Psychiatric Rehabilitation Journal, Vol. 24, No. 2, 2000. Copyright Notice: This material is posted with the knowledge and permission of the Publisher, Center for Psychiatric Rehabilitation and Trustees of Boston University. Granted September 8, 2008. The author wishes to thank Russell Noyes Jr, MD, for his editorial assistance.
Psychosis can have profound meaning for persons who have experienced it. The meaning attached to psychotic episodes can often be found in the hallucinogenic content of the experience. This article describes themes that emerged from interviews I conducted on eight persons with psychiatric disabilities. I am also a psychiatrically disabled person, but this study focused on the experiences of others, some of whom attend a psychosocial rehabilitation center for the mentally ill called a clubhouse. It is important for those involved with the mentally ill, i.e., the psychiatric community, to consider these themes. They call attention to painful struggles that may occur within the ill person’s mind, often involving conflict between life and death. They point to attitudes, behaviors and beliefs which significantly influence the quality of life for those with psychiatric disabilities. Also, they show that, despite the suffering that psychoses cause, meaning may be found that promotes the sanctity of life. These themes have implications both for individuals who experience psychoses and for psychiatric professionals who treat them.
The terms psychosis, hallucination, and mental illness are derived from the medical model of disease common to mainstream psychiatry. Other models, based on diverse philosophies and world views, attribute psychiatric symptoms to varied origins, some of them supernatural or spiritual. Different models of health and disease do not necessarily invalidate one another, but may focus upon different aspects of an experience (Tamm, 1993). It is beyond the scope of this paper to evaluate different models along with their diverse labeling of mental phenomenon. Instead, I have chosen to use medical terms common to the Western psychiatric community, but the reader should be mindful that other interpretations of psychiatric illness exist. However, this paper’s assertion is true regardless of which model is applied. For what I identified as “illness” is actually purposeful in nature and the success or failure of the “psychosis” has to do with universal truths regardless of the therapist’s interpretation.
The psychosis—its experiential reality—has proven to have consequences in the daily life of the ill. For example, when voices call a person derogatory names, he or she feels persecuted and oppressed. Voices that threaten cause fear. And, when they say, “kill yourself,” some people follow their command and commit suicide. This means that hallucinations can be persuasive and cause intense emotional reactions that may even result in destruction of life. Therefore, it is wise for psychiatrists, therapists and counselors to consider the content of hallucinations.
Over the years, I have seen heroic efforts made by psychiatric professionals to prevent clubhouse members from committing suicide. A feeling of despair overtakes many people with mental illness causing them to become suicidal. Often death romances them, making darkness look appealing. It seduces some into self-destructive behaviors through a gradual process such as smoking or an abrupt, violent end as in jumping off a tall building. Therefore, whatever gives hope and light to such people is valuable.
In the process of finding members of the clubhouse to interview for this study, I extended an invitation to anyone who had experienced a psychotic episode. No potential participant was excluded on account of his or her belief system or lifestyle. The age at which the eight persons interviewed had their first psychotic episode varied from seven years of age to thirty-five. The educational level completed was: three high school graduates, two with one or more years of college, one college graduate, and two with Master’s degrees. There was no relationship between age of onset of hallucinations or educational level and the content of hallucinations. Even though some had experienced delusions, this study’s primary focus was on hallucinations. The diagnostic break-down of participants was: six with schizophrenia, one with schizo affective disorder and one with bipolar disorder.
I asked participants about both negative and positive experiences. Some of both were reported. However, most participants emphasized an evil presence during their psychotic episode, while many reported good afterwards.
Nature of Psychoses
Beth was in college when she started to withdraw socially and then was hospitalized with her first psychotic episode. She heard frightening voices and felt like she was battling evil. It felt to her as though she were fighting for her life and the lives of her family and friends. She was terrified because she felt as though dark forces were tying to destroy her. She remembers that once, when locked in a quiet room she kept looking for a crucifix. “I needed to see one,” she said, “because I was fighting for my life.”
Beth also remembers voices saying, “Kill your mother!” Other times they made racist remarks and called people derogatory names. They told Beth she was stupid and no good. The voices used profanity, cursing God, Jesus, and the Holy Spirit. Beth believes her psychosis represented covert warfare.
When Janet first became ill she heard six different voices. One said it was going to kill her. Another told her to kill the mayor, and the rest said a variety of things. At the time, she was attending seminary where the voices helped her write papers. When she received failing grades she rewrote them without using the voices’ suggestions. Occasionally, a voice said something positive like, “I love you.” Janet said that, for her, the voices were real. From her religious background she knew about Satan and believed they came from him. Janet felt a lot of fear during this time; she thought she was lost to Satan.
Ron was in a psychiatric hospital suffering from depression when he first became psychotic. He was on a low dose of an antidepressant when, suddenly, the staff increased it by four times the original amount. He said this triggered a psychotic episode. Not only did he hear voices–he had visual hallucinations. These were of rough looking men who motioned for him to come, then shook angry fists as though they were going to beat him up. He also had vivid nightmares. One time, the voices convinced him that he had killed his brother, which was untrue. He said they sounded malevolent and he felt as though he were in hell.
Linda was only seven years old when she first heard voices. She experienced much abuse as a child. Contributing to the trauma that took place in her home were auditory hallucinations–voices that told her she was a bad person. Many times the voices told her to kill herself, that she would feel better if she died. They were persistent and became more malicious in her teen years when she began using street drugs and alcohol. The voices’ strongest message was that, if she committed suicide, she would know God, heaven, and the spirit world. Then, she would come back to life. It was told her that if she died, she would learn all the answers and be resurrected. Then, her life would be grand. As a result, she almost drank Drano. A counselor helped her get to a hospital before she hurt herself. Only a few times did a voice say something positive, such as, “Life is ok; you’re doing ok.”
Anne started having psychiatric problems in her thirties after giving birth to her fourth child. She heard voices for about twenty-four hours. One was the voice of a psychiatrist she had seen in the past. He was saying positive things about her to other people. She also heard imaginary airplanes flying over the house and music that changed quickly to match the mood and content of her thoughts. Anne did not report sinister hallucinogenic content; however, she was paranoid during her psychotic episode and believed her phone, house and car were bugged.
Among the eight participants, Sue was unique because, when she was psychotic, she hallucinated in all five senses. She identified themes of good and evil. Some of the hallucinations were positive and uplifting, but the majority were negative. When psychotic, she thought there was an evil plot against her and her family. She felt pressure to do or say the right thing and felt that, if she made the slightest mistake, evil people or forces would kill her family, as well as her. She was extremely frightened. When Sue was hospitalized she was afraid to sleep at night for fear someone was going to kill her. At that time, many of the visual hallucinations were of small men that looked oriental. She felt they were wicked people.
She also felt there were levels of evil. There seemed to be a malicious presence and something similar to a pattern or maze. In her words, “There was a complicated entanglement that led to another even more evil level. And then this whole pattern would continue, it would go to one more level and one more level. I think there were only about four levels. But they were extremely scary. Each level was worse and more evil.”
Barb was fourteen when she began to hear voices. As she described it, she began to talk to spirits. This frightened her. Also, once, when psychotic, her perception seemed surreal and she wanted to “scratch off her face.”
Hannah was also fourteen when she began to hear voices, and they filled her with fear. They said they were going to “get her.” She heard strange “talking in her head” and these voices often gave her false information. For example, they said that if she did not smoke a cigarette, something bad would happen to her. They called her derogatory names and told her she was a bad person. On one occasion, she thought satanic people were at the door of her room.
Strategies for Survival
From these examples, it is apparent that psychotic episodes can cause great suffering. The participants felt that dark, sinister forces were at work–sometimes aimed at destroying them and/or their loved ones. Many believed the voices were real. But, real or imagined, their influence was felt. And, to propound their misery, many had existential crises following their psychotic episodes. They questioned whether there was any meaning in life or purpose to their existence. Such questioning sometimes caused depression, but the participants’ religious faith or personal spiritual conviction often provided answers. Some became involved in organized religious communities, while others kept to private, individualized spiritual beliefs and practices.
Some participants found in their belief systems a source of strength to counter dark forces. Their religious faith and practice also fostered attitudes that promoted health and well-being. Such faith may contribute toward progress in psychiatric treatment (Fallot, 1998; Sullivan, 1998). Psychiatric professionals–even those who lack religious perspective–need to be aware of this resource and listen to their client’s religious experiences and concerns.
Regardless of a therapist’s spiritual beliefs or lack of them, it is prudent for him or her to recognize attitudes and practices that increase mental stability and emotional well being (Richards & Bergin, 1997). For several of those I interviewed, it was their faith in God that kept them from killing themselves. Just as the “evil forces” of psychosis had destructive consequences, good forces of religious beliefs–those that incorporated spiritual reality into personal experience–also had their consequences. By incorporating “spiritual reality into personal experience,” I mean that the person came to view the world and reality with a spiritual perspective. Based on this perspective, they focused their attention on spiritual truths, some of which are found in scripture, and participated in activities such as prayer or meditation that connects them to the spiritual Source. Also, for those involved in organized religion, this included church activities. This spiritual awareness and participation empowered them to make positive changes in their lives. The resulting improvement in the participant’s mental condition was often substantial and worthy of consideration.
The implications are clear. Those who have suffered from, what was for them, evil oppression may find strength to carry on with their lives, often in very productive ways. For example, Beth said that her faith now gives her hope. She believes she survived because of her relationship with a higher power and because people prayed for her. Beth reads the Bible daily, prays, attends Bible study, and church services. She says it is important to be able to discuss her faith with her counselor because it is a big part of her life. It really matters to her.
Ron explained how his faith helped him to get through his psychosis. He says he now has a better attitude and feels better because Jesus is his Savior. He has hope for the future. Ron said religion does not come up much in conversations with psychiatric professionals. He said he has not mentioned his religious beliefs very often because he thinks many psychiatrists and therapists dismiss religious beliefs as delusions–which they are not. He wants to protect himself and keep his faith private. Up until the time of his psychotic episode, Ron had been an atheist. He became a Christian after his mental breakdown.
Linda has found that prayer helps her. In her words: “God gives me strength, gives me strength within myself to better myself. Prayer makes me stronger. I pray every morning.” Reading the Bible increases her faith and the ability to cope. She said there are passages that apply to her situation, one being, “I can do everything through him who gives me strength.” Php. 4:13 (New International Version). Linda believes God helped her get through the experience of delusions and hallucinations so that she might continue with life. She said that before turning to God she despaired; she didn’t think there was anyone “out there” for her. She says that her faith and religious activity now give her hope.
Sue believes she would not have been able to survive without her faith. She says she would have killed herself. For the most part, her psychiatrists and therapists have been supportive of her relationship with the Lord and of her support system through the church. They have been very encouraging. For a while, she had a therapist who didn’t believe in God but felt a spiritual connection through nature. But, Sue told her about her activities within the church and her religious perspective and this therapist was supportive of that whole aspect of her life.
However, earlier, Sue had a therapist that didn’t approve of her religious practice. This therapist was an atheist and felt that Sue’s church, pastor, family, and religious friends had too much influence on her, and that her relationships with them were unhealthy. She thought Sue needed to distance herself from these people and rediscover who she was and what she wanted in life. So the therapist advised Sue to cut off her relationship with God, the church, and her family. The therapist said she was taking Sue apart so as to put her back together and make her a new person. Sue said the therapist succeeded in taking her apart but never put her back together. She said: “I was floundering and lost, and I got in with the wrong kind of people. I started drinking quite a bit, and that was the time I got hooked on smoking.” Fortunately, after about six months, Sue started seeing a new therapist, and reestablished her relationship with God and her religious support network.
Sue believes in a holistic approach to mental health that includes the health of mind, spirit, and body. She also believes that a relationship with a higher power is important. She has found her faith compatible with ideas about recovery and mental health. For her, recovery in mental health terms is “living the most satisfying and fulfilling life possible despite having a mental illness.”
Even though those who participated in this study saw their faith as important in their recovery, they also stressed the importance of medication. Their religious beliefs did not conflict with drug or psychological therapies.
Conclusion
The examples of psychosis given above had strong experiential themes. First of all, these psychotic individuals felt they were under demonic attack. Second, they felt they were bad people because of negative comments made about them. And third, they believed they were in a struggle to survive, to save their own lives or the lives of others. Less often, positive themes emerged, but this occurred infrequently. When hallucinations involved beautiful, encouraging or supportive content, some found these to have real meaning and considered them to be divine in nature. Still, others believed them to be deceptions on the part of the devil.
When asked what impact psychosis had had and what meaning they had found in illness, more positive themes emerged. For example, Beth responded that her psychosis had made her stronger. She said she has had to fight and struggle for most of her life. But also, the illness has given her a different outlook from most people. She finds herself more accepting of those who are different because of their disabilities, illnesses, etc. She sticks up for people with disabilities when others discriminate against them.
When Sue was asked how her illness had affected her philosophy of life, she replied, “I feel I am a different person because I have had mental illness. It is difficult to say, but after going through all the struggles, trials, and tribulations of coping with a mental illness, I feel I am a better person than I might have been otherwise. I might have been more shallow and superficial. I think I’m more able to empathize with and help other people. And, with my current job I find that I have an opportunity as a mental health advocate, to help a lot of people, and that adds a great deal of meaning to my life.”
As stated above, both Beth and Sue felt that psychiatric illness had changed their lives in positive ways. Therapy should involve exploration in depth for such beneficial and positive changes that may have taken place and provide encouragement for them to evolve. With proper treatment and support, psychotic episodes have transformative potential (Grof, 1998).
However, even with the positive life-changing qualities, mental illness can be devastating for those who experience it. It often takes months or even years to recover from a psychosis. The negative affects of a psychotic episode include depression and a loss of will to continue living. A relationship with a higher power may be the only safeguard against suicide. It is increasingly evident that, in conjunction with medication, a spiritual life aids the mentally ill. Thus, reliance on the psychiatric community is only one part of the equation, and when the psychiatric professional listens to the spiritual beliefs held by persons with psychiatric disabilities, this aids in the healing process (Richards & Bergin, 1997; Sullivan, 1998). A client’s interpretation of his or her psychotic episode and how to deal with it has relevance. And, often the solutions they find gives real meaning to their lives.
References
Fallot, R.D., (1998). The place of spirituality and religion in mental health services. New Directions for Mental Health Services: Spirituality and Religion in Recovery from Mental Illness, 80, 3-12.
Grof, Stanislav, (1998). Human nature and the nature of reality: Conceptual challenges from consciousness research. Journal of Psychoactive Drugs, 30 (4), 343-357.
Richards, P.S. & Bergin, A.E., (1997). A spiritual strategy for counseling and psychotherapy. Washington, D.C.: American Psychological Association.
Sullivan, W.P., (1998). Recoiling, regrouping, and recovering: First-person accounts of the role of spirituality in the course of serious mental illness. New Directions for Mental Health Services: Spirituality and Religion in Recovery from Mental Illness, 80, 25-33.
Tamm, M.E., (1993). Models of health and disease. British Journal of Medical Psychology, 66, 213-228.