A cognitive science based understanding of spirituality offering a less stigmatizing

clinical approach to psychosis.

Isabel ClarkeConsultant Clinical Psychologist

Southern Health NHS Foundation Trust.

Two Ways of Knowing

• Subjective, knowing by experience– Relationship– Emotion– Beauty– Spirituality – everything really important!

• Objective, knowing about– Science– Precision– Assumption that it is the only ‘true’ knowledgeWhere the two ways of knowing become

distinct, we get a different quality of experience

The levels of processing problem

• Being human is difficult because our brains have 2 main circuits – they work together most of the time, but not always.

• There is one direct, sensory driven type of processing and a more elaborate and conceptual one.

• The same distinction can be found in the memory.• Direct processing is emotional and characterised by

high arousal.• The other one filters our view to make it more

manageable• The direct processing system is the default system –

the one that dominates if the other gets disconnected – in which case we lose that filter – and land up ACROSS THE THRESHOLD –THE TRANSLIMINAL

Getting a scientific grip on the transliminal

The transliminal can be experienced like another reality, another world – this comes from the split in us!

• Interacting Cognitive Subsystems provides a way of making sense of this split.(Teasdale & Barnard 1993).

– An information processing model of cognition– Developed through extensive research into memory

and limitations on processing.– A way into understanding the “Head/Heart split in

people.

BodyState

subsystem

Auditoryss.

Visualss.

Interacting Cognitive Subsystems.

Implicational subsystem

ImplicationalMemory

Propositional subsystem

PropositionalMemory

Verbalss.

Linehan’s STATES OF MIND (from Dialectical Behaviour Therapy) – Maps onto Interacting Cognitive Subsystems

REASONABLE

MIND(Propositionalsubsystem)

EMOTION

MIND

(Implicational subsystem)

IN THE PRESENTIN CONTROL

WISE

MIND

WISE

MIND

Important Features of this model

• Our subjective experience is the result of two overall meaning making systems interacting – neither is in control.

• Each has a different character, corresponding to “head” and “heart”.

• The IMPLICATIONAL Subsystem manages emotion – and therefore relationship.

• The verbal, logical, PROPOSITIONAL ss. gives us our sense of individual self.

Two Ways of Knowing

• Good everyday functioning = good communication between implicational/relational and propositional

• At high and at low arousal, the implicational ss becomes dominant

• This gives us a different quality of experience – one that can be either valued and sought after, or shunned and feared

The Everyday The Transliminal• Ordinary• Clear limits• Access to full memory

and learning• Precise meanings

available• Separation between

people• Clear sense of self• Emotions moderated

and grounded• A logic of ‘Either/Or

• Numinous• Unbounded• Access to propositional

knowledge/memory is patchy

• Suffused with meaning or meaningless

• Self: lost in the whole or supremely important

• Emotions: swing between extremes or absent

• A logic of ‘Both/And’

A Challenging Model of the mind

• The human being is a balancing as the two organising systems pass control back and forth: there is no boss.

• The mind is simultaneously individual, and reaches beyond the individual, when the implicational ss. is dominant.

• This balancing act between logic and emotion gives us human fallibility

• The self sufficient, atomistic, mind is an illusion• In our implicational/relational mode we are a part

of the whole.

Web of Relationships

Self asexperienced

in relationshipwith primary

caregiver

Sense ofvalue comes

from rel. withthe spiritual

primarycare-giver

In Rel. with wider

group etc.

In Rel. withearth:

non humansetc.

Unpacking the Web

• We learn about ourselves from the way the important people around us treat us from babyhood on.

• The function of emotions is the organisation of relationship: relationship with others, but also our relationship with ourselves.

• Emotions communicate directly between people, bypassing the verbal-logical (they are catching).

Looking Beyond the Individual – to understand Spirituality

• We are defined by relationships that go beyond our current human bonds

• These include relationship with our ancestors and those who will come after us

• Moving out to relationship with our group, nation, other peoples, humanity

• Our relationship with the non human creatures is deep and significant for us

Taking Experience Seriously in Psychosis

• Acknowledging that psychosis feels different• Normalising the difference in quality of experience as

well as the continuity• Positive side as well as vulnerability• Helping people to manage the threshold – mindfulness is

key

• Sensitivity and openness to anomalous experience – continuum with normality: Gordon Claridge’s Schizotypy research.

• Understanding the role of emotion – where expression of emotion is not straightforward.

Evidence for a new normalisation

• Schizotypy – a dimension of experience: Gordon Claridge.• Mike Jackson’s research on the overlap between psychotic

and spiritual experience.• Emmanuelle Peter’s research on New Religious Movements.• Caroline Brett’s research: having a context for anomalous

experiences makes the difference between whether they become diagnosable mental health difficulties and whether the anomalies/symptoms are short lived or persist.

• (New chapters by Brett and Jackson in Psychosis and Spirituality: consolidating the new paradigm – along with new qualitative research)

• Wider sources of evidence – e.g.Cross cultural perspectives; anthropology. Richard Warner: Recovery from Schizophrenia.

Part of a 3rd Wave, Holistic Revolution in Psychosis

• Recognising the role of arousal (Hemsley, Morrison)

• Importance of emotion (Gumley & Schwannauer: Chadwick)

• Attachment and interpersonal issues (“)• Mindfulness - Chadwick• Self acceptance and compassion (“ +

Gilbert):Self esteem, (Harder).• Recognition of the role of Loss and Trauma• The Recovery Approach.All these lead to a blurring of diagnosis

The What is Real and What is Not Programme

First : Form an Alliance. • Validate their reality – shared and unshared reality• Away from illness language – diagnosis Normalising openness to unshared reality – idea of the

schizotypy spectrum• Advantages and disadvantages of openness to unshared

reality – positive role modelsIdea of the line/ the threshold.• Importance of being able to manage the line• Motivational aspect – pros and cons.Coping skills to manage the line• Arousal management – up and down• Grounding in the present• Wise mind and mindfulness• Focusing/mindfulness v. distraction

Session 2. The role of Arousal shaded area = anomalous experience/symptoms are more accessible.

Level of Arousal

Ordinary, alert, concentrated, state of arousal.

Low arousal: hypnagogic; attention drifting etc.

High Arousal - stress

Making sense of the experienceDiscussion:• Why do people click into/get lost in unshared reality/the

transliminal?

Different meanings for the experience• Meaning for the individual• Place in their life – what was happening in their life when

it all started?• Address and validate the emotion – that is reliable. • 'Problem Solving' idea – Mike Jackson’s research.• Touching on the transformative potential of the

transliminal.

Evaluation project

• 31 participants in 14 groups over a 6 month period. Before and after measures and satisfaction questionnaire.

• Mental Health Confidence Scale – increase in confidence, significant for coping

• Significant Increase in idiographic goal attainment

• CORE – not sig. but trend in right direction.

Comments

Q3: Has it made you think differently about anything? If so, please tell us about this.

• ‘I feel clearer about what’s real and what’s not, what to share and what is personal’

• ‘Yes without a doubt. I feel better about myself’ • ‘That I can take control of myself’ Q4: Please tell us what, if anything, has changed in the way

you think about your mental health issues since attending the group.

• ‘Yes, I am thinking of more positive things about my life’ • ‘I have now realised that I in-fact do have a problem’ In answer to questions about coping strategies, participants

identified mindfulness and breathing as the most helpful

Contact details, References and Web

addresses • Isabel.Clarke@southernhealth.nhs.uk• AMH Woodhaven, Calmore, Totton SO40 2TA.

• Clarke, I. (Ed.) (2010) Psychosis and Spirituality: consolidating the new paradigm. Chichester: Wiley

• Clarke, I. ( 2008) Madness, Mystery and the Survival of God. Winchester:'O'Books.

• Clarke, I. & Wilson, H.Eds. (2008) Cognitive Behaviour Therapy for Acute Inpatient Mental Health Units; working with clients, staff and the milieu. London: Routledge.

• www.SpiritualCrisisNetwork.org.uk• www.isabelclarke.org