Dr Arnold Mindell

CITY SHADOWS
Psychological Interventions
in Psychiatry

iz
Routledge
London & New York
First published in 1988 by
Routledge
11 New Fetter Lane, London EC4P 4EE

Published in the USA by

Routledge
a division of Routledge, Chapman and Hall, Inc.
29 West 35th Street, New York, NY 10001

Set in 10/12pt. Palatino

by Columns of Reading
and printed in the British Isles
by The Guernsey Press Co Ltd.
Guernsey Channel Islands

© Dr Arnold Mindell 1988

No part of this book may be reproduced in

any form without permission from the publisher
except for the quotation of brief passages
in criticism

Library of Congress Cataloging in Publication Data

Mindell, Arnold, 1940—
Cifty shadows.
Includes index.
1. Psychiatry. I. Title. IDNIM: 1. Mental Disorders
—therapy. 2. Psychology, Applied. WM 400 M663c1
RC454.4.6 1988 616.89 87-32196

British Library Cataloguing in Publication Data

Mindell, Arnold
City shadows : psychological interventions
in psychiatry.
1. Psychiatry
I. Title
616.89 RC454

ISBN 0-415-00193-5
To Dieter Wartenweiler
CONTENTS

Acknowledgments ix

Preface xi

I Introduction 1

1 Psychiatry in Crisis 3
2 The Process Paradigm in Psychiatry 21

II Schizophrenia 31

3 The Missing Metacommunicator 33

4 Working with a Schizophrenic State 44
5 Schizophrenia and Altered States 56
6 Processing a Catatonic State 67
7 Patterns in Schizophrenia 75

III MANIA AND DEPRESSION 91

8 Depression and Suicide 93

9 The Manic Savior 102

IV DRUG ABUSE 109

10 Heroin 111
11 Alcohol 121

vii
V THE CITY'S SHADOW 135

12 The Sociopath 137

13 Mental Retardation 149
14 The City's Shadow 162

Glossary of Terms: Psychiatry and Process Work 173

Bibliography 181
Index 185
ACKNOWLEDGMENTS

I am indebted to several Swiss Social Service centers for

exciting supervision weeks from which many of the reports
presented in this text are derived. Only the names and
personal material of the people we worked with during those
weeks have been changed in the otherwise verbatim
transcripts of video tapes.
I am also greatly indebted to Dr Dieter Wartenweiler for
having inspired me to do this work. I am also thankful to
Dr Joe Goodbread, Jean Claude Audergon, Ursula Hohler
and Dr Kathy Ziegler for participating with me, holding my
hand and helping me prepare some of the methods for the
interactions which occurred during those weeks. I am
particularly thankful to the 'Sozialdienst' of the City of
Zurich and of Dubendorf for asking me to supervise their
training programs. I gained much insight from these groups
into the nature of social psychiatric problems, especially
those dealing with criminal behavior.
Many special thanks to Amy Kaplan for numerous
debates, clarifying discussions and supporting material,
especially concerning the topics of Chapters 2, 3, 4 and 5.
Ursula Hohler also helped me a great deal by commenting
and adding to the original text. Special thanks go to
Dr Samuel Wiener for his useful comments and criticisms of
the manuscript. Furthermore, the following individuals have
greatly improved this manuscript by offering their criticism,
suggestions and information about psychiatric hospitals,
conditions and language: Jim Beggs, Larry Bearg, Erwin

ix
x ACKNOWLEDGMENTS

Lichtenegger, Jan Loeken, George Mecouch, Dawn Menken,

Carl Mindell, Scott Sandage, Suzanne Springs, Dieter
Wartenweiler, Kathy Ziegler, and Adam Zwig. I am
especially grateful to Julie Diamond for her enthusiastic
editorial help.
I am indebted to the students of my psychiatry class at the
Research Society for Process Oriented Psychology in Zurich
for going over the case material of this book with me as it
was presented in lecture form. They challenged me to
express unconscious beliefs, goals and speculations which
otherwise would have remained unconscious.
And finally, I am immensely grateful to those many
clients with whom I have worked during the last twenty-five
years who have suffered through their extreme and border-
line states with me and showed me clearly where my inner
representation of their realities had been incomplete. In the
final evaluation, they have turned out to be my most
important teachers about psychotic phenomena.
For general information about Process Oriented Psychol-
ogy, please write in the USA to:

Dr Suzanne Springs
Research Society for POP
PO Box 38572
Denver Co 80238

and in Europe to:

Madeleine Ziegler, Lic Phil

Research Society for POP
Etzelstr 10
8038 Zurich
Switzerland
PREFACE

This work stems from the need to express my experiences

and theories derived from many thousands of hours of work
with people in the midst of extreme states, such as those
occurring during psychotic episodes, drugged and hypnotic
conditions, violent convulsions, the pain of physical
diseases, parapsychological excitement and the events sur-
rounding death.
The verbatim reports of work with clients which appear in
the book come from the meticulously transcribed video
tapes of a supervision seminar at a state-subsidized social
work center in Switzerland.
The project consisted of fourteen interviews with clients,
considered by the social services to be their most difficult
cases. The original purpose of the seminar was to supervise
the work already going on there. My experience with other
social work agencies indicates that the present collection of
clients' material is representative of the kinds of difficulties
which any city meets when dealing with social psychiatric
problems, or alternatively, which any client in need of social
aid has with any given city in the modern western world.
The positive reactions from both the staff and the clients
to using the process oriented paradigm lessened the heavy
and sometimes hopeless feeling commonly experienced by
many mental health professionals working with difficult
clients and encouraged me to prepare this manuscript for
publication. This book attempts give the reader an overview
of methods for working with many different types of altered

xi
xii PREFACE

and psychotic states. The disadvantage is that this horizontal

study does not give a complete view of the multiple causes
and developmental psychology of a particular dient, as she
changes over long periods of time. Such a vertical study
would be a very different kind of book and one which is
now being attempted by my colleagues.
This work is based upon the concepts developed in The
Dreambody, Working with the Dreaming Body, River's Way, The
Dreambody in Relationships and Inner Dreambody Work. Appli-
cation of process theory to non-psychotic states can be seen
in the film Introduction to Process oriented Psychology (Grey,
1987). My background is based upon my work as an analyst
in Process Oriented and Jungian psychology, my early
studies in physics, my research and practice of body work
and knowledge of information theory. I have been in private
practice for over twenty-four years, have worked with
various clinics and supervised the therapy of hundreds of
psychotic patients. I am especially interested in alchemy and
Taoism, the belief and practice that nature, that is,
spontaneous happenings, contains the wisdom of the right
way to deal with life.
Despite the frequently spectacular results of process work
there are reasons for scepticism about its application. There
are several problems inhibiting satisfactory treatment for
anyone in need of help from a city's mental hospital or social
work center, problems which do not immediately appear on
paper or which cannot always be easily discussed.
First of all, what you are about to read is the result of
twenty years of study and experience. It cannot be applied
as easily as it appears on paper. To be able to do process
work, the student of psychology, psychiatry, social work
and medicine must not only be knowledgeable of his or her
given profession but must also be trained in the perception,
differentiation and methods of working with verbal and
non-verbal signals. Some students are able to acquire this
sort of training and education in a couple of years, most
need five years of experience working with the methods of
the process oriented paradigm to be able to deal with
extreme states. How we process what we perceive is a deep
 PREFACE xiii

and complicated matter involving our personal and collective

psychology. Readers requiring further background in process
oriented signal studies can find this in my Working with the
Dreaming Body and River's Way.
The second problem which arises in applying the process
oriented paradigm is having to shift from the medical model
which attempts to determine and ameliorate causes of
phenomena to a model which creates change through
appreciating what is happening. Such a change is bound to
arouse resistance in professionals who are already firmly
established in their policies and methods of treatment. I find
this resistance a welcome and exciting challenge, for, when
used constructively, it tests new ideas by pressing them to
develop more fully.
Thus, I warmly invite any reactions from my readers and
hope that those who find the following material difficult or
irritating for one reason or another will share their insights
and understanding so that I may learn how to better refine,
teach and write about process concepts.
All of us involved in the mental health professions are, it
seems to me, faced with many extreme situations which we
feel we do not deal with satisfactorily. Though we can quiet
down our most difficult clients, control extreme cases, even
ameliorate syndromes, we rarely feel that we have a model
or a paradigm which is sufficient for handling the total
personality and environment surrounding a psychotic
episode or an individual who has become, for one reason or
another, a permanent client of our hospitals and social work
agencies. As a result, most therapists, analysts, psychiatrists
and psychologists in private practice try to avoid extreme
and borderline patients. I hope to show that we need to
work together to discover the common thread in the most
useful elements of our theories and practice.
Not only are there difficulties involved in the training and
application of new ideas in psychology and psychiatry, but
working with clients in a process oriented way entertains
the philosophical concept that these clients might be
meaningful for the city they live in. Such concepts are not
always greeted enthusiastically by city officials. Like any
xiv PREFACE

family housing an 'identified patient,' the city itself resists

and will continue to resist the idea that it, too, may have to
change if its 'patients' are to get better. The city's attitude is
understandable, yet it ignores any potential responsibility it
may have in generating the difficulties in its communal
family.
Thus the original optimism and simplicity which appears
in the following pages should be tempered by knowledge of
the complex nature of the network changes involved in any
one particular case confronting a social agency. The satisfac-
tory treatment of the individual client in the midst of
extreme states involves not only the psychology of his
helper and the science of extreme states, but also the
psychology of the entire city, state and world in which he
lives.
My advice is to bring up these problems, spell them out
and not be naïve about them. Working with troubled people
has unavoidable political implications. The process of a
single person in need of aid from a city hospital, out-patient
clinic, social work center or police department implies
change in the client, greater research into altered states of
consciousness, changes in the special training of the mental
health professional to deal with his or her internal problems
and with the agency, changes in the attitude of city officials
and interactions with the public.
May the following manuscript be a hint about how to
meet at least the client's part of the immense network of
difficulties surrounding the highly unusual client, the
therapist, the agency to which this therapist belongs and the
city in which the client lives.
Chapter I
PSYCHIATRY IN CRISIS

This book is written for both students and experienced

professionals, psychiatrists, psychologists, psychiatric social
workers, nurses, nurses' aides, secretaries, city officials,
interested laymen and family members, who, by profession
or out of compassion, must deal with the wide spectrum of
people who are dependent upon the city's social work
agencies, drug rehabilitation centers or mental hospitals for
financial, psychological and moral support. It is a work
written in the spirit of new beginnings. What are the full
implications of process work with extreme states?
At the present time, near the end of the 1980s, the most
common paradigm in psychiatry is the so-called 'medical
model.' This model has various aspects to it. At its core lies
the concept of causality and the related programs of defining
disease, searching for its causes and attempting to cure it
with behavioral and chemical interventions. This program
organizes definitions, research and treatments of what are
defined mental illnesses.
The biomedical paradigm has proven to be useful in the
cure and amelioration of symptoms in medicine and
psychiatry, though its applicability to the latter is debated by
many authors [Greist et al., 1982). The global, and by now
common, critiques of modern psychiatry usually deal with
the incongruity of its focus. If it deals mainly with mood
states, with affects, feelings, hallucinations and disturbed
belief systems, then, according to many, it should stand on
its own relative to its parent, modern medicine, and not

3
4 INTRODUCTION

simply adapt medical concepts which only partly apply to

non-physical disease descriptions.

CONTENTS OF THIS WORK

A process oriented approach which attempts to discover the
structure and flow of 'psychotic' states is presented and
compared to given medical techniques. Thus, the terms and
diagnoses of the Diagnostic and Statistical Manual of Mental
Disorders (DSM III 1980), the most accepted and clearly
formulated medical statement about mental disorders, is
related to and differentiated from process work throughout
this text. (See the Glossary for the connection between
psychiatric and process work terms.)
Verbatim interviews are transcribed from video tape
recordings and psychotherapeutic interventions of disease
entities such as schizophrenia, manic-depressive reactions
(or bipolar disease), mania, depression, suicide, psycho-
pathy, organic brain damage, alcoholism, heroin addiction,
epilepsy, imbecility, forensic psychiatric problems and
sociopathy are presented here.
The biomedical model and associated methods for dealing
with the above mentioned classifications do not fully achieve
their implicit or explicit healing goals (Boyle, and Morriss,
Griest, et al., 1982; Torrey, 1974). However, this model
manages most acute psychiatric problems and makes it
possible for many to come through extreme states in
relatively short periods of time. Since many aspects of the
healing goal are not fulfilled, psychiatry might be termed,
using T. Kuhn's analysis of scientific revolutions, 'a science
in the midst of an evolutionary crisis' (Kuhn, 1970).
This chapter describes that crisis. The second chapter
presents the theory of process work and is followed by
descriptions and demonstrations of the process paradigm
applied to cases of schizophrenia, mania, depression, drug
dependency, psychopathy and related states. Finally, in the
last chapter, the implications of studying extreme states
upon psychiatry, psychology, social work and politics are
discussed.
The belief governing this work is that integrating psychia-
 PSYCHIATRY IN CRISIS 5

try with psychology will create important changes in both. It

seems to me that extreme human states are to psychology
what astronomical phenomena were to physics before
Einstein's theory of relativity: namely, facts which do not fit
present theories.

PARADIGMS AND INTERVENTIONS

A given paradigm determines the observational methods
and treatments of the patients. Basic to medicine in all
cultures, including ours, is the assumption that people who
do not function in a given society are ill; they are not in
order and require change. Thus, if we assume that people
are sick, we shall find its cause and eradicate it. Our
observations focus upon the symptoms which correspond to
our definition of a given illness. Curing a patient means,
then, eradicating his symptoms so that he corresponds to
our definition of normalcy.
My conclusion from supervising psychiatrists and psy-
chologists working with psychotic patients is that when the
above paradigm does not produce the desired results, the
reason for failure is not always due to a given therapist's
inability to apply the medical model. A core difficulty in
dealing with psychotic states is frequently traceable to
insufficient training in observing the actual details of the
patient's behavior. Thus, the detailed behavior of the
individual patient is frequently glossed over. For example, a
patient who is very passive and involved in his treatment is
obviously going to be more responsive to medication than
another patient who considers herself a revolutionary and
finds it necessary to despise authority. In the process
paradigm, to be presented briefly in the next chapter, the
client is not considered, a priori, to be sick. We do not
assume that his brain is functioning improperly, or that he is
conscious or unconscious. Rather, the exact nature and
content of his utterances and body signals are studied with
the idea in mind that appreciating these details will help him
best. We assume that if the signals and goals of altered and
normal states are followed, life is going to be more
worthwhile to him afterwards than if we only attempted to
6 INTRODUCTION

get him back on his feet and function again.

Process oriented psychology is a wide spectrum method
of perceiving, differentiating and enabling human signals,
both close to and far from the personal identity of the doctor
and patient, to unfold. The aim of process oriented
psychology is to allow these different signals and states to
unfold in an individual way which depends upon the client
and the therapist, by focusing on the underlying process
structures which connect them. In fact, the most able
therapist appears to be one who is familiar with all parts of
psychology, including dream and body work, meditation,
psychosomatic medicine, medical terminology and treat-
ments, relationship and family work, social work, etc. An
empirical discovery is that present problems and issues
become their own solutions, their own 'cures,' if you will.
Though there are many indications that psychology and
psychiatry might grow together, the mental health practi-
tioner today generally uses pieces of different psychologies,
medicines and psychiatry to help her clients. These various
disciplines, based upon different and sometimes contradic-
tory philosophies, have different methods of empirical
investigation and treatment, yet they deal with one and the
same person. Medicine attempts to enable patients to
function like the rest of their environment. However, since
medicine alone may not improve the quality of an individ-
ual's life, most therapists frequently add psychological
interventions to their practice. Most psychologies today,
however, are unable to deal with the gravity of psychiatric
situations alone.
While such differences have the advantage of creating
individual and global approaches to the human being, they
could become even more valuable if the unitary background
to the psychological sciences were better understood. A
disadvantage to having several different paradigms of
mental health is that the competition among them draws
energy away from treating the client and may hinder the
cooperation and team work necessary for creating a more
functional approach to the individual suffering from extreme
states.
 PSYCHIATRY IN CRISIS 7

THE CRISIS IN PSYCHIATRY

The situation in modern psychiatry is summed up by
Freedman et al. (1980) in their Modern Synopsis of
Psychiatry/IV. In the Preface it is stated

Sometimes the structures (of American life) and groups

cooperate, but often they act in competition with one
another. Each has its own responsibilities, and the
fulfillment of these responsibilities gives rise to diffuse
goals. The operation of such groups is seldom conducive
to the formation of unified conceptual systems, and the
history of American psychiatric schools is no exception to
this rule. This diversity is caused not only by the steady
growth of knowledge within the United States but also the
constant enrichment of American intellectual life through
immigration. New ideas brought here by our colleagues
from abroad have taken root and flourished. . . . To
present this diversity in all of its richness and contradiction it
is necessary to be truly eclectic. . . .
If pluralism is a feature of American life that demands
recognition, then pragmatism is one which requires
compensation. While truth needs testing by the practical
consequences of belief, commonplace American prag-
matism often goes beyond empiricism to a disregard for
theory. Thus, American psychiatry has shown strength in
the development of application of treatment methods
while neglecting nosology and clinical description.

This picture of contemporary American psychiatry is, I

believe, true of western psychiatry in general. The facts
noted by Freedman et al. have certain implications:

1. Psychiatry is a Pre-Science
The eclectic state of affairs is an indication that a governing
paradigm is missing in psychiatry and that both psychiatry
and psychology are in a pre-scientific stage of development
in the sense of having no single, generally accepted method
or organization. This means that the mental health sciences
8 INTRODUCTION

are governed in the moment, not only by experimental

methods, but also by various beliefs and affects. Apparently
there is no general agreement among psychiatrists at present
about their identity or goals (Adler, 1981).

2. Eclectic Pluralism Needs Processing

The competition between the schools is correct and is
something which requires processing. I can see a conference
in which different approaches are presented and discussed.
But discussion is not enough and it will become important to
find some sort of unifying principle which ties together the
various treatment methods. Then the school favoring the
use of psychopharmica for psychotic states will, I believe,
integrate what I shall call the 'meaning' schools of psychia-
try. These schools favor behavioral and transpersonal
paradigms, and perceive life from the viewpoint of peak
religious experiences. Concepts such as antipsychiatry,
social revolution, archetypal experiences, early split off
childhood experiences, systemic structures and dysfunc-
tional communication will then be differentiated into neutral
concepts such as local and early causality, immediate
environmental community effects and field influences from
the entire planet.

3. The Effect of Psychiatry's Problems on the Patient

Present treatment methods which, as a general rule, are
devoted to the individual patient are not only divided within
themselves but are also frequently pitted against the city
officials whose major interest is removing the 'disturbance'
from the public eye. Thus, psychiatry is split within itself,
divided from the various schools of psychology and
frequently at odds with the city government, all of whom
feel responsible in one way or another for the disturbed
client. Under these circumstances, it is not surprising that
the therapies for the individual are not as powerful as they
could be, for their diversification frequently mirrors the
compartmentalization characteristic of the disturbed person.
 PSYCHIATRY IN CRISIS 9

4. Pragmatism is Still Incomplete

The pragmatic attitude in psychiatry criticized by Freedman
et al. has not gone far enough. The present medical cause
and effect paradigm does not allow the mental health
practitioner to observe phenomena from the viewpoint of
the client. As a result, many definitions in psychiatry are
based upon community platitudes and unconscious assump-
tions about normalcy. Thus, it is not surprising that
treatment methods arising from these assumptions are not
always effective.

5. Iatrogenic Diseases
Iatrogenic diseases are disorders caused by the medical
profession itself. Today the medicines for many diseases
create symptoms which are frequently only slightly prefer-
able to those of the original disease. It is in fact common
practice to accept drugs which ameliorate syndromes but
which create new symptoms themselves.
One such occasionally occurring disorder, tardive
dyskenisia (TD), may be mentioned. TD is a disorder arising
in conjunction with many neuroleptic drugs which some-
times produce only marginal improvement of psychotic
states. TD is potentially irreversible, involuntary or chorea-
thoid movements which develop even after short term
treatments (Kessler and Waletzky, 1981). Forty percent of
elderly chronic patients now get it.
Even medical practitioners see some hallucinations as
tolerable relative to the TD side effects (Janson et al., 1985).
A recent report in Psychiatric News (May 17, 1986), lists
several dozen drugs which carry TD side effects. These are
Serentil, Moban, Innovar, Inapsine, Iositane, Haldol,
Triovil, Taractarn, Navane, Mellarille, Thorazine, Sparine,
etc.

6. Problems in the Maintenance of the Chronically Ill

Drugs, however, not only create other diseases, but seem to
be erratic in dealing with relapses associated with highly
emotional environments and difficult life situations. In
10 INTRODUCTION

Introduction to Psychopharmacology (Lader, 1980, p. 58) we

read that assessment studies on maintenance therapies
(antipsychotic medication which suppresses chronic symp-
toms such as hallucinations) show that 'drugs made a
demonstrable difference to patients in low EE homes.' An
EE home is one where the closest relative at the time of the
schizophrenic's admission was low on the number of
critical, hostile or emotionally overcharged comments. 'Life
events also seem important and tend to cluster in three
weeks immediately before relapse.' Drug maintenance
therapies seem relatively ineffective in preventing such
event-related relapses, especially when life events are major.
There are other problems connected with medications
besides their inefficiency. Many patients go off 'meds' not
only because they found something of value in even the
most nightmarish mental conditions, but also because they
cannot tolerate either the drug's effects or the social
implications of being drugged. These patients are disturbed
about the overall effects drugs have or do not have on their
lives.

7. Psychiatry and Culture

At present, psychiatric methods and theory support a basic
cultural tendency: preserving the outer appearance of order
while inhibiting direct experience of the psyche. As a result,
the patient is seen as 'sick' and as a 'disturbance,' but not as
the 'identified patient' of a community which itself needs to
change if it expects the statistics of mental disorders to
change.

8. Lack of Theory in Psychiatry

It is dangerous to outweigh the negative results of an
experiment against the positive ones. In terms of anti-
psychotic drugs, it should be mentioned that the relatively
recent explosion in research into the functioning of neuro-
leptica should be reason for optimism. This research creates
the hope for many that biochemistry will solve the chemical
problems behind mental disease in the future. Emotional
support is given to this hope by the general ineffectiveness
 PSYCHIATRY IN CRISIS I I

of psychotherapies. There is a widespread agreement (Karon

and Vandenbos, 1981, are exceptions) that psychoanalytic
techniques, group therapy, analytical psychology and other
psychotherapies do not work with psychotic situations (cf.
Greist et al. 1982).
From a theoretical viewpoint, however, the inadequacies
of both drugs and present psychotherapeutic techniques
point not only to logical inconsistencies in the psychiatric
viewpoint which lead to internal conflicts in that profession,
but also to the fact that the governing, conflicting paradigms
are insufficient to deal with the psychotic states they attempt
to control. This means that the basis of psychiatry is in the
midst of a revolution and points to an obvious conclusion.
Let us begin again with basic principles and review our
assumptions and methods.
The difficulty with such a beginner's mind approach to
psychiatry is that clear perception requires new ways of
thinking, new mind sets, so to speak. Emotionally, it is
difficult for a practitioner who has studied until the age of
thirty to begin at age fifty to review and speculate about the
foundations of his work. This difficulty undoubtedly inhibits
some professionals from thinking more deeply about their
professions. Moreover, it is easier in many ways and
perhaps less time consuming (to begin with at least) to
describe disease characteristics and to recommend medicine
for them than it is to determine, consider and probe the
potential meaning and evolution of a psychotic process
which so rambunctiously interrupts every normal state of
communication and harmony.

PREDICTABILITY, ORDER AND DISORDER IN 'MENTAL ILLNESS'

Almost all psychiatric textbooks speak of mental diseases in
terms of 'disintegration of the personality' and 'unbalanced
and chaotic states.' Such descriptions are based upon the
unexpressed assumption that the ideal person is able to
correspond to the statistical average, and this average is
taken as a measure of order, balance, harmony and health.
Thus, it seems as if individuals going through psychotic
states appear as the chaos and disorder for a culture with a
I 2 INTRODUCTION

particular idea of order and sanity. This black/white, polar

classification of the human being lies at the root of DSM III,
which only weakly tolerates the concept of a wellness-
notwellness continuum of inner experiences. Change and
differentiation are needed (cf. Boyle and Morriss; Engel,
Greist et al., 1982).
Process concepts understand 'mental illness' as an
extreme state which everyone goes through. As we shall see
in the following chapters, process science perceives
psychotic states not as chaotic, but as highly, even
mathematically, ordered structures; they are not disintegra-
tions, but highly patterned evolutions.
The concept of chaos and unpredictability is related to the
therapist's or observer's awareness and experience. Predict-
ability is a concept relative to a given observer and is not an
absolute characteristic of a patient. As far as the therapist is
concerned, what he sees in a client is a total surprise to him
when information appears which he, the therapist, has
never (consciously) been aware of before.
One of the tenets of process oriented psychology is that if
you are surprised by someone, you have not consciously
perceived signals forewarning you of a coming event. In
other words, the 'chaos' or unpredictability of a client is a
function of the therapist's inability to process information in
front of him, not of the client's inherent 'disorder.' Suicide,
insanity, unfaithfulness in relationships, criminal behavior,
etc. are all apparent in the signal system of our clients and
friends.
It is important for the therapist to constantly extend and
improve his ability to pick up signals from his clients. We
tend to focus only upon the content of what people say and
do not pay conscious attention to their other signals, such as
their tone of voice, their sitting position, the movement of
their legs, etc.

EXTREME STATES
The more our perception improves, the less we will need to
use terms such as 'disorder' and 'chaos.' In what follows,
except where I need to differentiate process thinking from
 PSYCHIATRY IN CRISIS 13

medical paradigms, I shall refer to mental disorders as

extreme states.
The word 'state' means for me a momentary picture of an
evolving process. The term 'extreme' refers to the frequency
with which these states are met with by the ordinary person
during everyday conditions outside of the psychiatric
milieu. Thus, they are rare only in terms of occurrence; the
majority of their content and structure is experienced by all
of us. In Chapters 4, 5 and 6 I will show that these extreme
states show a chronically missing 'metacommunicator,' that
is, someone who is able to talk about the states as if they
were occurring in another person.
This definition of psychosis frees me to study these states
as static momentary or cyclical processes which are evolv-
ing, have a purpose and an implicit order and direction.
Furthermore, I am removing them from the ordinary
categories of cause and effect, medical disease and cure, and
placing them in the realm of phenomenology, which
connects psychiatry to psychology, physics, medicine and
sociology.

FREQUENCY OF OCCURRENCE AND TRANSCULTURAL PSYCHIATRY

The term 'extreme states' indicates a certain infrequency of
occurrence for a given observer. A volcano for an inhabitant
of Hawaii will not be an extreme condition, for a New
Yorker or Zuricher, it will be. Hence, what is sick or extreme
for one culture will not be for another. By using terms like
'extreme states' and 'process work,' we have the chance of
developing a transcultural psychiatry which deals with
relative deviations from the norm and which is independent
of the specific cultural definitions of illness.
The western world differentiates its extreme states accord-
ing to the way people in these states do or do not
communicate. About one half of the people in our mental
hospitals are said to suffer from what is diagnosed as
schizophrenia, the rest are a mixture of severely depressed
or suicidal people, the aged and senile, people in manic
states, chronic alcoholics, heroin addicts, people with
organic brain damage, the so-called criminally insane, those
14 INTRODUCTION

laboring under subnormal intelligence, and a large category

entitled 'mixed psychoses,' those with a mixture of the
above, or the 'generally handicapped.' These categories vary
from one hospital and community to the next.

TREATMENT MODALITIES
It seems as if the newest treatment for psychiatric disorders
will eventually be derived from computerized tomography
(CT), an unobtrusive, acceptable radiologic view of the
living brain which will probably increase the use of drugs in
understanding the relationship between brain physiology
and behavior. As yet, however, brain scan techniques have
done more for stimulating brain-behavior research than for
providing immediate practical applications (Serafetinides,
1985; Wyatt:1984).
The most popular treatment today for a given category is
the administration of psychopharmica. Group therapy is
probably the next most popular treatment of choice for city
disturbers. Group therapy champions the integration of the
client into the rest of the community. This form of therapy is
linked with systems theory and family therapy, both of
which work with the communication problems within the
client's original milieu. The theory behind it is the assump-
tion that the client's problems are supported indirectly by
the world he comes from.
Neopsychoanalytic therapies seek an understanding
relationship with the client, whom, it is hoped, will
eventually achieve insight into his condition (Karon and
Vandenbos, 1981). A Jungian development based upon
empathetic understanding and patience is governed by the
concept that the client is experiencing an archetypal drama
which needs appreciation and understanding (Perry, 1974).
More recent therapies such as dance therapy are aimed at
enabling the client to express his condition more completely
(Marion Chace, 1975; Schoop and Mitchell, 1974).
Transpersonal psychology is attempting to understand
mental problems from a developmental viewpoint in which
the human being is conceived as being en route to
 PSYCHIATRY IN CRISIS 15

something like an Atman experience (Wilbur, 1984). No

specific treatment is associated, as far as I know, with
transpersonal psychology besides an appreciation of the
meaning and significance of the disorder.
Jung assumed in the first part of this century that mental
disturbances were not merely pathological but were mani-
festations of some meaningful behavior which he wanted to
understand. He later amplified this theory by suspecting
there to be chemical disturbance in schizophrenia (Jung,
1974).
In his autobiography, he tells about a schizophrenic
woman who showed him that mental disease could be
teleological. During his early work in Burgholzli, he
examined an old woman suffering from schizophrenia and
found that she continuously made the motions of a shoe
maker. He discovered that just before she had lost her mind,
a shoemaker had rejected her love, apparently precipitating
the psychosis.
He tells of another catatonic woman who fantasized about
living on the moon. Jung showed her that she had to live in
this reality and that this was not going to be easy. He
worked with another advanced schizophrenic woman who
had voices coming out of her entire body. He listened to the
ones which called themselves God coming from her thorax,
followed their directions, gave her bible readings and she
slowly improved. In time, this woman was freed from the
voices coming from at least one-half of her body. Jung
believed that when attending to the mentally ill one must be
content with small improvements.

ANTI-PSYCHIATRY
I do not intend to give a history of psychiatry here, though
such a study of the development of psychology would prove
fascinating. Thus, I cannot do justice to the main forms of
therapy, especially the popular behavioral treatments which
reward the patient for changes in behavior. I must,
however, mention the work of R.D. Laing, who, under the
controlled conditions of a mental hospital, allows the
'schizophrenic' to let his process unfold. In some of Laing's
16 INTRODUCTION

writings, we begin to see the schizophrenic not as mad, but

as a political radical relative to the world he lives in (Laing,
1967). Laing is easiest to read if we simultaneously consider
the fact that he is compensating a world which fears the
public consequences of madness.

CONCLUSION ABOUT THE CRISIS IN PSYCHIATRY

DSM III is a major step in the delineation of mental
disorder. It also creates the impetus to unify the language
and concepts of psychiatry in perhaps the most significant
way since its beginning. Nevertheless, the lack of agreement
over the identity of psychiatry relative to the rest of
medicine, the relatively high frequency and seriousness of
the iatrogenic diseases associated with neuroleptica, and the
inefficiency of these drugs at the present time give room for
reconsidering the foundations of work with extreme and
psychotic states.
Furthermore, one of the basic assumptions of psychiatry,
that disease entities are 'caused' by specific chemical
imbalances, has not, until present, been verifiable. For
example, schizophrenia strikes 1 percent of the population
today, a percentage which has not decreased throughout
history, in part because the supposed cause for schizo-
phrenia is still unknown. Some authors such as Karon and
Vandenbos (1981) claim that Freudian treatment of working
through early trauma manages such cases well, though
Greist et al. (1982) reflect the general psychiatric opinion that
all psychotherapies today fail with psychosis.
Moreover, the causes of the other psychiatric syndromes,
namely the manic affective disorders, the psychopathic or
antisocial disorders, certain epilepsies and many organic
brain deteriorations also remain unknown.
Not only do the supposed causes of the diseases remain
unknown, but their treatments are often vague and incon-
clusive, even though DSM III has reduced these 'shotgun'
diagnoses and treatments within the last ten years. Still, the
schools of psychiatry do not yet agree on the definition of
the diseases. An Englishman, for example, who is diag-
nosed schizophrenic in London may be termed 'over
 PSYCHIATRY IN CRISIS 17

excited' or 'manic' in Los Angeles and vice versa.

Fuller Torrey, who was at one time reserved about the
direction of psychiatry (1974), today fully supports the
biomedical approach (1983). Yet the vagueness of DSM III is
apparent in his work.

Unfortunately, many patients have symptoms which place

them somewhere on a spectrum between schizophrenia
and manic-depressive illness. Most psychiatrists have
seen individual patients who fit only one of these disease
entities perfectly, but most have also seen patients with a
confusing melange of symptoms of both diseases. Text-
books of psychiatry are written as if patients had one
disease or the other and imply that all patients can be
placed under one of the two disease categories. It has
been facetiously suggested that we need either to insist
that patients read the books and choose which disease
they wish to have or we need to become more flexible in
our psychiatric thinking. I personally have seen patients
with virtually every possible combination of schizophrenic
and manic-depressive symptoms (1985, 53).

To resolve some of the overlap between categories, 'schizo-

affective disorders' have been defined. Treatment is some-
where in between that for schizophrenia and manic-
depressive illness. This category demonstrates the lack of
congruency in psychiatric treatment and its dependency
upon the personality of the psychiatrist in the choice of
drugs. According to Torrey,

Those who are carefully diagnosed as schizoaffective are

more likely to have a good outcome to their illness,
especially if they are properly treated. And proper
treatment means a trial of lithium, the drug which has
been used so successfully to treat manic-depressive
illness. Any person with a schizoaffective disorder who
has not responded to other treatment deserves a trial of
lithium, and relatives of such a patient should continue
18 INTRODUCTION

shopping for a psychiatrist until they find one who uses

lithium in such cases. (1983:5)

CRISIS IN TREATMENT CENTERS

Unlike a scientific revolution in the natural sciences which
affects primarily an isolated group of scientists, a crisis in
psychiatry is not only felt among psychiatrists but among all
those confronted with the mentally ill. A common character-
istic of mental health professionals in the social services and
mental hospitals is demoralization and the cynical accept-
ance of the unsatisfactory methods of treatment for the
patients. Patients are either given maintenance measures or
are subjected to verbal psychotherapies, even though many
of them do not respond well to talk. There is also a large
measure of good-natured mothering and caring. The heroin
addict is weaned on methadone, a substitute for heroin
which is itself addictive. The depressed person is encour-
aged to talk about feelings. The manic is frequently ushered
off for a 'vacation' on downers. The psychiatrist faced with
a patient claiming to be the Virgin Mary, broadcasting the
wisdom of God in a downtown shopping center, is likely to
first search for the right drugs to quiet the patient and
appease the environment. The social worker endeavors to
work with the client, his impossible family conditions, his
neighbors, the police and even the court system. Many of
these workers feel overburdened and impotent in the face of
extreme states.
In spite of increasing sophistication in research and the
interconnection between chemistry and psychotic behavior,
there is still no one-to-one cause and effect relationship
between disease agents and cures. The applicability of
disease definitions based, to a great extent, upon the
experiences of a given society seems to be a dangerous
definition of a 'physical' disease. A mentally healthy person
in our culture is, according to medical definitions, capable of
verbally relating thoughts and feelings in the absence of
physical disease. Definitions in terms of given cultural
norms are bound to have limited application since they are
value judgements related to the observer's psychology
 PSYCHIATRY IN CRISIS 19

rather than empirical reports of the client's individual

language and body gestures. A qualitative classification can
hardly be expected to produce quantitative changes; there-
fore, it is logically inconsistent to even search for quantita-
tive causes for 'disease' which have no quantitative
measures!
We have to remember that a psychotic individual has,
during a psychotic episode, different values from the normal
person functioning well in a society. Many severely dis-
turbed people do not feel they are disturbed; they do not
come to an analyst of their own accord. They will frequently
insist that the city itself is ill. They are forced to go and seek
help from the city they live in because they can no longer
adapt to the financial or existential requirements of their
world. Most have no interest in 'growing,' 'insight' or
'development' they tolerate visits to a mental health
professional in order to get probation, social security,
financial or medical support.
Hence, we should be aware of the fact that one reason we
may not be able to work well with this 'non-grower's-club'
segment of the population is because our assumptions about
sickness and health, insight and consciousness may not
apply to them. However, it is not the logical inconsistencies
in the psychiatric paradigm which inhibit its usefulness, but
its inability to fulfill its goals of getting the patient healthy
again and behaving like others who do not burden the city. I
think it is generally accepted today that cures for the main
diseases have not been found. Research based upon the
description of symptoms, symptom clusters or syndromes
has focused on genetic inheritence, endorphine over or
under production, dysfunctional communication systems in
the family of origin, neurochemistry, ethology, cognition
and learning theory without being able to explain the origins
of the non-organic psychoses.
It could be argued that research has still not been able to
progress sufficiently to produce the desired results. Cer-
tainly inconclusive research is no argument for dropping an
organizing paradigm. The above difficulties, however, give
us the impression that the mental health sciences are in the
20 INTRODUCTION

midst of a typical 'pre-science' stage of development

characterized by either too many or insufficient paradigms.
Thus, psychiatry is in the midst of a paradigm crisis.
Chapter 2
THE PROCESS PARADIGM
IN PSYCHIATRY

The consensus view of the human being used in contem-

porary psychiatry is that the patient is a poor, inferior and
crippled being. Torrey, one of the most respected figures in
psychiatry today, says, for example, that the best way to
deal with schizophrenics is to

treat them most naturally as people. This can be verified

by watching the nursing staff in any psychiatric hospital.
The staff who are most respected by both professionals
and patients treat the patients with dignity, and as human
beings, albeit with a brain disease. (1983, p. 160)

An explorer with a beginner's mind would see the 'patient'

as someone he does not understand, someone to be
discovered. The process concept adds to this view the idea
that to discover someone you must pay strict attention to his
behavior and to the events around him. The human being in
front of us is perceived correctly only when he totally agrees
with our observations. Experience shows that this agree-
ment occurs most readily when we appreciate the content of
what he says, the structure of his language, the type of body
signals, relationships and synchronicities associated with
him.
The process approach to the individual is to find the mode
of communication in which the patient is experiencing
himself at a given moment, and work in that mode or
channel by methods adapted to that channel. If someone is

21
22 INTRODUCTION

hallucinating, instant communication is achieved through

visualizing with him. If someone is complaining about
voices, a strong intervention would be to speak in terms of
the voice. If someone complains a lot about relationships,
the therapist might work on his or her own feelings relative
to the patient at that moment. If someone behaves in a
drugged fashion, then he feels best if you use his drug-
language to communicate with him. If he does not talk and
looks withdrawn, then it is important to communicate with
his vegetative responses.

COUPLED EFFECTS
What we observe and experience is differentiated according
to the channels we observe in. Hence, you can feel
something in your body such as temperature or pressure
proprioceptively. You can hear voices auditorally. You can
move kinesthetically. You experience people through the
.channel of relationship. You contact the world through
synchronicity. You remember most dreams through the
medium of visualization.
The activities and signals of one channel are coupled, or
connected together. Hence, you may have a stomach ache,
feel your stomach to be like a rock, go to sleep and dream of
a rock on the ground. The proprioceptive experience of the
weight in the stomach was coupled to the dream rock. And
vice versa. You can dream of a volcano and have a 'splitting'
headache the next day.
However, you cannot assume that if you give someone
aspirin the stomach ache will go away. It frequently gets
better, but because of the coupled effect, that is, because of
the dreambody or the psychosomatic situation, the dream of
the stone is still present and will appear again in the
stomach, or in another organ. You can temporarily relieve a
symptom but cannot get rid of the gestalt or archetype
behind it. If the individual needs to be heavier or more like a
stone, then this experience is going to try to reach
consciousness in every way possible.
 THE PROCESS PARADIGM IN PSYCHIATRY 23

THE COUPLED EFFECT WITH PSYCHOPHARMICA

Hence, if you give someone medication to change his mood
from depression to elation, the depressed process may or
may not disappear. If it is time for the person to change his
mood and to combat these moods, then the medication will
also correspond to a change in behavior. If, however, the
person's dreams and process of individuation want that
depression for some particular reason, then medication will
not work in a causal fashion because of the somatic-psychic
coupling.
If you give medication to quiet down a highly aggres-
sive patient, the medication will work only if the patient
himself needs a pause from this aggression. But if the
patient needs to learn how to use this aggression more
consciously, he may not even take the medication in the first
place.
Thus, the concept of channels and their couplings helps
us to understand why it is that medication sometimes works
and sometimes does not. Working only in one channel,
changing proprioception through pills, body work or
jogging without considering the situation in other channels,
like vision or relationship, could even be dangerous. I
remember the case of one patient who had fits of negativity
towards everyone. His medication helped him to get along
better with others, but then, in a fit of anger, he threw
himself through one of the windows of his mental hospital.
That negativity needed expression and should have been
worked with in relationships.
The existence of coupled effects has long been recognized
in the physical sciences. We need only imagine a thermo-
electric effect, for example. In physics, heat is one macro-
scopic process, while the flow of electricity is another. Heat
up a certain material, and instead of it getting warmer, it
may emit electricity and light up a bulb. Or think of another
process in which you press a material and it gets warmer!
Heating up a piece of material does not necessarily mean
that it is going to get warmer! By the same token, giving
someone psychopharmica does not necessarily mean that
24 INTRODUCTION

his mood is going to change, especially if there are coupled

processes involved.

ON 'DISEASE'
Process oriented dreambody work uses the concept of
disease only as it plays a role in the personal psychology of
the individual. Diseases are frequently formulated by the
client as enemies to overcome. Many who experience their
symptoms discover them to be purposeful expressions of the
human unconscious which are searching for more ex-
pression. People are, a priori, neither ill nor well in the
process paradigm. Body work indicates that the body is
dreaming since amplifying body symptoms seems always to
produce processes which mirror what the 'sick person' is
dreaming. Thus, since one always dreams, it follows that
one also has many types of body experiences. Just as some
dreams are pleasant and others scary, some body experi-
ences are pleasant and others are troublesome. Being sick is
a primary description of a secondary process disturbing us.
Change, in the process paradigm, occurs through the
confrontation of awareness with processes trying to unfold.
Since many processes cannot unfold completely, they spin
in mid-air, like a wheel not touching the ground. This
spinning may be experienced as a relationship problem, a
body symptom, a dream, a neurosis, a psychosis or
combinations of all of these expressions.

ON TERMS
To ease communication between us, I will continue to use
terms belonging to other paradigms such as 'conscious' and
'unconscious' (depth psychology), 'sickness' and 'health'
(medicine), 'sanity' and 'insanity' (legal terms), 'mental
disorder,"schizophrenia,"sociopathy' (psychiatry), etc. I
attempt to define these words in terms of process concepts
and show how they may be limiting cases of the more
neutral paradigm. The reader interested in a brief explan-
ation of the interrelationship between psychiatric and
process terms may turn to the Glossary at the end of this
book for reference.
 THE PROCESS PARADIGM IN PSYCHIATRY 25

The terminology I develop is based upon my interest in

dealing with strongly altered and unusual states of con-
sciousness and upon my phenomenological approach to
these states. Older terms such as 'withdrawn' and 'related'
are not useful in actually understanding the structure of
processes, especially when these are very foreign to
everyday life. Hence, psychiatry needs a new language, one
which deals with events as they occur, in contrast to a
language which is strongly biased to consensus reality
thinking. Thus, I will have to speak of 'primary and
secondary processes,"channels,"double signals' and other
terms which are not common in psychology today. I hope
the reader will understand and bear with me.
Let us call primary processes those expressions with which
the individual identifies himself either explicitly or implicitly.
Someone who implies or says, 'I am the Virgin Mary,' or 'I
am a rock star or a business woman,' indicates that her
primary process is an identity experience of the Virgin, a
rock star or business person. Primary processes can be
identified even in strongly altered states of consciousness.
Secondary processes refer to all other processes which an
individual does not experience as belonging to him, and
which he speaks about as if they happened to him from the
outside, or as caused by another agent. For example, 'My
leg is killing me,' 'The police are after me,' 'The world is
against me,' or 'This other person helps me,' etc. are
statements which express that the leg, the police, the world
and a helper are the names of secondary processes. These
processes are further from awareness; they are projected
and experienced outside of the individual who expresses
them. Both primary and secondary processes are only
partially conscious.
The individual identity is connected to the primary
process. Consciousness is a term which I use only for those
moments in which the individual is aware of primary and
secondary processes. Consciousness refers to a reflective
awareness, to the existence of a metacommunicator, someone
who is able to talk about his experiences and perceptions.
I use the term double signals to refer to expressions coming
26 INTRODUCTION

from a person which are part of his secondary processes,

information with which he is not able to identify himself in a
given moment. The reader interested in the background to
these terms is referred to the first chapter of River's Way.

PRACTICAL CONSEQUENCES OF PROCESS THEORY

Change happens through or is associated with the unfolding
of patterns. This means, for example, that a man who is
constantly moody or a woman who tends to fall into a cool
nastiness towards others will not necessarily change
through insight into dream material alone. Empirical know-
ledge indicates that insight is most effective when it follows
experience; it is then likely to coincide with change.
In the analytical paradigm, for example, the man will
dream about his moodiness or the woman about her
coldness and this dream material will be discussed, inter-
preted and related to present or past situations. In the
process paradigm, the dreamer will be encouraged to
become aware of aspects of himself which are close to and
distant from awareness (namely primary and secondary
processes), and to follow their process of unravelling.
For example, someone dreams about an explosion and has
a stomach ache. If this stomach ache is experienced as
something trying to break out, it is a relatively constant
occurrence in process work that the stomach ache will turn
out to mirror the dream, showing the individual that a part
of him is trying to explode. By experiencing this more
completely, either through visualizing it, hearing it, feeling
it, acting it out, noticing it in relationships or synchron-
icities, consciousness and change happen simultaneously.

PROCESS ELEMENTS IN MODERN SCHOOLS

The Freudian encouraging her patient to experience her
transference is encouraging insight through process work.
The Jungian who uses active imagination to meet dream
figures on paper is using a process paradigm. The Gestalt
therapist requiring her client to act out a dream is
dramatizing an experience which has been secondary. The
neo-Reichian working through resistances to aggression in
 THE PROCESS PARADIGM IN PSYCHIATRY 27

body work is touching the process work paradigm if these

resistances are allowed to express themselves and are not
simply 'broken through.' The process paradigm is not new;
it plays a crucial role in all psychotherapies, and is accepted
as a basic concept everywhere in psychology. The process
paradigm may even be considered a central pattern in our
earliest sciences. Alchemy is based upon cooking what is
incomplete and Taoism encourages one to discover the
patterns behind reality and to follow their unfolding with
appreciation and awareness.
My background in process work is based upon the
finalistic philosophy applied by Jung to psychological
situations. He looked for the meaning of things; he was not
interested in pathologizing them, but attempted to take
them as facts for themselves. Since he was himself a
physician he recognized the usefulness of the medicial
model, but extended it by concentrating on the fantasy
world produced by the client.

RESERVATIONS ABOUT PROCESS WORK

Process oriented psychology differs from more popular
'process psychologies' in its differentiated method of obser-
vation. Thus, a frequent misunderstanding derived from
popular conceptions of the term 'process' is that clients can
get dangerously or uselessly wrapped up in their 'process,'
that is, get too involved in themselves. Would it not be more
useful and valuable at times to simply give direct and clear
instructions which a client could follow?
Encouraging clients to follow only one part of themselves
is always less useful then helping them contact all their
parts. Only the total process is really healing. Following a
client in process oriented psychology means not only
following the part which the client identifies with in the
moment, but following the total process, that is, with both
primary and secondary signals.
Thus, encouraging a client to be God when he is
proclaiming that he is God and that the 'authorities' are evil
would be less useful than enabling him to get in contact
with his own inner authorities. Once this is done, he will be
28 INTRODUCTION

able to take simple and helpful directions from others and

will even be able to give them to himself. As long as he is
identified with God, it is not likely he will be able to hear or
follow such instructions.
Until recently, contacting the other side of a polarization
during an acute episode has been difficult to achieve with
patience and psychological interventions alone, that is,
without drugs. The following chapters present psychological
interventions which may contribute to reducing the need for
such drugs.

INTRODUCTION TO THE SOCIAL WORK PROJECT

In this work I am going to investigate the usefulness of the
process oriented paradigm in relationship to 'difficult'
clients. Clients come more or less spontaneously to the
social service station where this project took place. Instead
of going to their normal social worker, psychologist, or
financial advisor, the clients seeking help from the station
were invited to sit together with me and my colleague,
Dr Joe Goodbread, the whole social work team, including
secretaries, social workers and bosses, and also with my
video camera which was taping the entire transaction.
The video taping was explained to all involved as an
attempt to improve my understanding of the client's
behavior and to help the team in their work. I asked the
clients to help us with this. Their response was almost
unanimously positive. They enjoyed the team atmosphere to
such an extent that most wanted to come back again soon.
The break in the normal one-to-one relationship with their
therapists was met at first with apprehension, but soon the
jovial and loose atmosphere relaxed everyone. Each client
felt appreciated and important sitting with the group of
therapists and social workers.
During the hour-long sessions there were between three
and eleven people present. Some meetings included every-
one interested in a given client, city officials, the head of the
regional social work services, social workers who had just
dropped in to see what was happening and who wanted to
learn more, and of course the Dubendorf team itself. The
 THE PROCESS PARADIGM IN PSYCHIATRY 29

focus of communication was placed, for the most part, upon

the client. The different therapists were encouraged to bring
in their separate reactions. I found all of these reactions
meaningful and even felt at times as if each of those present
was necessary.
These therapists had never worked together in such a way
before. I found that they relieved one another, comple-
mented one another, augmented and in some cases mir-
rored the patient's process. There would always be one
therapist interested in getting the client a job, helping him
into this reality, and another who would try to mother him
and communicate with feeling. Still another wanted to get to
the root of what was happening. All were necessary. The
problems which arose, were, I believe, typical of clients and
social work agencies everywhere.
Their leader's report after the supervision week stated,
'We presented our supervisor with our fourteen most
difficult cases and discovered that if there were any limits to
his approach, they did not appear in the present cases.'
Once the original excitement of the seminar had passed, this
enthusiastic report was tempered by the everyday reality of
the client, his long history of problems, and the difficulties
involved in employing the process oriented paradigm
without thorough training in signal work.
The problems involved in working with severely dis-
turbed people were a combination of what the team
experienced as 'tricks and traps' of the clients, pressure from
the client's environment to make him more adapted,
internal stress between the team members, internal diffi-
culties of each individual on the team, and a lack of training
in signal awareness. A quasi-medical approach to the patient
of viewing him as if he had a brain disease often clouded
accurate perceptions. Furthermore, difficulties arose which
were outside the scope of the video taping, difficulties
involving interactions with the client's neighbors, police and
court. In addition, I realize now in retrospect, after having
spent hundreds of hours studying and transcribing the case
material, that I, too, learned a lot about where I needed to
learn more. There were times I wasted energy conflicting with
30 INTRODUCTION

instead of following the client. Frequently things happened

so quickly that I was not able to understand the process
structure until after having studied the tapes.

METHODS
The basic process paradigm is that signals and information
from the client-therapist pair contain their own structure
and implicit evolution, that is, the solutions to the problems
at hand. The method was to wait to develop a strategy until
the structure had become apparent.
When working with people with whom I have trouble
communicating, I always refer to my video tape recording. I
often make decisions only after having studied the video in
order to discover which information I have not allowed
myself to pick up and why I did not pick it up. If the client
becomes increasingly unhappy during the session or after-
wards, or if my communication to the client does not receive
a favorable response, I assume that I have to change. I
usually find out that I have rigid conceptions of how people
should be or am unconscious of something I am projecting
onto the client which makes it impossible for me either to
pick up or to deal openly with what is happening. For
example, in one sitting where a woman suffering from
chronic alcoholism spoke about what seemed to me to be a
harmful interaction with her little children, I entered a
cyclical and antagonist process with her in which I was
anything but helpful, either to her or those around her. She
brought up problems in myself I first had to deal with before
I was even able to understand the video tape.
This particular woman helped me to be definitive about
my own goals in working with her and others, and helped
me to become aware of the occasional discrepancy between
what the therapist's and client's goals may be. As far as I
know, my goals seem to be (i) to achieve what I interpret to
be unequivocal positive response from the client, (2) to get
the same response from the environment, (3) to enjoy
myself to the utmost, and (4) to appreciate the nature of
difficult situations. Obviously I have to be wide awake about
myself because not every client will automatically join me in
these expectations!
Part II
SCHIZOPHRENIA
Chapter 3
THE MISSING
METACOMMUNICATOR

The definition of schizophrenia depends upon the school of

psychiatry and the treatment. Thus if physical factors such
as inheritance are considered (Freedman et al., 1980, p. 421),
then the bio-model is used. When relationships are focused
upon, the psychodynamic-interaction model arises. Such a
model can be seen in Freud's (1950) description of schizo-
phrenia as a 'deep, primary disturbance of a patient's object
relationships, a narcissistic psychosis which precludes
psychotherapy' because the patient is not ready for trans-
ference relations. The phenomenological-existential model
understands the patient strictly within the limits of his own
self-evidence. There are conditioning-behavior models
which demonstrate that the disease is connected to acquired
responses and sociological models indicating that schizo-
phrenia is produced by urban ghettos. A 'vulnerability
stress' theory combines English, American and Swiss-
German research as well as biomedical considerations and
social dynamics (Schweizerische Aerzte Zeitung, Band 66,
Heft 34, August 1985).
Though there is no one generally accepted definition of
schizophrenia, Bleuler's (1950) original definition seems to
prevail in European psychiatry text books. Bleuler diagnosed
schizophrenia from symptoms characterized by disturbances
of thinking, affect and volition. Schizophrenia means,
literally, a splitting of the mind. Bleuler observed that the
initiative of the patient is split into several potentialities.
Thoughts and associations are fragmented and 'devoid of

33
34 SCHIZOPHRENIA

meaning,' indicating a lack of apparent logic. Affect is no

longer 'adequate or appropriate' to a given situation.
Though there is no loss of memory, no obvious physical
cause and adequate time and space orientation, Bleuler
pointed out that the schizophrenic has difficulty distinguish-
ing between internal and external reality. There is frequently
an early and gradual onset between the ages of fifteen to
thirty.
According to DSM III, schizophrenia is diagnosed only
when the following criteria are fulfilled:

1 Symptoms of illness have been present for at least six

months.
2 There has been some deterioration of functioning from
previous levels in such areas as work skills, social
relations and self-care.
3 The disease began before age 45.
4 The disease symptoms do not suggest organic mental
disorders or mental retardation.
5 The disease symptoms do not suggest the manic-
depressive illness (bi-polar illness).
6 At least one of the following symptoms is present:
a Bizarre delusions where the content is patently
absurd and has no possible basis in fact, such as
delusions of being controlled, thought insertion,
thought withdrawal and thought broadcasting.
b Delusions of a grandiose, religious, nihilistic or
somatic nature if ideas of persecution are absent.
c Delusions of persecution or jealous content if
accompanied by hallucinations of any type.
d Auditory hallucinations in which a voice comments
on a person's behavior or thoughts, or two or more
voices converse with each other.
e Auditory hallucinations heard on several occasions
with content of more than one or two words and
having no apparent relation to depression or elation.
f Marked loosening of associations, markedly illogicial
thinking, incoherence or marked poverty of speech
if associated with either blunted or inappropriate
 THE MISSING METACOMMUNICATOR 35

affect, delusions, hallucinations, catatonia or grossly

disorganized behavior.

Diagnosis is obviously still a subjective factor which

depends upon the personality and values of the observer. It
is often difficult to determine what thought withdrawal or
inappropriate feeling is since many people have 'unusual'
feeling relationships. Schizophrenia is usually meant to
mean the coexistence of disparate affects and behavior, for
example, giggling and then killing someone, having a
pleasant evening, giving everyone a warm goodbye and
then committing suicide, yelling happily and stripping in
church, etc.

AN EXAMPLE OF PROCESS WORK

Instead of discussing schizophrenia in general terms, let me
introduce Herr E., a man who has been diagnosed with
schizophrenia and has been in and out of mental hospitals
for many years. Every Monday morning he appears
punctually at 8.00 am as the doors to the social service
station open in order to collect his weekly disability
payment.
As he walks in, I am informed that he has been
hospitalized many times and is once again being considered
for hospitalization because he has been disturbing the city
authorities with incoherent complaints. In his folder I see he
has been writing many letters to the police accusing the
social work agencies of having cheated him out of money.
There are over forty letters in the file. The letters, however,
are unconvincing because the logic is difficult to follow. As
he enters the room, I notice that Herr E. is over six feet tall,
heavily set, moves slowly and powerfully and speaks with a
deep voice, expressing himself vehemently and what seems
to me a bit menacing. The following is a verbatim tran-
scription and translation from Swiss-German of the interview
with Herr E., the staff director, Dan and myself.

Herr E.: I am looking for work in town, in private

industry, with a temporary office.
36 SCHIZOPHRENIA

Amy: What sort of work do you do?

Herr E.: It depends upon what they produce.
Amy: I understand.

I nod encouragingly so that he will go on speaking

though I do not know to what 'they' refers.

Herr E.: I have no patience. They give me no money for

vacation. Nevertheless I make vacation at home.
Amy: Yes.
Herr E.: Doing, understanding . . . I have written the
criminal police often for help and for money. This
social work boss sitting here [nodding towards Dan]
is not healthy. He reads . . . in the newspapers. The
newspaper is no longer coming to me. He and the
insurance people steal money from me. I have no
time to work. I am busy. . . .

As Herr E. speaks, he sits forward aggressively moving his

hands in front of Dan and me and then sits back, acting as if
he is listening. Then he sits forward and speaks angrily
again, saying to me,

Herr E.: They are dishonest, they are not healthy, they
need help, check them out, don't just inspect them,
help them.

The movements forwards and backwards in his chair occur

at intervals of approximately sixty seconds. A typical
statement when he sits back is

Herr E.: I have no time to work. I don't like it exactly. Now

I am on vacation.

PROCESS STRUCTURE
It is difficult to understand
Herr E. in terms of conscious and
unconscious, for everything he does seems to be uncon-
scious. If, however, we resist using these terms, we can ask
questions with more quantitative answers. What process
 THE MISSING METACOMMUNICATOR 37

does he identify himself with? What process does he

experience as being outside of himself or as happening to
him?
He identifies himself as being on vacation. He doesn't like
working and has no time for it. He is angry at the authorities
for not giving him money for vacation. This 'vacationer,' let
us say, is his primary process, the one he identifies with.
His secondary process, the process with which he is in
conflict and which he experiences as happening to him from
the outside, is the 'unhealthy' social worker. The authorities
are sick, steal from him and need help. The vacationer is well
but the authorities, in his opinion, are sick. It is important
that Herr E. sees only the 'others' as ill; he, as the
vacationer, is in order. We will return to this statement later
on.

OBJECTLESS PROJECTIONS
We should be careful in thinking that the actual authorities
are as dreadful as he imagines. Naturally, many people do
not like city authorities because some of them really are
difficult to deal with and sometimes even disturbed.
Herr E.'s authorities, however, are not identified with a
specific group or individual. These authorities are a 'field,'
an idea, a piece of his psyche, so to speak, hanging in mid-
air waiting to find an object. Anyone who criticizes or resists
him can and will fill the authority role.
For example, he said that Dan, the director of the social
service station, is not well. But two minutes later, when I get
tough with him and accuse him of being lazy, I become the
critical, resistant authority and Dan is relieved of this
projection. Herr E. defends himself against me when I
challenge his statement about not wanting to work.

Amy: I think you may be lazy.

Herr E.: This man here, this Dan, he is a very good
guardian. He will take care of me until I get to be 65.
The law says he is really good. He must see that I
live to 65.
3$ SCHIZOPHRENIA

ON 'INAPPROPRIATE FEELING'
We see from this short section of the work that Herr E. does
not relate to me or to Dan with any degree of continuity.
One moment we are good, the next we are bad. Our
positions change in his mind since his momentary behavior
is independent of what has been felt or said a moment
before. At one moment Dan is unhealthy and then in the
next he is wonderful. Because the past is unimportant for
him in his communication, we feel that he does not relate to
us. What we are perceiving is that he relates more to an
inner system than to our need for logical understanding.
Hence, it is tempting to call him 'unrelated' or say that his
affect is 'disturbed.' These judgements imply that 'inappro-
priate' and 'unrelated' are absolute characteristics instead of
relative ones connected to our models of communication.

FEEDBACK AND LOOPS

A more quantitative way of speaking about his behavior is to
notice that he does not adjust his opinions about us
according to what we do. Dan has not changed towards
him. Yet Herr E.'s feeling has changed towards Dan.
Herr E. has only a minimal feedback loop; either he does not
pick up or does not adjust to outer signals.
The short section which I have presented from our
interview is typical for many diagnosed schizophrenics. A
process oriented description would not call them sick but
would describe their particular process as having a special
kind of signal feedback loop in relationship to others. The
meaning and significance of this loop remains to be
investigated.

THE MEANING OF NOT PICKING UP FEEDBACK

One characteristic of a missing feedback loop is that it gives
the individual process the appearance of being a field with
two states. The two states in Herr E.'s field are the vacationer
and the unhealthy authority. The unusual characteristic of
this process in contrast to the majority of other processes is
that this field is unpopulated by real, living people. In other
 THE MISSING METACOMMUNICATOR 39

words, the authority figures are not projected onto specific

people but are object-less projections. At one moment Dan
is a sick authority and in the next he is a well-meaning
guardian and I become the nasty authority. Herr E. does not
notice that Dan has not changed towards him. Thus Herr E.
has a process without a feedback loop and appears to be a
psyche with two states floating in mid-air, a field looking for
people, so to speak.
What appears as inappropriate feeling, then, could be
seen as an attempt to relate only to an inner process, one in
which a story is trying to unfold about a city dweller fighting
the authorities. A psychoanalytical interpretation would say
that Herr E. is using a projection mechanism (a projective
identification) to split off a part of his past and work it out in
the present through Dan. From an analytical perspective,
Herr E. is working on a collective archetype, akin to the
story of the hero overthrowing the old and ailing king.
The lack of feedback, however, is not a pathological
feature, but one which can also be seen in non-psychotics as
well. Having no feedback loop makes Herr E. unconscious
of certain objective, environmental phenomena by filtering
out signals which oppose his belief in order to preserve and
complete the inner story or myth he is working on. In other
words, having no feedback loop functions to keep him in his
own dream world, and this is a function of unconsciousness
which can be observed in all of us. Such loops are at work
all the time, even in the therapist, as I will soon show.

THE THERAPIST AND PATIENT IN THE SAME BOAT

The therapist or theoretical paradigm which claims that the
patient has inappropriate feeling because he does not react
in an 'appropriate' manner suffers from unconsciousness in
exactly the same way as the patient. I have seen many
professionals telling their clients that they have brain disease
or that their problems are due to a particular illness while
the patient looks down at the floor or out of the window. If
the therapist would react 'appropriately,' i.e. with feedback
to these signals, she would realize that her diagnosis of the
patient gets little or no feedback from the patient. If the
40 SCHIZOPHRENIA

therapist does not react to this feedback and adjust her

therapeutic behavior to the patient's negative signals, then
she, too, lacks' a feedback loop.
What is the function of the therapist's unconsciousness? It
has helped her to formulate medical theories and to discover
chemical origins and connections to mental diseases. Hence,
it has helped to keep us in a medical myth in order to reach
completion. But this unconsciousness should be coming to
an end. We should note that telling a patient he is ill is not
an appropriate belief if the patient does not agree. At the
very least we should see that we, too, have no feedback loop
to large parts of reality.

METACOMMUNICATION
Lacking a feedback loop is not sufficient criterion for an
extreme or psychotic state. To understand the difference
between Herr E.'s process and the ones we normally meet,
we need one more concept: metacommunication.
This fancy term means communicating about some aspect
of communication. Metacommunication is the ability to
comment on a message, its sender or its effect. For example,
if I am able to metacommunicate. I can communicate about
my communication signals, what I say, how I say it,
whether or not I feel the receiver has understood, the reason
I have spoken, etc. Herr E. cannot metacommunicate; he
cannot talk about the way he is communicating, or what it is
he is saying. Thus he cannot comment on his communica-
tive mode to say that he is projecting or dreaming.

METACOMMUNICATION AND THE GROWER'S CLUB

One of the basic paradigms of classical analysis is that there
is always someone present in the patient to metacommuni-
cate. This means that the therapist assumes that the client is
interested in or will eventually be interested in dreams,
relationships, body experiences and therapeutic strategies.
Most of the time, patients coming to psychotherapy are
capable of and interested in metacommunicating. These
people and their therapists belong to what I call the
'grower's club:' those interested in growth, development
 THE MISSING METACOMMUNICATOR 41

and insight. Like most club members everywhere members

of the grower's club are prejudiced against non-members.
Great numbers of our population, however, do not belong
to the grower's club, and furthermore, they need not
belong. They have other processes. Some of those people
called schizophrenics and many other psychotic individuals
do not belong to this club. They do not like to, are not able
to, or think it is ridiculous to talk about their communication
and their states. Moreover most of you reading this
paragraph right now are capable of metacommunicating
only some of the time. I myself, for example, hate to
metacommunicate about anger while I am in the midst of it.
I try, but do not always Succeed.

THE AVAILABLE METACOMMUNICATOR:

NORMAL AND PSYCHOTIC
Thus, the terms 'normal' and 'psychotic' can be more
accurately defined by terms which enable one to work with
the processes at hand. The 'normal' person meta-
communicates. Temporarily, in an extreme state, he does
not. The 'psychotic person' does not metacommunicate for long
periods of time. There is no third party available to talk about
either his primary or secondary process. No one is 'at home'
to comment on intelligent interpretations. There is no one
there, for the moment at least, who is interested in or cares
to discuss a given therapeutic strategy. By 'no one,' I mean
that there is no one available. After coming out of extreme
states, many people will say that they felt 'the observer was
underwater or in a back room. Since there is a wide
continuum of time spans in which an available meta-
communicator is absent, reaching from a given moment to
long periods of time, we see that psychosis refers, in most
cases, to a temporary state capable of change.

THE AWARENESS PRINCIPLE

The question of the usefulness of having no meta-
communicator remains. The hologram, anthropos and field
theories of the world, the concepts of the evolving universe
in physics and of the hologram-like brain in biology
42 SCHIZOPHRENIA

(Pribram: 1981, indicate a world operating like a field or unit

(see The Dreambody in Relationships, Chapter 7). Anthropos
theories give us the idea that this field has an awareness of
its own.
A useful and tentative theory to consider is that a field
does everything it can to bring itself to consciousness.
People normally experience this in their personal lives when
they become aware of experiences which make life more
meaningful. In the case of an extreme psychotic state,
however, there is no one at home to pick up the
information, no one except the environment, that is. A
useful hypothesis is that the field in which we live uses
people like Herr E., people with no metacommunicator, to
express itself to the rest of the world. His inability to work
with his process forces us to confront it. We are pressed to
formulate theories and think about issues we would
otherwise neglect.
The field thus informs the general public about its
conflicts. This can be formulated in different ways, depend-
ing upon belief systems. One might say that the Self wants
to know itself, or that God is trying to discover himself, the
Anthropos we are living in is trying to wake up, the
collective unconscious is trying to express itself or the
universe is evolving in such a way as to make us more
aware of the meaning of life.
In the present case, the field problem being expressed is a
collective conflict of Switzerland. It is the problem between
the vacationer or tourist and the hard-working Swiss
governed by the motto that 'Work and Prayer Make Life
Sweet.' In Switzerland, relaxing is a main source of income
but also a great problem for a country where bureaucracy
and discipline rate high on the national scale of good and
bad.

GOALS, TREATMENT AND PROCESS WORK

One goal in dealing with Herr E. is to change him so that he
stops being a lazy vacationer, learns how to metacommuni-
cate about his problems and leaves the social service
agencies in peace. Though this goal will be shared by the
 THE MISSING METACOMMUNICATOR 43

social work authorities, the police and most Swiss, it is a

one-sided goal because it does not match Herr E.'s own
goals.
Process work's immediate aim is to understand and
unravel the processes at hand. This matches closely what
Herr E. wants. He feels he needs more peace and quiet and
more money to do this with. But he cannot achieve his goals
beause of the inner and outer authorities who are unhealthy
and need help.
In what follows, we will work with Herr E.'s inner
authorities and show how to improve their 'health,' while
simultaneously recommending a method of working with
the outer ones as well.
Chapter 4
WORKING WITH A
SCHIZOPHRENIC STATE

In the last chapter we talked about the psychology of

Herr E. Here I want to concentrate on developing tech-
niques for working with him in an extreme state.
To work with Herr E. we need more information about his
process structure and behavior. I have already mentioned
that the two processes, the vacationer and the authority, are
in conflict with one another. His lack of a readily available
metacommunicator has also been discussed.

FLIP-FLOPPING
On the video tape of the interview with Herr E., the
authority can be seen in his continual moving forward and
the vacationer is present when he sits backward. This dual
process occurs about every sixty seconds. The authority sits
forward, calculates aggressively with a red face and tries,
usually with insufficient logic, to make his point.
This flip-flopping is characteristic of processes in which
there is no available metacommunicator to hold, consider or
present any one of the parts. When two parts either follow
each other in rapid sequence or are simultaneously super-
imposed upon one another, it is due to the lack of such an
observer.
For example, when Herr E. says, 'I haven't time to work. I
am on vacation and must get up at 5.00 in order to do my
wash,' we hear two, almost simultaneous contradictory
statements without the experience of paradox from the
communicator. 'I have no time to work,' and then, 'I have to

44
 WORKING WITH A SCHIZOPHRENIC STATE 45

get up at 5.00 to do my wash,' means, I suspect, that he has

no time to work because he is working so much at
something else, presumably his inner material. With some
consideration, we can almost always make logical meaning
out of his statement, but at first inspection it appears that he
has no time to work because he is working too much.

NO DOUBLE SIGNALS
When he says this conflicting statement, he does not appear
to be in conflict with himself. He is simply angry at the
authorities for not letting him go on vacation. From
someone else, we would expect a more conventional
reaction to such a statement, namely one in which he
giggles or blushes, embarrassed about wanting to get up at
5.00 am to wash. The giggle would represent the availability
of another part which realizes the absurdity of what he is
saying. A person with a metacommunicator would feel
guilty for only wanting to 'do his wash.' But Herr E. does
not giggle; he does not double signal at all. Instead he has a
terrifying congruence, a convincing quality and single-
pointedness about what he is doing and saying since he
does not ostensibly suffer from the paradoxical nature of his
statements. The reason he does not suffer is because
suffering entails the presence of a metacommunicator,
someone aware of conflicts. Such a communicator or
sufferer is not available with Herr E.

TERRIFYING CONGRUITY
Since there is no metacommunicator, there is no conflict
between processes and they superimpose or flip-flop from
one to another without reserve. This can have disastrous
consequences for the environment. A person in such an
extreme and unusual state may be smiling at you, suddenly
hear a voice which says he should chop off a child's head
and then, without reflecting or inhibiting himself, actually
kill a child.
Such incidents do not happen often, but they are frequent
enough to be mentioned. The therapist should not think,
however, that these incidents are unpredictable; the voice
46 SCHIZOPHRENIA

was actually signalled months before. His voices had told

him to murder the child more than once. The therapist
working with this client had not sufficiently respected the
secondary murder process. In at least one way people who
go through psychotic episodes could be less dangerous than
'normal' people since normal people hide their secondary
processes more successfully!

AN EARLY EXPERIENCE
Since my first contact with a diagnosed schizophrenic some
twenty-five years ago, I have learned to treat secondary
processes with great respect. My first schizophrenic patient
was a man in a wild and ecstatic condition (he could have
been manic), radiating in all his glory and grinning at me. I
was terrified. He said, 'I am Lucifer, the bringer and
destroyer of light.' I was just beginning my practice at the
time and thought, 'He is just crazy.' I do not remember if I
told him what I thought, but he looked me straight in the
eye and said, 'And since you do not believe me, watch what
I can do now.' At that moment the lights in my house went
out. The fuses had not blown. Call it chance, synchronicity
or anything you like, but it cured my inflation of thinking
that I was real and sane and he was just crazy. Every signal
is real! The best working hypothesis is to believe in and try
to understand people's signals.

PROCESS WORK WITH HERR E.

To work with Herr E., I took the following information
which he gave me into consideration. He had said, 'Do not
talk to the authority, work with him, help him, he is sick.' I
saw the flip-flop nature of his process and its instability. I
imagined that previous to his psychosis, his identity was
probably close to what he now called the authorities. I
wanted to work with this 'authority,' to get to this part
which was so heavily projected onto the world around him.
Accessing this part would enable me to unravel its existence
in order to help it.
 WORKING WITH A SCHIZOPHRENIC STATE 47

OCCUPATION THEORY
The experience with normal individual processes indicates
that if two people are present in a field in which there is an
authority figure and a vacationer (a bad and good figure or
any other polarity), then one person will become an
authority figure, like I did at one point, while the second
person — even though he had previously been the author-
ity — will become the good guy or the vacationer. The
occupation theory states that the one who is momentarily
most authoritarian becomes the authority, while the weaker
one becomes the vacationer. This is true for any polarized
system. (See The Dreambody in Relationships.)
This is also the rule with families and groups. The part
any given individual plays in a system is determined by
what other parts are occupied. In other words, if there is no
authority in a group which has a pattern of the weaker one
versus the authority, then either one of the weaker people
will automatically begin acting authoritarian or else the
authority will be projected onto a person not present.
Since Herr E.'s pattern is the vacationer v. the authority,
the way to get the authority to appear is, theoretically, to
play the vacationer even better than Herr E. does. This
should bring out the authority. This is exactly what _I did
with my colleague Joe's help. I took home the video tape
and studied the vacationer in great detail. The next time
Herr E. came to the social work center, next Monday at
8.00 am, I greeted him using the facial expression of the
vacationer, his hand motion (putting them into my pockets
the way he did), his sentences and tone, in short, imitating
the vacationer as much as possible.

Amy: Hi, how are you? I am on vacation, and have no

time to work. I am too busy for that and want my
money, and damn it, have to wait here until I get it.
Herr E.: Well, if you want to get a job, then you must first
go to the office which has jobs, then you must. . . .
48 SCHIZOPHRENIA

He seemed to forget that I was there to supervise the social

work agency (no feedback loop!). He became an authority
for me and gave me, in the most convincing and congruent
fashion, information about Swiss laws and how to get a job.
He even told me about work permits in the country. When I
complained about my lack of money, he reached deeply into
his own pocket and brought out some change which he gave
me to call the social work office responsible for helping
people obtain jobs. Several days after this interaction I
received the following letter from him:

Dear Arnold Mindell,

Please realize that Switzerland has a 44 hour week and
that you should contact the Labor Department at for
work, naturally after first trying to get a job for yourself.
Please consider the last firm I worked for, they are
reliable.

Sincerely yours,
Herr E.

On the back of this letter was a copy of his last job contract.
His letter was legible — more than my writing is — though
not particularly neat.

MORAL CONSIDERATIONS
Before delving into Herr E.'s advice, I want to consider the
philosophical implications of psychological interventions. By
accessing the authority figure, I have been successful only in
a collective light. I have got Herr E. to behave normally, that
is, like the rest of us. This is possible to do with everyone in
his condition for shorter or longer periods of time. The
advantage in having done this is that now the original
primary process of Herr E. can be worked with and this part
can decide what should be happening in the future.
This part is the part which agrees with the rest of the
world that the schizophrenic is a sick person. It should be
noted that only 13 per cent of the schizophrenics in a given
study (Torrey, 1983, p. 185) felt that they were ill — I assume
 WORKING WITH A SCHIZOPHRENIC STATE 49

as long as they were in their vacationer or anti-social

process. Hence, we have not done anyone a real favor by
accessing the 'normal' or social part of the personality, and it
is dangerous to think that we have been successful because
such thinking neglects the patient's primary process,
Herr E.'s vacationer, who thinks that he is well and the
authorities are sick!
The advantage of having accessed the normal part is that
now both parts are more available to the patient and both
can be worked with. Now he may be able to make a decision
about his own future. After three or four days of intensive
work, every schizophrenic patient I have seen came out of
their extreme state. At this point many patients decide that
they hated their episode and want only to go back to normal
life. They remain in their normal life ever after. Others will
come back with another episode after as long as ten years.
Still others will stay with psychotherapy at this point and
begin to integrate their vacationer or other extreme states
while holding on to their social personality.
But each to his own. Some patients return to their extreme
state after only days, saying as one woman said to me,
'Doctor, it was so beautiful to be on the moon. I was so
happy there, why do you torture me by asking me to live in
your harsh world? I do not have the strength to bear it here.'
Several hours later she was back in the psychosis once again
with a euphoric expression lecturing to all about the moon
and other planets. Who is to say that she should be in a
different place? She had a choice, made a decision, and kept
to it.
I have heard of other cases in which the physician gave a
patient drugs, brought him out of his extreme episode only
to report the resulting suicide.

An elderly gentleman I treated had been living alone with

only his 'devils' (auditory hallucinations) for companion-
ship for many years. After carefully adjusting his medica-
tion we were able to get rid of the 'devils,' at which point
he fully realized how lonely and isolated he was and he
drowned himself. Given the symptom-caused torment
50 SCHIZOPHRENIA

and social isolation which many schizophrenics must

endure, in truth I find it surprising that the suicide rate
among them is not higher than it is. (Torrey, 1983, p. 174)

What this doctor does not mention is the possibility that the
schizophrenic had his 'devils' as friends; his extreme state
gave life meaning and prevented him from dying. Without
the devils, it is fully possible that there was no longer any
reason to live. Or, it is possible that one of his devils was no
longer friendly to him and helped him to drown! Or, it
could also be possible that the medication blocked the
auditory channel through altering neurotransmitters so that
the devils were no longer located there but took over his
movement, whereupon he killed himself. I do not know
what happened, but I would like the reader to suffer some
of the philosophical uncertainties involved in working with
psychotic states. My philosophy is doubt and observe, try to
follow the individual process as closely as possible.

EVALUATION
Now let us go back to the details of Herr E.'s situation.
Playing the vacationer constellated the authority in him
relative to me because he did not have the feedback loop to
adjust his behavior to changes in mine. This produced the
authority and showed the areas in the authority figure
(Herr E.'s letter was incomplete) which needed working on.
His writing was not particularly neat, for example. This
would need to be worked on. While maintaining the role of
vacationer, I would simultaneously be the therapist and get
the authority to be neater and more exact about his times
and dates by asking the authority to adjust himself and his
information to my particular sort of 'work problems.' This is
what continued therapy along these lines would look like.
This plan would have to be adjusted to changes which
occur. As he changes, I would have to change. The same
process structure, namely the vacationer and the authority, is
likely to change after the flip is completed, then other
processes will come up resembling the processes normally
dealt with in psychotherapy. I have focused mainly upon
 WORKING WITH A SCHIZOPHRENIC STATE 51

the extreme state, since this is the one felt to be inaccessible

to classical psychotherapeutic intervention. Process reversals
usually relieve the patient and simultaneously allow the
healing paradigm of medicine to function without tampering
with the patient's neurochemistry.

AN EXAMPLE
I remember a client I worked with who first came to me
calling herself the Virgin Mary. Apparently she had had
many such episodes before. She came from simple European
peasant surroundings. In the midst of the extreme state, her
secondary process was the 'evil mother' of the world who
hated Christianity and had no interest in her. 'The evil
mother cannot support the Christ Child, my child,' she said.
Moreover, she identified the doctors and clinics as being evil
mothers. I still recall how she flipped back into her old
process. When I played the Virgin Mary, she became a
typical negative mother, uninterested in the fantasies of her
child. She said to me, forgetting I was the therapist, 'Be
careful dear, if you continue in that mad euphoria, you will
either end up in the nut house or I will put you there.'
She regained and subsequently retained the 'evil mother
of the world' personality which she previously had, to the
contentment of those around her — her physician, husband
and neighbors. What had been her secondary process
during the episode now became her primary one; she was
an evil mother towards her own fantasies and her episode
and detested herself for having gone through such states.
For the time being then, the Virgin Mary who loves all
became her secondary process with no possibility of being
integrated into the primary one. The result was that she
simply turned cold to those around her and left it up to the
rest of us to integrate the Virgin Mary who supports divine
religious experience. She liked being back in her normal
state. I realized that the work was incomplete, because the
Virgin had not been integrated into her daily life. Several
years later she came back with a very mild version of the
first episode, this time prepared to put her parts together.
52 SCHIZOPHRENIA

LIMITATIONS
Process work's limitation is that it requires a thorough
knowledge of signals and the ability to differentiate between
them in order to discover the process structure organizing
behavior. Learning this takes several years.
Moreover, dramatizing the primary process of the person
in a flipped state is not every therapist's cup of tea. It
requires not only signal study but also the ability to feel into
and act out these signals. One need not be a perfect actor
because the individual in an extreme state reacts (according
to occupation theory) to the mere attempt to act out the
primary process. This attempt is almost always sufficient to
bring out the necessary change.

TRAINING
Complete understanding of a client requires observation and
action coming from the heart. But this will not be enough for
an individual in an extreme state or acute psychotic episode
because people in these states filter out signals which do not
directly fit into the drama of their inner life. This lack of
reactivity to normal communication is one of the reasons
which have made mind-altering drugs the choice of many
therapists.
To get into the world of the psychotic episode without
drugs, the therapist will have to learn how to clearly see, feel
and act out the primary process of the client. This gives her
the chance to get out of the polarization which makes the
rest of the world the denied part of the personality, the
secondary process. Without the ability to act out the primary
process, the therapist's understanding of what the client is
going through is bound to be judgemental, intellectual or
inhibited by diagnostic thinking. Value judgements cannot
be hidden and are always felt by the client who reacts
frequently by discontinuing potential long-term therapy.
I recommend to all those interested in trying to under-
stand psychotic states to experiment with their own extreme
situations. Each of us has two parts, one we identify with
and one which is in our dreams and body experiences. The
 WORKING WITH A SCHIZOPHRENIC STATE 53

schizophrenic episode is known to all. Just act out the

secondary process and make a discovery: it is a great relief
to 'flip' sides! Then ask a friend to act out your flipped side
better than you are doing and you will experience flipping
back to 'normal.'

THE THERAPIST'S TOLERANCE

Most people in extreme states will claim that the part which
seems normal to the therapist — in Herr E.'s case, the
authority figure — is sick. This is the exact opposite of what
the normal therapist thinks, namely that the patient's
primary process — in the present case, the vacationer — is the
disturbed one. Hence process work is difficult because it
requires a relatively objective and simultaneously emotional
involvement in the client's process. If you try to change the
vacationer (or convince a client that he or she is not the
Virgin Mary, etc.) or if you try to change what is defined as
being well, you are going to run into unnecessary resist-
ances and will probably fail to achieve either your own or
your client's goals.

ON RAPPORT WITH PARTS

Another difficulty with process work is that the therapist
has to be aware of her own reactions to the parts of her
client. Negative reactions to parts like the vacationer or the
Virgin Mary are usually 'dreamed up,' that is, they are
opinions which belong to the client's own secondary
process, or previous identity — in our case the authority or
evil mother. If you unconsciously become a part of
someone's process, you have no viewpoint outside the field
and consequently lose your objective ability to work with it.
The typical psychiatrist who feels that the patient's fantasies
are ridiculous and should not be mentioned in public is part
of the schizophrenic's secondary process. Herr E.'s author-
ities are 'sick' from the view point of the vacationer in the
sense that they do not fully appreciate his needs. If you just
fall into being a part of such a system, there is no relativity
and the effectiveness of your help from your emotional
condition is decreased.
54 SCHIZOPHRENIA

Thus the therapist will constellate resistance if she does

not like one of the client's parts, thinks it is sick or tries to
change it. No one, not even a part of the personality likes
being disliked. Resistance from a part of a personality
without a metacommunicator is a more serious resistance
than one normally met with in therapy because it is a
resistance which cannot be discussed or analyzed. And
therapy done in the neighborhood of a resisting part is
guaranteed to be only partial. If rapport and relatedness
mean understanding and direct contact with all the parts of
the personality, then process work may be useful when
considering how to deal with an extreme state.

WORKING WITH THE COLLECTIVE

The lack of a metacommunicator and the lack of interest in
psychological development make the schizophrenic a poor
candidate for normal psychotherapeutic treatment before,
during or after an episode. Though there are many people
who do want to work with themselves, those who do not
are a puzzle to therapists. It could be that one reason for
their resistance is for the benefit of the collective: if
everything could be solved internally for the individual,
there would be no impetus for collective change.
Working with the collective situation might then be a part
of the schizophrenic's treatment. In Herr E.'s case, working
with the collective would be useful because he is not asking
for psychotherapeutic help in the ordinary sense, that is, for
growth or insight. His personal problem is not personal if
there is no metacommunicator.
Working with the collective means bringing the informa-
tion channelled by Herr E. to the Swiss collective. By means
of radio, television, plays, books and newspapers the larger
collective can be informed about different aspects of the
conflict between the vacationer and the worker. Switzerland
may be faced with having to investigate the consequences of
the ancient ideal 'Work and Prayer Make Life Sweet.'
Support for the collective importance of schizophrenia can
be found in its demography. Already in 1835, J.C. Prichard
(Torrey, 1983, p. 204) said 'Insanity belongs almost exclus-
 WORKING WITH A SCHIZOPHRENIC STATE 55

ively to the civilized races of man: it scarcely exists among

savages, and is rare in barbarous countries.' More modern
studies (Torrey, 1983, pp. 96, 206) state that 'there is clearly
a disproportionate number of schizophrenics who come
from the cities, and especially from those portions of cities
where the poor live.' Countries like Japan, England,
Denmark and Germany have the same rate as the USA.
Higher rates are found in the Scandinavian countries,
Ireland and Northern Yugoslavia. Lower rates have been
found in Africa, with the exception of those exposed to
western technology and culture. It is very rare in Papua
New Guinea, which is probably the least developed country
remaining in the world. Clearly the collective plays a role in
schizophrenia and, as in the case of Herr E., we all need to
relativize some of our most rigid 'authority' concepts.
Chapter 5
SCHIZOPHRENIA AND ALTERED
STATES

Extreme states such as those occurring during schizophrenic

episodes are excellent examples of the individuality of
processes. They operate very exactly and powerfully and
cannot be changed even if an entire city fights against them.
They are tightly enclosed systems of patterns and infor-
mation. If you do not comprehend the exact pattern, you
have the feeling that the psychotic process is driven by a
mechanical, powerful machine.
These psychotic episodes can be understood with a little
reflection. Once the pattern is deciphered, we are able to
predict the psychotic's behavior. In fact, understanding the
patterns behind a psychotic episode makes the workings of
the episode appear mechanical. This may sound inhuman
and to some extent it is since the pattern operates without
an available observer, without a metacommunicator, cannot
be interrupted and is closed to outside intervention, unless
the intervention enters the pattern on its own terms. We
should also note that there are mechanical patterns in all of
us. Our metacommunicator, however, disturbs our patterns
so that they are not as apparent as in an extreme state.

HERR B.
Let us see the operation of such patterns in the case of
Herr B. I want to describe him from the city's point of view,
and then let him speak for himself.
Herr B. was brought to the attention of the social work
office because no one knew what to do with him. He

56
 SCHIZOPHRENIA AND ALTERED STATES 57

sometimes considers himself a healer or enlightened soul

and frequently travels to South American countries. Most
recently he tried to marry the daughter of one of the heads
of government there, made an awful spectacle of himself
and was quietly and kindly bound to the chair of a Swissair
747 and sent home. As he got off the plane he ran to a
downtown department store and stole a garbage can which
he said he needed to urinate into. Next, he was caught
stealing the cover to another such can which he said he
needed to cover the first one with. Since he was obviously
not malicious, the police let him go with warnings only to be
called for a third time to arrest him later that day. This time
Herr B. was singing too loudly in his apartment late at
night. When the police entered the scene they found him
sitting in an empty bath tub fully clothed.
The psychiatrist handling this case temporarily controlled
the acute episode with psychopharmica and then released
him. Now Herr B. appears at the social service station, a
man of around fifty years of age, well dressed, somewhat on
the heavy side, obviously slowed down by drugs. He looks
a bit depressed, sits with his head bent down and with his
hands folded politely together on his knees. As I saw him he
reacted and related warmly to those around him, but had a
funny glint in his eye. His expression was that of someone
who has seen something awesome and impressive but
cannot speak about it and tries to cover it up with a
pleasant, sociable smile.

HERR B. IN PERSON
As we drink coffee together, Herr B. complains about the
side effects of the psychopharmica he is using. Then he
says, when asked about the book on hypnosis he is carrying
with him,

Herr B.: I want to work with self hypnosis and cybernetics

in order to free myself from the psychopharmica
which help me to be normal. . . . My problem is that
I get into states of the subconscious and do not
know what I do.
58 SCHIZOPHRENIA

As he talks I notice that his tempo is slow yet intense. He

looks depressed, except in a normal depression themes do
not switch back and forth as they do with Herr B. I imagine
his behavior must be strongly induced by the drugs. They
apparently quiet him down in the foreground, while the
background excitement in his life is still shining through.

PROCESS STRUCTURE
I notice first of all that the state he is now in has a
metacommunicator because he is able to talk about himself.
He talks about other (subconscious) states and is interested
in controlling and freeing himself. His primary process is
wanting to work with himself and being the victim of the
problem of slipping into unconscious states. These states are
themselves secondary processes which I will have to find
out more about. In the moment, then, he is speaking as a
normal person about other states, extreme ones, psychotic
ones for which there is no metacommunicator who observes
or knows. I wonder if there is a function to not knowing
what he is doing in those states.

Amy: Tell me more about hypnosis.

Herr B.: Hypnosis helps me when things get too objective.
Then the world seems sterile and meaningless to
me, really, that can be too much, it is dangerous.
Then I do not notice that I begin to slide into these
states . . . afterwards I notice that the world has
caved in, everything is chaotic. No one can talk to
me when I am in a chaotic state.
Arny: What do you mean that things get too objective?
Herr B.: I mean that if I relate to life as if it were really real,
then I get lonely and bored, but I must be careful
about going too 'subjective,' . . . If I am 100 percent
normal then I am unhappy and the world makes me
unhappy.

HYPNOSIS
Notice that in the first of his statements presented above he
says that hypnosis should replace psychopharmica in
 SCHIZOPHRENIA AND ALTERED STATES 59

making him normal, that is, in keeping him away from

'subconscious states.' Now he says that he wants hypnosis
to help him to get away from the normal condition in which
things are objective.
If he is too normal, he says he is too objective, and then
the world becomes depressing for him, as a result he
becomes subjective, introverted, bored and finally flips. If he
is too subjective he has to become more objective and
normal, but the normal situation is intolerable and so he
flips into another world.
At the moment he is using psychopharmica and self
hypnosis in two ways. He uses them to do what he has been
told they do, namely to help him be 'normal' or 'objective'
and not 'chaotic.' And he is using hypnosis and drugs for
another purpose which he is less aware of, namely to free
himself from the 'objective,' painful world which is intoler-
able to him. In other words, he is using the same medication
which is supposed to make him normal in order to enter
into altered states. People sometimes use medication in
order to enter altered states though they are simultaneously
afraid of being possessed and overwhelmed by these
powerful secondary processes. If medication is used against
objective, normal life, then despite its normal effects it is
bound to contribute, in Herr B.'s situation, to tripping the
normal state into another episode at another time.

THE PURPOSE OF NO FEEDBACK LOOP

Since Herr B claims that he is now objective, his slightly
depressed expression is not only due to the drugs, but to his
unhappiness about being objectively in this world. Getting
jilted by the South American beauty or being turned down
by a Swiss girl-friend are probably enough to throw him into
unhappiness, which he then apparently deals with by
becoming lonely and 'subjective.' This means, I suspect,
cutting off feedback from the world around him, so that
.. no one can talk to me . . .' and he is free to indulge in
compensatory fantasies and states. One of his doctors told
me that in these states he imagines that he is Jesus.
The usefulness of the secondary process, the so-called
60 SCHIZOPHRENIA

chaotic state, is to cut off the pain of being rejected and to

experience the love of God. Here we see one of the
important purposes for a missing feedback loop which I
discussed in Chapter 3 in connection with Herr E.'s extreme
states: not picking up what others are doing and saying is a
means of saving yourself from pain and disappointment and
experiencing another, lifesaving reality. Picking up other's
feedback would disturb the compensatory effect of the other
reality and result in a more violent experience of this world.

BECOMING A HYPNOTIST
A hypnotist can control, in Herr B.'s mind at least, the states
of consciousness which he is subjected to. Hence, his
interest in becoming a hypnotist is similar to the drive to
become a psychiatrist or psychologist; one wants to under-
stand and control what happens. If Herr B. does not
learn how to do it consciously, then he will unconsciously
slip into becoming a healer or a Jesus figure. Thus, in his
normal state, the way he is now, he is asking for integration
of the experiences he had when he was in a psychotic
episode.

THERAPY STRATEGY
If Herr B.'s present primary process is to be objective and
normal, his secondary one is to be a healer or hypnotist.
When he flips, he becomes the healer, and then his
secondary process will be to become objective like the police
who pick him up, telling him he should not steal ash cans or
sing too loudly in an empty bathtub. If we acted like Jesus
when he is in a 'flipped' condition, then he would begin to
identify with the 'objective ones,' and look the way he does
now.
Process work in the present, normal state means helping
him integrate his Jesus/healer figure, as in ordinary psycho-
therapy in which you talk about the secondary process with
a metacommunicator. He said that he would have liked
ordinary psychotherapeutic help. I told him that I thought it
might be a good idea for him to really study hypnotism and
 SCHIZOPHRENIA AND ALTERED STATES 61

other psychological methods for working with altered states.

He was delighted with the idea.

ALTERED STATES AND THE HYPNOTIC PROCESSES

Hypnosis, one of the ancestors of modern psychology, is a
method of altering states of consciousness or, rather, for
getting around consciousness and accessing unconscious
secondary processes. Spontaneous alterations of conscious-
ness (i.e., of the primary process) as they occur in
schizophrenia where the secondary process becomes pri-
mary and the earlier primary one becomes secondary are
natural and meaningful conditions which one frequently
finds in psychology and medicine. The following illustrate
some examples of various processes which operate in
hypnotic-like fashion. Seeing that these states occur in all of
us will enable us to gain a greater appreciation for the
reversals which occur in schizophrenia.

STOPPING THE WORLD

When the conscious mind is unwilling or unable to let in a
secondary process such as the psychic healer or Jesus Christ,
then the psyche operates in such a way as to get around
consciousness by 'caving the world in,' as Herr B. states.
Don Juan, Castaneda's shamanic mentor, would call this
phenomenon 'stopping the world,' or, as we would say,
inhibiting the determining function of primary processes.
Someone who is afraid of the intellect and of thinking, for
example, will experience sudden states of logical and
sequential opinions or thought. A rigid thinking type will
periodically be overwhelmed by sentiment for the world.

THE POWER OF POSITIVE THINKING

Many processes operate in a hypnotic fashion to alter
consciousness, but are not explicitly called hypnosis.. For
example, going to the movies is an effective means of
altering consciousness. Talking to yourself with the 'power
of positive thinking,' insisting that everything is fine and
nothing is wrong is hypnosis. Hypnotism works if the
pattern for it is in your dreams, if there is a secondary
62 SCHIZOPHRENIA

process in the background waiting to be integrated or to

superimpose itself upon the primary one. When hypnotism
does not work, it is not due to the lack of power of the
hypnotist, but due to a lack of pattern for the hypnosis in
the client's secondary process. Thus if a mechanic dreams
about God, gets sick and then goes to a priest who advises
him to trust in God, his chances of getting better are high
because getting well and believing in God are already
present in his secondary process. In my experience, if this
were not his process, belief alone would work only
temporarily because it is not possible to insert a secondary
process into someone for more than just a few moments. If a
type of behavior is not present in one's secondary process, it
will not hold.

CHANNEL BLOCKING
Another way to alter awareness is to switch out of or block
the channels in which awareness is operating at any given
moment. Thus if you are bothered by imagining (a visual
channel experience) terrible things happening in the future,
going to the movies will make you feel better because the
visual and auditory excitement will temporarily block out
your own inner visualizations.
If you are a visual or verbal/auditory type, then feeling
your body will give you the experience of an altered state of
consciousness. If you are a feeling person, pressing yourself
to focus on dream imagery (switching from proprioception
to visualization) will create an altered state.
Illness can also alter the state of consciousness. When you
get sick with the flu, your temperature goes up and you
become sleepy and drowsy. This is an extreme state of
proprioception. The flu changed your channels, taking you
out of your normal one (most westerners are visual or
auditory) and forced you to feel your aches, pains, pressures
and temperatures.

EPILEPSY
Channel switching, channel blocking and accessing second-
ary processes are all methods for causing a change in
 SCHIZOPHRENIA AND ALTERED STATES 63

awareness. Organic brain changes, psychological shock or

epileptic seizures also alter consciousness by switching
channels. The difference is that in these examples, unlike
the ones above, the person is not in control. A typical
statement from a woman who experiences violent 'grand
mal' attacks is,

I do not notice until afterwards that an attack is coming. I

am simply thrown to the floor and awake later, confused,
not knowing where I am, bleeding as if I had scratched
my face on something while falling.

This woman is diagnosed as having grand mal epilepsy.

From the process viewpoint, however, she has a rigid
primary process which does not allow aggression. She is
strongly attached to being religiously 'good.' Her unoccu-
pied or most unconscious channel is movement (the
unoccupied channel is always where great experiences
happen. (See Working with the Dreaming Body, Chapter 2.)
But since her pious background does not allow her to move
much, let alone move aggressively (her kinesthesia is
therefore unoccupied), she experiences being 'thrown to the
floor,' and being the victim of 'attacks,' both of which
happen to her. Thus, aggression and movement are
secondary; they are not part of her conscious identity or her
primary process.

SUICIDAL FANTASIES
Suicide is yet another method of switching out of one state
into another. When someone who does not normally
experience extreme 'psychotic' states tells me that she has
fantasies of committing suicide, I take that fantasy very
seriously and encourage her to do it right then with me.
A woman suffering from a long-standing depression
complained that she had had enough of this world and
wanted to die. I told her to do it right there with me. She
closed her eyes, began to breathe deeply and lay down on
the floor. Apparently this was her method of 'dying.' After a
few minutes she opened her eyes and told me she had had a
64 SCHIZOPHRENIA

vision of standing in front of the gates of heaven. A great

voice yelled at her, saying, 'Get the hell out of here. Go back
to life and work instead of being so lazy.' I then knew how
to work with her depression. Instead of being sympathetic
to her sad story about life, I told her to stop being so lazy
and get to work. This brought immediate positive feedback
from her.
Altered states are full of unlived creativity. I could never
have given her that vision or have helped her in any other
way. Instead, I had empathized with her and felt badly for
her. For her, dying meant altering her state of conscious-
ness, dropping out of her feelings of sadness and heaviness.
By breathing deeply, she killed the primary experience of
sadness. From a process point of view, suicide means
overcoming the primary process. In this woman's case, by
breathing deeply, a new message announced itself through
vision and voice. Thus alterations of consciousness can be
accomplished through accessing secondary processes (like
the healer), channel blocking (like the movies), channel
changing (like feeling your body if you are a visual type) or
suicidal fantasies (like letting your primary process die).
We could enumerate many other methods for spontan-
eously altering states of consciousness. All of us use such
methods consciously or unconsciously every day. A thera-
pist with knowledge of these patterns and methods will be
able to help her client go through such processes more
consciously and usefully.

FLIPPING
The last program I want to mention is the one which
happens most frequently in schizophrenia: exchanging the
primary process (like the victim) for the secondary process
(like Jesus, the healer), dropping the metacommunicator
who, like most censors, may be too rigid to let this altered
state happen, and experiencing what the outside world calls
a 'psychotic episode.' This flip has much in common with
the processes of suicidal fantasies, channel blocking, chan-
nel switching and accessing secondary processes.
Why nature prefers one method over another will be
 SCHIZOPHRENIA AND ALTERED STATES 65

discussed in the next chapter. For the moment, we need to

remember that the same process of flipping which creates
the episode is the process which can reverse it, and that one
of the many functions of flipping is to avoid pain and to
allow secondary processes to come up. We need to
remember that belonging to the 'grower's club' means
suffering the conflict between the primary and secondary
processes and experiencing the pain and conflict which
happens when the one begins to transform the other.
Nature has provided us with many organic methods of
avoiding pain and confrontations between the primary and
secondary systems. If we do not learn to follow these
processes, then nature does it for us by producing experi-
ences such as schizophrenia and epilepsy. We see how these
may be avoided in certain cases through following the
individual processes of pain avoidance with expertise and
appreciation.

HERR B.'s FEEDBACK

For Herr B., avoiding pain was an important process.
Thinking of accessing the hypnotic effects of the healer in
the background, I said quite simply to him,

Amy: Let's stop talking about all of these painful past

experiences, and try to get you a job where you will
have a lot of fun and can look positively towards the
future.
Herr B.: I have experienced this sitting with you people
very positively. One hundred times better than in
the psychiatric clinic where one is always asked and
troubled with 'How are you feeling?' Here, we had a
good time . . . part of my disease is being able to
relate to others. I cannot go into a cafe and talk
normally to people. This helped me!

Two days later, Herr B. came back to us looking very happy,

clean-shaven and full of warmth.
66 SCHIZOPHRENIA

Herr B.: I owe you my health. Self hypnosis helps the

patients. We need to work and watch our
thoughts. . . . I should have used it earlier . . . all
psychically ill people are unconscious. You do not
know what you have done for humanity. I owe you
a lot. I will make notes about what I could do for
you.

He identifies himself at this moment as a patient and

member of the 'grower's dub' by saying, 'I owe you a lot.'
He simultaneously experiences beginning the training to be
a healer when he says, 'I will make notes about what I could
do for you.' These statements give me hope for the future.
From his present viewpoint, he will begin to study
psychology. I can imagine, however, the possibility of
another episode in the near future from his sentence, 'All
psychically ill people are unconscious,' implying the possi-
bility that they will need to be awakened.
Continuing to work with Herr B. would mean literally
helping him to take notes so that he could help not only
himself and me but others as well. If he were to become his
total self, the chances are that he would continue his interest
in psychology by studying it. No doubt the fate of many
people who have experienced extreme states is to become
psychologists in the future.
Chapter 6
PROCESSING A
CATATONIC STATE

Patricia suffers from a catatonic form of schizophrenia. She

assumes a rigid posture and is almost mute or stuporous for
long periods. She is led by hand into the social work station
by a psychologist. In fact, she looks like a little girl passively
following her mother. I am quickly informed that she is
twenty-two, has been a brilliant student in the Swiss schools
but has become increasingly withdrawn and dreamy over
the years. There is apparently no organic brain trouble. The
social worker caring for Patricia says that Patricia has always
been very polite but since she has left school, she irritates
everyone who tries to help her by being listless and passive.
I am told that she will not answer questions when they are
asked.
Patricia is sitting next to me now in the circle. I sit to her
immediate right, her social worker sits to her left. Joe and
two other social workers are also present. Patricia has an
unconvincing smile on her face, superimposed upon a
listless facial expression which becomes even more vacant
whenever she is not being addressed. When asked a
question, she will look at the questioner for a moment, smile
and then stare blankly and vacantly into space. A typical
interaction happens right at the beginning of the interview.
Ruth, the social worker handling Patricia's case, talks
rapidly about the passivity of her client as if Patricia were
not there.

67
68 SCHIZOPHRENIA

Ruth: Patricia's mother came with her once and told her
how to behave. Her mother said, 'Say hello to
everyone and say goodbye, be a nice girl Patricia.'

Ruth now looks at Patricia, apparently for a response, but

Patricia just sits rigidly and stares into space, giving no overt
reaction.

Jan (another social worker): Patricia, did you get angry at

your mother?

Patricia still looks blank, but then with a quick and sudden
movement, as if realizing she had been asked a question,
whispers in a barely audible tone of voice:

Patricia: I am not so little . . . any more . . . and my

mother does not realize this. On the other hand my
mother wants to be helpful, she realizes that I am
very afraid. . .

Patricia puts her hand in front of her mouth and pauses.

Ruth (with irritation): Patricia, I think you are really

blocked, and I want to help you work out your
problems.

Patricia just looks down and does not answer: in fact, she
hardly blinks.

UNDERSTANDING PATRICIA
Before we examine Patricia's process, I recommend that we
perform a technical exercise in order that we understand her
behavior. In fact, I strongly recommend to anyone working
with extreme states to act out the client's signals as a way of
understanding her.
In order to understand and appreciate the usefulness of
Patricia's state, try sitting a bit hunched forward, smile
nicely, act stuporous and blank, a little slowed down and
drugged, as if you are just waking up in the morning. Now
 PROCESSING A CATATONIC STATE 69

ask someone to bother you with questions, or try to

remember what it is like to have someone else ask you
questions. After a long pause, answer with one word
reactions. Then sink back again out of visual and verbal
contact. What do you experience?
After doing this exercise, one of my classes told me that
they did not feel psychotic in this state, but more interested
in maintaining their own inner world. They unanimously
agreed that in such a state they did not want to be disturbed
or pressed by questions. Most felt that they were too weak
and passive to tell the questioner to be quiet and leave them
alone. Therefore they could only smile sweetly and drop out
of contact.

THOUGHT BLOCKING AND BEING CONTROLLED

Like many people suffering from the subtype of schizo-
phrenia called catatonia, Patricia complains about difficulty
in concentrating and says that she is disturbed by the
camera, for example, which 'controls my behavior.' Never-
theless she does not object to the presence of the camera
and even jokes about it a bit when given the opportunity.
Patricia says that her thoughts are totally controlled or, as
termed in psychiatry, blocked. The experience of being
controlled by the camera, together with blocking, the
gradual sliding away from social contact and the lack of
commitment to her school and work are symptoms con-
nected with the possible diagnosis of schizophrenia.
The individual just on the verge of a catatonic episode
emits double signals due to the presence of a metacom-
municator. This is in contrast to someone in an extreme state
in which signals occur one after the other and not
necessarily simultaneously. Therefore, at this point in her
life, Patricia has a metacommunicator, albeit a weak one,
and thus acts sweetly while sending out negative signals.
This makes her seem 'negativistic' and she is often
experienced by others as irritating and unresponsive. It is
this signal of unresponsiveness that Ruth reacts to
aggressively.
70 SCHIZOPHRENIA

PROCESS STRUCTURE
Patricia says she is scared, weak and afraid of life, like a
child. The terrified child is her primary process. Her
secondary process is experienced as something which
'controls her,' as something which is 'terrifying' and also as
the mother who does not realize that she is no longer little.
Her secondary process is, pictorially speaking, a mother
who controls behavior.
When there is a metacommunicator present, secondary
processes come out as double signals filtered through the
uniformity of the primary process. When there is no
metacommunicator, as in the case of Herr E.'s extreme state,
secondary processes follow primary ones sequentially or in a
seemingly congruent fashion without disturbing the other-
wise uniform primary one. In the case of Herr B., the signal
of his secondary process, the split off religious experience,
appeared through his depressed primary process as a wild
gleam in his eye. In the case of Patricia, her secondary
process, the controlling mother, appears through the non-
response signal. No response to a stimulus is a negative
response, what we call negative feedback. There is no such
thing as no communication! Smiling politely is a primary
process and no verbal response is a negative signal which
controls the entire communicative setting. Hence, the
signals which irritate the social workers are controlling
signals, Patricia's secondary process, her mother.

STRATEGY
Our work will be aimed at bringing up the controlling power
of the mother in such a way that it can be made available to
the weak and scared child in the primary process. Aggres-
sion and power will not be easy to access because of the
weak identity in the primary process. If we cannot access
them, then Patricia will very likely continue to be possessed
by her lack of responsiveness.
It is important to analyze the process structure of such a
client because otherwise one will be unconsciously drawn to
combat the mother, either the inner, controlling one or the
 PROCESSING A CATATONIC STATE 71

outer one in order to save the poor child. The weak

metacommunicator and extreme lack of response organizes
and polarizes those in the environment who become angry
at the client for her negativistic attitude. Every attempt to
talk to someone who smiles without immediately responding
is a useless intervention into a powerful, unchanging process.
The question remains as to how one can communicate
directly with a powerful, controlling and apparently non-
verbal secondary process. One way is to assume that the
process is mother-like, intelligent, capable of taking care of
Patricia and independent. It is also necessary to assume that
responses need not be verbal, but may be transmitted
through signals occurring synchronistically in the environ-
ment and physically in the client. After having determined
this process structure, I decided to attempt direct communi-
cation with Patricia's silence, with what I assumed to be her
mother.

Amy: Patricia, I see you go off internally, thinking and

quietly meditating while we speak to you. And now,
I want you to do this, to follow your own process in
great detail. Take a lot of time, and when you are
ready, if you want to answer the following ques-
tions, answer them. My first question is, do you
have any questions of us now?

Patricia begins to go into one of her long pauses. I talk to the

others present in order that they do not disturb Patricia's
concentration by asking more questions.

Amy: You see, Patricia is now going through an internal

process in order to answer my questions in her own
time and way.

I notice that Patricia looked down, rotated her eyes slowly in

a circle, quickly looked to the left where Ruth was sitting
and then swallowed. From body work I have noticed that
swallowing is almost always associated with a moment of
understanding. Therefore I asked:
72 SCHIZOPHRENIA

Arny: What did you just think?

Patricia (answering immediately): What should I do for a
profession?

I was surprised that this intervention worked so well with

an otherwise silent person. This was the first time she posed
a question on her own or said anything directly and without
hesitation. I realized that her answer was positive feedback
to the new exchange method. I repeated her question:

Amy: What profession is the right one for you?

Again filling in the pause to keep the others out of Patricia's

internal process:

Amy: I know you are the only one who can tell us this,
Patricia, and I trust you to take all the time you
need, even more than that until you know the
answer.

Patricia rotated her eyes again, then, after about a minute,

swallowed.
Arny: Yes?
Patricia (immediately): I want to become a gardener.
Amy: How will you become a gardener?
Patricia (this time responding without using the long pause
or internal program): By slowly learning the pro-
fession, at first part time, living where I am
presently staying in the moment, then at a later
time, moving out, working more, beginning to risk
working and taking chances.

EVALUATION
Once the details of Patricia's internal state are understood it
is possible to access it. She is now speaking like a protective
mother and caring for herself. Therapy at this point would
entail getting her to take a minimal risk right now, as she
suggests, or telling her that she has been courageous to have
risked sharing her ideas with all these 'adults' present.
 PROCESSING A CATATONIC STATE 73

Continued work would involve a careful communication

process in which the therapist attempts to befriend the
mothering process and not fight against its controlling
negativism.
One advantage of process oriented work is its emphasis
upon the nature of individual communication. This means,
however, that the therapist must pick up signals which are
normally neglected, like swallowing, and must drop her
own preferred, usually verbal method of communication.
The necessity for greater receptivity to individual communi-
cative modes challenges the way in which one is working
and brings more discovery and research to traditional
therapeutic methods.

NONVERBAL COMMUNICATION IN EVERYDAY LIFE

The concept that the states met with in psychotic episodes
are extreme is due in part to the fact that we are not aware
of their appearance in everyday life because they are hidden
by a metacommunicator or a strong primary process.
Nevertheless they are present. In closing, I want to mention
a few of the many nonverbal states we frequently encounter
in psychotherapy.

NONVERBAL SECONDARY PROCESSES

1 During ordinary psychotherapy the client goes internal
when he is feeling something deeply and is not
interested in the conversation. He usually stops
talking, looks down at the floor and seems lost in
reverie. This emotion requires respect from the thera-
pist by focusing upon proprioceptive (i.e., feeling)
experiences or upon memories without requiring the
client to 'come back' and communicate to the therapist.
2 When a patient has become comatose because of an
accident or near-death condition, the color of the skin,
heart rate, breathing rate and pupil dilation are some
of many signals which may be used to communicate
with.
3 In organic brain disease such as one sees in advanced
alcoholism, drug abuse or senility where there is
74 SCHIZOPHRENIA

memory loss, clouding of consciousness or drunken-

like behavior, the normal primary process is missing
and nonverbal feedback is essential for communica-
tion. More will be said about such processes in the
chapters on alcohol and heroin addiction.
4 Individuals who are in meditation, in out-of-the-body
experiences and near death require nonverbal com-
munication. It is useful to pay attention to the rate at
which the eyelids flutter and verbally to guess at the
nonverbal feedback about the visions or experiences
which may be occurring. (See Inner Dreambody Work.)
5 In relationship work, being able to comprehend and
work with nonverbal signals can often facilitate the
end of a long-standing crisis. (See the Dreambody in
Relationships.)

Working with extreme states forces us to consider the

importance of nonverbal processes. The more we know
about them, the better we can deal with people in altered
states of consciousness and reduce the loneliness and
occasionally catastrophic consequences associated with them
by integrating them into ordinary everyday life. Appreciat-
ing nonverbal signals and introverted behavior in others and
in ourselves enables us to direct our lives from the
panoramic viewpoint of dreams and individuation.
Chapter 7
PATTERNS IN SCHIZOPHRENIA

In this chapter ways of working with some commonly

occurring verbal and nonverbal communication patterns in
schizophrenia are considered. Teaching and training experi-
ence indicate that the more familiar a student is with these
patterns the easier it is to process them without reference to
psychopharmica. Therefore I am going to review some of
the patterns which appeared in the last chapters before
going on to bipolar disorders.
Torrey (1983) writes that 'when one listens to persons
with schizophrenia describe what they experience and
observes their behavior, certain abnormalities can be noted.'
The following are some of these 'abnormalities,' followed by
what I believe are meaningful connections implicit within
them.

1 Alterations of the senses

2 Inability to sort and synthesize incoming sensations,
and inability therefore to respond appropriately
3 Delusions and hallucinations
4 Altered sense of self
5 Changes in emotions or affects
6 Changes in behavior

Each of these characteristics alone is insufficient evidence to

diagnose schizophrenia; the diagnosis depends upon the
sum of all the symptoms, not just one alone. Let us look at
these characteristics, one by one.

75
76 SCHIZOPHRENIA

1 ALTERATIONS OF THE SENSES

This refers primarily to amplifications or 'blunting' of
channel phenomena. Torrey (1983, p. 7) quotes the pro-
tagonist in 'The Tell-Tale Heart' by Edgar Allen Poe:

A True nervous very, very dreadfully nervous I had been

and am! But why will you say that I am mad? The
disease had sharpened my senses not destroyed not
dulled them. Above all was the sense of hearing acute.
I heard things in the heavens and in the earth.

Another schizophrenic described the state in this way:

B During the last while back I have noticed that noises

all seem to be louder to me than they were before. It's
as if someone had turned up the volume.

Not only is hearing more acute, but other senses as well:

C I seem to be noticing colors more than before,

although I am not artistically minded.

Other examples of heightened channel experiences include:

D Everything seems to grip my attention although I am

not particularly interested in anything. I am speaking
to you just now, but I can hear noises going on next
door and in the corridor.

E If I am talking to someone they only need to cross

their legs or scratch their head and I am distracted and
forget what I was saying.

F All sorts of 'thoughts' seem to come to me, as if

someone is 'speaking' them inside my head.

Amplifying channels is the basis of process oriented

meditation, it is found in Buddhist meditation methods and
 PATTERNS IN SCHIZOPHRENIA 77

is the essential element in becoming conscious and aware. In

schizophrenia, becoming conscious or aware is a secondary
process since it happens autonomously. Channel awareness,
increased brightness, distracting sounds, movements, etc.
arise spontaneously as if consciousness itself were trying to
happen, but the primary process or one's normal attention is
not trained to pick it up. The process paradigm does not
consider a symptom something to overcome, but an aspect
of the personality in need of integration. Thus the therapist
could work with these autonomous channel and sensory
experiences by encouraging the patient to go more deeply
into them. For example, the therapist could recommend in A
(above), that the client listen closely to all those noises in
heaven and earth and note exactly what they say; in B, that
the client talk to the person who has turned up the volume
and ask him why he has done that. Could it be that he had
not wanted to listen in the past? In C, that the client paint
the visual experiences, noting all the colors in detail; in D,
that the client listen closely to all the voices around him. The
therapist can support the client's disinterest in the conver-
sation by saying. 'You must have noticed that our conver-
sation is not the important thing, there is a lot of
superficiality in it. Listen closely to the corridor, make a
meditation out of it and tell me exactly what you hear. Then
we will find out why you must hear it.' In E, that the client
need not concentrate on superficial things, but should feel
free and strong to direct the conversation in the way he
needs. In F, that the patient find out who is talking inside
his head, could it be someone who has a lot of important
information for him?

Blunting
Whereas amplification is an early symptom, blunting or
deadening of the senses is frequently associated with later
stages of schizophrenia.

However hard I looked it was as if I was looking through

a daydream and the mass of detail, such as the pattern on
a carpet, became lost. (Torrey, 1983, p. 13)
78 SCHIZOPHRENIA

This is visual blunting. Early textbooks on schizophrenia

describe proprioceptive blunting or blocking in cases of
appendectomies and similar procedures performed with
little or no anesthesia. Nurses and other personnel in mental
hospitals know very well the phenomenon of schizophrenic
patients sustaining injuries such as fractured bones without
being in any pain. And, of course, it is quite a common
occurrence that schizophrenics will smoke their cigarettes to
the end and burn their fingers without realizing it.
According to Torrey, blunting may be related to changes
in the limbic area of the lower portion of the brain. Such
experiences are, however, also typical of channel changes
and are a regular feature of the switch between primary and
secondary processes which occur even in ordinary stages of
development. The primary process always experiences itself
as the victim in pain, but after switching into the secondary
process, as in the later stages of schizophrenia as well as in
ordinary development where one temporarily takes over a
secondary process, the client becomes identified with the
secondary process. The secondary process is not the victim
of pain, but the agent or pain-maker; hence the client feels
no pain — she herself has become a pain-maker. The next step
with a schizophrenic patient who feels no pain is to ask why
she needs to hurt herself or others.
Another possibility is to ask her if she is having an out-of-
the-body experience. It might be useful for the client no
longer to have a body; she may need to get rid of the old
body in order to change personalities!

2 INABILITY TO SYNTHESIZE AND RESPOND

Torrey (1983, p. 15ff) reports the following excerpts from
patients all describing their inability to synthesize and sort
incoming perceptions:

H I have to put things together in my head. If I look at

my watch I see the watchstrap, watch, face, hands
and so on, then I have got to put them together to get
it into one piece.
 PATTERNS IN SCHIZOPHRENIA 79

Everything is in bits. You put the picture up bit by bit

into your head. It's like a photograph that's torn in
bits and put together again. If you move it's
frightening.

J I can't concentrate on television because I can't watch

the screen and listen to what is being said at the same
time.

K If I do something like going for a drink of water, I've

got to go over each detail — find cup, walk over, turn
tap, fill cup, turn tap off, drink it.

In these cases, we are again dealing with a spontaneous and

autonomous increase in awareness. Awareness is being
increased without the patient being able to identify with the
changes. These experiences are strongly reminiscent of
vipassana meditation. An interesting way to work with and
amplify these experiences would be to criticize the patient
for his past unconsciousness and encourage him to be more
meditative and detailed in his method of observing what
goes on around him. For example you might say, 'You have
been too sloppy with your observations until now and have
not noticed enough details. You should be able to notice the
way and rate you are breathing, the kinds of feelings you
had when your eyes moved to the left and where those
feelings originated in your body. Why do you skip over so
many details about yourself?'
In the specific cases above you might say the following. In
H, 'You should begin to notice the kinds of words people
use. How do I use my verbs? What channel am I in now?' In
I, 'You need to learn how to put things together. Let me tell
you a few bits of a case like yours and you tell me what kind
of person it is.' In J, 'Do not move an inch, but concentrate
on the following puzzle and put it together. A man. Twenty
years old. Has been withdrawing for eight months. Lost his
girl-friend. A blond. Why?' (One of my clients answered this
question, 'Because this man was not made for this world, he
was a fallen star who had lost its way and someone needed
80 SCHIZOPHRENIA

to tell his story in a book.') In J, 'Stop trying to do two

things at the same time. Do not look but listen to me. Listen
only and do not look. Listen to my tone of voice. And when
you have registered that, then look and tell me frankly if I
look the same as I sound.' In K, 'You are a gifted vipassana
meditator. Now let us practice this in eating. First, notice
taking the spoon. Now bring the spoon to the mouth. Now
open the mouth. Now taste the flavors, salt, sugar.
Swallowing. Notice your stomach.'

3 DELUSIONS AND HALLUCINATIONS

I discussed the function of delusions and paranoid beliefs
earlier. The persecutor is a part of the personality, a
secondary process which the individual finally becomes. The
different delusions, whether one is being watched, perse-
cuted or attacked, or whether one is Jesus Christ, the Virgin
Mary or the President are all similar experiences in that they
are all secondary processes which need to be worked with
and integrated.

4 ALTERED SENSE OF SELF

I saw myself in different bodies . . . the night nurse came
in and sat under the shaded lamp in the quiet ward. I
recognized her as me, and I watched for some time quite
fascinated; I had never had an outside view of myself
before. In the morning several of the patients having
breakfast were me. (Torrey, 1983, p. 34)

I get shaky in the knees and my chest is like a mountain in

front of me, and my body actions are different. The arms
and legs are apart and away from me and they go on their
own. That's when I feel I am the other person and copy
their movements, or else stop and stand like a statue.
(Torrey, 1983, p. 34).

In the first situation I might recommend to the client to get

an outside view of himself or to look at himself in the
mirror. I would ask him not only what he sees in the mirror,
 PATTERNS IN SCHIZOPHRENIA 81

but what it is like to be the people he dreamed about the

night before, or the nurse or the people at the breakfast
table. The client needs to know a lot more about other
people; he should not just identify unconsciously with
them, but should feel them and know them more intimately
and find out why these people are all inside him. What do
they have in common? This client has a big need to know
more about himself and has not gone far enough with his
own processes until now.
In the second situation, I would recommend to the client
that she move in ways she has not done before. Since
movements and feelings are happening spontaneously to
her, I would suggest that she take it over by standing up
with me right in the moment and experimenting with the
movements her body is trying to make. This could be a lot of
fun; maybe a story will come out, or perhaps she will
become a statue. Out of the body movements will come a
meaningful dance or posture that could be worked with
creatively.

5 CHANGES IN EMOTIONS OR AFFECTS

Connected with this euphoric state, I experienced a gentle
sensation of warmth over my whole body, particularly on
my back, and a sensation of my body having lost its
weight and gently floating. (Torrey, 1983, p. 36)

What are the possible ways of working with this state? Since
it is indicative of a strong proprioceptive experience, one
might try amplifying it through yoga to increase the
awareness of the proprioception and then find the meaning
of these experiences for the client's everyday life. I did this
recently with one of my clients and he told me I was crazy. I
said, 'Don't mind me, just do the Yoga.' While in the midst
of one asana, he began screaming, 'Oh . . . oh . . . God . . .
God. . . I told him to quieten down long enough to tell me
what God was doing. 'GET TO WORK YOU LAZY
BASTARD' was what God had said to him. So I said this to
the client too and he left quite soberly, saying, 'Let's wait for
the next session.'
82 SCHIZOPHRENIA

6 CHANGES IN BEHAVIOR
Withdrawing, remaining quietly in one place for long
periods, being agitated and immobility are all common
behavioral 'disorders' of this illness. (Torrey, 1983 p. 39ff)

When I am walking along the street it comes on me. I start

to think deeply and I start to go into a sort of trance. I
think so deeply that I almost get out of this world. Then
you get frightened that you are going to get into a jam and
lose yourself.

The state of indifference reigning until now was abruptly

replaced by inner and outer agitation. At first I felt obliged
to get up and walk; it was impossible to stay in bed.
Singing a requiem without pause, I marched three steps
forward and three steps back, an automatism that wearied
me exceedingly and which I wished someone would help
me break. I could not do it alone, for I felt forced to make
these steps and if I stopped from exhaustion, even for a
moment, I felt guilty again.

. . . I was to lean on the back of my head and on my feet

in bed, and twist my neck by throwing my body with a
jerk from side to side. I fancy that I never attempted this
with sincerity, because I feared to break my neck.

In the second instance, I would say, 'You poor person. You

really need someone to enter with you into that lonely
world, so I am going to do that and I promise to stay there
with you until the terrible witch-like spell upon you breaks.
I love marching and singing. Now, let us get up and march
together, one, two, three, one, two, three, and let us sing
together . . . by the way, what is the meaning of this
requiem and for whom was it sung? How interesting. One,
two, three, do not forget the steps. Let's keep going, for if
we stop too early we are guilty of not really fulfilling a part
of your myth. Only when it is completed can we both be
free. I really understand you, you know, because I too often
 PATTERNS IN SCHIZOPHRENIA 83

feel driven to do things, even though I hate doing them.'

In this case, there is no choice about breaking the spell
alone. The man cannot break this spell, so it would be
unwise to advise it. As far as we can see, there is no pattern
for that, so it will not work. The man needs relationship
with an outer person and asks for that.
In the other case, however, the pattern is a bit different.
The patient says that he tried to resist the spell. Therefore I
would say, 'Wow, you are lucky, you have a really powerful
taskmaster inside. I am glad you did not break your neck
and follow him, that shows that you are stronger than he is
and have more feeling than he does. But I wonder, what can
we do with that force? How could you apply that discipline
in your life? Have you finished high school? Are you afraid
to finish college? Can you hold down a job?'

OPEN QUESTIONS ABOUT SCHIZOPHRENIA

It is frequently asked why schizophrenia often occurs early
in life and why its onset is frequently connected with taking
drugs. One answer to both of these questions from my
practice is that most episodes seem to be an attempt to open
the young person's mind to secondary material which has
been forbidden by his environment. Schizophrenia among
young people often looks like an attempt to broaden the
mind.
For example, a family came to see me with their son and
complained that the son had lost his interest in going into
the father's business after a psychotic episode induced by
ingesting hallucinogenic drugs in India during his travels
there. They brought him in to my office and he said to me
that he was no longer himself.

He: I was Peter, Allan, John, Alex, I was the universe, I

came from all over, but I was not from this country I
really come from, from Spain.
Me: Was it enjoyable not to be yourself?
He: No, I did not like it. I wandered the streets and had
nothing to eat.
Me: How did you get back into yourself?
84 SCHIZOPHRENIA

He: After months of people asking me who I was I decided

I had to become myself again.
Me: And what were you like before you went to India,
what did it do for you?
He: I had a narrow mind before. I saw only one goal, and
that was to become a famous businessman. Now, I
have other goals, many, and they are connected with
the relationship to God and the desire to know myself.
Me: Have you had any dreams recently?
He: I dreamed that I was high up on a mountain, and
looking down I saw little people, and a river running
through the valleys.

At this point, he got up on one leg, stood up as if on a

mountain and looked down upon me in a strange way. He
no longer saw or heard me and I realized that he was in an
altered state. The best way to help him through the state, I
thought, would be to get into it with him. So I got up on the
mountain with him.

Me: I want to come up with you on the mountain. Hi

there. Nice up here. What shall we do now? How do
we get down?
He: Talk to God.
Me: I like that. God, what would you suggest to my
friend?

My patient began to act in the role of God and said:

He (acting God): He must work hard on himself, and get

to know other human beings, and learn i to face me,
man to God.
Then he turned to me as the patient and asked:

He: What should I do with my life?

Me: Study yourself. Study psychology and begin to learn
about God and how to be with him.
He: Exactly. Thanks. I do not like many of the people my
age because they have such weak and narrow goals.
 PATTERNS IN SCHIZOPHRENIA 85

REVERSAL OF PROCESS STRUCTURE

Schizophrenia is one of the many types of psychoses in
which the primary process of the individual — which is
originally adapted to the culture in which she is living — is
exchanged for a secondary process. This gives rise to the
appearance of a total personality change. The emerging
'personality,' that is, the new primary process, is often
perceived as having nothing in common with the earlier
personality. It is this total personality change which is termed
'psychosis.' In process terms the primary and secondary
processes of an individual reverse.
The young man above became the whole universe, in part
because his primary goal was to become a businessman. If
you remember, Herr E. was previously a hard worker with a
secondary interest in relaxing, now he is a relaxer during the
period of life when most people are in the midst of working
hard. His secondary process is described as the authorities
of the world.
Herr B. is a rather intelligent, academic and well-adapted
fellow, with a slight depression and secondary interests in
healing and hypnotism when he is in his 'normal condition,'
and is Jesus Christ when he is flipped. The woman
mentioned in the chapter on Herr B. is the Virgin Mary with
secondary and projected negative mother characteristics in
her flipped phase, and is a negative mother with no interest
in God, healing or love when she is 'normal.'
Patricia was originally a highly intelligent and successful
child with a bit of a dreamy nature when she was younger,
and now she is a totally dreamy, terrified person whose
secondary process is intelligent and motherly.

SCHIZOPHRENIA AND THE COLLECTIVE

Herr E. is the relaxer at Switzerland's Round Table. Herr B.,
the one who wants to avoid pain, becomes Jesus and,
together with the woman who calls herself the. Virgin Mary
in an extreme state, balances the world's lack of belief in the
reality of the gods.
All of these people are not quietly schizophrenic. They
86 SCHIZOPHRENIA

disturb the city because their secondary processes are

unconscious phenomena for most of us. Herr E. upsets the
police with his letters, Herr B. has to be captured and sent
home from a South American country and Patricia upsets
everyone around her by doing absolutely nothing. In other
words, these people belong to given systems and societies.

THE NATURE OF THE PSYCHOTIC PRIMARY PROCESS

The primary process during the psychotic episode compen-
sates a given cultural viewpoint. The constant 1 percent of
the world's population suffering from schizophrenia tempts
me to make the following hypothesis. In a given collective,
the schizophrenic patient occupies the part of the system in
a family and culture which is not taken up by anyone else.
She occupies the unoccupied seat at the Round Table, so to
speak, in order to have every seat filled. She is the
collective's dream, their compensation, secondary process
and irritation.

An Example
I recall Lilly, a very delicate catatonic young woman of about
eighteen years who felt like a goddess. She did not talk and
was so sensitive that the slightest sound made her cry. She
had to pray for the animals and people of this world day
and night. When I saw her together with her family, they
complained that earlier she was good in school and not so
overly sensitive.
The father informed me that he had occasional heart
attacks, and said, 'I have been told that they could be a
matter of life and death, but do not think that I would spoil
myself at this point by treating myself as if I were sensitive,
frail or something special!' The mother and brother nodded
in support of the father's attitude, Lilly is obviously their
dream.

METACOMMUNICATORS
Since a schizophrenic has no metacommunicator with whom
we can discuss the different processes occurring, there is,
during the episode at least, no one present in the patient
 PATTERNS IN SCHIZOPHRENIA 87

who believes that he is ill. The given culture which is

disturbed by the activities of the patient defines the patient
as being ill. This cultural attitude towards schizophrenia was
mirrored in the original psychoanalytical dream theories
which viewed dreams in part as pathological material.
Herr E. thinks the authorities are ill, not he. Herr B.,
when he is normal, considers himself ill, otherwise he is a
manic healer. Patricia says she needs a profession, but does
not complain about being ill. In the opinion of the
schizophrenic while in the extreme state, it is the primary
process of the culture which is not well; it is our
consciousness, our minds which are not in order.

THE SURPRISE FUNCTION

The schizophrenic surprises and shocks his environment
because of the sudden emergence of a new personality. As
secondary processes arise in place of primary ones, without
the facilitation of a metacommunicator, what used to be
John is now the Devil, Napoleon, Jesus Christ or some other
surprising figure.
A therapist cannot claim to know her client if she cannot
imagine what the client will look like in a flipped state. In
order to do this, the therapist must be able to pick up the
client's secondary process in the moment they are together
and sharpen her perception and senses. If she is successful
at this, there should be no surprises and no malpractice
suits.
For example, Alice is a sweet and beautiful woman of
twenty-three. When I asked her how she was, she smiled
warmly and looked at me but her eyes were a bit vacant.
When I recommended to her to look vacant, she giggled and
then paused without apparently doing anything. Her
vacancy was a secondary tendency to leave the situation. I
asked her if she had ever tried to leave this world by
committing suicide. She told me about many near-death
experiences she had had with drugs, and then told me the
story of her attempted suicide. After having had a lovely
afternoon with her therapist and a fine dinner with some
friends, they were shocked and surprised to find her lying
88 SCHIZOPHRENIA

on the floor of her room the next morning, unable to

awaken because of an overdose of sleeping pills.
Alice's friends and therapist did not pick up the signals of
her secondary process which was to leave this world, NOW.
Behind her sweet and adapted expression was a double
signal representing that part of her which was not here and
did not want to be here. When she actually tried to leave,
her friends were shocked, not having been aware of her
earlier signals. Alice might be classified as being in the
beginning stages of schizophrenia. She wants to leave this
world because she is not interested in it or herself and
appears to dislike talking about herself much.

SIGNALS IN DREAM AND BODYWORK

This tendency to leave is apparent in her dreams as well. In
one dream, Alice saw fire and ran to save herself. She went
straight to a cemetery but, noticing that the fire was coming
there too, pressed her lips together and had the magical
effect of putting out the fire.
When working with her on the dream, I resisted the
motion of one of her hands at one point. At first she went
blank and said she did not want to get angry. Then she
began to get really angry, wanting to fight and explode with
anger. After a little wrestling, she abruptly sat down with a
happy expression on her face and said she loved wrestling
but that she was angry at her parents for many things but
was afraid to tell them so.
If we connect her body signals and dream together we can
see that she first gets angry (i.e., to be on fire) and then
represses her anger, as seen in the dream by running from
the fire to the cemetery and in her signals by looking vacant.
She identifies herself as a good daughter living at home and
being thankful to her parents who direct her life. Her
blankness is going to a cemetery, dying, so to speak, instead
of being angry. When I asked her to tell me what happens
when she presses her lips together as in the dream, she did
it and said it meant 'talking, being angry.' She then stated, 'I
would rather die than be angry at someone whom I do not
 PATTERNS IN SCHIZOPHRENIA 89

like,' whereupon she began once again to vocalize her

grievances against her parents.
Alice shows us that suicide, blanking out or flipping into a
'surprising' secondary state is a stage in the midst of a
process which consists of getting angry, not wanting to be
angry, acting blankly and then finally expressing the anger.
Knowing the pattern behind such processes allows us to
help their messages and meanings unfold in a more useful
way for the individual and the world than suicide or
insanity.

THE BEGINNER'S MIND

Why do we tend to either miss or underrate signals which
are, a priori, as obvious as other signals? One reason for our
oversight and inability to pick up certain messages is
insufficient education in signal theory. Another reason is
our unconscious tendency to complete, harmonize, perfect
or idealize the unknown. We can see this demonstrated in
the well-known example in figure 7.1. If ten people look at
the circle below, only one in ten will notice that there is a
gap in an otherwise circular line. The rest will see only the
circle itself.

Figure 7.1 Circular figure with point missing in lower left

quadrant

Analogously, when we see a beautiful, youthful person with

a winning smile, few are likely to think that a fleeting
though repetitive signal such as a blank or vacant expression
could be of much significance.
90 MANIA AND DEPRESSION

Thus one of the challenges in working with extreme and

borderline states is to examine critically our tendency to
overlook disharmonious signals. Missing signals of discon-
tent allows us to idealize the efficacy of our methods. A
positive way of formulating this challenge is to understand
borderline states as tests in developing what Suzuki (1976)
calls in his book on Zen, a 'beginner's mind.'
Having a beginner's mind is the only way to help the
therapist work with extreme states, for it allows a more
developed perception of the environment and a more
developed feedback loop, the two things the person
suffering from schizophrenia lacks. The beginner's mind
neither thinks nor feels, but is simply open. A beginner's
mind notices that the schizophrenic in the extreme state
seems unrelated to his immediate environment, flip-flops
according to who occupies what part in his field and sends
valuable nonverbal messages to the rest of us which need to
be taken seriously.
Part III
MANIA AND DEPRESSION
Chapter 8
DEPRESSION AND SUICIDE

Manic-depressive illness, now referred to as bipolar disorder

by DSM III, is, in its classical form, easy to differentiate from
schizophrenia. The clinical picture of the bipolar disorder is
dominated by congruency between the individual's mood
(either elevated or depressed) and the delusions or hallucin-
ations which coincide with the mood. A schizophrenic can
be God and continue eating dinner, whereas a person in a
manic phase will feel like a savior, act like a savior and be
euphorically helpful. Bipolar disorders are frequently found
in higher social economic groups, whereas schizophrenia, in
the United States at least, is a disturbance commonly
associated with lower income families. The manic person
has less need for sleep, is very active, talkative, displays
rapid thinking and short attention and is often inflated in
self value. The depressed phase of the disorder is character-
ized by feeling empty, sad and irritable, sleeping too little or
too much, having a poor appetite and losing interest in
ordinary life. People with bipolar disorders have periodic
episodes of mania or depression. In Western Europe, I think
at the present time we see mostly the depressed side of the
so-called bipolar disorder.
Frau R. would probably be diagnosed as having a
psychotic depression. She has been an irritating and difficult
problem for the social service people for the past year, since
her first visit after having tried to commit suicide. She still
feels severely depressed and wants to die.
I want to point out, however, that she comes for help but

93
94 MANIA AND DEPRESSION

does not present depression as her main problem. She

comes for help because she lost her false teeth at the bottom
of the Lake of Zurich after an attempt to drown herself. She
was fished out of the lake by the city police. This suicide
attempt not only left her without her teeth (the ostensible
reason for coming to the social service station), but without
any further interest in living. Her present depression began
about three years ago when she was fired from her job at a
candy store because she lost the use of one of her hands in
an accident.
She enters the interview room, about fifty-five years of
age, ashen colored and heavy set, moving and talking very
slowly, as if she were dragging one hundred years of misery
behind her. After a few minutes of polite chatter I ask her
about her most recent suicide attempt and she answers,

Frau R.: I tried to jump into the water but was not suc-
cessful. There I lost my teeth, watch and glasses
. . . the police only found my watch and glasses.
That was a serious loss for me. Life no longer
gives me any pleasure . . . if I had good teeth and
my old job back, then I would enjoy myself.

In transcribing the tape I notice that I missed her logical

manner, her matter-of-fact attitude. She is telling a sad story
without being overtly sad. I did not notice this consciously,
but began unconsciously to take over the sadness and fight
the matter-of-fact attitude.

Amy: If I were in your situation and was feeling so badly,

feeling as if life no longer gave me any pleasure,
what would you advise me?
Frau R.: I could not help. Psychiatric help stinks anyhow. I
hate talking . . . why would you have the feeling
you should help me anyhow? I do not expect it.
Amy: Would you then like to commit suicide again?
Frau R.: Yes.
She moves forward to get some tea from the table in front of
her.
 DEPRESSION AND SUICIDE 95

Social Worker: I feel helpless and hopeless with you.

Frau R.: I do not expect help from you.

PROCESS STRUCTURE
Her primary process is to be suicidal: 'I tried to jump into
the water.' She identifies herself primarily as an old woman
who is the victim of aging, as seen in the statement. 'I lost
my teeth, watch and glasses.' She does not want help and
hates her helpers.
Her secondary process can be seen in the statement: 'Life
no longer gives me any pleasure.' Her secondary process is
life, being young and hopeful: 'if I had good teeth and my
old job back, then I would enjoy myself.' Her primary
process is the older woman who wants to be younger, but is
growing older instead. She is therefore depressed and
finished with life.
Her primary process claims that she does not want help,
but secondarily there is a younger woman who enjoys life
and says that something should be done to help: to get her
new teeth and a new job. It is this secondary process which
has brought her to the social service station in the first place,
not her primary one which has given up on life and on
trying anything new. The younger woman is still hopeful
while the older one wants to commit suicide.
Frau R. is not asking for membership in the grower's club.
She is not identifying herself as someone interested in help,
but if she really did not want any help at all, she would not
be asking for her teeth and would not be able to constellate a
situation in which others try so hard to help her.
Many older people become depressed because they
identify only with their aging body, the one which cannot
perform as it used to. They turn against life, the inevitability
of existence, those trying to help them and even God. When
Frau R. takes medicine, however, she no longer identifies
with hopelessness.

Frau R.: Bad thoughts go through my brain. When I take

the medicine, these evil thoughts against God
disappear.
96 MANIA AND DEPRESSION

Here she identifies with the one taking the medicine to get
rid of her depression. She has flipped and is wanting to feel
better, while the evil thoughts against God and life, her
nasty moods which we saw before when she said, 'Psy-
chiatric help stinks,' have become secondary in that they are
occurring to her. It is dangerous, however, to repress the
evil thoughts because this aggression can suddenly turn
against her.
The definition developed for psychosis in the section on
schizophrenia fits her as well. In a psychosis, the earlier
primary process (the young working woman, hopeful about
life) flips into a secondary process (the aging phenomenon)
so that aging now becomes primary and the old hopeless
woman polarizes a new secondary one, the woman who is
trying to heal herself and get better. Drugs achieve this
process reversal once again so that as long as Frau R. takes
them she feels that life is worthwhile. Then the negative
thoughts, temporarily repressed, become autonomous,
secondary and drop out of awareness.

WORKING WITH THE TOTAL PROCESS

In the midst of a depressed episode, Frau R. is identified
with the process of being angry and hopeless about life for
not giving her the youthfulness, pleasure and mechanical
abilities she once had. Though there are fleeting moments in
which she switches and seems to want help, by and large
she is against life.
As long as we are unclear about the structure of her
process, we are bound to take the unoccupied part in her
pattern. In Frau R.'s pattern, the unoccupied part is the
healer who is trying to get her to live. In her depressed and
nasty state, the more she hears about help, the more she
rejects it. The more she rejects it, the more she splits off her
secondary request for help and the more the social worker,
psychiatrist, psychotherapist, hospitals and police are trap-
ped into trying to be helpful.
This is a vicious and dangerous cycle because if we
constantly act like helpers, she never gets the chance to help
herself and is constantly in the position of the depressed one
 DEPRESSION AND SUICIDE 97

who wants to die. But this situation can be reversed by

knowing the process structure well enough to flip the two
processes.
After trying for about twenty minutes to be the helper and
attempting different approaches, I decided to side with the
dying process since everything else resulted in negative
feedback. Thus I played her primary process better than she
could, hoping that she would take on the social worker's
process of being helpful and hopeful. I looked down and
spoke slowly and in a depressed voice:

Amy: I am now ready to go. Nothing worked, nothing

helps. I want to go off alone and think it all over.
Nothing can be done here anyway. Too bad.
Frau R.: No, I am happy that you are here.

I noticed that this was her first positive response and I was
genuinely surprised to see that my plan had actually
worked.

Amy: Really?
Frau R.: Yes. For me you are a stranger and it was a great
help and a good thing that I could talk about such
intimate things with you. I am even getting good at
talking about myself [she giggles].
Social Worker: Frau R., that is the first time I have ever
seen you laugh!
Amy: Give me a coffee, I have had enough here and want
to go.

The social worker did not notice what I was doing and said:

Social Worker: Amy, do you not see any chance for

helping her?
Stay!
Frau R.: Yes! Do you see any possibility of helping me?
Now I would be really interested if you could tell me
something helpful!
98 MANIA AND DEPRESSION

EVALUATION AND PROGNOSIS

I stayed for a few more minutes and worked with her by
putting most of the responsibility for the future in her
hands. Remember that a few moments before she had said,
'I hate talking . . . why would you have the feeling you
should help me anyhow? I do not expect it.' Now her
position has completely reversed and she is saying, 'I am
happy that you are here. . . . It was a great help and a good
thing that I could talk about such intimate things with you. I
am even getting good at talking about myself.'
My taking the position of the depressed and hopeless
person helped Frau R. pick up a secondary process, the
process of life and being interested in help and therapy. A
smile from a chronically and severely depressed person is
positive feedback. It should be mentioned, however, that
one reason why she became optimistic is because I was
congruently fed up with trying to help her. I was not just
playing a depressed role. At first, like everyone else around
her, I really wanted to help her. Only when I saw that it was
a waste of time and energy could I really act as if I was
finished helping her.
The fact that she smiled for the first time since she came to
the social work station is not yet grounds for optimism. Frau
R. would need continued treatment of this kind in a social
service network. This means that everyone would have to be
informed about the nature of her process and instructed on
how to follow it. Since this was a one-time supervision
seminar, such instruction was not possible. Under these
circumstances, her process of hopelessness was bound to
continue. Less than a year later she succeeded in killing
herself.

DEPRESSION AS COMPENSATION
In the 1980s, being depressed and hopeless cannot only be
seen as a compensation to the Judeo-Christian tradition but
to the psychotherapeutic paradigm of helping and healing as
well. Not every patient fulfills this paradigm. In fact, trying
to be helpful to a patient whose primary process is
 DEPRESSION AND SUICIDE 99

hopelessness is a dangerous undertaking, based on an

inappropriate paradigm and a bad working hypothesis
because helpfulness polarizes the secondary process even
more, and you create a situation in which the helper must
be resisted. Furthermore being helpful to a client who is not
primarily interested in help is a goal mismatch and is bound
to isolate the client even more than she or he already is.

PSYCHOSIS AND THE METACOMMUNICATOR

The kinds of depressive processes normally seen by the
psychiatrist or psychologist in private practice are depres-
sions with a metacommunicator. Someone within the client
is coming for help, somebody is present who is not
depressed but is concerned about the depression and wants
a cure for it.
This is not the case with Frau R. She is not coming to the
social service center primarily for psychiatric help, but
because she wants a new set of teeth. According to her
statements, she has already had enough psychiatric help.
Hence, there is no one present to discuss the seriousness of
her depression. There are only a few choices available in
such a case. You can help her by giving her psycho-
pharmica, assuming that the metacommunicator is strong
enough to want to take these pills. You can try to be helpful
and begin to hate her because she resists help, you can send
her to somebody else instead of challenging yourself or you
can try, and probably fail, at giving her insight into her
depression. The only other possibility I know of is to study
her process structure and enter it with awareness.

THE PURPOSE OF DEPRESSION

Instead of treating depression as if it were something we
should overcome, we can also ask what its meaning is. For
example, what was the usefulness in my giving up and
going home to think it over? From the material at hand, we
can see that if a depressed and hopeless experience is
allowed to come up, then the road is cleared for help.
Instead of constantly resisting the processes in front of us,
we might stop and admit to their presence. Instead of
I 00 MANIA AND DEPRESSION

hoping that the world will be saved by the scientists,

theologians and politicians, I wonder what would happen if
everyone in a given community would face all of the
depressing and disturbing facts in our lives and risk being
depressed by them. Only by risking a depression in this way
is a road for possible creative solutions to the future
prepared for.

OCCUPATION THEORY
When faced with an impasse in our world, most of us
become optimists and try to find the solution to the impasse,
imagining we have found it even when we have not. Such a
world needs Frau R. and others who become depressed to
sober up false and unbased optimism. If we understand the
world as a round table, then there is going to have to be at
least one chair for a depressed person if the other three are
filled with optimists. The depressed one sees that the world
is coming to an end, but, unlike the optimist, is uncon-
vinced by the imagined solutions. The existential hopeless-
ness of the depressed person is the bottom line, the
beginning of facing the facts and of constellating new and
creative solutions to life.
Intrapsychically, we can imagine a field or round table in
Frau R: three people are depressed and are balanced by a
therapist who is trying to help. If the therapist leaves his
chair, Frau R. will have to take the one of the optimist.
According to occupation theory, every system has to be
balanced, whole and complete, just as an atom with an extra
valence searches to combine with another atom and so attain
balance.

HOLOGRAM THEORY
The inner personal situation reflects the outer one and vice
versa. We see with Frau R. that the outer world carries the
same pattern as the inner one. This speculation is a form of
hologram theory since a hologram is a piece of material,
like glass, which carries a particular pattern. If the glass
breaks, then each of the parts of the glass carry the same
pattern as the whole.
 DEPRESSION AND SUICIDE 101

Seeing the world through the analogy of hologram theory

helps you understand how you can change the individual by
working with the world or change the world by working
with the individual. Thus there are two ways of working
with hopeless situations, extreme states and impossible
clients. One is by improving the psychotherapy of the
individual and the other is by working on the world
situation. In this present case, this means understanding the
value in looking soberly at a difficult situation. If everyone
in Frau R.'s world looked at the state of the planet at the
end of the 1980s and considered the apparently catastrophic
ecological, social and political problems, a sobering de-
pression might be followed with new and creative solutions
not presently part of our naive hope and belief in human
know-how. What would happen to the world is uncertain,
but it is likely that Frau R. and others like her would want to
help those who are hopeless.
The meaning of Frau R. for the world can be applied to
psychology as well. It seems to me that psychology is too
optimistic. Most psychologists and psychiatrists are naïvely
hopeful and radiate good will even when they do not know
what they are doing. For example, the entire area of
psychotic states is still in a pioneering period. The discovery
of the simplest structures to these 'disorders' is at a stage
which is equivalent to that of physics at the time Galileo
discovered that gravity exerts an accelerating force.
We are just learning about the forces and effects which
move people and we need to be very humble and respectful
of processes which we barely understand and get these
processes and the people who manifest them to show us the
way. Frau R. is just right for the present state of psychology
because she powerfully reminds us of the fact that the
course of nature is not in the hands of the therapist.
Chapter 9
THE MANIC SAVIOR

Frau P. was invited to the social service station this morning

because the program director thought it might be a good
opportunity for the city authorities, with whom she was
previously in conflict, to see her now in a calm and 'normal'
state of mind. It seems Frau P., during a manic episode,
took it upon herself to help her entire village. On any one
day she was in contact with dozens of townspeople and city
authorities, and disturbed her immediate environment to
such a degree that she was finally interned in a mental
hospital. Now she is about to return to ordinary life after her
stay in the hospital.
Everyone is present this morning: Frau P., the local staff,
two other social workers from the area, the chief of the
social services for this district of Switzerland, a city authority
whom Frau P. had previously bothered, Joe and I.
Frau P. sits in her chair wearing a colorful skirt. Her right
hand is holding her left elbow, her left hand is supporting
her head in a position I have frequently seen among people
who are sad, depressed and trying to support themselves.
In working with such a posture, it frequently turns out that
the hand holding the head is a supporting figure such as the
mother. The head which is being supported is the child. It is
not difficult to guess Frau P.'s primary and secondary
process from her first few sentences and her body posture.

Frau P.: I do not want to speak about myself but of other

people's problems. I heard of others who had

102
 THE MANIC SAVIOR 103

problems and tried to get to the bottom of them. I

made a lot of contact with these people. I tried to
find their private problems. There were a great deal
of misunderstandings which they suffered from. It
was difficult to find solutions. One woman with-
drew from the world because her neighbor was not
friendly with her. It is difficult to say . . . she
needed help with her environment, help in her
household. I have found much injustice, especially
where people needed a 'middle-man,' a helper .. .
but I have also learned that one cannot just go
forward and try to make solutions. It does not help.

PROCESS STRUCTURE
In the first place, we notice that she has a metacommunica-
tor. At the moment she is neither in an extreme state nor
psychotic. Her primary process adapts to the world around
her; she sounds psychologically insightful.
She identifies herself as not being interested in her own
problems, but in those of others. She is a helper, someone
who helps troubled people and someone who realizes that
she cannot force solutions. Since she is strongly interested in
the misunderstandings and conflicts of others in her primary
process, she is like a social worker or even a family
therapist.
The secondary process consists of the figures 'myself'
whom she does not want to talk about and also 'the people
who have private problems' and suffer from misunderstand-
ings and injustice. We can summarize her secondary process
as people who need help with the environment.

WORKING WITH FRAU P.

How do you work with a person who does not want to work
on him or herself? One way is to take her primary process at
its face value and just listen to her stories about others. But
since this is what happens to her in everyday life, it won't
be the most satisfying solution.
Another possibility is to think that the people she talks
about are parts of herself and thus she will eventually turn
104 MANIA AND DEPRESSION

towards herself and ask for help. The weakness with this
method is that it does not respect her wish not to talk about
herself. Though it is a normal therapeutic intervention, it is
no match for her primary process and is thus bound to get
negative feedback.
A third possible intervention is to ignore what she says
altogether and practice your own methods of intervention
with her. Ask her for dreams, get her to act out the other
people or press her about her feelings. If I worked privately
with her I might be tempted to work with her hand and arm
signals which I mentioned above. Yet I am sure my own
interests would get me nowhere and that I would be forced
to try the following method: taking her interest in others
seriously and asking her to learn how to really help them.
This means learning how to get along with others, obtaining
some sort of social or psychological education or perhaps
even learning how to confront people. She needs a teacher
who will press her to report accurately on what she does
with people and what kind of feedback it gets.
In this way she would simultaneously learn the tools of
psychology and discover how to work with herself. No
doubt this is the way most psychologists learn to work with
themselves. A lot of their interest in others is connected to
projections of their own problems. Through learning to work
with others, their own problems are indirectly worked on.
There is a belief, however, among different schools of
psychotherapy that one should first work on oneself and
then help others. This is a belief unique to the grower's club,
and at the moment I am not yet sure that Frau P. belongs to
this club. I noticed that as soon as she said she did not want
to talk about herself, everyone in the circle, the analysts,
social workers and city officials, got very upset. They do not
agree that she should do what she wants, namely, try and
help others. The following response is from the city official
whom she irritated during the acute phase of her most
recent episode.

City official: I am impressed with you today Frau P. I

notice that you can now listen to us. Don't think that
 THE MANIC SAVIOR 105

what I said about you earlier, in your previous

condition, was so negative that one would think that
you were crazy. Now you are quiet and no longer
aggressive. Now you are peaceful, positive and
stabilized. In the past you did not sleep or eat!

Frau P. first looks down at her watch, then quickly at the

rug and then looks up and says quietly:

Frau P.: But for me it was not bad to eat only a little for
several days. And I did not miss sleeping.
City official (placatingly, as if to a child): But you called us
constantly and bothered us incessantly.
Frau P. (directly, almost angrily): Only when it was urgent.

CONVERSATION PROCESS
The authority acts, in his primary process, as if he were a
good man who cared for others. Secondarily, he double
signals to her that she is crazy by saying: 'Don't think that
what I said about you earlier . . . was so negative that one
would think that you were crazy.' Frau P. feels misunderstood
by him, just like the people she talked about. But feeling
misunderstood and needing help is a secondary process,
primarily she is carrying on a nice social conversation like
everyone else. Nevertheless she is irritated by the insinu-
ation that she is a crazy, sick and aggressive woman. The
message she experiences is, 'Cool off baby or you'll go back
to the nut house!'
The problem with the conversation is not that the city
official thinks that she is nuts but that he and she are both
unable to express themselves directly. He too needs to learn
about communication so he could express his messages
directly and not have to double signal them. I am certain
that if he could, he would have said to her at the times she
bothered him, 'Listen lady, cool off or I am going to call the
authorities and have you interned. You better believe me,
you bug me too much!'
Certainly this would have been difficult for him to do, for
no one wants to be nasty. On the other hand, by not being
106 MANIA AND DEPRESSION

direct and only double signalling his irritation to her, the

mental institutions were left to pick her up and calm her
down with drugs.
Moreover, the city official's difficulty in standing for what
he thinks is similar to Frau P.'s problem. She, too, feels
guilty about what she thinks, namely that the official
misunderstands her. Not eating during her episode was not
a serious problem for her and she had trouble asserting this
directly to the official.
Though I tried to take the focus off her and put it on the
entire interaction, Frau P. and I were alone in this intention.
Near the end of the conversation, after I had tried to focus
on the group interaction while the others tried to change
her, she said:

Frau P.: I am not content because all our talk centered

around me.
A therapist: But we wanted to learn how to get along with
you better, that is the problem.
City official: For me this has been a very positive experi-
ence, I liked it. It gave me a chance to see you again,
to meet you when you are not on medicine.
Frau P.: I know that I made a lot of problems, it is not so
funny. [She laughs.]

LAUGHTER
Why does she laugh? The situation is really amusing. There
are three different goals and viewpoints. Frau P. is inter-
ested in others. The official is interested in cooling her down
and the therapist is interested in working with her. But
there is even a fourth viewpoint, mine. I was interested in
the entire interaction scene! What else can you do but laugh?
We might easily have been talking English, German, French
and Italian!
The scene vaguely reminds me of Ken Kesey's novel, One
Flew Over the Cuckoo's Nest. The book deals with the attempt
to repress a madly creative and wonderful guy who was
disturbing the environment. The psychiatrists and nurses
gave him electroshock treatment to cool him off and make
 THE MANIC SAVIOR 107

him normal. A greater perspective on the city or group

problem was obviously missing in that fictional story and, as
you can see for yourself, here as well. The officials and
therapists want to cool off Frau P.'s manic behavior while
she is only interested in the betterment of mankind.

CHANGE
Who should change? If Frau P. could concentrate on her
own problems she would calm down the environment. If
the official would study his own interaction difficulties he
would realize that he, too, is unconscious and needs to
change. When the therapist wakes up, he will change his
attitude and stop concentrating solely on Frau P.
I can only guess about Frau P.'s possible changes because
we did not work therapeutically with her. One of her
personal problems did come out in the midst of the
interview which indicates how and where she needs help.
Her ex-husband took her children from her custody and she
could not defend herself properly. She did her best,
however, by throwing an hysterical fit as the kids were
taken away. She suffered immensely, but could not suffi-
ciently support herself. Thus she swallowed the whole
problem and became a manic helper for other women in the
city who had been misunderstood.

THE COLLECTIVE'S CHANGE

In Switzerland, as in other countries, custody of the children
usually goes to the mother. This is due to many factors,
among them the fact that women are not used to defending
themselves in public against city officials. Thus, the laws
compensate for this by favoring their interests.
Women's liberation has also tried to increase the support
given to women, but laws and liberation movements are not
enough. Women and men alike need training in communi-
cation so that everyone can work together better. Since
women frequently suffer from their inability to defend
themselves in the community, Frau P. must play the Joan of
Arc role for those who are being victimized. Frau P. thus
compensates the way most of us behave in the community.
108 MANIA AND DEPRESSION

Few women or men stand up and turn the county

courthouse upside down in an effort to find out which
women have not been cared for sufficiently.
We need a broader perspective in psychiatry and social
work. We need to look at the entire communication network
and work with Frau P. as well as the world she is living in,
the world which she compensates and teaches. Focusing
only upon Frau P.'s problems would mean ignoring the
cultural problems she is compensating. People not only
need more protection from the city authorities but encour-
agement in developing the necessary personal strength to
stand up in public and defend their individual viewpoints.
Relying on the police, lawyers, psychologists and city
government officials is a way of ignoring our own develop-
ment and worldly responsibilities.
The story of Frau P. thus shows us again that the
individual is disturbed by and suffers from the city, while
the city suffers from the commotion made by the individual
in an extreme state. Once again we see that solving the
problems of an individual who suffers from extreme states is
inextricably intertwined with the city's problems.
Part IV
DRUG ABUSE
Chapter I0
HEROIN

According to the World Health Organization, drug addiction

is the need to increase the dosage of a drug which is
destructive to the individual and environment in order to
maintain or increase its effect. Common addictive drugs are
alcohol, heroin, morphium, methadone, cocaine, ampheta-
mines and related compounds.
This definition of addiction leaves undefined the nature of
the drug and its destructive effects. For example, there are
physiological and psychological addictions to cigarette
smoking, coffee and black tea. Behavior associated with
taking these drugs may actually meet the above definition
for addiction: occasional overactivity which is disturbing to
the environment. In the case of marijuana or hashish, the
addiction may have minimal physical consequences for the
user, but could place him in the position of community
scapegoat.

ENDORPHINES
Studies of addiction and drugs are complicated by the fact
that the body itself is capable of producing mind and mood
altering drugs called 'endorphins.' This term is derived
from 'endogenous morphine.' Endorphines refer to any
naturally occurring substance in the brain or tissue having
pharmacological effects resembling opiate alkaloids such as
morphine or heroin.
Opiate-like effects from the body's own endorphine
production occur during such ordinary activities as long-
I 12 DRUG ABUSE

distance running, meditation, yoga or other calming and

relaxing sports. Are these activities addictive? They can also
be dangerous for the individual and may also be associated
with conflicts and disturbances in the environment.

COLLECTIVE ATTITUDES TOWARDS DRUGS

Western interest in drugs dates back to the beginning of
written history, though recent interest in heroin and its
derivatives has flourished because of its increased use
among young people. Collective opinion about drugs is
widely divergent. Mind researchers like Andrew Weil (1972)
have promoted the use of drugs as an aid to exploring
altered states of consciousness while the general public
views drugs as ruinous to one's health and well being.
Drug research has shown that the extent of organic brain
intoxication depends upon the individual's psychology. By
analogy the effects of brain damage upon the individual also
depend upon the psychology of the person affected. My
experience with many drug takers verifies Weil's idea that
drugs do not cause altered states, but open doors to these
states. Whether or not the drug user goes through the door
depends upon his individual situation. Thus many shamans
use drugs to assist them in their spiritual adventures. For
example, don Juan, Castaneda's mentor, uses them to help
his students, but claims that they are unnecessary.
Collective opinion about drugs stems from the fear of
altered states which is perceived as a threat to everyday
reality (cf. Weil, 1972). The social conflicts, neurophysio-
logical considerations and spiritual states connected with
drugs are issues of great interest to those in the mental
health profession, especially since medicine is now the main
user of mind altering drugs! The question remains as to who
chooses to use these mind altering drugs and when the
choice is to be made. However, I want to keep to my main
topic, and refer the interested reader to the literature.

WORKING WITH HERR C.

Let us keep these general remarks about drugs in mind as
we listen to Herr C., a long-time heroin addict who has
 HEROIN H 3

become dependent upon the city's hospitals, drug clinics

and social welfare agencies for medical, moral and financial
aid. Herr C., twenty-eight years old, suffers from the many
typical problems connected with heroin addiction.
John, one of the social workers, is sitting in a chair talking
to Herr C. as I walk in. John informs me that Herr C. has
been addicted to heroin for more than nine years. He goes
through periodic cycles of addiction and withdrawal. With
the help of medication, he appears to be 'cured,' but then
falls back onto heroin for one of many reasons. John seems
to be aiming his therapeutic endeavors at discovering the
feelings and reasons behind Herr C.'s addiction.
Herr C. begins to describe to us some of the details of his
heroin problem. He is sitting in a relaxed position and
speaks with a slight slur, most likely due to the consump-
tion of sleeping pills which are meant to aid the withdrawal
from methadone, which is itself used to ease the withdrawal
from heroin. He speaks in a rapid although slurred tempo
which does not allow much chance for us to respond.

Herr C.: Heroin attacks the central nervous system, right?

Feelings are more intense on heroin. The longer you
are on the poison the more you like to shoot it. I
can't say what it's all about, but it's wild. After
shooting it up, what comes later is absolute con-
tentment.
I get aggressive when I am on heroin. Of course I am
also aggressive when I am withdrawing. Once, while I
was kicking the habit, someone at the hospital
where I was said to me that I should help wash the
dishes. I picked up the dish rag and threw it at him.
He should have left me in peace. I had so much
going on with myself that I didn't want to have to
relate to anyone.

PROCESS STRUCTURE
Herr C.'s primary process, that which he identifies with, is
all aspects of taking heroin. He shoots it up, he gets
aggressive while taking it, he picks up objects and throws
1 1 4 DRUG ABUSE

them while withdrawing and he gets angry if he is not left in

peace. While withdrawing, he is so busy with himself that
he has no interest in relating. I notice this lack of interest
with us in his tempo: he talks so quickly that no one else but
he can speak.
His primary process is similar to that of many addicts. He
actually identifies with heroin itself. 'Heroin attacks the
central nervous system,' and, since 'The longer you are on
the poison, the more you like to shoot it,' we can say that
Herr C. himself is a 'poison' which attacks the central
nervous system or anything that might give him the impulse
to work and disturb his peace.
Thus, like the old adage which states that 'you are what
you eat,' Herr C. is heroin. People who are addicted to
coffee actually begin to produce coffee-like effects on those
around them, just like alcoholics, as we shall see in the next
chapter, produce alcoholic effects in their environment.
Herr C.'s secondary process, that which he does not
identify with, is portrayed by the man in his story who told
him to wash the dishes. 'Cleaning up' and pitching in to the
work in his environment is a secondary process with which
he is in conflict. It is no coincidence that a slang expression
among addicts for getting off heroin is 'cleaning up.'

WORKING WITH HERR C.

It is important to notice that when I describe Herr C.'s
psychology I assume that what he says about the states he
experiences on heroin are accurate descriptions of what he
feels now. The reason for this assumption is that if you are
able to verbally formulate something, it is true in that
moment.
His total process includes a metacommunicator. He is able
to talk about his states in contrast to drugged states in which
the chemistry of the body is so altered that a metacom-
municator appears to be absent. His process can be
described as a conflict between heroin, the tyrannical
protector of peacefulness, and the collective interests of
'cleaning up' and working. The entire process behaves in a
holographic fashion which Herr C. carries into his environ-
 HEROIN 115

ment. Whenever he is the one most interested in peace, he

will have conflicts with others interested in keeping the
world in order. Now he is bound to have a conflict with us.

Herr C.: I dropped the recent withdrawal attempt at the

hospital because it was too tough for me. Do you
understand, John?

John nods his head.

Array (to Herr C.): Apparently John understands but what I

don't understand is why you won't promise John, as
he has required many times in this conversation
already, to call him when you have problems instead
of just taking heroin and giving up on your
attempted withdrawal.
John: Yes, please Herr C., do come and call me when you
need me.
Amy (escalating the conflict): There you are, trying to
weasel out of getting off heroin again. I want you to
promise that you will call!

While reviewing the tape, I notice that at this point Herr C.

shakes his head very gently from side to side, indicating 'no'
but says:

Herr C.: I would like to call . . . I promise . . . right?

I did not see his double signal implying 'no' while talking to
him. Therefore I unconsciously doubted his promise.

Amy: Is it possible that you are really promising to call?

John: If you would come and talk, it would be better for
you, Herr C.
Herr C.: Yes, but you know as soon as I get out of the
hospital, heroin is around. It is on the tram, in the
street, in front of my door. It is so easy to get and
take when I do not call you.
1 16 DRUG ABUSE

I raise my voice again and try to escalate the conflict:

Amy: There you are again, trying to weasel out. You first
intend to withdraw and then find an excuse to get
addicted again. So I don't believe that you want to
withdraw.
Herr C.: You have to understand that when you're on
heroin you don't think. Do you understand?
Amy: You are lazy and weasling out of thinking!

The tenseness of the struggle upsets John and he changes

the subject:

John: But what do you feel when you withdraw?

THE WITHDRAWAL ISSUE

Herr C. is trying to explain his difficult situation to John and
me but we do not understand that withdrawing is difficult,
that he gets too tired to call for help, that heroin is
everywhere, that thinking is difficult when on heroin and,
finally, that'he wants peace and does not want to 'clean up.'
After reviewing the tapes, I think Herr C. is correct to say
that I did not understand him. He has helped me change the
way I work with heroin addicts. I understand now that
getting off heroin is difficult because what it is like to be on
heroin is not sufficiently defined and understood.
You cannot work with a state unless you know what it is.
For example, as we saw in the previous chapters, you
cannot work well with schizophrenia if you use cultural
definitions to understand it. So let us see exactly what state
Herr C. is talking about and see how we could have used
his descriptions of the heroin or withdrawing states in order
to work with him.
He complains that he is tired and cannot call for help
when he needs it because heroin is easier to get than
psychotherapy. The discussion proceeds as if we are talking
about a process in the past and not one which is also going
on right NOW. Right now Herr C. is exhausted. Right now
he is not calling and not asking for help. Right now, with
 HEROIN I 17

us, all he wants is money from the agency, methadone to

ease his pain and sleeping pills to make him sleepier.
For Herr C., heroin is a state which inhibits thinking and
promotes peace. At the moment with us he does not want to
think, he wants peace from life, from trouble, from thinking,
from working and from us. And the way he deals with us is
the way he deals with all of his conflicts: he filters out his
own anger towards the world which wants him to work and
agrees to change, while feeling that he won't. Knowing this
structure, we could either take up his secondary process of
cleaning up and fight with his lazy primary process, or we
could take over the primary process by relaxing and going
against consensus reality as he does. The approach which
gets the best feedback depends upon the client and
therapist.

ENVIRONMENTAL SUPPORT FOR ADDICTION

Herr C.'s present environment supports heroin addiction
and the tendency to avoid difficulties. We saw above how
the social worker had trouble with the escalating tension
between Herr C. and me when I pressed him to admit that
he did not want to withdraw. In order to avoid the tension
and ensuing conflict, John asked him about his feelings.
As part of the environment, John creates a 'heroin-like'
process by asking about feelings and trying to avoid the
conflict. In this way, the therapist makes heroin available by
postponing the pain of withdrawal. Talking about heroin as
if it existed only in the past or probable future is a way of
avoiding Herr C.'s current state of not wanting, or not being
able, to think and work.

WORKING WITH THE HEROIN STATE

Thus I work with such a discussion today by pointing out to
the individual that he is now on heroin, every time he
refuses to think, every time he refuses to meet a conflict,
even every time he slouches. I would point out to him how
he is on heroin now whether or not he has taken it.
Intoxication is a state which occurs with or without the real
drug. The real drug makes the state more available to the
1 18 DRUG ABUSE

individual, but the state is there before the drug!

Upon knowing this, each client will react differently and
what I do depends upon which process is in the foreground.
One type of addict is shocked to realize that she now
behaves as if on heroin and reacts by immediately producing
a sober state. Other addicts will begin to analyze why they
want to leave their feelings and why they do not want to be
here. Like those who have experienced extreme states
without drugs, they complain how depressing the world is.
These people need help in learning how to deal with painful
problems and how to reduce their pain.
Another kind of addict might refuse to admit that he is in
a heroin state. In this case, I would ask him to act as if he
were on heroin, to feel, move and appear the way he would
when on it. He would then realize that heroin is a state
independent of the real drug. With others who refuse to
consciously access the heroin state or who are too drugged
to even talk, I myself could act as if I were drugged and ask
them for help. This type of intervention operates in the
same way as in psychotic states. A process reversal occurs
and the addict takes over the role of the psychologist trying
to help me clean up. The potential for this reversal
frequently makes addicts excellent therapists in drug clinics
after kicking their habit.
Still there is another group of drug takers who are really
hidden shamans and who need help in investigating the far
reaches of their own human potential. These people often
turn out to be psychic researchers of the future, wanting and
needing tools to enter, deal with and investigate the entire
human condition. They need to learn the ins and outs of
working with altered states, processing their own material
and learning methods and procedures of body work and
psychology.

ON THE USE OF THE PAST

Talking about heroin as if it were a problem of the past or a
potential future problem is not very helpful for the addict.
One of the functions of telling stories as if they were in the
past or future is to convince the story teller and the listener
 HEROIN I I 9

that the events are unalterable. The future and past tenses
have an hypnotic effect on the listener and teller. For
example, Herr C. states that when he left the hospital,
heroin was readily available. One thinks that this is an
unalterable situation. Whether or not the situation can be
changed is a subject for debate. Pointing out how heroin is
readily available now makes the addict's present state more
accessible to alteration.
Descriptions of the future and the past are not only
accompanied by the implication that they cannot be altered
but also by hopelessness. Talking of the past and future
hypnotizes us into believing that nothing can be changed,
the world is the way it is, everything is just a game anyhow
and life is worthless.

CULTURAL REACTIONS
These messages are carried by many young people today
and provoke the establishment to be against drugs. The young
person on drugs who is supposed to be going out and con-
quering life is, in the minds of his elders, giving up because he
is depressed, hopeless, or angry at the social structure around
him. Therefore simply revolting against the junkie by trying
to wipe out heroin addiction will not solve the tension and
differences of belief between the old and the young.
Mao's solution to the drug problem was to force with-
drawal by detainment in a work camp. Clearly Mao is going
to have a greater cure rate than any western drug clinic,
which at best claims that 30 percent of the addicts
successfully withdraw. Though successful, such pressure
does not take into consideration the counter-culture aspects
of drug taking, the fact that part of the addict's message is
that the world as it is is unacceptable.

HERR C.'s FUTURE

In the interview with Herr C. the process which is likely to
happen to him is already implicit in what he says.

Herr C.: If I do not make it this time in withdrawing, then

you can forget me. You can give me methadone
I 20 DRUG ABUSE

until the end of my life, until I die. You can forget

me. Terribly simple. That is that. Finished.

Today, I would deal with this statement by amplifying its

tough and militaristic tone. I would say to Herr C., 'Well, I
feel badly that you may die, but I like the way you cleaned
up your thinking and can now be concise. I notice how you
speak about yourself without sentiment and regret and
therefore I will not give you methadone any longer than two
weeks. If you can make it off heroin by then, fine. If not, I
shall, as you advise me to, forget you. As you say, it's
terribly simple. That is that. Finished. Come back in two
weeks and we'll see what to do next. I like your brevity!'
Chapter I I
ALCOHOL

Before hearing about Herr G., let us discuss the facts about
alcohol. At least 20 percent of the western world is either
directly addicted to alcohol or else connected to the alcoholic
through family ties. Some texts say that 50 percent of all
arrests in the United States and in Europe are associated
with alcohol consumption (Freedman, 1980, p. 676).
Alcoholism is a widespread problem. The public views the
alcoholic as a disturbed and problematical social disgrace,
though alcohol is simultaneously the most socially accept-
able mind altering drug available. Though alcoholism has
been a public difficulty since ancient times, there is, in my
opinion, very little known about how it operates. To
demonstrate this I would like to recommend that the reader
takes part in the following experiment.

EXPERIMENTING WITH ALCOHOL

Do you remember the last time you drank a large quantity of
beer or wine? Were you alone or at a party? Can you recall
the atmosphere? Can you remember why you drank? This is
undoubtedly a difficult question. What were your reasons?
Were you uncomfortable with some problem or some
person, were you depressed or nervous? Did you want to
get over your inhibitions, or did you want to forget an outer
problem or a part of yourself?
Now try to reaccess the drunken state. Try to act drunk:
move, think, feel, see, talk and relate to others as if you
were inebriated. Now, in your present drunken state,

121
I 22 DRUG ABUSE

answer the following questions. How has your ability to

relate to others changed? Do you feel pain when you pinch
yourself in the arm or in the cheek? Do you recall painful
memories? What is in the foreground of your awareness?

ALCOHOL: FACT OR FICTION?

Through this experiment I hope you discover that being
drunk, stoned or 'high' does not depend upon alcohol or
heroin. You can access a drunken state without drinking
anything. If you compare the answers you get in the state
that you just accessed to the answers you get when you
really drink something, you will be surprised to discover
that they are quite similar.
The ability to access a state is a power we all have. We can
alter our states of consciousness at will as well as with the
help of drugs, dreams, hypnotism and psychosis. This
ability of ours is what causes the placebo effect and other
mind over matter phenomena. The very suggestion that our
pain will diminish prompts us to access a less painful state,
regardless of whether we take real aspirin or a placebo.
Naturally, this can also happen in the reverse.

INTRODUCING HERR G.
By this time I hope you have realized that being an alcoholic
means having a preference for a certain state of conscious-
ness. Let's use a beginner's mind to work with this state. Let
us access this beginner's mind now as we meet Herr G.
Herr G. stumbles into the social service station at around
9.30 am after having a breakfast of some thirty beers. He sits
down and waits politely for the interview to begin . He .

moves forwards and looks down at the floor. He seems

unhappy, but then looks up suddenly when he is spoken to
as if he were embarrassed about being caught in his
thoughts.
He is a heavy-set man in his middle fifties and looks
drunk: he switches his sitting position unexpectedly, wipes
his head awkwardly and uncoordinatedly, and points a
wobbly finger while he talks, a finger that sometimes aims at
the person he is talking to and sometimes does not. There is
 ALCOHOL 123

a time lag between what he says and the body gestures he

uses in association with his words. His laughter is abrupt
and a bit rough, unrelated to what he or others say. He will
ask the same thing three or four times, as if he were not
listening or could not remember the answer. We have the
impression that he is not quite here.
Sitting with Herr G. this morning are Joe, Ron, who is
Herr G.'s therapist, Sally and myself. The content of the
conversation will soon reveal a tragic accident which,
however unfortunate, seems to happen often in alcoholic
couples. Several weeks ago, Herr G.'s wife, who was also an
alcoholic, in the midst of a binge stumbled and fell into their
dog's straw basket. A piece of straw went through her
throat and killed her.
Herr G. still has a lot of feeling wrapped up with this
tragedy. His main issue turns out to be the guilt associated
with her death and the question of having the courage to
clean up his own problems. The interview begins as follows.

Ron: I would like to introduce Amy and Joe to you,

Herr G. They are here this week to supervise our
work.
Herr G (looking confused): Amy?
Ron: Amy.
Herr G: Amy?
Ron: Amy.
Herr G. (thoughtfully): Amy.
Ron: Yes, Amy.

From this interaction, one could surmise that Herr G. is

drunk, has an organic brain syndrome, has short-term
memory loss or is not occupying his ability to hear. But the
question is, why? What is the function of not being able to
remember a name and of acting drunk? Is he trying to forget
something? Is he listening to something else internally? We
could have worked with this by saying, 'Don't listen to us,
listen to yourself.' The conversation, however, went
differently.
124 DRUG ABUSE

Ron: How are you? What, have you been doing?

Herr G. (laughing): You know Ron,... I like you. You
always ask such stupid questions.

Ron ignores this negative feedback and perseveres.

Ron: What did you do yesterday?

Herr G. I called my mother.
Ron: Why didn't you go directly and talk to her?
Herr G.: I had a nice talk with her on the phone.
Ron: Was she upset that you didn't go to see her?

Herr G. responds slowly, apparently irritated, but neverthe-

less with a smile

Herr G.: Again, those stupid questions . . . I did not have

the courage to .. .

I wait a while for him to continue. Then I say:

Amy: You did not have the courage to do what?

Herr G. [pause]: It takes a lot of courage to say .. I
am . . . I am . . . like I am . . . a fool.

PROCESS STRUCTURE
Herr G. has a metacommunicator. Despite his drunken
state, he takes great pride in discussing his states and
making judgements upon himself. Hence we could, if we
wanted to, even ask him to change states. What are his
states? Herr G.'s primary process is to act drunk and be the
fool, a weakling who does not have the courage to admit it.
He lacks courage. He is very good at making people feel
well around him by smiling at us, but in fact he does not
stand for what he thinks. He did not like Ron's questions,
but did not tell him to stop. Instead, he ignored the question
about his mother and changed the subject.
His secondary process is having the courage to criticize
himself and others. He said to Ron, 'You . . . ask . . . stupid
 ALCOHOL 125

questions.' He says it with a laugh, however, and does not

identify with this 'courageous' part of himself.
This is the information about the process structure available
to us one minute and twenty seconds after the interview
begins. We can now begin to work with it. An interesting
idea would be to bring up the secondary process of courage
and make it available to him. But before working with
someone, it is important to establish a feeling of relationship
with them. This means relating to their primary process. In
the case of Herr G., a relationship means, to begin with at
least, not only feeling my way into his life situation, but
also, by means of noting his signals and pacing the tempo of
his talk, relating to him as one drunk to another.

Amy (laughing, speaking slowly and gesturing in Herr G.'s

tempo): Oh, you know . . . I am a fool too,
yeah. . . .
Joe (picking up the atmosphere): Me too, I have failed many
times.
Herr G.: Really, you too?

Another social worker joins in and says:

Social worker: I have failed too, twenty-six times.

Herr G.: If I am honest . . . then . . . I have to admit .. .
that I have failed . . . only once.
Amy: Not me, I fail once every five minutes.
Herr G.: You guys are a gift to me.

Everyone laughs and the atmosphere becomes very warm

and friendly. I want to stress, however, that while we have
been successful in feeling our way into Herr G.'s process,
there is a danger that by pacing and mirroring the client, we
enter into the same state. Hence, we could begin to relax in
the warm atmosphere and lose our relativity. The alcoholic
state here is one of warmth and brotherly love. It is so
powerful that it can put a whole room in a similar state. In
this way, the alcoholic is alcohol: he is like a drink for us,
I 26 DRUG ABUSE

and if we want to work with him we have to be careful not

to drink too much.
Ron aims at bringing up the content which was previously
missing in the conversation, assuming that Herr G. was
avoiding the problematical topic of his wife's death.

Ron: What have you failed at exactly?

Herr G.: Now pick this up with your camera. Pick this up
Amy. I need the courage to say that in life, to
say . . . to say . . . [pointing to Ron] to say . . . that I
have failed once in my life. Ron, we have fought
with one another. . . . We . . . if I have to be
honest . . . [crying] . . . we talked . . . Ron . . . what
is life? What is life? [Pointing again at Ron, now
vehemently.] What is life? (Now to me.) Amy what is
life?
Amy: Herr G., what is life?
Herr G.: Life is shitty. . . . Did someone say I was sad .. .
I am . . . sad . . . [now slowly, quietly] . . . about the
death of my wife.

He cries, looks down, and covers his eyes. Then suddenly

another social worker comes in the room and he raises his
head, smiles and greets her.

Herr G.: Hello, how are you?

MORE ABOUT SECONDARY PROCESSES

His sadness is a secondary process; 'someone' says he is
sad. His primary process is to be sociable and nice, to the
newcomer in the room, for example. When the social worker
enters, he immediately pushes away his sadness.
In addition, Herr G. said that in the past he had fought
with Ron. Fighting is a secondary process he cannot stand
up for in the present. He only half-heartedly resists Ron.
This is in no way an unusual case, however. Most of us are
shy about being direct and confronting others. Many of us
 ALCOHOL I 27

split off these feelings and therefore experience ourselves as

being unrecognized by others. This is the case with Herr G.

Herr G.: I know the reason for her death. She ruined
herself slowly. Knowing this makes me un-
happy . . . and [pointing his finger at Ron] . . .
Ron . . . you are guilty for her death . . . why did
she do it . . . why? You are guilty . . . she did not
know what do . . . she loved me a lot . . . [breaks
down again].
Ron (soothingly and philosophically): Herr G., sadness is a
noble feeling, but you do not understand things
properly. You did not cause your wife's death.
Herr G (angrily): Ron, you cannot take my sadness from me!

Herr G. is correct in thinking that Ron is taking his feeling

away and replacing it with understanding. But then Ron is
not the only one guilty of this, for Herr G. himself dropped
his feelings just a moment before when the social worker
came in. Herr G. has an internal program called alcohol
which invites him and others to drop the feelings they have.

Herr G.: You cannot take my sadness from me . . . but

what's the difference. She needed me and she died.

Herr G. cries now, covering his face with both hands. I put
my hand on his knee in a gesture of sympathy, waiting
while he cries. He puts his hand over mine and then
suddenly picks up my hand and moves it away.

Arny: What feeling is being taken from you, Herr G.?

Herr G.: Feeling . . . feeling becomes weak and shal-
low . . . I am only a human being .. .

THE THERAPIST AS THE DRUG

Just as the therapist can become heroin by helping a client
avoid painful tension, so too can he become alcohol by
helping a client make feelings weaker and more shallow by
sympathy and understanding. Most of us, therapists and
I 28 DRUG ABUSE

non-therapists alike, are afraid of working with intense

emotions. Hence, we tend to cut them off before they have
been processed. The result is that the secondary processes of
the client cycle and appear only in the form of dreams,
fantasies and psychosomatic complaints.

WHO IS THE WIFE?

The death of Herr G.'s wife is a tragic and depressing
episode which happened in the past and which Herr G. is
now mourning. Nevertheless, I must ask myself who this
wife is in Herr G.'s psychology and where she is in his
signals. Who is the alcoholic who slowly ruined her life
through drinking and who finally and unconsciously com-
mitted suicide? Mentioning third parties who are not
present is an indication that the figure is present somewhere
at that moment.
When consumed over a long period of time, alcohol
slowly undermines one's health by disturbing the liver, the
nervous system and the pancreas. Hence, the wife repre-
sents that part of Herr G.'s present personality which is in
the midst of unconsciously committing suicide. If he
continues to drink as heavily as he does now, he will injure
his physical health either through the effect of alcohol or
through an accident. She is his own hidden potential for
accidental suicide.

THE THERAPIST'S GUILT

Herr G. is right to be angry at Ron. I have no idea whether
Ron was guilty of letting Herr G.'s wife die. But the present
danger is that Ron is not forceful enough with Herr G., who
himself is in danger of dying.
It is useful to amplify a client's criticism. In this case, the
therapist will eventually have to admit that he has not only
failed with the wife but is failing with Herr G. too. Ron is
not succeeding with Herr G.'s alcoholism. It could possibly
be useful for Ron to admit that he is not only failing now,
but may fail altogether in clearing up Herr G.'s addiction!
An addiction which has successfully possessed someone for
 ALCOHOL 129

thirty years, which almost seems to be inherited, as it does

in some cases, and which determines so much of the client's
life may, in fact, never be 'curable.' A therapist who admits
his weakness in the face of such a problem is not just being
honest but is also asking the client for help. Two people
working with a demon may do better than one or none at
all.

FLIPPING WITH THE CLIENT'S HOLOGRAM

The occupation phenomenon in which all parts of a pattern
must be occupied can cause a serious problem for a
therapist. In Herr G.'s situation, for example, when he is the
weak one who avoids difficult feelings, Ron becomes the
courageous one trying to get to the truth. Then, when
Herr G. begins to tell his true feelings, the occupation of the
pattern flip-flops and Ron reframes Herr G.'s sadness,
trying to avoid the feelings.
The same structure organizes all the other interactions
around an alcoholic. When one member of a couple drinks,
he deadens certain perceptions, like alcohol itself. In order
to live with him, however, the other member must also
deaden those perceptions. He is alcohol, and she drinks it
and her perceptions die. She in turn becomes like alcohol for
him, a perception deadener. We have two people in one
process consisting of a drinker and the drink being drunk.
The situation flips when the partner of the alcoholic gets
angry at the alcoholic, makes a nasty threat, but, like a
weakling, never carries the threat to completion. During this
phase of the relationship the alcoholic gets very tough and
reacts violently. The flip-flop process could be useful, but it
usually occurs unconsciously and is therefore hurtful,
dangerous and tragic.
This process structure can be used at any time with
anyone in an altered state. When an alcoholic acts drunk, a
schizophrenic mad, a heroin addict stoned or a suicidal
person depressed, only one of their parts is drunk, mad,
stoned or depressed. There is always another part which can
be accessed. In the case of the alcoholic with an available
metacommunicator, the easiest way to access the secondary
I 30 DRUG ABUSE

sober state is to appeal to the available metacommunicator

by telling him that he need not act drunk. You can even say
to the metacommunicator, 'Stop acting drunk! Cut it out!
Wake up and be sober! Let's deal straight with what is going
on.' Note that you cannot do this with a psychotic person
because during the acute episode there is no metacom-
municator available who can help organize and access
states. With a drugged person, however, accessing any
secondary process when the primary one is drunk will be a
very sobering experience because drunkenness is only a
primary process. This knowledge was the motivating force
behind the following interaction.

Herr G.: My wife ran off the track. . . . It is true . . . she

had no one to help her . . . I should have put her in
a clinic . . . I knew . . . I knew her. . . . I knew it
would not work . . . I knew that she would have
exploded. I knew Ron, . . . it is no criticism of you
that you did not help her.

Still keeping in mind that 'she' was the drunken part of him,
I hoped a confrontation with him might produce an
explosion, but might also bring about 'her' correcting 'her'
life.

Amy: Herr G., YOU did not have the courage to tell her to
enter a clinic. [Forcefully] YOU are the one who has
failed her and who is now failing himself. So face
this now!!

Herr G. looks upset. He drops his drunken appearance,

opens his eyes wide open, faces me, and with one hand
raised emphatically and operating in phase with his words,
he increases his tempo and rhythm from a low tone to a
crescendo, and says utterly soberly:

Herr G.: I know that I did not have the courage. BUT
NOW I DO HAVE THE COURAGE TO SAY THAT I
DID NOT HAVE THE COURAGE THEN!
 ALCOHOL 131

Regardless of the content of the conversation, I speak in the

same raised tone of voice in order to bring out the sober
state more:

Amy: NOW YOU HAVE THE COURAGE TO SPEAK.

Herr G. withdraws a bit, sits back in his chair and with a

slightly lowered tone, disidentifies himself from the courage:

Herr G.: Is that courage? I have the courage today, but I

did not have it when I needed it.

At this point Ron becomes like alcohol itself:

Ron: Herr G., relax. She was not unhappy or disharmon-

ious on the day she died. I spoke with her on the
phone. You could not have prevented her death, be
realistic, Relax!

Herr G. gets angry. He increases his tempo and arches his

back:

Herr G.: NO! You are not right!!

Another social worker breaks in angrily to Ron:

Social worker: Ron, what are you doing, what are you
doing?

Ron reacts defensively, not to the question but to its implicit

attack about not doing the right thing.

Ron: What am I doing? I am trying to tell GG. . . we can

talk to him . . . I am not his enemy.

What exactly happened here? Herr G. sobered up, became a

bit more courageous and stopped acting like a failure. He
found the courage to look closely and soberly at the fact that
he was partly responsible for his wife's death. As soon as he
I 32 DRUG ABUSE

became courageous and sober about his failure with his

wife, Ron became the other side of the hologram again and
said, 'Relax.' Telling him to relax polarized the situation
again. Herr G. defended himself strongly and soberly, but
his edge against his forcefulness was still there so he did not
completely quieten Ron down. As a result, someone else
stepped'in and tried to do it.

ALCOHOLICS ANONYMOUS
One of the most successful drug therapies is Alcoholics
Anonymous (AA). The somewhat evangelistic tone of AA
works with many because it picks up on the alcoholic's
secondary discipline and courage. Part of the program is for
the AA member to claim, 'I am and always will be an
alcoholic.' This statement mirrors Herr G.'s description of
himself: 'I am a fool, and a failure.'

GOALS
Without understanding and following a given process
structure, however, special methods such as AA are not
necessarily successful because simply forbidding alcoholism
uses only one part of the personality. There are many
people with complicated processes who require more than
escalating and accessing the courage and militarism in their
secondary processes. They also need to find the meaning
and the teleology in their drinking. Why was it a necessary
thing for them? In Herr G.'s case, for example, the alcohol
allows him, while acting drunk, to be less inhibited with his
forcefulness towards others than he might otherwise be. In
time, he needs to develop this courage with himself.
Many alcoholics will thus not be satisfied with simply
resisting their tendency to drink and will want psycho-
therapy because only when they learn to follow their life
process as a whole are they content. The above snapshot
taken out of an interview is meant only as an indication of
how to get along with a person in an intoxicated state. How
far one must go with the alcoholic after having accessed the
sober state is an individual matter depending upon the
client and therapist.
 ALCOHOL I 33

THE FUTURE
It is possible to take a reasonable guess at what will happen
in the future or what could potentially happen by noticing
how close a client comes to the secondary process. The
following interaction gives me the feeling that Herr G. has
the potential to develop all sides of himself.

Amy: Herr G., I saw how you spoke a few minutes ago. I
was impressed. I now want to show you what I saw.
Take a good look at me now. You said [I act like G.,
using his gestures in order to anchor his courage], I
do have the courage to act. Now I do have this courage
though I did not have the courage in the past.
Herr G. (amazed and proud): Did I say that?
Amy: You did, and today you have the courage to give up
alcohol and today you have guilt feelings because
today, now, you are an alcoholic even though you
know that you have the courage to give it up.

Herr G. grins from ear to ear and clasps his hands in a

gesture of triumph.

Herr G.: Look. I am astounded by myself, by my own

courage. You know, I always had it.
Part V
THE CITY'S SHADOW
Chapter 12
THE SOCIOPATH

Paul exhibits some of the characteristics which would

identify him as a psychopath, sociopath or an antisocial
personality. According to the American Psychiatric Associ-
ation's manual on mental disorders, a sociopath may be
charming and of normal to high intelligence, though
unreliable, untruthful and insincere. In addition, a sociopath
usually lacks remorse for his acts and does not exhibit
thinking characteristic of schizophrenia. 'Psychoneurotic
manifestations' are lacking (Freedman et al,).
Sociopaths are usually, from earliest childhood onward, in
conflict with their home life. Their childhood is typically
disturbed and upset by alcoholic parents. They are incapable
of loyalty to individuals, groups or social values. They are
selfish, callous, irresponsible, impulsive and are usually
unsusceptible to punishment. They tend not to feel love.
They are rebellious and individualistic, but do not normally
require institutional detention. As a whole, they tend to
become more adapted during their forties. They rarely visit
psychotherapists and come to the attention of the mental
health profession through their conflict with the police and
interactions with the social service agencies.

PAUL
Paul, at age thirty-nine, has a long record with the
psychiatric and social work agencies because of his numer-
ous interactions with the police. His file also mentions a
heart attack and an attempted suicide. Because of his normal

137
138 THE CITY'S SHADOW

Paul
Amy Ron
Joe
Dan Sally
The Video

Figure 12.1 Paul's Circle

intelligence, his long history of conflicts with his family and

his antisocial behavior, his earlier diagnosis would probably
have been in the s9ciopathic range. Today, however, he is
trying to reform.
As he walks in we see a solid, powerful-looking man with
black curly hair, an open shirt, leather vest and a straight-
forward, uninhibited way of relating. Paul has been
addicted to various drugs, including heroin and alcohol. He
is presently living in a cliiiic in an attempt to break his drug
addictions. He says he is 'on leave' today in order to join us
in our social work experiment.
As he speaks, Paul gives us the impression that he has
been and still is the greatest drinker, fighter and musician in
his village. His present process is somewhat the reverse of
Herr G.'s in that Paul's present primary interest is in gaining
insight, getting off alcohol and generally being 'good.'
Sitting around the circle with Paul are Dan, Sally, Joe and I.
Ron, who is Paul's social worker, is outside the circle,
separated from Paul by about six feet.

Amy (to Paul): Hi, how come you are visiting us today?
Paul: I am a patient in a clinic.
Amy: Why?
Paul (very loudly): Because of drinking! Let me explain. I
am an alcoholic.

Everyone in the circle laughs at his boldness and self-

effacing nature.

Paul: Though I did not drink for awhile, it began again.

Now I am in the clinic for treatment. Perhaps I will
 THE SOCIOPATH 139

get better, perhaps I will fall back into it again.

Dan: You have a long record of always getting into
trouble, being in the middle of something all the
time. Getting into fights, jealousy fits, gambling,
losing your temper, getting picked up by the police
for stealing, everything.
Paul: This is true. The problems I have now are the same
as I had twenty years ago. I have not solved my
problems. I run away from them.
Arny: What are your problems?
Paul: I have love problems for example. Yeah . . . that's
a problem too! Twenty years ago I tried to shoot
myself because of love troubles. Now I still have
them. Later I had a lot of car accidents. I've always
had accidents.

PROCESS STRUCTURE
Paul has a metacommunicator who discusses his various
states. His primary process is to be 'a patient in a clinic,'
identifying himself as an 'alcoholic' who has 'love problems
and accidents' and who 'runs away from problems.' He is a
'cop', so to speak. What appears in his secondary process are
violent car accidents, the police and a clinic. His secondary
process is also to be an entertainer, as when he made us
laugh by bragging about being an alcoholic. We can see this
secondary process in his realism, when he states, 'perhaps I
will get better, perhaps I will fall into drinking again.'

Paul: My parents never cared for us much. In early

childhood my father wanted to take it easy and he
and Mom did not pay much attention to us. The old
man got remarried and changed for the better. All of
us boys were wild and troublesome, so our mother
had trouble with us. Especially since we always
wanted to be the center of attention . . . my mother
had trouble with us wild boys, poor woman.
[Everybody laughs]
140 THE CITY'S SHADOW

When Paul talks about the past, like all of us, he is

dreaming, so to speak, in that he is compensating his
present reality. Through stories of the past we all vicariously
identify with secondary processes which we cannot or dare
not live in the present.
In his present life, Paul is trying to reform and by doing
so, he is the cop, the mother who tames his wildness. In his
story of his childhood, his present secondary process
appears in the form of a neglected child to whom no one
pays attention, and thus the child is strong, wild and
troublesome. He was and still is undoubtedly angry and
wild about being neglected. The primary processes, embod-
ied by the mother and also the police, are having trouble
with the 'wild boys.' The authority in himself has little
empathy for his neglected feeling situation.

Paul: I always wanted to be more than I was, but not

today.
Amy: You mean today, too. Not even a little bit?
Paul: No, it is not good to want to be more than you are.
Amy (insisting): But I want to be more than I am!

BRAGGING
It is obvious that Paul is dissociated from his bragging. He
says, 'I always wanted to be more than I was, but not
today.' He has split off the need to be the center of attention
and therefore is not aware of how he grabs our attention. He
does not appreciate himself enough.
To understand Paul's secondary process of wanting to be
more than he is, remember a time when you have
spontaneously bragged about something and then felt
embarrassed about doing so. Do it now. Brag, claim that you
are more than you are. Now see if you can find your edge
against bragging. What stands in the way of your bragging?
What have you got against it? When you have answered this
question find out who you are now in the present moment
in contrast to the part of you who bragged. The person who
you are now is your primary process. The person who
bragged is your secondary process which is already present,
 THE SOCIOPATH I 4 I

but which you do not want to identify with! Now let us look
at Paul's secondary process and find out how to access it so
he can use it consciously.

Paul: No, it is not good to brag.

Amy: But I want to be more than I am.

All the others speak up in agreement. It appears that

everybody is having fun.

Paul (breaking in as the others enter the conversation):

Well, naturally, I too want to be more than I am.
Amy: For example I wanted to show my son that I could
somersault. And I did but almost broke my back
doing it. How do you show you want to be more
than you are?
Paul: If I could be more, I . . . was always able to entertain
people with music. I had a local and popular little
band, and we played all over town, in every
restaurant and bar. Friday and Saturday nights. And
in those days, I was very happy. I could do what
others could not do. But then I got into a car crash
and could not go on because of a paralysis. Then `I
changed. I tried to succeed in another way, I began
to bluff. . . . For example I told people that I had a
Mercedes instead of a bike. [Everyone laughs.] One
should have insight. You should say that you don't
have a Mercedes, only a bike. Earlier I would have
said that I had a big car, even a Cadillac. It is not
good, you should only say what you can do!

PROCESS WORK
How are we going to make him aware of his secondary
process, his Mercedes Benz, his Cadillac? We are going to
have to get around his negative mother who tells him he's a
bad boy for bragging so much and needing to be the center
of attention. The method I use here is to point out where he
is a Mercedes now. I decided to show him how he is the center
of attention and entertains us now, how he is powerful and
142 THE CITY'S SHADOW

will not let anybody enter the conversation. But since he

was the center of attention, I had to wait, and then
something interesting turned up.

Paul: About a year ago I had a heart attack. Around that

time I had trouble with my girl friend, Mary. I
myself always secretly wished that she would
become, at that time, my wife and have kids with
me. After five years, however, I realized that she did
not want kids and that she had different life-style
ideas than I. This made me [placing his right hand
quickly on his chest] kaputt. I did not want to admit
it but it did.
Arny: I noticed that you put your hand on your heart
when you said you did not want to admit that she
made you kaputt.
Paul: Yeah, you see, in our dialect, we say that if you are a
troubled person (in German, angeschlagen, which
means literally `to be hit'), then your heart or
soul . . . can . . . no longer go on.

One of the reasons love events are so disastrous is because

the sufferer has an edge against feeling. The whole event is
described in the past because though it is happening now, it
is a secondary process. Now Paul is disturbed by a lot of
things, now he is hurt by all sorts of problems but will not
admit it. He is unconsciously acting like a tough guy, saying
nasty things about himself, being hard and critical, and he
does not admit that he is hurting himself. So right now, the
pattern for the heart attack process is still going on. His
mother, his primary and sober realism, is hurting the
ordinary guy, the patient, his secondary process who has
troubles. This is a common program for people with heart
attacks.

TO DRINK OR NOT TO DRINK

Caring and loving himself, seeing that he is a powerful and
sensitive guy is his core problem. His belief in himself as an
 THE SOCIOPATH I 43

individual will determine whether or not he will get off

alcohol.

Paul: Without therapy . . . I may fall back into drinking.

Arny: How will this happen? I mean exactly?
Paul: That happens faster than you can know. Assume you
are let out of the hospital. You get out, you go into a
cafe to get a coffee. There you see an old buddy with
other friends and their women. They invite you to
celebrate a bit with them . . . they are drinking a lot
but you have given it up. . . .
Joe: Let's act that out.

Everyone else in the room likes this idea and enters into the
scene. There is a lot of fun and laughter and generally a
good feeling.

Paul: Everybody's having a good time, they're happy, and

I get angry. They have their drinks and I have my
mineral water.

I move in closer to Paul to support him in his efforts to

resist.

Amy: I'll sit with you, man, I'm on your side.

Others (trying to lure him into drinking): Come on Paul,
have a drink!
Amy: Don't do it Paul.
Paul: Now, in the moment, you are here Amy, you're
helping me. But if no one is there . . . a half-year
ago, I would have told you, Amy, to leave. Today, I
am no longer embarrassed by mineral water. II. . .
I . . . I am no longer embarrassed.

He will probably return to drinking because he is embarras-

sed to drink mineral water, which means not being the kind
of man all the other guys are. The problem is that he does
not realize that he is important, central and worthy of
attention. Hence, he tries to be important in less useful
144 THE CITY'S SHADOW

ways. He needs support in getting attention and in being

himself. The next story shows this.

Paul: Years ago I got fed up with living with others in a

therapy house. Everyone butts in, puts their noses
in your business. Take my rabbits for example, I
took care of them myself and bought, out of my own
pocket money, their apples and lettuce and carrots.
My money. But the others always put in their own
two cents and said I should simply give them
ordinary grass because the other food was too
expensive. Of course, grass is also healthy. But I did
not want to care for the rabbits like the others said,
with only grass. I wanted to give them everything. I
wanted to spoil my rabbits as if they were my wife,
you know. I bought them all the best food. The
others said I shouldn't. They drove me so mad that
one day, I grabbed the rabbits, put them in a box,
brought them to the butcher and said, 'Serve them
in a restaurant!' I listened to the others. The
pressure was too great. You can not do what you
want when others are around.

Being an individual is very painful because it frequently

goes against everything which the collective believes in.
Most of us will throw away our most peculiar and individual
personality traits if the pressure from without and the
pressure from within to adapt is too great.
With Paul we still need to make him aware of the power
he has to be himself when others are around, a power which
is still secondary and which would make him a leader. The
easiest way to do this is to point out how he is a leader and
director now, with me, and with all of us.

ACCESSING THE LEADER

Arny: Bragging is not so bad.
Social worker (not understanding my approach): But Amy,
being a bragger is not accepted as being a good
thing.
 THE SOCIOPATH I 45

Amy: But WHY does one brag?

Paul (interested): Yeah, that is a good question.
Amy: Let us say I brag that I have a Mercedes. I do this
because I really am more powerful than I am
presently acting. I am just afraid or unconscious of
it. I am a powerful Mercedes now, I am not just a
bike. Everything you say is somehow true.
Paul: Yes. I am a tough . . . in fact I am afraid of
myself . . . I have no patience, I am afraid of myself.
I am afraid of this power in my impatience. I could
explode at any moment like (moving his arms
explosively) — POW! —

If I were alone with Paul in my office, I would have worked

with his nonverbal cue and have done body work with him.
By gently resisting his arm motion which corresponded to
'POW,' I could have accessed his physical power. Such work
is less adapted to the social work agency, however, than
verbally accessing his power.

Amy: Yes! I see your powerful hand motions.

Paul (quickly): Wait till I am finished talking!
Amy: There it is, there is your power! [I was referring to
his telling me to wait.
Paul (breaking in again): Wait, I .. .
Amy (interrupting him): There is your power again.
Paul: Wait!
Amy: Here it is now!
Paul: Wait a minute. [Continuing his theme.] I always
wanted to be more than I am.
Amy (raising my voice): Here you go again. You broke in.
Paul (ignoring me): Let me finish.
Amy (speaking quickly to get my message across): No.
This is your power. You see, your power and
impatience manifest themselves now in your ability
to lead me around. This ability is your Mercedes. I
wanted you to see it. I tried to get a word in
edgewise, and you said, 'Be quiet.' Though you are
supposed to be the patient you do not respect my
146 THE CITY'S SHADOW

supposed authority as your doctor. I like this

powerfulness in you. This is the Mercedes. You are
not a bike [in a little tiny voice] you are no little
mouse. [Loudly] You are a powerful guy.
Paul: I do not understand.
Social Worker: Amy says you are a powerful guy in
directing.
Paul: Oh! Ah ha!

APPLYING INSIGHT
Insight alone is rarely enough, but needs to be experienced.
Paul needs not only to understand himself, but to feel his
leadership and power with us or in the outside world. The
next step would be to anchor this insight with experience.
Paul leads the way.

Paul: I have a question of my own. When I get out I'll need

a job. I'd like to be in your area Amy, in psychology.
I want to work in social stuff. I know that I must
have the strength to do it. But who will take me with
my sad record?

Instead of working with that part of him, his mother, who

does not take him seriously because he is or has been a bad
boy, I deal with his extraverted problem.

Amy: Me!
Paul (pausing): Thanks but I will need a job in three
weeks. In three weeks.

I think to myself that he is a great story teller, that he is very

visual and that his primary process is to get away from his
problems.

Amy: In three weeks you will need a job. Let us say that
you could create your own job. I know you can't.
But let us say you could. How would you do it?
How do you see yourself? Fantasy whatever you
want. Forget your present problems.
 THE SOCIOPATH 147

Paul (enthusiastically): That's a good idea! Hmm. I would

like to help young kids who do not know what to do
with their lives. I would like to be responsible for
them, to make a sort of home, to be a house father,
give kids a place to live, something like Father W. I
would like to care for kids to organize their eating,
living. I feel responsible for them. But it is not
possible for me to do this, not with my history.

Even though Paul is talking about his future, the problem in

the future is almost always present and approachable
through what he is doing right now with himself in the
moment. Right now he is trying to care for himself. His
secondary process, his father, mentioned earlier, is improv-
ing and taking care of the 'kids' more. Paul wants to be a
father, a spiritual leader, but first we must put the mother
aside.

Amy: Don't come back to your problems now. I will deal

with them later. I am not interested in your past life
now, but I want to know how you want to help
others.
Paul: I could care for drug addicts, alcoholics, kids,
jailbirds, people like me. For these people I want to
be there. Yeah.
Amy: What a good idea! How can we do this?
Social worker: I think that this Father W. is really looking
for helpers.
Paul: Yeah, I already help people. I brought two boys in
last week for drug treatment. They like me. I used to
be the biggest drinker in town. Twenty liters a
morning. The kids respect me because I got off
alcohol.
Joe: Call up now, show us who you are. Call up Father W.

Here is an example of why a team of social workers is better

in many respects than a single therapist or social worker. I
can understand process signals, but was uninformed about
job opportunities. The social worker compensates my
148 THE CITY'S SHADOW

insufficient information. I need her and I need Joe who

challenges Paul to put his power into practice. I did not
think of calling Father W., but it was a good idea.
Paul goes over to the phone in the room.

Paul: Hello, Father W., this is a request concerning social

work, about becoming a social helper.

INDIVIDUAL AND COLLECTIVE CONSIDERATIONS

Paul is right, this is a request about becoming a social
helper. This interview concludes with a story book ending,
with the hope that a poor guy with a painful and rough
background turns good and helps others.
However, there is a subtle message in his story. From
earliest childhood he did not have a warm, personal family.
The city allotted him guardian parents through the social
work agency. He has never been parented by a normal
family system. But just this unusual situation is his fate, his
process, his family. There are a lot of people from
underprivileged homes who have suffered from rough
conditions. But these people, seen from the process
viewpoint, are not just underprivileged. They are children of
the city. They belong to a larger collective commune, not to
a personal, intimate family.
These troubled kids create and define the city as a family
unto itself. Most of us have little awareness of this aspect of
our cities. The city's kids are the ones who are alone or
abandoned, who are outside of the nuclear-family paradigm.
The city's kids are the ones no personal family can deal
with. If the city's clients are its kids, then the entire mental
health network becomes the parents of these children. This
view of the social work network is a field concept and one
which coincides with Paul's. A lot of therapists were, like
Paul, simply kids who did not fit into their original and
immediate surroundings.
Chapter 13
MENTAL RETARDATION

The American Psychiatric Association uses the terms

'borderline, mild, moderate, severe and profound retard-
ation' to differentiate intellectual development under the
normal IQ of 100. Borderline mental retardation ranges
between an IQ of 68 and 85, while profound is 20 and
under. The terms moron, imbecile and idiot, though
obsolete, are still used to categorize subnormal intelligence,
referring to adults with mental age levels corresponding to a
child of eight, three to seven and three years respectively.
In England, the psychiatric profession classifies slightly
subnormal and severely subnormal 'mental deficiency'
where the IQ is less than 50 (Henderson and Gilespie, 1969).
There, mental deficiency is differentiated from 'moral
deficiency,' (the American 'sociopath') by the fact that the
criminal or morally deficient person has a normal
intelligence.
Subnormal intelligence due to known and unknown
causes affects approximately 1 percent of the population. It
is unusual for the psychotherapist in private practice to see
this 1 percent. Though I have seen many in clinics in the last
twenty-odd years of practice, I have worked with only four
such individuals in my private practice. The mentally
retarded person with an IQ of under 50 frequently requires
supervision from a guardian or clinic and practically
everyone in this category requires temporary help when
faced with mild social or economic stress. The retarded
person is usually kinesthetically oriented and performs

149
150 THE CITY'S SHADOW

poorly relative to others in verbal expression. Retardation

may develop, be acquired through childhood diseases or be
present at birth.
According to the American Association on Mental Defi-
ciency, mental retardation refers to subaverage general
intellectual functioning which originates in the develop-
mental period and is associated with impairment in adaptive
behavior. In addition, 'social maturation and learning are
impaired.' Moderate retardation allows the individual to
progress to between the second and sixth grade in academic
subjects. Above the age of twenty-one the individual may
achieve self maintenance in unskilled or semi-skilled work
under sheltered conditions. The retarded adult often comes
under supervision because of difficulties arising in relation-
ship to city authorities, just as the retarded child commonly
disturbs the rest of his class and his teacher as well.

EXPERIMENTING WITH RETARDATION

In order to understand Sam, the next client, it is important
to see mental retardation as a state we can all, at one time or
another, access. Imagine, for the moment, that you are
retarded. What happens to you? Do you notice that your
mouth and jaw relax? Have you noticed that you seem less
alert than you normally are? What interests you and what
do you want to talk about? Do you find that you are more
interested in the basic things in life, like what to do next,
who likes you, who doesn't like you, food, sex or money?
When was the last time you were mentally retarded? Are
you retarded in the way you deal with love, money, sex,
food and relationships? Do you recognize retardation as a
state you are sometimes in when you are tired or over-
stressed? Do you sometimes act retarded instead of admitt-
ing that you are depressed or angry? As a retarded person,
how do you behave when you are faced with strain or
personal difficulties? Can you feel how much you want to be
like everybody else and how sensitive you feel when you're
not treated like others? If you can access your own retarded
states, you will have more empathy and understanding for
Sam who has a lot of troubles this morning.
 MENTAL RETARDATION 151

SAM
Sam, now aged thirty, is the youngest of eight children and
has suffered his whole life from his inferior intellectual and
professional position in his family. Since he is not able to
support himself, he has been a client of the social services
for many years. He is not able to hold a regular unskilled job
and has been receiving social security from the government.
It seems that he can begin a job but then cannot attend the
job regularly.
Our present meeting with Sam occurs under highly
stressed conditions. He is running from the police. More-
over the entire interaction from the beginning emergency to
the end solution took only fifteen minutes. He is fleeing
from the home he has been living in after having got into a
fight. The police are looking for him. In his confusion and
nervousness, fear and unhappiness, he is seeking protection
at the social service station where Jim, his guardian, is
present. Sam is an emergency case this morning and is
desperate.
Sam is already sitting when I get there. As I sit down I
notice that he is very thin, weak and small looking. He has
an unusually high pitched voice and stares at the floor
unless talked to. He is dressed in an old suit jacket, like
someone who wants to maintain a certain standing, though
cannot quite afford it. When not directly spoken to, he
drinks his coffee quickly and gobbles down a bunch of
cookies. He is hungry and upset. I notice that his body
gestures are more congruent, more stable and easier to
understand than other types of people. He sits with a
cigarette in his left hand while his right rests on his hip in an
apparently aggressive position during the entire interview.
His first sentences come out so quickly and emotionally that
it was extremely difficult to understand him.

Amy: Hello, I am Amy.

Sam: I am Sam. [He looks down again after looking at me]
Amy (I turn to Jim and the others): Why has he been
rushed in here so quickly?
152 THE CITY'S SHADOW

Jim: He is in a home, and did not hold out there. He ran

away Saturday. He got into a mess. He did not
know what to do. It is nice that he came to visit us
here with his problems.
Array (to Sam): Is it bad there in the home?

Jim answers for Sam.

Jim: Yes, he did not know what to do.

Sam answers with such intensity and rapidity that it is

difficult to even transcribe from the tape, much less
understand him in person. His hand and arm motions are
more powerful than his words. It is obvious that he is
describing some powerful episode. Now, looking at me, he
says:

Sam: I can stand up for something. . . . Simply .. .

something . . . went wrong . . . but . . . then .. .
something has gone wrong . . . or, and . . . and to
be . .. something . . . spoken about but that doesn't
work.

EDGES
While looking at the tape without the intensity of the
moment it is clear that he has an unoccupied relationship
channel. 'I can stand up for something. Something . . . went
wrong,' . . . implies that something has happened to him in
a relationship which he did not create. Relationship
problems happen to him, thus we say that this channel is
not occupied.
He must have an edge (see Glossary) in that channel since
he formulates what he considers to be an impossibility:
'Speaking, talking things out . . . that doesn't work.' When
an edge appears, one way to deal with it is to test it directly
by saying (whether or not you know the issue), 'Of course it
works.' Locating the channel of a client's edge is an
important task since this is where their psychological
development lies.
 MENTAL RETARDATION 153

I ignore the content of what Sam was trying to say

because it was so difficult to comprehend, and relate instead
only to the overall disturbance facing Sam.

Amy: It is nice that you came to talk. Sam, what sort of a

state are you in, nervous?

Sam, in his excited and agitated state, did not pay attention
to my exact question or was not able to understand
the meaning of the concept of state, thinking 'state'
meant 'place.'

Sam: It is not my place in the house, it is a place

where . . . where one works, lives and eats. It is not
my place. It is a worker's house.

I was still trying to make contact with him and therefore

switched my theme to his, his 'home.'

Amy: Isn't it nice?

Sam: No, there are aggressive, nasty and addicted people
there.

PROCESS STRUCTURE
Finally I begin to see some light in the mystery. Sam's
primary process is to be an easy-going, decent fellow who
feels a lot and who expresses himself kinesthetically. He
claims he wants to talk things out and has trouble doing so.
He dresses like a very sociable person.
His secondary process consists of the aggressive, nasty
and unmannerly people in the house he is running from.
His own aggression is obvious to me; I see his right hand on
his hip while he is sitting, like a cowboy's posture. What
exactly is this split off anger about?

Amy: Why do you live there?

Sam (shaking his head 'No'): People are there who did
nasty things . . . came from other places. . . .
[Changing the subject] . . . at the table I could not
154 THE CITY'S SHADOW

take it any more, such disgusting asses at the table.

They act and eat terribly, throw stuff on the floor. I
left the table several times . . . and I had to leave.
Amy: How do they eat?
Sam: They throw stuff on the floor, not appetizing . . .
you know? Or they throw stuff . . . awful.

Because I could not understand Sam's story, I did not focus

on the content of what he was saying. I did not think of
those nasty guys as part of the world he has to learn to get
along with or as part of his process, his own aggression and
sloppiness.

Arny: But why are you there?

Sam: I was told it is the best place for me . . . ah .. .
oh . . . I was forced to go.
Amy: But why were you sent there, did you steal? Did you
hit someone? I would not live there even if they
forced me.
Sam (interrupting me in a moral and indignant tone): Before
I hit, I always talk to people!

EXAMINING MY OWN BEHAVIOR

As I transcribe the interview I notice that I appear to be
confused about what Sam is saying. As a result I miss the
relationship issue, i.e. with whom is he fighting? Instead, I
search for my own grounding, ignore the information in
front of me, and then do something which is probably very
typical for people around Sam. I talk about him with the
others as if he were not there or not capable of taking part in
the conversation.
Sam accepts this passively, without realizing that he is
being treated as if he were absent. Being constantly ignored
is very humiliating and hurtful to him as it would be to
anyone. Though he does not refer to our present interaction,
later in the interview he tells me that it was awful being the
youngest and the most handicapped of eight kids, the one
who was never able to learn a normal profession and who
was always neglected by the others.
 MENTAL RETARDATION 155

THE HYPERACTIVITY OF THE RETARDED

Hyperactivity in small children and aggression in later life is
due, in part, to being ignored and neglected. Much
hyperactivity is concealed anger and humiliation. Though he
is an adult, Sam is treated like a child. This treatment is an
insult to him, though he does not consciously realize it. His
aggression, therefore, is a defense against the insult. The
above interaction shows us that he does not identify with
being a nonverbal, kinesthetic person. 'Before I hit, I always
talk to people!' means that affect and aggression overtake
him, partly because he has trouble discussing things and
needs to learn to express anger verbally.
To avoid neglecting and ignoring the retarded person
because he does not relate in a verbal mode, it is necessary
to understand his communication. Sam's feelings and
movement are, in some senses, more developed than other
people's. An 'intelligent' communicator (no such person was
present in the situation at hand!) will learn to switch
channels and relate with motions and emotions. Most of us
do not naturally possess this communication intelligence
and will have to learn it. My recommendation is that we
video tape all interactions with unusual clients in extreme
states in order to learn from them how to communicate
nonverbally.

WORKING WITH SAM

If I had the time to work in depth with Sam (I could not
because there was another emergency at the agency that
day), I would show him that we ignore him partly because
he passively accepts being discussed and does not press us
to understand his feelings better. I would tell him that his
apparent intelligence defect could be due to the fact that his
emotions need more expression. If they are kept back, they
disturb his ability to concentrate and think.
In order to get this point across, I would ask him if he gets
upset when people mistreat him. If he said no, I would
deliberately and provocatively ignore him in order to elicit
his awareness of how he lets people walk over him. If he
156 THE CITY'S SHADOW

succeeds in getting angry at me when I irritate or ignore

him, I would then help him verbalize his anger with me,
right there and then. Or, on the other hand, I might tell him
to have greater pride in himself. He should not only wear a
nice jacket, but should increase his self-esteem completely.
His task would be to stop us, ask what we are talking
about, and tell us if he does not understand. He should
make certain that we do what he wants to do. And if we
don't, he will have to learn to stand up for himself. To help
him learn this, I would actually move him, as I have done
with other such people, to a corner of the room and then
deliberately neglect him in order that he physically experi-
ences the feeling of being left out. If he does not learn to
defend himself he will do it unconsciously in a non-
constructive way like a fight, which may cost him his
relationship to people who are meaningful to him.
Returning now to the interview, we see how relationship
problems constitute his central issues.

Arny: Do you have family?

Sam: My family is in Biel.

Apparently a big complex has been constellated here, for Sam

puts his hand on his head and pushes his hair back. The
social workers, who apparently know more about his family
history than I, move about uncomfortably.

Sam: I have to tell you an example, I called my father the

other day. He was in agreement. My brother is a
bit . . . greedy for money . . . married . . . ah .. .
married a rich girl. . . . I get along well enough with
the old man, but the brother . . . [raising his voice]
when the old man is not there, my brother holds or
grabs everything for himself. And with eight
kids . . . well . . . he is greedy [showing me the
brother's greed with his hands] greedy, greedy.

Sam gulps down another cup of coffee and gobbles up a few

more cookies. I decide to aim now for the secondary process:
 MENTAL RETARDATION 157

Amy: Yes, HE can get what he wants. If we knew how he

did that then we could apply that pattern now.

I am thinking symbolically, hoping to access Sam's own

greed and power, so that he will not be dependent upon the
social services and the rest of the world for money. But my
track is interrupted by a social worker who does not
understand my intentions.

Social worker (to Sam): Now, getting back to the situation

at hand. Are you sad?
Sam: Yes, I am . . . it hurts, deeply . . . down to the
bone. It costs . . . I notice. . . .

I let go of my interest in his brother and adapt to the overall

situation.
Amy: When you first came in here, you were so nervous.
How come you now feel better?
Sam: I felt uneasy, I could not sleep. I felt pinned in as if I
had done the stupidest thing, as if I had done the
worst thing or had been a criminal.

Apparently he feels better because we have accepted him as

a person, but the problem is still here, it is in the
background, in the past ('I felt uneasy'). The relationship
conflict is still present because one of his hands is still on his
hip, cowboy style, waiting for what, I ask myself.

Amy: You need friends . . . good friends.

Sam: I have a buddy. I do not know where he is now.
Another friend invited me for a two-week trip to
Spain.
Amy (to the others): I would like to see him with one of
these friends. He needs to work on his relationships.
Sam: I have a girl friend. But she is divorced, has a big
apartment. She got kids. Been there twice, nice girl,
like her.
Amy: Could you bring her once with you?
Sam: Well, I don't know. . . .
158 THE CITY'S SHADOW

Social worker: Amy, what do you mean by relationship?

Sam: It is like this . . . it is like this . . . to make a
friendship [taking his hand from his hip to express
himself fully], you have to fight for it. It is always
that way. . . .

ON RELATIONSHIP
Two very interesting aspects of the work are evident here.
First, the concept of relationship is missing in this social
work center. Relationship for me is learning how to process
the communication which is present. It does not mean
securing a permanent or necessarily harmonious contact
with someone. The relationship which the social worker and
the client have in mind is state or role oriented, having
someone there who is your friend, in contrast to process
oriented; being aware of and working with what happens to
yourself when you are with others.
The second interesting aspect of the above conversation is
that Sam tells us that to have a relationship you must be
prepared to fight. His primary process is not ready to stand
for anything or to fight. His secondary process, like his
brother, will grab whatever he needs. Fighting for what he
wants has been the missing element in relationships until
now.
How can we bring this out? We could either constellate a
fight now with us or return to the place of his problems and
work there. In the following interaction, both were
attempted.

LEARNING TO FIGHT
Amy: What is the problem there in the home? What is the
real problem in the outer world?
Sam: For me it is . . . it could be good . . . for people
who . . . for example . . . there were many
reasons . . . for alcoholics, when they have money
in their pockets. . . .
Social worker: He has too high requirements for his
environment.
 MENTAL RETARDATION 159

Sam: NO! THAT I HAVE TO DISAGREE WITH YOU

ABOUT!!! THAT IS NOT TRUE. When there are
people there who have money, they go drinking.
Alcoholics. They disturb me. I don't need them.
How do you get along with them?

I notice that his fighter is beginning to come out as he resists

the social worker, but I am hoping to locate the relationship
problem where the present situation began.

Amy: Who is the person who hurt you? Who hurt you?
Sam: I know. . . . Everyone has troubles. Everyone blames
others.
Amy: I will not tell anyone. Who hurt you?
Sam: Yeah. . . .
Amy: Who?
Sam: I must be. . . . [mumbling quietly to himself].
Amy (warmly but forcefully): Who? Who did it?
Sam: Well, . . . well . . . the boss. If you work they are
happy, they like you.
Amy: What did he do?
Sam: He says . . . each . . . the boss looks at you like
cattle, you feel locked in, like pinned in, you are like
locked in there.
Amy: I want absolutely to talk to him. A relationship
problem, I want to talk to him. Sam runs into
relationship trouble, and then runs from his prob-
lems, because he feels too weak . . . like all of us.
Sam (spontaneously): No, it is not just that. For example
with housekeeping. The thing I cannot take is, the
room is checked at 9.30. Like in military, no worse.
No alcohol, no alcohol, no drinking. I don't like
being controlled. But if I see that the boss is in the
cafe and is drunk, then, when he comes home and I
see him . . . yeah. He comes back, then I would get
really angry . . . I would like to slap him. Yeah, it is
simply unfair [He lights a cigarette]
Amy (to the social workers): You will have to stand in
between him and the boss of the home and mediate,
160 THE CITY'S SHADOW

help them both process what is happening.

Sam: The boss in not fair.
Social worker: But the problem of keeping the house in
order is still there. He needs to be orderly, no?
Arny: True, but this is not just a personal problem, it is a
relationship problem as well. It has to do with how
he behaves at the moment when others bother him.
And this is where he is at the moment. If he solves
this relationship issue, then he can work on the
next. But at the moment it seems as if his
disorderliness is an unfinished battle against those
in himself and in the world around him who treat
him poorly.
Jim: That's right. He has the same problem all over.
Social worker: Tomorrow, when we see the head of the
home, what shall we do?
Sam (apparently afraid of this new thing): OK. If it's so
bad, and nothing else works, then I will return to
the home. (Now very angrily, using both hands.) Do
you think it is nice to be put down? It hurts to
always be at the end of things, to be at the bottom.
Do you think it is nice to be at the bottom of eight
kids, and the smallest and the one with the least
skills? Do you think that is nice?

I agree with Sam that it must have been awful for him to be
the last of eight kids and the one with the fewest skills. But I
also think that it must be terrible for him constantly to
identify himself as the weakling who only notes the injustice
in the past. Why does he dwell on his stories about the past?
As we saw in earlier chapters, things which happened in the
past are experienced as unchangeable; they become part of
our fate, an unalterable myth or pattern, frozen into the
glaciers of time. Thus the reference to past events indicates
that Sam experiences the present as a hopeless and
inevitably unjust situation. He needs help not only exter-
nally but internally as well with his hopelessness about
becoming a strong and independent person.
 MENTAL RETARDATION 161

THE MEANING OF RETARDATION FOR THE CITY

I also think, however, that Sam's present inferior position in
our culture makes him and others like him all the more
sensitive to the governing authorities in a given community.
One of the teleological meanings of retardation for the
individual is, as it is with all handicaps, to learn to stand up
for and appreciate oneself as an original and individual
creation.
But as long as Sam cannot do this, he is dependent upon
others for help. His problems dream the social services into
being; they create the need for the city's agencies. And these
agencies in turn create networks which must deal with Sam
and with difficult and painful problems, such as Sam's
home director whom no one but the retarded person fully
experiences. In other words, because the retarded person is
less able than others to rationalize his feelings away, he
becomes the city's sensitivity towards its own insensitive behavior.
In Sam's case, it turned out that the director of the home
was a highly disturbed alcoholic who needed someone to
stand up to him and to force him to change. Sam was the
warning signal indicating that all was not well and that he
and others were being maltreated. Working with people like
Sam inevitably means working with the community and its
leaders. In a case like this, as in all cases, social psychiatry
must widen its reach and work with all aspects of the
community situation.
Chapter 14
THE CITY'S SHADOW

The foregoing process studies of schizophrenia, mania,

depression, heroin and alcohol addictions, mental retarda-
tion and sociopathy are only part of the immense topic of
extreme states. Missing from the present study are investi-
gations of senile psychoses, extreme states in children and
comatose phenomena near death.
The client of the city often appears to be the identified
patient of the community; he channels its repressed and
unrealized psychology. This shadow is like the city's dream
portraying its neglected gods, the hopelessness it will not
admit, its withdrawal from superficial communication, its
suicidal tendencies, mania, addictions, murderous rage
and hypersensitivity. The shadow reminds us of the
smoldering revolution we normally perceive only in the
dark of night or in the impinging quality of physical
symptoms.
None of the above 'diseases' appears to be purely random
or meaningless pathological behavior; each shows, in all
situations, a highly ordered, almost mathematical predict-
ability. One goal of this work has been to demonstrate that
the cause-and-effect, illness-and-cure philosophy governing
much of psychiatric research and treatment is not the only
useful way of either observing or treating the effects of the
above syndromes. A process oriented paradigm which
studies the various channels of human expression and
which deals concretely with both individual and collective
issues, normal and extreme states, is sorely needed. The

162
 THE CITY'S SHADOW 163

The Client
Client's Family The Neighbors
Psychologist Analyst
Psychiatrist Social Worker
Psychiatric Researcher Psychological Researcher
Medical Doctor Psychiatric Nurse
City Authorities Courts
Police Insurance Agencies
The City

Figure 14.1 The mental health team

new paradigm blends psychiatry with social work, psy-

chology and politics.
The mental health professions of the future will, I
imagine, see our present psychiatry, psychology, social
work, medicine and politics as specialized and divided
approaches to extreme states and social and physical
problems. One way of bringing these specialized pro-
fessionals together today is to see them as one team. This
team looks approximately as shown in Figure 14.1.

TO THE ANALYST
In my opinion the analyst should be a model of understand-
ing and flexibility in modes of treatment for other mental
health disciplines. However, most analytical interventions
are only weakly applicable to psychotic states. It is possible
that there are basic assumptions in the way you, the analyst,
practice which are limited to normal psychology and which
do not apply to extreme states.
If you find that your work does not apply to the psychotic
states, you normally conclude that the people are uncon-
scious and must wait for enlightenment. Secretly you
believe that humankind will never change. You are hope-
less. Alternately, you may believe that psychosis is due to
social ills, God, the collective unconscious, an undiscovered
toxin, early childhood experiences or fatefully weak egos.
These beliefs indirectly help to sustain the steady number
of psychotic episodes because you, who are best trained to
I 64 THE CITY'S SHADOW

work with these people, defer such work to others.

Moreover, your hopelessness acts hypnotically on patients
in extreme states by intensifying their own anger and sense
of hopelessness. Please let us be aware of our beliefs about
psychotic states.

TO THE PSYCHOLOGIST
Psychotic states are process reversals in which secondary
processes are exchanged for primary ones for more than a
short duration. Everyone has such altered states; hence,
psychosis is just one end of a spectrum of states. At one end
is consciousness and awareness, while at the other there is
literally no control. Everyone's psychotic corner can be
accessed by touching upon a central, mythical, painful issue.
An important characteristic of altered states is that many
of them cannot be sufficiently dealt with without entering
them. For example, consider a man who complains that he
is troubled by anxiety attacks which he says, upon
questioning, make him 'flutter.' Normally, he says, he is a
very sensitive and delicate person, but not anxious. His
'normal state of mind,' that is, his primary process, is to be
sensitive, cool and unafraid, his secondary one is to flutter.
We can remain in our primary process and talk to him,
encouraging him to remain in a normal state but the chances
of our getting at the core of his anxiety and relieving it are
not very great. To deal directly with his present problem
we might, for example, encourage him to get into that
altered state, into his secondary process by using the
'fluttering' as a signal characteristic of this state. When he
begins to flutter, he visualizes a figure threatening him.
Then suddenly he tells us that he is afraid his father will
strangle him! Now he automatically comes out of the altered
state.
He seems his normal self again. He tells us that while in
that state he realized that he has preferred to repress his
own voice rather than be forceful with others. The insight
obtained from the experience, that being forceful is difficult
for him, coupled with the fact that the fluttering stopped
when he began to be more forceful, leads us to wonder why
 THE CITY'S SHADOW 165

talking about his 'negative father complex,' that is, about the
way he represses himself, did not help him. It seems as if
one solution to his anxiety problem lay hidden in the
complete experience of an altered state and therefore
occurred in switching states and processes, in accessing the
fluttering and finding out more about its nature.
Only a few of the problems people suffer from can be
dealt with by remaining in this reality. The solutions to most
problems require wisdom and experience of altered states.
We need to learn how to switch realities fluently, how to be
able to transport information back and forth between an
altered state and a normal primary process. I think that the
biggest problem we have working with psychotic episodes is
therefore connected to our inability to define, access and
switch realities, to remain in one while carrying information
from another. So let's learn!

TO THE BIOMEDICALLY ORIENTED PSYCHIATRIST

What are our basic assumptions behind ameliorating psy-
chotic effects? We should check our desire to medicate all
extreme states, otherwise we propagate an inadvertent form
of communism, a collective ban on abnormality. We know
that there are many individuals suffering in extreme states
whose processes are potentially mind expanding, whose
behavior is highly critical of western technological society
and who, given the proper help, could be constructive
culture changers. Some may even become future therapists.
If we medicate such people, we may be avoiding our own
myth of truly helping. Are we giving medication because it
is really the process of the individual or are we sometimes
giving it because we no longer want to think about the
complex situation of our patient or about the basic premises
of our profession?

Paradigm Revolution
Being a psychiatrist today means being part of a revolution
in medicine. Psychiatry, more than any other branch of
medicine, is faced with the limitations of causality. As a
166 THE CITY'S SHADOW

student you once challenged the basis of your profession; its

flaws confront you no less glaringly today.
A central term in psychiatry is 'psychosis.' In this text
psychosis is defined as a process reversal without a
metacommunicator. The primary process which was origin-
ally adapted to a given family or community is, for a number
of reasons, reversed with the secondary process long
enough to change the way in which the individual
experiencing the reversal is observed by others. Instead of a
primary process which is adapted to the reality in which one
lives and which is periodicially disturbed by a secondary
process, we have a new and surprising primary process
which is unrelated to the consensual reality and disturbed
by reality orientation.
The definition assumes that the individual in an extreme
state experiences a highly patterned process and that
psychosis is one of many processes characterized by
temporary process reversal. This definition requires you to
be aware of your own state of awareness and that of your
city. It also demands knowledge of the individual client's
idiosyncratic messages and signals.
This definition has cross-cultural applications as well,
since it examines the individual's feeling, thinking and
relationship to the world independently of their cause.
Specific western terms for an extreme process such as
schizophrenia may now be compared with apparently
analogous disease entities defined in other cultures ([Link],
1973), since all psychoses are reversals of a culture's primary
process.
Thus, if law and order, cleanliness, tidiness and hard
work are characteristic of a given culture, a person will be
psychotic if he tends, for a long period of time, to be
unlawful, disorderly, unclean, untidy and lazy. In a culture
where intuitiveness is accepted, fantasy is not likely to be
considered a symptom of disease.

Polarization
Defining psychosis as a process reversal and as an unusual
or extreme state implies that the client's ability to exist in a
 THE CITY'S SHADOW 167

given environment is disturbed. This means that the

psychiatrist has to be acutely aware of her client's resist-
ances to the world and also of her own resistances to the
client, for process reversal polarizes the environment. The
world around an individual in the midst of a process
reversal always becomes her opposite, just as the client
becomes the secondary process for the world. Without
understanding what is happening, a therapist usually finds
herself acting out the opposite part of a client's pattern, the
cop to the robber, the optimist to the depressive and so on,
instead of making both processes more accessible to the
client.
If the therapist becomes antagonistic to the patient's state,
both are in for trouble. Creative work with an extreme state
requires you to be outside the state and outside of its polar
opposite, while simultaneously getting inside and fully
empathizing and appreciating it. But the latter is only
possible when you are not caught in it.
The psychiatrist is faced with many unanswered ques-
tions. Why is one client susceptible to one type of process
reversal rather than another? Our knowledge at present
indicates only how patients become psychotic and how to
deal with them. We know that individuals with weak
primary processes become schizophrenic under stress, in
contrast to becoming physically ill. Individuals with strong
primary processes, on the other hand, become psychoso-
matically ill and experience process reversal as a temporary
fever or debilitating handicap. Where there is an edge
against violence, epilepsy is common. The following hypo-
thesis needs testing as well; people attached to a primary
process of peace become addicted to drugs or endorphine
effects such as those produced by physical exercise. What
kinds of belief systems are present before the onset of
catatonic states? Can retardation be altered through pro-
cessing?

Prediction
One problem which you are often faced with is predict-
ability. You will be asked to predict which people are likely
168 THE CITY'S SHADOW

to be dangerous to others and to themselves, and then have

to make decisions based on those judgements. The process
paradigm, at this early stage, offers a few notes about this.
Clients with no edge to their secondary processes will follow
these processes with little or no hesitation. For example,
someone who says, 'Others have killed themselves. Why
not me?' is in dangerous trouble. A congruent primary
message without double signals is also believable. 'I will kill
myself soon,' without any superfluous or contradictory body
motions is a serious statement. The best way I know of
dealing with these situations is to believe them and help the
individuals play, imagine or fantasize these situations now,
as if they were happening in your office. In this way,
dangerous situations can turn into constructive ones.

TO THE SOCIAL WORKER

Some of you have already had a lot of training in managing
medical and city authorities. I will therefore address others
who might need a greater overview and additional support
for their work.
You are required to be part psychiatrist, part analyst, part
business and economic expert, family therapist, and medi-
ator between the courts, the family and the taxpayer.
Your role is full of problems! You frequently feel inferior in
training and importance to the psychologists and psychia-
trists you work with and feel that your position is not
respected enough. And you are right, but this is partly your

Social team conflict

clinic guardians
doctor : social agencies
police family
courts social worker client
city government •. the client's boss
debtors : family
neighborhood relatives
your inner problems.

Figure 14.2 The social worker's position

 THE CITY'S SHADOW 169

own doing. Many of you did not want to submit yourselves

to the long and arduous training offered to analysts,
psychiatrists and psychologists. But perhaps you were right;
some of the training is not really as useful as it could be!
Why not define the problems of your profession better and
seek the kind of training you need, training which will bridge
the gaps between individual psychology and city problems?
I recommend that you redefine your role. In Figure 14.2,
your position relative to the world around you is schematic-
ally portrayed. Your job is a mixture of all the abilities
needed in the client's situation, as well as the ability to
switch roles as the situation demands. Since your job deals
with the entire city you are like a mind in the midst of a
body. A problem in one part of the body demands that you
make contact with that part and examine the entire situation
surrounding it. As a general rule, the organization of the
entire body must change so that the troubled part improves.
Your client is the city's 'identified patient,' the part
identified as being ill or troublesome. But the city's tendency
to identify him will also have to change, in the same way the
family who identifies one of its members as a problem has to
change. In other words, both the individual client and the city
are your clients. Both your individual client and your city are
in the midst of change. What a difficult, impossible and
exciting job!
You are going to have to mediate the relationship conflict
between the restaurant manager who threw out your
alcoholic client and the client himself. You will have to help
him with his neighbors and them with him. You will have to
interact with the police and with the courts who accuse your
client of stealing and who implicate you for refusing to give
him more money to continue his habit. You must bargain
with the store owner who wants immediate compensation
for the stolen property and with your client who is unable to
come up with the compensation. You are working not only
with your client's personal psychological problems, but with
the restaurant's role in creating addiction, the policeman's
brutality, the store owner's vindictiveness and the clinic
director's private problems.
170 THE CITY'S SHADOW

The city requests you to keep the client out of trouble and
under the rug. Consider yourself part of a city that expects
you to be a trash collector responsible for hiding the wastes,
that disregards the human consequences and disasters
resulting from this attitude. You get the person nobody else
can deal with. Knowing that your present role is often
subtly defined as the city garbage dump may help you
change this situation. Your experience has political implica-
tions. No one knows better than you the total story around
heroin and sociopathy. Who else could inform the city about
the life of an alcoholic?
The court can no longer pass their problems on to you, it
will have to learn to have it out with the client. Tell the court
about how they and the client blackmail you! How they
threaten you with not giving the client his social security.
Tell them that being tough with a client in a given moment
may risk a burglary but may also finally solve a problem
which has been hanging on for years. Tell them that the
garbage dump is overloaded, it cannot take any more and
that the public is going to have to learn to process the
difficulties faced by the social services.

The Staff Problems

To deal with the city's problems, you will have to work on
the internal tension which is characteristic of all mental
health staffs. Though this deems to be adding more
problems to your agenda, wc rking on staff tensions will
improve your working atmospnere and your ability to deal
with difficult clients. For many cases are so complicated and
troublesome that you need others to help you with your
work. Don't try to handle impossible situations alone.
Find as many helpers, trained and untrained, as you can.
You may need to work in teams of three, four or five at a
time. If you need more time or money to do this, you should
fight for it, claiming that getting one client off the streets
saves the city a lot more money than it costs to hire more
helpers. A financial investment with the potential of saving
in the future is a wise one.
 THE CITY'S SHADOW 171

TO THE CITY GOVERNMENT

Each year you must pay city officials, social agencies, state
agencies, insurance funds, police and tax losses to support
the kinds of clients mentioned in this work. Instead of trying
to maintain the status quo and implying that your social
services should keep the shadow quiet because the tax-
payers want this, consider the following. The shadow
destroys cultures if it is not valued and its meaning not
understood. Intensive care for the city shadow would mean
learning about it and publicizing both its financial costs to
the city and its message from another world about the future
of our planet. Some of its present messages seem to be:

1 Trance states are important

Introversion is not a disease, but a corner of the
personality waiting to be experienced by everyone.
Not everyone needs to talk. Look into trances, examine
them. In these states, the world itself is stopped and
reconsidered.

2 The gods are still around

The city's shadow shows that the archetypes of the
Virgin Mary, Napoleon and Jesus are still around,
though nobody takes much interest in them these
days. Fantasy is important, for it teaches about the
totality of being human. These savior figures and god-
like experiences are channeled through the shadow
because they are not welcomed by the collective. You
don't believe in these figures because you do not know
yourself yet.

3 The shadow is a trickster

A message of the city's shadow is to relax. It is
important to be retarded sometimes, not to think but
to focus only on feeling problems which everyone else
skips over. The shadow is a trickster because it says
that it is always time for vacation, time for more sex
and fun. The shadow says to brag more, because by
172 THE CITY'S SHADOW

bragging we see parts of ourselves we do not take

seriously now. The shadow says a good fight in the
best of families sometimes clears the air. The city
shadow says that we are crazy, the shadow is the
healthy one.

The shadow wants to be cared for. He says, 'I am not

interested in pain. I have no courage and am not a hero in
life like you. I give up on life, I sometimes need to collapse,
even commit suicide. I am sometimes a slow and timid
outsider, won't you wait for me? I have troubles. I am old,
senile, sick and suffering and cannot make it alone. I am
mad, addicted, violent, lonely and homeless. I have fits of
jealousy and feel betrayed. You know me in yourself!'

TO THE CLIENT
I know that you suffer from feeling unwanted. You are the
identified patient of a troubled world family. We contribute
to making you believe that you are a useless failure and I
know that you secretly feel that life is not for you. You are
partially correct when in your altered states you perceive
that this world is in trouble and that you are in order. Your
life could show us the dreaming element in the world yet we
dwell upon categorizing you. While we maintain the threads
of history, you thieves, bag ladies, gods and holy people
spin the eternal present.
Your living demon frightens us and we try in vain to turn
away. For when we see your unthinkable visage we
remember that part of ourselves which is connected to the
wonder of life. Why don't you realize that we are both
inflexible; both think the other is crazy, both feel unrelated
to and incapable of relating. Both feel despised. Both of us
are asleep. Who will wake up first?
GLOSSARY

In the following Glossary, psychiatric definitions are related

to process concepts. This Glossary is neither complete nor
definitive, but is meant to aid the reader in understanding
certain sections of this work without having to refer to other
texts on the subject of process work.
*preceding a word indicates that it is defined elsewhere in
the Glossary.

Addiction
Conflict between a *primary and a *secondary process in
which one uses increasing quantities of a drug to support
a secondary process in order to overcome the primary
one. Typical drugs are morphium, heroin, alcohol, cigar-
ettes, coffee and tea.
Affect
Overwhelming secondary emotion which partially or
totally submerges the *primary process.
Alcoholism
An *addiction to alcohol.
Altered states
A term referring to a *state of *consciousness which is
different from the state connected to *collective primary
process. For example, if ordinary waking consciousness is
our primary state, altered states include nocturnal dream-
ing, hypnotic conditions, drunken and drugged states,
states centered around strong emotions like rage, panic,

173
I 74 GLOSSARY

depression, elation, or states induced by meditation.

Archetypes
The implicit structure and organization of *processes
which may appear in dreams, body problems, relation-
ships, *synchronicities and hallucinations.
Computer Aided Tomography (CAT) Scanning
X-rays of brain structures formed by the difference in x-
ray absorption from the fluid in the ventricular spaces and
the brain tissue itself.
Channel
The specific mode in which information is received, for
example, the visual, auditory, proprioceptive, kinesthetic
relationship and world channels refer to information
picked up respectively by seeing, hearing, feeling, mov-
ing, through another person or an outer event.
Collective primary process
This is a consensus reality, a *primary process shared by
the majority of individuals in a given family or commun-
ity. This process simulates the world and the environ-
ment. A *psychotic person no longer shares this picture of
reality. This process resembles the primary process of an
individual, except that instead of 'I', which an individual
uses to refer to his role in a given collective, he uses 'we,'
by which he refers to a primary process shared with
others.
Collective unconscious
A term developed by Jung referring to experiences which
are found among people from all over the world. These
experiences are symbolized in dreams by figures without
immediate personal associations from one's past such as
kings, queens, magicians, trees, animals, etc. The collec-
tive unconscious frequently appears in *secondary
processes.
Complex
A term originally defined by Jung which in this work
refers to a disturbance of attention due to a *secondary
process which has been accessed and disturbs the stability
of the *primary process. The complex is organized by an
*archetype, has an awareness of its own and structures a
given secondary process.
 GLOSSARY 175

Consciousness
This term refers to having an observer who can *meta-
communicate and who is aware of the mode and channel
in which perception is occurring.
Depression
A *state of great unhappiness in which one's tempo of
speech and movements are slowed down. It can become a
*psychosis if there is a reversal of the original *primary and
*secondary processes. There is, except in psychotic cases,
a *metacommunicator present who is able to communicate
with others.
Dreaming Up
This expression refers to the phenomenon which occurs
when a *double signal creates reactions in another person.
The term comes from the empirical observation that the
reaction in the other person is always reflected in the
double signaller's dreams.
Double signal
Language or body gestures which the communicator does
not identify with. Signals or communication which are
related to a *secondary process.
Dreambody
The phenomena which occur when body experiences
which have been *secondary are amplified creating an
*altered state of consciousness which mirrors one's
dreams.
Edge
The experience of not being able to do something, being
limited or hindered from accomplishing, thinking or
communicating. Structurally speaking, an edge separates
the *primary from the *secondary process.
Endogenous
Coming from or occurring within.
Epilepsy
A group of symptoms characterized by the sudden and
temporary loss of the *primary process. One suddenly
loses awareness, either by falling asleep or into a stupor,
losing control of speech and body movements, etc. In
'petit mal' seizures, speech and actions may simply be
interrupted briefly or the person may drop something.
I 76 GLOSSARY

'Grand mal' seizures involve repeated, uncontrolled,

violent clonic movements of all the muscle groups. The
person may be injured in thrashing about or may bite the
tongue. Subjectively, a seizure may typically be experi-
enced as being thrown to the floor or possessed by an
alien spirit.
Exogenous
Coming from or occurring without.
Extreme states
*States which are normally antagonistic or unusual in a
given community, for example, a *psychotic episode or
*altered state of consciousness.
Feedback
A response occurring as a reaction to a given stimulus.
Feedback loop
The chain of reactions in which a stimulus signal receives
and is altered by *feedback. There is no feedback loop in
many *extreme and *psychotic states.
Field
A feeling of causal or acausal interconnectedness between
various places or people, and evidence for the existence of
such interconnectedness as in the case of *synchronicity.
Global dreambody
Two or more people together with their environment
considered to function as a body whose *processes, body
gestures and outer *synchronicities mirror their dreams.
Grower's club
A jovial way of describing the kinds of people and
*processes in which there are *metacommunicators inter-
ested in integrating *primary and *secondary processes.
Hologram
A concept borrowed from physics which describes the
behavior of parts and the whole. Each part carries the
same patterns as the original whole.
Illness
Subjective experience of being disturbed by a *secondary
process.
Individuation process
This term was originally defined by Jung and refers to the
 GLOSSARY 177

life-long development of an individual capable of integrat-

ing all of the various parts of the personality into ordinary
life. In process thinking, individuation also refers to the
ability to access any *altered state, such as a dream figure,
body problem or relationship projection and to live and
process these states in the moment they are present
without losing contact with one's ordinary identity.
Mania
Wild excitement usually connected to identifying with a
*secondary process which disturbs the environment while
still being capable of communicating with it.
Medical model
According to this model of *extreme states, malfunction-
ing of the brain causes mental disorders and requires
pharmacological intervention. This model is based upon
the discovery that various physical and mental processes
are controlled by different parts of the brain and that
certain chemicals affect electrical transmission in the
neural network.
Mental illness
An *illness without known chemical causes in which
behavior does not conform to the norm of a given
community.
Mental retardation
Subnormal intelligence accompanied by emotional diffi-
culties and a sober-minded *metacommunictor who re-
quests supervision and assistance with daily life.
Metacommunication
The capacity to communicate about the content and
process of communication.
Neurosis
Any long-lasting experience in which a *meta-
communicator experiences his *primary process as being
endangered or overcome by a *secondary one.
Occupation
The process of relating to or identifying with one of the
parts or *states of a *process. For example, visualization is
not occupied if we say that others look at us and we are
unaware of our own active looking. Or a man's father is
I 78 GLOSSARY

not occupied if he dreams of the father and projects it

onto the outside world.
Personal unconscious
A term defined originally by Jung. The *primary process
of a person in consensus reality. This process is usually
symbolized in dreams by known figures identified with
one's past.
Positron emission tomography
A neurotransmitter analog in which one of the atoms is
replaced by an isotope (a positron emitter) and given to a
patient to see where the drug is and how it combines
while the patient is alive.
Primary process
The body gestures, behavior, and thoughts with which
one identifies oneself or which it can be assumed one
would identify with if asked.
Process
The flow of signals and of information as defined by those
who perceive it. Process is differentiated into *primary
and *secondary information which is closer to or further
from the sender's awareness.
Psychiatry
The study and management of *extreme states.
Psychosis
In process terms, psychosis is the process in which an
earlier *primary process is exchanged and becomes
secondary while the earlier *secondary process becomes
primary. This process occurs without a *meta-
communicator and lasts for more than several weeks.
Psychotic corner
A *psychotic process of relatively short duration such as a
week or two. Everyone has psychotic corners.
Schizophrenia
A *psychosis in which there is no *metacommunicator
present and which has minimal *feedback loop with the
content of communication.
Secondary process
All the verbal and nonverbal signals in an individual's or
community's expressions with which the individual or
 GLOSSARY I 79

community does not identify. The information from

secondary processes is usually projected, denied, and
found in the body or outside the sender.
Shadow
A term originally defined by Jung to mean a dream figure
of the same sex as the dreamer which symbolizes or
'personifies everything that the subject refuses to acknow-
ledge about himself' which nevertheless thrusts 'itself
upon him directly or indirectly.' It is, 'for instance, inferior
traits of character and other incompatible tendencies.'
(Collected works vol. 9, Part 1, pp. 284-5.) Depending
upon the state of the individual and his awareness, the
shadow may be either *primary or *secondary. As far as
the city is concerned, the shadow is secondary since
power, jealousy, laziness and *altered states of conscious-
ness refer to tendencies not identified with.
Sociopath
An individual who breaks the stated rules of a given
society over a long period of time to the extent that he
constantly requires supervision or social control (such as
in a prison).
State
A *process in a static condition. Thus, the *primary
process is normally a state since it remains stable in spite
of strong changes in the world around and impinging
signals from *secondary processes within. A secondary
process implicit in a *complex or *illness can also be a
state. *Schizophrenia, bipolar disorders, and other mental
illnesses are states.
Synchronicity
A term defined by Jung, used here to mean a *secondary
process occurring in the world *channel.
Tardive dyskinesia (TD)
An iatrogenic disease characterized by movements which
are involuntary and purposeful. First evidence is often
masticatory-like movements of the surface of the tongue
or floor of the mouth. Occurs particularly in older
patients. TD can progress to neck, fingers, toes and face.
Postural control is also disturbed.
180 GLOSSARY

Unconscious
All *primary and *secondary processes which are not
available to the observer's or experiencer's awareness.
BIBLIOGRAPHY

Abend, S., M. Porder and M. Willick, Borderline Patients: Psycho-

analytic Perspective, New York, International University Press,
1983.
Adler, David, 'The Medical Model and Psychiatry's Tasks,' Hospital
and Community Psychiatry, vol. 32, June 6 1981, p. 387.
American Psychiatric Association, The Diagnostic and Statistical
Manual of Mental Disorders (DSM III), Washington, American
Psychiatric Association, 1973.
Bassuk, E.L. and S. Gerson 'Deinstitutionalization and Mental
Health Services,' Sci. American, vol. 238, 1978, pp. 46-53.
Bernheim, K.F., R.R.J. Lewine and Beale C.T., The Caring Family:
Living with Chronic Mental Illness, New York, Random House,
1982.
Blanck, B., and R. Blanck, Ego Psychology, II. Psychoanalytic Develop-
mental Psychology, New York, Columbia University Press, 1979.
Bleuler, E., Dementia Praecox or the Group of Schizophrenias, New
York, International Universities Press, 1950.
Boyle, Joan and James Morriss, 'The Crisis in Medicine. Models,
Myths and Metaphors, in Et Cetera, vol. 36, no. 3, 1979, pp.
261-74.
Chaiklin, Harris, Ed. Marion Chace: Her Papers. American Dance
Therapy Assoc., 1975.
Clement-Jones, Vicky, 'The Role of the Endorphins in Neurology,'
March 1983, vol. 227, p. 487.
Clifford, T., Tibetan Buddist Medicine and Psychiatry, Welling-
borough: Aquarian Press, 1984.
Companion to Psychiatric Studies, 3rd ed. R. E. Kendell and
A.K. Zealley (eds), Edinburgh, Churchill Livingstone, 1983.
Crombach, G., Psychopathologie aus der Sicht Verdnderter
Bewusstseinszustande, Confinia Psychaitr. 17, 1974, pp. 184-191.
Diagnostic and Statistical Manual of Mental Disorders (DSM III) (See
The American Psychiatric Association)

181
 I 82 BIBLIOGRAPHY

Diamond, Ronald, 'Drugs and the Quality of Life: The Patient's

Point of View, J. Clin. Psychiatry vol. no. 46, 5, (Sec. 2, May 1985.
Engel, George, 'The Need for a New Medical Model: A Challenge
for Biomedicine,' Science, vol. 96, 8 April 1977, p. 129.
Freedman, Alfred, Harold Kaplan and Benjamin Sadock, Modern
Synopsis of Psychiatry/4, Baltimore, Williams 4 Wilkins Co., 1984.
Freud, Sigmund, 'Psychoanalytic Notes Upon An Autobiographical
Account of A Case of Paranoia, (Dementia Pradnoides),' Collected
Papers, vol. 3., p. 316, London, The Hogarth Press and the
Institute of Psychoanalysis, 1950.
Greist, J., J. Jefferson and R. Spitzer (ed), Treatment of Mental
Disorders, New York, Oxford University Press, 1982.
Grey, Grady, Bainbridge Island, Washington, Introduction to Process
Oriented Psychology, a film in three parts, 1987.
Henderson, D.K. and Gilespie, R.D., Textbook of Psychiatry for
Students and Practitioners, tenth ed., revised by Ivor R.C.
Batchelor, New York, Oxford University Press, 1969.
Introduction to Psychopharmacology, A Scope Publication, 1980, p. 58.
Johnson, D.A.W., et al., 'Antipsychotic Medication, Clinical Guide-
lines for Maintenance Therapy,' J. Clin. Psychiatry, vol. 46, no. 5,
sec. 2, May 1985, pp. 6-15.
Jung, C.G., The Psychogenesis of Mental Disease, vol. 2, C.W.,
London, Routledge & Kegan Paul, 1974.
Kandel, Eric R., 'From Metapsychology to Molecular Biology:
Explorations into the Nature of Anxiety,' Am. J. Psychi., 140,
1983, pp. 127-93.
Karon, Berthran P. and Gary Vandenbos, Psychotherapy of Schizo-
phrenia, the Treatment of Choice, New York, Jason Aronson, 1981.
Kessler, K. and J. Waletzky, 'Clinical Uses of Antipsychotics,'
Am. J. Psychi., vol. 138, no. 2, February 1981, pp. 202-9.
Kiev, Ari, Transcultural Psychiatry, New York, The Free Press, 1973.
Kohut, H., The Restoration of Self, New York, International
Universities Press, 1977.
Kuhn, T., The Structure of Scientific Revolutions, Chicago, Ill.,
University of Chicago Press, 1970.
Lader, Malcolm, Introduction to Psychopharmacology, Kalamzoo,
Mich., The Upjohn Company, 1980.
Laing, R.D., The Politics of Experience, New York, Ballantine Books,
1967.
Leary, Thomas, 'The Religious Experience: Its Production and
Interpretation,' Psychedelic Rev., 1, pp. 324-46.
Lehman, A.F., 'The Well Being of Chronic Mental Patients:
Assessing their Quality of Life,' Arch. Gen. Psychiatry, 40,
pp. 369-73, 1983.
Marmor, Judy, 'Systems Thinking in Psychiatry: Some Theoretical
and Clinical Implications,' Am. J. Psychi, 140, pp. 833-38, 1983.
McGeer, P.L., J.C. Eccles and E.G. McGeer, Molecular Neurobiology
 BIBLIOGRAPHY 183

of the Mammalian Brain, New York, Plenum, 1978.

Mindell, Arnold, The Dreambody, Boston, Sigo Press, 1982.
Working with the Dreaming Body, Routledge & Kegan Paul,
Boston, 1985,
River's Way, Boston, Routledge & Kegan Paul, 1985.
The Dreambody in Relationships, Boston, Routledge & Kegan
Paul, 1987.
- Inner Dreambodywork, Process Oriented Medication, forthcoming.
Moline, Roland Sant Singh, Alan Morris and Herbert Meltzer,
'Family Expressed Emotion and Relapse in Schizophrenia,'
Am. J. Psychi., no. 142; no. 9, September 1985.
Perry, J.W., The Far Side of Madness, Englewood Cliffs, Prentice
Hall, 1974.
Pribram, K., Language of the Brain, Englewood Cliffs, NJ, Prentice
Hall, 1971.
'Non Locality and Localization: A Review of the Place of the
Holographic Hypothesis of Brain Function in Perception and
Memory,' Preprint for the Tenth ICUS, November 1981.
Schoop, Trudi, and Peggy Mitchell, Won't You Join the Dance? A
Dancer's Essay into the Treatment of Psychosis, Palo Alto, Ca.,
Mayfield Publishing Co., 1974.
Masque of Madness, Palo Alto, Ca., National Press, 1973.
Schweizerische Aerzte Zeitung, Bond 66, Heft 34, August, 1985.
Serafetinides, E.A., 'Cerebral Lateralization Research; From Speech
and Epilepsy to Consciousness and Schizophrenia, Psychiatric
Annals, vol. 15, no. 7, July 1985. pp. 427-429.
- 'Cerebral Lateralizaation and Psychiatric Disorders: Intro-
duction,' Psychiatric Annals, vol. 15. no. 7, July 1985. p. 423-427.
Smith, Andrew C., Schizophrenia and Madness, London Allen &
Unwin, 1982.
Suzuki, Shunryu, Zen Mind, Beginner's Mind, New York,
Weatherhill, 1976.
Szymanski, Herman, J. Simon and N. Gutterman Am. J. Psychi.
March 83, p. 335.
Talbott, J.A. (ed.), The Chronic Mentally Ill: Treatment Programs,
Systems, New York, Human Sciences Press, 1981.
Tart, Charles T., States of Consciousness El Cerito, Ca., Psychological
Processes, 1975.
Altered States of Consciousness and the Search for Enlighten-
ment, Open Mind, vol. 2, no. 4 January 1985.
Taylor, R.L. Mind or Body: Distinguishing Psychological from Organic
Disorders, New York, McGraw Hill, 1982.
Torrey, E. Fuller, Surviving Schizophrenia, A Family Manual, New
York, Harper & Row, 1983.
- The Death of Psychiatry, Randor, Penn., Chilton, 1974.
Vaughn, C.E., M.A. Snyder and M.B. Jones, Family Factors in
Schizophrenia Relapse: A California Replication of the British
184 BIBLIOGRAPHY

Research on Expressed Emotion. Schizophr. Bull., 8, pp. 425-6,

1982.
Weil, Andrew, The Natural Mind, London, Jonathan Cape, 1972.
Wilbur, Ken, 'The Development Spectrum and Psychopathology:
Part I, States and Types of Pathology,' J. of Transpers. Psych.
vol. 16, 1984, p. 75.
— Part II, J. of Transpers, Psych, vol. 16, no. 2, 1984, p. 137.
INDEX

accidents, 73, 123, 128, 139, 141 channel switching, 62, 63, 64,
active imagination, 26 164; and creativity, 64; definition
acute episodes, 28, 52, 57, 104, 130 of, 173; and drugs, 59, 112, 117-18;
addiction, 111, 128-9, 138, 167; and hypnotic processes, 61; and
definition of, 111, 173; heroin, 4, illness, 62; and metacom-
13, 18, 74, 111-20 munication, 64; process
Adler, David, 8 structure of, 129-30; working
affects, 3, 75, 155; definition of, 173; with, 84, 164-5
as inappropriate, 35, 38, 39 American Psychiatric Association's
Africa, 55 Manual on Mental Disorders, 137,
aging, 95, 96 149
aggression, 23, 36, 44, 63, 70, 96, amphetamines, 111
105, 113, 114, 153, 154, 155, 167, amplification, 79; of body
172; in neo-Reichian theory, 26-7 symptoms, 24; of channel
alchemy, 27 phenomena, 76-7; of criticism,
alcohol, 111, 121-33„ 138, 142-3, 128; of proprioception, 81; as a
147, 159, 162 symptom, 77; of verbal statement,
alcoholic, 138, 139, 158-9, 161, 169, 120
170; couples, 123, 129, 137; analytical psychology, 11, 39;
definition of, 122; holographic paradigm in, 26, 40, 163-4; and
aspects of, 129; primary process role of analyst, 163-4
of, 124, 126, 130; secondary anger, 37, 88-9, 117, 119, 131, 140,
process of, 124, 126-7, 129-30, 132; 153, 155, 156, 158-60, 164
and sober state, 129-30, 131, 132; Anthropos theory, 41-2
state, 121-2, 123, 124,'125, 129-30, antipsychiatry, 8, 15-16
132 antisocial disorders, 16
Alcoholics Anonymous, 132 anxiety attacks, 164-5
alcoholism, 4, 13, 30, 73, 74, 114; appendectomies, 78
definition of, 173; facts about, 121; appetite, 93
and the collective, 121; meaning archetypes, as collective, 39, 171;
of, 132; process structure of, definition of, 174; experiences of,
124-5, 129-30, 132; and 8, 14; and symptoms, 22
sociopathy, 137 asana, 81
altered states, 5, 25, 74, 164, 172; aspirin, 22, 122
accessing of, 121-2, 165; and Atman experience, 15
channel blocking, 62, 64; and atoms, 100

185
 186 INDEX

auditory: channel, 22, 50, 123; 100, 107-8, 161, 165, 169; and
experiences, 76, 77; hologram theory, 101; of mood,
hallucinations, 49; type, 62 23, 24; and out-of-body
awareness: and alcohol, 122; and experiences, 78; and use of tenses,
change, 24, 62-3; of channels, 77; 118-19, 160
and distance of processes, 25, 26; channel: awareness, 77, 79;
and extreme states, 164, 166; of blocking, 62-4; concepts, 23, 162;
observer, 12, 18-19, 21, 22, 27, 35, definition of, 174; switching, 62-4,
41, 44, 52; principle, 41-2; and 78, 155, 164, 165
schizophrenia, 77, 79; of signals, channels (see also auditory,
29, 73, 88, 90, 166; of therapist, 12, kinesthetic, proprioceptive,
53, 73, 87, 88, 89, 90, 99 relationship, visual and world
channel), 21-2, 25; and
beginner's mind, 11, 21, 89-90, 122 amplification, 76-7; as coupled,
behavioral therapy, 15 22-4; and edges, 152; and
biochemistry, 10, 93 observation, 22, 79; as
biology, 41-2 unoccupied, 63
bio-medical paradigm, 4, 5, 9, 17, 33, chemical disturbances, 15, 16, 18,
165-6 163
bipolar disorders, 4, 75 childhood experiences, 8, 163
Bleuler, E., 33-4 choreathoid movements, 9
blunting, 76-8 Christianity, 51
body: and endorphin production, cocaine, 111
111-12; experiences, 24, 52; coffee addiction, 111, 114
signals, 5, 19, 21, 88-9, 102, 104, cognition theory, 19
123, 132, 142, 145, 151, 152, 153, collective (see also culture): and
156, 157, 158, 160, 168 alcohol, 121; archetype, 39;
body symptoms, 24, 162; as change, 54-5, 100, 107-8, 161, 165,
mirroring dreams, 26 169; depression, 98-100; and drug
body work, 6, 23, 24, 27, 71, 145 addiction, 111-12, 117, 119; and
borderline states, 90 extreme states, 98, 99, 107-8, 162,
Boyle, Joan, 4, 12 167, 169, 170, 171, 172; and family
bragging, 138, 139, 140-1, 144-5, systems, 148, 168; being
171-2 individual in, 144, 148, 161; and
brain, 14; damage, 4, 13, 16, 67, 112; mania, 102, 107-8; primary
disease, 21, 29, 39, 73-4; and process, 174; and retardation, 161;
endorphines, 111; as hologram, and schizophrenia, 48-9, 54-5, 56,
41-2; organic change of, 63; 83, 85-6, 87, 90; shadow, 171-2;
physiology, 14, 78; scan working with the, 54-5
techniques, 14 collective unconscious, 42, 163, 174
breathing, 63, 64; rate, 73, 79 comas, 73, 162
Buddhist meditation, 76 communcation, 30, 52, 70, 105; and
Burgholzli, 15 the community, 107-8;
dysfunctional, 8, 19; and
Castaneda, Carlos, 61, 112 metacommunication, 40, 41;
catatonia, 67-74, 86, 167; Jung on, models of, 38; non-verbal, 18, 22,
15; process structure of, 70 69-75, 90, 145, 155; problems, 14,
causality, 3, 5, 8, 9, 13, 16, 18, 19, 23, 30, 107, 154-5; and process
162, 165, 166 approach, 21-2, 73; and
Chace, Marion, 14 relationship, 158; and
change, 23, 107; according to process terminology, 24; verbal, 18, 73, 75,
paradigm, 24, 26; collective, 54-5, 150, 155, 156
 INDEX 187

complex, 156, 165, 174 iatrogenic, 9, 16; and primary

computerized tomography, 14, 174 process, 167; process-oriented
conditioning-behavior models, 33 concept of, 24, 162, 176
congruency, 45, 48, 70, 93, 98, 151, Don Juan Matus, 112
168 double signals, 25, 88, 105, 106, 115,
consciousness (see also altered 168; definition of, 25-6, 175; and
states), 5, 19, 24, 36, 164; alteration metacommunication, 45, 69, 70
of, 61, 63, 64, 122; and change, 26; dream work, 6
definition of, 25, 175; and fields, dreambody, 22, 175; global, 176
42; and hypnosis, 61; and primary The Dreambody in Relationships, 42,
and secondary processes, 25; and 47, 74
schizophrenia, 77 dreaming up, 53-4, 175
coupled effects, 22-4 dreams, 22, 52, 74, 81, 84, 128; and
courts, 18, 29, 108, 163, 168, 169, 170 altered states, 122; and analytical
criminal behavior, 12 paradigm, 26; as collective, 86; and
criminally insane, 13 Gestalt Therapy, 26; and
culture (see also collective), and hypnotism, 61; and medication,
extreme (psychotic) states, 11-14, 23; as mirroring body symptoms,
187 19, 86, 119, 165-6, 171-2; and 24, 26; and psychoanalytical
health, 5, 9, 10, 11-12, 13-14, theories, 87; signals in, 88-9; and
16-17, 18, 19, 48, 49, 87, 166, 172; visual channel, 22
and primary process, 86-7, 107-8, drug: abuse, 73, 111-33; addiction,
166; and psychiatry, 10; Swiss, 42, 111-20, 128-9, 138, 162, 167;
48, 54 clinics, 119; overdose, 88
custody cases, 107 drugged state, 22, 118, 129-30
cybernetics, 57 drugs (see also medication, medicine,
psychopharmica and specific
dance, 81 drugs): and altered states, 111,
dance therapy, 14 112, 117-18, 122; and brain
death, 63-4, 93, 97, 98, 120, 123, physiology, 14, 111; and collective
126-8, 131; near, 73, 74, 87-8, 162 attitude, 111, 112, 119, 121; and
Denmark, 55 connection to schizophrenia, 83;
depression, 4, 13, 18, 23, 57, 58, 59, hallucinogenic, 83
93, 118, 119, 162; and the
collective, 98, 99-100, 101; as eating, 105, 106
compensation, 98-9; definition of, ecological problems, 101
175; and metacommunication, 99; edges, 132, 140, 142, 152, 167, 168,
and occupation theory, 100; 175
process structure in, 95-7, 98, 99; ego, 163
as psychotic, 93-9; purpose of, Einstein, Albert, 5
99-100, 101; signals of, 102; and elation, 23, 93
suicide, 63-4, 93-101, 129 electroshock treatment, 106
epth psychology, 24 endogenous morphine, 111
evil, 49, 50 endorphines, 19, 111-12
Diagnostic Statistical Manual of Engel, George, 12
Mental Disorders' (DSM III), 4, 12, England, 55, 149
16, 17, 93; diagnosis of epilepsy, 4, 16, 62-3, 65, 167, 175-6
schizophrenia, 34-5 ethology, 19
i sease (see also illness, mental euphoria, 81
illness, and specific diseases): Europe, 93, 121
causes of, 16, 18, 19; definitions of, extreme states (see also psychotic
3, 5, 9, 13, 16-17, 18, 33, 166; states): in children, 162; coming
 I 88 INDEX

out of, 49, 129-30; as collective finalistic philosophy, 27

compensation, 98-9, 107-8, 162, flu, 62
167, 169, 171-2; and collective forensic psychiatric problems, 4
change, 54-5, 100, 107-8, 161, 165, Freedman, Alfred, et al., 9, 33, 121,
169; as cultural, 11-14, 18, 19, 86, 137; 'Modern Synopsis of
119, 165, 166, 171-2; definition of, Psychiatry/IV', 7
13, 56, 176; and the environment, Freud, Sigmund, 33
18, 19, 42, 45, 90, 102, 107, 108, Freudian treatment, 16, 26
114-15, 166-7; and mental illness,
12, 13; and missing feedback loop, Galileo, 101
38-40, 48, 50, 59-60, 90; and genetic inheritance, 19
missing metacommunicator, 13, gestalt therapy, 26
33-43, 44, 45, 54, 56, 64, 70, 86-7, gestures, 19, 102, 123, 132, 151, 152,
99, 130, 166; and occupation 153, 156, 157, 158, 160
theory, 47, 52; as patterned, 12, Germany, 55
56,162, 166; police and court global approach, 6
involvement with, 18, 29, 35, 43, global dreambody, 176
57,94, 108, 121, 137, 139, 140, 151, God, 15, 18, 27-8, 42, 60, 62, 81, 84,
163, 168, 169, 170, 171; relapses of, 85, 95-6, 162, 163, 171
9, 10, 38, 49, 51; and suicide, 49, government, 8, 171-2
50; understanding of, 68-9, 116, grand mal attacks, 63
167 Griest, J. et al., 3, 4, 11, 12, 16
eye movements, 71, 72, 74, 79, 87, group therapy, 11, 14
105 groups, and occupation theory, 47

facial expressions, 47, 67, 88, 89 Haldol, 9

family: and retarded member, 151, hallucinations, 3, 9, 10, 22, 75, 80, 93;
154, 155, 156; and schizophrenic auditory, 49
member, 86; work, 6, 83-4; as hallucinogenic drugs, 83
world, 172 handicapped, 14, 161
family therapy, 14 hashish, 111
family systems, 148, 166, 172; and headaches, 22
dysfunctional communication, 19; health: concepts of, 11, 12, 19, 24, 41,
identified patient in, 169; and 46, 53, 58; and culture, 5, 9, 10,
occupation theory, 47 11-12, 13-14, 18-19, 48, 49, 87,
fantasy, 128, 168, 171; as 166, 172
compensatory, 59, 60; of suicide, hearing (see auditory channel)
63-4 heart attacks, 86, 137, 142
father, 165 heart rate, 73
feedback, 117; definition of, 176; Henderson and Gilespie, 149
loops, 38-40, 48, 50, 59-60, 90, heroin, 111-12
176; negative, 39-40, 70, 97, 124, heroin addiction, 4, 13, 18, 74,
194; non-verbal, 74; positive, 64, 111-20; and endorphines, 111-12;
65, 66, 72, 97, 98 and the environment, 114-15, 117,
feeling (see proprioceptive channel) 170; and process reversals, 118;
field: concepts, 148; definition of, process structure of, 113-14, 117;
176; and dreamed up reactions, 53; working with, 117-18
influences, 8; and objectless hologram, 10, 114, 129, 132, 176
projections, 37, 38, 39; and hologram theory, 41-2, 100-1, 114,
occupation theory, 47, 52, 90, 100, 129-32
129; theory, 41-2 hopelessness, 95, 96, 97, 98, 99, 100,
fighting, 158-60 101, 119, 160, 162; in mental
 INDEX 189

health, 163-4 laughter, 106-7, 123, 125

hyperactivity, 155 limbic area, 78
hypnosis, 57-60, 65, 66; and altered lithium, 17-18
states, 61-2, 122; effectiveness of, liver, 128
61-2 Lucifer, 46

iatrogenic disease, 9, 16 maintenance therapy, 9-10, 18

'identified patient', 10, 162, 169, 172 malpractice suits, 87
illness (see mental illness, disease mania, 4, 13, 18, 46, 93, 102-8, 162;
and specific illnesses) definition of, 177; process
imbecility, 4 structure of, 103, 105-6
'inappropriate feeling', 38, 39 manic affective disorders, 16
Inapsine, 9 manic depressive illness, 4, 93;
India, 83-4 Torrey on, 17
individuation, 74; process, 23, 176-7 Mao Tse-tung, 119
Inner Dreambody Work, 74 marijuana, 111
Innovar, 9 medical model: definition of, 177;
insanity (see also mental illness, and Jung, 27; and psychiatry, 3-4,
notions of), 12, 24, 54-5 5, 9, 29, 33, 51
insight, 26, 54, 99, 146-7 medication (see also medicine, drugs
integration: of altered states, 74; of and psychopharmica), 5, 18, 49,
psychotic episodes, 49, 51, 60; of 106, 165; and altered states, 59;
secondary process, 62, 80; of antipsychotic, 10; and behavioral
symptoms, 77 change, 23, 58, 95-6; choice of, 17,
internal states, 69, 71, 72, 73, 74 52; effectiveness of, 23, 50;
introversion, 74, 171 inadequacies of, 10, 11, 16;
Iositane, 9 maintenance and, 10; and process
Ireland, 55 reversals, 95-6; side effects of, 9,
10, 57; working without, 28, 75
Japan, 55 medicine (see also drugs, medication
Jesus, 59-61, 64, 171 and psychopharmica): field of, 3,
Johnson, D.A.W. et al., 9 5, 6, 13, 16, 24, 163, 165; and
Judeo-Christian tradition, 98 iatrogenic disease, 9; and mind
Jung, Carl, 15, 27 altering drugs, 112-13;
Jungian psychology (see also psychosomatic, 6
analytical psychology), 14, 26 meditation, 6, 71, 74, 77, 112;
Buddhist, 76; process-oriented,
Karon, Berthran P., 11, 14, 16 76-7; vipassana, 79, 80
Kesey, Ken, One Flew Over the memory loss, 74, 123
Cuckoo's Nest, 106 Mellarille, 9
Kessler, K., 9 mental health sciences, 7-8, 18,
Kiev, Ari, 166 19-20, 163
kinesthetic channel, 22, 63, 81; and mental health staff, 170
mental retardation,149-50,153,155 mental illness (see also disease and
Kuhn, Thomas, 4 specific illnesses), as chronic,
9-10; classifications of, 4, 7, 11, 12,
Lader, Malcolm, Introduction to 14, 16, 17, 19, 34, 35, 166; and
Psychopharmacology, 10 culture, 10, 11-12, 13-14, 18-19,
Laing, R.D., 15-16 48, 166, 172; definitions of, 3, 5, 9,
language, 19, 22; structure, 21; use of 13, 16-18, 33, 166, 177; as extreme
tenses in, 38, 118-19, 140, 142, state, 12, 13; and medical myths,
147, 157, 160 40; notions of, 5, 10, 12, 24, 38, 41,
I 90 INDEX

53-4, 165; order and disorder of, neo-Reichian school, 26

11-13, 15, 24; and teleology, 15 nervous system, 113, 114, 128
mental retardation, 149-161, 162, neurochemistry, 19, 51
167; according to American neuroleptic drugs, 9, 10, 16
Association on Mental Deficiency, neurosis, 24, 177
150; according to American neurotransmitters, 50
Psychiatric Association, 149; non-organic psychoses, 19
according to Henderson and non-verbal, communication, 18, 22,
Gilespie, 149; and the collective, 69, 70, 71, 72, 73, 74, 75, 90, 145,
150, 161; and communication, 155; 155; secondary process, 73-4
definition of, 177; and 'normal' (see health, concepts of)
differentiation from sociopath, nosology, 7
149; and hyperactivity, 155;
meaning of, 161, 171; process
structure of, 153-4; as a state, 150; objectless projections, 37, 38, 39
working with, 155-60 occupation, 177-8; theory, 47, 52, 90,
100
metacommunication: definition of,
opiate alkaloids, 111
40; and grower's club, 40-1; with
organic brain: changes, 63; damage,
secondary process, 60
4, 13, 16, 67, 112; disease, 73-4;
metacommunicator: as available, 41,
intoxication, 112; syndrome, 123
45, 56, 58, 69, 70, 73, 99, 103, 114,
'out-of-body experiences', 74, 78
124, 129-30, 139; and
consciousness, 25; definition of,
25, 177; as missing, 13, 33-43, 44, pacing, 125
45, 54, 56, 64, 70, 86-7, 99, 130, pain, 59, 60, 62, 65, 78, 117, 118,
166; as weak, 71 121, 122, 127, 172
methadone, 18, 111, 113, 117, 120 pancreas, 128
mirroring, 125 Papua, New Guinea, 55
Mitchell, Peggy, 14 paradigms: analytical, 26, 40;
mixed psychoses, 14 behavioral, 8; biomedical, 3, 4, 5,
Moban, 9 9, 51; as inappropriate, 98-9;
mood: and bipolar disorder, 93; process, 4, 5, 21-30, 77, 162-3, 168;
changes, 23, 24 in psychiatry, 3-5, 6, 11, 19-20, 39,
moral considerations, 48-50 162; psychotherapeutic, 98;
morphium, 111 transpersonal, 8
Morriss, James, 4, 12 paralysis, 141
mother, 51, 102, 141, 146, 147 paranoia, 80
movement (see also kinesthetic passivity, 67, 69, 70, 71
channel): choreathoid, 9; and Perry, J. W., 14
schizophrenia, 15; signals, 12, 36, personality: anti-social, 49, 137;
44, 47, 68, 88, 145, 152, 156, 168; as social, 49
unoccupied, 63, 81; working with, penomenological-existential model,
79, 81 33
murder, 45-6 physics, 5, 13, 23, 41-2, 101
mute, 67 placedo effect, 122
pluralism, 7
narcissistic psychosis, 33 Poe, Edgar Allen: 'The Tell-Tale
Navane, 9 Heart', 76
negative father complex, 165 polarizations: of processes, 28, 47,
negative mother, 51, 141, 146, 147 52, 71, 96, 99, 132, 166-7
negativism, 69, 71, 73 police, 18, 29, 35, 43, 57, 94, 108,.
neopsychoanalytic therapy, 14 121, 137, 139-40, 151, 163, 169, 171
 INDEX 191

politics, 101, 163, 170 processes, 25, 46

postures, 67, 81, 102, 113, 117, 122 proprioceptive: blunting, 78;
positron emission tomography, 178 channel, 22, 23; experience, 22, 62,
pragmaticism, 7, 8 73, 79, 81; type, 62
Pribram, Karl, 42 psyche, 37, 39, 61
Prichard, J.C., 54-5 Psychiatric News, 9
primary process, 25-6, 70, 140, 164; psychiatry: in America, 7; crisis in,
of alcoholism, 124, 126, 130; and 3-20, 165; and culture, 10, 16-17,
awareness, 77; of catatonia, 70; 108; definition of, 178; and disease
and conflict with secondary descriptions, 3, 4, 5, 7, 9, 11, 12,
process, 65; congruency of, 168; 13, 14, 16, 17, 18, 19, 33, 34-5, 166;
and culture, 86, 87, 107-8, 166; and integration with psychology,
definition of, 25, 174, 178; 4-5, 6, 13, 163; medical model in,
dramatization of, 52; of epilepsy, 3-4, 5, 9, 29, 33, 51; paradigm in,
63; and extreme states, 41, 48-9, 3-5, 6, 7, 11, 19-20, 39, 162; as pre-
52, 53, 73, 165, 166, 167; flipping science, 7-8, 20, 101; process
of, 64-5, 85, 87, 96, 164; of heroin paradigm in, 21-30; and role of
addiction, 113-14, 117; psychiatrist, 165-8; terms in, 24-5,
identification with, 78; inhibition 33; transcultural, 13-14, 166;
of, 61; of mania, 102-3, 104, 105; treatment in, 8-9, 14-15, 16, 17, 18
and mental retardation, 153, 158; psychoanalysis, 14
and metacommunication, 70; as psychoanalytic: dream theories, 87;
missing, 74; relating to, 125; as interpretation, 39; technique, 11
rigid, 63; of schizophrenia, 37, 48, psychodynamic model, 33
51, 58, 60; of sociopath, 138, 139, psychological interventions: and
140, 142, 146; and suicide, 64, 95, inaccessibility to extreme states,
96, 97; as weak, 167 51, 56, 104; moral considerations
probation, 19 of, 48-50
process (see primary and secondary psychology (see also psychotherapy
process): concepts and terms, 12, and specific schools), 104; depth,
24-6, 27, 173, 180; definition of, 24; integration with psychiatry,
178; field aspect of, 38-9, 47, 52, 4-5, 6, 13, 163; optimism in, 101;
90, 100, 114-15; paradigm, 4, 5, as pre-science, 7, 101; trans-
21-30, 77, 162-3, 168; personal, 14-15
psychologies, 27; reversals, 51, 61, psychopath, 137
65, 85, 96, 118, 164, 166-7; psychopathy, 4
structures, 25, 30, 36-7, 44, 50, 52, psychopathic disorders, 16
58, 70, 71, 95-7, 98, 99, 103, 105-6, psychopharmica (see also drugs,
113-14, 117, 124-5, 129-30, 132, medication, medicine and
139-40, 153-4; unfolding of, 24, specifics), 8, 58, 59; coupled effects
26,43, 89 of, 23-4; side effects of, 57;
processes: coupled, 24; flipping of, treatment with, 14, 17-18, 57, 99
44-5, 46, 50, 51, 52, 53, 59, 60, psychoses: mixed, 14; non-organic, 19
64-5, 85, 87, 90, 96, 97, 129-32 psychosis: as altered state, 122;
process-oriented meditation, 76-7 definition of, 13, 85, 96, 164, 166,
process-oriented psychology, 6, 12, 178; and failure of psychotherapy,
27,53, 54, 73; concept of disease, 16; future predictions of, 133,
24; goals of, 43; limitations of, 52, 167-8; as patterned, 12, 56, 162,
53 166; and previous identity, 46, 48;
projection, 30, 104; mechanism, 39; relapses of, 9, 10, 38, 49; as a state,
as objectless, 37-9; of and 41, 164; understanding of, 52, 56,
occupation theory, 47; secondary 101, 167
I 92 INDEX

psychosomatic: complaints, 128; 56-66, 67-72, 86, 87-9; as

illness, 167; medicine, 6; situation, catatonic, 67-74, 86; cause of, 16;
22 and the collective, 48-9, 54-6, 83,
psychotherapy: and alcoholics, 132; 85-7, 90; definitions of, 33-5, 85,
beliefs in, 104; ineffectiveness of, 96,178; and delusions, 75, 80;
10-11; and process paradigm, diagnosis of, 34-5, 75, 166;
26-7; and sociopaths, 137; verbal, 18 differentiation from bipolar
psychotic: corner, 164, 178; disorder, 93; Freud on, 33; and
episodes, 19, 28, 46, 49, 52, 56, hallucinations, 75, 80; and
64-6, 73, 83, 86, 93, 102, 163, 165; inability to synthesize, 78-80; Jung
individuals, 19 on, 15; Laing on, 15-16; and
psychotic states (see also extreme metacommunication, 40, 41, 64,
states and psychosis), access to, 86-7; onset of, 83; and pain, 78;
52, 56, 164; as acute, 52; and and process reversals, 61, 64-5,
analytical approach, 163-4; beliefs 167; process-oriented definition
about, 163-4; and chemistry, 18; of, 38; process structure of, 36-7,
and culture, 11-12, 13-14, 18, 19, 58-9; rate of, 16, 55, 86; and social
86, 119, 165, 166; definition of, 164; economic groups, 93; and suicide,
integration of, 49, 51, 60; meaning 49, 50, 87-9; Torrey on, 17-18, 21,
of, 11, 50, 99, 172; and missing 48, 75, 77-8
metacommunicator (see schizophrenics: as political radical,
metacommunicator); process- 16; and psychological
oriented approach to, 4, development, 54
52; structure of, 12, 56, 101, 167 Schoop, Trudi, 14
pupil dilation, 73 science, 4, 18, 27
scientific revolution, 4, 18
relapses, 9, 10, 49, 51 secondary process, 25, 26, 60, 65, 70,
relationship, 21, 35, 83, 125; 140, 164; accessing of, 62-3, 64, 65,
definition of, 158; and feedback 70-1, 72, 98, 129-30, 141, 144 6,
loops, 38; and mental retardation, 156-7; of alcoholic, 124-5, 126-7,
150, 152-61; problems, 24, 65, 113, 129-30, 132; and altered states, 59,
114, 115-16, 117, 152-60, 169; 64; as awareness, 77; of catatonia,
unfaithfullness in, 12; work, 6, 22, 70; as collective, 85, 86; cycling of,
33, 74, 157, 158-60 128; definition of, 25, 26, 178-9;
relationship channel, 22, 23; as and delusions, 80; as dreamed up,
unoccupied, 152, 154 53; of epilepsy, 63; and extreme
relativity theory, 5 states, 41, 52, 53, 70, 86, 166, 167;
religious experiences, 8, 51, 70, 171 flipping of, 64-5, 85, 87, 89, 96,
resistance, 54 164; and future predictions, 133,
retardation (see mental retardation) 167-8; of heroin addiction, 114,
River's Way, 26 117; and hypnosis, 61, 62;
identification with, 78; as illness,
sanity (see health, concepts of) 24; and language structures,
Scandinavia, 55 118-19, 140, 142, 147, 157; of
schizoaffective disorders, 17 mania, 102-3, 105; and mental
schizophrenia, 4, 13, 24, 65, 90, 116, retardation, 153, 156, 157, 158; as
129, 162; and alteration of senses, non-verbal, 73-4; respect of, 46; of
75, 76; and altered sense of self, schizophrenics, 37, 51, 58, 59, 60;
75, 80-1; and awareness, 77, 79; of sociopath, 139, 140, 141, 142,
and behavioral change, 75, 81-3; 144-5, 147; and suicide, 87-8, 95,
Bleuler on, 33-4; and blunting, 97,98; use of, 59-60, 83
75-8; cases of, 35-55, 46, 49-51, seizures, 63
 INDEX 193

self, 42 stress theory, 33

senility, 13, 73, 162 subconscious states, 57, 58, 59
senses: alteration of, 75-7; blunting subnormal intelligence (see also
of, 75, 77-8 mental retardation), 14, 149, 150
Serafetinides, E.A., 14 suicide, 4, 12, 13, 49, 50, 63-4, 87,
Serentil, 9 129, 137, 139, 162, 172; process
shadow, 162-72, 179 structure of, 95-7; and psychotic
shamans, 112, 118 depression, 93-9; Torrey on,
shock, 63 49-50; as unconscious, 128
sickness (see mental illness and Suzuki, Shunryu, 90
disease) swallowing, 71-3, 72, 73
signals (see also body signals, double Switzerland, 42, 48, 54, 85, 107
signals and movement signals): symptoms (see also body symptoms):
and communication, 73; as integration of, 77; relief of, 22
coupled, 22; dramatization of, 52, synchronicity, 21, 22, 46, 71, 179
68; and feedback, 38; as filtered systemic structures, 8
out, 38-40, 42, 45-6, 52, 89, 90; systems, 47, 100
negative, 39-40, 69, 70; and systems theory, 14
pacing, 125; perception of, 5, 6, 12,
29, 46, 73, 88, 90, 166; primary, 27;
Taoism, 27
repetitive, 89; secondary, 27, 46,
Taractarn, 9
164; structure of, 30, 52; as
Tardive dyskenisia, 9, 179
synchronistic, 71; system, 12; and
tea addiction, 111
third parties, 128;
teleology, 15
unconsciousness of, 39
therapies. behavioral, 15; dance, 14;
singing, 82
family, 14; group, 11, 14;
sitting positions, 12, 102, 113, 122,
maintenance, 9-10;
131, 151, 153
neopsychoanalytic, 14
skin color, 73
therapist: awareness of, 12, 53, 73,
sleep, 93, 105, 157
87, 88, 89, 90, 99; as a drug, 127-8,
sleeping pills, 113, 117
131; goals of, 30, 53, 99, 106; guilt
smoking, 111
of, 128-9; and missing feedback
social psychiatry, 161
loop, 39-40; unconsciousness of,
social revolution, 8
39, 40, 89, 107
social security, 19
thermoelectric effect, 23
social services, 18, 161, 170, 171
Thorazine, 9
social work, 6, 108, 147-8, 163; and
thought blocking, 69
role of social worker, 18, 147-8,
Torrey, E.F., 4, 17-18, 21, 48, 49, 50,
168-70; project, 28-30
54-5, 75, 76, 77, 78-9, 80, 81
sociology, 13; and models of
training: with extreme states, 52-3
schizophrenia, 33
trance states, 171
sociopath, 137-48; definition of, 137,
transcultural psychiatry, 13-14
179; diagnosis of, 137-8, 138; and
transference, 26, 33
differentiation from mental
transpersonal psychology, 14-15
retardation, 149; and police, 137,
treatment centers, 18-19
139; process structure of, 139-40
trickster, 171-2
sociopathy, 4, 24, 162, 170
Triovil, 9
Sparine, 9
sports, 112
state (see also specific states), 13, 179 unconscious, 5, 24, 30, 36, 163;
stealing, 169 definition of, 180; as personal, 178;
stomach aches, 22, 26 states, 58; and symptoms, 24
I 94 INDEX

unconsciousness, 79; function of, 39, Waletzky, S., 9

40, 58 Weil, Andrew, 112
United States of America, 7, 55, 93, Wilbur, Ken, 15
121 withdrawal, 22, 25, 67, 81, 162; from
heroin, 113, 114, 115, 116-17, 119;
Vandenbos, Gary, 11, 14, 16 of thought, 35
vegetative responses, 22 women's liberation movement,
vipassana meditation, 79, 80 107
Virgin Mary, 18, 51, 171 Working with the Dreaming Body, 63
visions, 64, 74 world: change, 54-5, 100-1, 107-8,
visual: blunting, 78; channel, 22, 23, 172; channel, 22; problems, 98,
62, 80-1; experience, 76, 77; type, 100-1, 119, 171-2
62 World Health Organization, 111
visualization, 22, 62, 164 Wyatt, Richard, 14
voice signals, 12, 58, 68, 80, 113, 114,
130, 131, 151, 156
voices: and schizophrenia, 15, 45-6; yoga, 81, 112
working with, 22, 64, 77, 80 Yugoslavia, 55