Religion and Spirituality in Psychiatry

328 Charles Knappinsight or experience that interrupts confusionand helps one to become oriented to the reality,potential sanity, and promise of the here andnow. Stated succinctly by Trungpa in Creating anEnvironment of Sanity , “Earth is good.”( 18)Julie’s first shifts with each clinician after thisbreakthrough were a little awkward. She wasembarrassed that people had seen her act theway she had and was very touched that everyonestood by her. It seemed to her that we hadmore confidence in her than she had in herself. Itappeared that she genuinely no longer wanted todie, but instead was connecting with energy andpassion to be physically active and to resume herartwork.This middle phase felt like an unleashing of herpent-up desire to have a normal life again. If thatwere simply a matter of her taking medicationsand having some therapy to help recover fromfive years of life trauma, we could have ended theteam. But having had a radically unstable moodfor such a long time, it took Julie about a yearand a half to get her moods, and the persecutoryvoices that came along with them, to settle. Ashard as it was for her to be patient with this continuedmood cycling, it was encouraging whenshe noticed that, as she became more stable andcloser to her normal mood baseline, the quieterand at times nonexistent the voices became.As her mind became less chaotic, Julie continuedto become clearer about what she valued inher life and to pursue reengaging activities thatreflected these. Volleyball and tennis, first withthe team members, later with the city’s Parks andRecreation leagues, became great opportunitiesto get her weight back down to where she feltmore comfortable, had more energy from beingin shape, and felt more like her competent self.These activities also helped her to meet new peopleoutside the team.At this point, a major part of the work of theteam was helping her learn that how she engagedwith her physical world, including medications,how she related to people, how she workedwith meaningful activities, and how she workedwith her thinking had a profound effect onwhether her moods were more or less stable. Shelearned that sleep was connected to appetite, thather relationship world affected how she ate andslept, and that her thinking was related to everything.As this understanding grew, she was beginningto have more of a sense of maitri towardherself. She was developing unconditional confidencethat she was not a bad and hopeless failureof a person. She was feeling better, more alive,and more positive and she liked herself again.She was gaining windhorse energy.Julie was also becoming a peer on the team toall of us, and she did not hesitate to confront uson our blind spots. For instance, she felt that forall our nice attitudes about the therapist-friendrelationship, she often found us to be arrogant,as psychotherapists can be, about the fact thatshe was the “client” and we were the “matureprofessionals” who have their lives together and,therefore, could help her with how to live hers.As uncomfortable as this was at times, we alsoappreciated the piercing accuracy of her observationsand her confidence to speak directly tous. Our team meetings were now almost alwayslively, sometimes intense, as we were all not holdingback as much. That shift in honesty with all ofus was the outer reflection of a shift in her interestand capacity to be more honest with herself.She was gaining strength in unflinchingly identifyingwhich of her actions and thoughts ledto more confusion and suffering, and which tomore health and harmony in her life. It was clearthat her allegiance to sanity was becoming a reliablereference point.Julie never felt compelled to be an ongoing partof the family meeting as the tension between herand her mother, Beth, seemed to resolve throughtheir informal contacts. Between the infrequentface-to-face meetings we had with Julie and Beth,and Beth’s more frequent phone conversationsand visits, they did manage to establish a muchmore natural relationship tone and distance for amother and her adult daughter. This was largelypossible because Julie was being “held” by therecovery environment. She was healthier, andBeth was not induced into so much vigilance andprotection. Beth could behave more like a motherand not as a caretaker. Also, in a parallel process