Lecture to World Congress of Social Psychiatry, Hamburg, June 1994 (Note: This article should be read ideally together with the article on understanding mental breakdowns as life management breakdowns, also to be found on this website. In focusing in this article on the way in which childhood can powerfully form one's orientation and responses to life situations, it is important to give proper emphasis to what has to be coped with in later life if people have a breakdown or psychological difficulties. Psychotherapists have an unfortunate tendency to reduce everything to what has happened in childhood.)
Upbringing and Psychosis
Madness is, in the common understanding, where the experiences - the thoughts, emotions, and actions - of a person are not understandable to those around him or her and that person is not coping and/or exerting a disruptive influence in the lives of other people. So madness is by definition incomprehensible. Nonetheless I think that most of those thoughts, emotions and actions that our society describes as madness can ultimately be made understandable. As the mental health service user movement develops the people who have suffered mental health problems will more and more develop their own explanatory framework for their experiences. The discussion of these explanatory frameworks will begin to suggest coping strategies. Professor Romme's approach, in this regard, in relation to 'Hearing Voices', would also be valid, for example, for mania (prolonged excitement creating impulsive behaviour), and many other so called mental illness symptoms. With these 'symptoms' also I believe that people could share their ideas in regard to coping strategies. But first we should stop using words like 'hallucination', 'mania', 'delusions', 'confusional states' etc. Rather we should see these as more powerful versions of what everyone experiences (excitement, day dreaming, wishful thinking, panicking, impulsive behaviour, flashback memories, looking for 'signs' to predict the future etc.). The use of ordinary language would help us discover that everyone experiences the mind states that, in insanity, become so powerful as to be overwhelming. It would be possible to learn from each other better how to avoid, or how to cope with, these reactions of extreme emotional stress.
Part of the difficulty of understanding mental health problems lies in their tendency to have a regressive character. When a person is psychotic they are acting and interpreting things like a distressed and terrified baby, infant or small child, albeit in the body of an adult. It is not difficult to understand why this should happen. When we find ourselves in situations in life which generate prolonged stress (fear, frustration, anger, sorrow, despair) we fall back on using the coping strategies we evolved earlier in our lives for dealing with such stresses. We cope by drawing on what we have learned during our upbringing. This is not something we are necessarily aware of doing but, to use an example, if we are attacked on the street, we fall back on whatever fighting skills we learned as we grew up - we might have to rely on whatever self defence skills or survival strategies we evolved in our play behaviour. Much psychotic behaviour is, I believe, a reversion to inadequately developed play behaviour and play fantasies.
Unfortunately our upbringing may not have prepared us well for various stresses. As we make our way in life we have, with limited knowledge, to take decisions, judgements and actions in a host of unfamiliar situations with uncertain outcomes. This is when we are likely to suffer what are called mental health problems - when we do not know what decisions or actions we can take to escape from situations (jobs, relationships, environments) which cause us anguish. It might be that we do not know what decisions or actions we can make that will get us positive emotional experiences (e.g. affectionate relationships, jobs that will stretch, without breaking, our confidence). Or again we might not know how we can pursue aims in life which seem important to us, but which no one else sees as important or are extremely hostile to - leaving us isolated and alone, fearing that we will die with our lives fruitless and unfulfilled.
In these kind of situations, taken to extreme, our emotions eventually overwhelm our thinking. Instead of our emotions motivating and guiding our thinking and actions our emotions come to overwhelm our whole thinking about relationships with the world. Our inner feelings become so strong we cannot take a balanced view of the outside world since all we can see in it are reflections of our frustrations, our terrors and our desperate hopes.
It is my experience this sort of situation can create mind states in which everyday background noises come to be structured as conversations reflecting frustrations, hopes and fears. This was the sense in which I 'heard voices' (which may not be the same experience of others where voices are experienced separately from background noises, more internally). This was my interpretation of what I heard, of my auditory experience. At the same time what I saw, - advertising slogans, street signs, cloud formations, astrological predictions, the Tarot, tea leaves - were also read as signs, as pointers, of what I hoped or feared would happen in an uncertain future. I interpreted these entirely in terms of my inner concerns - rather than for their generally understood meaning. Underlying all of these was the profound loneliness, an absence of feedback, as I pursued personal agendas I perceived no others understood or cared about. (One of my greatest frustrations eventually lay in trying to communicate my developing theory of madness - since this was mostly ignored by local medical psychiatrists. One of them said 'We don't have to listen to him, he's only a patient'. Others listened but it has made little difference to their practice. I knew I was on to something important and was desperate for the breakthrough when I hoped they would realise the value of what I was saying. The fact that they ignored what I had to say aroused powerful feelings that became too frustrating. The anger spilled over into all my relationships and periods in which I would withdraw from everyone. In isolation nearly all thinking is fantasy as there is no feedback to reality-check in conditions of intense aroused emotion. Later I saw I was rather 'father/teacher fixated' as I was appealing to local psychiatrists to support my attack on their work. I wanted them to accept me even as I attacked them - acting out repressed feelings as rebellious son/pupil. This was a reproduction of, and a failure to go beyond, chronically unsatisfactory childhood relationships. It was Professor Romme, who did see the value of my work, who advised me, very wisely, to address my ideas to those who would listen, not to those who would not).
When we are finding it difficult to cope in our current life this generates powerful negative emotions like fear, frustration, sorrow and despair. The function of emotions are to motivate our actions. Positive emotions like affection motivate bonding behaviour for example. The function of our negative feelings is also to motivate our actions (fear to motivate running away, anger to motivate resistance, despair to motivate giving up - thus making possible fundamental rethinks which start us on new tracks). Unfortunately our past may not have prepared us to use our emotions in this way. We may have been told it is cowardice to run away, or that it is wicked to get angry, or that only failures feel despair and give up. Our upbringing will reflect the authority structures of society in this respect - authority structures want people who do not run away when things get frightening or unpleasant, who do not explode in anger against their (supposed) superiors, and who do not give up (unless told to). It is not too strong to say that in all sorts of authority relationships, including parent-child ones, there is a powerful pressure on subordinates to 'be happy' (i.e. lie to oneself and everyone else about one's true feelings).
In this context, voices may function as representatives of the feelings that have been invalidated, that are not acknowledged as part of the self.
Our upbringing may therefore have prepared us, unwisely, to refuse to experience despair (motivating giving up and, from thence, turning to new paths). Instead we turn to strategies based on fantasies that give us false hopes. As we feel ourselves in situations of stress we may try to base ourselves on terms of reference from our past as to what to do in our life crisis. But we may find no past lessons as to what we should do. We may find ourselves reliving the memories of earlier terrors and anguish which were never really resolved satisfactorily because we were, and remained, powerless during those past crises. At that time our despair could only give rise to tears - and if there was no response to those tears then we were lost. If our infantile expressions of despair had no function we cut off from these awful feelings into numbness - refusing to feel despair again. ('Poverty of affect'). In those earlier crises we may have learned nothing that would help us act now. If we were being persecuted, for example by older children, we could not yet get out of our cot, we could not yet walk or speak. If we could speak we might have got little priority. We might have been made to feel small when we were small. We might have been bullied, or neglected, and were powerless to do anything in what seemed to us as, perhaps at a preverbal age, like eternities of incomprehensible pain. Eventually we cut off from our feelings and thus from ourselves. I believe that a connection will often be found between child abuse and neglect and psychosis.
This does not mean, reasoning the wrong way round, that all mad people, were parentally abused. Circumstances and environments can also serve to traumatise children without parents being what would be described as cruel. A traumatic birth can set up a mental predisposition to be anxious about any major change in life whose outcome cannot be known and controlled in advance. In my case I was born within one hour of the onset of my mother's labour pains and she went into shock. I was, as was the usual way at that time, turned upside down and smacked, then put on one side while attention was devoted to my mother.
An isolated setting where a child grows up may mean a child has no one of its own age to play with so is unable to easily form emotional relationships - ending up without the personal skills to later escape from loneliness. Early isolation may be caused by growing up in a rural area or an urban one where traffic and estate design meant parents dare never let the child be free with other children. I suffered in this way because I lived in a neighbourhood with a very low population density. My sister was five years older. At seven I was liberated from my isolation. My parents moved putting me in direct contact with other children of my own age in an environment I could wander in at will. I would often come back hours late for meals. If I had moved in the other direction, from social relationships to isolation, it would have been traumatic. A move at a critical stage in life may rip a child away from important early emotional relationships.
Also the traumatisation of parents (the death of their parents, unemployment etc.) may undermine their ability to be supportive and affectionate during a critical period for a child (e.g. when the child first becomes aware of death or is first bullied by older children). All these, or similar factors in combination, may mean that later, when confronted by new situations of fear or frustration, an adult will find themselves without realistic hope or action strategies that would enable them to make life better. Indeed they may be filled with anxieties and terrors because their new adult situation has reawakened the feelings from their earlier period of powerlessness. Or their hope may based unrealistically - and therefore fantasy.
I write this to stress that we should help people look holistically at their lives to seek their own explanatory frameworks for their problems. I believe that childhoods of abuse and neglect will often be found to be the factor that predisposes people to break down when they are stressed. In stress they regress to their original experiences of fear and helplessness. But we should constantly be wary of theoretical preconceptions. We might, indeed, find equal meaning by turning some of my arguments the other way round. For example, I recently saw a humorous postcard. On it was a picture of a young woman, above which was written something like: 'I am assertive, adventurous, creative, curious, intelligent, open, honest. I have a high self esteem...' and underneath the picture '...so naturally I find it extremely difficult to find friends and get a job.' A relatively positive and healthy upbringing may make one emotionally out of tune with other people who are more emotionally damaged, more defensive, paranoid, authoritarian.
What matters then is the mismatch between upbringing and later life. We might express this as how far peoples' pasts prepare them for their struggles in their presents as they try to make their futures. Their past may actually have been more positive than the social norm in many respects - but putting the person out of tune with the social and environmental milieu that they live in in later life. So they have an emotional crisis and regress to the real, but perhaps less prevalent, emotional traumas of their past. The more emotionally damaged people may be those who set the contexts of the lives of such social victims. These others may not be having breakdowns because they are defending themselves against ever feeling small and frightened again by taking control over other people's lives. As managers, psychiatrists, teachers, preachers etc. psycho-toxic people have excellent opportunities to be cruel and aggressive with complete social acceptance under the guise of management, treatment, pastoral guidance, teaching, punishment, helping - always supposedly for the good of their victims. In such cases, however, the psycho-toxic people or institutions put their victims in intolerable positions and disempower them from any ability to do anything about their situation.
In this respect we need a definition of the kind of relationships between people that are not psycho-toxic. This definition will be equally to the relations between adults and children and to the relationships between people who hold formal positions of social power and those 'subordinate' to that power. Non psycho toxic relations are those where people are able, in their relations with each other, to express their own feelings, to be heard, and to pursue their own agendas and initiatives. The strong would not overrule the purposes of the weak and make their lives intolerable. In health and social services this would mean that professionals would be available 'on tap' with out being 'on top'. In parenting it would mean something similar. If parents continually try to control, direct and interfere in the lives of their children then these over-critical and over-controlled relationships stop the child developing its independent ability to choose for itself, on the basis of its own feelings, what it likes and dislikes. It invalidates and undermines the child's creativity and independence. By definition it invalidates the feelings of the child - and thus also the child's ability to be aware of the feelings of others. It creates children that grow up to be either tyrants, modelling their lives on their parent's demands for obedience, or emotional doormats, obediently following people who claim to be saviours, people whose principal message is a message of hatred against social scapegoats. - This relates to themes explored elsewhere in this world congress.
Brian Davey
References:
Brian Davey, Psychosis, in Romme, Marius and Escher, Sandra, 'Accepting Voices', Published by MIND Books, London 1993.
Brian Davey, Madness and its Causative Contexts, in Changes (An International Journal of Psychology and Psychotherapy), Vol 12 No 2, pp113-131, June 1994. (ISSN 0263 8371).
© BRIAN DAVEY