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In Defense of Psychosis
from Division Review
by Kendra TERRY
It was Bedlam all over again. Foucault’s pendulum had swung too far and, again, we failed to evolve.
The first thing you notice when you walk into a psychiatric inpatient unit are the patients loitering by the door, pacing back and forth, like broken wind-up G.I. Joe figurines. Once fighting, now relegated to the circular motion of group therapy, Saran-wrapped sandwiches, and vital signs in perpetuity. A door locked to all those without a Diagnostic and Statistical Manual of Mental Disorders in their back pocket, abridged and boorish. A door with signs like “ELOPEMENT DANGER!” and “XXX.” You walk in farther and you see nurses trailing patients, patients like kids all over again, infantile, stripped of their freedom, needing to be watched over, tended to, told NO, shown how to live.
When we think of “madness,” we are thinking of psychosis. In psychosis, we see a breakdown between subject and object; internal events are projected onto the outside, interpreted as if they belong to an external entity, whether it be to God, the government, or the rotation of the world itself. What if, however, the psychotic individual’s sense of what is real were not reduced, cavalierly, to psychopathology? What if the seeming loss of contact with an external reality so characteristic of psychosis in fact put them in contact with the subtle, the vital, the real?
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In Eros the Bittersweet, Anne Carson (1986) talks about edges. It is at the edge of oneself where one finds romantic love, desire, eros. “Eros is an issue of boundaries. In the interval between reach and grasp, between glance and counterglance, between ‘I love you’ and ‘I love you too,’ the absent presence of desire comes alive…. The experience of eros as lack alerts a person to the boundaries of himself, of other people, of things in general” (Carson, p. 30). What Carson evokes specifically here is an act of reaching, of going beyond the boundary of the self. We reach from the known towards the unknown, from ourselves towards our lover, from the actual towards the possible, and “beauty spins and the mind moves” (Carson p. xi).
In psychosis, what we find is a similar edge. Psychosis pushes up against the edge at which “the soul parts on itself in desire [and] is conceived as a dilemma of body and senses” (Carson, p. 7). The psychotic individual reaches across the in-between space where breath breaches the boundary that separates internal from external, self from other, and temporarily exists in the space where metaphor conjoins the two in hallucination. An edge that marks the periphery of a standard of normal. An edge that, if they cross, they enter into a sort of parallax of consciousness. A revolt against the skin that surrounds them, the intersubjectivity that engages them, the self that binds them. The edges of a razor just as sharp and just as fragile. But what if there were an in-between space that were like the swimming pool of a synapse, in which the individual in psychosis could float between the action and reaction of its correspondence? And what if it were an edge upon which, if they could temper it, they could find the very edge of themselves?
To some, psychosis may appear as neuronal firings gone awry, random and loose, or perhaps proof of an inferior gene pool, upon closer look, the delusion has a function. It is meaningful. “Properly a noun, eros acts everywhere like a verb. Its action is to reach, and the reach of desire involves every lover in an activity of the imagination” (Carson, p. 63). In psychosis, this reaching of the imagination stretches too thin. The mind loses its footing in the symbolic order and the psychotic delusion reaches to fill in the gaps that were once occupied by our fundamental significations, by the order of gestures, rituals, and more generally, the agreed upon languages of society. In its place, fantasy creeps in.
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The holler of a stranger orchestrates the patient’s every movement. Doctors on the loudspeaker ring in as if speaking to them and them alone. A stop sign renders them catatonic. There becomes meaning in every sound, every sight. The meaning, they become drunk off it, in a network of associations that creates a different sense of order, the associations ever bloated as the unconscious stretches into infinite sets. The movement from sanity to madness demarcates the edges of the mind, outlines the faculties that define its very difference. Delusions are systems of meaning connecting all of their nodes. It is here, as Carson describes, that we become alive.
Anderson (1938), Landis (1964), and Custance (1952) detail the patients’ experience as follows.
One patient writes:
I seem to merge with everything. [There is] an intense consciousness of power and absolute ecstasy…. A terrific consciousness of power in surges, like the sea coming against you…. I feel calm as well. Things appear more real, as if you were just becoming alive and had never lived before (p. 290).
And another patient:
The sense of being intimately in tune with the ultimate stuff of the universe can become so overwhelming that those affected naturally proclaim themselves to be Jesus Christ, or Almighty God, or whatever deity they have been taught to look on as the source of all power…. It seems to me as though all truth, all the secrets of the Universe were being revealed, as though I had some clue, some Open-Sesame to creation (p. 287-88).
Other thinkers have conceptualized psychosis in ways that diverge from mainstream psychiatric views, from anti-psychiatry movements that gained popularity in the 1960s, to post-Lacanian thinkers and contemporary ideas of “ordinary psychosis,” to narrative autofiction writers on their personal, first-hand experiences of psychosis. This is to say that not everyone in the profession believes psychosis is neurological misfiring. Psychotherapists and researchers from Frieda Fromm-Reichmann and Harold Searles, Harry Stack Sullivan and Wilfred Bion, R. D. Laing, Bertram Karon, and Christopher Bollas, offer a more varied understanding of the psychotic spectrum disorders. They talk about hallucinations and delusions as being interpretable in the way dreams are interpreted; that what comes up for an individual in psychosis is valid as an experience and not reducible to mere symptoms of mental illness; that what patients of psychosis need is to be offered a space in a safe environment to explore the experience as a process of self-discovery and an alternative to being treated with medication; that madness needs to be normalized; and that break-down can be generative, inviting the potential to be reconstructed, ultimately leading to break-through.
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We see the origins of psychosis as described in D. W. Winnicott’s concept of unintegration, a time before the child discerns a self that is separate from her mother, when the child does not mind the difference between being whole or being in bits. There is not yet the sense of a unified self, but rather the infant exists as inputs of discontinuous sensory perception and outputs of behavior all the same. Psychosis is a regression back to this pre-symbolic phase when there is no I separate from not I. The infant and the mother communicate at the edge of language, with their bodies, in mutual attunement: the child cries and milk appears, in symbiosis, as if by its own act of creation. There is no separation.
Margaret Mahler talks about psychosis similarly as a return to a state of symbiotic relatedness, wherein during the early years of the child’s life she lives in mutually inhabited space in relation to the mother. In Mahler’s theory of schizophrenia, something “goes wrong” during this stage such that the child does not achieve separation individuation. This lack of mastery results in a confusion of self and other. The edges blur. There is no boundary, no periphery, no inside distinct from outside. The self is not separate from its surroundings. The child lies in the crib, vulnerable, powerless, at the mercy of its own existence, at once volatile and free. But for the adult, they are no longer allowed to play in the space of the imagination. For the adult, fantasy becomes dangerous.
With a loss of this ego boundary, when hallucination occurs in psychosis, the internal world is projected, experienced as if originat- ing from the external environment. There is a perception of literal bodies or voices, moving, speaking, but these figures are a mere reflection of the psychotic experience of one’s own internal state. The patient “merge[s] with everything,” becoming “in tune with the ultimate stuff of the universe” (ibid) as if the doors of perception open and what is undeniably true is revealed at last. Gaining the ability to speak, to explicate, the real tugs at the mind of the psychotic, while the symbolic stirs our ability to ascribe meaning. In its characteristic return to a pre-symbolic state, hallucination is a psychotic interpretation of the symbolic to be that of the real.
Michael Eigen (1986) describes Winnicott’s unintegration as “a ‘purer’ state. The subject dips into creative formlessness…. Unintegration refers to the chaos of experiencing before it congeals into psychic formations” (p. 334). Stripped of the schemas that define the self-concept, the individual in the midst of the psychotic state experiences a sort of unification with the external world, inside of creative formlessness, not able to find their way out. Without the sense of I, a boundary is lost between self and not self. Carson describes the experience of Eros similarly: “Boundaries of body, categories of thought, are confounded” (Carson, p. 7). In primary process, the dreamlike, fantastical, and often unconscious thinking of the child, the world is experienced in the way Buddhists describe phenomena simply as such. The stance is “not one” and “not two,” negating the dualism that divides the whole into parts; where judgment is suspended, and experience of the world is as such, just as it is. Here, the brain is in a state of network hyperconnectivity, parts of itself communicating with other parts it didn’t even know existed.
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But let’s return finally to where Carson begins, in her preface to Eros the Bittersweet, where she retells Kafka’s The Top. In the original story, a philosopher hurries after children in an effort to steal their “top spins” (p. 1). Carson says of the philosopher that if only he could catch the impertinent spinning of their tops, of the playfulness of youth, of the vertigo of love, the fragility of beauty, he would be able to stay there, spinning, forever:
The story is about the delight we take in metaphor. A meaning spins, remaining upright on an axis of normalcy aligned with the conventions of connotation and denotation, and yet: to spin is not normal, and to dissemble normal uprightness by means of this fantastic motion is impertinent (p. xi).
But what if we could pause in this spinning, of eros, take a breath, immediately at the edge between sanity and madness. Perhaps somewhere along this flight, there is a glimpse of something that is true, at the edge of what is possible. We come to the edge of perception, the edge of conversation, the edge of logic, and the edge of memory. We revel in Carson’s “edges of sounds, letters, words, emotions, events in time, selves” (p. 51). At each point, the disturbance comes closer into focus. As we traverse from one side to the other, we trace a map of the place, defining its topography. It is at the edges that we find the definition of the shape itself. We don’t know the shape of the Earth until we are in outer space; only upon the collapse of the mind, do we become aware of its constituents.
Psychosis is often defined as a thought disorder and perhaps it is just this simple. Our minds open corridors of thought within us. And it is when we travel to the edges of these corridors that we discover what the mind is capable of. But it is also where we find its limit, the point at which it starts to break down. Here, it is no longer the stuff of thought; we are confronted with word salad, a loss of reality testing, at times dangerous misconceptions about the world around us. Here, we cross over from thought order to thought dis-order.
It is a tempering of this edge, a coming to know it, that allows us to find ourselves propped up on it. The closer we get, the more familiar it becomes. And at the peak of tempering there is a sort of taming. We must trace this transgression as if breath, moving between two spaces and ask, “What is breath? For the ancient Greeks, breath is consciousness, breath is perception, breath is emotion…. Breath is everywhere. There are no edges. The breath of desire is eros… As the planes of vision jump, the actual self and the ideal self and the difference between them connect in one triangle momentarily. The connection is eros” (p. 48-49; 62). The breath passes through us, seamlessly between inside and outside, just like Mahler’s infant, or the psychiatric institute’s psychotic. Breath is eros, reaching across this edge. When edge becomes breath, in this triangle between sanity, madness, and our known, momentary identity, we find our self at the edge of our self. We find our self the moment at which it begins to turn into something else. Here, the real and the ideal come into focus.
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At first, we notice the streets around us, the people, our favorite neighborhoods, start to become unfamiliar. Our surroundings fade into a distant background, apartment buildings losing their edges, street crossings losing their edges, horizons losing their edges, the signposts, they’re close to us, begin to light up like actors on a stage, demanding our attention. A man in a red suit signals to us, the apocalypse is coming, and we think, “This! This is what we’ve known all along! This is what we’ve been waiting for.” Time becomes circular, nonlinear, symmetrical. Lacan’s three registers fold in on themselves and the Symbolic is misinterpreted as the Real and the Imaginary disintegrates with the sense of I, myself; William James’ narrator in the stream of consciousness drops out and there is no longer the sense of this is me. Metaphor collapses and the word becomes the thing itself. The internal is interpreted as external, metaphor is interpreted as the literal. And the structure that is an arrangement of these fundamental dimensions of psychical subjectivity in which each of them and everything they contain exist only in relation to the others. This three-dimensional plane turns inward and the three-dimensional figure collapses into a single point, back to its original primary state, absent of a frame of reference, in relation to nothing but itself, surrounded by edges on all sides. We tip over Carson’s edge and move to where the thunderstorms are coming and like Ingmar Bergman’s Karin as “I walk through the wall, you see? I think it’s God who will reveal himself to us,” catching a glimpse of Lacan’s Real through a glass no longer darkly. It is the obvious that remains invisible, until we shout. It is the grotesque in Flannery O’Conner’s prose. It is the limit of our perception.
A dog turns to look at us, a bird flies overhead, a siren passes, grazing our elbow, we hold our breath, and before we know it everyone and every thing pivots toward us, each pair of eyes closing in on us, moving closer, they look, uncanny, and our skin feels permeable, breath all around, as they continue to come closer, and closer, folding in on us, we at the very center of the spinning of the entire world, and at last, the curtain falls and the bricks of the buildings, the way they are stacked, the flashing of the streetlights, and the movement of the crowds they dictate, the blinking of these passers-by, and the way the sun is positioned in the sky, falling discretely on each and every one of these objects, and in this soft gaze, just as such, we notice the light entering our retinas, and the shapes it is carved into deep inside our heads, the shapes whose edges of which mark the edges of the cognitive machinery itself, and we begin to know that indeed we are coming to see it all as if for the very first time.
Can we not feel the periphery of this experience alongside our own fragility, at the very rotation that precedes our escape velocity, just as gravity begins to give way to weightlessness, as our stomachs turn, when we think for a second too long about how we, smaller than dust, are forever falling through an open sky, amidst a great darkness thicker than Vantablack spread out across the ocean floor, circling the sun, while we circle our own axis, while it circles the Milky Way, and indeed everything from the solar systems to the planets to Odysseus’s travels to the hands of clocks all the way down to the electron circling its own nucleus, all of it, is moving is circles? Or when we think about Kafka’s bug, being sucked into the imagination of our own metamorphosis, with our mouths shuttering up and our larynxes going soft, confined to a mutable self, sinking further and further away, unable to utter a single word until we’ve lost any sort of contact with the external world like a small child who has lost the grip of his mother’s hand looking up to find himself alone in Times Square? Or when we wonder about Hume’s cause and effect and know that even with the finest instrument, we cannot prove that smoke means fire because such a conjunction rests merely on the belief in infinitesimal mechanisms sitting between one matter of fact and the next, but that these are in fact imaginary? Or when we meditate on Kant’s mathematical sublime until our bodies seem to evaporate into thin air? Or when we repeat the word escalator a hundred times until it loses all meaning and we are left with a suspicious doubt that everything we speak is based on a fundamental promise of emptiness? Or when we reflect on the fleshy, offpink organ floating inside our heads and we know this is all we are, neurons firing, nothing more than a bunch of fancy organisms that seem to be somewhat conscious that we are, in fact, alive?
Psychosis is the attempt to find a solution to the unsolvable problem of our existence. Of the mind and of the self, of the imaginary, of the symbolic, and of the real. It sits out at the farther edges where things get strange, strange when the limits of our perception get mixed up and truth becomes a proxy for God. It is a manifestation of the general structure that underlies the culturally-constructed normal. In all of our diagnosis and fear of the unknown, fear of the unexplained, we must learn to tolerate the uncertainty of this madness. It is time to transgress the pendulum’s swing back to Bedlam, time to progress to the next rotation. Here, the disorder is not simply a disorder, dangerous and cataclysmic, but it is also an entryway into indescribable experience, a kind of logic that cannot be put into words, an insight and a discovery of the structures of the mind itself. The question then becomes, how do we find the edges of ourselves? Where is it that we go when we go past this edge? And finally, how do we get to the edge and back?
References
Carson, A. (1986). Eros the bittersweet: an essay. Princeton University Press.
Custance, J. (1952). Wisdom, madness, and folly: The philosophy of a lunatic. Pellegrini & Cudahy Eigen, M. (2018). The psychotic core. Routledge.
Landis, C. (1964). Varieties of psychopathological experience. Holt, Rinehart & Winston.
