Sally and James Colbert – USA
BACKGROUND OF THE AUTHORS
It might be asked as to the qualifications of the authors to write the article. One of the authors, a clinical psychologist, brought forth two schizophrenic daughters through a former marriage. One is still living and the other died from breast cancer. The other author’s mother was diagnosed with schizophrenia and she died a number of years ago – most probably due to suicide. Together we have participated in multiple forms of family support, had care giver support, explored a wide range of psychiatrists and other treatment options, provided the day-to-day care, went through multiple psychiatric hospital experiences with family members – both voluntary and involuntary, and experienced the treatment in both private and public facilities. In addition, one of the authors provided professional treatment for schizophrenic patients in hospital settings as well as in private practice. All family members have Theosophical backgrounds. Both daughters with schizophrenic diagnoses thought of themselves as Theosophists. We feel it is important to relate this background as it is important to know of this disease from the standpoint of the patient, family member, and the professional. And, to find in the Theosophical teachings concepts that may help in understanding.
WHAT IS SCHIZOPHRENIA?
Schizophrenia is a brain disease (E. Fuller Torrey, M.D.). Schizophrenia is due to genetic transmission (National Institute of Mental Health). Schizophrenia is due to nutritional deficiency (Orthomolecular psychiatry). Schizophrenia is due to early childhood trauma (Clancy D. McKenzie, M.D.). Schizophrenia comes from a psych spiritual crisis (C.G. Jung, M.D.).
The only real fact is that the cause of schizophrenia is not known. This, despite almost all current theory proponents claiming treatment cures. The term does not mean “split personality.” It was derived by a 19th Century Swiss psychiatrist (Eugen Bleuler, M.D). Meaning a splitting of the various parts of the thought process. Some also use it to mean simply splitting off from reality.
What is Schizophrenia? Although the Diagnostic and Statistical Manual of Mental Disorders (IV) uses three pages towards this definition the most of the common features of schizophrenia are when an individual displays delusions, hallucinations, disorganized speech, disorganized behavior and so called “negative symptoms” inclusive of emotional flattening.
Until recent times prevalence of schizophrenia was reported to be 1% of the population across all cultures with slightly more males affected than females. Later studies appear to show greater variation with indications that the numbers may be increasing. Even with fully reviewing these studies, however, one is impressed by the consistency of the prevalence from culture to culture. It is almost as if the world shares the burden without sparing any particular area.
Yes, it is true there have been some findings of brain abnormalities with schizophrenics. But, are they cause or effects? There is really no way of telling. Yes, it is true that identical twin studies have shown that when one twin has schizophrenia, there is a 30% chance the other twin will be schizophrenic as well. But, what about the other 70%? The 70% without schizophrenia would appear to weaken the genetic argument. Early childhood trauma and developmental effects of parenting fall by the wayside as well. Why does the onset mostly occur in the 20 to 30 year old age span? Most persons who have schizophrenia have their first psychotic break as young adults. Why is this? No one knows.
THEOSOHICAL LITERATURE REGARDING SCHIZPHRENIA
The great onrush of mental health research and writing did not really start until the 20th Century. This was after the introduction of the primary Theosophical literature.There are some references to insanity and lunacy, but even this is somewhat limited. There is an incredible insight, however, offered by H.P. Blavatsky. She writes: “In many cases of lunacy the confusion among the vibrations of all kinds is so enormous that there is not correlation between the inner and the outer man, and we have then a case of aberration. But even in some of these unfortunate cases the person inside is all the time aware that he is not insane but cannot make himself be understood. Thus often persons are driven really insane by wrong treatment.”(Path, June, 1893, Occult Vibrations, A Fragment of Conversation with H.P.B.).
We suggest there are very meaningful implications to the statement above. It is inclusive of the confusion so often experienced by one with schizophrenia, it affirms that the person does not see him/herself as mentally ill, and it underlines some of the tragic consequence of “wrong treatment.” We will let this paragraph stand here for now but will return to it later.
AUIDITORY HALLUCINATIONS
By far the most prominent symptom is the hearing of “Voices” by those who are schizophrenic. The Hearing Voices web site (www. Intervoices.com) records: “A 1991 National Institute of Mental Health study reported 5% of 15,000 Americans who had experienced auditory hallucinations, heard them for a complete year. Only 1/3 of the 5% that had experienced the hallucinations met the criteria for a psychiatric diagnosis.” Other research suggests 4 to 10% of the world's population hear voices. You do not need to be mentally ill in order to hear voices. However, it can be a terrifying experience. A patient we had hospitalized informed me that he wanted to share with us what the voice was saying but the voice had told him it would be necessary to kill me (the therapist) if he were to reveal the content. He was asked what he wanted to do. With agony he began to reveal the inner world he was experiencing. He poured forth streams of information over multiple therapy sessions. Many clinicians apparently do not listen or pay much attention to the voices, viewing them as simply artifacts of brain dysfunction. We think this is a mistake as this is where their patient lives and is an integral part of their reality.
With one of our daughters, who later came to live with us as an adult, and sometime after she first suffered the disease, often called stating she could not deal with the critical voice that was always in her head judging her in everything she did. By this time she was taking a full dose of psychotropic medications which did little good to eliminate the voices. In a kind of desperation a technique suggested to her was an approach introduced by Hal and Sidra Stone referred to as the Voice Dialogue Technique. Based on this it was suggested that she take the part of the Voice and have the Voice take the part of her and begin a dialogue. Act as if the Voice was speaking through her. There seemed to be a desperate pleading from the Voice stating that it could only have existence through her. She reasoned with the Voice saying it must go and this was not something she could accept in her reality. While this may sound far out, it nevertheless worked. The Voice and Voices disappeared. Later, however, when this same daughter developed breast cancer, the Voice reappeared. It is our understanding that trauma of almost any kind increases the likelihood of hearing voices for the mentally ill. Months were spent on a nightly basis communicating with her Voice where she would relay what the Voice had to say to either her or my questions. Interestingly, to me, the content while sometimes very sophisticated. It was also very demeaning of my daughter and skeptical of me. Also, it seemed to be similar to what W.Q. Judge offered regarding communication with “Spirits” through mediums. In other words, there were no direct solutions or information that could be helpful. “But the mass of communications alleged as made day after day through mediums are from the astral unintelligent remains of men, or in many cases entirely the production of, invention, compilation, discovery, and collocation by the loosely attached Astral body of the living medium” (Judge, Psychic Phenomena and Spiritualism). Also, “materializations of spirits cannot be possible, and that the sometimes really coagulated forms are liable to be frauds of a pious nature, inasmuch as they are not the bodies of the dead nor in any sense whatever their property, that they are over and over again simply surfaces or masses on which pictures of dead or living may be reflected, being thus a spirit-conjurer's trick beyond our power (Judge, Communications from ‘Spirits).
THE HOSPITAL EXPERIENCE AND MEDICATIONS
Hospitalizations are likely for most persons experiencing this disease whether voluntary or involuntary. Having gone through multiple hospitalizations with two daughters and served on the staff of several psychiatric hospitals, we were able to appreciate the different cultures found in different hospitals. We strongly suspect that money and/or good insurance has lot to do with level of care. In one hospital we loved to work in, it overlooked the ocean and the dorms were almost condo-like in appearance. Ceramic classes, volleyball and multiple group meetings were included in the daily schedule. Violence was rarely encountered. However, in another hospital (less than 50 miles away) the setting included chain link fences and forced restraints. Sometimes screams were heard especially during the night. For the most part, however, patients, and even staff, can be and are very gentle people.
One of the authors uses a wheelchair. As a result, in that setting he was perceived as a fellow patient rather than as a staff member. He enjoyed this perception and participated in yoga classes and other activities as a patient rather than as a therapist. Being a fellow inmate, so to speak, provided a very close kinship with many of those hospitalized. The fears and inner conflicts were often shared with a different perspective. Having lunch and dining together with other patients is so different than lunching with other staff members.
One of the insights gained was the significant embarrassment related to the side effects of medications. Some of the meds bring about twitching, nervous ticks, and a compulsive need to pace back and forth. There are other medications to help control these side effects, but they often do not fully compensate for what are called Parkinsonian effects. There is often weight gain which can be controlled with dieting, but it can add to disfiguring which does not help.The meds often, as well, can lead to a lethargy making it difficult to get out of bed and be motivated to participate in activities and there is the feeling of being pushed by the staff.
The hospital does, however, provide an important function offering structure and regularity to the patient’s life. The patient gets up at a given time, may then go to community meeting, breakfast, creative classes, etc. The dictum that external order can enhance internal order is very true. Included is the importance of a neat and ordered environment. If one has a family member with mental illness living on their own, you may understand this. Often, the cluttered home reflects the cluttered mind and confusion.
RESISTANCE TO MEDICATIONS
By far the greatest anguish for families who may have a mentally ill member is the refusal of the mentally ill member to take medications. Laws in most U.S. states prevent the forcible administration of medication. The family may be caught in the helpless feelings of almost begging their relative to take medication, possibly watching them wandering the streets (it is estimated that 30% of the homeless population in the United States are mentally ill) and exposed to danger. There can be a forced emergency hospitalization but usually for only 72 hours. This is where there is an imminent danger to self, to others, or gravely disabled (e.g., may not eat or care for self). However, even when meds are forcibly given, the patient discontinues taking the medication after being discharged from the hospital. The multiple books that have been written on this subject, in this author’s opinion, do not offer much in the way of solution.
SUICIDE
It is reported that the death rate by suicide is at least 10 per cent. The suicide attempt rate, although this figure is not known to the authors, is probably very high. It is likely if you have a family member with this illness, you may well encounter this event. Sometimes the voices direct the person to take this step. Depression can certainly be part of the picture. The emotional components of Post Traumatic Stress Disorder can be involved. Many clinicians in the fields feel that PTSD is a direct result of having the first “psychotic break” with the onset of schizophrenia.
SPIRITUAL HUNGER
There are articles and books written by persons with varying spiritual backgrounds indicating that patients do and will want to find a spiritual connection in their lives. Our two daughters, both identifying themselves as Theosophists, craved for this experience. One wanted to be read to from the Upanishads, the Dhammapada, and The Voice of the Silence on a nightly basis. The other wanted to be read to from the book she used as a child in Theosophy School – The Eternal Verities. There were some hesitations by some in including them in regular Theosophy meetings, even though they very much wanted to come, with the fear that the teachings may “set them off.” Some of this could be true as one of them continued to focus on the Dyhan Chohans. It did not seem to hurt anything. Some are uncomfortable in meetings in accepting a mentally ill or disturbed person.
FAMILY AVOIDANCE
Many family members may show signs of not wanting to be around a mentally confused person. There is the fear of saying the wrong thing, avoiding conflict, and a seemingly higher level of tension. The authors remember a family holiday meal which, coincidentally, did not include a mentally ill member, a guest who overheard the expression, “It is so wonderful to have a ‘normal’ family meal.”
A POSSIBLE UNIQUE THEOSOPHICAL APPROACH
Let us review again the statement by HPB regarding “lunacy.” Remember the term schizophrenia was not in use at the time of Blavatsky’s writings. It was: “In many cases of lunacy the confusion among the vibrations of all kinds is so enormous that there is not correlation between the inner and the outer man, and we have then a case of aberration. But even in some of these unfortunate cases the person inside is all the time aware that he is not insane but cannot make himself be understood.”(Path, June, 1893, Occult Vibrations, A Fragment of Conversation with H.P.B.).
The Healing Approach
We feel this has extraordinary insight and may provide some clues to a healing approach. The first part of this statement is that “there is not correlation between the inner and outer man.” To Theosophists, this may suggest the connection or bridge (antaskarana) between the higher and lower man needs healing. It may be the difficulty in making this connection that allows Voices and delusions (elementals?) to find an opening. It should be remembered that the “cause” of schizophrenia is not really known. And, the “cause” of the Voices is really not known. The lack of correlation between the inner and outer man and influence of elementals, one could say, is as good of an explanation as any.
If true, however, there are some direct implications. It may suggest that a person with this disease can be on an important journey to find the wholeness of their being. They have the task of establishing their connection. They may need a supportive, caring and nurturing environment. We, as family members, are there to help in this way, but maybe not to “fix” or take on the responsibility of “getting them over it” or blaming ourselves or each other. Their healing path is ultimately their responsibility and possibly we can have some gratitude that our family has been chosen to help provide a loving environment for them to find their way. They are on their own search for their soul.
Another part of Blavatsky’s statement is that the person inside is all the time aware that he is not insane but cannot make himself be understood.” This may explain some of the reason for the tremendous resistance to medication. If one feels that they are not mentally ill yet the doctors are telling them they are, and trying to get them to take powerful medications with significant side effects, most of us would resist as well. When one of our daughters regained a kind of clarity in life, she became a group leader for an organization called “Schizophrenics Anonymous.” They have a six step program which has an approach similar to Alcoholics Anonymous. In these meetings one of her tasks was the gradual encouragement for attendees to learn about and take their medications. There was no coercion and it was a patient supporting other patients.
There is the possibility that the “Voices” might be best viewed as “elementals” as described in the Theosophical literature. Today’s science tells us that “roughly 70% of the Universe is dark energy. Dark matter makes up about 25%. The rest – everything on Earth, everything ever observed with all of our instruments, all normal matter – adds up to less than 5% of the Universe.” (http://science.nasa.gov/astrophysics). HPB in her article on “Elementals” tells us two things: (1)” Elementals, as said already, have no form, and in trying to describe what they are, it is better to say that they are "centres of force" having instinctive desires, but no consciousness, as we understand it. Hence their acts may be good or bad indifferently.” She says as well, in the same article, “not only is there no unoccupied portion of universal nature, but also that for each thing that has life, special conditions are furnished, and, being furnished, they are necessary. Now, assuming that there is an invisible side to the universe, the fixed habit of nature warrants the conclusion that this half is occupied.” The effects of schizophrenia may be to open the window to be influenced by these “centres of force” or elementals. As described in the literature they can have either positive or negative effects. Both Mahatma Gandhi and Abraham Lincoln, for example, strongly emphasized the importance and guidance they received from the Voices which came to them. This is a topic deserving of greater attention.
A Spiritual Journey
This is not to say we should avoid medical resources. We should find the best doctors we can and get the greatest help available. However, we may also realize there is a spiritual journey involved as well. And, our task is to offer a compassionate environment free of blame and with the recognition that the real journey is theirs. We can feel honored, as well, that we have been honored to help in this journey of the soul.