Chapter Six
The understanding of the nature, origin, and dynamics of psychogenic disorders is a factor of critical importance for the theory and practice of psychotherapy. It has direct implications for the concept of the healing process, the definition of the effective mechanisms of psychotherapy and personality transformation, and the choice of therapeutic strategies. Unfortunately, the existing schools of psychotherapy differ as greatly in their interpretation of psychogenic symptoms and their therapeutic strategies as they do in their descriptions of the basic dynamics of human personality.
I will not here touch on behaviorism, which sees psychogenic symptoms as isolated collections of faulty habits with no deeper meaning, rather than manifestations of a more complex underlying personality disorder. I will also omit supportive methods of psychotherapy and other forms of psychological work that refrain from in-depth probing for practical rather than theoretical reasons. However, even when we deliberately narrow our focus to the schools of so-called depth psychology, we find far-reaching differences of opinion about these issues.
In classical Freudian analysis, symptoms are viewed as the result of a conflict between instinctual demands and defensive forces of the ego, or compromise formations between the id impulses and prohibitions and injunctions of the superego. In his original formulations, Freud put exclusive emphasis on sexual wishes and saw the opposing countersexual forces as manifestations of the “ego instincts,” serving the purpose of self-preservation. In his later drastic theoretical revision, he considered various mental phenomena to be products of conflict between Eros, the love instinct striving for union and the creation of higher units, and Thanatos, the death instinct, the purpose of which is destruction and return to the original inorganic condition. In any case, the Freudian interpretation is strictly biographical, operating within the confines of the individual organism. The goal of therapy is to free the instinctual energies bound in symptoms and find for them socially acceptable channels of expression.
In Adler’s interpretation, the neurotic disposition stems from childhood programming, which is characterized by overprotection, neglect, or a confusing mixture of both. This results in a negative self-image and neurotic striving for superiority to compensate for exaggerated feelings of insecurity and anxiety. As a result of this self-centered life strategy, the neurotic is incapable of coping with problems and of enjoying social life. Neurotic symptoms are, then, integral aspects of the only adaptive system the individual has been able to construct from the misleading clues from the environment. While in Freud’s conceptual framework everything is explained from antecedent circumstances, following rigorous linear causality, Adler emphasizes the teleological principle. The neurotic’s plan is artificial and parts of it must remain unconscious because they contradict reality. The goal of therapy is to prevent the patient from living in this fiction and to help him or her recognize the one-sidedness, sterility, and ultimately self-defeating nature of his or her attitudes. In spite of some fundamental theoretical differences, Adler’s individual psychology shares with psychoanalysis its strictly biographical focus.
Wilhelm Reich contributed to depth psychology a unique understanding of the dynamics of sexual energy and the role of energetic economy in psychopathological symptoms. He believed that the repression of the original trauma is maintained by the suppression of sexual feelings and by blocking of the sexual orgasm. According to him, this sexual suppression, together with the corresponding muscular armoring and specific characterological attitudes, represents the real neurosis; the psychopathological symptoms, then, are only its secondary overt expressions. The critical factor determining emotional health or disease is one’s economy of sexual energy, or the balance between charge and discharge that one maintains. Therapy consists in releasing stored and pent-up sexual energies and freeing the muscular armor through a system of exercises utilizing breathing and direct body work. Although Reich’s approach represented a far-reaching theoretical departure from classical psychoanalysis and a revolutionary innovation of the practice of psychotherapy, he never transcended the narrow sexual emphasis of his former teacher and his biographical orientation.
Otto Rank challenged Freud’s sexual theory of neurosis by shifting the etiological focus to the trauma of birth. According to him, neurotic symptoms represent attempts to exteriorize and integrate this fundamental emotional and biological shock of human life. As a result of it, no real cure of neurosis should be expected until the client confronts this event in the therapeutic situation. In view of the nature of this trauma, talking therapy is of little value and must be replaced by direct experience.
The recognition of the primary and independent significance of spiritual aspects of the psyche, or of what would these days be called the transpersonal dimension, was extremely rare among Freud’s followers. Only Jung was able to penetrate really deeply into the transpersonal domain and formulate a system of psychology radically different from any of Freud’s followers. During years of systematic probing into the human unconscious, Jung realized that the psychopathology of neuroses and psychoses cannot be adequately explained from forgotten and repressed biographical material. He complemented Freud’s concept of the individual unconscious with that of the racial and collective unconscious and emphasized the role of “myth-forming” structural elements in the psyche. Another major Jungian contribution was the definition of archetypes, transcultural primordial ordering principles in the psyche.
Jung’s understanding of psychopathology and psychotherapy was altogether unique. According to him, when drives, archetypal urges, creative impulses, talents, or other qualities of the psyche are repressed or not allowed to develop, they remain primitive and undifferentiated. As a result, they exert a potentially destructive influence on the personality, interfere with adaptation to reality, and manifest themselves as psychopathological symptoms. Once the conscious ego is able to confront these previously unconscious or repressed components, they can be integrated in a constructive way into the individual’s life. Jung’s therapeutic approach does not emphasize rational understanding and sublimation, but active transformation of one’s innermost being through direct symbolic experiencing of the psyche as an autonomous “other personality.” The guidance in this process is beyond the capacity of any individual therapist or school. For this purpose, it is essential to mediate for the client a connection with the collective unconscious and utilize the wisdom of untold ages that lies dormant in it.
This discussion of the conceptual differences and disagreements between the major schools of depth psychology regarding the nature and origin of emotional disorders and effective therapeutic mechanisms could be continued to include the views of Sandor Ferenczi, Melanie Klein, Karen Horney, Erich Fromm, Harry Stack Sullivan, Roberto Assagioli, and Carl Rogers, or the innovations of Fritz Perls, Alexander Lowen, Arthur Janov, and many others. However, my main purpose is to demonstrate that there are popular and vital theories and systems of therapy with radical disagreements about the dynamics of psychopathology and therapeutic techniques. Some are limited to the biographical or analytical-recollective level, others put almost exclusive emphasis on perinatal elements or existential concerns, and a few include a transpersonal orientation.
We can now focus on the new insights from experiential psychotherapy that make it possible to reconcile and integrate many of the conflicts in contemporary psychiatry and to formulate a more comprehensive theory of psychopathology and psychotherapy.
The data from experiential psychotherapy with or without psychedelics strongly suggest the need for the “spectrum approach” that has already been described. Clearly the model of the psyche used in serious self-exploration should be broader than any of the existing ones. In the new context, various psychotherapeutic schools offer useful ways of conceptualizing the dynamics of specific bands of consciousness (or of only specific aspects of a certain band) and should not be treated as comprehensive descriptions of the psyche.
Emotional, psychosomatic, and interpersonal problems can be associated with any of the levels of the unconscious—biographical, perinatal, and transpersonal—and occasionally have important roots in all of them. Effective therapeutic work must follow the process into the area involved and should not be limited by conceptual considerations. There are many symptoms that persist until and unless the individual confronts, experiences, and integrates the perinatal and transpersonal themes with which they are associated. For problems of this kind, biographical work of any variety and any scope or length will prove ineffective.
In view of the observations from experiential sessions, any psychotherapeutic approach restricted to verbal exchange is of limited value and cannot really reach the core of the problems involved. The emotional and psychosomatic energies underlying psychopathology are so elemental that only direct, nonverbal experiential approaches have any chance of coping with them effectively. However, verbal exchange is essential for proper intellectual preparation for the experiential sessions and also for their adequate integration. In a paradoxical way, cognitive work is probably more important in the context of experiential therapies than ever before.
The powerful humanistic and transpersonal techniques of psychotherapy originated as a reaction against the unproductive verbal and overintellectualized orientation of traditional psychotherapies. As such, they tend to stress direct experience, nonverbal interaction, and involvement of the body in the process. However, the rapid mobilization of energy and release of emotional and psychosomatic blocks that these revolutionary methods made possible tend to open the way to perinatal and transpersonal experiences. The content of these experiences is so extraordinary that it tends to shatter the individual’s conceptual framework, basic belief system, and the world view shared by Western civilization.
Modern psychotherapy thus faces an interesting paradoxical situation. Whereas in the earlier stages it tried to bypass intellect and eliminate it from the process, at present a new intellectual understanding of reality is an important catalyst for therapeutic progress. While the resistances in more superficial forms of psychotherapy are of an emotional and psychosomatic nature, the ultimate obstacle for radical therapies is a cognitive and philosophical barrier. Many of the transpersonal experiences that are potentially of great therapeutic value involve such a basic challenge to the individual’s world view that he or she will have serious difficulty in letting them happen unless properly intellectually prepared.
Defending intellectually the Newtonian-Cartesian definition of reality and the common-sense image of the world is a particularly difficult form of resistance that can be overcome only by the combined effort of the client and the facilitator. Therapists who do not offer cognitive expansion, together with powerful experiential approaches, put their clients into a difficult double-bind. They are asking them to give up all resistances and to surrender fully to the process, yet such a surrender would lead to experiences that their conceptual framework does not allow and does not account for. In such a situation, insisting on biographical interpretations, clinging to the mechanistic world view, and seeing the process in terms of linear causality will seriously impede therapeutic progress and serve as a powerful mechanism of defense, whether it occurs in the client or the facilitator. On the other hand, knowledge of the expanded cartography of the human mind that includes perinatal and transpersonal experiences, of the new paradigms emerging from modern science, and of the great mystical traditions of the world can become therapeutic catalysts of unusual power.
Since psychopathological symptoms have a different dynamic structure, depending on the level of the psyche with which they are connected, it would be incorrect and useless to describe them all in terms of one universal formula, unless such a formula could be unusually broad and general. On the recollectire-analytical level, symptoms appear to be meaningfully related to important memories from childhood and later life. In this connection, it is useful to see them as historically determined compromise formations between instinctual tendencies and the repressive forces of the superego, or between emerging painful emotions and physical sensations and the defenses against facing them. In the last analysis, they represent elements from the past that have not been successfully integrated and are interfering with an appropriate experience of the present time and place. They typically involve situations that have interfered with the individual’s feelings of basic unity and harmony with the universe and contributed to a sense of separation, isolation, antagonism, and alienation. A situation in which all the basic needs are satisfied and in which the organism feels secure is closely related to the sense of cosmic unity. A painful experience or a state of intense need creates a dichotomy that involves a differentiation and conflict between the victimized self and the noxious external agent, or between the unsatisfied subject and the desired object.
When the individual connects experientially with the perinatal realm, the Freudian framework and all the other systems limited to biography become entirely useless, and attempts to apply them serve the interests of defense. On this level, the symptoms can best be understood as compromise formations between emerging emotions and sensations related to the biological birth trauma and the forces that protect the individual against reexperiencing them. A useful biological model of this conflict of opposing tendencies is to see it in terms of simultaneous experiential identification with the infant struggling to be born and with the biological forces representing the introjected, repressive influence of the birth canal. Because of the strong hydraulic emphasis in this situation, the Reichian model stressing the release of pent-up energies, and loosening of the character armor can be extremely useful. The similarity between the pattern of sexual orgasm and the orgasm of birth explains why Reich confused pent-up perinatal energies with jammed libido stored from incomplete orgasms.
Another way of conceptualizing this dynamic clash is to see it in a longitudinal perspective in terms of a conflict between one’s identification with the ego structure and the body image, on the one hand, and the need for total surrender, ego death, and transcendence, on the other. The corresponding existential alternatives are continued entrapment in a limited way of life governed by ultimately self-defeating ego strategies versus an expanded and enlightened existence with transpersonal orientation. However, an unsophisticated and uninformed subject naturally would not be aware of the second alternative until he or she actually had the experience of spiritual opening. The two basic strategies of existence related to the two extreme poles of this conflict are: approaching the world, or life, as struggle—the way it was experienced in the birth canal or, conversely, as a give-and-take exchange and a nourishing dynamic dance—comparable to the symbiotic interaction between the child and the good womb or breast.
Additional useful alternatives for conceptualizing the process underlying symptoms on the perinatal level are anxious holding on versus trusting letting go, determined clinging to the illusion of being in charge versus accepting the fact of total dependence on cosmic forces, or wanting to be something else or somewhere else than one is versus accepting the present circumstances.
The best way to describe the dynamic structure of psychogenic symptoms that are anchored in the transpersonal realm of the psyche is as compromise formations between defensive holding onto the rational, materialistic, and mechanistic image of the world and an invading realization that human existence and the universe are manifestations of a deep mystery which transcends reason. In sophisticated subjects, this philosophical battle between common sense and cultural programming on the one side and an essentially metaphysical world view on the other can take the form of a conceptual conflict between Freudian and Jungian psychology, or between the Newtonian-Cartesian approach to the universe and the new paradigms.
If the individual opens up to the experiences underlying these symptoms, new information about the universe and existence will radically transform his or her world view. It will become clear that certain events in the world that should be irreversibly buried in remote history or have not yet occurred in terms of our linear concept of time can, under certain circumstances, be experienced with the full sensory vividness otherwise reserved only for the present moment. Various aspects of the universe from which we would expect to be separated by an inpenetrable spatial barrier can suddenly become easily experientially available and in a sense appear to be parts or extensions of ourselves. Realms that are ordinarily inaccessible to the unaided human senses, such as the physical and biological microworld and astrophysical objects and processes, become available for direct experience. Our ordinary Newtonian-Cartesian consciousness can also be invaded with unusual power by various archetypal entities or mythological sequences that, according to mechanistic science, should have no independent existence. The myth-producing aspects of the human psyche will portray deities, demons, and rituals from different cultures that the subject has never studied. It will present them on the same continuum with elements of the phenomenal world and with the same accuracy of detail with which it depicts historically and geographically remote events of material reality.
Having set forth what appear to be the typical conflicts underlying psychogenic symptoms on the biographical, perinatal, and transpersonal levels of the human psyche, we can now attempt to bring all these seemingly diverse mechanisms under a common denominator and formulate a comprehensive conceptual model for psychopathology and psychotherapy. In view of what has been said earlier about the principles of spectrum psychology and the heterogeneity of the individual bands of consciousness, such a unifying umbrella must be unusually braod and encompassing. To create it we need to return to the new definition of human nature emerging from modern consciousness research.
I suggested earlier that human beings show a peculiar ambiguity which somewhat resembles the particle-wave dichotomy of light and subatomic matter. In some situations, they can be successfully described as separate material objects and biological machines, whereas in others they manifest the properties of vast fields of consciousness that transcend the limitations of space, time, and linear causality. There seems to be a fundamental dynamic tension between these two aspects of human nature, which reflects the ambiguity between the part and the whole that exists all through the cosmos on different levels of reality.
What psychiatry describes and treats as symptoms of mental disease can be seen as manifestations of interface noise between these two complementary extremes. They are experiential hybrids that represent neither one nor the other mode, nor a smooth integration of both, but their conflict and clash. On the biographical level this can be illustrated by a neurotic whose experience of the present moment is distorted by partial emergence of an experience that belongs contextually to another temporal and spatial framework. He does not have a clear and appropriate experience corresponding to the present circumstances, nor is he fully in touch with the childhood experience that would justify the emotions and physical sensations he is having. The mixture of both experiences without a discriminating insight is characteristic of a strange spatiotemporal experiential amalgam that psychiatry calls “symptoms.”
On the perinatal level, the symptoms represent a similar spatiotemporal hybrid connecting the present moment with the time and space of biological birth. In a sense, the individual experiences the here and now as if it involved a confrontation with the birth canal; the emotions and physical sensations that would be fully consonant with the event of birth become, in a different context, psychopathological symptoms. As in the above example, such a person is experiencing neither the present situation nor biological birth; in some sense he or she is still stuck in the birth canal and has not yet been born.
The same general principle can be applied to symptoms that involve experiences of a transpersonal nature. The only major difference is that for most of them it is impossible to imagine a material substrate through which such phenomena could be mediated. Those that involve historical regression cannot be easily interpreted through memory mechanisms in the conventional sense. For others that involve transcendence of spatial barriers, the transfer of information through material channels is not only untraceable but frequently unimaginable from the vantage point of the mechanistic world view. On occasion, the phenomena underlying the transpersonal type of symptoms are outside the Occidental framework of objective reality altogether, such as the Jungian archetypes, specific deities and demons, discarnate entities, spirit guides, or suprahuman beings.
Thus, in the broadest sense, what is presented as psychiatric symptom can be seen as an interface conflict between two different modes in which humans can experience themselves. The first of these modes can be called hylotropic consciousness1; it involves the experience of oneself as a solid physical entity with definite boundaries and a limited sensory range, living in three-dimensional space and linear time in the world of material objects. Experiences in this mode systematically support a number of basic assumptions, such as: matter is solid; two objects cannot simultaneously occupy the same space; past events are irretrievably lost; future events are not experientially accessible; one cannot be in more than one place at a time; one can exist only in a single time framework at a time; a whole is larger than a part; and something cannot be true and untrue at the same time.
The other experiential mode can be termed holotropic consciousness2; it involves identification with a field of consciousness with no definite boundaries which has unlimited experiential access to different aspects of reality without the mediation of the senses. Here there are many viable alternatives to three-dimensional space and linear time. Experiences in the holotropic mode systematically support a set of assumptions diametrically different from that characterizing the hylotropic mode: the solidity and discontinuity of matter is an illusion generated by a particular orchestration of events in consciousness; time and space are ultimately arbitrary; the same space can be simultaneously occupied by many objects; the past and the future can be brought experientially into the present moment; one can experience oneself in several places at the same time; one can experience several temporal frameworks simultaneously; being a part is not incompatible with being the whole; something can be true and untrue at the same time; form and emptiness are interchangeable; and others.
Thus, an individual can take LSD in the Maryland Psychiatric Research Center on a particular day, month and year. While remaining in one sense in Baltimore, he can experience himself in a specific situation in his childhood, in the birth canal and/or in ancient Egypt in a previous incarnation. While aware of his everyday identity, he can identify experientially with another person, another life form, or a mythological being. He can also experience himself in a different location in the world or in a mythical reality, e.g. the Sumerian underworld or Aztec heaven. None of these identities and temporo-spatial coordinates compete with each other or with the basic identity of the subject and the space and time of the psychedelic session.
A life experience focusing exclusively on the hylotropic mode and systematically denying the holotropic one is ultimately unfulfilling and fraught with lack of meaning, but can be practiced without any major emotional difficulties. A selective and exclusive focus on the holotropic mode is incompatible with adequate functioning in the material world for the time it lasts. Like the hylotropic mode, it can be difficult or pleasant, but it presents no major problems as long as the external situation of the experiencer is covered. Psychopathological problems result from a clash and disharmonic mixture of the two modes when neither of them is experienced in pure form nor integrated with the other into an experience of a higher order.
Under these circumstances the elements of the emerging holotropic mode are too strong not to interfere with the hylotropic mode, but at the same time the individual fights the emerging experience because it seems to disturb mental equilibrium or even to challenge the existing world view, and its acceptance would require a drastic redefinition of the nature of reality. It is the mixture of both modes interpreted as a distortion of the consensual Cartesian-Newtonian image of reality that constitutes a psycho-pathological disorder.3 The milder forms that have a biographical emphasis and do not involve serious questioning of the nature of reality are referred to as neuroses or psychosomatic disorders. Major experiential and cognitive departures from the mandatory “objective reality” that usually herald the emergence of perinatal or transpersonal experiences tend to be diagnosed as psychoses. It should be mentioned in this connection that traditional psychiatry also treats all pure experiences of the holotropic mode as pathological phenomena. Such an approach, still predominant among professionals, must be considered obsolete in view of the theoretical contributions of Jung, Assagioli, and Maslow.
Not only psychopathological symptoms, but many otherwise puzzling observations from psychedelic therapy, laboratory consciousness research, experiential psychotherapies, and spiritual practices appear in a new light if we use a model of human beings that reflects the basic duality and dynamic tension between the experience of separate existence as material object and that of limitless existence as an undifferentiated field of consciousness. From this point of view, psychogenic disorders can be seen as indications of a fundamental imbalance between these complementary aspects of human nature. They appear to be dynamic nodal points suggesting the areas in which it has become impossible to maintain a distorted, one-sided image of one’s existence. For a modern psychiatrist, they are also the points of least resistance where he or she can start facilitating the process of self-exploration and personality transformation.