This post is quite interesting and challenging. I am going to write a longer reflection on it, because I think it merits a longer response, but that'll take me a week or so (I'm slow). For now a few observations.
It has never been clear (to me) how important it is, for Garson, that there be some sort of purpose-like element in his story. Two candidates for serving that role appear in your account – the ‘subpersonal’ (“My subconscious self is sending me a message”) and evolutionary adaptationism (“mental breakdowns are an evolutionary adaptation”). Garson also mentions those. (A third makes several appearances in Garson’s historical examples, Divine intention.)
Perhaps the idea of ‘madness as strategy’ is more compelling if we get rid of the apparent felt need to tie it to purpose. (Yes, the word ‘strategy’ invites this connection.) Perhaps function is a better concept, not function as in “what is this thing *meant* to do?” but function as in “how does this thing work?” I will suggest (without further discussion, here) that thinking in this way transforms the analogy between mental breakdowns and car accidents.
Adopting this shift from purpose to function (if it is a shift), the contrast to ‘madness as dysfunction’ would still stand. The car accident isn’t a matter of the world functioning incorrectly. That’s how the world functions – when poor decisions are made, car crashes can happen. We have far less clear and general understanding of the analogous antecedent in the case of mental breakdowns, but perhaps the proponents in the two cases that you mention have correctly identified antecedents in their own particular cases.
It’s also important, in fairness to Garson, to remember that he does not think that one or the other of his models is exclusively true. He thinks they are both true. So yes, it would seem that for Garson the depression is a kind of dysfunction. It’s just that at the same time, it can be understood as a kind of strategy, or, as one might put it in light of above, the world functioning as it does. (That’s my spin, not necessarily Garson’s but maybe his.)
There’s a lot more to be said, here, and thanks for giving food for thought. I’m now resisting the temptation to say quite a lot! (I’ll give in to it later...)
Zsuzsanna Chappell and I wrote a little about this in our forthcoming (very soon now! I'm doing the proofs) research encyclopedia chapter on Philosophy of Madness. We suggest that the terms "dysfunction vs function" are better than design or strategy vs dysfunction, and makes a comparison with asthma and fever.
Quoting our chapter:
"When an asthmatic person’s bronchi close up, the person suffers from a breathing dysfunction. They need help to have their breathing restored. Fever, on the other hand, is a more complicated matter. Fever can be damaging in itself if it becomes too high or persists for too long, but in infectious diseases it also serves a function; the fever helps to slow down pathogenic reproduction. Similarly, scholars and physicians have discussed whether, e.g., psychotic states might serve as an escape mechanism from an intolerable situation. Garson later suggests that insofar as Madness is a strategy, it is not a medical matter, but as the fever analogy shows, this conclusion need not follow. The ‘escape psychotic’ may still suffer and need help. Nevertheless, a fever-like Madness which serves a function may call for different approaches than an asthma-like Madness that is completely pathological."
You list this as one error: "Preventing car accidents might also prevent necessary transformation"
I would challenge this. I think your car accident example is just one more example of negative life experiences, ones often severe, that turn people's lives around. There are endless anecdotal stories from literature and history of this occurring: cancer diagnoses, spousal infidelity, hitting "rock bottom" during addiction. I would also say that just because these crises happen to many people who don't have positive change doesn't mean they can't be the actual causes of change in others. I think hitting "rock bottom" with substance abuse is an excellent example because these individuals have often had many negative events in their lives from substances, but there seems to be a threshold of severity that needs to be crossed for them to change their lives. Sometimes this is a life-threatening overdose, other times it is the loss of a spouse or loss of the custody of their children. Again, this severity doesn't work for everyone; many people never change or die of overdose. But this, in and of itself, doesn't discount the potential good that can be caused by these crises. As much as I want people to be happy, safe, and live good lives, I think if we remove every potential cause of crisis or harm, such as by curing illnesses and preventing accidents, we are removing opportunities for potential crises. This is strange to say, but I think it is a difficult but necessary nuance to the conversation.
I have reflected on this a great deal. There were points in my own story when I thought I had to go through everything to make transformation possible, but I no longer think that's true.
I think there are two very reasonable ways of looking at this: enactivism, where mental illness is seen as an operationally closed system in the extreme end or as an overly rigid system on the lighter end of the spectrum, and Dabrowski's theory of positive disintegration.
From the enactivist perspective, crises are shocks to the systems that can potentially lead to shifts in function and structure. The outcomes are dependent on the interplay between the context and the system (organism). I think what allows transformation to occur is removal of the factors that kept the processes and the system on a fixed trajectory, but without so much perturbation that the system is destroyed (that's kind of like what happens in decompensation and total decompensation means death).
Dabrowski was writing before Varela et al, but it's fairly similar. He saw mental illness and symptoms as opportunities for change which needed to be engaged, not treated away. Disintegration (of the personality) can be followed by reintegration (at a higher level) and that's what transformation is.
I'd spent a decade in therapy and on countless medications, had gone through multiple points of inflexion that could have served as catalysts for change before the moment that lifted the dissociative veil, yet these only led to deeper and deeper decompensation and reduced ability to function. Why? It wasn't because I didn't want to heal or wasn't trying. I'd always been incredibly driven to heal, and even when all I was consciously doing was fixing and trying to function better, I was unconsciously exposing myself to material to confront my past (like the time I spent a year writing psych reports on PTSD while not being able to even use the word trauma in relation to myself). The conditions and context simply weren't there, and the people in my life were harmful. It was only when I removed myself from everything and everyone and had reclaimed enough of myself that I was able to hold the ridiculous amount of trauma in conscious awareness, and recovery and integration are ongoing processes. From the outside, it doesn't look like "progress" or "growth" or even "healing" are occurring, especially when I look at slices in time and don't see the wider and deeper picture. You have to go down to come up, but that doesn't mean you need to go down all the way to the depths of hell, especially because you might not make it back up.
I think there is a gentler way to go into and out of our inner dimensions that don't involve quite so much trauma. I do believe that most people are driven towards greater health and integration, it's just that the actions they're taking are ineffectual and their context is disabling or harmful. A crisis comes along and can clear the path so to speak, but the crisis itself is not the driver of transformation.
Awais: I hope you read this essay by Ackerman. It gives a far more detailed description of his experience with depression and recovery. He learned to practice a kind pf cognitive therapy on himself in which he came to realize that he couldn't live a life with a single goal but that his human nature demanded respect for a variety of goals. This essay is referenced in one of responses to his X post.
This is excellent. The thing that I've never understood about Garson's account - although I confess that I've not read everything he's written - and I guess it would be a bit of a shocker if a philosopher hadn't dealt with the following obvious objection as part of his 'strategy' account, so perhaps it's futile of me to comment without further reading! - is that I couldn't see how his theory made the distinction you mention. Sure a depressive episode could be a wake-up call. It could, in a purely metaphorical way, "tell us" that our life was confounded in ways we hadn't got our head around. But the fact is that depression actually doesn't "tell us" this even in the still-somewhat-metaphorical way that, say, foot pain tells us to remove the scorpion from our foot, hunger tells us to eat, loneliness (supposedly) tells us to go see our friends. It mainly tells us that we are worthless, that our future is hopeless, etc. Whereas if we could read the apt behaviour off the state, then we'd not think "I am hopeless" but instead "my situation sucks". We need to bring our self-reflective capacities to bear on it, and so prima facie at least it does look rather more like the wake up call that the heart attack offers the obese person. Now perhaps it is said that the function, the strategy, is working at a much more primitive biological level - rather like the things that Jordan Peterson used to say about lobsters. (IIRC, something like: if you're kinda a weedy loser of a lobster, you're not gonna get any lobster love any time soon, so your low serotonin will now help you not be fruitlessly motivated to play the risky games of lobster derring do, and so you'll not waste energy or even get killed on the mating fields.) But at this level, depression seems very clearly to not promote reproductive fitness in individuals, and even if it was once adaptive, it now seems mainly bunk. And alongside the fact that the existential angle you mention - the fact that we can reflect on our poor health or clumsy accidental overdose or suicide attempt or generalised anxiety and, with the benefit of psychological nous, think 'yep, I better change things up' - clearly ascribes no *intrinsic* function to the putative illness, it seems hard to me to know how to motivate the function claim in any way that ought to invite us to change up our understanding of the nature of mental illness.
On Kemptrup's nice comment: "“Sometimes the pt and analyst/therapist explore things similar to what gets described in science as “underdetermination of theory by evidence” wherein two or more explanations equally fit with the available case history, facts about the pt. And the pt can BENEFIT from understanding that he can be understood in more than one way, and humility is felt as a virtue, which opens up possibilities for new ways of thinking, acting, and feeling. Often, a sign of health in a patient is that they start to understand themselves pluralistically, through multiple lenses. “I suppose one way to think about what I did is this, but another is this. I don’t really know which is true at the moment.”": There are I think two ways to understand this, although the last sentence does rather push it toward one of them. On one reading of it, the different understandings aren't in competition. An 'understanding' here is like a picture, a metaphor, a perfectly legitimate in itself way of organising data. On the other reading, an understanding is more like a theory; it's something which further information could falsity. The bucolic jigsaw puzzle I'm now doing: this shape here on the left could easily be part of a milk maid's bonnet - but then, as I pick out further pieces, iI see that it ACTUALLY is the rear end of a chicken. My first thought was simply WRONG. The former seems to me to map onto the kind of "understanding" we get with the wake-up-call idea. The latter seems to me to fit the kind of "understanding" that evolved functions are supposed to offer us.
Thanks for posting this. I had been wondering about the transformatory effect of mental crises. In my case, a handful of episodes of depression, mania and psychosis packed in a five year period. Somehow this period changed me into a slightly different person. More outspoken, less anxious and afraid, more sociable. Less stress-sensitive also (knock on wood). I sometimes wonder whether this has to do with the opportunity (especially in mania and psychosis) to experiment with new behaviour, and to engage with otherwise unreachable unconscious fears and trauma. Or would all this personality-development just be a lucky side-effect of lithium treatment, quenching lifelong subclinical dysthymia?
I think what's interesting is the different levels of abstraction people can (choose to?) derive meaning from their experiences. These aren't mutually exclusive. Some derive direct meaning from the content - i.e. engaging with voice hearing. Some derive meaning from the content as a sort of poetically resonant with a trauma or something (thinking delusion formation, trauma, core beliefs... madness as an expression of something unsayable). Some derive meaning from having been through such as experience that they feel uniquely positioned to help others who are going through something similar. Some derive meaning from overcoming. Some derive meaning from a sort of specialness - only a small % of people experience something like psychosis. Some derive meaning from having exclusive access to the kinds of social connection having a powerful experience in common can afford.
I recently went to a film screening about a local hearing voices group and wrote some words about meaning. Reflecting on what meaning I've gleaned from my psychiatric crisis... I read "can a psychiatric crisis save your life" while writing so there are some resonances
I want to offer a perspective as someone whose life did not return to baseline, or find a new normal after a psychiatric crisis. My first psychiatric crisis coincided with the onset of chronic illness of mysterious aetiology, which was also a life-altering crisis. The psychiatric crisis returned for an encore about half a decade later, precipitating a major life change that eventually led — rather counterintuitively, since it first led to homelessness — to what I've been referring to as "partial remission" for both psychotic/affective illness and chronic pain and chronic fatigue. I'm mildly to moderately symptomatic, but living independently, and able to function as a version of myself that's in fragile health but recognizable as an older version of the person I remember being before things went to hell.
Both of these (all three of these?) life-altering catastrophes did result in me making changes I had been avoiding, though it took years, and none of those changes directly addressed the knock-on effects of the catastrophes (they may have indirectly). But the ability to re-interpret my Madness and disability as necessary episodes in my life *has* resulted in strengthening my desire to adapt and move forward even as the chances of returning to baseline or finding a new normal continued to dwindle to nothing, and when some kind of return-to-self finally emerged, I had not been expecting it and was able to greet it as what it was — a significant and lasting improvement — and not as an inadequate version of perfect recovery.
I think for many people who survive psychiatric crises, it is not the crisis per se that saves us, but the gaining or uncovering of the ability to reframe a crisis and incorporate it into a stable, positive narrative about our own lives. But when it comes to understanding one's own life, it may well be that for many people, that's one and the same thing.
Regardless, I'm still perversely grateful for the crises of my 20s. I'm naturally empathetic in that it's easy for me to feel bad for people in adversity, but I am not naturally empathetic in the sense that I have an instinctive or intuitive understanding of the pain others experience. I have to sit and think about things to do that. I have a broader range of experiences to draw on now, and I've learned the hard way how to hold compassion without judgement and disagree without condemnation. But if I'd not found or created resilience (not to mention if I had been a little less lucky — all other things being equal, I'm a white man, and I cannot rule out the possibility of having benefited from systemic bias), I think I would be dead.
There is so much balance and so much to deeply consider in this piece. The idea that psychotic or even depressive breaks can press a person toward reflection and change is one offering but at the same time @AwaisAftab wisely recognizes that its the making sense of the illness and not the illness itself that brings perspective and new life.
Writing "The Parts of Him I Kept: The Gifts of my Fathers Madness" was my act of making sense not just of my experience but an inquiry into what his illness meant in our family and even the larger community. Not that his illness was transformative but caring for him and making sense of our relationship was of tremendous value.
I appreciate this thoughtful post. I would add that many of us do believe that a car crash or cancer could happen in order to save a life. Even if you don’t believe in God, I’m sure many of your patients do.
"I can’t help but wonder: Would Alterman have been receptive to his current interpretation while he was acutely depressed?"
"I also wonder about how the interpretation is offered, by whom, and under what conditions. Coming from a dismissive clinician, the interpretation of symptoms as purposeful could even have been seen as invalidating (“You don’t need medical treatment; nothing is wrong with you; you need to change your whole life”)."
These were the two reflections running through my mind as well as I was reading through.
It's a delicate balancing act for clinicians teasing out alternative interpretive lenses without conveying certitude or provoking defensiveness in the client. One of the most difficult virtues for therapists to cultivate is remaining measured and controlled against a sense of certitude in our own picture of what's going on. This is very important in circumstances where we have judged that the client hasn't yet attained the mental and emotional threshold for embracing a particular proposition. For it's possible to further delay the natural process of recovery if we inspire in the client the unconscious need to prove us wrong.
What these stories capture isn’t that madness is secretly wise, but that collapse can reintroduce constraint when a life has become uncorrectable by normal feedback. A psychiatric crisis can sometimes function like a hard stop, an interruption that forces reality back into alignment when softer feedback have failed. The danger is mistaking the interruption for the design, rather than seeing it as an extreme and costly way a system regains limits after too much drift.
Awais,
This post is quite interesting and challenging. I am going to write a longer reflection on it, because I think it merits a longer response, but that'll take me a week or so (I'm slow). For now a few observations.
It has never been clear (to me) how important it is, for Garson, that there be some sort of purpose-like element in his story. Two candidates for serving that role appear in your account – the ‘subpersonal’ (“My subconscious self is sending me a message”) and evolutionary adaptationism (“mental breakdowns are an evolutionary adaptation”). Garson also mentions those. (A third makes several appearances in Garson’s historical examples, Divine intention.)
Perhaps the idea of ‘madness as strategy’ is more compelling if we get rid of the apparent felt need to tie it to purpose. (Yes, the word ‘strategy’ invites this connection.) Perhaps function is a better concept, not function as in “what is this thing *meant* to do?” but function as in “how does this thing work?” I will suggest (without further discussion, here) that thinking in this way transforms the analogy between mental breakdowns and car accidents.
Adopting this shift from purpose to function (if it is a shift), the contrast to ‘madness as dysfunction’ would still stand. The car accident isn’t a matter of the world functioning incorrectly. That’s how the world functions – when poor decisions are made, car crashes can happen. We have far less clear and general understanding of the analogous antecedent in the case of mental breakdowns, but perhaps the proponents in the two cases that you mention have correctly identified antecedents in their own particular cases.
It’s also important, in fairness to Garson, to remember that he does not think that one or the other of his models is exclusively true. He thinks they are both true. So yes, it would seem that for Garson the depression is a kind of dysfunction. It’s just that at the same time, it can be understood as a kind of strategy, or, as one might put it in light of above, the world functioning as it does. (That’s my spin, not necessarily Garson’s but maybe his.)
There’s a lot more to be said, here, and thanks for giving food for thought. I’m now resisting the temptation to say quite a lot! (I’ll give in to it later...)
Good comment, Michael.
Zsuzsanna Chappell and I wrote a little about this in our forthcoming (very soon now! I'm doing the proofs) research encyclopedia chapter on Philosophy of Madness. We suggest that the terms "dysfunction vs function" are better than design or strategy vs dysfunction, and makes a comparison with asthma and fever.
Quoting our chapter:
"When an asthmatic person’s bronchi close up, the person suffers from a breathing dysfunction. They need help to have their breathing restored. Fever, on the other hand, is a more complicated matter. Fever can be damaging in itself if it becomes too high or persists for too long, but in infectious diseases it also serves a function; the fever helps to slow down pathogenic reproduction. Similarly, scholars and physicians have discussed whether, e.g., psychotic states might serve as an escape mechanism from an intolerable situation. Garson later suggests that insofar as Madness is a strategy, it is not a medical matter, but as the fever analogy shows, this conclusion need not follow. The ‘escape psychotic’ may still suffer and need help. Nevertheless, a fever-like Madness which serves a function may call for different approaches than an asthma-like Madness that is completely pathological."
I post on my blog, occasionally: jeppssonphilosopherauthor.blogspot.com
You can also look me up on PhilPeople or Google Scholar for my peer-reviewed publications. :-)
Boisen had this idea around 1946
This is a genuinely thought provoking article.
You list this as one error: "Preventing car accidents might also prevent necessary transformation"
I would challenge this. I think your car accident example is just one more example of negative life experiences, ones often severe, that turn people's lives around. There are endless anecdotal stories from literature and history of this occurring: cancer diagnoses, spousal infidelity, hitting "rock bottom" during addiction. I would also say that just because these crises happen to many people who don't have positive change doesn't mean they can't be the actual causes of change in others. I think hitting "rock bottom" with substance abuse is an excellent example because these individuals have often had many negative events in their lives from substances, but there seems to be a threshold of severity that needs to be crossed for them to change their lives. Sometimes this is a life-threatening overdose, other times it is the loss of a spouse or loss of the custody of their children. Again, this severity doesn't work for everyone; many people never change or die of overdose. But this, in and of itself, doesn't discount the potential good that can be caused by these crises. As much as I want people to be happy, safe, and live good lives, I think if we remove every potential cause of crisis or harm, such as by curing illnesses and preventing accidents, we are removing opportunities for potential crises. This is strange to say, but I think it is a difficult but necessary nuance to the conversation.
I cite Enara Garcia less often that I would like, but I think she speaks directly, and in depth, to what you said: https://link.springer.com/article/10.1007/s11229-024-04854-y
I have reflected on this a great deal. There were points in my own story when I thought I had to go through everything to make transformation possible, but I no longer think that's true.
I think there are two very reasonable ways of looking at this: enactivism, where mental illness is seen as an operationally closed system in the extreme end or as an overly rigid system on the lighter end of the spectrum, and Dabrowski's theory of positive disintegration.
From the enactivist perspective, crises are shocks to the systems that can potentially lead to shifts in function and structure. The outcomes are dependent on the interplay between the context and the system (organism). I think what allows transformation to occur is removal of the factors that kept the processes and the system on a fixed trajectory, but without so much perturbation that the system is destroyed (that's kind of like what happens in decompensation and total decompensation means death).
Dabrowski was writing before Varela et al, but it's fairly similar. He saw mental illness and symptoms as opportunities for change which needed to be engaged, not treated away. Disintegration (of the personality) can be followed by reintegration (at a higher level) and that's what transformation is.
I'd spent a decade in therapy and on countless medications, had gone through multiple points of inflexion that could have served as catalysts for change before the moment that lifted the dissociative veil, yet these only led to deeper and deeper decompensation and reduced ability to function. Why? It wasn't because I didn't want to heal or wasn't trying. I'd always been incredibly driven to heal, and even when all I was consciously doing was fixing and trying to function better, I was unconsciously exposing myself to material to confront my past (like the time I spent a year writing psych reports on PTSD while not being able to even use the word trauma in relation to myself). The conditions and context simply weren't there, and the people in my life were harmful. It was only when I removed myself from everything and everyone and had reclaimed enough of myself that I was able to hold the ridiculous amount of trauma in conscious awareness, and recovery and integration are ongoing processes. From the outside, it doesn't look like "progress" or "growth" or even "healing" are occurring, especially when I look at slices in time and don't see the wider and deeper picture. You have to go down to come up, but that doesn't mean you need to go down all the way to the depths of hell, especially because you might not make it back up.
I think there is a gentler way to go into and out of our inner dimensions that don't involve quite so much trauma. I do believe that most people are driven towards greater health and integration, it's just that the actions they're taking are ineffectual and their context is disabling or harmful. A crisis comes along and can clear the path so to speak, but the crisis itself is not the driver of transformation.
Awais: I hope you read this essay by Ackerman. It gives a far more detailed description of his experience with depression and recovery. He learned to practice a kind pf cognitive therapy on himself in which he came to realize that he couldn't live a life with a single goal but that his human nature demanded respect for a variety of goals. This essay is referenced in one of responses to his X post.
https://forum.effectivealtruism.org/posts/AjxqsDmhGiW9g8ju6/effective-altruism-in-the-garden-of-ends
This is excellent. The thing that I've never understood about Garson's account - although I confess that I've not read everything he's written - and I guess it would be a bit of a shocker if a philosopher hadn't dealt with the following obvious objection as part of his 'strategy' account, so perhaps it's futile of me to comment without further reading! - is that I couldn't see how his theory made the distinction you mention. Sure a depressive episode could be a wake-up call. It could, in a purely metaphorical way, "tell us" that our life was confounded in ways we hadn't got our head around. But the fact is that depression actually doesn't "tell us" this even in the still-somewhat-metaphorical way that, say, foot pain tells us to remove the scorpion from our foot, hunger tells us to eat, loneliness (supposedly) tells us to go see our friends. It mainly tells us that we are worthless, that our future is hopeless, etc. Whereas if we could read the apt behaviour off the state, then we'd not think "I am hopeless" but instead "my situation sucks". We need to bring our self-reflective capacities to bear on it, and so prima facie at least it does look rather more like the wake up call that the heart attack offers the obese person. Now perhaps it is said that the function, the strategy, is working at a much more primitive biological level - rather like the things that Jordan Peterson used to say about lobsters. (IIRC, something like: if you're kinda a weedy loser of a lobster, you're not gonna get any lobster love any time soon, so your low serotonin will now help you not be fruitlessly motivated to play the risky games of lobster derring do, and so you'll not waste energy or even get killed on the mating fields.) But at this level, depression seems very clearly to not promote reproductive fitness in individuals, and even if it was once adaptive, it now seems mainly bunk. And alongside the fact that the existential angle you mention - the fact that we can reflect on our poor health or clumsy accidental overdose or suicide attempt or generalised anxiety and, with the benefit of psychological nous, think 'yep, I better change things up' - clearly ascribes no *intrinsic* function to the putative illness, it seems hard to me to know how to motivate the function claim in any way that ought to invite us to change up our understanding of the nature of mental illness.
On Kemptrup's nice comment: "“Sometimes the pt and analyst/therapist explore things similar to what gets described in science as “underdetermination of theory by evidence” wherein two or more explanations equally fit with the available case history, facts about the pt. And the pt can BENEFIT from understanding that he can be understood in more than one way, and humility is felt as a virtue, which opens up possibilities for new ways of thinking, acting, and feeling. Often, a sign of health in a patient is that they start to understand themselves pluralistically, through multiple lenses. “I suppose one way to think about what I did is this, but another is this. I don’t really know which is true at the moment.”": There are I think two ways to understand this, although the last sentence does rather push it toward one of them. On one reading of it, the different understandings aren't in competition. An 'understanding' here is like a picture, a metaphor, a perfectly legitimate in itself way of organising data. On the other reading, an understanding is more like a theory; it's something which further information could falsity. The bucolic jigsaw puzzle I'm now doing: this shape here on the left could easily be part of a milk maid's bonnet - but then, as I pick out further pieces, iI see that it ACTUALLY is the rear end of a chicken. My first thought was simply WRONG. The former seems to me to map onto the kind of "understanding" we get with the wake-up-call idea. The latter seems to me to fit the kind of "understanding" that evolved functions are supposed to offer us.
Thanks for posting this. I had been wondering about the transformatory effect of mental crises. In my case, a handful of episodes of depression, mania and psychosis packed in a five year period. Somehow this period changed me into a slightly different person. More outspoken, less anxious and afraid, more sociable. Less stress-sensitive also (knock on wood). I sometimes wonder whether this has to do with the opportunity (especially in mania and psychosis) to experiment with new behaviour, and to engage with otherwise unreachable unconscious fears and trauma. Or would all this personality-development just be a lucky side-effect of lithium treatment, quenching lifelong subclinical dysthymia?
Any thoughts?
I think what's interesting is the different levels of abstraction people can (choose to?) derive meaning from their experiences. These aren't mutually exclusive. Some derive direct meaning from the content - i.e. engaging with voice hearing. Some derive meaning from the content as a sort of poetically resonant with a trauma or something (thinking delusion formation, trauma, core beliefs... madness as an expression of something unsayable). Some derive meaning from having been through such as experience that they feel uniquely positioned to help others who are going through something similar. Some derive meaning from overcoming. Some derive meaning from a sort of specialness - only a small % of people experience something like psychosis. Some derive meaning from having exclusive access to the kinds of social connection having a powerful experience in common can afford.
I recently went to a film screening about a local hearing voices group and wrote some words about meaning. Reflecting on what meaning I've gleaned from my psychiatric crisis... I read "can a psychiatric crisis save your life" while writing so there are some resonances
https://substack.com/@thehauntedhiker/note/p-188429100?r=2lqwvt&utm_source=notes-share-action&utm_medium=web
I want to offer a perspective as someone whose life did not return to baseline, or find a new normal after a psychiatric crisis. My first psychiatric crisis coincided with the onset of chronic illness of mysterious aetiology, which was also a life-altering crisis. The psychiatric crisis returned for an encore about half a decade later, precipitating a major life change that eventually led — rather counterintuitively, since it first led to homelessness — to what I've been referring to as "partial remission" for both psychotic/affective illness and chronic pain and chronic fatigue. I'm mildly to moderately symptomatic, but living independently, and able to function as a version of myself that's in fragile health but recognizable as an older version of the person I remember being before things went to hell.
Both of these (all three of these?) life-altering catastrophes did result in me making changes I had been avoiding, though it took years, and none of those changes directly addressed the knock-on effects of the catastrophes (they may have indirectly). But the ability to re-interpret my Madness and disability as necessary episodes in my life *has* resulted in strengthening my desire to adapt and move forward even as the chances of returning to baseline or finding a new normal continued to dwindle to nothing, and when some kind of return-to-self finally emerged, I had not been expecting it and was able to greet it as what it was — a significant and lasting improvement — and not as an inadequate version of perfect recovery.
I think for many people who survive psychiatric crises, it is not the crisis per se that saves us, but the gaining or uncovering of the ability to reframe a crisis and incorporate it into a stable, positive narrative about our own lives. But when it comes to understanding one's own life, it may well be that for many people, that's one and the same thing.
Regardless, I'm still perversely grateful for the crises of my 20s. I'm naturally empathetic in that it's easy for me to feel bad for people in adversity, but I am not naturally empathetic in the sense that I have an instinctive or intuitive understanding of the pain others experience. I have to sit and think about things to do that. I have a broader range of experiences to draw on now, and I've learned the hard way how to hold compassion without judgement and disagree without condemnation. But if I'd not found or created resilience (not to mention if I had been a little less lucky — all other things being equal, I'm a white man, and I cannot rule out the possibility of having benefited from systemic bias), I think I would be dead.
https://open.substack.com/pub/danieljmurray/p/exposing-the-iatrogenic-trap-my-undercover?utm_campaign=post-expanded-share&utm_medium=post%20viewer
There is so much balance and so much to deeply consider in this piece. The idea that psychotic or even depressive breaks can press a person toward reflection and change is one offering but at the same time @AwaisAftab wisely recognizes that its the making sense of the illness and not the illness itself that brings perspective and new life.
Writing "The Parts of Him I Kept: The Gifts of my Fathers Madness" was my act of making sense not just of my experience but an inquiry into what his illness meant in our family and even the larger community. Not that his illness was transformative but caring for him and making sense of our relationship was of tremendous value.
I appreciate this thoughtful post. I would add that many of us do believe that a car crash or cancer could happen in order to save a life. Even if you don’t believe in God, I’m sure many of your patients do.
"I can’t help but wonder: Would Alterman have been receptive to his current interpretation while he was acutely depressed?"
"I also wonder about how the interpretation is offered, by whom, and under what conditions. Coming from a dismissive clinician, the interpretation of symptoms as purposeful could even have been seen as invalidating (“You don’t need medical treatment; nothing is wrong with you; you need to change your whole life”)."
These were the two reflections running through my mind as well as I was reading through.
It's a delicate balancing act for clinicians teasing out alternative interpretive lenses without conveying certitude or provoking defensiveness in the client. One of the most difficult virtues for therapists to cultivate is remaining measured and controlled against a sense of certitude in our own picture of what's going on. This is very important in circumstances where we have judged that the client hasn't yet attained the mental and emotional threshold for embracing a particular proposition. For it's possible to further delay the natural process of recovery if we inspire in the client the unconscious need to prove us wrong.
What these stories capture isn’t that madness is secretly wise, but that collapse can reintroduce constraint when a life has become uncorrectable by normal feedback. A psychiatric crisis can sometimes function like a hard stop, an interruption that forces reality back into alignment when softer feedback have failed. The danger is mistaking the interruption for the design, rather than seeing it as an extreme and costly way a system regains limits after too much drift.