Understanding Madness as Life
Management Breakdowns
Despite what medical psychiatrists say the best way to understand a mental breakdown is to see the psychological breakdown as one aspect of a larger crisis - a life management breakdown. Breakdowns in relationships and ordinary life routines commonly occur at the same time, or come before, psychological chaos. Mad thinking it is meaningful in the context of the life management breakdown and the strange thought patterns of madness often reflect in a garbled way emotional turmoil dragged up from a distant past - from that other time of great vulnerability, childhood.
Practical living relationships are commonly embodied in personal networks, in habitats and work places. If relationships break down so too do life's practicalities. Routine ways of washing, eating, sleeping and spending one's day breakdown. The opposite is also true - for example the loss of a job, income and/or home will disrupt relationships.
Such life management crises may occur at any time for a host of reasons. The pattern of a person's life may be disrupted by outside forces which they do not control - e g redundancy hitting a fragile relationship, a debt financed loaded lifestyle and a personal identity reliant on being a big spender and a success at work. Sometimes the existing patterns of life become unsustainable for some reason - as when a hope for change evaporates in a life characterised by prolonged boardroom, isolation and/or fear. At other times there are botched attempts to change - typically in early adult life where a young person has neither the skills, nor emotional independence, nor economic means to leave home, having been the " institutionalised" by their own family. At other times the goals person a person sets themselves, or the way they pursue these goals, may make them clash with other people. To many people the agenda is to prove their intellectual and moral superiority in a competitive life-game they started as a way of coping with being made to feel small as children Perhaps they become manically excited and work hard if they seek fame and fortune near, becoming infuriated when others do not acknowledge their supposed greatness. The person may have built a life style in opposition to the mainstream by joining a sect or a gang. Exclusion from this group entails chaos.
The lead up to such a life management breakdown is inevitably preceded by emotional arousal and a tendency to withdraw from relationships. This makes it difficult for the person to reality check. Confrontational isolation generates powerful hopes and fears about how others are responding, or will respond, to the agendas of the crisis person. These emotionally powerful concerns and linked thought patterns become uppermost in their minds - to the extent of driving out an ability to concentrate upon and cope with mundane practicalities. If a person is very isolated over a long period, inactive and in poverty, then this day to day experiential deprivation, this chronic and severe lack of stimulation and crippling boredom, may be so great that their internal fantasies may be more compelling than their external reality. Rather as if they had been obliged to endure an extended psychological experiment about sensory deprivation, the absence of other activities and relationships to engage their minds, throws their internal mental and emotional content of their minds into greater prominence in the stream of consciousness.
When one interprets an ink blot test or "consults the tea leaves" one projects onto a random pattern one's private concerns. The crisis person tends to interpret everything in this way - traffic signs, advertising hoardings, even the pattern of the clouds. The traffic lights on red is understood by them as signaling personal danger. This personal reading of their surroundings in terms of their hopes and fears works by emotional associations in a way familiar to advertisers. Objects become like the props used in the play of a child. The behaviour of the isolated person becomes akin to childhood play.
The breakdown in relationships and practicalities can come to be accentuated by the strange thought patterns. The crisis person may also be disorientated by the new settings they may be forced to use - eg what to do and how to relate to people in the homeless hostel or how to organise food and shelter on a lower income. There may be new anxieties as the person improvises unfamiliar ways of washing, eating, sleeping, in new settings. Such experiences accentuate powerful memories of childhood when keeping warm, dry, clean and safe were things that the person needed support with, bringing to the surface long buried feelings of the humiliations of being small and helpless.
When relationships and life's routines breakdown of the feelings are those of powerlessness and vulnerability - re-creating the mind-set of an infant that feels powerless and vulnerable - and/or is in a tantrum. The most difficult to interpret experience in a madness are like the incoherent thought patterns infants have before they have access to the language - for example the infant's terror that it will cease to exist without another heartbeat to co-ordinate with. This is the terror of the newborn child separated from its mother - babies on a natal ward will stop crying if a heartbeat is played to be. Only with language do children discover a world beyond the range of their own perceptions and get a full measure of themselves. A baby cannot know that the face in the TV making sounds towards it is not like the other faces that makes sounds for it alone. If, as child, and the crisis adult person was abused, neglected or, quite unintentionally traumatised, for example by having emotional roots pulled up by a move at a critical age, then they may have been left with a buried sense of horror, terror and despair which re-emerges in the psychosis, overwhelming the remaining coping abilities. "Paranoias" are akin to the hyper-aware terror of the baby trying to predict from its parents reactions what the hell "being naughty" will mean next. It was not born knowing or expecting such terrifying responses from its parents to, what to it, are entirely innocent exploratory actions.
The preceding analysis lends itself to an entirely different way of working with people who are, or who have been, psychotic. Since psychological breakdown is only part of a wider crisis, it should no longer be regarded or treated as pre- eminently a medical problem. The crisis person, and ideally, other involved people, should be encouraged to find an explanatory framework for what has happened and what is happening. This should be linked to short term coping and long-term change. Conventional therapy is a long slow business which is sometimes helpful in understanding the influence of past family relationships but which often isn't helpful because it plays down current problems - work, unemployment, poverty, poor living conditions, frustrated ideals. It is better to help encourage the person, perhaps in a dialogue with others who have had similar crises, or find their own explanatory frameworks.
The emphasis here is how the person cannot re-establish a manegeable pattern to their lives. Part of this is about learning to recognise and cope with arousal states (anger, fear, stress, tension) better - since one can rarely change one's life so dramatically and quickly that the stresses disappear. Here exercise, Yoga, massage, aromatherapy and other self help approaches have something to offer. But the more fundamental solutions are long-term and there is a need to avoid an over-emphasis on the purely psychological and impersonal. Crises of the sort described here emerge in economic, social and environmental contexts. It can be shown, for example that poverty and poor environments like heavy traffic in a neighbourhood, severely stress adults - child relationships with damaging psychological effects as well as creating many of the preconditions for a later breakdown in adult life. A crucial strategy is therefore to encourage people who have had crises to help each other in mutual aid and community self-help, linking community care with community regeneration.
Of course, once a person has had a breakdown they tend to find it difficult to get back into employment, their income declines, their chances of finding relationships suffer. The fact that psychiatry claims their problems are first and foremost mental and genetic gives the suffering person an explanator framework for their problems that they cannot do anything about. This explanatory framework focuses attention on the doctor and the drugs they can give, or perhaps gives undue prominence to the explanatory framework which a psychotherapist will give to childhood influences. It has been known for some time that a person in the Third World is far less likely to have a second breakdown if they have broken down once when compared to people in the First World. One interpretation of this is that destructive effect of First World psychiatry which often does more harm than good.
The long term psychiatric patient tends to becomes long term unemployed, long term poor, long term isolated and long term bored. He or she keeps mental health workers and the pharmaceutical industry in good incomes and (usually unjustifiable) self esteem. However the patient's own life oscillates between an escape into fantasy day dreams and periodic bouts of apparently inexplicable terror - when it is suddenly remembered that one day death will come and there is nothing more terrifying than to die before one has actually been able to live.
Brian Davey
1996 - 1999References:
For a more detailed explanatory framework to understand madness see my article "Meaning, Madness and Recovery" in Clinical Psychology Forum 103, May 1997. Also my earlier article: "Madness and its Causative Contexts" in Changes, An International Journal of Psychotherapy, Vol. 12 No 2, June 1994.
© BRIAN DAVEY