Saints and Madmen : Psychiatry... | Buy

Chapter One

The New Psychotics

Consider that you are in God, surrounded and encompassed by God, swimming in God.

--Mother Teresa

Space is the place.

--Sun Ra

The cracking open of Joshua Bell's world began on a thick August day in 1996, in New York's Central Park. Actually, depending on how you figure these things, it could have started at the beginning of that summer. No one knows why a large percentage of what psychiatrists call psychotic episodes occur at the coming-of-age stage of life--late teens to early twenties--but one guess is that the unhinging of one's sense of reality is in these cases related to that first significant severing of connection to home and parents. Going out on your own, planting your identity in new soil, giving it new air to breathe, a chance to grow in new directions, not necessarily the straight-up path your parents encouraged but maybe sidewinding, maybe forgoing the air altogether and burrowing down, exploring the soil itself--such wild freedom may be just too much for some psyches.

In Joshua's case there was an extra dose of disorientation. He had been born and raised in Honolulu, where body-boarding, pottery, and Bob Marley were his major interests. The only other part of the world he knew was the even more laidback surf town of Santa Cruz, California, where he had spent his first two years of college at U.C. Santa Cruz. But his father thought he could do with a bit of real-world experience, so he arranged a summer internship at Citibank in New York City. Out of filial duty, Joshua went along with the plan, but the new environment was almost overwhelming; he had never been to the East Coast, and the throbbing, broiling, stiff-necked skyscraper cauldron of Midtown Manhattan was like another planet. He had no friends in the city, no points of contact with anything he knew, and the pin-striped account jockeys that surrounded him might as well have been zoo creatures.

On that day in August, his wandering around the city landed him in Central Park. He was wearing sandals and had cut his foot; he asked someone nearby if he happened to have a bandage. In answer, the fellow handed him a rolling paper. Joshua grinned and said thanks, whereupon the stranger gave him a shaka , a waggle of the thumb and little finger, the Hawaiian "be cool" sign. They began talking; the guy had been to Hawaii. Joshua fell in with the young man, whom we will call Alan, and who turned out to be "temporarily homeless and temporarily unemployed." He had an interesting potential business, though, selling quartz crystals, which he said he had mined himself. He took Joshua to a truck; indeed, the back was filled with crystals. He just needed a little money to get things off the ground. Joshua loaned him two hundred dollars. He was beginning to feel a little light-headed. "Let's go clubbing tonight," Alan said.

They ended up at Wetlands, a downtown club that showcased world music. Late in the evening, after a few drinks and a modest amount of marijuana, Joshua found himself in a separate room in which a "drumming circle" was taking place. He picked up a drum and joined in. And then it happened. He doesn't know how much time passed, but he began to feel part of the rhythm, that he was the rhythm, that he was carrying the whole drumming circle. Very quietly, as if tiptoeing across an unnoticed line, his personality unhinged.

Standing outside the door of his apartment building at four o'clock that morning, he noticed a shadow on the back of his hand. As he watched, it took the form of a falcon. Then the falcon flapped its wings and transformed into a bear, then a bull. He was mildly astonished, and went inside to get a better look at himself. In his apartment, he saw a "rainbow of electrical beams" shooting through his palm. He held his arms out to the sides and watched light pass through his body. He examined his mood, and realized that he felt exhilarated and wonderfully peaceful at the same time. He had enough attachment to reality to understand that something unusual was going on, but he felt sure--and continues to this day to be sure--that he wasn't delusional. "These were not hallucinations," he said, "because I definitely saw them." Instead, he had the strong impression that this was "the beginning of some sort of enlightenment process."

Hold it right there. The glossary of the American Psychiatric Association defines psychotic as "grossly impaired in reality testing," meaning that a person loses the ability to tell the difference between the real world and the fairies of the mind. Psychosis involves delusions or hallucinations; one common manifestation of psychosis is "hyperreligious ideation": believing you are God, seeing angels, believing you have a special mission to save humanity. Throughout the past century, and right up to the present, psychiatrists and psychotherapists have done a lot of hand-holding with people in psychotic states, listening to reports of their ecstatic visions, their accounts of meetings with Jesus and Lao-tzu, nodding a great deal, and then beginning the slow job of grounding the person, encouraging a reconnection with ordinary reality by talking about the weather or common objects. There is even a (rather grotesque-sounding) term for it in behavioral psychology: extinction ; the goal is to extinguish the delusional behavior with a bucket of cold, bracing mundanities. The strategy has been to get the patient out of the state, the way one might climb out of a ditch, and forget about it.

In the days following his drumming circle experience, Joshua found himself submerging more and more frequently into his sublime state of awareness:

I might be staring at a tree, and all of a sudden I see the spirit of the tree manifesting itself, the God-createdness of the tree. I see how it relates to the tree next to it, the roots and branches touching the next tree. I see the meaning in that, and it flows over to touch events in my own life, how things that have happened to me are related to other things in the world. People say that everything happens for a reason--suddenly I really believe that. From out of nowhere I'm plunged into moments of spiritual truth and awareness of the interconnectedness of matter and mind and of my place in this beautiful universe--moments of totally feeling the presence of God. I don't need any proof of the existence of God.

But the bliss soon took on a jagged edge. "Ideas of reference" is a psychiatric term meaning that in a delusional state people often think that other, seemingly unrelated things--song lyrics, TV news commentators--are directed at them. Joshua began "referencing like mad"--he became convinced that radio DJs were communicating coded messages to him; he interpreted casual references to religious figures--the prophet Mohammed, Jah Rastafari--as pointed at him.

Two weeks after the drumming circle experience, Josh's summer was over and he was due back at school in Santa Cruz. In Hawaii his parents had begun to suspect that something was wrong, however, and asked him to come home before he returned to college. Up to this point, Joshua hadn't talked to anyone about what he was experiencing; he was convinced that if he did so people would try to halt his journey to enlightenment. In Honolulu, he did what he called a "red shirt/blue shirt routine" for his parents' benefit: "You know, it's like, you wake up one morning and put on a bright red shirt, and everyone compliments you on your beautiful blue shirt. You're confused so you look in the mirror, but you keep seeing a red shirt. The point of the parable is, what color is the shirt? While I was in Hawaii, I told my parents what they wanted to hear. I said, `Yeah, it's a blue shirt.'"

Having successfully ducked his parents' fears, he went back to Santa Cruz, where he roamed the beach and wandered in the redwood forests, dumb with wonder and feeling "this intense connectedness with everything around me." He reviewed his past, particularly episodes that had troubled him, and saw them with a new, broader vision. He asked for forgiveness for past wrongs, and felt cleansed.

The semester started, and he found that schoolwork was much more difficult. A single sentence in a homework assignment might arrest him with its cosmic significance, so that he could go no further. He could see the auras of professors; he became convinced that one professor, whose aura appeared as a beam of light coming straight down from the ceiling to engulf her, was an angel. He developed an elaborate angelology: the unseen spaces of the universe were peopled by hosts of good and evil creatures, and they liked to place bets over his smallest actions. The act of putting on shoes became a moral battle, with phalanxes of cosmic creatures casting bets on which shoe would go on first. He would go catatonic, rigid in fear that he might choose the wrong shoe and send the universe out of moral alignment. One way out of the dilemma was to decide not to wear shoes; he frequently opted for this solution.

Things descended quickly. Televisions, telephones, microwave ovens--any electrical device might be bugged or used by one or another angel gang to coerce him. He started to rave. He stopped bathing; for several days he didn't eat, sleep, or change his clothes. He was too far gone to even know who reported him, but on October 22, Santa Cruz police officers came to his dorm room and took him into custody on California Code 5150, being a danger to oneself.

One might think the nightmarish aspect of the experience was over at this point, but in fact it was just beginning. As he was taken away--barefoot, filthy, in ankle restraints and handcuffs--he remained very still and tried to keep his mind from exploring the depths that had become normal: "I felt that anyone of any importance could read my mind. It seemed natural that they were doing this to me. It was Christ-like. It confirmed the delusion that I was important. They were going to crucify me."

If the fact that he had become godlike was now known by his enemies, whose agents were about to torture him and experiment on him, he could at least tell them that he understood their game. At Belmont Hills Psychiatric Hospital in Santa Cruz, psychiatrists administered a standard reality test called Draw a Person; they gave him a piece of paper and a pen, and asked him to draw a human figure. He swiftly drew a clear, recognizable body with all of the major features, then he asked them for a second sheet. With this one he took his time, covering it with circles, eyes, linked infinity symbols, connecting arrows. He handed both sheets to the doctor, leaned in close for emphasis, pointed first at the man and then at the other drawing, and said, "This is what you wanted me to draw. This is what it is ." His initiation in the mysteries had progressed too far for him to humor anyone with any more games of red shirt/ blue shirt.

His psychiatrist at Belmont Hills believed he was in an acute manic episode with schizophreniclike symptoms, and that he showed signs of schizoaffective disorder, a combination of schizophrenia and bipolar disorder, a condition from which a large percentage of patients do not recover. She prescribed Haldol, a powerful antipsychotic medication designed to grip the reins of the mind, pull the charging teams of ideas to a halt, and blinker them to prevent any straying. The side effects of Haldol can include, in the words of the Synopsis of Psychiatry , "acute dystonic reactions and Parkinsonian symptoms"--neck and tongue spasms, face twitches, and stiffness, as well as "cognitive dulling." At large doses it produces what mental patients refer to as the Haldol Shuffle, a zombie-like walk, eyes down, slippers scraping along linoleum floors, facial features giving the distinct impression that very little is going on upstairs. The psychiatrist also put him on lithium to control his mania and regulate his mood.

Meanwhile, Drake and Judy Beil sat at their son's bedside stricken with anxiety. "It was absolutely frightening to think that we had sent off into the world a gifted kid and what came back was a vegetable," said Drake Beil. "We were overcome by guilt. Did we fail in preparing him to deal with the real world? And through it all was the thought that he might not come back, that this might last forever." The emotional low-point was the day Drake Beil pulled out the same building blocks Joshua had played with as a two-year-old and carefully stacked them up in front of his debilitated son. "I said, `Let me show you what I think is happening here. These blocks are inside your head. Now, maybe they just got knocked down, in which case we can build them back up.' But ... maybe they're not there anymore."

But the blocks were still there. Over the next several weeks Joshua was moved from the hospital in California to one in Hawaii, taken off Haldol, and given another, newer antipsychotic drug called Risperdal. His memories of his weeks in various hospitals are classic horror stuff: men in white lab coats coming and going, leaning in to ogle at you; time out of whack; diving into sleep as into a refuge; more lab coats; his parents' faces leaning in, their voices seeming distorted. All of it hazed, as if experienced through cheesecloth.

And then ... done. Joshua was to be one of the lucky ones: the antipsychotics had done the trick; his consciousness came swimming back to the surface. One day sitting with his parents, Wheel of Fortune came on the television. `All of a sudden Josh started guessing the puzzle and goofing on the contestants," his father said. "Then he turned to me and said, `Josh has entered the building.'"

Joshua was released into his parents' care. He still felt a profound confusion and disorientation, but he knew he was back, that it was over. He could now put the whole ugly episode behind him and begin the slow task of getting on with his life. He took a couple of classes at a community college, got a job at a local Starbucks, made plans to re-enroll in college and finish his degree.

But no, it wasn't going to be that neat. He couldn't just forget. In many respects, Joshua's story is fairly commonplace. Psychosis is a general term that covers a wide variety of out-of-touch-with-reality conditions; one of the most common and severe of these, schizophrenia, afflicts two million Americans, nearly 1 percent of the population. At least 40 percent of those who are laid low by a schizophrenialike episode will develop it as a more or less permanent condition. For those lucky ones who are visited by a single psychotic episode that then vanishes, most, following professional advice, treat it as something akin to a vicious bout of the flu and push ahead with their lives. Joshua's encounter with mental illness entered a different category, a whole new realm, when, after the illness itself, he decided not to let go of it.

Why would he decide such a thing? Because, simply, it had felt good--it had felt wonderful. There was something so wonderful about it, in fact, that it seemed to crack through his ordinary way of knowing himself and the world and deliver him into a new awareness of the world as whole and true, and of himself as an integral part of it. It was so wonderful that the memory of it still glinted through all the horror and murk that had surrounded it. Because of it, Joshua had a glimmer of himself as a better, fuller, healthier person. How could that be bad? Yes, there was a great deal of horror and neurological mayhem involved in the experience, but equally surely there was something so profound and blissful that he simply couldn't let it drift away:

I close my eyes and look directly at the sun and feel the warmth. I know it is God, like a form of communication that he uses. Why didn't I know this before? It's so obvious, so obviously HIM. I am blissed-out on the world itself. I understand the internal workings of the universe and my role within it, the innerconnectedness of all things.

It was this determination to hold on to his psychotic experience that made Joshua different. He was one of what might be called the New Psychotics, people who, even after returning to sanity, continue to believe that their mental illness somehow pushed them into a state of spiritual awareness. Granted, people have done something similar in the past. Anthropologists have studied the ritualization of this state of consciousness in primitive societies: how, at around the time of adolescence, tribal youths undergo a ceremonial form of madness, sometimes involving the use of psychoactive drugs to bring on the altered state. The rite-of-passage ceremony signals the death of childhood and the birth of a new adult member of the community; it is, by some thinking, an institutionalized way to manage what comes about haphazardly in cases such as Joshua's. And while it is impossible to be certain, especially since psychosis is such a modern notion, various people throughout history may have seen themselves as having gone through both a psychotic and a mystical experience. On such a list might be found Saint Paul, Saint Teresa of Avila, Martin Luther, Saint Francis of Assisi, the playwright August Strindberg, George Fox, the founder of Quakerism, the dramatist Antonin Artaud, and the writers Allen Ginsberg and Dostoevsky.

Unlike these famous sufferers, however, Joshua came to his determination at a crucial time in the history of the psychotherapeutic professions. On January 4, 1993, in a meeting of almost surreal historical proportions, Dr. Joseph English, president of the American Psychiatric Association, entered the Vatican Palace and commenced a dialogue about sin, guilt, God, and medicine with Pope John Paul II. These representatives of two world-historic priesthoods did not merely exchange platitudes, but seemed actually to see eye to eye on some fundamental points. Dr. English, the representative of a field that has traditionally treated religion as a form of illness, told the pope, "Some of us feel, in the spirit of this season, that we have followed a star to be with you on this day, that we are here in the spirit of Epiphany." Perhaps more remarkably, after the pope had expressed his belief that a full understanding of an individual must take into account the "spiritual dimension and capacity for self-transcendence," the psychiatrist agreed.

The meeting between the psychiatrist and the pope was reported in news media around the world as a milestone. In fact, it was a metaphoric climax to a quiet but remarkable change of outlook that had been building over the previous decade or so. Everyone knows that psychology speaks a language that is profoundly different from religious language, that the two spring from different eras of human history and involve different understandings not just of human beings but of even vaster enterprises: life, the universe. And many people know of various recent efforts by psychologists to link their field with some religious tradition or technique, such as meditation.

What may not be so well known is just how widespread is this reaching out to religion on the part of psychologists and psychiatrists. These modern sciences of the individual, born in the age of Queen Victoria, are transforming themselves before our eyes. Many professionals in these fields have come so far from Freud's classic definition of religious experience ("regression to primary narcissism") that they believe it is a biological fact of life, that religion is in our genes.

One result of this change of thinking is that there are now mental health professionals who are willing to examine people like Joshua Beil with a widened ontological lens. Some people in the profession want to study psychotic delusions and mystical experiences side by side, to bring religious experience into the realm of science.

As recently as the 1970s, the standard thinking in psychiatry was that schizophrenia (which at that time referred to all psychotic illness) stemmed from childhood experiences, specifically from a smothering, anxiety-ridden mother. But the pendulum took a huge swing in the other direction over the next twenty years; nearly all psychoanalytic theories about mental illness are now out the window, replaced with neurochemical explanations. Magnetic resonance imaging, PET scanning, and other technologies have helped bolster the biological argument by revealing neurological abnormalities in schizophrenic brains. Schizophrenia, says the National Alliance for the Mentally Ill, a vigorous, 170,000-member lobbying group, is a "biologically-based brain disease." This is widely considered to be a liberating notion since alternative explanations in effect assign blame for the disease to a parent or to the person afflicted. The neurochemical focus has also led to a new wave of antipsychotic miracle drugs that have pulled in people like Joshua from their unmoored, storm-tossed voyages of madness and given them a chance to start rebuilding their sanity one block at a time. Joshua firmly believes that antipsychotic drugs saved his life.

But there have also been attempts to look at psychosis in other, broader terms. Throughout the past few decades, some psychiatrists and psychologists have dealt with the borderland between psychosis and mysticism. In the 1960s and 1970s psychiatrists R. D. Laing and John Perry became famous for antipsychiatry crusades; both accused their profession of pigeonholing the psychotic as diseased and thus fundamentally different from, and inferior to, so-called normal people. A schizophrenic may indeed be mad , Laing has said, but he is not ill . The mind as a whole--including the unconscious, the place of dreams and phantasms and the source of awe--is like an ocean, of which the ego remains mostly ignorant. But a psychotic is in touch with it: he is swimming (one might say drowning) in it. He is not out of his mind but, in fact, in his mind; we, the sane, are the ones who are out of our minds, or rather out of touch with most of our minds, in that we can't access them. The psychotic is thus on a profound, dangerous, mystical voyage whose purpose is to find new, deeper ways to communicate. The psychotic isn't content with the ordinary ways of knowing that the ego offers, any more than the religious mystic is. By looking at psychosis as a mere illness, these thinkers said, psychiatry misses the whole point of the affliction: that it is ultimately an attempt to find deeper meaning.

Many of these radical ways of looking at psychotic illness have been reactions to the dominant medical model. Where the recent establishment view is that the problem is in the chemicals, and the solution is likewise a chemical one, these critics have charged that drugs are the enemy, that drugs bring dullness and slowness and the end of all that it means to be human; they can be useful but are ultimately a dangerous short-circuiting of a slower, deeper, more natural process. Such thinking has percolated in the profession for years, but it has remained largely peripheral.

The new wave of thinking that has taken root in recent years is different. It does not reduce the whole business of altered states of mind to drugs, and it also doesn't shy away from drugs: we are physical beings, it says, and as such we have physical brains that work via chemical transactions. But, this new thinking goes, we can also see ourselves as spiritual beings, as having a capacity to transcend ordinary me-in-here/you-out-there ways of knowing. This spiritual side of the human being is tied, in unfathomed ways, to the physical side and to the emotional. If that is so, then the work of a psychiatrist or psychologist goes deeper than those professions have traditionally believed. Psych, after all, means "spirit" or "soul," and psychiatry is, etymologically, soul-doctoring. The feeling has grown, especially over the course of the 1990s, that mental health professionals perhaps ought to take a slightly wider view of "abnormal" states of mind.

As an example of this new approach, at Oxford University in the early 1990s, five thousand psychotic and religious experiences were studied and analyzed for features of both psychopathology and spirituality. One of the findings was that the way an experience is treated by others influences how the subject deals with it. According to British pastoral counselor John Foskett, "If they were listened to and accepted, individuals found ways to integrate even the most disturbing ideas and emotions. If they were ignored or pathologised by others then the trauma was aggravated." Foskett added that "a purely psychiatric approach which explains [the experiences] in terms of dysfunction may actually be instrumental in producing pathological syndromes."

Perhaps more to the point than these findings is the fact that such a study even occurred to anyone and was deemed worth doing.

In his post-psychotic search for a deeper understanding of his psychosis, Joshua eventually found his way to a man who not only proved to be the ideal mentor to a twenty-one-year-old just back from the country of the mad, but who personifies this whole new way of dealing with psychosis and has helped to bring it into the mainstream of his profession.

His name is David Lukoff. Joshua went to Lukoff seeking "validation," and got it. You have been through something akin to Native American vision quests, to shamanism, Lukoff told him. Look at Van Gogh's artwork--he catalogued a similar experience. You can look at it as having to do with your relationship to a higher power. You were clearly in the grip of mental illness, but at least some of the experience was spiritually valuable. Your challenge now is to sort through it, to separate the wheat from the chaff, to isolate where you were onto something good and important, and then to figure out how to use those clues to reorient your life. The challenge is to find the deep meaning in your madness, to let that meaning flow through your whole life, to grow from your madness in ways that you couldn't possibly have grown without it. If you manage to do that, you will find that your illness wasn't a meaningless detour but in fact the most important, most fulfilling event in your life.

David Lukoff is a psychologist at the Saybrook Institute in San Francisco and at the San Francisco Veterans Administration Day Treatment Center. He has served on the faculties of Harvard and UCLA. In 1994, he, along with psychiatrists Francis Lu and Robert Turner, achieved a career-capping milestone when the American Psychiatric Association added to the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM), the bible of the field, a new diagnostic category that they had proposed. This category, the "religious or spiritual problem," while largely symbolic since it is not a billable diagnosis, has been like a hole punched through a wall. Suddenly psychiatrists were authorized to deal with issues of religion and spirituality as such, rather than translating them into the language of psychopathology. The establishment of the new category was covered not just in the Psychiatric News , but in the New York Times , where it was heralded as a sign that the field of psychiatry, traditionally so narrowly focused on the biomedical model, was opening itself up to religious experience.

At fifty, a thin-boned, neat, studious-looking man, David Lukoff is one of the leaders of the new spiritually attuned psychology. He writes and lectures to colleagues on the historic implications of this change; he has worked for years with people in the depths of psychosis; he more than any other single person brought the new DSM category into being. But he had other, more personal reasons for being interested in Joshua Beil's story. Joshua's appearance in his life took him back to the hippie-era roots of the current fascination with psychosis and to his own early adulthood. "When I heard his story," Lukoff said, "it was déjà vu."

(Continues...)