TREATMENT APPROACHES The following excerpt is from John Nelson's book, Healing the Split: Integrating Spirit into our Understanding of the Mentally Ill (1994). Nelson is a psychiatrist who has integrated traditional and nontraditional approaches. Our students rave about his book, so you might want to take a look at it. In the piece below, Nelson discusses how to assess and how to work with altered states of consciousness (ASC) which have become psychotic.
ASSESSING AN ACUTE PSYCHOTIC ASC With the exception of people in the early stages of mania, most individuals who enter a psychotic ASC for the first time are frightened and confused about their shift in consciousness, and many seek professional help. At that point, there is no way of knowing if the ASC will take a malignant or benign turn. The way a healer responds is crucial in determining how patients view themselves, their ASC, and future helpers. If their caretakers are kind and empathic and their treatment is tailored to the specific characteristics of their ASC, there is an excellent chance that regression can be arrested and spiritual growth resumed. This is true no matter what the source of the shift in consciousness or the level of regression. Like the antipsychiatrists of the 1960s, some transpersonal therapists reject the very idea of diagnosis, believing that it restricts their ability to relate to a patient as a whole person. They instead prefer a "wellness" orientation that may lead them to misapply "consciousness raising" techniques to everyone who walks through the consulting-room door. This is little different from those orthodox psychiatrists who believe that all psychotic ASCs can be quickly treated with the same class of medicines. Because spiritual growth cannot be hastened by short-circuiting the ego, the potential for harm in the name of treatment can be as great on the transpersonal side as it is on the orthodox side. An artful healer is alert to nuance as he tries to distinguish malignant from benign regressions. Although he regards his intuition as equal to objective signs and symptoms as he makes a diagnosis, he also collects the following information about any acute ASC: • • • • • • •
the person's current level of regression the duration of the regressive process whether the ASC began insidiously or abruptly the level at which the patient operated before regressing what, if any, events precipitated the change what meaning the individual assigns to those events what previous experience the person has had with ASCs, psychotic or
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otherwise how the person feels about his shift in consciousness- frightened, enlightened, confused, fascinated, and so forth how the person feels about himself against the inflowing energies of the Ground-paranoia, denial, grandiosity, religiosity, occult beliefs, simple bewilderment, denial that anything is wrong how firmly attached the person is to his delusions (for instance, can he say, "I know this sounds crazy, but…") the presence or absence of hallucinations, their character, and what beliefs the person has formed around them the presence or absence of paranormal manifestations-telepathy, precognitions - and how much control he exerts over them the presence or absence of Kundalini phenomena, and the locations of any physical blockages to this energy the response of the person's spouse, friends, and family to the ASC
After the healer gains an appreciation of the state of consciousness of his patient, he gathers information about his patient's personal history. This usually requires interviewing the family and includes the following information: • • • • • • • •
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the highest developmental level the person has ever attained his habitual modes of defending himself the nature and quality of his relationships with others the stability of the person's ego during past stressful life events the occurrence of similar psychotic ASCs in any blood relative, and the outcome of these recent or past involvement in spiritual practice or religion recent or past use of psychedelic medicines or other drugs circumstances of the person's conception, his mother's experience or pregnancy, difficulties during labor, and the child's adaptation during infancy the person's position in the family, how family members express love and disapproval, and their expectations of him throughout life
TREATING AN ACUTE PSYCHOTIC ASC Getting to know someone this well takes time and effort. It also requires rethinking the idea that all acute psychotic ASCs are medical emergencies. This misguided notion has led to the practice of rapid neuroleptization--injecting large doses of antipsychotic medicines hourly until all evidence of the ASC has been stamped out. There is no evidence that this leads to a better long-term outcome, and there is at least some reason to believe that it makes matters worse. Not only does it impede attending to the nuances of the ASC, but it sends a clear message to the patient that his experience is of no value, no matter how reparative it may be on a psychological level.
Ideally, during the early stages of a psychotic ASC antipsychotic medications are appropriate under only three circumstances: (1) when there is obvious danger of suicide or violence to others in the environment (in which case the judicious use of antipsychotic medicines is preferable to physical restraints); (2) when a person defends himself through paranoia (unchecked paranoid delusions can lead to suicide or assaultiveness, and so require direct intervention; in this case, measured doses of neuroleptics can reduce fearful vigilance and guardedness to the point where the person is receptive to psychological methods); (3) when a patient who has had previous psychotic ASCs is in extreme distress, feels unable to cope, and requests relief from the disturbing mental effects. For the many cases that do not meet these three criteria, it is better to treat acute psychotic ASCs not as medical emergencies but as spiritual emergencies, until proven otherwise. This tactic is labor-intensive, but likely to save valuable labor and hospital space in the long run. The best way to handle an acute psychotic crisis is to provide a quiet retreat away from the stressors that precipitated it. For instance, if the healer determines that the patient's family is a source of ongoing stress, he limits the patient's contacts with them and substitutes continuous attention by people trained to provide empathy, support, and soothing. They should keep records of what the patient talks about, and what feelings come to the surface during the acute phase of his psychosis. If the patient becomes uncomfortably agitated or restless, he is probably overstimulated. A quiet, secluded environment may be all that is necessary to quell anxious arousal. There is reason to believe that quiet rooms of certain colors, especially pink, have sedating effects on hyperaroused people. While in seclusion, a person may find that memories or feelings arise that he wishes to share. A staff member should always be available for this purpose. For a person in a psychotic ASC, being left alone in a secluded room with no one available to attend to his physical or emotional needs can turn into a terrifying nightmare. The legacy of the psychedelic-infused rock concerts of the late 1960s provides us with much useful information about dealing with panic reactions that arise during psychotic ASCs. People experiencing bad LSD trips--a special form of spiritual emergency--were steered by their sympathetic peers into "freak-out stations" that offered asylum for people whose chemical indiscretions created untoward openings to the Ground. Although neuroleptic medicines--antidotes for LSD trips as well as schizophrenic ones--were readily available, the young counterculture physicians found that they achieved better results by providing a dimly lit environment, speaking in a soft voice, and encouraging a passive "flowing with" the experience rather than forcible resistance. When nueroleptics were given, they effectively slammed the door on the bad trip, but they also left the recipient fearful of similar experiences, prone to unpleasant flashbacks, and depressed for days. A long-abandoned but harmlessly soothing technique for quieting agitated people in acute psychotic ASCs is to wrap them in cool wet-sheet packs. This tactic was used to good effect until about thirty years ago, when such laborintensive methods were replaced by quick injections of tranquilizing medicine.
Thought by some to be a coercive form of "bughouse torture," the procedure is actually quite pleasant and reassuring and is well known to health-spa habitues, who happily pay for its relaxing effects. Following an explanation of the procedure, the agitated patient is wrapped in cool wet sheets so that he is comfortable but immobilized, like a swaddled infant. Once wrapped, the patient initially feels cold, but warming is rapid due to circulatory changes. This is usually followed by a welcome respite from an escalating cycle of arousal and anxiety. A staff member sits with the patient, who is encouraged to express whatever is on his mind. The procedure lasts for up to two hours, but may be stopped sooner at the patient's request. I once volunteered to experience this technique, which I found to be both deeply relaxing and evocative of vivid memories from childhood. This method could be combined with repetitive rocking movements and soothing music, which could further reduce the need for more intrusive restraints. Because it is a greater error to medicate a spiritual emergency out of existence than to temporarily delay treating a malignantly regressive ASC in a safe setting, the least intrusive responses should be tried first. After a medicine-free observation period that may last from several hours to several days, the artful healer is in a position to determine if he is confronted with an authentic spiritual emergency or a severe psychotic regression that requires physically oriented treatment. The likely outcome of a drug-free observation period conducted by an empathic staff in a soothing environment will be that about one-fourth of those in their first acute psychotic ASC will spontaneously return to the ordinary state of consciousness within a few days without chemical intervention. This is contrary to the common wisdom that all acute psychotic ASCs turn chronic unless promptly squelched with antipsychotic medicines. When a patient spontaneously returns to the consensual state of consciousness, it is an excellent prognostic sign that he is ready to engage in intensive psychotherapy to uncover the underlying conflicts and growth impediments that triggered the regression. Of the remaining three-fourths whose psychotic ASCs persist, there will be a significant number who meet the criteria for spiritual emergency. These may be expected to gradually recover with further intensive non-drug treatment. The remainder--somewhat more than half of any original sample of acute psychotics-- will be caught up in a regression so intractable that they require physical means to arrest the process before less intrusive methods may be attempted. In any case, the goal of any treatment for acute psychotic ASCs should be restoration of the patient to a condition in which spiritual growth can resume. For some this means surrendering the ego; for others, fortifying it. During spiritual emergencies, for instance, restoration means allowing the process to unfold in a protective and supportive environment with techniques designed to integrate the inflowing energies of the Ground and free the psyche for further expansion. In other words, therapy aims at moving the patient form uncontrolled spiritual emergency to controlled spiritual emergence. For people in schizophrenic ASCs, restoration means arresting regression with the artful
use of medicines, then engaging the person in treatments designed to promote third-chakra skills, along with supportive therapy to strengthen the ego. For extreme manic ASCs, restoration means quelling the escalating hyperarousal with lithium, then helping promote a more gradual expansion into higher-chakra consciousness in order to build tolerance for future openings to the Ground. For borderlines prone to psychotic ASCs, restoration means longterm, intensive psychotherapy in which the therapist provides a reliable surrogate ego, which is slowly grafted onto the patient's self. For MPD victims, restoration means intensive, long-term psychotherapy of a specialized sort in which alter personalities enter into a dialogue that gradually dissolves their psychic boundaries and allows a larger self to emerge, inclusive of each of the alters. (Treatment strategies for MPD were presented at some length in chapter 3.) ADDITIONAL REFERENCES: Nelson, J. (1994). Healing the Split: Integrating Spirit into our Understanding of the Mentally Ill. Albany, NY: SUNY Press.