Listening to the Psychotic
There are times when ministers and congregations are faced with people in their midst in services and in pastoral encounters with conversations and behaviour that can seem bizarre and, for some reason that we cannot quite work out, rather frightening. Added to that, there are times when feelings arise in us that take us by surprise and may frighten us and at times seem as though they could overwhelm us. We may hear elaborate conspiracy theories where the person takes centre stage as both the innocent victim of cruel and persecutory forces envious of their significance and power to transform the lot of humanity, or at least their little bit of it. Some will reveal in the course of their story that they are emissaries of the divine in some way, perhaps God’s Son or Jesus, awaiting God’s final public vindication and anointing when all will see who they really are and accept them. There will of course be many other kinds of stories.
One disconcerting aspect of meeting such people can be that initially their story can seem extreme, but not beyond the realms of possibility, so that it is only as the tale continues that the more bizarre nature becomes apparent, like a progressive revelation in a film or book. Along with this there are already mentioned accompanying the feelings that become apparent in ourselves. With some people, and on some occasions, they may have a very strong impact on us, leaving us with a sense of being disturbed but none too certain why. What kind of emotions? Irritation, boredom, disgust, anger, rage, hatred, fear for example.
There are times when we feel somehow mentally and emotionally ensnared, as though we cannot break free of the person, what they were saying and the emotions that they seem to have produced in us.
In the light of this it is perhaps not surprising that we can find such encounters very unsettling and if we look a bit deeper a source of considerable anxiety. For they set up a series of oppositions within our minds; between our experience of people in this mental state and the beliefs that we hold; between the feelings we discover in ourselves and those we feel we should have as ministers and people of faith; between the thought that we should have answers and the reality we do not; between the minds that we have and the confusion in which can find ourselves left.
This kind of experience is, I would suggest, quite normal. It is to a greater or lesser extent what all of us who work with psychotic people experience. It is of the essence of the encounter. It is because of the very nature of psychosis.
I would also suggest that what we are experiencing in these situations is the psychotic person communicating with us. Although on the face of it they are telling us bizarre and perhaps unbelievable and disturbing stories they are telling us something of how they are experiencing the world and themselves. When ill they are not able to distinguish between the world of external reality and the dream like phantasies that they are experiencing. Both are equally real. It can be said that the dreams we experience when we are asleep are moments of self-revelation when our unconscious minds “speak to us” in symbolic ways. When we wake, although we may be aware of anxieties that have been with us in the dream and are still available to us on awaking, we usually immediately know the difference between the external world around us and the dream we were having. As we recognise the symbolic nature of the dream we have the possibility of finding a measure of understanding it. This is not available to the psychotic person, for whom there is no sense of a symbolic world, it is concrete and real. What we may say is an hallucinogenic experience, to them is real.
It is important that we listen to the person and do not just dismiss what is being said. What they are saying has real meaning. Some strange convoluted conspiracy theory, may be telling you how terrified they are of the world around them, but if we listen harder, we might hear just how terrified they are of their anger and rage against themselves, which is so unbearable it is projected onto “them” or us. In a story of how others envy the person, we might be listening to a story telling us of their powerful envy towards others, but that feeling is so intolerable it has been projected onto others. In a not dissimilar way it is helpful to listen to the feelings that might arise in us during an encounter, for example a feeling of utter helplessness that there is nothing you can do to help and the desperation that this can produce, might be you becoming aware of the person’s own sense of helplessness and despair.
The voices that are heard may well be split off parts of their own minds containing thoughts that are so unbearable that they are experienced as being spoken by an outside agency, such as spirits of one kind or another. Thus a person might report hearing voices about how terrible they are, dirty, wicked, and that they deserve to be hurt and some may have the experience of being told to do something particular. As said earlier listening to the person carefully can give us a possibility of understanding something of how they are experiencing themselves.
A final thing to be listening for is the function that we have for them when we are talking to them. They may well be talking to us because we are clergy, or pastors or pastoral assistants. However when they are talking to us, we are also likely to symbolise other relationships that they have had in the past, some good some bad. We might become a minister who they fear is going to judge and condemn them. Or we might be being seen as a parent, that might be good or bad, we might be someone who is out to persecute them or is in league with those who have or are persecuting them. Sometimes it is the way that they are talking that gives it away, suddenly taking offence, reacting in a verbally aggressive way. Once again this is important and tells you something about them.
Mentally they are fragmented, and some part of their mind, may be a healthy part is trying to put together a story, in order to reconstruct meaning that has been lost. We need to remember that when we are sitting talking to these people, and listening to what they are saying, we are both in this together. They are contributing something that needs to be listened to. In this context it is also important to remember that these media of communication arise from the person’s unconscious. They do not set out, in a conscious, calculated way to tell you a story that will tell us how they are experiencing the world and themselves. As far as they are concerned they are telling us a story of the terrible things that have happened to them and the terrible way they are being treated. Of course we must also not lose sight that they have suffered terribly, whether it has been caused through terrible external circumstances or internal ones, or a mixture of both.