ck and P.D.
jm or disso-
i why people
lc ta Psychi-
? be Used in
ttry and Psy-
Dissociation, psychosis and
spirituality: Whose voices
are we hearing?
Patte Randal, Jim Geekie, Ingo Lambrecht
and Melissa Taitimu
Whose 'voices' are we hearing when we alternately consider unusual experiences to be
signs of psychosis, dissociation, or spirituality? Research has shown that phenomena such
as hearing voices, experiences of derealization and depersonalization, or odd beliefs alien
to one's culture or subculture, are more common in the general population than are the
diagnostic conditions whose presence they (are usually assumed to) indicate (Tien, 1991;
Poulton et ai, 2000). Despite this, these experiences are generally not considered normal
or commonplace and, as such, will be referred to as 'out-of-the-ordinary' experiences
(OOEs). In this chapter, we are not concerned so much with OOEs in themselves, but
with the different ways in which they can be understood, the context within which this
understanding takes place, and the impact various understandings have on the person experiencing
OOEs and on those around him or her. Thus, the question posed by our title,
'Whose voices are we hearing?', is not only about the subjective experience of hearing
voices, but also, more importantly, about the theories of explanation available to account
for such OOEs. Our discussion of these issues is located within a social framework as we
consider the importance of power relationships in determining who is allowed to provide an
explanation for these experiences. After an overview of relevant theoretical concepts, we
'flesh out' our ideas by presenting the personal experience of one of the authors (Randal),
and by exploring ways of understanding OOEs in different cultural contexts.
Psychosis, Trauma and Dissociation Edited by Andrew Moskowitz, Ingo Schafer and Martin J. Dorahy
© 2008 John Wiley & Sons, Ltd
334 CH 24 DISSOCIATION, PSYCHOSIS AND SPIRITUALITY: WHOSE VOICES ARE WE HEARING?
Given the personal nature of the experiences presented here, it is appropriate that we
tell you something about us. We all live and work in New Zealand (though only one of
us was born here). Melissa Taitimu is a New Zealand Maori researcher and clinical psychologist
who descends from the tribes of Te Rarawa and Te Aupouri. She is a spiritual
person (though not religious) who has encountered experiences herself and within her family
that may be variously defined as psychotic, spiritual or dissociative in nature. Another
coauthor, Jim Geekie, is an atheist brought up in the Catholic faith, who currently works
as a clinical psychologist in a first-episode psychosis unit. Ingo Lambrecht is a clinical
psychologist working with people suffering from psychosis. He was privileged to train as
a South African shaman (sangoma). Access to sangomas provided the basis for his PhD
research concerning shamanic trance states. Finally, Dr Patte Randal is a medical officer in
rehabilitation psychiatry; her story will follow.
The causes and meaning of the kinds of OOEs associated with diagnostic terms such as
'psychosis' and 'dissociation' are open to dispute and disagreement. Indeed, the very terms
'psychosis' and 'dissociation' are themselves competing attempts to account for these experiences,
both concepts being located within a broader mental health framework of meaning.
Another framework which has been proposed to account for these experiences is that
of spirituality and 'spiritual emergency', a term coined by Grof and Grof (1990). They
define spiritual emergencies as:
critical and experientially difficult stages of a profound psychological transformation
that involves one's entire being. They take the form of non-ordinary
states of consciousness and involve intense emotions, visions and other sensory
changes, and unusual thoughts, as well as various physical manifestations. These
episodes often revolve around spiritual themes; they include sequences of psychological
death and rebirth, experiences that seem to be memories from previous
life times, feelings of oneness with the universe, encounters with various
mythological beings, and other similar motifs. (Grof and Grof, 1990: 31)
In these states, people can present as disoriented, fearful, experiencing hallucinations,
delusional, affectively dysregulated and having interpersonal difficulties (Randal and
This by no means exhausts the range of available frameworks of explanation. In addition
to the variety of professional understandings of OOEs, research into the subjective
experience of psychosis shows that clients of mental health services develop complex and
multi-faceted explanations for their own experiences, explanations which have been shown
to have therapeutic worth (Geekie, 2004; Geekie and Read, 2008). Such is the extent of the
contest for the meaning of OOEs that we propose that these concepts are what the philosopher
Gallic (1955-56) has referred to as 'essentially contested' concepts: that is, concepts
which are inherently contestable (see Geekie, 2004).
The contest for the explanation and meaning of OOEs does not take place within a
politico-historical vacuum. Rather, it occurs within social contexts, where power relations
have an important impact on which perspective comes to dominate. Foucault's (1980) analysis
of the relationship between 'power' and 'knowledge' is helpful in drawing attention
to the pluralistic nature of knowledge and the tendency of the dominant discourse to 'subjugate'
discourses (such as that of individual subjective experience) which challenge its
hegemony. A related useful concept is Snorter's (1981) notion of 'authoring', which is the
24.1 A COSMIC BATTLE: PATTE'S STORY 335
'moral right' of the individual to 'decide what his experience means to him'. Geekie's research
(2004; Geekie and Read, 2008) shows that authoring, and challenges to this through
invalidation, are significant concerns for clients of a first-episode psychosis service.
We will use the above concepts to explore OOEs associated with psychosis and dissociation.
The contested nature of OOEs, the power relationships within which this contest takes
place, and the personal importance of authoring are not mere academic concerns. They are
important considerations which have crucial impacts on our lives, on both an individual
and a cultural level. We will show how the way in which OOEs are understood and related
to is central in determining the impact these experiences have, as well as the course and
outcome of such experiences.
24.1 A cosmic battle: Patte's story
The following is a detailed account of events from 1976, and a brief account of the subsequent
I was 24, halfway through my medical training, having begun research for my
D.Phil thesis. I'd had a baby, my marriage had failed, and my father had died. I
was also on the verge of falling in love with my supervisor, and at some point
had a puff of marijuana. As if this wasn't enough, two of my friends lost babies
to cot death within a week of each other.
Suddenly one night, I found it hard to sleep, and yet felt full of energy. I spent
much of the night writing furiously, expressing everything I knew about the
purpose of life. In moments of a fitful sleep-like state, I experienced a gradually
intensifying state of physical arousal and terror to the point of total obliteration,
alternating with an intensifying state of orgasmic, ecstatic joy beyond joy. I felt
as if I was caught up in a cosmic battle between fear and trust. Ultimately, it was
the sense of joy that stayed with me. In the morning, I rang my friend whose
baby had just died and said, T know this sounds strange, but everything's going
to be OK.'
I raced off to the university, feeling elated at the possibility that the world had
changed. Suddenly, I was the Mother of the World and the laws of gravity no
longer applied to me. I stepped off the top of a flight of concrete stairs, and fell
15 feet to the ground. Feeling great pain, I 'realized' that I had broken both my
legs. I saw two students passing on the footpath below me. They both appeared
beautiful, golden, God-like. I called out to them, 'Do you believe in miracles?
Can you heal me?' They glanced at me and walked on. To me, that meant that
they must have healed me, otherwise they surely would have come to my aid. I
jumped up, amazed at the miracle of healing that had just taken place, and ran
through the university, greeting everyone I saw with a hug. 'We're all the same!'
I shouted, 'We're all the same.' We're all God-like, I thought, and rushed into
the Student Health Centre, down the corridor and straight into the room of my
therapist, saying to the young woman who was in there with him, 'You don't
need to be in here, you don't have to be a patient - we're all the same!'
336 CH 24 DISSOCIATION, PSYCHOSIS AND SPIRITUALITY: WHOSE VOICES ARE WE HEARING?
I don't recall exactly what happened next, but I ended up in the university sick
bay, where my bleeding and bruised, but - in reality - not broken, legs were
bandaged, and I was forced briefly to take chlorpromazine, which resulted in
cholestatic jaundice (apparently, a very rare side effect) that left me physically
sick for three months. At the time, I saw this as a mystical experience, though
this did not fit easily into my world view. I had been trained as a scientist, and
brought up by a secular atheist Jewish mother and agnostic father. Somehow I
sensed that what happened had something to do with earlier confusing experiences
of childhood sexual encounters with a much-loved uncle. As a child, I had
tried to tell my mother about it, but she denied that it could have happened. In
retrospect, I understand that she had been a motherless child herself, having lost
her own mother when she was nine and, as a result, her anxiety overwhelmed
her capacity to cope with my distress. Once I had recovered from the medication
side effects, I resumed and completed my D.Phil, and went on to complete my
medical training. I became a GP, and then trained to be a psychiatrist. My extraordinary
experiences had left me with a strong sense of 'pathway' in my life.
I knew my life had a purpose, but because I had no world view with which to
make sense of what had happened, I was unsure quite what that purpose was.
24.2 Maori perspectives
The indigenous people of New Zealand, the Maori, use alternative understandings for experiences
similar to Patte's. In her PhD research, Taitimu (2007) investigated Maori healers',
service users' (with a diagnosis of schizophrenia) and clinicians' understandings of this
range of phenomena (i.e. OOEs). This research revealed that Maori believe in shamanictype
initiation crises as the explanation for some distressing OOEs, which Western clinicians
might construe as psychotic symptoms: 'People diagnose it as that thing [schizophrenia],
but we would say he was a divine healer. If I ask if a person has these things, what
would you call them? We would say a healer. But they say sickness and diagnose' (Taitimu,
2007: 34). One healer (tohunga), who worked with a mental health service, indicated that
he often helped individuals with a diagnosis of schizophrenia to understand their experiences
as a gift.
Taitimu (2007) reports that mate Maori (literally, 'Maori illness') is a construct commonly
used to describe OOEs associated with diagnoses of dissociation and psychosis.
Mate Maori is characterized by various illness states that all relate to some form of spiritual
crisis. One participant (healer) commented:
I would put schizophrenia with the same thing as porangi, pohauhau, wairangi
(states of mate Maori), all those different states of confusion. My understanding
of schizophrenia is like having two or three states of that confusion. Schizophrenia
is so big, it's one word but covers a lot of things. The same applies to
porangi, pohauhau, wairangi, they cover a lot of things in themselves. But those
are Maori words that I know that cover those things, that is mate Maori. (Taitimu,
24.3 SHAMANIC CRISIS 337
Porangi is at times used as a stigmatizing label within Maori communities. However,
Taitimu found that porangi actually refers to a form of spiritual crisis. Glavish (2000)
elaborated that the 'po' (night or darkness) in porangi is akin to feeling lost, a feeling
of total despair with nowhere to turn, while 'rang? (sky, day) refers to the sky (the atua
or god) where the individual is trying to reach upwards - but it is out of their reach. A
similar definition was provided by a participant in Taitimu's research: 'Porangi is that the
poor person is in darkness, his mind is in darkness. If we go back to rangi and papa and
his mind is in darkness, he doesn't see any light at all, his world is in darkness' (Taitimu,
This notion of sinking and reaching resembles Patte's experiences of oscillating between
fear of total obliteration and extreme joy and trust in the world. 'Te po', within a Maori
context, is a state of nothingness and lifelessness, before there was time and space in the
world, while rangi refers to the time when light and knowledge entered the world. In this
sense porangi also refers to the dissociation one may experience when caught between
these two states: a loss of sense of self (the terror of obliteration referred to in Patte's story)
and total connectedness (joy and trust, in Patte's story).
24.3 Shamanic crisis
Shamanism can be defined as a family of traditions across the world whose practitioners
focus on entering altered states of consciousness in a voluntary manner, often through
inductive techniques. In these states, they have experiences of interacting with spirits, beings
and ancestors, or travelling to other realms in order to heal and serve their communities
(Walsh, 1990). Shamanistic constructs and technologies are found not only in yogic
and Buddhist practices, but also in many other religious and modern mystical movements
(Doore, 1988; Harner, 1990; Hultkrantz, 1988).
During a shamanic initiation crisis, some trance states could be seen in Western psychiatric
discourse as psychotic states with extreme distress. For example, a Tamang shamanic
apprentice in Nepal who is possessed by voices will shake convulsively, be confused, not
eat, have distorted visions and seek solitude (Peters, 1987). Similarly in South Africa,
the Zulu and Xhosa traditions differentiate clearly between OOEs that require healing
(amafufunyana) and the shamanic initiation illness (ukutwasa) (Ngubane, 1977). Whereas
amafufunyana has negative connotations of suffering and affliction, ukutwasa is part of
a painful transformatory process towards becoming a shaman. However, both categories
could be perceived from a Western psychiatric standpoint as including psychotic symptoms
(Niehaus et al, 2004).
In other cultures, not all psychotic symptoms are by definition signs of a debilitating
illness. When OOEs are considered indicative of an initiation illness, crises and bizarre
behaviour are explained in terms such as 'the ancestor's attempts in shifting a talented
but resisting person into the healing profession'. Ingo Lambrecht was told during his own
shamanic apprenticeship that the pain would lessen 'as the relationship between the ancestral
voices and the apprentice improves over time'. Ingo recalls asking his teacher,
'How would I know whether the voices I heard are the ancestors or just me simply going
mad?' 'Ah, that's easy', his teacher replied, 'we test them.' The 'true ancestral voices'
would be those that, in the eyes of the community, are accurate, for example, in helping
to find herbs and lost cattle, or in diagnosing and healing illnesses. The shamanic crisis is
338 CH 24 DISSOCIATION, PSYCHOSIS AND SPIRITUALITY: WHOSE VOICES ARE WE HEARING?
usually understood as a developmental crisis, strongly grounded in shamanic world view
and practices (Eliade, 1964; Halifax, 1979). In alternative Western discourses, this is similar
to a spiritual emergency (Grof and Grof, 1990; Randal and Argyle, 2006), a 'mystical
experience with psychotic features' (Lukoff, 1985), or part of the 'hero's journey' (Campbell,
1968). When resolution of the crisis occurs, the person appears somehow strengthened
by the experience and goes on to become a healer and contribute to their community.
In terms of hearing voices, many people in non-Western cultures maintain contact with
their dead relatives or ancestors through trance states in which they converse with the
voices of the departed (Steadman, Palmer and Tilley, 1996). In the South African context,
shamans hear their ancestors in their head during divination and while dancing, and see
them in dreams or visions. The shamanic training allows shamans to strengthen their relationship
with the ancestral voices. Central to the shamanic training is that in her or his
developmental transformation, a shift occurs from being a victim of spirits at the beginning
to becoming a master of spirits. The shaman is the expert in engaging a meaningful
and effective relationship with spirits. The shaman supports the positive and effective relationship
with spirit guides and shifts the quality of relationship with negative spirits or
voices that could lead to psychosis or a dissociative disorder (Lambrecht, 1998) so that this
becomes a less likely outcome. It is this journey of mastery that allows the shaman to heal
themselves in their training in order to heal others by working within the spirit world.
24.4 A cosmic battle - Part 2
The following is an account of events that took place in 1986 and in 1989 in Patte Randal's
life, and their consequences over the subsequent 14 years.
Twelve years after my 'mystical/psychotic experience', having begun training in
psychiatry, I found myself being very open with friends and colleagues about
what had happened. I felt no stigma. I began formulating a way of working with
people diagnosed as having psychosis, to help them make sense of their OOEs.
Then a series of events overtook me - another baby, moving house, a visit from
my uncle's (my abuser's) son, and marital difficulties.
I was not sleeping much. I woke at 3 a.m. There was an eerie light; I was very
cold, all was quiet, my third child was asleep in my arms, my mouth was dry.
I was extremely thirsty, felt freezing cold, and my teeth were chattering uncontrollably.
I felt terrified. This must be the nuclear winter, I thought.
Then, three years later, after a sequence of difficult and stressful events, I found
myself being admitted to an inpatient unit, having stopped sleeping and having
become increasingly agitated. I lay on the floor, trying to make myself as thin as
possible so that I could slip out between the molecules of the wall. When this escape
attempt failed, I experienced being somehow rapidly transported towards a
gigantic object that threatened once again to totally obliterate and destroy me.
I suddenly 'knew' that a senior colleague, who I had trusted, was the Devil (a
concept that was not part of my world view). This colleague had encouraged me
24.5 THE SUBJUGATION OF OTHER CULTURAL PERSPECTIVES 339
to develop and write down my ideas about working with psychosis, but later advised
me to 'lie low', because other senior colleagues 'were worried about my
fragility'. Just prior to this episode, and undoubtedly the immediate precipitant,
I was unexpectedly told by the same trusted colleague that I was not going to be
allowed to be re-appointed as a psychiatry registrar.
I went on to have five more similar episodes over the next 14 years. At times I was
briefly hospitalized, and compelled to take antipsychotic medication, which had
severe side effects for me, the most significant of which was a very rare form of
tardive dystonia that affected my voice and made it very difficult for me to speak.
I stopped believing that these episodes had a mystical or spiritual meaning, and
came to believe that I had a chronic relapsing mental illness, namely bipolar
disorder, the diagnosis I was eventually given. I believed that I would never fully
recover and that I would need to be on medication for the rest of my life. I
lived for some years with a constant dread that another episode would ensue if I
were to become too stressed. I felt deeply undermined in my self-confidence and
uncertain about the validity of my own reality.
24.5 The subjugation of other cultural perspectives
Patte's initial explanatory model of her OOE as having a mystical and spiritual meaning,
which had brought a sense of purpose, was subjugated by the dominant discourse of the
illness model as an explanation of her 'symptoms'. It appears that this happens frequently
within Western cultural contexts and indeed, in New Zealand, traditional Maori cultural
views have also been subjugated by the dominant 'voice of psychiatry'. The higher prevalence
of schizophrenia diagnoses among Maori than the general population in New Zealand
may reflect this (Kake, Arnold and Ellis, 2008).
This stigmatizing of OOEs by the 'voice of psychiatry' within Western contexts has
its historical and political roots in the Christianity of the Middle Ages and the prevalent
understanding of demonic forces. Colonial powers executed thousands of witches and sorcerers
(also in Europe), and through torture yielded confessions about consorting with
spirits and the Devil (Krippner, 2002). To justify this, the shaman, as an expert in OOEs,
became 'the evil other', which allowed for easier marginalization and destruction in order
to wield power over indigenous people. During the Western European Enlightenment
age, this shifted to the shaman being positioned as a charlatan, a trickster in the face of
'glorious' reason and rationality with its scientific method (Flaherty, 1992). The shaman
thus became 'the ridiculous other', not worthy of interest or importance, which made it
easier to colonize those cultures in which shamanic traditions were common. The shaman
has also been seen as an 'idealised other', through the idealization of 'the primitive'
and the 'natural' (Krippner, 2002). More recently, psychoanalysis has pathologized crosscultural
differences (Walsh and Vaughn, 1993), and psychiatry has viewed the bizarre behaviour
and symptoms of shamans during trance states as psychotic (Silverman, 1967).
Shamans are seen as being schizoid, 'switching into dissociative states and going into
shamanic trances to try to put themselves together' (deMause in Krippner, 2002: 966).
The shaman, together with people who experience OOEs within and outside Western
340 CH 24 DISSOCIATION, PSYCHOSIS AND SPIRITUALITY: WHOSE VOICES ARE WE HEARING?
cultural contexts, has become 'the mad other', and is thus excluded from the realm of expertise.
It could be argued that this is essentially what happened to Patte. Her narrative was
subjugated, leading her to lose her voice, both literally and politically. She was silenced.
However, Patte, as we shall see, contested this silence, allowing her to work through her
OOEs to achieve an alternative discursive position. This alternative narrative position or
voice not only suggests a means of mastering OOEs, but also presents a different way of
understanding 'dissociation' and 'psychosis' in relation to 'spirituality'.
24.6 Dissociation and psychosis as states of consciousness
Traditional Western discourse on consciousness allows only a few 'normal' states of consciousness:
waking, hypnogogic/hypnopompic states, dreaming and sleeping. However,
for many millennia, many other cultures, such as Tibetan Buddhism, have acknowledged
the existence of more complex models of consciousness. Recently, Western transpersonal
psychology has begun to explore some of these models and integrate them into various
'maps' of consciousness (Fischer, 1971; Grof and Grof, 1990; Walsh, 1995; Wilber, 1980).
Different maps of consciousness place psychosis, dissociation and spirituality in different
relations with one another.
Ethnographic data from 437 societies worldwide reveal that trance-induced auditory and
visual hallucinations are found in 89% of cultures (Bourguignon, 1973). In conventional
Western understanding, these hallucinations are pathological. However, such trance states,
within their cultural and healing practices, are voluntary and experienced positively. Altered
states of consciousness (ASCs) can be understood as different mental states triggered
or entered into through special induction techniques. For example, sensory deprivation,
respiratory techniques, or certain drugs can all be forms of induction, as can voluntarily
induced dissociation. Many cultures use various techniques as voluntary dissociative
tools in order to induce specific ASCs. Dissociative methods are taught and practised in
order to provide the shaman's or sangoma's body with a vessel for the ancestral spirits
to enter. In contrast, trauma, psychosis, or coma states could be considered pathological,
non-voluntary forms of induction (Vaitl et al., 2005).
In Western discourses on dissociative phenomena, what is deemed communication from
ancestral spirits in another culture could be related to 'the inner self-helper', a controversial
concept in the dissociation literature (Comstock, 1991). Some people with dissociative
disorders have considered this as a form of inner guidance from a separate entity, typically
experienced differently from the 'split-off' parts of themselves, and defined in spiritual
terms as God, Atman, Christ, ancestors, angels and so on.
Non-Western cultures may have technologies, practices and disciplines that could provide
theoretical and practical insights into ASCs, trance states and spiritual states different
from common Western views, and thereby provide new insights into psychotic and dissociative
states, if only these cultural 'voices' were allowed to be heard. These insights would
allow a move away from psychosis and dissociation being merely understood symptomatically
and pathologically (as they are currently in most Western cultures). They might rather
be considered dynamically as a transformational process of change in consciousness, over
which mastery may be gained by specific teaching methods. This perspective may also
provide an understanding of how symptoms of both dissociative disorders and psychosis
24.7 A COSMIC BATTLE - PART 3 341
involve the same or similar psychological processes (Castillo, 2003). Therefore, people
experiencing psychotic and dissociative states may, through training, healing and mastery,
shift from being victims of involuntary disintegrative states to greater levels of personal integration
and consciousness. A number of people in the West with lived experience of this
type of transformational process, often on a background of early trauma, are now speaking
out and their voices are beginning to be heard (Coleman and Smith, 2006; Deegan, 1992;
Lampshire, 2005; O'Hagan, 1994).
24.7 A cosmic battle - Part 3
In the past 18 years, since losing and subsequently regaining my place in psychiatry,
I have experienced a series of synchronous happenings through which I have
gradually developed a spiritual understanding of the universe and my own place
in it. This was a very difficult transition for me. The contexts in which I found
myself (both psychiatry and my immediate family) existed within an atheistic
world view in which science was the supreme arbiter of truth. It seemed, according
to the medical model, that I had a future that would be dominated by psychosis
and mood instability. There was no sudden conversion experience, but a
process that happened painstakingly slowly and experimentally, with many times
of doubt and uncertainty. It is only recently that I seem to have come through to a
more steady sense that I can view my psychotic experiences as a form of repeated
spiritual emergency - 'breaking through' times when I was overwhelmed by circumstances,
without a sufficient capacity to contain, process and acknowledge
the intensity and depths of my emotional reactions, and without a world view or
framework to make sense of it all. I now can see that in the same way that I very
quickly and catastrophically misinterpreted the pain in my legs as meaning they
had been broken, equally quickly I misinterpreted body sensations and emotions
as indicating that I was in a literal nuclear winter, or was literally going to be
obliterated. In reality, these were lived metaphors for how I felt emotionally in
my life at the time. I can see now that the emotional reality was too unbearable
for me to face, because I may have needed to act in ways that seemed impossible
to consider. I have gradually learned to recognize and tolerate my intense
emotions of sadness, rage, hate and shame, so that I no longer need to dissociate
from them. Somehow, in developing a greater capacity to acknowledge, face
and experience the intensity of these previously unbearable affects, I can 'stay
with the pain' for its duration - I've discovered that emotions really do come in
metaphorical 'waves', and the waves really do pass, so I no longer seem to have
to immediately jump to (wrong) conclusions about their meaning. Therefore, I
suppose, it has become less likely that I will become 'psychotic' (dissociated
from intense affect and finding metaphorical ('delusional'?) meaning instead of
facing the reality of my situation). I no longer see myself as having 'bipolar
disorder', 'recurrent brief psychotic episodes', or any form of relapsing mental
illness over which I have no control. I no longer take medication. I see myself
now as being on a journey of 're-covery' (Randal, 2003), with the skills to deal
with life as it unfolds, and the capacity to help others do the same.
342 CH 24 DISSOCIATION, PSYCHOSIS AND SPIRITUALITY: WHOSE VOICES ARE WE HEARING?
What has helped me is not the shamanic journey I once fantasized I might embark
on, but a gradual recognition that the biblical meta-narrative contains my
own whakapapa - my personal Jewish cultural and spiritual heritage. Within
this, I have found narrative accounts that I can relate to in terms of my own story
and its transformational meanings, 'voices' that I can now 'hear' that have more
personal and empowering meaning for me than the voice of psychiatry - for example,
the story of Joseph, the pivotal story of Jesus, and also, very strongly,
the concept of the 'spiritual battle' - that we are not fighting human enemies but
are fighting 'a war in the spirit' (Ephesians 6.10-20) and that, although this cosmic
battle continues in 'time', it has already been won 'in eternity'. My struggle
for personal meaning has been difficult but of immense value to me, especially
because I have found others who validate and share my hard-won perspective.
Twelve years ago I was re-appointed to complete my training in psychiatry and
won an international essay competition addressing the role of science and the
essence of psychiatry (Randal, 1995). In that essay, I argued that it was the quality
of the relationship between the clinician and the person that was the essence
of psychiatry. I went on to publish research demonstrating that hospitalized people
with chronic 'treatment resistant' psychosis could, with a multimodal psychotherapeutic
approach (which includes a spiritual dimension), recover sufficiently
to live in the community (Randal, Simpson and Laidlaw, 2003).
24.8 From victim to victor - a new model
The theoretical models that I have developed based on my own experiences, together
with my clinical and research experience, are becoming accepted regionally
and beginning to find a place globally; I hope to be able to research their
potential to facilitate the culture-shift that is happening within mental health services.
The models are entitled 'building a bridge of trust' and 'the map of the
journey of recovery' (an early version of these is found in Randal, Simpson and
Laidlaw, 2003). The former depicts the 'bridge' of non-judgemental acceptance
and trust we need to build between ourselves - with our values, attitudes, beliefs,
experiences, thoughts, feelings and memories - and the people we serve - with
their values, attitudes, beliefs, experiences, thoughts, feelings and memories. The
latter is a spiral developmental model that demonstrates how, from in-utero and
birth, as we go through life, we tend to 're-cover the same old ground' in our
journey of recovery. We are all born with some resilience and the inherent vulnerabilities
of the human condition. The traumas of life can sometimes make
us more vulnerable, and we can get into vicious cycles, repeating old patterns
which in turn increase our vulnerability. However, with each new life crisis, we
have the opportunity (often in the context of spiritual meaning-making) to increase
our strengths and decrease our vulnerabilities, and to create a victorious
cycle. When I use these models in my clinical practice, and share some of my
own experiences, I find that they help to bring hope and healing to the people I
serve and their families. I have a feeling of well-being. I believe that all that has
happened to me makes sense and has happened for a purpose. I'm finding my
voice - metaphorically at least - and I am being heard.
In conclusion, we have argued that, whatever difficulties we may have in distinguishing
'dissociation', 'psychosis' and 'spirituality' at a phenomenological level, the way in which
we construe, individually and culturally, 'out-of-the-ordinary' experiences and different
states of consciousness influences the impact and outcome of these states. How each individual
does this will reflect their personal situation, experience and choices. The sociopolitical
context will shape the range of understandings considered legitimate and available
to the individual.
We began this chapter with the question, 'Whose voices are we hearing?' We have considered
this metaphor in some detail, and looked at the notions of essentially contested
concepts and authoring in relation to the dominant discourse in Western psychiatry. We
have argued that trying to determine the validity of various explanations for these experiences
without acknowledging the cultural and political power relationships inherent in
these determinations is meaningless and potentially destructive. In recognizing this, perhaps
we can move the question from 'Whose voices are we hearing?' to 'Whose voices
do we choose to hear?' Or to put it another way, when next asked whether a particular
experience is psychotic, dissociative, or spiritual in nature, might we not respond, 'Who is
asking?' or simply, 'Why?'.
Bourguignon, E. (1973) Introduction: a framework for the comparative study of altered states
of consciousness, in Religion, Altered States of Consciousness, and Social Change (ed.
E. Bourguignon), Ohio State University Press, Columbus, pp. 3-38.
Campbell, J. (1968) The Hero with a Thousand Faces, World, New York.
Castillo, R. (2003) Trance, functional psychosis and culture. Psychiatry, 66, 9-21.
Coleman, R. and Smith, M. (2006) Working with Voices II: Victim to Victor, P&P Press Ltd.,
Comstock, C. (1991) The inner self helper and concepts of inner guidance. Dissociation, 3,
Deegan, P.E. (1992) The independent living movement and people with psychiatric disabilities:
taking back control over our own lives. Psychosocial Rehabilitation Journal, 15,
Doore, G. (1988) Shamans, Yogis and Bhodhisattvas, in Shaman's Path (ed. G. Doore),
Shambala, Boston, pp. 217-25.
Eliade, M. (1964) Shamanism: Archaic Techniques of Ecstasy, Princeton University Press,
Fischer, R. (1971) A cartography of the ecstatic and meditative states. Science, 174, 897-904.
Flaherty, G. (1992) Shamanism and the Eighteenth Century, Princeton University Press,
Foucault, M. (1980) Body/power, in Power/Knowledge: Selected Interviews and Other Writings,
1972-1977 (ed. C. Gordon), Pantheon, New York, pp. 55-62.
344 CH 24 DISSOCIATION, PSYCHOSIS AND SPIRITUALITY: WHOSE VOICES ARE WE HEARING?
Gallie, W.B. (1955-1956) Essentially contested concepts. Proceedings of the Aristotlian Society,
Geekie, J. (2004) Listening to what we hear: clients' understandings of psychotic experiences,
in Models of Madness: Psychological, Social and Biological Approaches to Schizophrenia
(eds J. Read, L.R. Mosher and R. Bentall), Brunner-Routledge, Hove, East Sussex,
Geekie, J. and Read, J. (2008) Fragmentation, invalidation and spirituality: personal experiences
of psychosis - ethical, research and clinical implications, in Psychotherapies for the
Psychoses: Theoretical, Cultural, and Clinical Integration (eds. J. Gleeson, E. Killackey and
H. Krstev), Routledge, London.
Glavish, N. (2000) Maori Concepts of Assessing Behaviours for Mind Wellness, Office of Chief
Advisor Tikanga, Auckland District Health Board, Auckland.
Grof, C. and Grof, S. (1990) The Stormy Search for the Self: A Guide to Personal Growth
through Transformational Crisis, Jeremy P Tarcher, New York.
Halifax, J. (1979) Shamanic Voices: A Survey of Visionary Narratives, Arkana, New York.
Harner, M. (1990) The Way of the Shaman, Harper, San Francisco.
Hultkrantz, A. (1988) Shamanism: a religious phenomenon?, in Shaman's Path (ed. G. Doore),
Shambala, Boston, pp. 33^4-2.
Kake, T., Arnold, R. and Ellis, P. (2008) Estimating the prevalence of schizophrenia amongst
New Zealand Maori: a capture-recapture approach. Australian and New Zealand Journal of
Psychiatry, 42, 941-949.
Krippner, S. (2002) Conflicting perspectives on Shamans and Shamanism: points and counterpoints.
American Psychologist, 57, 962-77.
Lambrecht, I. (1998) A Psychological Study of Shamanic Trance States in South African
Shamanism. In Fulfilment of the Degree in Philosophy of Arts in Psychology, University
of the Witwatersrand, Johannesburg.
Lampshire, D. (2005) From psychosis to personhood: the Dollhouse effect. Paper presented at
3rd annual Making Sense of Psychosis Conference, Auckland NZ.
Lukoff, D. (1985) The diagnosis of mystical experience with psychotic features. Journal of
Transpersonal Psychology, 17, 155-82.
Niehaus, D.J.H., Oosthuizen, P., Lochner, C. et al. (2004) A culture-bound syndrome 'amafufunyana'
and a culture-specific event 'ukutwasa': differentiated by a family history of
schizophrenia and other psychiatric disorders. Psychopathology, 37, 59-63.
Ngubane, H. (1977) Body and Mind in Zulu Medicine, Academic Press, London.
O'Hagan, M. (1994) Stopovers on My Way Home from Mars: A Journey into the Psychiatric
Survivor Movement in the USA, Britain and the Netherlands, Survivors Speak Out,
Peters, L.G. (1987) The Tamang Shamanism of Nepal, in Shamanism (ed. S. Nicholson), Theosophical
Publishing House, Wheaton, 111, pp. 161-80.
Poulton, R., Caspi, A., Moffitt, T.E. et al. (2000) Children's self-reported psychotic symptoms
and adult schizophreniform disorder: a 15-year longitudinal study. Archives of General Psychiatry,
Randal, P. (1995) Divining psychiatry. Australasian Psychiatry, 3, 393-7.
Randal, P., Simpson, A.I.F. and Laidlaw, T. (2003) Can recovery-focussed multimodal psychotherapy
facilitate symptom and function improvement in people with treatment-resistant
psychotic illness? A comparative study. Australian and New Zealand Journal of Psychiatry,
Randal, P. and Argyle, N. (2006) Spiritual Emergency-A Useful Explanatory Model?, Spirituality
SIG Publications archive and Newsletter 20, http://www.rcpsych.ac.uk/spirit.
Shotter, J. (1981) Vico, moral worlds, accountability and personhood, in Indigenous Psychologies:
The Anthropology of the Self (eds P. Hellas and A. Lock), Academic Press, London,
Silverman, J. (1967) Shamans and acute schizophrenia. American Anthropologist, 67, 21—31.
Steadman, L.B., Palmer, C.T. and Tilley, C.F. (1996) The universality of ancestor worship.
Ethnology, 35, 63-76.
Taitimu, M. (2007) Nga Whakaawhitinga: Standing at the Crossroads. Maori constructions of
Extra-Ordinary Experiences and Schizophrenia, Unpublished doctoral thesis, University of
Auckland, Auckland, New Zealand.
Tien, A.Y. (1991) Distributions of hallucinations in the population. Social Psychiatry and Psychiatric
Epidemiology, 26, 287-92.
Vaitl, D., Birbaumer, N., Gruzelier, J. et al. (2005) Psychobiology of altered states of consciousness.
Psychological Bulletin, 131, 98-127.
Walsh, R. (1990) The Spirit of Shamanism, J.P. Tardier, New York.
Walsh, R. (1995) Phenomenological mapping: a method for describing and comparing states of
consciousness. Journal ofTranspersonal Psychology, 27, 25-55.
Walsh, R. and Vaughn, F. (1993) Paths Beyond the Ego: The Transpersonal Vision, Jeremy T.
Tarcher/Perigee Books, Los Angeles.
Wilber, K. (1980) The Atman Project, Quest, Weaton, 111.