Mad in America: Is an Ominous New Era of Diagnosing Psychosis by Biotype on the Horizon?

Hi All,

In this new article I sound the alarm on an ominous shift in how psychosis is diagnosed, that will use a system of bio-marker tests to label people in extreme states as being in a psychosis biotype group.


Medication Mechanization: Microchip Sensors in Abilify to Increase Medication Compliance

This entry first appeared at Mad In America on November 10, 2015.

I felt a chill go through my body when I read that the FDA has agreed to review for possible approval in early 2016 a new form of the drug Abilify that contains a microchip sensor capable of sending a message that indicates the exact time a tablet dissolves in the stomach. The message is recorded by a skin patch – along with data such as the person’s body angle and activity patterns – and, according to a press release from Proteus Digital Health, the developer of the device, “this information is recorded and relayed to patients on a mobile phone or other Bluetooth-enabled device, and only with their consent, to their physician and/or their caregivers.”

The Japanese drug giant Otsuka teamed up with Proteus Digital Health in 2012 to create this potentially profitable new “chip in a pill” just as its patent on Abilify – at $6.9 billion the #1 most profitable drug in the U.S. in 2013 – was set to expire in 2014, leaving one of Otsuka’s most valuable markets vulnerable to generics. It is especially ominous to me that our government is teetering toward passing the Murphy Bill, which would make forced in-home treatment the law of the land, at the same time it is lurching toward putting such an Orwellian device in the hands of a pharmaceutical company, courts, and families.

According to the Washington Examiner:

”The new smart drug could be particularly useful for ensuring the mentally ill continue taking their medications, not just by giving doctors a way to monitor their behavior, but courts as well…all but five states have court-ordered programs where a judge can mandate that offenders with severe mental illness stick with a treatment program as a condition of remaining in the community.”

As one Facebook commenter noted; putting a pill in your mouth and swallowing it, knowing it’s going to transmit a message to prove one is submissive and compliant, is beyond Orwellian – it feels fascistic. I agree. The social contract draws an invisible line that must be guarded against forces in a society that, driven by fears, fantasies of benevolence, or by simple greed, and are blind and deaf to the cries of its citizens as their bodily and personal integrity are ground into powder along with the preparations they are compelled to take in the specious name of “health” and “safety.”

Sometimes, radicalizing people politically takes a really callous, stupid, and dangerous threat to people’s liberty. This is one of those times.

The Washington Examiner article cites recent research that shows 74% of people who are started on antipsychotic medications stop taking them within 18 months. That’s the justification offered for a psych drug that monitors its own use.

“These individuals already have a history of problems due to their unwillingness or inability to voluntarily comply with treatment … this could be an important advance for them that would help them maintain treatment compliance.”

— D.J. Jaffe of the Mental Illness Policy Org.

Think about it: faced with the overwhelming 74% failure of a pharmaceutical intervention, why is the core issue deemed to be compliance rather than efficacy, and consumers’ safety & satisfaction? And why are we “gearing up” to ensure compliance in particular for a drug that even the FDA admits has an unknown mechanism of action?

What other medical specialty would blame its patients for so overwhelmingly choosing not to take the medications that have been prescribed to them? For a field that has taken on the charge of controlling and regulating social deviance, the ethical boundaries that the FDA should be protecting are blurred by the growing perception that people who are DSM-diagnosed are potential risks to society, despite overwhelming risk to the contrary; that a DSM diagnoses should be a signal that a person needs and deserves our protection.

Only a worldview that embraces the disease and deviance model of human emotional suffering would dare to suggest putting a sensor in a psychoactive substance to monitor and enforce its ingestion by an otherwise free citizen.

I believe that at some very basic level empathy seems to have failed in a society that sees the need to develop a sensor-equipped psychoactive substance. The blasé emphasis on prioritizing prescription compliance, without considering the profound subjective experience – to anyone, let alone a person in crisis – of having a digitalized foreign object inserted deep inside, an object that is in turn sending messages to an invisible outside presence. This oversight amounts to a vertiginous stumble forward in our society’s failure to muster empathy and compassion for its members, instead delivering them, in the form of a now-literally captive market, to the drug makers.

I’ve been seeing clients in therapy for over 35 years, and at no point can I imagine sitting a few feet away from a person in distress and suggest to them that they should consider having a device inside them that would let me know every day at a distance their most intimate experiences – let alone when they digest something, lie down, or when they have taken their meds. I couldn’t do it. It would feel ghoulish and perverse.

And I don’t want to be a part of a society that would do. Even – and perhaps especially – if it were being done “in my name.”

There is an aura of something shameful, a violation of a basic human right to privacy and bodily boundaries that is being ignored in the pursuit of this new digital monitoring of psychiatric medication. The shame is that, with a pill that records the moment of its absorption into our bodies, we are seeing the realization of a long-sought ideal of totalitarian governments; to cross the blood-brain barrier, gaining access to the very seat of our autonomy, and of our souls. With this, Otsuka could fairly revamp its marketing for Abilify by renaming it “Dis-Abilify,” without so much as risking – and potentially augmenting, in a society that seems to be exuberantly embracing an Orwellian ideal – its market share.

This is a time, if there ever was one, for citizens to act, and to act decisively; before the ability to make decisions, let alone act on them, is excised from our bodies completely by the next wave of pharma development.

Of course some will object to my characterization of those who developed this seeming well-meaning medical breakthrough as lacking a moral compass. But I have already heard the cries of outrage and fear from many of those for whom this Orwellian medicine is intended.

I’ll end here with an ever-more apt quote from C.S. Lewis –

“Of all tyrannies, a tyranny sincerely exercised for the good of its victims, may be the most oppressive.”

Mad in America: “My Ego Strength is Too Developed for Me to Ever Become Psychotic!”

Hi All,

A brief new article here about mental health providers who believe they never could suffer in the ways many of the people they serve experience, and how that belief limits the provider’s capacity for empathy and compassion.

Best wishes,


The Esalen Connection: Fifty Years of Re-Visioning Madness and Trying to Transform the World

This entry first appeared at Mad in America on December 12, 2013.

When Richard Price was a young man, he experienced extreme states for which he was labeled schizophrenic and forcibly ‘treated’ with psychiatric medications, ECT, and insulin shock. He suffered from residual effects from this for the rest of his life. In 1962, Price and Michael Murphy founded the Esalen Institute on the Big Sur coast of Northern California. From its beginning, Esalen worked to create sanctuary for people who, like Price, experienced extreme states. “Esalen was Price’s revenge on the mental hospital!” says Murphy.

Both at the institute itself and through the creation of projects like the rigorously designed, NIMH-funded Agnews Project research, Esalen helped to create the contemporary model of madness sanctuary. Agnews, which yet stands as the largest randomly-assigned, double-blind study on first episode psychosis, showed a 70 percent lower re-hospitalization rate advantage from providing a med-free environment for people in initial extreme states; a result which provided impetus and support for John Weir Perry’s med-free sanctuary Diabasis House, and the creation of the I-Ward sanctuary that I served at and wrote about here on MIA in “Remembering a Medication-Free Madness Sanctuary”.

Dick Price

Dick Price also wanted Esalen to be the kind of outside-the-box think tank that could fundamentally re-vision the experience of madness away from the medical model vision. Price realized the applied practice of the medical model belief system was the cause of the greatest trauma in his life. Price said about his own experience that “The so-called ‘psychosis’ was an attempt towards spontaneous healing, and it was a movement towards health, not a movement towards disease.” He believed his experience of madness was not pathological but was full of meaning and was transformative, even perhaps touched with mystical power. He saw Esalen as a refuge for people in extreme states, “A space where it’s possible to live through experience rather than having it blotted out, a place where there aren’t the same negative self-definitions of someone going through this type of experience.”

In addition to Price’s commitment that Esalen provide refuge for those in extreme states, Esalen’s broader liberating influence on world culture would prove to be enormous, as pioneers in philosophy and psychology made it the birthplace and epicenter of the human potential movement. (Sascha Dubrul has written a great article here on MIA about the lasting relevance of the human potential movement for current activism.) The young and gifted Price and Murphy attracted figures like Alduous Huxley, Alan Watts, and Abraham Maslow, who helped put Esalen on the map with week-long and even month-long gatherings for re-visioning madness. Ongoing symposia with names like “The Value of Psychotic Experience” went on for the whole summer of 1968! Gregory Bateson, Murphy and Price, Alan Watts, RD Laing, Erik Erikson, Fritz Perls, John Weir Perry, Claudio Naranjo, Virginia Satir, Julian Silverman, Alan Ginsberg, Michael Harner, Joan Halifax, Stan Groff, and many others all contributed to a growing understanding of extreme states that continues to evolve, as it certainly always must. They saw a neglected possibility for humankind, rooted in a philosophy that has always served to bring a dimension of the sacred and numinous into view.

That ancient but always emerging mythic vision serves as a counterweight to the objectifying, pathologizing and materialistic world view that I believe makes the tragically narrow vision of psychiatry possible. Esalen’s role in altering the views and approaches to madness, or extreme states, continues to this day.

Last month, following in the tradition of passionately focused Esalen conferences, I organized a week-long invitation-only gathering there; “Alternative Views and Approaches to Psychosis.” This conference was preceded in 2011 and 2012 by a workshop and then a conference on alternative approaches to extreme states that began a revival of this aspect of Price’s work, one that had been dormant at Esalen since his death in 1985, when he was struck by a boulder while tending to the Esalen grounds following a flood.

This year, the Esalen conference was attended by 40 people involved in one way or another in the mental health revolution that is daily chronicled here on Madinamerica. People with lived experience brought their invaluable perspective to a gathering that included peer counselors, psychiatrists, therapists, authors, film makers, researchers, mental health services administrators and family members. A great many of the 40 people who gathered felt a sense of urgency to come up with collaborative, strategic ways to unite against the ever-growing human rights abuses of forced treatment. Those human rights abuses are being justified more and more in the name of protecting society from the suspected danger of people who have been given a psychiatric label. That public demonizing of those of us with lived experience of extreme states is being fueled by wide-scale fear mongering and draconian laws that threaten all who experience extreme states.

A number of us at the Esalen gathering committed to work together to fight human rights oppression on many fronts, via media, public education, legal campaigns, and expanding on existing – and developing new – humane, alternative supports for those in extreme states.

Dick Price was a psychiatric survivor whose compassion still touches us now. I know I wouldn’t be writing here on MIA if not for him, because the I-Ward medication free extreme state sanctuary I went to work at in 1980 would never have existed without the Agnews research Price made happen. John Perry’s Diabasis House – that I did my doctoral research on – never would have existed either.

So, thank you Richard Price, for fatefully touching my life, but so much more for helping so many people in extreme states receive the love you were denied in your hour of need, and escape the soul-shrinking diminishment of self-worth, and the hopelessness that a psychiatric diagnosis can inflict. Esalen lives on as an example of what can happen – for individuals and for society at large – when we respond to the extremes that sometimes come with human life not with fear and control but with receptivity and encouragement. There’s no knowing – ahead of time, at least – how much accrues to each of us and to society at large when we learn to listen to the voices – weak, tenuous, or frightening as they may sometimes be – of people who are struggling with the process of coming-to-be in a world that often silences or eliminates them before they have a chance. Dick Price’s voice was silenced early but lives on in the place in which he came to live and die; a memory and evidence of what can happen when the best of mind, body, spirit and community are given a chance to come together.

Why Involuntary Out-Patient Treatment Isn’t Necessary – A First Person Account

This entry first appeared at Mad in America on August 2, 2013.

The last sentence in a recent New York Times article entitled “Program Compelling Outpatient Treatment for Mental Illness is Working, Study Says” tells of the police taking a man to get his monthly Haldol injection under the involuntary treatment law.

For years I worked on a community based team that helped homeless people in extreme states who had histories of being frequently hospitalized.

I met them wherever they lived – on the streets, under bridges, in abandoned buildings, and in parks. I formed close, trusting connections by being open-hearted and harmlessly helpful. I wasn’t trying to “treat” them or enforce medication compliance.

Many people made remarkable changes because I had truly befriended them, pursued them with compassion to where they lived in isolation, helped them get food, wash their clothes, find safe housing.

It breaks my heart to see that police-state tactics such as forced Haldol injections are understood to be the only thing that can reach some people. I know it isn’t true.

I remember the supervisor of our county hospital psychiatric emergency unit contacting me, because a long-time homeless man who I was helping, hadn’t been there in over six months.

He had been the most frequently-hospitalized person in our large county mental health system. He often had been brought to psychiatric emergency by the police – sometimes several times a month. He had spent long months in the state hospital.

The supervisor really couldn’t understand that my simply spending time with him on the streets almost every day was making the difference.

But it was.

That simple friendly contact – when we are not forcing anything on someone, but instead are harmlessly helpful and kind – is precisely what helps someone relax and choose to pursue the basic things they need, like food, clothing and shelter.

But more, that frequent time spent with me simply listening and warmly feeling concern for the homeless man, began to gradually reduce the intensity of the extreme emotional state he usually was in. He became more and more present in the moment, more lucid and at ease.

That gradual shift into a more focused and relaxed state, has happened with many other people in extreme states that I have spent time with in that heart-centered way over the past 35 years.

You might want to see one of my related MIA blog essays, “Responding to Madness With Loving Receptivity: A Practical Guide.”

I hope that our society doesn’t persist in the fear-induced reaction that forces people in our communities who are experiencing extreme states to experience violations of their human rights as well.

It’s not right, and It’s not necessary.

Remembering A Medication-Free Madness Sanctuary

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:

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