Mental Experience and Dissociation in Psychosis

The experience of our minds may be shaped by belief. The idea that our minds are whatever we imagine them to be may seem like an assertion that is hard to prove. But confidence is crucial to learning and knowledge, so the term “imagination” in this sense simply connotes a confident belief in our constructed mental processes and our minds’ content.

Essentially, the mind may be understood as a “blank slate” in the human infant, and from that point onwards, knowledge is accumulated through association and confidence, including imagination. The mental world relies on belief, association and confidence in what we learn. This can be contrasted with consensual sensory experience that allows for a perspective of reality that is more unified among and between people. The mind may be simply a more imprecise arena of experience, perhaps construed accurately as a “black box” or a field for activity that relies on imagination.

Even mistaken or inaccurate knowledge can be based upon association and confidence. This is certainly true for people with psychosis, who believe in auditory hallucinations and other “entities” within their minds.

Confidence and association may even be the basis for intelligence. Even when people with psychosis associate their experiences with delusional beliefs, they may remain confident in their hallucinations. Essentially, they may imagine these “entities” to occupy their minds, and associate them with whatever delusional beliefs seem most relevant. It may be that hallucinations may represent a psychotic individual’s mother and father, for example, in that the composition and appearance of such hallucinations may be based on early object relations or relationships that are primary for that individual.

The corresponding ambiguity and ambivalence with which hallucinations are approached by the psychotic individual allows for an impetus in their imagined changing and dynamic presentation. Such entities conform to whatever the psychotic individual imagines them to be, and the imagination of the psychotic individual mutates their presentation to conform to the psychotic individual’s changing perception of them, based upon ambivalence and ambiguity with which parental objects are perceived.

The mind of the psychotic individual is formed by enmeshment and over-involvement with one’s hallucinations in that they are based on early object relations. Escape from them may therefore be impossible. This means that hallucinations and accompanying delusions penetrate the sanctuary of the mind, and thus may be abrasive and damaging. The self of the psychotic individual can be assaulted by a lack of privacy and an attunement to negative aspects of the self as reflected by hallucinations taking the form of imagined entities within the mind.

Dissociation is when the world seems unreal. It represents a perceived detachment from your body or emotional state in which both seem not real. It’s a concept which may apply to the psychotic individual’s experience of his mental realm, shaped by a retreat from punitive auditory hallucinations.

The onslaught of auditory hallucinations would allow for the phenomena involved in dissociation to occur in the mental realm, in addition to causing dissociation in the material realm. The “diminished affect” of psychotic persons is evidence of this. Diminished affect results from punitive emotional experience, as seen in situations that promote the phenomenon of learned helplessness. Learned helplessness and dissociation are compatible with punitive experience. In terms of dissociation, feelings of unreality of the self and the environment represent a defense mechanism that protects the psychotic individual from mental and emotional suffering from which that individual cannot escape. Likewise, learned helplessness emerges from suffering that one cannot escape.

Overall, the reality of trauma emerging from auditory hallucinated experiences will cause psychotic individuals to dissociate and withdraw even from experience in their own mental realm. The symptoms of dissociation may be targeted for treatment.

A compassionate and empathic psychotherapist may be able to alleviate some of the schizophrenic’s suffering in this regard. The psychotic individual will respond well to treatment by his psychotherapist when this clinician can be trusted to not harm the schizophrenic client. Essentially, implacable good will on the part of the psychotherapist is advocated as treatment for the dissociative symptoms of schizophrenia.

Image via Miguel A / Shutterstock.

  • Claire

    One question.. have you ever been psychotic? If the answer is no, then all the psychobabble above is meaningless. The experience of psychosis cannot be reduced to ‘parental objects’ and ‘association and confidence’. It’s offensive and patronizing to say so.

    Freud didn’t know what to do about psychosis. And psychoanalysts still do not. But that does not stop them from trying to drown it in psychobabble. I wish they would just cut it out and admit that psychosis is part and parcel of a brain gone haywire due to MANY factors including genetics and physiology. My mother and my subconscious has little or nothing to do with it.

  • Roberta

    I definitely agree with the above article, as a sister to a delusional man. Since we shared a childhood, I do see how the delusion and associated anxiety are closely related to experiences from his childhood from a well-intentioned, but extremely ignorant and aggressive, punishing father.

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  • I don’t have a lot of firsthand encounters with people who have schizophrenia. I could see the incredible challenges in overcoming that first stage of trust in that the therapist is not there to harm.

    My personal experience is with bipolar I mania with psychotic features. In those psychotic episodes I had I didn’t hear actual voices but thoughts in my mind communicated from other entities. I still perceived every person around me, but they were somewhat phased out. I was in my own world, way far gone at times and closer to home at other times. When my family visited me in the hospital, that brought me back home if not for just a little bit while they were there.

  • Paul

    I have suffered with Sz. I understand that the author is trying to come up with a cognitive narritive for the condition.

    For me the focus should be purely on symptoms.

    Because i believe it is the symptoms that invaribly cause the delusions.
    Sz therapy should focus purely on symptoms.

    E.g What do you feel. I feel anxious. Or
    What sensations are you feeling right now. I have odd sensations in my legs and i feel pressure in my head,

    Simple questions and simple answers that will eventually educate the sufferer to what is causing them to become delusional.

    Because i believe at the core of this . is that physical sensations and perception and sensory problems are feuling psychosis.

    People are afraid and scared. Why are they? It usually comes down to ‘things speed up’ or ‘it seems like people are shouting’ or ‘i can not understand what people say’. These are all symptoms , then a doctor or therapist should seek to remove these symptoms one by one.

    Its really that simple. And the patient should become aware of this.

Ann Reitan, PsyD

Ann Reitan, PsyD, is a clinical psychologist and well published essayist of fiction and creative nonfiction. She holds a Bachelor of Arts in Psychology from University of Washington, Master of Arts in Psychology from Pepperdine University, and Doctorate of Clinical Psychology from Alliant International University. Her post-doctoral research at Washington University in St. Louis, MO, involved personality theory, idiodynamics and creativity in literature. She recently published Illuminating Schizophrenia: Insights into the Uncommon Mind.

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