Psychological Interventions In Psychiatry

Facilitating extreme and unusual states of consciousness is DIFFICULT, EXCITING, RENEWING and PROVOCATIVE. Since I have written scientifically about this work elsewhere, perhaps I can share a few personal notes about it with you here.

Difficult

In my practice in Zurich and here in Portland, I see many people in extreme and unusual states carrying a variety of psychiatric diagnoses. Working with these people can be difficult, because they challenge me to learn more about the limitations of my own communication abilities.

Instead of immediately diagnosing this or that condition, it is challenging and rewarding to ask what people going through these states arc trying to inform me about and why I am not able to understand them. When I forget to ask these questions, I find myself assuming that something is wrong with them.

Exciting

When I investigate myself, the first thing I encounter is closedness, and the second is openness. Then my mind begins again and I start to recognize that a severely withdrawn state or apparently crazy word-salad is not a biological defect, but a highly ordered and reasonable condition expressing a crucial message. This is really exciting.

In fact, I can get so excited that I begin to believe what people are doing and saying even more than they do! When I find myself doing this, I really do it. I allow myself these beliefs and watch the reactions in my clients. Those who are going through spiritual emergencies are helped immediately. Since one of their greatest problems is hating themselves and refusing to accept the powerful, eternal convictions and feelings which are trying to emerge within them, my belief in what they are doing and saying relieves this problem.

Believing in their extreme states encourages people to sober up long enough to tell me that I am crazy for beUeving and doing what they were doing before. "Don't

be crazy," they advise, and then they proceed to tell me how to get normal. A few such stories are included in my book City Shadows.

Working with people in extreme and unusual states, I am pressed to leave my world and my identity for short periods. These situations give me the opportunity for "walking on the moon", so to speak. And "walking on the moon" is just what I need. Again and again, these people remind me, remind us, of the city's unknown, the city's shadow. As long as I, or we, are straight and normal, others must remind us of other dimensions.

Renewing

Working with clients who are severely withdrawn, madly hallucinating, drug-addicted, comatose or badly depressed is always incredibly renewing for me. At one time, I only wanted to work with those who were having spiritual experiences that they would later integrate. (I still have a preference for these people.)

But those who I could not immediately get along with were a challenge to me. In fact, City Shadows came from a bet I made with a colleague. "Find me the fourteen most impossible "cases" in your country, and I will show you that none of them are hopeless," I said to him. Maybe I was naively optimistic, or maybe I was just fed up with hearing about how sick everyone was!

A certain belief helped me to win that bet: the belief that I can only meet my own fate. Therefore, if I meet something which confuses me, I will be renewed by discovering that part of myself which is confusing. This has proved true in my work. What a time I had working, for example, with a retarded man! And, in another situation, though I had no chemical addictions to speak of myself, I was 'addictable' enough to find my way into the heart of a man who was living off twenty beers for breakfast.

Provocative

Working with extreme cases provokes me to consider the world around my clients. What good is psychological theory and practice if it does not succeed in improving the lives of the people who are going through these extreme states? Why sit around and meditate with someone who is comatose? Why simply feed him oxygen through a tube when we should be learning how to go into this state and help him to complete it?

But even if we do succeed with some people, we run into new conflicts with others who are not yet able to do this. Work with extreme states means not only personal development for me and my client but organizational development as well. And, my god, who is up to all of that? Periiaps the more provocative question is, why arerit we up to all of that? After all, this is the point where individual work, group work and political work are indistinguishable.

Penguin-Arkana, London, 1989; Viking Penguin, New York, June 1990.

Luckily, we have good helpers in this work: our clients! For example, I recall working with a doctor recently who thought that he was insane. He came into my office saying that he'd been picked up on the highway by the police because his feet were bleeding. He'd been walking for hours without shoes. Now, he felt that he was still losing his mind because his hands always wanted to punch something. "So, hit my punching bag," I recommended. Wham! He hit it again and again, stopped, and with encouragement continued until he said that he was angry. "About what?" I asked. "About being bored and overworked in the hospital where I am employed," he replied. He was instantly relieved by this discovery, sat down and laughed at himself for thinking that he was crazy.

I helped him to connect with his negative inner boss, his myths, incarnations and feelings. I even helped with his present-day problem of being bored. And his anger gave me courage to rethink things for myself.

A larger social task lies beyond new interventions and theories. We need to improve our training, education and practice so that it is not boring. We need to get more fantasy and feeling involved in dealing with extreme states, before the whole area drives us all crazy in a very non-spiritual way!

Hearts in Prison

Since theory and practice are extensively discussed in City Shadows, I want to take a less formal approach here and just chat about a good interaction I had with a conventional institution on the East coast of the United States.

Amy and I had the opportunity to work with teen-agers in a locked ward at a state hospital. I would have preferred to work with each of the three young people in a one-to-one setting, but the hospital's team wanted to see us work with them as a group.

The young man had been accused of killing his girlfriend in an automobile accident. He appeared to be pretty menacing now. He was tough and apparently brutal. Both of the young women had tried to kill themselves with razor blades.

All three looked like they were in strongly altered states in spite of their medication. The young man was morose and looked like he was going to kick the next cat he could find. One of the young women seemed strongly withdrawn, hiding her face behind her lovely red hair. The other young woman spoke a lot. "He needs help," she said courageously.

Amy and I looked at "him". All he could do was grunt, "Ugh". I challenged his "ugh" by asking him what he wanted and, to my surprise, he responded bluntly, "Get me out of this prison, I want to play baseball!" In the same rough tone of voice, I told him that he was a fool to wait until we got outside, we should do something fun right here and arm-wrestle! "Great," he said, immediately pulling his chair up to a table, getting ready to go.

I felt more timid than I acted, but I moved to the table and entered into an arm-wrestling match with this powerful young man at least twice my size. After he had beaten me, we tried another "game", testing who could crunch the other's hands first. I fared better than in the first match and mentioned in an offhand way (sweating all over) that he was really strong.

"Naw, ain't true," he said, "I also got a big heart!" Shocked, we were all touched, amazed by his change.

Then the withdrawn woman relaxed. She sat back after having watched the scary encounter with the young man. Her hair was still draped over her face. The only thing which moved was one little toe sticking out of a hole in her shoe.

I introduced myself to the toe, "Hi there, little toe. Nice to meet you." Then, imagining into her world, I went on, "You must be the front door to the home of this redhead who has a big love story in there." In a flash, the redhead came out from behind her hair and began speaking of her recent love affair with a rebel teenager.

Amy was so moved that she cried. I was too shocked to speak. Watching those kids open up to love was a spiritual experience for us. It was like finding the most tender hearts in prison. Immediately thereafter, it was just as moving to meet the entire hospital team of twenty-five, and to hear how interested they were in learning more about communication, signal exchange and psychological interventions in psychiatry.

Amy Mindell, psychotherapist, analyst and founder of Process Work, is author of 12 books. He is a former teacher at the Jung Institute in Zurich and has been a resident scholar of the Esalen Institute. He currently conducts seminars throughout the world with his wife Amy, and teaches at the Process Work Center of Portland, and the Research Society for Process Oriented Psychology in Zurich.