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Down the Rabbit Hole
Paul Kiritsis, PsyD Clinical Psychology, DPhil., MA (History)


Psychosis: Moving Towards a More Holistic Understanding of the Phenomenon

Paul Kiritsis - Friday, January 10, 2014

In the early 1900s individuals suffering from paranoid schizophrenia, brain damage, alcoholism with psychotic features, and severe dissociative disorders would have been locked up in high security wards in some obscure region of mental asylums where they could not be seen or heard by visiting relatives and authorities. One cannot imagine the fear if not outright terror that these poor souls would have suffered at the hands of administrative officers and wardens that were supposed to be sympathetic to their cause. For the most part life in the asylum would have taken on the guise of a harrowing circus characterized by repetitive tasks and activities, repetitive entertainment, and the same insipid flavour of repetitive thoughts. In fact reality would have resembled a broken record replaying the same musical sequence. And as we know, the musical sequence for most psychotics would have been an unrelenting repetition of delusional beliefs. From our examination of the archives, it becomes blatantly obvious that most are either persecutory or exalted in nature. Some psychotic patients thought they were innocent victims of conspiracies devised by their immediate relatives; others thought they were Jesus Christ, Joan of Arc, or the Biblical embodiment of the diabolical mind in Satan; and others still believed it was everyone else’s purpose in life to sabotage them and make their life a living hell. Natural, then, would be an examination attempting to pinpoint the exact origin of delusional beliefs that cannot hold up to empirical scrutiny.  

First and foremost we should probably define delusion. Delusions are a set of established beliefs about the world contradicting the logical and empirically valid ones of the collective ‘norm’. They do not stack up well against consensual reality as experienced by the majority and hence stick out like sore thumbs and ‘ugly ducklings’. Contrary to the established biological language of our limes I may choose to jettison the fact that oxygen and water are prerequisites for the evolution of life and indulge in serious fantasies about a lost tribe of albino Homo sapiens that inhabit the dark side of the moon. Or better still, I may reject paleontological evidence and common sense that precludes the existence of green unicorns with the double-wings of dragonflies and believe that I was reared by such a fantastical creature in the Princess Margaret Rose Caves. Obviously the most likely consequence of externalizing such preposterous beliefs would be to be labelled ‘mad’, ‘crazy’, or ‘insane’, or worse still, lose a horde of valuable, nurturing empathic relationships.      

How these form depends on multiple factors, none more critical than a cluster of atypical sensory experiences that mysteriously emerge into consciousness without the activation of the five physical senses. They can be visual, auditory, olfactory, gustatory, or tactile and are not accessible to others. Dynamic psychiatry labels these unusual phenomena hallucinations, a word with pejorative connotations because it suggests that these experiences are imagined and ‘unreal’. But from what we know and from what has been described in the psychological and psychiatric literature, patients who experience hallucinations state explicitly that they are real, if not more real, than other stimuli that are mutually detected. Hallucinatory ‘voices’ and ‘visions’ do not differ in tone, depth, and amplitude from stimuli consensually agreed as originating from the shared environment; in some cases psychotic patients have described them as being even more vivid and colourful. This makes them every bit as pivotal in shaping the perceptions of the inner world as the meaningful contrivances that derive from the external interactive field. Thus, the picture that emerges is that ‘psychosis’ straddles the line between normally unconscious aspects of the mind (i.e. personal affects, feelings, ideas and impersonal archetypal material) turned conscious and a personal awareness struggling to interpret these personified intrusions in light of signals coming from the social environment. In most cases the result of prolonged confluence isn’t advantageous by any stretch of the imagination; the patients undergo a negative transformation through a personified pastiche of symbolic truths, self-deceptions, and illusions about oneself and the world in which we live. Chaos runs rampant and wreaks havoc with the inner mental processes.

So what actually happens during psychotic episodes is that the patient is forced into a premature confrontation with the contents of the unconscious. Naturally the patient has an acquired short-sightedness when it comes to correctly interpreting these irruptions; he or she is so mesmerized by the humane quality of their internal ‘voices’ and ‘visions’, the allegations they make, their third-person conversations, and their third-person critiques of the patient’s life that seeing through the personified veneer to the true ‘form ‘and correctly decoding its purpose is all but impossible. A young male teenager plagued by ‘voices’ that continuously draw attention to fellatio, masturbation, sex, sadism, and sadomasochistic activities may have repressed his libido and sexual instinct to an abnormal extent. A middle-aged woman who has mooched her way through life conning and stealing from others and committing unlawful acts for the monetary and selfish accumulation of material wealth might discover that her inner world is being haunted by an Osiris-like figure who burns and judges. Alternatively, a devout Roman Catholic father attempting to reconcile spirituality and the higher values of a moral life with sedimentary routines as a promiscuous lover might hear the voices of demons telling him that he should go out and “use and abuse everyone under the sun” for his sexual gratification.

Joining these repressed and dissociated contents paradigmatic of the instinct and sexual drives of the personal unconscious are both altruistic and benevolent values of the higher unconscious and transpersonal effusions from the collective unconscious. Their primary function is to refurbish a prevailing sense of orderliness and lawfulness in the cosmos, an inherent belief that life is well worth the heartache and emotional highs and lows that was lost when the individual began a precipitous withdrawal from the social environment. Quite frequently, individuals will be shown signs and symbols rife with literal, historical, mythological, and cosmic significance. Might the purpose of such be to illuminate the creative powers of the universe, its teleological processes, and the inventive hierarchical manner in which they manifest? Whatever the case the significance of what emerges cannot be under rug swept by the mechanists and reductionists of our time, for the personal revelations the symbols have offered up have been catalytic in the regeneration of personal willpower on so many occasions. Further still they have generated the reinstatement of purpose and ambition within individuals who have literally hit rock bottom on the socio-political ladder (i.e. the criminally insane). As Jung would have no doubt asserted, a steep bend, pull, or gravitation towards one psychic reality will activate and manifest its natural counterpart. At the core of amoral decadence is the seed of ethical and honourable piety, and the dichotomy of the psychotic schisms proves it!

The problem for most psychotics is that the narrowing of their consciousness, in effect the tendency to abnormally fixate and elaborate on delusionary crumbs, comes at a very heavy price. They become pathologically obsessed and possessed by delusionary content to such an augmented degree that the identification and interpretation of symbolic and meaningful content is all but lost. Hence the work of any clinician working with psychotics should incorporate the working through and assimilation of symbolic figures within the context that they present themselves. Acting with the greatest sympathy and respect for constitution of the fragmented personality, clinicians should also modify their psychotherapeutic techniques of choice as to dissolve the relationship between the patient and the delusionary ideas. The destructive power and hold of delusions over patients can be minimized if not blighted out altogether by demonstrating in practice that the ‘voices’ or ‘images’ are bereft of intuitive and intellectual powers separate from the patient’s own. The best course of action for a ‘voice’ that claims powers of extrasensory perception would be to request that they read your thoughts; the best one for a ‘voice’ threatening the demise physical body would be to request the infliction of punishment upon another as proof of its supernatural talents; and the best one for a ‘voice’ that thinks its God is to demand the vocalization of a complete autobiographical history of its host (Which as most clinicians know it won’t be able to give!). Authenticating the unreliability of ‘voices’ in providing an accurate description of consensual reality goes a long way in dampening their influence on the psychotic patient. Once the link is severed it isn’t long before the ‘voice’ disappears from consciousness completely. All this takes us back to the concept of choices and the fact that a correct set of choices compatible with an individual’s creative potentialities and psychological constitution can dispel the self-inflicted illusory world. The diabolical ‘voices’ and ‘images’ of the psychotic universe is indeed an extravagant illustration of our collective plight against ambivalence. 

Let’s now interpret the delusionary beliefs of patients incarcerated at the Aradale Mental Asylum in the early 1900s. When Thomas Parker Ewing looked at trees and buildings they morphed into grimacing faces[1], an unconscious personification of his inner despair. Similarly, David Marshall Baird’s distress at his own inability to lift the world in its proper place[2] betrays the existence of a pathogenic secret, perhaps dismal failure in consummating an oath for a beloved relative. Duncan Cameron, the bank clerk who declared faith in his paranormal powers[3], probably misconstrued transient aches and pains originating from his highly unsatisfied somatic unconscious as premonitions from God. The young Victor Theodore Schurmann apparently suffered from delusions of grandeur in believing he was the Elect of God.[4] Could this in fact be an unapologetic admittance of a self-centredness ubiquitous to our left-hemispheric consciousness and shrewdly concealed by the social mechanisms of non-pathological survival personality? Egocentricity is undoubtedly rife in the human condition. On a different note the higher-order visions of the Virgin Mary and the archangels perceived by the criminally insane David Dewitt[5] could have been a conscious metaphor for the heartfelt conviction that he had reached a psychospiritual impasse and that life just wasn’t worth living anymore. Those of John Falkner regarding the ESP (extrasensory) powers of a man he murdered[6] probably evolved from some very vivid metaphysical experiences in dream consciousness.

There are some pretty interesting ones from the Mayday Hills Lunatic Asylum at Beechworth as well. An eighteen year-old dredge miner from South Melbourne named Alexander Ernest Cottrill who complained of fire burning his heart[7] was probably suffering from psychospiritual inertia connected to inner uncertainty of what he wanted to do and achieve with his life. Having his heart burned was simply a romantic metaphor for this insignificant truth, erupting as it were from the cavernous depths of the personal unconscious. James Powley, a forty-two year-old labourer from Victoria[8] appears to be one of the finest pathological exponents of an eternal battle between human construct and human instinct; being of a highly religious fabric, he renounced personal responsibility for committing acts of hedonism by attributing these manifold temptations to the agency of supernatural forces, in his case the Devil (How convenient!). Sometime in his later years fifty-three year-old broom maker James Barker inveigled himself in outrageous fantasies involving a supposed conspiracy to murder the wife and children he never had.[9] His tragic lapse into delusionary belief could be put down to a long-term motivation for fecundity and contentment in the guise of family, to the profound unconscious wish of becoming a nurturer in the conventional form of a husband and father that for one reason or another never quite came to fruition.

Advances in cognitive neuroscience definitely support the aforementioned perspectives on the phenomenology of psychosis. Hemispheric studies show that the two halves of the brain are wired slightly different in encountering reality. The right is image-based and rather intuitive with a preference for symbolization whilst the left encompasses more compartmentalistic modalities of knowing that circumscribe immaterial aspects of being and the social environment through quantification and language. From the ontological level of neural mechanisms, auditory hallucinations transpiring during psychotic episodes have been described as atypical, transitory intrusions of right hemisphere processes into the integrated experience of self as concocted by the domineering left-hemisphere. Virtually untutored in right-brain language, the left brain utilizes interpretative mechanisms indigenous to its own being in identifying and categorizing these mental stimuli and is thus complicit in the rationalization of delusional content. Thoughts, the substrate of mind, are extremely powerful and can initiate subtle changes in the composition of matter. When there is a radical alteration of dopamine levels and subcortical activation of consciousness regulators such as the thalamus due to the prolongation of abnormal and inwardly-orientated thoughts, the inner unconscious universe embodied by the right hemisphere inverts, becomes conscious, and interjects into personal awareness, appearing as though ‘voices’ are streaming forth from a space beyond the unified self. If for one moment we recall the delusions of the psychotics at Aradale and Beechworth, we see that in a remarkable number of cases there was a conscious reconfigurement of symbolic and metaphorical content in literal terms, a phenomenology which vindicates the symbolic-right, literal-left neural hermeneutic along with the intrusion hypothesis. In truth we might say that phenomenology and neuroscience are expressing complementary views on the same phenomenon; one is psychological and the other a neurobiological interpretation.  

Thus far empirical correlations between the hallucinatory nature of psychosis and significant reductions of lateral dominance[10] as well as left-hemispheric capacity in the amygdala and hippocampus[11] of those who experience it have been demonstrated by various researchers. Further studies tailored to the examination of possible associations between chemical and neuroanatomical changes in the two hemispheres and the hallucinations and delusions of acute psychotic episodes would undoubtedly strengthen the hemispheric model. My instincts tell me that this narrowing chasm of critical inquiry is very close to being bridged and sealed…

[1] Case Book of Male Patients 1906-1908, Unit 9, Vol 1, Series Number VPRS 7403, Consignment Number P0001, Public Record Office Victoria, Archives Department, file no. 4125.

[2] Case Book of Male Patients 1906-1908, Unit 9, Vol 1, Series Number VPRS 7403, Consignment Number P0001, Public Record Office Victoria, Archives Department, file no. 4159.

[3] Case Book of Male Patients 1909-1912, Unit 10, Vol 2, Series Number VPRS 7403, Consignment Number P0001, Public Record Office Victoria, Archives Department, file no. 4433.

[4] Case Book of Male Patients 1909-1912, Unit 10, Vol 2, Series Number VPRS 7403, Consignment Number P0001, Public Record Office Victoria, Archives Department, file no. 4450.

[5] Case Book of Male Patients 1905-1906, Unit 3, Vol M, Series Number VPRS 7403, Consignment Number P0001, Public Record Office Victoria, Archives Department, file no. 73.

[6] Case Book of Male Patients 1887-1905, Unit 4, Vol J Ward, Series Number VPRS 7403, Consignment Number P0001, Public Record Office Victoria, Archives Department, file no. 58.

[7] Case Book of Male Patients 1906-1912, Unit 7, Vol 1, Series Number VPRS 7395, Consignment Number P0001, Public Record Office Victoria, Archives Department, file no. 114.

[8] Case Book of Male Patients 1906-1912, Unit 7, Vol 1, Series Number VPRS 7395, Consignment Number P0001, Public Record Office Victoria, Archives Department, file no. 170.

[9] Case Book of Male Patients 1906-1912, Unit 7, Vol 1, Series Number VPRS 7395, Consignment Number P0001, Public Record Office Victoria, Archives Department, file no. 345.

[10] Louis, Cozolino, The Neuroscience of Psychotherapy: Healing the Social Brain (New York, NY: W.W. Norton & Company, 2010), pp. 109.

[11] Louis, Cozolino, The Neuroscience of Psychotherapy: Healing the Social Brain (New York, NY: W.W. Norton & Company, 2010), pp. 108.

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