This entry first appeared at Mad in America on February 3, 2012.
In my last blog entry, I described how the I-Ward first episode madness sanctuary came into being and how I ended up working there as a therapist for over three years.
As you read now about my time there, I would again like to ask you to keep in mind the question I posed in my first two blog entries – “If Madness isn’t what Psychiatry says it is, then what is it?” Because on I-Ward, madness was not believed to be anything like what psychiatry imagined it to be.
At the end of this post, you will find a list of references that support an alternative understanding of madness and how best to respond to someone in that madness process. For scientific data on this approach, please see the Agnews study, the Soteria research, and other medication-free results. John Bola has written several articles summarizing this literature, and one of his articles a few years ago set off a firestorm of debate in the academic psychiatric community and in the pages of the New York Times because it challenged the practice of prescribing antipsychotics as a matter of course during first- and early-episode psychosis.
Also, the recent Open-dialogue research in northern Finland, which involves minimizing use of neuroleptics, and a process that involves defining madness as a process that should be responded to as a meaningful life crisis, shows similarly remarkable first-episode results. Schizophrenia diagnosis rates have plummeted in northern Finland as a result of the Open-Dialogue program, as cited in Robert Whitaker’s Anatomy of an Epidemic.
The program leaders in Finland describe madness almost exactly as R.D. Laing described madness and the psychosis-inducing family almost 50 years ago in a partially NIMH- funded study of 25 families with a mad member in Great Britain! The Open-dialogue leaders say: “Psychosis does not live in the head. It lives in the in-between of family members, and the in-between of people. It is in the relationship, and the one who is psychotic makes the bad condition visible. He or she ‘wears the symptoms’ and has the burden to carry them.”
Here is the story of I-Ward, a 20 Bed, Medication and Diagnosis Free, First Episode Madness Sanctuary.
In 1975, Contra Costa County Hospital I-Ward founder Dr. Stanley Mayerson was emboldened by the California state hospital Agnews project. This was a gold-standard, NIMH-funded double-blind study, where the longer-term outcomes for the unmedicated patients (first and early-episode madness) that they were seen by some as seriously challenging the validity of the schizophrenia diagnostic category itself. The much, much lower follow-up re-hospitalization rate of the randomly assigned placebo group vs. those who got Thorazine pointed to the efficacy of non-medication treatment of first and early-episode psychosis.
Mayerson designed I-Ward based mainly on a vanguard definition of madness that was formulated at the Esalen Institute and demonstrated on the Agnews project where he had worked.
I-Ward founder Mayerson, who also focused greatly on the role of the ‘identified patient’ in the family therapy we did there, had actively been part of an Esalen Institute initiative on ‘Alternative Approaches to Psychosis,’ which was led by Esalen Co-founder Richard Price.
Price had been through his own madness ordeals, forced hospitalizations and shock treatments and wanted Esalen to be a refuge and force for developing an alternative vision and response to madness. That Esalen activity grew and became responsible for the design and implementation of the Agnews Project.
The Esalen initiative on madness was a remarkable, decades long series of gatherings- some for up to two months in length! Last month I co-led an Esalen workshop called “An Integrative Approach To Psychosis,” in an attempt to revive that venerable tradition that had gone dormant for some years.
Attending those earlier invited, closed symposia were more than a few veritable giants in the field of western psychology, philosophy and anthropology. These historic multidisciplinary explorations about madness held at Esalen drew Gregory Bateson and Erik Erikson, Fritz Perls, Joseph Campbell, John Weir Perry, Abraham Maslow, Alan Watts; Michael Harner, Stan Grof, Claudio Naranjo, Allen Ginsburg, Jullian Silverman, R.D. Laing and more.
The syncretistic, alternative vision of the very nature of madness and how best and humanely to respond to those in a madness process that partially evolved out of that brain trust at Esalen, sees madness as a very complex and multidimensional subjective, somatic, familial, archetypal, trauma influenced and social/cultural bound experience that is not a form of bio-medical pathology.
Early onset madness came to be seen as a purposive, necessary healing crisis that is often a rite of passage into young adult hood. Madness occurring later in life was seen as an attempt to integrate earlier wounds or a response to overwhelming adult trauma and loss. Both passages of madness were seen as needing a heart centered, non-pathologizing response by care givers,
Every form of modern madness was also held to be an experience of the ancient archetypal mystery that has been marveled at and feared throughout human history, as described in Plato’s Phaedrus, in the Bible and by C.G. Jung, Anton Boisen, John Weir Perry, and also by the writings on shamanic initiation by M. Eliade.
Madness in our lifetime was also viewed through the historical lens of seminal writers such as Michele Foucault, Gregory Bateson and R.D. Laing – who believed our post modern culture was itself a fragmented, often heartless wasteland which was the inescapable, toxic petri dish in which record numbers of young adults were required to become mad in order to move into an authentic and fuller life.
Their young, ‘leaving home’ madness was seen by the Esalen thinkers as an effort to free themselves from the injuries inflicted by the dog eat dog social Darwinism and soul killing materialism that permeates our largely loveless social environment, that has caused the socially embedded nuclear family to become the wounding crucible of our culture.
Our culture itself was seen as being self-destructively mad and actively endangering human survival on earth.. In this view, the modern family itself is the primary but unwitting vehicle for inflicting the madness inducing wounds of the broader culture’s traumatic impact on childhood development.
Feminism was another important influence in the evolving, alternative vision of madness that was discussed at Esalen. The feminist critique of culture dialed the historical microscope further back to look at the over-arching myth our culture lives by and through. From the perspective of the effects of the patriarchal mono myth that reifies guilt, shame and fear of punishment as core values we are effected by every moment, madness was also seen as a rebellious outburst of polytheistic pagan energy, a Dionysian and Aphrodite led revolt against the oppression of the sacred feminine and sexuality.
Madness itself was seen as a vehicle for revolutionary cultural change because it supplied needed visionary content that pushed the edges of understanding and contained numinous elements from beyond consensual consciousness. For John Perry and Joesph Campbell especially, madness was seen as an ancient source of inspiration and a contributor to the evolving, emerging myth form that was challenging patriarchy.
Through the visionary, shamanic and prophetic content of madness that often involved themes of world renewal and a messianic vision of a healed and peaceful earth, the mad among us were seen as possible harbingers of change at the level of the development of a new myth form itself. Campbell and Perry pointed to the emerging myth motif that appears repeatedly in modern people’s madness as being centered on a compelling concern for the earth, our sacred home that has been likened to Gaia, a living organism that births all life.
The recent publication of Jung’s ‘Red Book’ shows how his visionary madness did bring enriching content for the culture in addition to being the emotional and symbolic record of his own transformative madness. He said it contained the prima materia for his lifetime’s work.
The work of my friend David Lukoff and the Esalen based work of Stan Grof also support the claims of the field of Transpersonal Psychology that madness can be a rich personal transformation, even an initiatory spiritual emergency at one level that also brings valuable, numinous material into the broader culture.
I was already a true believer in this Esalen style, comprehensive version/vision of madness cited above before I got to I-Ward, so it was like finally finding my tribe when I got there in 1980.
But there is always a risk involved in feeling one is part of a vanguard movement. In the 60′s and 70′s many of us felt that we were part of a naturally occurring cycle of revolution that would overthrow the capitalist, war making patriarchal system. We made many mistakes, the largest to my mind was demonizing those who we opposed. Those who aspire to hold the purist vanguard truths often find themselves inflated and acting from arrogance and without compassion.
So, the feet of clay of some of the pioneers in the alternative madness revolution were starting to show as I walked through the wide open, never locked double doors onto the I-Ward madness sanctuary for the first time.
The building was a single story, free standing old TB ward that was on the edge of the hospital grounds, with a miles of open hillside behind it and it had a wonderful redwood grove overshadowing the building.
As I entered that amazing zone, the hair on the back of my neck stood on end because there was a palpable energy filling the air I had never felt before.
It mainly was being generated by the several young men and women I saw moving about who were fully ramping up in their first ever madness experience. The strangely almost electric buzz in the air was buoyed up also by the several young men and women who were into their second or third week of madness as I would soon learn.
They also were of wild and shiny eyes and, like the newcomers, were expressing unbridled emotion and displaying bodily movements and using metaphorical speech that was out of the ordinary, but not as intensely as those that had just arrived that in the past few days.
The last group of young men and women residing there that made up the contingent of 20 souls were still mad, but were a lot less mad. They could easily be mistaken for staff. Everyone wore their own casual clothes of mostly Levis and short sleeved shirts.
The program director came out and met me, and when we sat together, he seemed nervous as he asked me a very surprising job interview question. He started by saying that the staff had just recently had a training by one of R.D. Laing’s close associates from Kingsley Hall in London who had exhorted the I-Ward staff to be willing to have sex with the residents if necessary, in order to prove that all the trappings of the colonial oppressors of our corrupt culture had been cast aside.
So the director asked me if I agreed with Laing’s co-worker that we should have sex with the mad young people there. I could see it was a serious question for him that he felt he had to ask me. Although it felt quite surreal, I found myself answering, ”No, I don’t believe it ever is right to have sex with people we are serving.”
He seemed relieved and after a few more questions I was offered the job.
How far, I then realized, was I from the world of the high end private psychiatric hospital where I still worked. The bearded, wild haired I-Ward director sported several hoop earrings of various sizes and wore a leather pouch across his chest. His fellow psychiatrists at the private hospital usually wore camel hair coats and Armani suits and even I had managed a tweed sport jacket and affected a briar pipe in a self conscious and now laughable attempt to fit in as a young intern still in graduate school.
But I immediately felt at home on I-Ward. Madness was palpably in the air and so was a loving, receptive acceptance of it that felt viscerally right to me.
In many ways I-Ward was more radical than both Mosher’s Soteria and Perry’s Diabasis, the other SF Bay Area med-free sanctuaries that were seen by us as competition for who provided the best model of responding to madness.
We served everyone who came to psychiatric emergency who was mad for the first and sometimes second time. There was a larger locked ward on the hospital grounds where medication and restraints were used for people who had been in the system for a longer time. We wanted to divert and prevent any new mad people from being in the system.
Within minutes of someone’s first contact with the system, one of us would walk down the hill and after a brief intake, bring them up to the sanctuary. Unlike Soteria and Diabasis, we took all comers – no matter how violent, wild, suicidal or out of control. Our resident population was very ethnically diverse as were the staff.
Although I-Ward was open for eight years and served vastly more young mad people than any other alternative program that has ever existed in the United States- easily more than many times the amount of Soteria and Diabasis combined, it is almost unknown about today because there was no research component built into the program design as at Soteria.
On I-Ward we did not believe in a mental illness paradigm of human emotional suffering and madness and the diagnostic labeling that supports the medical model. So we were opposed to testing anyone to see what their symptoms and functioning were when they arrived using the standard tests that we felt were dehumanizing and that objectified people.
From our revolutionary perspective, I-Ward was a pirate ship or a Trojan Horse, or perhaps the leaven that would transform the whole system around us, but we didn’t want to prove it’s value by putting the mad people we sheltered there through the seeming degradation ceremony of measuring their subjective madness with qualitative, medical model designed testing.
As part of a county mental health system we were required to have a diagnosis for every person to receive public insurance payment, but since we didn’t believe in mental illness, diagnosis or schizophrenia, and because we knew that if people were given sanctuary when first mad- they didn’t have to earn the six-month schizophrenia label, we just diagnosed everyone with brief reactive psychosis.
But we described madness to residents, family and loved ones as a process of growth and individuation – a necessary developmental crisis of dramatic separation from the family. Again, this seems quite similar to the current open-dialogue approach.
Two weeks after my memorable job interview I took a leap of faith and left my job at the high end private psychiatric hospital and reported for work at I-Ward. But they wouldn’t let me work! They instead just required me to be there with no responsibilities for over a week. That was their way of seeing how the mad residents related to me and how I related to them. It was unnerving. I was afraid I wouldn’t be kept on, and would be dismissed, without a job to return to at the private hospital.
Until finally one day I was met by a somber senior staff person as I arrived at work. He pronounced- “We have decided that you are able to be entrusted to…do the work!”
The work. That is what they called this way of being with mad people.
He told me that the first person I was to work with who had just arrived from our psychiatric emergency unit down the hill was alone in the back day room. I asked who it was and he just said, “Go find out.”
I walked back to the day room and standing on a table about three feet off the ground was a totally nude beautiful young woman in an ecstatic transport! Her arms were were outstretched to the heavens and her face was a mask of radiant ecstasy as she chanted over and over in a quavering, almost sobbing voice, “Glorious, Glorious, Glorious!”
I was so stunned I didn’t know what to do. In my two weeks of job probation until that day, I had never seen anyone on I-Ward this completely gripped or possessed by madness.
I remember now introducing myself which felt pretty stupid, like someone interrupting Saint Theresa who I remembered seeing paintings of, that looked very similar when she was in mystical transport.
The young woman finally looked down at me kindly with such sweet kindness, that I again was at a loss to account for her nudity and saint-like demeanor.
I ushered her to her nearby room where she wrapped herself in a blanket and sat and continued to more softly now repeat “Glorious, Glorious, Glorious.”
Writing this now, 32 years later, I still am moved and humbled by the incredible power and at times terrible beauty of madness I was fortunate to have witnessed that day in the young mother that I came to know so well over the next many weeks.
But her divine light filled consciousness was soon to shift to the other pole. Within a day I remember meeting with her as she explained that the glorious spirit of god resided in the right side of her body and directed her right hand, but that satan was in and controlled her left hand and half of her body.
She extended her left hand to me and as she did her face was transformed into a mask of almost snarling malevolence and her voice became guttural as she rasped, “In this hand is the evil of satan.”
She then tried without prompting from me to shift back to her light and love filled right side and easily was able to do it.
She was not frightened by this back and forth shift of darkness and light. I must say that I was. It was so uncanny to witness this and to feel responsible for her life and her healing. There had been a suicide of a heavily medicated young woman at the private hospital while I worked there and just before I started on I-Ward there had been a suicide by a young unmedicated man on I-Ward.
But the young mother in my care was meant to survive her dramatic journey through madness.
We were always expected to convene a large meeting of family members and close friends of every young mad person on I-Ward within 24 hours of their arriving there – much like the current Open-dialogue practice.
The young mother’s husband and parents and siblings attended my first ever family meeting. I must say that what I witnessed there has sadly been my experience to varying degrees in every family where a young adult has gone mad in 30 years of specializing in serving people in madness processes.
On I-Ward I soon came up with my own litmus test that every family where a young adult becomes mad has sadly not passed- the apple of my eye test. Does at least one parent look at and express the feelings I have for my own daughter – that she is the apple of their eye? Do they insist that they will move mountains to get help for their precious son or daughter out of a strong passion that has juice, energy and won’t stand for less than the best.
Freud said that nothing is more important for the healthy development of a child than the loving, protective presence of their father. At least one parent needs to be there and hold the child in their heart as the apple of their eye. Even then the lack of the other parent’s love can be a big enough wound that the developmental hurdle of young adulthood requires madness to occur.
There was a measurable lack of emotional warmth in the nuclear family of the young mother.
There was a palpable sense of subjective isolation existing between them all as we sat together.
No one but her overwhelmed young husband leaned forward in their chairs to offer concern and emotional caring. I realized that I was witnessing the emotional wasteland Laing had described in the families he researched.
There was a subtle mystification of experience in the communication between family members that Laing said resulted in the identified patient not being able to trust their own mistrust.
In other words, people were not communicating directly, but through confusing half-truths, through statements that both blamed and praised her at the same time, contradictory signals of incongruous facial expressions such as smiling when being hostile were happening.
This madness inducing situation Gregory Bateson described as a double bind, which leaves the recipient not knowing which of the mixed messages they are getting they should respond to. It is a contributing factor to the sense of being isolated and unable to connect with family members authentically.
I believed that my work in meeting with the family of the young mother was to help untangle these family communications so that she could start to know where she stood with her parents especially. I don’t know that I ever really succeeded in my freshman family therapist efforts.
Looking back now I believe it was the caring connection with me and other staff she connected with that made for a space or crucible for her psyche to do it’s own re-organization, using the rocket fuel of unmedicated madness to surge up emotion and the imagery that gave form to the emotion.
I believe that process of being held emotionally, in warm human-hearted connection ultimately allowed her to resolve the dark/light polarities- the good mother/bad mother judgements she was tormenting her self with before she got mad.
Emotion is the core of madness and medication stills it and stops the needed power of emotion to carry the psyche’s mission forward. She would rage for over an hour at times in our padded, unlocked room where we would hold people lovingly when they were out of control.
We used no restraints and every time after long periods of wild raging people would wind down and end up cuddling into the sometimes two or three staff members needed to hold them. They would then softly start to cry and sometimes sob in a deep regression of safely being held by strong and loving parental figures.
The young mother left I-Ward after about two months and I wondered for several years what ever became of her. Then one day I received a phone call from her at the clinic where I then worked asking me for a referral for a family member who had a problem. I came up with some phone numbers for her and then asked her how she had been since I had last seen her.
She answered matter of factly as if I should have known, “Oh Michael, didn’t you know, I got all of mine out on I-Ward!”
It was my privilege to serve many other people on I-Ward in the next three years. It made a believer out of me in people getting what they need when they need it.
One more I-Ward story must be told here though, because it is what I remember most from those years on the sanctuary.
I was working the pm shift and was sitting outside a young person’s room in a chair in a vigil as we did when someone was feeling suicidal. The lights were dim in the long hallway stretching down towards the entrance. I saw a young woman come out of her room looking to be frightened, as night time often stirs fears that day would hold at bay as I knew well from my own season of madness.
She was approached at once by one of the very kind women staff who put her arm lovingly around the frightened young woman’s shoulder. The older woman leaned her head over and smiled warmly at the young woman, speaking words of comfort that I could not hear at the distance.
Suddenly a golden light surrounded them both. I shook my head as if to rouse myself from a dream I was slipping into. But I wasn’t slipping into a dream. Some would say I was hallucinating. but I don’t believe I was, because the light somehow held an emotion in it that hung there in the air around them. It was a light of love that seemed ancient, old, very rare. It vibrated and my heart was shaking with a feeling that took my breath away. It was the light of the sanctuary, the ancient healing light that hovers over and in sanctuaries where the mysteries of madness and healing occur and have occurred ever since we became human.
Research references and reading suggestions:
Bateson, G. 1956- Towards a theory of schizophrenia
Bateson, G. 1972- Steps to an ecology of mind
Boisen, A. 1936- The exploration of the inner world
Bola, J. 1998- Evaluation of treatment in early episode acute psychosis
Bola, J and Mosher, L. 2003- Treatment of acute psychosis without neuroleptics
Bower, B. 2001- Back from the brink: psychological treatments for schizophrenia
Breggin, P. 1994- Should the use of neuroleptics be severely limited
Burton, A. 1961- Psychotherapy of the psychoses
Campbell, J. 1984- The way of the animal powers
Ciompi, L. 1995- Alternatives to the hospital for acute psychiatric treatment
Dabrowski, J. 1964- Positive disintegration
Dallet, J. 1988- When the spirits come back
Duerr, M. 1996- Hearing voices
Eliade, M. 1954- The myth of the eternal return
Eliade, M. 1974- Shamanism
Fisher, D. B. 1994- Health care reform based on an empowerment model of recovery
Fortuna, J. 1995- The Windhorse program for recovery
Foucault, M. 1965- Madness and civilization
Fromm-Reichman, F. 1948- Notes on the development of treatment of schizophrenics by psychoanalyitic psychotherapy
Goffman, E. 1961- Asylums
Greely, A. 1974- Ecstasy: a way of knowing
Grof, S. 1989- Spiritual emergency
Gunderson, J and Mosher, L.- 1975- Psychotherapy of schizophrenia
Haley, J. 1997- Leaving home: the therapy of disturbed young people
Harding, C. The Vermont longitudinal study
Harner, M. 1980- The way of the shaman
Henderson J. 1997- The spiritual foundations of madness- an interview with John Weir Perry
Jung, C.G. 1953- Forward in J.W. Perry – the self in psychotic process
Jung, C.G. 1965- Memories, dreams, reflections
Jung, C.G. 2010- The red book
Karon, B. 1981- The psychotherapy of schizophrenia: the treatment of choice
Kuhn, T. 1962- The structure of scientific revolutions
Laing, R.D. 1959- The divided self
Laing, R.D. 1964- Sanity, madness and the family
Lukoff, D. 1985- The diagnosis of mystical experience with psychotic features
Menninger, K. 1959- Towards a unitary concept of mental illness
Mindell, A. 1988- City shadows: psychological interventions in psychiatry
Morrisey, M. 1988- Exploring burch house
Mosher, L. 2004- Soteria
Pao, P. Therapeutic empathy and the treatment of schizophrenics
Perry, J. 1953- The self in psychotic process
Perry, J. 1962- The reconstitutive process in the psychopathology of the self
Perry, J. 1974- The far side of madness
Perry, J. 1976- Roots of renewal in myth and madness
Perry, J. 1986- Spiritual emergence and renewal
Perry, J. 1999- Trials of the visionary mind
Rappaport, M. 1978- Are there schizophrenics for whom drugs may be unnecessary or contraindicated- the agnews project reasearch
Scheff, T. 1975- Labeling madness
Seikkula, J. 2003- Open dialogue approach
Szasz, T. 1974- The myth of mental illness
Sullivan, H.S.- Schizophrenia as a human process
Whitaker, R. 2002- Mad in america
Whitaker, R. 2010- Anatomy of an epidemic
What a heartwarming, valuable story! I-Ward and the impulse that created it, and its siblings (Soteria and Diabasis) is the same one that moves me to envision a similar approach to the growing number of children who are prescribed anti psychotic medications. Thank you for sharing this seed of possibility.
Thank you for your comment Angel!
Bless you for your activism helping children and those in need.
The epidemic of human rights abuses visited on children and teens via medications and shock therapy, violates the medical practitioner’s solemn oath to- “First, do no harm..” .
I address this in a brief video here, of my remarks at the recent Occupy APA protest.
Best wishes, Michael
ive been working in the field of psychology for 7 years and am now working on competing my doctorate. thank you. in reading this I realize my thoughts and perceptions, which I keep to myself, are not off. I hope I get to meet you and work with you some day.
Thank you for writing Caroline-
I hope to meet you too!
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Hi my name is Jennifer and i suffer from schizophrenia, manic depression and anxiety as does my uncle and my brother. This article is right on and i always knew all my brother ever needed to heal was love. My family doesn’t believe my though and wouldnt be cabable of providing it either. Its up to me to help them and after reading this article i know i can. Thank you endlessly.