The Human Condition and the Mentally Illby Ann Reitan, PsyD | August 30, 2012
There are benefits to viewing the problem of psychosis from a variety of psychological and philosophical perspectives. In this article, several perspectives in psychology represent various useful angles with which to approach the problem of psychosis. This discussion includes elements of the following: the biopsychosocial perspective, the biological perspective, the humanistic psychotherapeutic perspective, the perspective of behaviorism, the Gestalt perspective, and a postmodern philosophical perspective.
Psychosis is a biopsychosocial phenomenon. It is a manifestation of biological and neurological mechanisms in the brain that produce hallucinations. The experience of these biological elements of psychosis allows for the labeling of the individual enduring hallucinations by society. Such labeling drives some psychotic individuals to mask their own outward and apparent experience of hallucinations by retreating farther into their mental realms, in their somewhat incognito flight from stigmatizing labels. This, in turn, causes individuals to become more involved, subjectively, in their own mental realms. It is interesting that society has created the term “behavioral health” as a goal for the wellbeing of psychotic people. This term conveys an emphasis on Behaviorism, and moreover, it reflects a focus on observable symptoms as cited in the Diagnostic and Statistical Manual of Mental Disorders (DSM). Healthy “behavior” or an outward appearance of normative behavior may be one of the most effective goals for individuals dealing with psychosis. Healthy behavior or normal behavior undoubtedly represents an avenue toward social acceptance, but perhaps only a shallow sense of belonging with the world, as experienced by the psychotic individual.
Often, the psychotic individual will experience a dissociative state or a sense of unreality regarding reality. This is an understandable reaction of a person who is thus labeled. It has been noted that psychotherapy is inadequate in treating psychotics. This has been blamed, in part, upon the reduced frontal lobe activity in psychotics. The idea of diminished frontal lobe activity in the psychotic mentally ill represents a biological view of psychosis. One may wonder whether reduced frontal lobe activity is a cause or a consequence of psychosis, and perhaps it is both. Perhaps reduced frontal lobe activity represents a cycle of maladaptive circumstances relating to psychosis, as is seen in the biopsychosocial model of mental illness, commented on above.
In terms of humanistic psychotherapy, we are healthy as a result of receipt of an accurate reflection and unconditional acceptance by another person. This may be, ultimately, a curative element in all forms of psychotherapy. The psychotic is unable to obtain such a demonstration of understanding from a therapist who cannot agree with or even understand his view of reality and, moreover, his view of himself. This represents a reasonable and defensible perspective by a therapist, who likely has an entirely different perception of reality than that the psychotic individual. Nevertheless, these circumstances have the effect of diminished therapeutic reflection of the psychotic individual’s internal state by the therapist, and empathy by even the well-intending therapist toward the psychotic individual may not be forthcoming. The mentally ill may have non-normative and skewed beliefs, but they also have a need for human empathy. It may be possible to achieve some empathy when the psychotic individual communicates to his therapist or his peers his delusion system, and those listeners can communicate to the person experiencing those delusions what they think it feels like, emotionally, to experience those beliefs or thoughts.
Psychotic individuals do have an understandable basis for their delusions that is intellectually accessible to therapists and clinicians. This can be seen in the applicability of Skinner’s views regarding superstitious behavior to psychotic delusions. Skinner’s behavioral perspective can serve to illuminate the conditions of perpetuation of psychotic ideation. Skinner elicited superstitious behavior in pigeons by reinforcing them on a random basis. The pigeons responded by enacting the behavior that they had been exhibiting when the chance reinforcement occurred. Interval ratio reinforcement of subjective, psychotic beliefs that deviate from conventional reality is entailed within the material world by chance alone. Thus, chance events reinforce delusional material. Essentially, the psychotic individual will sometimes and to some extent be reinforced for psychotic belief based on “evidence” that appears sporadically. Note that this is the most difficult reinforcement system to break. This means that random environmental circumstances signify for the psychotic individual a basis for reinforcement that will not easily be diminished.
Of course, this presupposes that delusional “evidence” for psychotic ideation can be termed reinforcement. Even if the reification of psychotic belief in the mind of the psychotic individual cannot be termed reinforcement because it is punitive rather than reinforcing, the psychotic person’s perspective on reality may attenuate that individual to perceive “evidence” for his belief system. This evidence may not be sought by the individual, but it is clear that, if one is looking for the color blue, he will see that color everywhere: the sky, the Chevrolet on the street, the dress of a passing woman. This represents an application of the ideas of sensation and perception as understood from a Gestalt frame of reference. In a sense, it is the punitive nature of psychotic experience that mentally ill individuals cringe from, and they are hypersensitive to this “evidence” even when it is punitive.
There is a certain applicability of a nonepistemological approach to dealing with the manifestations of mental illness and delusions, in particular. This emerges from postmodern thought as it may be applied to psychosis. A therapist may advise the psychotic individual to refuse to make a judgment about his hallucinations. Such a course may represent the only avenue toward sanity, due to the fact that we all have little knowledge about knowledge, and this essential lack of knowledge is defined by nonepistemology. Nevertheless, a nonepistemological world view is an experienced truth that differs from dogma, and it represents a logical conclusion as opposed to a superimposed assumption, however salient that assumption may be.
The psychotic individual’s acceptance of no knowledge about knowledge is incompatible with many aspects of delusional systems. Nevertheless, the psychotic person’s experience of hallucinations is clearly visceral. Moreover, that person has non-normative experience, an utterly different relationship with the world than other people, and within their own internal world, in particular. The paranoid presentation in one type of psychotic individuals is understandable. Acknowledging one’s lack of knowledge about knowledge represents a nebulous state that is difficult to deal with especially on a daily basis. To actually live with no knowledge about knowledge of reality, which may be construed as the cause and result of a perspective that is nonepistemological, is perhaps terrifying. Moreover, a perspective of doubt regarding reality may leave one to wonder unceasingly. This type of mental activity may be punitive as well, and it may, paradoxically, lead to reduced activity in the frontal lobe of the brain. In terms of personal alienation, it is clear that psychotic individuals partake in the existential loneliness that may be a reality for many people. If they understood this aspect of their condition that is a part of the human condition, perhaps they might be better able to cope with being mentally.
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