There are as many types of mental illness as there are people who suffer them.
The World Health Organization estimates that approximately 450 million people worldwide have a mental health problem.
None of us is immune from the existential worry that nags away in the back of our mind. We are all vulnerable to emotional and psychological turmoil in our lives and there is something fundamental about the human condition that makes it so.
There is something at the core of the experience of mental illness that draws sufferers towards the spiritual. Their suffering is an echo of the suffering we all contain within us.
EVERYONE NEEDS A BANISTER; a fixed point of reference from which we understand and engage with life. We need something to hold on to, so that when we’re hit by life’s inevitable disappointments, pain or traumas, we won’t fall too far into confusion, despair or hopelessness. With a weak banister we risk getting knocked off course, losing our bearings and falling prey to stress, psychological turmoil and mental illness. A strong banister will stand the test of time in an ever changing world, giving us more confidence to face the knocks and hardships of life more readily.
Understanding who we are and how we fit into the world is a quest we start at birth and continue through the whole of our lives. Sometimes these questions come to the fore, but usually they bubble away somewhere beneath the surface: ‘Who am I?’ ‘Am I normal?’ ‘Why am I here?’ ‘Is there any real point to life?’ Deep down inside we know that nothing lasts, the trees, landscapes and life around us will all one day perish, just as surely as we ourselves will, and everyone we know too. But we have evolved ways to hold this reality and the questions it hurls up at bay.
We construct banisters to help us navigate our way round this maze of pain and insecurity: a set of beliefs and lifestyles that help us form a concrete context to make sense of things and, as the saying goes, ‘keep calm and carry on’. But, for most of us, the core beliefs and lifestyles that hold us together still leave us vulnerable to instability. The sense of identity we evolve is so precarious that we’re often buffeted by life onto shaky ground. And, as a consequence, we become prone to various forms of psychological distress; indeed, for vast swathes of society this proceeds all the way to mental illness, whether that be labelled as anxiety, depression, bipolar disorder or the most severe form of mental illness, psychosis.
There are as many types of mental illness as there are people who suffer them. One of the reasons I decided to specialize in psychiatry, shortly after qualifying from medical school, was that, unlike any other branch of medicine, no two people I saw ever came to me with the same issues. Although different presentations might loosely fit into different categories, there appeared to me to be as many ways of becoming mentally unwell as there were ways of being human. I have since specialized in the more severe and acute end of psychiatry. I currently work in a secure, intensive care facility but to this day, in 16 years of practice, I have never seen two cases that were exactly the same.
And the numbers just seem to be going up. In the UK today, one in four adults experiences at least one diagnosable mental health problem in any one year. In the USA, the figure is the same and this equates to just over 20 million people experiencing depression and 2.4 million diagnosed with schizophrenia, a severe form of mental illness where the individual experiences major disturbances in thoughts and perceptions. The World Health Organization estimates that approximately 450 million people worldwide have a mental health problem.
Beyond these figures, however, are all the people who struggle with various levels of stress throughout life and, all the while, carry a fear at the back of their minds, that they too may one day slide into mental illness. In my experience, this is a fear that pervades virtually every stratum of society. Rarely am I introduced as a psychiatrist to new people in a social gathering without at least some of them quietly feeling, or even explicitly reporting, that they worry that one day they are going to need my help. Such comments are often made in jest, but the genuine anxiety that underlies them is rarely far beneath the surface. There is a niggling worry at the back of many people’s minds that something might be wrong with them; that something isn’t quite right. What they don’t realize, however, in their own private suffering, is just how much company they have in this fear. Indeed, I include myself and my colleagues among them, too. None of us is immune from the existential worry that nags away in the back of our mind.
But, if we look closely, there is also another process that can be discerned underneath all of this. Deep down inside every bubbling cauldron of insecurity, we can also find the seeds of a kind of liberation. Something is just waiting to burst forth. This something is hard to define or describe in language, but it is often in our darkest hours that we can feel it the most. And the further we fall the closer to it we get. This is why, I believe, mental illness can be so powerful, not just because of the deep distress that it contains, but also because of the authentic potential that it represents.
Mental illness, however, is just one aspect of a continuum we are all on. All of us have different ways of reacting emotionally to the experiences we encounter in life and the ones that involve a high level of distress either for oneself or for others are the ones we choose to label as mental illness. And it is this end of the spectrum that l will focus on most in this book, as it is these most stark forms of distress that present us with the greatest opportunity to observe the seeds within, and thus, ultimately, learn what is in all of us too.
There may be a variety of factors that contribute to the various forms of mental illness, of course, from childhood traumas to one’s genetic make up, but as the cut-off point always centres around distress which is grounded in subjective experience the definition itself will always remain somewhat arbitrary. That’s not to say that such definitions have no utility. By helping us communicate with each other about these complex shapes of suffering, they will also help us communicate our ideas with one another about how to help reduce the suffering encountered.
That is why I use these terms in this book, but it should be noted that I attach this large caveat from the outset. Ultimately, the only person who can really describe a person’s suffering is the sufferer himself; outside that individual, the rest of us are always necessarily off the mark. What must invariably be remembered, however, is that there is no ‘them’ and ‘us’. We are all vulnerable to emotional and psychological turmoil in our lives and there is something fundamental about the human condition that makes it so.
That is why I believe, as a psychiatrist, that the best research I ever engage in is when I explore my own vulnerabilities. That is when I start to connect with threads of the suffering that my patients are undergoing too. And what I find particularly fascinating about this process is that the deeper I descend into my own world of emotional insecurity, the more I grow to appreciate an indescribable dimension to reality that so many of my patients talk about in spiritual terms, engage with, and indeed rely upon so much of the time.
In a survey of just under 7,500 people, published in early 2013, researchers from University College London found a strong correlation between people suffering mental illness and those with a spiritual perspective on life. Though the results confused many, to me they made perfect sense.
There is something at the core of the experience of mental illness that draws sufferers towards the spiritual. Their suffering is an echo of the suffering we all contain within us.
That is why I can say from the outset, and without reticence, that my insights are based largely on a subjective pathway to our shared inner world. And it is through this perspective that I have evolved what I believe is a new banister: a new way of seeing the world and being within it. It is, however, not just that my introspection has taught me about my patients, but that my patients have also taught me about myseIf. Indeed I can safely say that I have gleaned just as much from the individuals I have cared for as I have from the professionals and teachers I have learnt from.
I consider myself hugely lucky to work in a profession in which looking into myself and learning about my own inner world has been, and continues to be, a vital requirement of my work (though, it has to be said that, sadly, many within my profession do not recognize this). It has propelled me into a journey of limitless exploration of both myself and the people I care for and this has led me to ever deeper understandings of the nature of mental illness, the mind and reality itself. I have drawn upon a diverse array of wisdom along the way, and my journey has ultimately led me to construct a synthesis of modern psychiatry and ancient philosophy; of new scientific findings and old spiritual practices.
But this banister comes with a health warning, as indeed all should. Just as a set of perspectives and insights can be a useful support in times of instability, so too can overreIiance on them become counterproductive. That is why a banister needs to be held lightly. Gripping too tightly to anything in life is a recipe for exhaustion and, consequently, even greater instability.
What we need is a banister that, when held lightly, can allow us to move forward, rather than hold us back. I believe that such an understanding of reality and our place within it actually exists; it is also imperative to our survival as a species. I believe that life’s potential is far greater than most of us are ever aware of, and that our limitations are a lot more illusory than we know. In a sense I feel we are all suffering from a form of mental illness a resistance to the realization of our true nature, and to that end I humbly offer this book as a guiding rail out of the turmoil.
My Journey. An Exploration of Inner and Outer Worlds
Wisdom in Bedlam
‘One must still have chaos in oneself to be able to give birth to a dancing star.’ Friedrich Nietzsche
MENTAL ILLNESS IS SOMETHING that most of us shy away from. Someone who exhibits behaviour or feelings that are considered out of the ordinary will, sooner or later, experience a fairly broad radius of avoidance around them. Even in psychiatric hospitals this is evident, where the less ill patients will veer away from those who are more unwell. The staff themselves are often prone to such avoidance, too. But contrary to this natural reflex that exists within all of us, moving closer to, and spending time with, someone suffering mental illness can often be quite an enlightening experience. It took me many years to realize this myself, but through the cloud of symptoms, a fascinating display of insight and depth can often be found in even the most acutely unwell. And this turned out to be true whatever the type of mental illness. The problem might be mood related for example, depression or bipolar or what we term neurotic like anxiety, panic or post-traumatic stress disorder or all the way up to the paranoia or hearing voices that we see at the most severe stage of mental illness termed psychosis. Indeed, the more severe the symptoms, the deeper the wisdom that appeared to be contained (though often hidden) within it.
A frequent observation of mine, for example, is just how perceptive the people I treat can be, regardless of the very evident turbulence that is going on inside. It is not uncommon for those who are newly admitted to share with me their impressions of the nursing and other staff on the ward with an uncanny degree of accuracy within only a few days of arrival. They’ll sometimes rapidly intuit the diverse array of temperaments, perspectives and personality traits among staff members and so have a feel for who is best to approach, avoid, or even wind up, depending on their mental state and needs at the time. It is likely that this acute sensitivity is one of the initial causes of their mental illness in the first place, but the flip side is that they have also managed to glean a lot about life from their experiences to date. This wisdom is often hidden by the symptoms of their illness, but it lurks there under the surface, often ready to flow out after a little gentle probing. I am frequently struck by the profundity of what I hear from my patients during our sessions and I often find myself feeding this same wisdom back to them even when, at the same time, they are undoubtedly experiencing and manifesting a degree of almost indescribable psychological pain.
Most of us spend our lives going to work, earning a salary, feeding our families and perhaps indulging in sport or entertainment at the weekends. Rarely are we able to step back from it all and wonder what the purpose of all this is, or whether or not we have our perspectives right. During the football World Cup one year, a patient told me that he felt such events served a deeper purpose for society, ‘It stops us thinking about the plight of the poor around the world.’ Events such as this kept us anaesthetized, he believed, so we could avoid confronting the depths of inequality and injustice around the globe, and that would ultimately enable the system that propped up the very corporations who were sponsoring these events to keep going. I had to admit that I had never thought of it that way before.
Compassion is a frequent theme I observe in those suffering mental illness, even though they are usually receiving treatment in a hospital setting because, on some level, they are failing to demonstrate compassion towards either themselves or others. I have often been moved by hearing of an older patient with a more chronic history of mental ill-health, perhaps due to repeated long-term drug use, or failure to engage with therapy, taking the time to approach a younger man, maybe admitted to hospital for the first time, and in effect tell him, ‘Don’t do what I did, son. Please learn from my mistakes.’ There are few moments, I believe, that are more powerfully therapeutic than that.
It is only in the last few years that we have discovered, after trialling a variety of treatments, that one of the most powerful interventions for what are known as the ‘negative symptoms’ of schizophrenia, is exercise. These negative features relate to a lack of energy, drive, motivation and, often, basic functional activity. Whatever the diagnostic label you choose to put on it, this can often be the most disabling part of such illnesses, and there are hardly any known treatments for it. Although an evidence base has recently evolved around the practice of regular exercise. I never quite understood why this could be until a patient one day put forward a hypothesis to me. It takes you out of your mind, he explained to me. ‘You see doc, you can’t really describe a press-up. You just do it.’ The whirlwinds within could be overcome for a few moments at least, while attention is paid, instead, to the body. Suddenly I realized why going to the gym was the highlight of his week.
A rarely described but key feature of mental illness, therefore, is just how paradoxical it can be, with the same person who is plagued by negative, obsessional or irrational thoughts, also able to demonstrate an acute and perceptive understanding of the people and world around him. It is as if one mental faculty deteriorates, only for another one to branch out somewhere else; or rather, consciousness constricts in one area only to expand in another. There is actually some quite startling experimental evidence to back this up. An interesting study was conducted by neuroscientists at Hannover Medical School in Germany and University College London, Institute of Cognitive Neuroscience. It involved a hollowmask experiment. Essentially, when we are shown a two-dimensional photograph of a white face mask, it will look exactly the same whether it is pointing outwards with the convex face towards the camera or inwards with the concave inside of the face towards the camera. This is known as the hollow-mask illusion.
Such photographs were shown to a sample of control volunteers.
Sometimes the face pointed outwards, and sometimes inwards. Almost every time the hollow, inward-pointing concave face was shown to them, they misinterpreted it and reported that they were seeing the outward-pointing face of the mask instead. This miscategorization of the illusion actually occurred 99% of the time. The same experiment was then performed on a sample of individuals with a diagnosis of schizophrenia. They did not fall for the illusion: 93% of the time, this group was actually correctly able to identify when the photo placed before them was, in fact, an inward-pointing concave mask.
Clearly what we see here is an expansion in perceptual ability compared to normal controls. Data like this has begun to pierce the notion that mental illness is purely a negative or pathological experience. In fact, in this study, it was the normal controls who were less in touch with reality than those with a psychotic illness!
The most interesting aspect of this is that, whether they be suffering neurosis, depression, bipolar or even psychotic disorders, many people actually have some awareness of the fact that they are also somehow connecting, through this process, to a more profound reality that they were like the rest of us hitherto ignorant of. The experience might be disconcerting, even acutely frightening, but there is a sense that there is also something restorative about it too; they are rediscovering some roots they, perhaps along with the rest of us, had long forgotten about. One patient put it to me this way, ‘I feel like I am waking up. But it’s very scary because I feel like I have been regressing at the same time. It’s almost as if I needed to go through this in order to wake up.’
This sense of a wider meaning and purpose behind a breakdown is not an uncommon theme among the people I see but it is, nevertheless, so counterintuitive that it continues to halt me in my tracks whenever I encounter it. In psychiatry, for genuinely caring reasons, we are striving to reduce the distress that the people we see are experiencing. That, after all, is the reason we became health-care professionals in the first place: to heal the sick. So our reflex, whenever we see people in any kind of pain, is to remove it. But when one senses that the sufferer himself/herself sees value in the experience then we need to stop and think. So long as they are not a risk to themselves or others, perhaps our usual reflex to extinguish such an experience might lead to the suppression of something that could otherwise have been valuable or even potentially transformative.
I have had many experiences of treating people who, even after a terrible episode of psychotic breakdown, came out the other end saying that this was good for them and that the experience, despite being horrendous, was something they needed to go through. This has sometimes been attributed to an expansion of awareness that they felt they needed, and that they believed the illness brought to them. A patient once talked with me about a profound, almost overwhelming, sense of gentleness and warmth he felt when listening to music one evening, just hours before his relapse into psychosis, and as we were talking in the session, he suddenly looked up at me and said, with a mixture of awe and joy on his face, and tears in his eyes, ‘Sometimes I feel that there is something out there so beautiful and so much bigger than me, but I just can’t handle it.’
Though we will be exploring the whole gamut of psychological distress and mental illness in this book, it is the psychotic experience that usually invokes the greatest stereotype and stigma, and so merits extra attention in this opening chapter. Psychosis is when someone is said to have lost touch with reality, and this may involve hearing voices, seeing things or holding some delusional ideas. The idea that someone suffering psychosis can also be the conduit of genuinely deep wisdom and insight, therefore, surprises most people, even mental-health professionals who might not be familiar with this client group. First-person accounts of this are not easy to find in the academic literature, but one particularly good case study was published by David Lukoff in the Journal of Transpersonal Psychology. He wrote it in conjunction with a gentleman who had himself suffered a psychotic breakdown and went by the pseudonym of Howard Everest. Howard was able, in a very articulate way, to describe his own breakdown which he referred to as a form of personal odyssey both during and after it actually happened.
. . .
Dr Russell Razzaque is a London based psychiatrist with sixteen years experience in adult mental health. He has worked for a number of national and international organizations during his career including the University of Cambridge, the UK Home Office and the Ministry of Justice, and he currently works in acute mental health services in the NHS in east London. He is also a published author in human psychology with several books on the subject, and he writes columns for a number of publications including Psychology Today, The Independent, The Guardian and USA Today.
Breaking Down Is Waking Up. Can psychological suffering be a spiritual gateway?
by Dr Russell Razzaque
get it at Amazon.com