by Russell Razzaque
The full article appears in Kindred Spirit, issue 133.
Psychiatrist asks whether a break down could also be a wake up?
Zen Buddhists use koans – a series of questions to contemplate – as spiritual practice; each of which are considered to be, in some respects, portals to deeper levels of reality. The most common koan used is the simple question, ‘who am I?’ This is also the question that one of Hinduism’s greatest contemporary teachers, Sri Ramana Maharishi, suggested we ask ourselves repeatedly, as a means of attaining enlightenment. It sounds very simple, of course, and something we expect we should all know the answer to but, in fact, it lies at the heart of the existential conundrum with which we are faced every waking moment of our lives.
When does the air we breathe cease to become ‘inert’ and a part of the ‘outside world’ and suddenly become ‘me’ as we inhale it into our system? And what is it that we call ‘me’ anyway? The red blood cells in our veins last no more than four months. Our livers lasts about a year, our stomach lining is replaced every week, and the whole of our skin is completely replaced once a month. In fact, even our skeleton is replaced once a decade. And our internal world provides us with even less consistency; for it is said that we have something in the order of 12,000-60,000 thoughts every day.
So who is this constant me that we imagine walks around, lives and breathes and celebrates one birthday aft er another? Is there such a thing at all? Developing an uncertainty around one’s sense of self is a fundamental spiritual practice,that helps us get ever closer to our true nature, however, through years of working in my fi eld, I have realised that this is an experience that is not only confi ned to the spiritual seeker. There is, in fact, another group of people who are going through the exact same process. Namely, those who have been deemed ‘mentally ill.’
In a very similar way, severe forms of suff ering can lead an individual to question who they really are and why they are here. And, while seen by many as neurotic, it is exactly this questioning that the spiritual seeker is encouraged to engage in. And after a certain amount of practice, over time, the seeker might start to feel that she is more than just this skin-encapsulated ego that she hitherto believed.
A sense of connection with a greater reality –one that essentially knows no bounds– is a common outcome of meditation and certain forms of yoga. But on the wards where I work, and in psychiatric units up and down the country, this same shift ,away from a concrete, boundaried sense of self, is what those who are having what is known as psychosis are experiencing too.
There is a sudden sense of connection to a variety of things outside one’s traditional definition of ‘self’. In fact, the parallels between spiritual awakening and psychosis are so strong that a book exploring spirituality and psychiatry, published by the Royal College of Psychiatrists, stated that phenomenologically, the two experiences were, in fact, indistinguishable.
The key diff erence existed, not in the nature of the experience itself, but what came afterwards. For those who were seeking spiritual enlightenment, the experience was followed by a renewed sense of purpose and meaning in life, with which came a deeper satisfaction and contentment with the present moment and all their circumstances. Those who had not arrived at this place voluntarily, however,reacted with fear and anguish, and this sometimes then led their thinking ego mind to start to impose interpretations onto the experience, which is what then plunges the suff erer into a potentially terrifying cycle of paranoia or, alternatively, grandiosity. It is as if the ego is fi ghting back to regain control.
Trauma and the Ego
In fact, the ego is no diff erent from a piece of skin in this respect. If a piece of skin is battered and bruised, it will start to crack. This leads to an infl ammation of the skin itself but, at the same moment, it will also produce cracks, and it is through these cracks that the outside world starts to seep in. And so it is with the ego. Those who experience mental illness have almost always experienced trauma, either personally, or somewhere historically in previous generations. This trauma then punctures the ego, which then reacts with a combination of infl ammation and dissolution and, as a result, as well as the pain and hardship that such suff ering brings, there is also a genuine brush with deeper levels of reality that comes with it.
It is no coincidence, therefore, that surveys show that around three-quarters of those who have experienced severe mental illness describe themselves as ‘deeply spiritual’ compared to perhaps a tenth of that fi gure in the general population.
A study by a psychologist at King’s College, London, found that those who had encountered such experiences ‘accidentally’ as it were, were more likely to have poor outcomes, in terms of future functioning, involvement with psychiatric care and other diff iculties, if they did not have around them a community that provided some degree of validation of that experience. In other words, if an articulation of the experience – however difficult– was met with a pejorative interpretation from others, for example, describing it as ‘madness’ or illness, then they were less likely to do well, whereas those who were received more sympathetically, with an open mind and no automatic judgements, proved more likely to do better in future life.
What this tells us is that in order for us to see better outcomes in people enduring this kind of suff ering, society needs to change its attitudes to what is being described. If we become more able to approach such experiences with a warm heart and an open mind, then the outcomes can change signifi cantly. And interestingly, this is exactly what happens in the developing world. A series of studies by the WHO, over the last 30 years have consistently shown that long term outcomes in people diagnosed with schizophrenia are better in the developing world – where there is very little by way of mental health services – than they are here in the West. What this is almost certainly due to is the wider, more accepting community that forms around the individual. Extended family gets involved and, crucially, there is an openness to the spiritual and this is then used as a lens through which the experience can be interpreted – as well as any available medical and scientifi c paradigms too. In some countries, in fact, spiritual practitioners – like holy men in India, or shaman in Brazil – work in active partnership with psychiatrists.
About the Author: Dr Razzaque is a consultant psychiatrist in East London, Associate Medical Director of the local Trust and the Dean of The College of Mindful Clinicians.