EFFECTIVE CLINICAL WORK WITH PEOPLE SUFFERING FROM
MAJOR MENTAL CONDITIONS
What follows is a summary of the seminar presented by Ernesto Vasquez, MD at
the April, 2019 meeting of the Network of Christian Counselors.
1. To understand the neurobiology and psychology of major mental conditions more accurately in order to help the sufferers more effectively, the first requirement is a paradigm shift to complex systems thinking with which we can then develop the needed complexity mindset. The second requirement is the moving away from the doctrine of rigid dualistic thinking of traditional psychology (inside-outside, subjective-objective, mind-body, emotions-thought, etc.) which fractures human psychological life into decontextualized
2. One of the most damaging dualisms for people with major mental conditions is the dogma of the absolute unreliability of subjective experience (inside) and of the conforming to external reality, or reality testing (outside) as the absolute measure of normality. To tell someone that he or she “has lost touch with reality,” or “has little or no reality testing,” is equivalent to saying that they are hopelessly insane. It shatters even more an already badly shattered soul.
3. Complexity science is the field in physics that studies complex systems. The term complexity refers to the interconnectedness, unitedness, or wholeness of everything in the universe.
In contrast to traditional psychology’s dualistic way of thinking, a complexity mindset is a series of personal attitudes or dispositions rather than a number of steps that can be learned. It is an open, flexible, creative, and imaginative cast of mind that anticipates new possibilities beyond what something exclusively is at the
moment. This perspective can help us convey more effectively the Christian message of hope.
4. Complex systems neuroscience considers the brain a functional global network inseparable from body function. The two are functionally integrated systems that seek and establish coordinated function for our whole organism.
5. In the mental health field, the only psychology to date that elucidates functionally integrated systems seeking coordinated function for the whole of our psychological life is Intersubjective–Systems Theory and Practice. The intersubjective perspective focuses on our subjective emotional experience which always takes form in a relational, intersubjective, or interaffective system. The originary or earliest intersubjective system is the one formed by the interplay of the mother’s and the infant’s world of subjective emotional experience.
From this interplay emerge configurations of self and other called emotional convictions that organize our experience below awareness. These embodied emotional convictions are complex networks formed by the confluence of our 4 complex, mutually influencing, information-processing systems: emotion, thought, body, and spirit, which within do not exist apart from one another within the network. The term body and embodiment herein refer to the non-verbal experience of the physiologic state of our body, information which is processed by emotion, thought, and spirit.
The interplay of our emotional convictions undergirds all human relatedness, all our psychological functioning, and, partially, our physiological equilibrium. Embodied emotional convictions are thebuilding blocks of our personality. Their totality constitutes our character.
6. With complex systems as a theoretical foundation in common, biology (the material realm) and psychology (the immaterial realm), including our spiritual life, become unified dimensions of our being-human-in-the-world-in-relationship-with-God-and-others.
7. Steady attuned responsiveness to the emotional life of one another is the foundation of empathy, and, therefore, of the healing partnership with our patients and of the healing process.
The intersubjective form of psychotherapy practice and the healing process involve – indeed require– the interplay of theas full as possible human expe-rience of both practitioner and patient, all of which is no mean achievement.
8. All this astonishing functional integration and coordination of our psychological life is disrupted in people with major mental conditions.
One of the most important research findings of the last decade is that many risk factors including childhood trauma and prolonged stress are shared across common psychiatric conditions.
Likewise, symptom complexes such as thought disorder and emotional dysregulation are present across several conditions. There is a large overlap as well in risk genes for major mental conditions. And
statistical analysis of risk ratios has demonstrated that early life trauma specifically predicts adult psychiatric illness including psychosis. This form of complex systems thinking has helped us to understand that psychiatric diagnoses should not be considered as entirely separate entities but rather as
different points in a spectrum.
9. Psychiatric thinking in general, and the DSM classification of major mental conditions are detrimental to the understanding and, therefore, to the treatment of people with shattered souls.
To treat these patients with psychotherapy, it is more helpful to consider the suffering that madness inflicts on human beings– that is, the so-called symptoms of psychosis– as clustering around certain forms of subjective emotional experience.
These forms of experience help us to discern the symbolic meaning of the patient’s psychotic symptoms, which is one of the key elements of working intersubjectively.
•A sense of personal annihilation or self-loss manifest in repeated experiences of being erased, rendered into non-being. The boundaries demarcating the I and not- I dissolve. There is fragmentation and dispersal of one’s very identity.
• A sense of the destruction of the world. Experiences of self and world are inextricably bound up with one another, in that any dramatic change in the one necessarily entails corresponding changes in the other. The experience of the world itself loses coherence.
• A sense of objectless foreboding, a feeling of being menaced but without any clear focus of what the threat might be.
• The surrender of personal authenticity in an enslaving pattern of compliance— an extreme form of what we used to call ‘people pleasing’— hoping to secure threatened ties to emotionally important others. This too is an experience of annihilation, of self-loss.
10.Working intersubjectively also means considering the therapista practitioner, not a technician, whose expertise consists in practical wisdom regarding the emotional life of human beings. This wisdom is not a body of knowledge but a capacity for applied understanding of individual human beings in relational contexts. Practice involves thoughtful and reflective choice, and embodies an attitude of inquiry, deliberation, and discovery. It includes an attitude of inquiry and thoughtful reflection to indicate the attitude and process of figuring things out.
Psychotherapy is a conversation that leads to a shared understanding of the patient’s life.
A practitioner wants to know: what happened to this person, in what contexts of relatedness or experienced isolation, to bring about the suffering he or she brings to treatment; how do our own history, personality, and theoretical and religious allegiances, affect the understanding we reach with this patient; what resources
for healing are available in this therapist-patient pair?
11. If we consider complexity in biological science and in psychology as instances of informal revelation of God’s creative glory, then we reclaim something that has been God’s all along, and can, reverently, discern it, experience it, marvel at it, treasure it, and make use of it. We would thus mend a long-standing false dichotomy between what is God’s and what is not.
Isaiah 65:24 — “Before they call I will answer, and while they are yet speaking I will
hear”— highlights the degree of relationally engaged and responsive therapeutic
comportment required to work effectively with people suffering from major mental