That’s How The Light Gets In
The following article was published in September 2019, Journal of Humanistic Psychology, Volume 59, No. 5. Published with permission from the Journal of Humanistic Psychology.
Abstract
Out of the broad range of possible causes and helpful responses to extreme states psychosis, this paper focuses on the environmental and psychological aspects, primarily from a contemplative and Windhorse therapeutic perspective. While understanding that the psychological basis for spiritual development is the same for extreme states, the helpful responses presented are based on the principles that all beings are fundamentally sane and inseparable from their environment. This discussion concludes with the recognition that each person in an extreme state, no matter how confused, has the very real potential of transforming this life disruption into a highly individual path of discovering and manifesting their own unique, intrinsic sanity.
The purpose of this paper is to discuss two questions: First, what are the causes and experiences of extreme state psychosis, and secondly, how does understanding this inform how we might be helpful? Though incorporating Western psychological views, what follows reflects the orientation of Tibetan Buddhist inspired contemplative psychotherapy, and specifically my work within the Windhorse approach (Podvoll, 2003). My personal experiences of mental health challenges are also formative, as is my meditation practice, which has been active for longer than I have been working in psychology.
It is not within the scope of this discussion to explore all of what I understand to be causes. Instead, we’ll consider two areas, environmental and psychological causes, which most specifically relate to our later discussion of how to be helpful to someone in an extreme state.
Environmental factors shape us from birth, and may combine and persist as powerful conditions for generating extreme states. Environment begins with one’s family and includes all dimensions of one’s local and greater communities, shaped by the times in which we live. For instance, from a global perspective of 21st-century life, our collective incapacity to live in a way that is environmentally sustainable is a radical de-synchronization, arguably moving us toward the destruction of our ability to survive as a species. As an atmospheric presence for some of the more sensitive people I know, this is an implacable undertow of dissonance, rendering day-to-day life more grotesquely senseless than arranging deck chairs on the Titanic.
Furthermore, environment is typically a significant factor once an extreme state occurs. In the presence of a person, perhaps a loved one, going through this experience, most people won’t likely know how to be helpful. Fortunately, many people’s environments will respond with skill and gentleness. However, in uncertainty, particularly in combination with the most readily available resources of institutional mental health, other environments may respond with some kind of aggressive intervention. Included in this is often a spiritual death sentence: a conclusion that the person is fundamentally damaged and always will be. The environment is now at least compounding the person’s difficulty, and possibly creating a synergistic exacerbation of the original causes. If not interrupted, the environment will be making the entire situation much more intractably complex.
Fundamental to understanding the psychological causes of extreme states is the recognition that life as it appears to us in consensus reality is a generalized approximation in which we find a relatively narrow, flickering bandwidth of common agreement. However limited, consensus reality is not just useful, but is a critical factor in healthful living. It allows us to take care of ourselves and each other, to work, exchange money, and generate agreements that function to one degree or another. This also allows us to express our basic sanity, communicating and being in community, all essential elements for happiness and survival. But taking the perspective of Buddhism, mystical spirituality throughout the ages, and more recently of quantum mechanics, there is a more fundamental level of reality that isn’t generally present in our day-to-day awareness. From that deeper perspective, everything around us is starkly impermanent, comprised of overlapping systems of dynamic processes. Without exception, all phenomena are in a highly fluid state of birth, development, decay, and death. There are actually no things, only processes. Looking at the nature of the materials that make up what we see around us, including ourselves, it is all composed of energy, space, light, and forces of attraction and repulsion.
The Buddhist concept of ego similarly points to the non-existence of a continuous self. Instead, “I” is a habitual construct of mind, a self-perpetuating illusion, not actually existing in a continuous manner. While recognizing our existence on a relative level as individual beings, from this perspective we are a unified field in which all are completely interconnected: illusory individuals comprising one big-mind, with no existence apart from that inseparable whole. Likewise, we are inseparable from our environments.
Personally, meditation immediately began to consciously reveal this egoless, impermanent state of life, which ironically, helped me to relax. Through years of self-medication and compulsive high-energy work and play, I had actively avoided awareness of this level of reality, which nearly killed me. In some way, the avoidance helped me feel like I existed, relentlessly searching for something to save me from my fears and discomfort. Simply seeing and accepting such groundlessness was an unbelievable, life-changing relief, allowing my fears and compulsions to begin relaxing.
From the perspective of psychological causes, what I have just described is a dynamic for many people who are experiencing, or are vulnerable to, extreme states. As stated in Tibetan Buddhist Medicine and Psychiatry:
“Realization of the inevitable facts of decay and death, of impermanence in all aspects of life, can be devastating,” and, “Herein lies the crucial point. The psychological basis of insanity is the same basis for enlightenment. If accepted, comprehended, and skillfully worked with, it is the key to liberation. If not, because the realization is still there subconsciously, it is the cause of denial, repression, and ultimately mental illness.”
While this dynamic may cause some to fall painfully and helplessly out of consensus reality, for others it may actually produce the bliss of a “god-intoxicated” mast (pronounced “must”). Described by Maher Baba, “Masts are totally different from ordinary mad persons. Although to the casual observer they might seem to be like each other, they are utterly dissimilar in their intrinsic nature and significance” (Donkin, 1948).
Disorganizing torture for some, disorganizing bliss for the mast, when related to with discipline and training, this sensitivity forms the basis for spiritual development. In Buddhist writings as well as in the literature of all mystical traditions, the sublime finds its evanescent expression. Stated by Rumi:
“Out beyond ideas of wrong-doing and right-doing,
There is a field.
I’ll meet you there ...
When the soul lies down in that grass,
The world is too full to talk about
Ideas, language, even the phrase
Each other
Doesn’t make any sense ”
Though extreme-states and mysticism may share common ground, a diverging point was succinctly stated by R.D. Laing, “Mystics and schizophrenics find themselves in the same ocean, but the mystics swim whereas the schizophrenics drown” (Capra, 2015). Interestingly, Joanne Greenberg, author of I Never Promised You a Rose Garden and a genuine voice of authority on extreme states and recovery, also finds the image of drowning to be particularly descriptive of such a predicament’s confusion and desperation—so much so that it’s the central theme of her “favorite joke about mental illness” (J. Greenberg, personal correspondence, April, 2017).
There are as many ways for a person to “drown” as there are people who don’t know how to “swim.” But generally, as conditions for extreme-states converge and ripen, perhaps catalyzed by traumatic experiences, a person becomes more absorbed into dream-like states, and mind becomes desynchronized from the grounding connection to one’s body and senses (Fortuna, 1994). Extreme fear, abject uncertainty, with untethered mind accelerating free from restraint, one is no longer familiar with oneself; common reference points and consensus reality have become unreliable. One’s attempts to find a continuous sense of self, the habitual reflex of maintaining one’s sense of “I,” may now get attached to magical beings and powers so that one feels godlike. Or, in this dreamscape, some become tormented and pursued by demons or aliens. As the contrast with consensus reality is too painful to bear, awareness at that level will tend to propel one further away from being present and in one’s body.
As we consider the vulnerability of a person in this state, our second question comes into focus: “How does understanding causes and experience inform how we might be helpful?” While bearing in mind that there are as many ways to help a person learn to swim as there are swimmers, listed below are four Windhorse principles (Knapp, 2008) and additional thoughts for understanding how to be with a person in this situation.
The first principle is: People are fundamentally sane and healthy, thus mental confusion exists and functions in a secondary position (Trungpa, 2005). This reflects both the view and experience one realizes through contemplative practice. Practice further reveals how our minds are made of the same stuff; each person’s differences being more about the evolution of one’s natural disposition within the conditions of life, in combination with the degree that mind is in balance. Reminiscent of Thich Nhat Hanh’s poem, Please Call Me By My True Names (Hanh, 1997), in over thirty years of knowing people in extreme states, I’ve not encountered a thought, emotion, or process in others that I don’t recognize as part of my own mind. The upshot of all of this is that when we are familiar with mind and confident in fundamental sanity, we are less afraid of our own mind and of extreme states in others.
Confidently regarding a person as being fundamentally sane, we naturally communicate that attitude and respect in conscious and unconscious ways. Thus sanity, and one’s islands of clarity (Podvoll, 2003), are invited into relationship from the outset. Also critical to understand is one’s history of sanity. A person’s past experience of health contains many of the keys to how one may reconnect with functional life. Having this in the conversation brings a sense of fresh start and re-orientation to experiences of confidence and discipline (Podvoll, 1983).
The second principle is: We are inseparable from our environment. Because of this, the creation of a sane environment rouses the fundamental healthiness of everyone involved (Trungpa, 2005). In order to understand how we create these environments of sanity, it’s necessary to say something about the Windhorse approach’s varied use of mindfulness disciplines for therapeutic purposes.
Fundamentally, the principles we’re discussing are all expressions of Buddhism, and can be distilled into some basic elements: appreciation for oneself and the sacredness of life, honest communication, mutually respectful relationships, acceptance of others, and nurturing wholesome domestic environments—all aspects of healthy living. If a Windhorse clinician is on a path of working with their own life in this manner, then when in relationship with another person, that kind of gentle sanity is contagious. Our primary dyadic clinical practice, Basic Attendance, “requires that one use everything of who one is, and how one relates to the world, basically bringing who one is to the relationship with other”(Podvoll, 2003). A form of meditation in action, Basic Attendance is practiced in the context of everyday life in relationship with the client: an “interpersonal contemplative method” attuned to the present moment, combining one’s clinical sensibilities with environmental awareness (Emery, 2013; DiGiacomo & Herrick, 2007; Fortuna, 2001). Given that our relationships with a client occur primarily within the context of one form of basic attendance or another, though experienced as ordinary life activity, the client is participating in an interpersonal contemplative practice from the moment they begin with us. And relationship, nurtured within basic attendance, is the primary glue that holds our environments together.
Another Windhorse interpersonal contemplative form is the whole-person environment we create: A mindful therapeutic environment. Based on ancient concepts of ceremonial healing circles and intentionally created mandalas for beneficial purposes, these environments are intended to transmute confused patterns of life into clarity and harmony (Freemantle, 2001). Extreme states arise out of the combined conditions of a person’s physical, social, and mental life; therefore, we create an individually tailored therapeutic environment for the whole person, including her family. We invite the person back to a grounded relationship with her body and senses, open communication and relationships with those around her, and to the wakeful potential of her own mind. To accomplish this, especially while in the acute phase of an extreme state, it is helpful for one to be in the company of people with relatively stable minds.
Comprised of the physical, social, and mental/spiritual field of the entire activity of a therapeutic team (body, speech, and mind in Buddhist terminology), a mindful therapeutic environment includes the entirety of the team activity: the household, relationships, the complementary roles designed to create broad-spectrum functioning and awareness, and the mind-space of the client, family, and staff. The natural evolution of this environment generates strong unseen connections we know as the dynamics, deep power, and self-regulation of groups, families, and systems. With these synergistic features of capacity, cohesion, and learning, a mindful therapeutic environment can adapt to the constantly changing needs of a recovery path. As such, this takes the interpersonal contemplative method to an exponentially more dynamic group form, further potentiating the contagiousness of sanity, and allowing us to welcome and hold a wide variety of extreme state experiences: those of our clients, our families, and our own. For many of us, it takes just such a critical mass of focused, resilient health to invite, effect, and sustain necessary change.
One vital element in such an environment is that the clinicians involved are on a path of mutual recovery, working with the synchronization of their own body and minds. Instead of, “I’m well, you’re sick, and we’re going to fix you,” all of us being on a path engenders humility, curiosity, and mutuality.
Contemplative practice also opens up clinicians to the phenomenon of exchange: Directly experiencing another person’s mind and physical states (Knapp & Gipple, 2015; Wegela, 1996). When in the company of someone in an extreme state, this kind of resonance (Siegal, 2010) may sometimes produce illuminating but uncomfortable experiences. For example, when my own mild, dystonic suicidal inclinations become warmly inviting, I am usually in the presence of someone whose suicidality is heightened. Exchange is easy to miss, as often we may only feel a heightened or slightly altered sense of our own energy styles and thoughts. But invariably, it offers information about those around us, as well as reliably invoking our sense of compassion as we tune into another person’s experience.
Fortunately, exchange is reciprocal, so the person in extreme states is also experiencing healthy aspects of the stable minds in the environment. For instance, healthy self-love and acceptance is a key realization of contemplative practice: we may feel bad, but that doesn’t mean we are bad. And we do hurtful and confusing things to ourselves and others, not because we’re bad, but because we’re human. Such self-love in an environment is powerful and contagious, experienced through exchange with everyone involved.
Though many of our clinicians are Buddhist or meditators, it is by no means required. Some kind of contemplative practice is highly encouraged, which, for instance, could include Yoga, Tai Chi, martial arts, or centering prayer. In my experience, people who don’t have a genuine connection to practice are not compellingly drawn to this work, nor do they tend to stick with it. On the other hand, many of our senior people have been doing this work for upwards of fifteen years, some twenty-five years and longer. For those of us who have sustained our connection, we fully know the power of it to enhance our health, to be of benefit to others, and to create an often uncomfortable but rich path of mutual recovery.
Our clients also do not need to be Buddhist or meditators. But recognizing spirituality as being a significant factor in recovery, we attempt to always create an inviting, interfaith (or non-faith) atmosphere. Similar to clinicians who don’t have a meditation practice, clients who don’t resonate with the interpersonal contemplative form of Basic Attendance also tend to find it difficult to sustain a connection to us.
Whether or not we suggest individual meditation practice to a client depends on a number of factors, including primarily if someone is actually interested. After having extensive experience with the surprising and sometimes unpredictable power of mindfulness practice in the clinical setting, we are careful if, how, and when practices might be suggested. This typically hinges around whether we think the effect will create more stability and groundedness, or whether it will exacerbate tendencies toward dis-connection from ordinary life and relationships, and an increase in one’s speed of mind. As is frequently the case, extreme states reflect a lack of connection to earth. Recognizing this, through basic attendance we nurture a more substantial relationship to the wholesomeness of one’s domestic ground, thus helping to restore balance and a connection to the earthy, reliable aspects of healthy life (Akong, 2005). Once this balance is reasonably stable, we often inquire if one is interested in exploring a mindfulness practice. This can be a form of mindfulness-awareness meditation, common in Buddhism, but typically in the beginning we may suggest body scans or guided breath work, done in the context of a psychotherapy session or basic attendance shift. Yoga and tai chi are also reliable alternatives, and as they’re frequently taught in group settings, they expand one’s community at the same time.
The third principle is: Recovery is the path of discovering and synchronizing with one’s own health and sanity. This is about starting where you are. And though there may be people in your life serving as sane reference points, genuine recovery is not about becoming someone else’s version of you.
Though we may not be able to control much of what occurs in our lives, we have a lot of choice in how we respond. Offering a person healthy relationships and attractive life choices creates a gentle invitation back to one’s senses, passions, and life force. Coming back to earth allows one to begin functioning again in consensus reality. This opens up a path into so much of what is healthy in our communal activity: the further engaging of responsibility, expanding community, and relaxing our minds.
Contemplative practice also engenders confidence in the possibility of path. For myself, this confidence began with the experience of a nearly complete life tear-down in my mid-20s. As a child, I had periods of extreme fear and suffocating paranoia but thought that had mostly resolved. Then, as young a businessman off to a roaring start, the world as I’d known it—my sense of self, pride, pattern of life, and finances—succumbed to impermanence in a brutal way. I was dying to myself and, as if looking in a mirror, some of my more dangerous business associates were literally threatening to kill me. Though not actually psychotic, I was having spontaneous out-of-body experiences, paralyzing depression, and was still in a daily practice of poly-drug intoxication. I knew that I’d been looking for how I might die, pushing various edges and envelopes for years. And now here it was: it wasn’t safe, pretty, or particularly under control. However, intertwined in the death throes of my shattered life were luminous gaps where unconditional brilliant joy created a sense of buoyancy and hope; strangely but unmistakably, I finally felt at home in my life.
It was in this opening, this gap in the familiar, conceptual framework of my life, that new books, spiritual teachings, meditation, and Buddhism appeared. For the first time, I was meeting others who thought like me. Out of the chaos and rubble of the tear down, the parts of me that were actually not aligned with my more basic nature fell away. In its place, I was discovering and synchronizing with my basic sanity, spurring me onto a path that is still vividly alive and unpredictable all these years later. Subsequently, when I meet with someone who is in the depths of some kind of extreme state, I never lose track of the fact that some people don’t survive this process. But more fundamentally, I have complete confidence that the experiences of tear-downs and massive gaps in life as one knows it have the possibility of being the creative chaos of a vulnerable, early-stage path.
It is well known that many people in extreme states feel unspeakably lonely—their inner worlds unknown to others and cut off from contact with people who are willing to just be with them. As a therapist, to simply feel another’s pain and predicament without looking away and without trying to change them is often a meeting point where genuine communication can occur. This is so much easier said than done, as much of the time we are trying to cure, rescue, or pretend that we are not two human beings in a very real relationship. Not surprisingly, when genuine connection happens, it typically rouses a sense of spirit and buoyancy for both the therapist and client, as the courage to simply be with one’s experience is now part of the relationship. Taking this to its root, the mutual recognition of our common ground of death, though not necessarily spoken, is central to the healing process (Trungpa, 2005). In my experience, such stark and honest reality is almost always in the mix when in relationship with people in extreme states. This is likely why I have been inspired to work in that territory for my entire career.
The fourth and last principle is: No matter how disturbed a mind has become, recovery is possible. This begs the question, recovery from what? The “what,” is “drowning”: when the conditions of life have become confused to the degree that one is unable to satisfactorily maintain life in consensus reality; when realms of magic and power become more real and compelling than our body and senses; when we cease being in reciprocal relationships and community; and when one’s mind confuses dream states for waking. In this state, again quoting Joanne Greenberg, “a person is so overwhelmed in confusion, that they’re not able to grapple with the problems that everyone else gets to deal with, like relationships and work and living your own life” (Greenberg, 2017).
But “swimming” does not mean becoming somebody else’s version of normal. Thankfully, there’s infinite variation in how healthy life can look in this world. By my standards, one of the most sane people I have ever known, a woman whose mother and grandmother both lived with extreme states, experienced almost constant audio hallucinations for the many years I knew her. But her deep self-acceptance, relaxation, and wisdom of life I still admire. She’s also the only person I’ve ever known who fully got my sense of humor. In my truth, I would not trade her life for that of someone who has all the outer trappings of success, but who has not truly seen, accepted, and come to peace with herself.
Tibetan Buddhism describes sanity as a path: the intention to live with one’s body and mind synchronized, with ever-increasing awareness of the nature of one’s mind, in harmony with the way things appear and with the way they actually are (Thrangu, 2016).
More elegantly expressed: sanity is the continual process of waking up to our basic nature, with the intention of helping every other being to do the same. This recognizes the unlimited variations for how life might be lived: being fully oneself without shame, with compassion for oneself and others, all arising from wisdom at the deepest levels of reality.
In a song that took him ten years to write, singer-songwriter Leonard Cohen, a Zen Buddhist monk very familiar with creative dark uncertainty, spoke to path and self-acceptance—not as who we think we should have been, but with confidence in who we genuinely are:
“Ring the bells that still can ring
Forget your perfect offering
There’s a crack in everything
That’s how the light gets in”
This “crack” refers to gaps in our minds as well as in our familiar life: continually ripe with destructive and creative potential, moment-to-moment as well as in longer cycles. For better or worse, extreme states are a gap, and how one’s ensuing path works out depends on an unfathomable range of variables. For those of us who are in positions of being helpful, confidence in these gaps’ potential to catalyze highly individual paths of sanity should never be forgotten—for the person, their family, ourselves, and for our collective human consciousness.
References
Akong, R. (2005). Restoring the balance, sharing Tibetan wisdom. Eskdalemuir Dumfriesshire, Scotland: Dzalendara Publishing.
Capra, F. (2015). Author’s personal notes taken at the R.D. Laing in the 21st Century Symposium. Esalen Institute, Big Sur, CA.
Clifford, T. (1984). Tibetan buddhist medicine and psychiatry, the diamond healing. York Beach, ME: Weiser.
Cohen, L. (1992). Anthem. On The Future (CD). New York, NY: Columbia Records.
DiGiacamo, A. M., & Herrick, M. (2007). Beyond psychiatry: The windhorse project. Berlin, Germany: Peer Lehman Publishing.
Donkin, W. (2001). The wayfarers: Meher Baba with the god intoxicated. Myrtle Beach, SC: Sheriar.
Emery, K. (2013). Basic attendance: full presence caregiving the fruition of mindfulness. Natural transitions magazine, vol. 3, issue #1, 6-8.
Fremantle, F. (2001). Luminous emptiness, understanding the Tibetan book of the dead. Boston, MA: Shambhala.
Fortuna, J. (1994). The windhorse project: recovering from psychosis at home. Journal of contemplative psychotherapy. Volume 9, 73-96. Boulder,
CO: The Naropa Institute.
— (2001) Contemplative practice at windhorse associates. Unpublished paper.
Greenberg, J. (2006) Author’s personal notes taken at the international society for psychological and social approaches to psychosis
conference, Austen Riggs, Stockbridge, MA.
Hanh, Thich Nhat. (1997, summer). Earth saint thich nhat hanh. Earth light magazine, issue #26,16-17.
Knapp, C. (2008). Windhorse therapy: creating environments that arouse the energy of health and sanity. In Kaklausdas, F., Nimanheminda,
S., Hoffman, L., Jack, M. (Eds.), Brilliant sanity, Buddhist approaches to psychotherapy, 275-298. Colorado Springs, CO: University of the Rockies Press.
Knapp, C. & Gipple, J. (2015). Group dynamics within therapeutic environments. GROUP: the journal of the eastern group psychotherapy society,
39(3), 199-240. Huntington Station, NY.
Podvoll, E. (1983). History of sanity. Journal of contemplative psychotherapy. Volume 2. 11-32. Boulder, CO: The Naropa Institute.
— (2003). Recovering sanity. Boston, MA: Shambhala.
Rumi, J. (2004). The essential Rumi. Barks, C. (Translator). New York, NY: HarperOne.
Siegal, D. (2010). The mindful therapist. New York, NY: W.W. Norton.
Thrangu, K. (2011). Vivid Awareness. Boston, MA: Shambhala.
Trungpa, C. (2005). Becoming a full human being. Gimian, C. (Ed). The sanity we are born with. Boston, MA: Shambala.
— (2005). Creating an environment of sanity. Gimian, C. (Ed). The sanity we are born with. Boston, MA: Shambala.
— (2005). Attitude toward death in the healer-patient relationship. Gimian, C. (Ed). The sanity we are born with. Boston, MA:
Shambala.
Wegela, K. (1996). How to be a help instead of a nuisance. Boston, MA: Shambhala.