This article begins with two of my experiences of extreme inner states. It goes on make some observations about psychiatry, psychiatric training and wider culture.
These experiences could well have led to me being put in the loony bin (as it used to be called):
1. I was returning from Europe by myself when I was 17 (in the early 1970s). I landed at Heathrow airport late at night. Knowing I could not travel home to Bristol at that late hour I was just going to wait for public transport to start up again in the morning. During the early hours I started to play chess with a young man who was also waiting for the public transport. The last thing he did before we went our separate ways was to light a joint which he offered to me to share. Being naïve and curious, I took a total of four puffs before he departed, and I was left alone and scared at the way my mind was rapidly changing. Completely confused and imprisoned in my own psyche I lost any sense of what other people were about and how they would react to me as a person. I could not think straight at all; even adding two numbers together was beyond me, let alone working out public transport well enough to get myself home. I avoided all eye contact in case someone could see what a very weird person I had become. I could not trust myself to speak; who knows what would come out of my mouth and how people would react! I was terrified the police would haul me in, and that my fear and confusion would last for ever. Fortunately, the effects of the weed eventually wore off and I was able to find my way home. This experience could be called “Paranoia”
2. Three years later I was walking down Whiteladies road in Bristol. I was just my ordinary self, not affected by any drugs or psychological influences when, with great power and authority a voice in my head said “Fly!” and I started to be pulled out of my body. Energy came pouring in; tearing me upwards and outwards and I knew that as I left my body it would go smack on the pavement. Not wanting that to happen I desperately fought by pulling downwards hard and, losing the battle, I wordlessly and emotionally prayed for assistance with my entire being. A tremendous tension followed, energy pulling me out and energy holding me back, like super-conducting magnets fighting with each other. The force lifting me out suddenly left, and I returned to my everyday self.
I do not associate the voice that said “Fly!” with myself, it did not have the same handwriting my own thoughts have, and I have no power to tear myself out of my body when I am awake! This experience could be called “Disassociation” (a bad fit into a diagnostic category).
I think it very likely that if I had talked to psychiatrists about these experiences forty-five years ago, they would have said I was mad. These experiences were clearly outside the consensus of what reality is, and therefore the label of mad was justifiable. They would say I was mad because they did not understand the experiences, and the situation is not much better today. Professional practice, backed up by the legalities of the Bolam defence (1957 to the present day), would require that I be diagnosed as suffering from a psychiatric disorder and medicated. This “treatment” would doubtless have made it extremely difficult to participate in life: to develop inwardly and outwardly, and to work. Effectively the psychiatrist would have contravened the Hippocratic oath of doing no harm.
Many psychiatrists work helpfully with individuals who have had extreme experiences. Individuals who have extreme experiences are often grateful for psychiatric support and treatment. One psychiatric skill frequently seen is the ability to get a manageable balance between the benefits and the drawbacks of medication. However, psychiatrists rarely receive unmixed appreciation: frequently individuals do not feel listened to, or understood. The background to why we are not listened to and understood has many strands to it, but I suggest that their ability to provide informed and authentic listening could, and should, be improved. Psychiatry also seems to have been blinded by its own self-importance, as it appears very reluctant to seriously consider the nature of unusual experiences. The range of the psychiatrists understanding could well be expanded, to include useful first hand perspectives on what it is like to disconnect entirely from everyday life. Powerful insights about the nature of, and the pros and cons of these experiences are easily available from a range of individuals, and they need to be read, discussed, and internalised with care and respect.
These experiential accounts are not integral to the psychiatrists training which is mainly informed by psychiatric practice and research. The training does not adequately inform psychiatrists about human consciousness and this can be clearly seen in the content of the latest curriculum (on the Royal College of Psychiatry website). The most promising heading I could find was: “Describe the various biological, psychological and social factors involved in the predisposition to, the onset of, and the maintenance of psychiatric disorder” (intended learning outcome 2). This does not indicate material leading to a thorough understanding of the kind of experience I describe above. This inadequate psychiatric training could, however, be the main understanding that the psychiatrists apply throughout their career.
The research that is undertaken is usually funded by major funding agencies, which all have criteria that the research proposal must meet. For instance, the Medical Research Council (MRC) defines research as: “The attempt to derive generalisable or transferable new knowledge …”. The difficulty with this is by concluding research with generalisable statements the nature of individuals’ unusual experiences is unlikely to be revealed. This is because the research and also the generalisable conclusion is based on an ontology (philosophical position) founded on measurement. Extreme states are unique and not measurable, even though there can be some very useful commonalities between them. General understandings gained through this usual form of research are unlikely to work well for any unique individual. In the National Framework for Mental Health Research, neither in ‘Basic Science’, nor in the section on ‘Discovery Sciences’ (part of section 5.3: Translational Research), is there any indication of support for exploring the nature of unusual human experiences.
Additionally, most psychiatrists’ understanding of their own inner nature does not appear to be much better than anyone else’s understanding of themselves. There is no compelling evidence that most psychiatrists understand the further realms of human nature in a particularly thorough way. Both understanding their own nature and unusual experiences are important in psychiatric practice when working with individuals who have had, or are experiencing extreme states. Because trainees’ awareness has usually been restricted to ordinary states of consciousness, there is no experiential learning about, especially, unusual states. Psychiatric training does not require that trainee psychiatrists explore their own nature, through counselling or meditation, for instance. This lack of awareness is a severe deficiency in their professional training and development.
In our culture the authority of good reasoning and professional expertise is still a powerful influence on our behaviour and experiences. There are cracks appearing in this dominance though and new approaches are gaining ground. It would be helpful if the wisdom of an informed and intuitive support, which acknowledges and respects the full scope of human individuality, becomes an influential part of psychiatric practice.