Psychosis and The Ground Beneath Our Feetby Ann Reitan, PsyD | October 4, 2013
I once knew a paranoid schizophrenic who believed that his kitten was going into an alternate universe when it went behind his refrigerator. This is a bizarre delusion formed spontaneously and irrationally, making it evident that visceral experience related to hallucinations is difficult to combat. Could using metatheories to explain psychotic delusions help schizophrenics deal with their illness?
Psychotic individuals deal with experiences which may be unthinkable to the larger population. They may distort their experience and their understanding of it into delusions; an effort to rationalize and create theories about their psychotic experience. Metatheories are theories about theories, and using this approach to understanding psychoses offers the ability to derive abstractions from other theories, even those delusions created by psychotic individuals.
As a counselor twenty years ago, I knew a young woman who was psychotic. She sought reasons for her schizophrenia: She believed that she had been physically abused as a child, and that someone had come into her room in a psychiatric group home and raped her. When I questioned her about the details of these events, she contradicted herself and she seemed to impulsively fabricate details. Perhaps she herself sought a belief in these delusions because she required a basis for why she had become mentally ill.
The beliefs most adhered to by all people are derived from experience in the material world, and experience in the material world is concrete. The cement ground under our feet — literally and symbolically — reflects our strongest belief. It is the information derived from our five senses that we believe foremost. Even infants know pain and pleasure, and the cement ground, symbolically, is that on which the trust in life gained by infants is built.
However, philosophers have contended that the material world may not exist, and schizophrenics may be pressed to deal with this possible nonexistence of the material world to a greater extent than others. This is due to dissociation, derealization and depersonalization that result from their dubious perceptions of reality of the world and themselves.
The fact of biochemistry is as abstract as any other theory of mental illness and perhaps more so. However, it is seldom that a schizophrenic can hear an auditory hallucination that says: “You are going to be killed,” and then say to himself: “That’s just my biochemistry acting up again.” Hallucinations represent visceral experience that the psychotic individual may perceive in his material and mental worlds as an indication of ‘no ground under his feet’. If it is possible for the schizophrenic to hear a voice in his consciousness, then what other improbable aspects or conditions of the world are likely to ensue? This is a dilemma that most schizophrenic individuals feel poignantly.
Twenty years ago, another client of mine, Stuart, was preoccupied with questioning reality and spoke frequently about “parapsychological mystical connections”. One day, I said to him: “It must be terrifying to feel like the world could come out from under your feet at anytime.” In response, he said: “You’re the only one who thinks so.” From then on, I was acknowledged to be the only counselor at the facility where Stuart lived who was able to get through to him. Stuart understood the metaphor of the cement ground in terms of what seemed to him to be the absent ground under his feet, and this applied to him exactly.
So can a schizophrenic be any more able than others to discount the information that seems to him to be akin to sensory experience? Can ideas represent visceral and immediate experience? Do we all believe less in ideas than experience?
My contention is that ideas, even abstract ideas, elicit emotion, and thus serve as a basis for a constructed view of reality. We are so inclined to believe habitually in the cement ground under our feet that we do not even think about possibilities that are, albeit, rare events, but are nevertheless possible. When some traumatic event appears out of nowhere, our complacency is shattered. Schizophrenics may feel the emergence of their own mental illnesses as poignantly as any catastrophic event is experienced in psychologically healthy people.
One cannot say that there is an easy way for a schizophrenic to combat hallucinations and ensuing delusions any more that anyone can discount actual sensory and perceptual experience: So much of what we understand to be reality is as visceral as the sun shining on a summer’s day. To relate to abstractions regarding our perceived realities is like looking up at the sun and thinking about particles and wave theory, instead of experiencing it as it is in its immediacy, as real to us as the cement ground.
However, my understanding as a clinician is that some psychotic individuals may manifest, more than others, delusional beliefs based on hallucinations. One client that I encountered more than twenty years ago stated that he did hear auditory hallucinations, but that others told him that they were not real, and, as a consequence, he treated his hallucinations as not real.
Perhaps psychotherapy with schizophrenics should be approached with an emphasis on clearly differentiating between visceral experience and derivatives of this experience: the metatheories that pertain to psychotic experience. If, through psychotherapy, the schizophrenic can grasp the reality of metatheories about psychosis, regardless of the impact of visceral qualities relative to the nature of their experience, it might make a difference in terms of mitigating extremes of psychotic psychopathology.
The well-founded validity of metatheories corresponding to delusional theories harbored by psychotic individuals is clearly evident. Although schizophrenics’ visceral experience may combat their acceptance of metatheories, the reliability of empirical data concerning the efficacy of medication, for example, may be accepted as valid by them if such material is explained to them. Although there are various levels of understanding and interpreting visceral experience, the experience of hallucinations, and auditory hallucinations in particular, may be negated by the education regarding brain chemistry, including many examples how and why metatheory applies to the world generally.
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