and even life-saving. And sometimes being sectioned is necessary to protect people and society.

Tim and I are now going to put together a book of people’s first-person accounts of spiritual experiences, to answer the questions – what are they like from the inside, and what did people find helpful? The focus is on the practical things that help people, the set and setting. If you’d like to contribute, more details can be found here.

Finally, I wonder what these experiences say about the nature of reality and God. I think evangelical Christians can have a naïve view of God and the tidiness of religious experiences. You meet Jesus, who is totally loving and good for you, and instantly both this life and the afterlife are better. In fact, spiritual awakenings often feel like death, and can totally mess up your life. They’re closer to the God of the Old Testament, the God of the Burning Bush and the Book of Job, the God who turned Nebuchadnezzar into a beast and made Ezekiel lie on his side for 430 days.

What does it say about God, or the Self, that sometimes spiritual awakenings can destroy a life, can actually lead people to starve themselves or jump off a building in their search for transcendence (two instances mentioned in Tim’s book).

To me it suggests that sometimes the dissolution of the ego and the opening to the Self is incredibly rough, sometimes fatal. It can be a confrontation with a Shiva-like god – the cosmic creator and destroyer. It makes me hope that reincarnation is real, so we can hope that, while the archetypal call of the Self is sometimes harmful and even fatal to the individual, eventually, over many lives, we move towards the light. Or maybe God / the Self / the Tao doesn’t care about individuals, only the awakening of the species. Or maybe there is no God. Even if there isn’t, we can still help people navigate these rough moments of ego-dissolution, so that they can move towards positive and fulfilling lives, as Lou, Anthony, Anna and I have done.

Nebuchadnezzar by William Blake

Gods, voice-hearing and the bicameral mind

A few months back I was giving a philosophy workshop in a mental health charity. It was one of my less popular events – only one person turned up, a Romanian man who had recently moved to the UK and was finding it tough. We talked about Socratic philosophy, about the idea of engaging your inner voice in a rational dialogue, and the man (let’s call him Anghel) quietly told me that he heard voices.

Anghel heard one particular voice, and wondered who or what it was. He’d gone online, to an app called God Picker, and in very postmodern fashion picked a God – he’d chosen an ancient Mediterranean fish goddess called Atargatis – and made it his personal deity. Things went OK for him, he said, as long as he obeyed the commands of Atargatis. He was nervous about telling the local authorities about the fish-goddess, in case they locked him up and put him under heavy medication. I suggested he contact the Hearing Voices Network instead, to find support from other voice-hearers.

I thought about Anghel this week, as I was reading an extraordinary book called The Origin of Consciousness in the Breakdown of the Bicameral Mind, by a Princeton psychologist called Julian Jaynes.

The book was a big hit when it came out in 1976, and has an unusually diverse roster of fans – Daniel Dennett was influenced by its theory of consciousness, David Bowie picked it as one of his 100 must-read books, Terence McKenna thought it was ‘a most provocative book’, while Philip K Dick thought it was a ‘stunning theory’. Richard Dawkins spoke for many when he said (in The God Delusion): ‘it’s one of those books that is either complete rubbish or consummate genius’.

Jaynes’ thesis, baldly stated, is this: human consciousness (which Jaynes defines as self-conscious introspection) only emerged around 3000 years ago. Before that, everyone heard voices and saw visions, which they took as the commands of the gods, and obeyed unquestioningly. These voices or commands came from the right hemisphere of the brain, which ‘bicameral man’ experienced as alien or Other.

Achilles: the lights are on but nobody’s home

This, says Jaynes, is the world we meet in the Iliad. Homer’s heroes have no inner world, no capacity of introspection. The gods appear to them at various points and tell them what to do, and they do it. They don’t have free will in the modern sense, rather they are ‘noble automatons’. They are, in effect, a different species – not homo sapiens but rather ‘bicameral man’.

Jaynes’ astonishing hypothesis is that you can have a whole civilization operating without consciousness, that’s to say, without introspection or free will. A zombie civilization. You can see why the theory appealed to Daniel Dennett and Philip K. Dick.

He speculates that voice-hearing developed as a form of social hierarchical control. When we’re near the chief, we can hear his commands. But when we’re further away and out of the chief’s presence, we can still hear commands from our inner chief, so to speak.

Then, sometime in the second or first millennium BC, subjective consciousness emerged. Jaynes thinks this happened through the expansion of metaphor – our minds became able to make analogies, to link like with like, to imagine time as stretching forwards and backwards, to imagine ourselves as narrative heroes with a variety of choices (what he calls ‘the analog I’). As metaphors connect, like synapses, homo sapiens generated a rippling field of metaphoric consciousness.

With the emergence of subjective consciousness, the ‘bicameral mind’ breaks down – or rather, the external voices become integrated into internal consciousness. The gods are no longer heard so often, except in moments of extreme stress. Instead, we internalize their commands as the voice of conscience. We notice the gods speak to us less, and we miss their guidance and fear their wrath. We wonder what we did wrong, to make the gods go silent.

Michelangelo’s Jeremiah, waiting for a call

Another of Jaynes’ astonishing hypotheses is that the great organized religions emerged out of a ‘nostalgic anguish’ for the lost voices / departed gods. In one remarkable chapter, he uses the Bible as evidence for this departure. In the beginning, Elohim (the Mighty Ones) spoke to us all the time. Then came the Fall – the emergence of subjective consciousness. After that, the Mighty Ones only appear to certain chosen prophets, like Moses, and are organized into one entity, called Jehovah, to which we must be monogamously faithful, or else.

Instead of the constant presence of the Mighty Ones, we have instead the poor substitute of Deuteronomic priestcraft and scripture. The Bible is indeed filled with anguish at the silence of the Divine (like Psalm 35: ‘Do not stay silent, do not abandon me oh Lord’). But at moments of stress, like the exodus from Egypt or the fall of Jerusalem, the voices return to prophets (just as, for Anghel and many other immigrants, voice-hearing may emerge as a response to the stress of immigration).

Although humans evolved into a higher state of subjective consciousness, vestiges of the bicameral mind still remain, most obviously in voice-hearing. As much as 10% of the population hear voices at some point in their lives, much higher than the clinical incidence of schizophrenia (1%). For many people, voice-hearing is not debilitating and can be positive and encouraging.

Sensing a voice or presence often emerges in stressful situations – anecdotally, it’s relatively common for the dying to see the spirits of dead loved ones, likewise as many as 35% of people who have recently lost a loved one say they have a sense of the departed’s continued presence. Mountaineers in extreme conditions often report a sensed presence guiding them (known as the Third Man Factor).

A bear of very little brain (roughly 50%, to be exact)

And around 65% of children say they have had ‘imaginary friends’ or toys that play a sort of guardian-angel role in their lives – Jaynes thought children evolve from bicameral to conscious, much as Piaget thought young children are by nature animist (ie they attribute consciousness to things, and may attribute special consciousness to favourite toy-companions, like Winnie the Pooh or Sheriff Andy).

These are all vestiges of the bicameral mind, according to Jaynes, as is our capacity to be hypnotized (our hypnagogic openness to external commands is a remnant of the bicameral mind’s obedience to social hierarchy) and our love of poetry, which seems to come to poets from Parnassus or some other Beyond.

Such is Jaynes’ remarkable theory. Alas, he never wrote another book, but his magnum opus is increasingly popular, not least because some recent brain-imaging studies confirm his ideas about brain-function lateralisation and the origin of auditory hallucinations in the right hemisphere.

His book is similar in some respects to Iain McGilchrist’s recent work, The Master and his Emissary, which also uses the bicameral mind for a Grand Historical Theory. But McGilchrist thinks the two hemispheres have become progressively less integrated, rather than more, and this is why the gods have gone silent. He thinks we need to bring the right hemisphere back into the game, through poetry or religious practices, while Jaynes is much less concerned with returning to some bicameral utopia. Indeed, like Max Weber he warns we should resist the nostalgic desire for the right hemisphere’s charismatic certainty.

Genius or bonkers?

What can we say about Jaynes’ theory? Well, it’s refreshingly bold. But as a theory of consciousness it doesn’t really solve the ‘hard problem’ of how mind comes from matter. Even if Achilles isn’t self-consciously introspective, he is still experiencing mental events.

Jaynes’ theory that auditory hallucinations are a form of social control doesn’t sound quite right, either. Look at how many voice-hearers have resisted and destabilized social control, from Moses to Socrates to Jesus to Joan of Arc.

Jaynes doesn’t have much evidence for his contention that everyone used to hear voices and lack introspection – his main evidence is the Iliad. But the characters in that are special, they are heroes, with a special relationship to the divine. If the gods spoke to everyone, why are prophets like Cassandra remarkable or different? Why the need for divination in the Iliad, if the gods are constantly telling people what to do?

And is Jaynes saying that schizophrenics or voice-hearers today lack conscious introspection and free will, that they are automatons? Better to say that they have the capacity to question and not obey their voices, it’s just that often they choose to follow their voices’ commands because they are terrified of them. Some voice-hearers learn a more flexible and egalitarian relationship to their voices. (Marcel Kuijsten, who has edited Jaynes’ work, tells me Jaynes did not equate schizophrenia with bicameral man – in schizophrenics subjective consciousness has emerged).

Those are some of my reservations about the theory. What I like about it is the suggestion that subjective consciousness emerged at a particular moment, and this moment was quite recent. I think, in fact, that fifth-century BC Athens was one of the moments when modern consciousness was born.

Suddenly, in fifth-century BC Athens, many people stopped hearing or believing in the gods, and some sophists insisted that the only real authority was Public Opinion. As a result, rhetoric, or the art of seeming, is born. This was taken as a profound heresy by bicameral minds like Sophocles, the inspired tragedian, who insisted we must honour the intuitive and god-hearing part of us rather than denigrate it or try to leave it behind. What you see in Sophocles’ last two tragedies (Philoctetes and Oedipus at Colonus) is a last-ditch attempt to marry together the splitting parts of the Athenian soul – the worldly and the other-worldly.

Oedipus (right) and Theseus, the intuitive and the pragmatic…
…and Philoctetes (right) and Neoptolemus, also representing the marriage of the intuitive and the pragmatic

And at this moment of the birth of modern consciousness, there stands Socrates, with one foot in each era. He insists that we must bring our unexamined beliefs into consciousness and ask if they make sense. He is the midwife of subjective consciousness. And yet he also has a daemon who gives him moral commands, and he insists he has been sent on a mission to humanity by the Gods. I love these two figures – Sophocles and Socrates – because they are trying to integrate the two eras, to marry the two hemispheres.

Jaynes and the Hearing Voices Network

Perhaps the most impressive practical consequence of Jaynes’ book was the establishment of the Hearing Voices Networks, and the beginning of a more enlightened approach to voice-hearing.

In the 1980s, a Dutch psychiatrist called Marius Romme was treating a 30-year-old voice-hearer called Patsy Hague. She was on tranquilizers, which failed to stop the voices and made it difficult for her to think. She became suicidal. Then Romme happened to lend her a copy of Jaynes’ book. It made her think perhaps she was not ill so much as ‘living in the wrong century’, and also gave her confidence that her voices were ‘real’, or as real as the invisible God that Romme and others believed in. Hague told Romme: ‘You believe in a God we never see or hear, so why shouldn’t you believe in the voices I really do hear?” Why not listen to what the voices had to say, rather than dismissing them as meaningless pathological symptoms?

Romme set up a meeting between Hague and other voice-hearers, who enthusiastically swapped stories and shared their sense of helplessness, vulnerability and alienation from their society. A sort of peer-led support network emerged, and has continued to blossom since then.

Today, the voice-hearers network is increasingly challenging the traditional theory that auditory hallucinations are sufficient for a diagnosis of psychosis or schizophrenia, which should be treated with anti-psychotics without any regard for the content of the messages. More and more healthy and high-functioning adults are ‘coming out’ as people who have occasionally or frequently heard voices. I personally heard a voice once, during that near-death experience in 2001, although I’ve never heard one since.

I’m particularly interested in the link between voice-hearing, dissociation and creativity, and in the incidence of voice-hearing among creative individuals like novelists Marilynne Robinson (who occasionally hears a voice inspiring her novels), comedians Graham Linehan and Jonny Vegas (both of whom hear or have heard voices), and musicians like Lady Gaga and David Bowie (the former says she heard voices and started to act them out as personae, while the latter likewise embodied and acted out radically different personalities and has a history of schizophrenia in his family).

Not to mention the dissociative capacity of gifted actors to become other people (Le Carre called Alec Guinness’ ability to become someone else a ‘complete self-enchantment, a controlled schizophrenia’); or all the many poets and song-writers who say their poems came to them from a voice / presence / spirit / muse.

What Jaynes fails to address, I’d suggest, is the value of these ‘vestiges of the bicameral mind’. When we seem to feel or hear messages from the beyond, it’s not just a primitive throwback to Homeric times. These messages sometimes tell us something useful, beautiful and wise, something our ordinary consciousness does not know. They are often sources of moral inspiration or consolation. I’d suggest the right hemisphere is still not entirely accessible to our ordinary consciousness, and there is a value in learning how to access it through things like meditation, trance states or techniques of ecstasy (though of course there are risks as well, particularly if you end up with an inflated or Messianic sense of self).

To go a step further into the mystical, if we do receive inspiration through the right hemisphere, does that mean the origin is definitely purely material or neurochemical? Could we not consider William James’ hypothesis that the right hemisphere / unconscious is the door through which the divine speaks to us? Such has been the suggestion of various spiritual critics of Jaynes’ theory, from Owen Barfield to Philip K. Dick.

Still, the voice-hearing network is fascinating, from a theological perspective, because in some ways it suggests a very modern attitude to the gods. We hear their commands, and yet we don’t have to obey unquestioningly. We relate to them less as a child to their all-powerful father, and more like a friend to their equal, rather like Lyra’s friendship with her daemon, Pantalaimon, in Philip Pullman’s Dark Materials. Happiness, then, is eudaimonia: having a friendly daemon to keep one company in life and through death.

Very well, says my daemon, looking over my shoulder as I write. But who made the daemons?