Discounted sessions for Vets!

Are you a Vet from the Iraq and Afgan wars? Do you suffer from PTSD, depression, anxiety, addiction, mood swings, paranoia, carrying or have a weapon,insomnia, violent outbursts, intrusive thoughts, images you can not forget?
I am not here to judge, but to listen and suggest if you wish to have objective feedback.
All Vets will receive 1/2 of their sessions that they commit to. The other half of sessions, will be at discounted fees. If one can not afford sessions I am willing to do pro-bono sessions.
If working with a psychiatrist we will work together as a team.I also offer couples therapy and/or family therapy with our Vets too. I also see Vietnam Vets as well. Please contact Buirge for more info:
See contact page!
Bring the troops home now!

Iraq and Afgan Vets suffering from PTSD, Depression,Addiction,etc. will receive 1/2 sessions FREE

Are you a Vet from the Iraq and Afgan wars? Do you suffer from PTSD, depression, anxiety, addiction, mood swings, paranoia, carrying or have a weapon,insomnia, violent outbursts, intrusive thoughts, images you can not forget?
I am not here to judge, but to listen and suggest if you wish to have objective feedback.
All Vets will receive 1/2 of their sessions that they commit to. The other half of sessions, will be at discounted fees. If one can not afford sessions I am willing to do pro-bono sessions.
If working with a psychiatrist we will work together as a team.I also offer couples therapy and/or family therapy with our Vets too. I also see Vietnam Vets as well. Please contact Buirge for more info:
See contact page!
Bring the troops home now!

Online Therapy now available using Skype!

Online Therapy now available using Skype!

I do allow sessions over the internet. I would of course, prefer to meet in person for therapeutic reasons, BUT I feel that Psychotherapy needs to be current with the technology of today! Many may wish to have a quick session after a hard workday or when a crisis emerges. That is why I can offer such a service to the online community.

Please contact me if you wish to have online sessions. Payment for online sessions will vary, and we can discuss your payment options. I will be using PayPal services for those whom wish to have online sessions. You MUST pay for your sessions beforehand and the payment MUST clear before we begin our sessions. I do not allow refunds, unless for some technical reason our session breaks down.

See contact info for my number and email address!

For those that struggle with depression or bi polar disorder-You are not alone! Feel NO shame!

This is a list of people who have, or have had, major depressive disorder. A number of well-known people have suffered from the disorder. While depression was sometimes seen as a shameful secret until the 1970s, society has since begun discussing depression more openly. Earlier figures were often reluctant to discuss or seek treatment for depression due to social stigma about the condition, or due to ignorance of diagnosis or treatments. Some historical personalities are presumed to have suffered from depression based on analysis or interpretation of letters, journals, artwork, writings or statements of family and friends.

A

Caroline Aherne, British comedian[1]

Buzz Aldrin, American astronaut, the second man to set foot on the moon[2]

Woody Allen, American film director[3][4]

Claus von Amsberg, German diplomat and husband of Queen Beatrix of the Netherlands[5]

Hans Christian Andersen, Danish writer[6]

Hideaki Anno, Japanese animator and film director[7]

Malcolm Arnold, British composer[8]

Richard Ashcroft, English singer-songwriter[9][10]

[edit]B

Alec Baldwin, American actor[11]

David Banner, American hip hop artist[12][13]

Parveen Babi, Bollywood actress.[14]

Christian Bale, American actor[15]

Maria Bamford, Comedienne and voice-over actress[16][17]

Charles Baudelaire, French poet[18]

Ingmar Bergman, Swedish film director[19]

Halle Berry, American actress.[20]

William Blake, British poet and painter[21]

Kjell Magne Bondevik, Norwegian politician and former Prime Minister of Norway[22]

David Bohm, British quantum physicist[23]

Terry Bradshaw, American football player,[24] Football Analyst, Sports Anchor

Conan O’Brien, American talk show host[25]

Chris Brown, American singer[26]

Art Buchwald,n humorist[27]

Joe Budden, American hip hop artist[28]

Delta Burke, American actress[29]

Robert Burton British academic (author of The Anatomy of Melancholy)[30]

[edit]C

Anthony Callea, Australian pop singer[31]

Drew Carey, American comedian and actor[32]

Jim Carrey, Canadian actor and comedian[33]

Johnny Carson, American television presenter.[34]

Dick Cavett, American talk show host[35]

Melanie Chisholm, English pop singer-songwriter[36]

Courteney Cox, American actress[37]

Raymond Chandler, writer of detective fiction[38]

Iris Chang, Chinese American writer and historian[39]

David Chase, American television writer, television director and television producer (The Rockford Files, Northern Exposure, The Sopranos)[40]

Lawton Chiles, American politician[22]

Agatha Christie, English crime writer[41]

Winston Churchill, British Prime Minister[42]

Catherine Cookson, English author[43]

Leonard Cohen, Canadian songwriter[44]

Joseph Conrad, Polish writer[45]

Calvin Coolidge, 30th President of the United States.[46]

Billy Corgan, American musician (The Smashing Pumpkins)[47]

Sheryl Crow, American singer-songwriter[48]

Rivers Cuomo, American musician (Weezer)[49]

Ian Curtis, British musician, leader of Joy Division[50]

[edit]D

Roméo Dallaire, Canadian general, senator and humanitarian[51]

Rodney Dangerfield, American comedian and actor[52]

Edgar Degas, French painter[53]

John Denver, American musician[54]

Diana, Princess of Wales[55]

Charles Dickens, British writer[21]

Fyodor Dostoyevsky, Russian writer[56]

Nick Drake, British musician[57]

Doug Duncan, American politician, candidate for the Democratic nomination for Governor of Maryland in the 2006 elections[22]

Kirsten Dunst, American actress[58]

[edit]E

Thomas Eagleton, American senator[59]

T. S. Eliot, American poet[60]

James Ellroy, American crime writer[61]

Eminem, American Rapper[62]

Robert Enke, German footballer[63]

Richey Edwards, guitarist and lyricist (Manic Street Preachers)[64]

[edit]F

William Faulkner, American author[65]

Paul Feyerabend, Austrian philosopher of science[66]

Harrison Ford, American actor[67]

Michel Foucault, French philosopher[68]

John Frusciante, American musician[69]

Craig Ferguson, American talk show host[70]

Lupe Fiasco, American rapper[71]

[edit]G

Geoff Gallop, Australian politician[72]

Romain Gary, French-Lithuanian-Polish novelist and diplomat[73]

Paul Gauguin, French painter[74]

Carlo Gesualdo, Italian composer, after murdering his wife, her lover, and his own son[75]

Paul Getty, British philanthropist[76]

Francisco de Goya, Spanish painter[77]

Spalding Gray, American actor and writer[78]

Graham Greene, British writer[79]

Zack Greinke, American MLB pitcher[80]

Eddie Griffin, American NBA Player[81]

Ken Griffey Jr., American MLB player[82]

[edit]H

Jon Hamm, American actor[83]

Tony Hancock, English actor and comedian[84]

Andrew Hansen, Australian comedian (part of The Chaser team)[85]

Elizabeth Hartman, American actress[86]

Anne Hathaway, American actress[87]

Friedrich August Hayek, Austrian economist[88]

Ernest Hemingway, American writer[21]

Margaux Hemingway, American actress; granddaughter of Ernest Hemingway[89]

John Hinckley, Jr., American would-be assassin of Ronald Reagan[90]

Frankie HowerdOBE, British Comedian[91]

Sir Julian Huxley, British biologist, author and administrator[92]

Geoffrey Hill, English poet[93]

Herbert Hart, British philosopher[94]

Michael Hutchence, Australian singer–songwriter[95]

[edit]I

Natalie Imbruglia, Australian singer-songwriter, actress and model.[96]

Jack Irons, American musician, drummer for the bands Eleven, Pearl Jam, and Red Hot Chili Peppers[97]

[edit]J

Janet Jackson, American singer[98]

Henry James, British writer[99]

William James, American philosopher and psychologist[100]

Richard Jeni, American stand-up comedian and actor[101]

Billy Joel, American musician[102]

Daniel Johns, Australian musician[103]

Samuel Johnson, British lexicographer, biographer, essayist and poet[104]

Angelina Jolie, American actress[105]

Ashley Judd, American actor[106]

Jung Da Bin, Korean actress[107]

[edit]K

Antonie Kamerling, Dutch actor[108]

Sarah Kane, British playwright[109]

Hamid Karzai, Afghan President[110]

Susanna Kaysen, American writer[111]

John Keats, British poet[112]

Marian Keyes, Irish writer[113]

Kool Keith, American hip hop artist[114]

Alicia Keys, American singer-songwriter[115]

Ernst Ludwig Kirchner, German painter[116]

John Kirwan, New Zealand rugby player, former All Black, currently coach of Japan national rugby team.[117]

Beyoncé Knowles, American singer-songwriter[118]

Joey Kramer, American musician (Aerosmith)[119]

Akira Kurosawa, Japanese film director[120]

[edit]L

Alan Ladd, American actor[121]

Hugh Laurie, British actor[122]

Denis Lawson, British actor[123]

Heath Ledger, Australian actor[124]

Amy Lee, American singer of Evanescence[125]

John Lennon, British musician

Neil Lennon, Northern Irish footballer[126]

David Letterman, American comedian and television presenter[127]

Joseph Gordon-Levitt, American actor[128]

Meriwether Lewis, American Explorer[129]

Abraham Lincoln, American lawyer and politician, 16th President of the United States[130]

Oscar Lopez, Chilean-Canadian folk guitarist[131]

Federico García Lorca, Spanish poet[132]

Martin Luther, German priest and theologian[133]

[edit]M

Shirley Manson, Scottish singer of Garbage[134]

Paul Merton, English comedian[135]

Gustav Mahler, Austrian composer[136]

Heather Matarazzo, American actress[137]

Henri Matisse, French painter[138]

Vladimir Mayakovsky, Russian writer and poet[139]

Brian May, British guitarist[140]

Guy de Maupassant, French writer[141]

Ewan McGregor, Scottish actor[142]

Herman Melville, American writer[143]

Charlotte Mew, British poet[144]

Michelangelo, Italian painter and sculptor[145]

John Stuart Mill, British political philosopher[146]

Spike Milligan, Irish comedian and writer[147]

Joan Miró, Spanish painter[148]

Morrissey, British singer and former frontman of The Smiths[149]

Wolfgang Amadeus Mozart, Austrian composer[112]

[edit]N

Isaac Newton, British physicist[150]

Friedrich Nietzsche, German philosopher[21]

[edit]O

Bill Oddie, British comedy performer and naturalist[151]

Eugene O’Neill, American playwright[152]

Robert Oppenheimer, American physicist (‘father of the atomic bomb’)[153]

Oprah, American talk show host[154]

Patton Oswalt, American comedian and actor[155]

Marie Osmond, American musician[156][dead link]

Ronnie O’Sullivan, English snooker player[157]

[edit]P

Gwyneth Paltrow, American actress[158]

Henri Paul, French chauffeur (driver during the car crash that killed Diana, Princess of Wales)[159]

Ryan Phillippe, American actor[160]

T. Boone Pickens, Jr., American oil tycoon[161]

János Pilinszky, Hungarian poet[162]

Sylvia Plath, American writer[21]

Edgar Allan Poe, American poet and writer[21] (speculated)

Natalie Portman, American actress[163]

Bill Pulsipher, American baseball player[164]

Jackson Pollock, American painter[165]

Charley Pride, American country music singer.[166]

[edit]R

Sergei Rachmaninoff, Russian composer and pianist[167]

Charlotte Rampling, English actress[168]

Trent Reznor, American musician[169]

Anne Rice, American writer[170]

Rainer Maria Rilke, Austrian poet[171]

John D. Rockefeller, American industrialist[172]

Mark Rothko, American painter[173]

Hans Rott, Austrian composer[174]

J. K. Rowling, British writer[175][176]

[edit]S

Terry Sawchuk, Canadian goaltender[177]

Jim Salinger, New Zealand climate change scientist[178]

Siegfried Sassoon, British poet and soldier[179]

Robert Schumann, German composer[180]

Jean Seberg, American actress[181]

Brian Sewell, English art critic[182]

Will Self, English novelist, reviewer and columnist[183]

Anne Sexton, American poet[184]

Brooke Shields, American actress[185]

Sarah Silverman, American comedian[186]

Elliott Smith, American musician[187]

Brittany Snow, American actress[188]

Andrew Solomon, American author[189]

Britney Spears, American pop singer[190]

Layne Staley, American musician.[191]

Vivian Stanshall, British humourist and musician (Bonzo Dog Doo-Dah Band)[192]

Aaron Stainthorpe, British singer of My Dying Bride[193]

Rod Steiger, American actor[194]

Gwen Stefani, American pop singer[195]

William Styron, writer[196]

[edit]T

T.I., American Rapper[197]

Amy Tan, American writer[198]

Catherine Tate, English comedienne and actress[199]

James Taylor, American singer-songwriter[200]

Corey Taylor, American singer of Slipknot and Stone Sour[201]

Pyotr Ilyich Tchaikovsky, Russian composer[202]

Uma Thurman, American actress[203]

Leo Tolstoy, Russian writer[204]

Georg Trakl, Austrian poet[205]

Lars Von Trier, Danish film director[206]

Tuomas Holopainen, Finnish songwriter and keyboardist of Nightwish[207]

Mark Twain, American writer[21]

Jeff Tweedy, American musician (Wilco)[208][dead link]

[edit]V

Ville Valo – Finnish singer (HIM)[209]

Ned Vizzini – American writer[210]

Kurt Vonnegut – American author[211]

Joey Votto – Canadian baseball player[212]

[edit]W

David Foster Wallace, American writer[213]

Mike Wallace, American journalist on 60 Minutes[214]

David Walliams,British actor, writer and comedian[215]

Evelyn Waugh, British novelist and journalist[216]

Denise Welch, English actress and television presenter[217]

Billy West, American voice artist[218]

Delonte West, American basketball player[219]

Dan White, American killer of Harvey Milk and George Moscone[220]

Walt Whitman, American poet[221]

Kevin Whitrick, British electrical engineer[222]

Kenneth Williams, British Comedian[223]

Robbie Williams, British pop singer[224]

Tennessee Williams, American playwright[225]

William Carlos Williams, American poet[226]

Brian Wilson, American musician (Beach Boys)[227]

Owen Wilson, American comedian and actor[228]

Gregory Wilton, Australian politician[229]

Reese Witherspoon, American actress and producer[230]

Hugo Wolf, Austrian composer[231]

Lewis Wolpert, British developmental biologist, author and broadcaster[232]

Virginia Woolf, Adeline Virginia Stephen, British novelist (1882–1941)[233]

Elizabeth Wurtzel, American writer[234]

[edit]Y

Boris Yeltzin, first President of Russia[235]

Thom Yorke, English musician, lead singer of Radiohead[236][237]

[edit]

A excellent article on “Can psychosis be prevented?” written by Rachel Aviv

WHICH WAY MADNESS LIES

Can psychosis be prevented?reality did not come to Anna fully formed. Throughout her first year of graduate school, she kept monitoring her own perceptions, wondering whether they didn’t have some “tinge of unreality.” She searched for a nar- rative that would explain why the world was being transformed. One day, wandering the halls of an academic department, she became fascinated by the physical details of the building: tiny cracks in the wall, a light switch, a rubber doorstop that looked lumi- nous and functionless. A bust of Plato, which she had never noticed before, seemed to be calling out to her. As she gazed at Plato’s mournful expression, she imagined that he had singled her out to unburden himself and shed light on the “overwhelming strange- ness of the world.”

But after she left campus and re- turned to her apartment that day, the electricity of her mood passed, and she wanted nothing to do with Plato’s secrets. She blamed herself for attending too avidly to the stream of her own consciousness. “It wasn’t as if this bust suddenly started talking to me out of thin air,” she told me. “I wanted him to, and then I sort of convinced myself that he did. It didn’t feel like I was passively being subjected to another reality. It felt P like I somehow actively

engaged in creating it.”

sychiatry has many names for the symptoms of florid psychoses but almost no language that describes the anomalous experiences that gradually lead up to this state. The psychoanalyst Harry Stack Sullivan, who worked with hundreds of peo- ple with schizophrenia, proclaimed as early as 1927, “I feel certain that many incipient cases might be ar- rested before the efficient contact with reality is completely suspend- ed.” But doctors had no means of finding and recruiting patients who were, for all intents and purposes, still healthy.

It is impossible to predict the pre- cise moment when a person has em- barked on a path toward madness, since there is no quantifiable point at which healthy thoughts become insane. It is only in retrospect that the prelude to psychosis can be di-

agnosed with certainty. Yet in the past decade, doctors have begun to trace the illness back to its earliest signs. The place where Anna re- ceives therapy, the First Episode Psychosis Clinic at the University of Illinois Medical Center (she began treatment in April 2008, shortly af- ter she noticed the particles sur- rounding her), is one of about sixty clinics in the United States that work to help people experiencing early psychotic symptoms maintain a grasp on reality. About a third of these programs focus exclusively on patients who appear to be in what is known as the prodrome, the aura that precedes a psychotic break by up to two or three years. During this phase, people often have mild hallucinations—they might spot a nonexistent cat out of the corner of their eye or hear their name in the sound of the wind—yet they doubt that these sensations are real. They still have “insight”—a pivotal word in psychiatric literature, indicating that a patient can recognize an al- tered worldview as a sign of illness, not a revelation.

By working with people when they are still skeptical of their own delusions, doctors hope to stop the disease before it has really begun. Three years ago, the results of a study of nearly 300 patients who sought treatment because of “recur- ring unusual thoughts,” “unusual sensory experiences,” or “increased suspiciousness” were published by the North American Prodrome Lon- gitudinal Study, a collaboration of eight prodromal outpatient clinics. The researchers found that 35 per- cent of patients had a psychotic break within two and a half years of enrolling at a clinic.2 (If symptoms continue, the patients will eventual- ly be diagnosed with schizophrenia or another psychotic disorder.) This line of research may promise the closest thing there has ever been to a “cure” for psychosis, but because of the high false-positive rate, the work has been tempered by ethical dilem-

2 The others found that their symptoms passed or plateaued. For patients who used cannabis, amphetamines, opiates, or hallucinogens, the risk of psychosis rose to 43 percent.

mas. Many psychiatrists worry that young patients will become fatalistic about their future and define them- selves in relation to a chronic disease they may never develop. Yet once people have a full-blown psychotic episodes—the schizophrenia diagno- sis requires a month of psychotic behavior—there may be irreversible changes in the brain. Studies have shown that the longer someone is unhinged from reality before getting treatment for the first time, the worse their long-term prognosis.

Based in part on the findings of the Prodrome Longitudinal Study, a new diagnosis, the psychosis risk syn- drome, was proposed last year for the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (forthcoming in 2013), psychiatry’s central reference text. Symptoms would include

feeling perplexed, confused, or strange, thinking that the self, the world, and time has changed (often in ways that cannot be described), having ideas of reference that are not perceived as di- rectly threatening to the individual, unusual ideas (about the body, guilt, nihilism), overvalued beliefs (about philosophy, religion, magic) . . .

Once patients believe in their delu- sions with full conviction, they are said to have crossed the threshold to

36 HARPER’S MAGAZINE / DECEMBER 2010

psychosis—a process com- monly called “conversion.”

lthough the DSM is written by

A

the country’s leading psychiatrists, the neurological mechanisms behind mental disorders are too poorly under- stood to have much bearing on the way the manual separates health from pathology. Instead, the fifty-eight- year-old book guides psychiatrists to- ward diagnoses with checklists of be- havioral signs that require a “minimal amount of inference on the part of the observer” (according to the 1987 edition). The outer limits of normality are decided by committee, with defi- nitions of illness deferring to consen- sus opinion. A “delusion,” one of the five key symptoms listed for schizo- phrenia, is a “false belief . . . firmly sus- tained despite what almost everyone else believes.” A “bizarre delusion,” a more severe symptom, has gone

through numerous revisions. In one edition of the manual, it had to have “patently absurd” content with “no possible basis in fact”; in the next, it involved “a phenomenon that the per- son’s culture would regard as to- tally implausible.” After the re- vision, 10 percent of patients who were previously deemed schizophrenic were given a new diagnosis, the majority of them because their delusions were no longer bizarre.3

The DSM is designed to avoid the slippery spaces be- tween disorders, the complaints not easily named or seen. Per- haps more than any other dis- order, the psychosis risk syn- drome puts pressure on the logic of the entire enterprise, as it forces doctors to break down the process of losing one’s mind. They have to identify delusions before the patient re- ally believes in them. When does a strong idea take on a pathological flavor? How does a metaphysical crisis morph into a medical one? At what point does our interpretation of the world become so fixed that it no longer matters “what al- most everyone else believes”? Even William James admitted that he struggled to distinguish a schizophren- ic break from a mystical experience.

For Anna, early symptoms were nearly impossible to describe, and the only way to communicate them was by making up new phrases: she wrote in her journal that she was struggling with “migrating electrical sensations” and the sense that “words were alive.” The first thera- pist Anna went to see didn’t know what to make of her disparate symp- toms and, after a few sessions, told Anna she didn’t know how to help her. Anna left without a referral. Two months later, she became a pa-

3 Michel Cermolacce, Louis Sass, and Josef Parnas, writing in Schizophrenia Bulletin, offer a detailed account of the evolution and uses of this descriptor. Non-bizarre delusions are easier to pin down: according to the DSM-IV they include “situations that occur in real life, such as being followed, poisoned, infected, loved at a distance, deceived by spouse or lover, or having a disease.”

A Walk in the Park, by Sebastiaan Bremer. Courtesy the artist and BravinLee, New York City

tient at the Psychosis Clinic, after finding it online. She was still get- ting A’s in school, and there was no one symptom that bothered her most—it was only the sum total of these nameless experiences.

Anna’s psychologist, Cherise Rosen, would not speak to me di- rectly about Anna’s treatment, but Anna said that she was initially told that her symptoms were mild and her prognosis good. Although she never received an official diag- nosis, Anna tentatively concluded, after scouring psychiatric literature on psychosis and recognizing her- self in the descriptions, that she was in the prodrome to schizophre- nia. (The clinic accepts some pro- dromal patients but primarily works with people soon after a first psy- chotic break.)

Anna and I spoke several times over the past year, and she always approached her symptoms with crit- ical distance. As an adolescent, she

had vigorously argued that the fan- tastical stories her mother told were logically impossible: there was no global conspiracy, the phones weren’t tapped, there was no need to put all their belongings on the sidewalk. Anna was terrified of be- coming schizophrenic herself—more than 10 percent of people with a schizophrenic parent develop the disease, compared with about 1 per- cent in the rest of the population— but by the time she reached her ear- ly twenties, she was so socially and intellectually at ease that she as- sumed the window of risk had passed. “I defined myself in opposi- tion to that backdrop of illogicality,” she said.

Yet in the course of a few months, she had become too suggestible: she would come up with sweeping theo- ries about the structure of reality— that time no longer existed, that the world was made entirely of gasses— and then, moments later, scold her-

REPORT 37

self for allowing the experience when there was “not a shred of sci- entific evidence.” She kept waiting for the particles to vanish on their own. When they didn’t, she worried she was “addicted to an idea.” She felt that by wondering about the properties of matter—by blowing on books to see whether they would disintegrate—she had taken some irrevocable step toward illness.

Anna’s doctors urged her to take antipsychotic medication, but Anna did so only sporadically, rarely at a therapeutic dose, primarily because the drugs made her feel too tired and mentally cloudy. During her weekly sessions, the psychiatrist at the clinic would check up on her with a stream of standard queries: Do you think your thoughts are not your own? Do you ever hear voices? For months, Anna said no, but she became increasingly uncertain. The boundary between fantasy and lived reality had become too po- rous. When she focused closely enough on her thoughts, she could make herself hear a soft voice be- hind them. More and more, her thoughts began to feel like “things,” she said. They had their own loca- tion and sentience: she could feel F them circling around

her brain.

or the past two centuries, schizophrenia has been defined in part by its incomprehensibility. The psychiatrist Karl Jaspers wrote that schizophrenic symptoms embody “something inaccessible and foreign which, for this very reason, language defines as deranged.” In the 1940s, doctors turned their own sense of alienation into a diagnostic marker. If they could not feel empathy for their patients, they would get a cold, vertiginous sensation known as the “praecox feeling” (schizophrenia used to be known as dementia praecox). Sigmund Freud apparently got this feeling and gave up on talk therapy with schizophrenics. “Ultimately I had to confess to myself,” he wrote to a colleague, “that I do not care for these patients, that they annoy me, and that I find them alien to me and to everything human.”

The pessimism surrounding 38 HARPER’S MAGAZINE / DECEMBER 2010

schizophrenia is so deeply entrenched in psychiatric practice that when pa- tients recover, they’re occasionally told that they must have had a differ- ent disorder all along. People with schizophrenia take up 25 percent of the nation’s hospital beds, and 10 percent of them eventually commit suicide. Over the past century, doc- tors have tended to grasp at anything resembling a cure, allowing little time to elapse between a new theory and its practical application. They injected patients with blood drawn from epileptics; put them into insu- lin-induced comas so that they might wake up renewed and transformed; and carved out parts of their prefron- tal cortices—where unhealthy fixa- tions were thought to reside—with ice picks.

Then, for decades, the prevailing treatment model called for no physi- cal contact. Patients reclined on leather couches while psychiatrists plumbed their childhoods for hints of abuse or neglect, for mothers who had been too frigid or overprotec- tive or needy. “We were just build- ing castles, sand castles,” Thomas McGlashan, the first American doc- tor to open a prodromal clinic, told me. He spent fifteen years as an an- alyst at Chestnut Lodge, a famous psychiatric asylum in Maryland, un- til he was overwhelmed by the sense that the disease had eluded him and his colleagues. “We can’t just sit there and guess why someone has gone mad,” he said. “We have to watch it happen.”

McGlashan was inspired by the work of the New Zealand psychiatrist Ian Falloon, who, in the late 1980s, had attempted to treat all the people in two towns north of London who showed possible signs of impending psychosis. After giving these patients low doses of antipsychotics and home-based therapy for four years, Falloon reported that the two towns had one tenth as many new cases of psychosis as the rest of the country. More recent studies have shown that in the years before people have a psy- chotic break, they struggle to identify tastes and smells—a banana no lon- ger tastes like a banana, or fresh wa- ter begins to carry the odor of mold—and they lose gray-matter vol-

ume in certain parts of their brains, particularly the hippocampus, which is crucial for learning and memory. (These findings are too rough to serve as a diagnostic tool.) In one study, McGlashan and other re- searchers had patients listen to re- cordings of several people speaking simultaneously so that their words were indecipherable. Those patients who could detect meaning—they heard the words “the children,” “bombing,” “the administration,” “seem to have trouble,” “practice dancing”—were more likely to be- come psychotic within one year.

McGlashan and his team at Yale are among those who have pushed for the psychosis risk syndrome (or, more recently, the “attenuated psy- chotic symptoms syndrome”) to be included in the DSM, so that psychi- atrists won’t turn away patients sim- ply because they haven’t fulfilled di- agnostic criteria. McGlashan has compared the historical importance of prodromal research to Freud’s dis- covery that dreams reveal the un- conscious. But many of his colleagues object to adding the diagnosis, since even the best clinics predict psycho- sis with less than 40 percent accura- cy and there is no clearly established method for preventing conversion. It’s impossible to know whether early intervention has prevented a psy- chotic break or whether the patient was never going to have one in the first place.

A few prodromal clinics prescribe antipsychotics to the majority of pa- tients but most, including Mc- Glashan’s, treat patients for the symptoms they have, not the ones they may eventually develop.4 Thera- py, psychosocial education, and anti- anxiety and antidepressant medica- tions are used. But if the diagnosis is administered by clinicians not spe- cially trained in the field, the possi- bility of overmedication is much greater—a potential “public health

4 In one early experiment, McGlashan ex- amined the efficacy of the antipsychotic drug olanzapine, but the study produced mixed results. It also prompted an investigation by the federal Office for Human Research Pro- tections, in part because McGlashan had not adequately informed his patients that the drug has side effects: participants gained an average of twenty pounds.

␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣

catastrophe,” in the words of Allen Frances, chair of the DSM-IV Task Force. In a letter to the board of the American Psychiatric Association last year, he and Robert Spitzer, the architect of DSM-III, warned that if the psychosis risk syndrome were in- cluded in the manual, the associa- tion would run the risk of “medical- izing normality, and of trivializing O the whole concept of psy-

chiatric diagnosis.”

ver the course of several months last winter, I visited the Cen- ter of Prevention & Evaluation (COPE), a prodromal outpatient clinic on the fourth floor of the New York State Psychiatric Institute in Manhattan’s Washington Heights neighborhood. The clinic’s director, Cheryl Corcoran, a compassionate, soft-spoken psychiatrist who has studied schizophrenia for her entire career, does not think the “risk” di- agnosis is ready for unrestricted use, because of the difficulty of reliably identifying inchoate psychotic symp- toms. Some patients can still hold down jobs, excel at school, or lead full social lives, yet they complain of transformations in their moods or perceptions. They often come to the six-year-old clinic (by referral or In- ternet search) because other doctors aren’t sure how to classify what they are going through. In a paper in Psy- chiatric Quarterly, Corcoran pub- lished excerpts of interviews with pa- tients’ parents, many of whom relied on non-medical explanations to ar- ticulate what had changed: “I didn’t know if he was possessed by the dev- il, because he was himself one day and then dramatically different and not coming back.” “She is like a ves- sel that is never full.” “It’s hard be- cause I don’t even know this person.” “It’s not good to go against God— you can lose your soul.”

I met with six patients individually in a small therapist’s office overlook- ing the Hudson River and with pho- tographs of serene scenery on the walls: Central Park in autumn, a dock overlooking the sea. They rare- ly used the word “schizophrenia,” but they all spoke of the fear of losing their minds. “This whole thing has turned me into a philosopher,” said

Jorge, a peppy high school junior who was referred to the program two years ago after walking across the George Washington Bridge with a four-foot samurai sword wrapped in a blanket. He had become obsessed with black magic, spending hours a day on a website for occult research- ers. At the time, he felt like he was on the brink of tapping into his own mystical powers. “I need to control myself when I study something,” he told me, swiveling around in an of- fice chair. “It sticks on me too hard. I get so dragged into the subject that I become it.”

Like nearly all American prodro- mal clinics, COPE admits patients based on their responses to the Structured Interview for Psychosis- Risk Syndromes, a two-hour exam developed by McGlashan—modeled on a similar test authored by psychia- trists in Melbourne—that evaluates genetic risk, cognitive deterioration, social withdrawal, and the earliest flickers of psychosis.

Do you daydream a lot or find yourself preoccupied with stories, fantasies, or ideas?

Do you think others ever say that your interests are unusual or that you are eccentric?

Do familiar people or surroundings ever seem strange? Confusing? Un- real? Not a part of the living world? Alien? Inhuman?

Have you ever felt that you might not actually exist? Do you ever think that the world might not exist?

Another part of the exam assesses people’s capacity for abstract thought. They are asked to interpret proverbs, such as “Don’t count your chickens before they hatch,” and to describe the similarities between an apple and a banana. The correct response— “Both are fruit”—eludes some of the sicker patients, who instead home in on concrete characteristics. The psy- chologist who administers the exam told me that one of the most common wrong answers is “Both have skin.”

At the clinic, health is measured by degrees of conviction. Corcoran routinely checks up on her patients to see how compelling (on a scale of 1 to 10) they find their unusual be- liefs. How do you think people are reading your mind? she asks gently.

REPORT 39

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Are they reading it right now? Do you ever think it could be your imag- ination? As they flesh out their sto- ries, people sometimes dismiss their fears as “crazy” or “goofy” or “absurd.” Treatment becomes a process of rein- terpreting and naming experiences that once felt too private and ineffa- ble to share. “The man on the sub- way may know what I’m thinking” is translated as “I’m feeling paranoid.” “When people are not entirely con- vinced, you can work with that in- sight,” Corcoran said. “The experi- ence doesn’t have to impose a change on their identity.”

Although people with schizophre- nia are born with a biological vul- nerability that predisposes them to the disease, the theory that psychosis arises from psychological turmoil is not as anachronistic as many have been led to believe. (As if to com- pensate for the psychoanalytic era, when a generation of parents were made to feel responsible for their children’s suffering, psychiatrists have become squeamish about en-

gaging with questions of cause and effect.) Studies have shown that peo- ple’s chances of developing the disor- der increase after demoralizing events—sexual or physical abuse, emotional neglect, witnessing a bombing or shooting, a mother’s death. Other factors include poverty, growing up with more than three siblings, living in an urban area, and immigration. When people move to a neighborhood where they are the ethnic minority, their chances of be- coming schizophrenic increase. As the anthropologist T. M. Luhrmann put it, “If your skin is dark, your risk for schizophrenia rises as your neigh- borhood whitens.”

About a third of the patients at COPE immigrated to the United States. Chloe, a glamorous, well- dressed twenty-four-year-old Japa- nese American who worked as a writer’s assistant, told me that many of her symptoms stemmed from “this constant questioning of what my true self is—even though that sounds really cheesy.” She kept her

black peacoat buttoned up to her chin for the length of our conversa- tion. Each time she described a par- ticularly troublesome symptom, she would laugh at herself, a soft, low, infectious giggle. “I think too much about every action I take. Like, ‘I’m moving my hand right now! That’s so magical!’ ” She wiggled her fin- gers in the air.

Chloe described her father as the “town nut” and then quickly apolo- gized for saying it. As a child, she had struggled to understand that the sto- ries he told about ghosts from the Civil War were no more real than the fairy tales she read before bed. When she went home to visit her family re- cently, she sat in the back yard with her father, who had refused treatment his whole life, and played house with figures he had made out of sticks. “I never want to be one of those people,” she said softly.

At times, she imagined that the act of having a bad thought—and then thinking about that act—would cause blood to leak from her brain.

40 HARPER’S MAGAZINE / DECEMBER 2010

Mirror, by Sebastiaan Bremer. Courtesy the artist

The fear was new to her and, like Anna, she struggled to hold on to the experience. “Sometimes I’ll just sit there and be like, ‘Is there really anything wrong with me? What if I am making these things up because I’m so attention-starved?’ ” She man- aged a polite smile. “Or what if it’s the fact that I’m making these things up that makes me mentally ill?” When I asked which experiences she may have invented, she put her chin in her palms and shook her head. “There are no words. It’s like trying to explain what a bark sounds A like to someone who’s nev-

er heard of a dog.”

lthough the psychiatric liter- ature describes a premorbid person- ality common to those who later de- velop schizophrenia—withdrawn, self-conscious, alienated—few of the patients I spoke with at COPE or at the Aware Program in Bangor, Maine, another prodromal clinic where I interviewed patients, fit that description. The only commonali- ties were that nearly all of them had moved through childhood and ado- lescence feeling more thoughtful, intelligent, or probing than their family and peers and that there had been an existential tinge to their preoccupations years before their symptoms emerged. Aaron, a patient at Aware who had been the presi- dent of his high school class, said that he and the others in his thera- py group had “all gotten caught up on the deep, fundamental questions—religion, morality, ethics—and sucked in by them.”

The raw material of delusions tends to evolve with the times, and over the past century, literature about psychosis reflects a steady the- matic progression: delusions about communing with prophets and kings gave way to fears of being ma- nipulated by the secret powers of factories, UFOs, radio DJs, fax ma- chines, Al Qaeda, the Internet. Jes- sica Pollard, the director of the Aware Program, said that a few of her patients have become consumed by the fear that their private thoughts are being chronicled on- line. “I’ll say, ‘Okay, you really think there’s a website about you? Well,

then let’s look for it,’” and they go on the Web together. (When pa- tients can’t find the site, Pollard says, they are usually able to accept that it doesn’t exist.) Whether about all-knowing blogs or guiding angels, there’s a uniformity to many delusions. They offer an explana- tion for an unfamiliar feeling: the experience of losing control over one’s mind.

The terror of this loss was de- scribed most vividly to me by one of the oldest patients at COPE, a slim twenty-eight-year-old named Mela- nie, who wore khakis, penny loafers, and a turtleneck to our meeting. She seemed to have come closer to psy- chosis than any other patient I inter- viewed there, but she used a few shreds of logic to tether herself to re- ality. Her symptoms began in Janu- ary 2009, shortly after US Airways Flight 1549 hit a flock of geese and landed in the Hudson River. As she watched the footage of passengers huddling on the wings of the floating aircraft, she recalled a status update she’d recently posted online that re- ferred to the saying “A bird in the hand is worth two in the bush.” “I felt a huge jolt,” she told me, speak- ing rapidly. Her pale face flushed. “I’ve never been one to say I predict- ed anything, but—for one thing, birds. Birds had taken down the plane. And then bush—President Bush. I thought, ‘Oh my God, this is another 9/11, and I predicted the whole thing.’ ”

Although raised Mormon, Mela- nie had been an atheist since col- lege, and in the days after the crash she was dismayed to find the God of her childhood reentering her life. Every encounter seemed to have been orchestrated by Him. “When I heard a car honk out in the street, I remembered that there are supposed to be two trum- pets announcing the Second Com- ing,” she said, sitting upright at the edge of her chair. “The first trumpet calls for the good people, and the second trumpet is for ev- eryone else. There was a part of me that wondered”—she lowered her voice to a whisper—“ ‘Is that one of the trumpets?’ ” She felt like an “alien on this earth” and decid-

ed to check herself into the hospi- tal, but the first cab she flagged down had an advertisement for the Broadway play Wicked on its roof. “I knew it might be crazy, but there was a part of me that felt that if I got into a cab that says ‘Wicked,’ it would take me to Hell. Because I’m wicked!”

Eventually she got into another cab. This one had an advertisement for Absolut Vodka. “I thought, ‘Oh, Mormonism says you can’t drink al- cohol! But that’s lesser. A smaller sin. All right, I’ll get in the cab.’ ” As she drove to the hospital, she had a kind of double awareness: she felt crazed and terrified, and yet she also saw herself as crazed and terrified—a person she couldn’t quite relate to. “I have a science background,” she told me. “I was thinking, Why are you having these religious feelings? You are an atheist now. Richard Dawkins! The God Delusion! You’re misinter- preting! There’s something wrong with your brain!”

If Melanie had waited longer be- fore she went to the hospital, if her symptoms had persisted for another few weeks (the religious thoughts lasted for about two days), she might have been diagnosed with schizophrenia. But she began tak- ing a low dose of antipsychotics and almost immediately stopped worrying about Hell. A few days later, she went back to work and recently received a promotion. She’s not sure whether the medica- tion and therapy cures psychosis or just delays it forever, or whether the distinction even matters. In the past year, she has occasionally wondered whether people are tracking her, but she’s usually able to ignore the fear. “I can catch it right at the beginning—before it becomes so intense that the only thought that matches up with those brain signals is: It’s the Apoc- alypse, your soul is suffering.”

Melanie said that her grandfather, a former aerospace engineer, had a schizophrenic break while he was testing missiles for the government. When he began to have delusions that his coworkers were spying on him, the fantasy was close enough to his everyday life that it did not

REPORT 41

strike him as obviously implausible. Melanie, on the other hand, was at a point in her life where the con- cept of a religious awakening was clearly out of context. “I was T like, Ha!” she said. “My

atheism saved me.”

he course of psychosis is much more variable than the DSM’s definitions allow, and one of the dangers of including the risk syndrome in the manual is that this subtle state of mind is not eas- ily expressed as a list of behavioral signs. Thomas McGlashan says psychiatric diagnosis is “just as completely primitive as it’s always been,” yet if he wants prodromal intervention to be widely practiced he will have no choice but to ad- here to diagnostic standards. The Psychosis-Risk Syndrome, his new guidebook for clinicians, features a series of tables with a list of his pa- tients’ symptoms and a correspond- ing interpretation, but with no speculation as to what gave rise to a particular behavior or belief, the analysis is circular. The symptom is essentially the interpretation and the disorder itself. A critique in Schizophrenia Bulletin describes such methods as “akin to predict- ing extreme heat by an increase in temperature, without identifying the fire.”

Case: Trinity presented at the inter- view in a lovely spring dress, wearing a straw hat that was completely lined with aluminum foil. She had plastic wrap around her hands and her shoes and large wads of cotton protruding from her ears.

Interpretation: Grossly strange ap- pearance

Case: Mike reported that he thinks people think negatively about him and are plotting to make him con- fess everything that he has ever done wrong.

Interpretation: Concern about plots

Case: Dexter stated that he spends an increasing amount of time think- ing about different ideas and is be- coming preoccupied with these ideas. . . . He feels that it is important to write these ideas down and to en- code them in a private codebook. He carried the codebook with him,

showed it to the interviewer and translated the title to the interviewer as “The Book of Ideas.” Interpretation: Preoccupation with unusually valued ideas

Case: Larry reported that he was not his usual self, as if part of him was missing. He reported feeling discon- nected from everything but found people’s concern for him strange. Interpretation: Missing self

What it means to have a self— and then to lose it—is central to any attempt to understand psycho- sis, but the DSM (and the reams of psychiatric literature it has spawned) do not encourage doctors to probe their patients’ subjective experiences. The manual is so con- cerned with statistical reliability (the book was meant to show “psy- chiatry becoming more of a sci- ence,” as one editor put it) that the brain is portrayed as a kind of black box: only behavioral output is chart- ed. For a person who feels that her thoughts are implanted by the gods, or broadcast on the radio, or stolen by her own cat, the standard medi- cal model—which treats symptoms as something external and discrete, independent of the self—fails to capture the core of the illness.

Psychiatrists hope that soon a neu- rological explanation will make terms like “self” and “reality” irrelevant for diagnosis, but in the absence of a cure, even the most nuanced neuroscientific theory can go only so far in explaining someone’s altered sense of the world. Aaron, at Aware, struggled with the delusion that he was attracted to young children and would be persecuted for his desires. He said he was assured that these beliefs were “chemical” and “brain-based.” “What happens if there’s some truth to your delusion? What if it is tied to reality?” he said. “They don’t want you to come up with mythical explanations. So they keep telling you T over and over again: it’s just

your brain.”

hirty years ago, people with psychotic symptoms might have ex- plained their problems by talking about the mixed messages they had received at home. “It’s the way I was raised,” or, “It’s because my mother always rejected me.” But these ex-

planations have been replaced by a new narrative. When I asked pa- tients at COPE and the Aware Pro- gram about the “cause” of their symptoms, many responded by refer- ring to neurobiological processes: “The hippocampus is firing too much and telling me to be afraid.” “It’s the adrenaline, the epineph- rine, and the norepinephrine; and the amygdala can either heighten the anxiety or diminish it, depend- ing on which direction I take with my thoughts.”

Anna, too, found herself scruti- nizing the degree of agency she had over the inner workings of her brain. She enrolled in a neurobiolo- gy elective in school and tried to determine which pathological neu- ral process was making her thoughts take on their own timbre. “It’s the whole efference copy system,” she told me. “I’m double-hearing, I think, and my thoughts are coming back to me as external.” But the knowledge did little to ease the phe- nomenon, and sometimes, in the midst of writing a paper, she would become alarmed that she had ever imagined she could come up with an idea and wonder whether her thoughts were outside of her brain, floating. “The more I focus on my thoughts, the more it feels like they don’t actually belong to me,” she said. “It physically feels like my head is just completely hollow.”

For Anna, there was no single mo- ment of “conversion,” no sudden break from one state of mind to the next. If there is a boundary between health and insanity, Anna felt her- self creeping across it with pained self-awareness. She remembered as a teenager feeling dismayed by her mother’s inability to communicate: her thoughts no longer conformed to the “laws that literally allow us to make sense.” Now Anna worried that she, too, had somehow been un- moored from the rhythms of every- day life. Occasionally she could read dense academic texts, but other times she couldn’t follow more than a few lines. She stopped going to class. Time no longer felt as if it passed: each moment had become discon- nected from the next. She would lie in bed for hours, with the lights off,

44 HARPER’S MAGAZINE / DECEMBER 2010

watching the play of shadows on a wall that she wasn’t sure existed.

An elegant and scrupulous writer, Anna was often dismayed to look back at earlier pages of her journal and see notes about futuristic mind experiments involving implanted memories and telepathy, or the phys- ics of a new sphere of reality. In col- lege, she had romanticized madness, but this was insanity as cliché. It of- fered no revelation. Knowing that these thoughts were just “symp- toms”—a word that struck her as overburdened with consonants— didn’t diminish their force. She struggled to create some theory that would explain why people seemed so phony and lifeless and small, as if they could be manipulated in her fingers. She considered many possi- bilities: they were marionettes, ro- bots, drawings, automatons, agents of an omniscient godhead. Eventually, she settled on paper figurines. It was never a conclusion with which she was content, just the one that seemed to border on reasonable. She would walk down the streets talking to herself and didn’t care that people were staring at her, because they were only made of paper.

A year after beginning treatment, she was briefly hospitalized after she came to the clinic incapable of utter- ing a word. She assumed that the hos- pital billed her insurance for treating schizophrenia, but she has never seen her formal diagnosis. “Schizophrenia” is a term that Dr. Rosen tends to avoid, since it implies (because of its history, and the way the DSM constructs the illness) a bleakly fixed outcome, which is often not the case.5

Anna went back and forth be- tween feeling as if there was some- thing inevitable about the cascade of symptoms and wondering wheth- er the illness might not have pro- gressed if she had gotten help even earlier, when the only trouble was a low yet constant hum of anxiety—a state of mind that, for most of us, is

5 Some psychiatrists now argue that the term “schizophrenia” shouldn’t be used at all because it describes not a coherent entity but a collection of symptoms with widely varying outcomes. In Japan, the syndrome was renamed “integration disorder” in 2002; this led to twice as many patients be- ing informed of their diagnosis.

not abnormal. But her current con- dition now shades everything that came before. Since psychiatric diag- noses are based almost entirely on the patient’s self-report—and Anna always felt that her descriptions were inadequate and distorting— she was left with the feeling that she’d somehow constructed the ill- ness herself. By naming these expe- riences, she worried she had brought them into being.

Anna said she would have been a “lost soul” had she not found Dr. Rosen, who was the only person with whom she could openly share these experiences, but at times she strug- gled to maintain belief in the reality of her appointments. “Dr. Rosen will try to convince me, through Socratic reasoning, that the appointment is actually happening,” Anna told me in March. She kept her thick, cord- like hair tucked behind her ears and wore a small, fitted V-neck sweater that narrowed her body. “She’ll say, ‘Anna, you are sitting on a chair, why aren’t you falling through the chair?’ And I’ll have to admit, ‘Yes, I am sit- ting on a chair, and I know the chair is solid because I am sitting on it.’ She’ll say, ‘Well, are you talking to me right now?’ And I’ll say, ‘Yes, I’m talking to you right now.’” She dug her fingers into her hair, cupping the back of her head with both hands. “But the thing is, it goes nowhere. She can reason with me like that, and it doesn’t in any way change my mind. I’m perfectly aware that I can navigate space and move in time, and at the same time, none of it feels like it’s happening. It just doesn’t make a difference.”

It wasn’t as if she had surrendered to the world of particles; she found it dismaying and unbelievable, and yet she couldn’t dismiss it as false. “There’s a sense in which the law of contradiction—that something can’t beXandnotXatthesametime— has ceased to matter,” she said slowly. “What I know and what I believe no T longer coincide, and I

can’t make them.”

he last time I spoke with Anna, in June, more than two years after she first became a patient at the clinic, she said her delusions

had become less compelling. Ordi- nary activities, like lounging on a bed and trusting that it wouldn’t sink through the floorboards, no longer felt alien and unnatural. She said that her psychologist and psy- chiatrist strongly believed the change came from her taking a new antipsychotic drug, asenapine, for the past two months, but she couldn’t convince herself of this ex- planation and was thinking of stop- ping the medication. It wasn’t as if her perceptions had become normal again, she argued. Hard surfaces still felt airy and insubstantial, but now she made conscious decisions every day to rely on them just as she had before. It was a matter of ignoring swaths of her own perceptual expe- rience, of relearning how to con- struct the world in her mind.

Along with a renewed interest in the mundane chores of living— eating, reading, exercising, clean- ing dishes—she felt overcome by academic ambition for the first time in a year. She was preparing to ap- ply to a new school, where she could start fresh, away from the people who had seen her at her most unhinged. She seemed both calmer and more energetic, and I wondered whether she felt as good as she had before her earliest symp- toms emerged, before she ever be- gan doubting the solidity of ob- jects. That was impossible, she told me. The illness was about not just the active symptoms but also a more fundamental shift that made them plausible. “The symptom that bothers me the most is the one I can’t even begin to describe,” she said, leaning back on her white couch, the sun pouring into her living room.

After months spent struggling to articulate what she was going through, she felt her memories of the experience slipping away. “I can resort to bizarre metaphors, but I can’t even in the grossest, rough- est way communicate that state of mind.” She paused, looking away. “The substance of my experience is thrown into doubt. I am left with this incredibly deep sense that none of these things ever happened to me.” ␣

46 HARPER’S MAGAZINE / DECEMBER 2010

Buddhist Archetypes and the Mandala Principle: Applications for Therapists in Training and for Counseling Clients

Buddhist Archetypes and the Mandala Principle: Applications for Therapists in Training and for Counseling Clients by Buirge Sullivan Jones

BUDDHIST ARCHETYPES

Abstract

This paper explores the use of Tibetan Buddhist archetypes, symbols, and mindfulness teachings for the training of the Contemplative Psychotherapist and therapeutic work with clients. I will examine a universal aspect of Tibetan Buddhist teachings: the archetype and the lessons of the mandala. I will demonstrate how this archetype and lessons associated with it, once translated into everyday language, can prove most useful in therapy. My own experience as a participant in a maitri mandala retreat also proved essential to the development of my thinking. I have included a description and assessment of that experience along with clinical examples of how the mandala as archetype can be most helpful in therapeutic practice.

BUDDHIST ARCHETYPES

Acknowledgements I would like to acknowledge Chogyam Trungpa Rinpoche, Dr.Edward Podvall, Marvin Casper, and Shunryu Suzuki for their vision, aspiration, and insight in developing the maitri space awareness rooms (mandala). I also wish to acknowledge Chogyam Trungpa and Dr. Edward Podvall in their vision and aspiration in the development the Masters of Arts Contemplative Psychotherapy program.

Love and deep thanks to my spiritual teachers that have inspired me to become a therapist, especially those of the North American Indian lineages and the Europe/American Pagan revival lineage. Appreciation and deep bows to my teachers, mentors, and spiritual friends on my educational and professional journey: Camille D’Ambrose, Gail Smogard, Patrica Denny, Robert Johnston, Karen Wegela, Paul Bialek, Alexandra Shenpen, and especially William Malcom Raich.

My love and appreciation to my father Dr. Thomas B. Jones Jr. PhD and his father Dr. Thomas Bard Jones Sr. PhD for their wisdom, love, and passion for teaching and higher education. I hope to follow in their steps. In addition, to my “crazy wisdom” mother, Janet Jones, whose deep appreciation, love, and practice of the art of expression has been therapeutic and inspiring. My eternal love and gratitude, to my lifelong best friend: Cathlin Matson and our small band of kitties (mock children)-Jerry, Morgaine and Dylan.

Lastly, to all artists and therapists, who came before me, who have used art as a method to help heal and express the spirit of human experience through painting, music, prose, and film. Also, to my fellow cohort members of the class of 2010 of the MACP program who have been my support, teachers, and fellow travelers on the road to becoming a Contemplative Psychotherapist.

BUDDHIST ARCHETYPES

Buddhist Archetypes and the Mandala Principle: Applications for Therapists in Training and for Counseling Clients

In the contemporary practice of psychotherapy, an interesting shift is occurring. Clients are expressing a desire to integrate personal spiritual and religious journeys into the therapeutic experience. Psychologists, counselors, and analytic psychotherapists realize that Western psychology has its limitations in this context.

As a result, many therapists are turning to Eastern and Western psycho-spiritual modalities to provide a compliment to traditional therapy. Therapists are learning how to remodel spiritual-religious path work into a non-theistic framework. New therapeutic modalities are on the rise, inspired by Eastern and Buddhist practice techniques. In this changing environment, mindfulness techniques are used in therapeutic interventions, meditation techniques are employed for anxiety issues and the regulation of

BUDDHIST ARCHETYPES

emotions, and a focus on clients’ present situations is often the first order of business rather than delving into past experiences.

Some of the most prominent new therapies gaining momentum are DBT (Dialectical Behavior therapy), ACT (Acceptance and Commitment therapy), and Mindfulness based cognitive therapy. These new Eastern modalities form the basis of new therapeutic treatment plans and therapeutic interventions simply by taking Eastern spiritual concepts, archetypes, and symbols and converting them into common, everyday layman terminology and conceptual understandings.

In the training of the Contemplative Therapist, a fine line exists between Buddhist psychology and Buddhist spirituality. How can the Contemplative Psychotherapist serve their clients’ desires for the integration of the spiritual journey along with therapy? How does the Contemplative Psychotherapist effectively translate Buddhist psychology training into everyday layman terms? Examining the Buddhist mandala concept in therapeutic situations I have faced may help answer these questions.

The word mandala in Sanskrit literally means “essence,” “having,” and/or “containing.” In Tibetan, it is described as “circle circumference” or “completion” (Arguelles, 1972, p. 12). Carl Jung defines it as “a representation of the unconscious self “ (Jung, 1976, p. 178). In Native American and other indigenous cultures, the term used is “the sacred holy circle” (Arguelles, 1972). We also can find the mandala represented in various aspects of American culture (for example, stained glass church windows, business training modalities, and in management training graphs).

The mandala symbol is found most everywhere in world cultures, expressed in theistic and non-theistic realms. The mandala itself surely proves Carl Jung’s theory of the “collective

BUDDHIST ARCHETYPES

unconsciousness”—a theory that explains, for example, why symbols and archetypes may appear in two cultures half way across the world from one another and which have had little or no contact with each other. Jung purposes that there are common universal themes, archetypes, and symbols embedded in the collective unconscious of the human race as a whole.

These universal symbols, archetypes, and similar expressions can be found within individuals, within their historical cultural heritage, within the societies in which they live, and even within their dream worlds. The mandala can be manifest in spiritual visions, dreamtime, artistic expression, and in what may be called “mother nature” (e. g., flowers, rock formations).

In this paper, I will not be writing about the spiritual experience of the mandala or its manifestation in the “collective unconsciousness.” I will not go into detail concerning the lessons and techniques of mandalas within the Tibetan culture. Rather, I will be discussing how the concept of the mandala has been used in the training of Contemplative Psychotherapists and its use as a therapeutic technique. I will add some personal insights concerning my own experience of the Tibetan Buddhist mandala concept as well as investigate how I have integrated my personal experiences of Buddhist psychology into the therapeutic process with my clients.

BUDDHIST ARCHETYPES

Tibetan Buddhism and the Training of the Therapist

At the outset of my internship, I nervously awaited working with my first clients. Even though I had completed the required psychology classes, I did not feel well-trained in a specific psychological modality at that moment. My Transpersonal Counseling Practitioners (TCP) companion counselors confidently espoused a variety of techniques and exercises.

In comparison, I could talk to clients only about my meditation experience insights, what I had learned about the human mind through academic study, and how some of the basic Western modalities might be useful (which I felt anyone would have known sitting through a class in basic Psychology 101). I feared not having a ready kit of tried and trusted therapeutic tools. I felt somewhat lost, without confidence, and quite anxious. Would the men and women I was about to counsel pose serious issues and problems beyond my ability to respond?

As the journey began with my new clients, I gradually realized the need for strong and useful modalities and techniques. My experiences of working with my states of mind in meditation, reflecting on the theories and techniques behind Buddhist psychology, and participating with groups all promised to be of value dealing with the suffering of clients.

However, two important questions still haunted me: How would I most effectively apply the language and concepts I have learned from Buddhist psychology to my work with clients? How could I avoid imposing a Buddhist belief system on those who have never heard of Buddhism or did not consider themselves as Buddhists?
I am not a Buddhist. Yet, I have been able to take what I have learned within the Buddhist framework and apply it to myself without altering significantly my spiritual outlook.

So, in one sense, I could relate to my clients on this level and that it would be helpful for me to come from that perspective in working with clients. Buddhism compliments my spiritual beliefs, and helps me understand how I perceive, react, and sometimes get caught within belief systems.

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My introductions to concepts like bodhicitta, compassionate action, the paramitas, maitri, and other Buddhist teachings have helped me cope with personal suffering. The process has also revealed how I can become “stuck” in my own self-centered perceptions of the world.

Every time I have encountered and reflected on Tibetan artwork — mandalas, deities, and artistic representation of teachings, for example — it has been psychologically helpful for me. Tibetan artwork has enhanced my understanding of the foundations of Buddhist teachings, sometimes better than any reading or discussion of Buddhist concepts. The art inspires me and complements my passion for the study of universal archetypes in world religions and spiritual philosophies. I also have begun to make connections from one spiritual culture to another.

Though Buddhist archetypes have not been a big part of my training or experience at Naropa University, I am interested in linking these archetypes with aspects of western, in-depth psychology and exploring the use of universal archetypes in a therapeutic context. Because of my ongoing relationship with clients, interviewing sessions, and working to understand more about their learning styles, perception patterns, and means of inner reflection, I have found something quite exciting. By downplaying, to an extent, the labels, definitions, and language of Tibetan Buddhist psychology, I can take what I have learned at Naropa and apply it to the needs of my clients.

Meditation retreats at Naropa especially have inspired me to use therapeutic approaches drawn from Tibetan Buddhist psychology. After several weeks of meditation, aimed at calming the mind and its emotional and discursive thought patterns, the training therapist is ready to experience the “maitri rooms.” The maitri rooms are, in effect, a living mandala in artistic form. The training therapist meditates for thirty minutes at a time, in a yogic posture, within the maitri five rooms. Each room has a different color, direction, and symbolic teaching derived from the

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Buddhist psychology concept of the “five wisdom energies” (which can be experienced as both neurotic and enlightened). These five wisdom energies are a product of the Tibetan Buddhist teachings dealing with the “five buddha families”. The five wisdom energies or “buddha families” are broken down symbolically into five rooms.

“Each room is vibrant, painted a single color corresponding to one of the five basic energies. They are slightly different in size and design.There is a fifteen foot tall green room with a window to the sky at the very top, a square yellow room with a large sun like window, a red room with a small rectangular window, a deep-sea blue room, very narrow with several tiny slits of windows, and a smaller off-white windowless room in the middle” (Evans, Shenpen, & Townsend, 2008, p.207).

These five rooms are “considered the quintessence of the five elements of water (vajra family), earth (ratna family), fire (padme family), wind (karma family) and space (buddha family) “ (Evans, Shenpen, & Townsend, 2008, p. 208). The five wisdoms are said to give rise to all inner and outer phenomena of the relative world. One can experience the rooms “as flavors of compassionate openness, as neurotic confusion, or in their most fixed state, as psychosis” (Evans, Shenpen, & Townsend, 2008).

The building, as mentioned before, is a symbolic Buddhist archetype come to life. It is a living mandala. If one observed the construction of the rooms from directly above, a bird’s eye view, they would see how the building resembles a Tibetan mandala. There is a center (buddha room), and surrounding the very center are the other four rooms each placed in a certain direction (i.e. west, north, etc.). Each room also represents a direction and a season of the year (i.e. spring, winter, etc.). Again, the buddha room is dead center in the middle of all the other rooms, emulating Tibetan mandalas where there is usually a symbolic archetype or deity used for

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meditation. By emulating, I mean that the rooms are contained in a circular pattern. Then we have a room pointed in each cardinal point, ending with a center point that usually represents the symbolic teaching as a whole.

Buddhist Archetypes as a Psychological Tool: The Mandala

As I sat in the “buddha” room, meditating several inches away from a white wall in a room painted completely white, suddenly I had a powerful insight and experience: to my eyes, the arrangement of the maitri rooms comprised a symbolic, living representation of a mandala. The maitri rooms had a center (buddha) with rooms to the east, west, north, and south. Starting and then ending in the center room, the discovery of this symbolic arrangement of rooms left me eager to learn more. Of course, starting and ending my meditations in the buddha room heightened my psychological journey and understanding of the maitri room teachings.

Within the buddha room, staring at the angle and yogic position while meditating, all visible lines, boundaries, and barriers in my perceptual field “disappeared.” All I could see and experience was white light. At first, I felt anxious. I liked boundaries and barriers because they gave me a sense of place and, I suppose, a more familiar reality. However, as time passed, the unfamiliar became more familiar. Positioned in the center of this mandala and freed of

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boundaries and barriers, I could appreciate the symbolic representation of Buddhist teachings on emptiness.

‘Emptiness is form. Form is emptiness.’ This famous Buddhist phrase concerning an experience of emptiness has puzzled more than a few practitioners. No one has been able to forge these concepts into common knowledge and an adequate description.

Nevertheless, my experience in the buddha room with the formless white light gave me some insight into the meaning of this concept. I think of the buddha room as a symbolic representation of what emptiness may be. I recognized how I project my thoughts, opinions, perceptions, and senses on a world outside of myself—essentially on blank empty space (something analogous to a canvas devoid of form until the artist starts to paint her concepts and reality upon it).

I extended my experience when I wandered aimlessly outside of the rooms. I saw the universe like a mandala and the teachings on emptiness. Outside of my projected mental construction of world, our world has form and matter with the trees, earth, water, and the like. However, what sense did it make to project my own personal feelings, opinions, and reactions on this world of form?

Essentially, the world outside of my personal projections is purely and innocently devoid of what I felt to be solid and true for my experience. Like so many before me who have attempted to describe their understanding of emptiness, words alone prove inadequate. Such a concept must be deeply experienced, and it remains intensely personal.

The buddha room experience also exemplified the teaching of the Buddha’s fourth noble truth for me: that is, a path or tools of cessation are available to end our own and the suffering of others. My experience in the buddha room, centered on this fourth noble truth, helped me break free from years of neurotic stress, irrational perception, fear, and anxiety. These burdens fell away from me. For a brief time, I entered into a feeling of bliss, of inner peace.

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To this day, when I sense myself becoming dissociative, paranoid, irrational, or consumed by negative emotion, I recall my lesson in the buddha room. It is a great visual reminder that I am projecting my fears and insecurities onto the world at large, which in turn is empty of what I “think” is happening.

The maitri rooms also helped me better understand the role of the ego—how and why it wants to maintain itself constantly. The fear and anxiety I initially faced in the maitri room at seeing no boundary, form, and lines to define the room proved to me how my ego’s fear of a non-existent, solidified environment created mental and emotional projections to maintain an illusion. I saw quite vividly how the ego tries to use projection and solidification to maintain itself. If all this sounds confusing, let me offer a quote by Chogyam Trungpa, in which he describes what a buddha room experience may be.

“There is experience, then space or emptiness, and then the final aspect, which is called luminosity. Luminosity has nothing to do with bright visual light. It is a sense of sharp boundary and clarity. There is no theoretical or intellectual reference point for this, but in terms, but in terms of ordinary experience, it is a sense off clarity, a sense of things being seen as they are, unmistakably” (Trungpa, 1991, p. 132).

Later, upon reading on maitri space awareness, I realized I was not alone in having such an experience. Another student/therapist described her time in the buddha room:

A quality of bare awareness prevails, a sense of well-being and simplicity arise. There is an experience of an expression of non-aggression, of simply being. Nothing extra, just awake. Nothing, but awake. There is room for everything, it seems—including all types of personalities, and room to just to be oneself. But, there is room for considerable projection as well, because assumptions can flourish in the absence of much expression (Evans, Shenpen, & Townsend,2008 p.199).

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After this profound experience, and as I continued to notice its affects even months later,

I thought about how I could work the experience of the maitri rooms into therapy sessions with my clients. In doing so, I saw the possibility of underwriting a different sort of therapeutic intervention for my clients. I am a visual learner, and so are several of my clients. Sometimes, transmuting the maitri room experiences into common everyday language and as a concept for my clients has proved helpful. Therefore, as appropriate, I may use a mandala picture (similar to the maitri room) and teachings associated with it so my clients might gain universal insights similar to mine.

Western and Eastern psychology accept that the ego and its filters (perceptional choices on how we view the self and the world) are some of the main causes of human suffering and why people seek therapy. Many persons are taught to believe that there is something wrong with them or that they are inherently bad. The concept of the mandala, especially in Tibetan Buddhist terms, I think, can be a tool to learn how we may be causing our own personal suffering—in addition to how outside environments may influence our suffering.

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The Symbolic and Archetypal Teaching of the Mandala

Many years past, seeking historical spiritual and religious answers to the problem of human suffering, I came across a book, Journey Without Goal, by the Tibetan teacher, Chogyam Trungpa (1981). Most of the book seemed foreign and confusing to me, but one chapter (“Mandala”), made great sense. This chapter contained a picture of a Tibetan mandala, and Trungpa went on to explain what it symbolized: “Our relationship with the world of perceptions is called the outer mandala; our relationship with the world of the body is called the inner mandala; and our relationship with the world of emotions is called the secret mandala” (Trungpa, 1981, p. 31).

Most Tibetan mandalas have three circular boundaries contained within a circle. In the center is usually a symbolic deity that embodies the teachings of the mandala. The Tibetan Buddhist practitioner meditates on the mandala and his focus is to bring attention to the symbol at the center.

In Trungpa’s discussion of the mandala concept, he asserts that human beings are a living mandala. As we think about our own lives and the world around us, the three boundaries of the mandala are apparent and we can see how they influence each other. The “outer mandala” represents our sense perceptions of the external world. (In Tibetan Buddhism, “thinking” is a sense). The “inner mandala” stands for our actual bodies and how they can influence our perceptions and reactions to the world — including how we act with our bodies in terms of mannerisms, touch, speech, and so on. The “secret mandala” is our inner world of emotions and all the energies associated with it. The last boundary or mandala, contains the universe or world at large.

At the same time as reading Trungpa, I came across the teachings and theories of Carl Jung and Joseph Campbell. Jung’s book, “Man and his Symbols” (1987) and Joseph Campbell’s,

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“Power of Myth” (1991) seemed to link with Trungpa. In Jung and Campbell, the mandala was a major theme. The ideas of the three authors complimented each other. Each thinker seemed to be writing about a universal theme found throughout many cultures and throughout the centuries. Mandalas, of course, have origins in some of the very first cultures unearthed by anthropologists.

As Jung sees it, “The symbol of the mandala has exactly this meaning of a holy place, a temenos, to protect the centre. And it is a symbol, which is one of the most important motifs in the objectification of unconscious images. It is a means of projecting the centre of the personality from being drawn out and from being influenced from outside” (Jung, 1976, p.179).

Here’s how Joseph Campbell described the mandala in an interview with PBS’ Bill Moyers:
“CAMPBELL…you try to coordinate your circle (mandala) with the universal circle (mandala).
MOYERS: To be at the center?
CAMPBELL: At the center, yes. For instance, among the Navajo Indians, healing ceremonies are conducted through sand paintings, which are mostly mandalas on the ground. The person who is to be treated moves into the mandala as a way of moving into a mythological context that he will be identifying with- he identifies himself with the symbolized power. This idea of sand painting with mandalas, and their use for meditation purposes, appears also in Tibet. Tibetan monks practice sand painting, drawing cosmic images to represent the forces of the spiritual powers that operate in our lives.
MOYERS: There is some effort, apparently, to try to center one’s life with the center of the universe-

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CAMPBELL: . . . by way of mythological imagery, yes. The image helps you to identify with symbolized force. You cannot very well expect a person to identify with an undifferentiated something or other. But when you give it qualities that point toward certain realizations, the person can follow”. (Campbell 1991, p. 217)

The Mandala-Its Meaning and Use in Psychology

In this next section, I will further explore the concept of the mandala and how it has influenced individuals in terms of a universal archetype with important psychological aspects. I also will examine how the mandala helped me on my personal journey as a therapist. Lastly, I will provide two clinical examples in which the concept of mandala has proved useful for the clients in therapy.

To repeat, I am more comfortable as a visual learner. In reading the three books by Trungpa (1981), Jung (1987), and Campbell (1991), the pictures of mandalas (especially Tibetan and Native American) especially drew my attention. The main concept of a mandala is that of a sacred circle. The Sanskrit word for mandala literally is, “circle”. What this circle represents may differ from culture to culture, but a main theme seems to arise repeatedly. This main theme

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concerns the representation/symbolization of how the individual (or “self”) exists in relation to the macrocosm of the universe. The “self” is most often positioned within the center of a mandala–which also seems to represent the micro (self) in comparison to the macro (universe/environment at large).

Mandalas have been used to depict this conceptualized representation of the universe in relation to the self (individual), or can aid the individuals to re-stabilize harmony and balance with their environment, emotional states, and the world at large. In the latter case, an individual attains healing and balance by constructing or meditating on a mandala.

Jung discovered mandala archetypes in his journey as a psychotherapist. Exploring his unconscious, Jung sketched his personal mandalas. He found that “each single mandala he drew was an expression of his inner state of being at that particular time. As his psychic state changed, so did the mandala he would sketch. He concluded that the mandala represented “Formation, Transformation, Eternal mind’s recreation ”. (Moacanin, 1986, pp. 27)

A quote from Jung’s work with mandalas strikes a common theme that many seem to experience:

“I had to let myself be carried along by the current, without a notion of where it would lead me. When I began drawing the mandalas, however, I saw that everything, all the paths I had been following, all the steps taken, were leading back to a single point-namely, to the mid-point. It became plain to me that the mandala is the center. It is the exponent of all paths. It is the path to the center, to individuation”. (Carl Jung as cited by Moacanin, 1986, p. 28)

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Louise Von Franz (1994) also describes a similar concept of mandala in her book, Archetypal Dimensions of the Psyche:

“The mandala can be in a circular or square form-the appearance is accompanied by inner balance and order. An image stands for the unity of the cosmos and the individual as well as for the meaning of all life. As such, it plays a crucial role in Eastern religions. From the empirical point of view, this center seems to be the core that regulates the equilibrium of our psychic systems; from this core, the healing and ordering function of the unconscious arises. It is often perceived as the ultimate goal and fulfillment of life and gives religious experience, which resembles the satori of Zen Buddhism”. (p. 250)

Rob Preece (2006), a psychotherapist and Tantric Buddhist practitioner, also discusses the therapeutic process of mandala visualization as a self-transforming technique in his book, “The Psychology of Buddhist Tantra”:
“In the generation stage (with the visualization practice on Tibetan mandalas), a practitioner cultivates a visualized form of self as a person and/or deity standing within an intricately detailed mandala. This self-transformation is repeated time and again, day after day, for long periods. With continuous practice, the power of visualization develops sufficiently to be able to maintain awareness of the mandala’s complexity for a long time”. (p. 97)

I had similar impressions and reactions as these scholars when contemplating the mandalas. But Trungpa (1981), it seemed to me, had more depth to his discussion of the

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symbolic and psychological meanings of Tibetan mandalas. Trungpa’s excellent interpretation of eastern mandalas for the western mind has affected me profoundly. I found especially influential his words on the symbolic content of the mandala.

Trungpa teaches that we all are living mandalas. Concerning what a “living mandala” is, Trungpa (1991) concludes in “Orderly Chaos” it is “a space to create a situation based on a territory or boundary. It depends on whether we relate with space as space or space as solid, or with boundary as space or the other way around” (p. 6).

The Use of Mandala as a Therapeutic Intervention

“Concerning mandala as a therapeutic tool-through, this process (interpreting information through patterns) develops complexities, these nevertheless manifest in terms of certain forms of styles, all kinds of them. We cannot actually make systematic predications as to exactly what is going to happen in this process and exactly what is going to happen in this process and exactly how it will work; we cannot study behavior patterns and put all the details down on an information sheet. However, there are rough patterns. The only approach seems to be to try

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to the extent possible to perceive a generalized pattern without trying to interpret every detail. Therefore, to realize the mandala perspective at all, we need some kind of aerial point of view, a way of seeing the whole totally and completely. In order to have that, we have to be willing to give up the details and direction”. (Trungpa, 1991, pp. 122-123)

Here is how I translate these Tibetan teachings on mandalas into layman terms for therapy. I begin with a short introduction to clients on the use and concepts of a mandala, and then offer a personal interpretation by way of a visual representation. Next, I use a white board and draw a center. Following that action, I draw four consecutive circles around the center. I tell the clients to picture themselves at the very center, suggesting that the center is where the conscious and unconscious perceptions reside. I go on to describe the first circle as inner feelings that only clients know about, unless these are expressed to someone else.

The second circle represents the clients’ biological form. I explain about sensations within our bodies and how they can influence the first circle (the emotional and conscious/unconscious). The third outer circle, I continue, is the immediate environment around us, such as the room in which we sit. It is related to the other two circles and the clients’ center within the three circles. This outer circle represents our perceptions of the world around us. I also emphasize also that there are “environments” (work, school, home, and so on) which can influence the three circles of one’s mandala.

The fourth and last outer boundary is the “world at large.” If an event of global scale occurs affecting the world’s population, that environmental influence might also impact the three other circles (boundaries) and the “self” at the center of the mandala.

What I try to convey is that all four circles of the mandala influence one another and our personal center. Therefore, if one circle is out of balance, it will eventually affect all the

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consecutive circles (boundaries) within our personal mandala experience/perception.

If one aspect of our mandala is out of balance, then usually all the other aspects are as well. So, I will ask clients if they see or can point to which part of their mandalas are most out of balance in relation to a problem they are having or how they are feeling that day. Joseph Campbell (1991) in his book “The Power of Myth “, mentions this technique in an interview about Jungian psychology and archetypes:

“In working out a mandala for yourself, you draw a circle and then think of the different impulse systems and value systems in your life. Then you compose them and try to find out where your center is. Making a mandala is a discipline for pulling all those scattered aspects of your life together, for finding a center and ordering yourself to it. You try to coordinate your circle with the universal circle”. (p. 216)

I do not ask clients to practice on Tibetan mandalas or to do intensive Buddhist meditation daily work on a mandala like other Tantric practitioners of mandala meditation. However, they most often go ahead and reflect on the concepts throughout the week. I find it helpful sometimes to have them mindfully practice how all the environmental factors might be influencing their personal experiences throughout the week.

Clients seem to respond well to the psychological tool of the mandala. Nevertheless, I make sure to use this approach with clients I feel are best fitted to using it as a perceptive tool. In my experience, some people will not respond to the approach of the mandala. Just like any therapeutic tool or intervention, the therapist should assess if it would be beneficial for the client by conducting a therapeutic client assessment, getting to know the client better through sessions,

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and introducing the tool only with the proper foundation, all the while remaining alert to the client’s reactions. In my experience, clients who are right-brained types tend to gravitate to the concepts of the mandala. For the individuals who like to talk about and relate to metaphors within therapy, the mandala approach is extremely effective. In this regard, I will offer two case examples. Names are changed for anonymity.

Two Clinical Examples of the Therapeutic Value of the Mandala

Shelia is a client who came to me complaining of the “speediness” of her thoughts and problems with maintaining healthy boundaries. In addition, she was upset by experiences with authority figures that excited an impulsive anger within her. As time progressed, Sheila and I worked on transforming her anger by using the concepts of bodhicitta (inspirational practices to see the sufferings of others in relation to our own experiences of suffering), which I had translated into everyday layman terms.

This approach helped slow down her compulsive ruminations–concerning her anger, what she was going to do, or should do, and other thoughts that fueled her neurosis. We applied mindfulness techniques (such as recognizing discursive thought patterns and practicing mindfulness techniques like “touch and go” (Wegela, 2008) to separate Sheila’s emotions from her thought patterns.

Again, I introduced some Buddhist

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teachings on how we can transform anger into compassion towards others by translating experiences of personal suffering into everyday language. Sheila responded well to this practice. She began to feel compassion for those she previously had only room for anger. She was able to separate her own projections and counter transference experiences as a result of our work on her anger and destructive emotional triggers. She also learned how not to react aggressively even when someone showed aggression towards her.

At one point, Sheila’s compulsive thinking returned. She returned to her previous concerns about others and to the conflict between her goals at school and her goals at work. She lost sight of what might be influencing her inability to discern what she could take on and what she could not. So, making use of my supervisor’s introduction to a similar concept—about environmental influences pictured as a circular graph with the client in the center—I decided to introduce the concept of mandala to Sheila. I took a white board and drew a center circle with four circles around it.

I asked her if she had any experiences with mandalas. She had not. Therefore, I explained the universality of mandalas in many different cultures, and she understood the general idea. Next, I used the drawing and told her about the concepts of outer, inner, and secret mandalas, but labeled them the world environment at large, the immediate outer environment, her bodily environment, and her inner emotional environment. I explained if one were influenced, so would be the others.

To illustrate, we took the example of Sheila’s struggles with work and school environments. She was battling with many authority figures in both realms. We looked at how her body experienced these realms. She commented on the high energy she experienced because of anger and the speeding up of thought that proceeded hand-in-hand with her battles. I asked

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about her inner emotional states, and we found her anger fueled by sadness. This sadness had a connection to other individuals Sheila identified (based on her intuition) as victims of authority figures. She then traced some of her original feelings to psychological wounds suffered at the hands of her parents, who had taken advantage of Sheila emotionally and never assumed responsibility for their actions.

We chose to also reverse Sheila’s experiences in these realms by using the mandala to trace her inner emotional world to her bodily realm and to see how she projected her secret and inner mandala onto the outer mandala (though again, we did not employ that terminology). She seemed quite astounded by this process, and enjoyed the exercise.

As weeks went by, subtle changes in Sheila’s three environments occurred: she worked hard to care of herself physically and mentally, and she moved forward to change her home and work environments. We continued to focus on using boundaries and referred to them as the inner and outer circles of her experience (mandala).

Her commitment to therapy and changing her inner and outer worlds seems to have brought positive results. When things started to fall back into habitual patterns, we would resurrect the visualization process of the mandala to refocus and center any rising emotional chaos.

To succeed using these approaches, a person needs to be willing and committed to looking within her life and environment. The mandala concept can also be used in other ways. For Shelia, it helped in defining boundaries and mindfulness with her inner and outer environments. My therapeutic use of the mandala concept was quite different in another case I will now discuss.

Lisa came to therapy very anxious, depressed, and fearful. For the first time in her life, she was on her own, away from her family and birthplace. She had moved half way across the

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country to live alone in a new city. She complained of heightened auditory senses, paranoia, and anxiety around others. However, her main complaint had to do with her inability to articulate her emotional states in a way that others might understand.

After a couple of sessions, we agreed that her transition from family and home to a new place without support was the cause of heightened fears, anxiety, and auditory senses. As therapy progressed, her heightened experiences and anxiety started to dissipate, but she still had a hard time finding the words to describe her emotional states.

Lisa would speculate, “Do I have an Attention Deficit Disorder problem?” In addition, she wondered if her difficulty focusing and feeling grounded enough to talk about her problems be a result of ADD? I disagreed with Lisa’s speculations, but did not share my disagreement with her at this point. I feared causing her more stress. She did not seem to have the tools and language necessary to talk about her problems with others. Nevertheless, in some sessions, we worked to analyze some of her most vivid dreams, and Lisa had some success talking about her problems in these sessions.

I decided that introducing the mandala principle in visual form might lead Lisa to better express herself and understand her inner and outer perceptual reality. I went through some of my personal collection of mandala artwork, and picked out several Tibetan and Western mandalas. These mandalas illustrated different states of mind and emotions. Some of these mandalas pictured archetypes of gods and goddesses, others illustrated wrathful and peaceful states of mind, and the remainder represented therapeutic mandalas used for calming techniques.

In our next session, I brought out all the mandalas, spreading them about the floor. I asked Lisa to examine them and first pick out those she felt depicted being calm and centered. Then I asked her to choose the mandalas that matched her negative states of mind. What transpired next proved illuminating for both of us. We found that what she selected for both

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choices gave her a symbolic archetype to use for depicting states of mind. As a therapist, I gained good insight diagnostically into some important causes for her suffering. Mandalas she picked out that represented being calm and centered proved to be those that contained symbols and archetypes of nature (trees, birds, water, etc.). Mandalas representing her inner emotional chaos were crowded with perhaps too many symbols or had wrathful looking deities surrounded by fire. In the latter case, Lisa felt these mandalas represented “the fire of anger”.

From this point on, we now were able to focus on common everyday language and concepts. We could now use nature visualizations to restore calm and balance. At times, Lisa would imagine herself at the very center of a visualized mandala. I would have Lisa practice letting go of the other four consecutive boundaries as well as her worries and fears about how these boundaries were influencing her. This practice “grounded” Lisa when she felt overwhelmed or caught up in world crisis issues. We also now had a language of sorts for Lisa to express her emotional states, be it showing me a picture or using the words she gathered from viewing mandalas and describing what she saw. Therefore, for example, she used “fire” to describe the anger that she felt looking at mandalas picturing the wrathful deities.

Lisa greatly appreciated that our session had given her some visual tools for relaxation and grounding. She also recognized that she could move forward and improve her ability to discuss problems. I presented her with the three mandalas she valued most for calmness and grounding. I told her to put them up in places where she could use them in times of stress. I advised Lisa that when she felt hyperaware or anxiety ridden, she should use the mandalas. “But what about when I am at school and feel anxious?” Lisa asked me. We decided that she should take one of her favorites, and fit it into the sleeve of her notebook. She could use it as a visual reminder or tool to reference when she felt anxious at school. So far, Lisa reports this device has

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proved most helpful. Our session with mandalas even inspired her to find and bring in other pictures and artwork from magazines. She used these to help explain and talk about her weekly processing of experiences. Lately, we have moved away from using these tools, because Lisa has found her voice. She now talks more openly about her emotional states and the problems she may be experiencing.

I did not need to introduce the boundaries of mandalas with Lisa in the same way as I did with Sheila. However, if needed, the approach taken with Lisa could be quite useful and beneficial in Sheila’s case. She is a visually expressive personality and a strong dreamer. The uses of archetypes, symbols, and mandalas have worked quite nicely in our therapeutic sessions. Eventually, I would like Lisa to design and draw her own personal mandalas. I believe these drawings would enhance her continued emotional expression, as well as her discussions of personal goals and outcomes. Lisa might well find a way to “talk” about her problems when she struggles to find the words necessary to do so.

Discussion

As we can see, the mandala principle is an intimate part of the Western psychology lineage of Jungian psychologists and within the Eastern Buddhist cultural framework. In the case of the Contemplative Psychotherapist, a much deeper introduction to the therapeutic usefulness of the mandala results from the maitri room experience.

The Maitri Rooms Mandala

With each meditation retreat, the Contemplative Psychotherapist acquires new and more substantial information and training in regards to the “maitri mandala”. At the first retreat, orientation information precedes an introductory experience in the rooms. At the next retreat, more information is presented before and following the experience within the maitri rooms. This

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information deals with the symbolization of the neurotic and sane sides the maitri mandala represents. At a final retreat, by reading and meditating on teachings from The Tibetan Book of the Dead (Fremantle & Trungpa, trans., 1974), the therapist learns how each room of the living maitri mandala connects to the death-dying-birth cycle.

Rather than reading about a mandala or briefly being introduced to it in Western psychological terms, the therapist has the opportunity to experience a living mandala by practicing meditation within the maitri rooms. In my experience, it is far more powerful to engage in a ritual rather than reading about it. Merely reading about the concepts of mandala, or using it in a Jungian therapeutic sense may be somewhat limiting for the training of a Contemplative Psychotherapist. But why is there this difference?

In my opinion, experiencing these living maitri rooms rather than reading or being taught about them affords unique insights and experiences. Chogyam Trungpa and Suzuki Roshi (a Japanese Zen Roshi Master) originally constructed these rooms because they had many people showing up at their meditation centers in distress from psychosis or mental illness.

Trungpa and Suzuki came up with the idea of creating the mandala maitri rooms as a possible stabilizing experience for these people in distress. Unfortunately, Trungpa and Suzuki found in many cases that the maitri rooms only increased the states of psychosis. Later, Trungpa and others agreed that perhaps the rooms might be more useful to those working in the mental health field if they experienced the rooms as individuals.

Individuals within the rooms might better glimpse the neurotic energies produced by the yogic positions (meant to cause irritation) within rooms constructed with a mindful placement of windows and specially selected color schemes. As time progressed, Trungpa and Suzuki found it beneficial for therapists, mental health workers, and others to experience and practice in these rooms. These
professionals would be in a better

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position to gain understanding and insight that might inform and enhance their work with clients. In Western psychology, the uses of mandalas should not be discounted, either.

Clients who draw or find pictures of mandalas can often express hidden emotional worlds as well as center and regulate conflicting emotions (see the discussion above of my two clinical examples). I have found it most exciting to use these techniques with clients. In addition, through research and supervision, I discovered with equal excitement that the techniques have been used for centuries to aid in psychological-spiritual health.

Carl Jung, and even Sigmund Freud (though seemingly only in dream archetypes), used the general idea of the mandala in their psychotherapy practices. I need not go into the process and history behind Jung’s methods and how he came to apply them at this point. However, it is interesting how Jung’s work and writings feature the concept of the mandala. This archetypical analysis continues in the world at large through the work of Spiritual teachers, in-depth psychotherapists, transpersonal psychologists, and now, I believe, Contemplative Psychotherapists.

Though Contemplative Psychotherapy does not make a prominent place for archetypes, it has been influenced through contact with Tibetan Buddhist culture. Of course, Tibetan Buddhist culture has employed archetypes to illustrate teachings for over 2, 500 years. I would like to expand my knowledge of these archetypes so I can translate them into universal archetypes and a language to which my clients will respond. I realize my techniques and methods are nothing new, but sophisticationing and refining their structure and use promises an effective therapeutic approach.

I have found a wonderful bridge between Western and Eastern psychology for the benefit of my clients and a wonderful ongoing educational practice and training modality for becoming a Contemplative Psychotherapist. My personal experiences with the maitri mandala, researching

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the psychological uses of mandalas, and experimental use of the mandala principle with my clients has opened an exciting path to my future career.

Using the Tibetan Book of the Dead

“Now when the bardo of darmata dawns upon me, I will abandon all thought of fear and terror, I will recognize whatever appears as my own projection and know it to be a vision of the bardo; now that I have reached the crucial point I will not fear the peaceful and wrathful ones, my own projections!” The Tibetan Book of the Dead (Fremantle & Trungpa, trans., 1974, p. 40)

The final Naropa retreat found me once again meditating in the calm stillness of the buddha room. It seemed as if I had come full circle in my personal journey as a therapist, but more so concerning my ongoing relationship with the Tibetan Buddhist culture. Befitting the occasion, as part of this last gathering, my classmates and I were reading and contemplating The Tibetan Book of the Dead (Fremantle & Trungpa, trans., 1974). —one of the first books I came across exactly twenty-four years ago.

I remember even so long past decorating my rooms with the images of peaceful and wrathful deities and contemplating their meanings. The images and Tibetan artwork fascinated me. I tried my best to read and understand the book, but its full meaning lay beyond my reach.

Nevertheless, the images, archetypes, and symbols I discovered captured my imagination and stayed with me years down the road. The book I had found at random, now would symbolize the educational journey of my classmates and I towards a future career as therapists. A reading and study of The Tibetan Book of the Dead (Freemantle & Trungpa, trans., 1974) would also mark the ending of our experience as a group.

The maitri rooms took on another deeper meaning and significance for me. These rooms represented the stages of death, dying, and rebirth. This living representation of a mandala, like so many other Tibetan mandalas, held an even deeper meaning at this time. We learned that each

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of the rooms also represented the “in between stages” or bardos described in The Tibetan Book of the Dead—something I had suspected while spending time reading in preparation for the retreat. I looked forward to seeing what might unfold for me during my return to the maitri rooms.

The Tibetan Book of the Dead (Freemantle & Trungpa, trans., 1974) describes several stages that the Buddhist practitioner will experience when their body dies.

The Tibetans believe that our basic consciousness survives after death and we will experience realms of fear, desire, and bliss. The book describes what may possibly happen in a day-by-day experience before we are forced or choose (depending on our spiritual work in this life) rebirth in another form. This rebirth might take the form of an animal, spirit being, deity, or human entity. Rebirth depends on our previous karma in a lifetime, the cause and effect of our actions.

Sitting in the buddha room, again I experienced the state of space and light. Perhaps I was experiencing the empty “luminous mind” state described in many of the Tibetan Buddhist teachings. Could this be the basic state of mind always accessible to us? Could this be a universal, truthful reality experience all human beings can share?

I believe we experience this state as babies entering this world, our minds free from cultural, social, and parental imprintation. When we may be in the pre-developmental stage, before we are taught a cultural identification through the speech, symbols, and archetypes of our society. It is the “blank page” or “blank canvas” we may experience before the suffering and pleasurable experiences occur that will possibly shape our personalities for a lifetime. These experiences, which may cause a person suffering in this lifetime, also are those that impel individuals to seek therapy.

In the buddha room, I also wondered if the state of mind I have described is what we

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return to at death. It might be as if we were watching a film of our lives, seeing and feeling the “good and bad” experiences, we had. It warns us, though, that the images and memories might be only projections upon what lies behind experience—that basic, luminous state of emptiness (the blank canvas).

We must recognize that in life as in death, we are always attempting to maintain or control reality by projecting our constructed existence on that blank canvas or on the experience of pure borderless space/emptiness. Only by such recognition can we obtain a peaceful state of mind in life and in our parting from this world.

The Tibetan Book of the Dead (Freemantle & Trungpa, trans., 1974) describes persons being exposed to images and memories from this lifetime, both peaceful and wrathful, when nearing death. We are warned, however, that the images and memories might only be projections upon what lies behind experience—that basic, luminous state of emptiness (the blank canvas).

We must recognize that in life as in death, we are always attempting to maintain or control reality by projecting our constructed existence on the experience of space/emptiness. Only by such recognition can we obtain a peaceful state of mind in life and in our parting from this world.

“O son of noble family, now has the time come for you to seek a path. As soon as your breath stops, what is called the basic luminosity of the first bardo, which your guru has already shown you, will appear to you. This is the dharmata, open and empty like space, luminous void, pure naked mind without centre or circumference, recognize then, and rest in that state, and I too will show you at the same time”. The Tibetan Book of the Dead (Fremantle & Trungpa, trans., 1974, p. 35)

Perhaps salvation from suffering is always available in the here and now by transcending our projections and ego the best we can through the spiritual and rational employment of Buddhist tools and methods. Or perhaps through the help of a therapist, spiritual teacher, parent

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or friend, we can access a primary original state of mind—the “luminous emptiness” found in Buddhist teachings on the maitri mandala. The mandala teaching requires a person to empty their thoughts, projections, emotions, and physical sensations in order to fully experience its meaning.

I also realized that we eventually need to let go of the mandala principle. We need to let such concepts return from where they arose in the first place–emptiness. Are not mandalas a projection upon reality as well?

Conclusion

Observing how the mandala, as a therapeutic tool and therapeutic intervention, has helped alleviate the suffering of my clients is exciting and inspiring. On reflection, I find that anxiety ridden therapist at the very start of his internship worthy of quite a humorous anecdote.

All I needed was to let go and settle into trusting my experiences with Buddhist teachings and believing in my training as a Contemplative Psychotherapist. The mandala principle eventually emerged as an important tool for working with my clients and as a wonderful training method for becoming a Contemplative Psychotherapist.

Now at the end of my journey at Naropa as a therapist, as a practitioner of Buddhist techniques that compliment my spiritual path and therapeutic techniques, I am greatly appreciative of the Buddhist teachers who brought us the experience of a living mandala. Through this teaching, I have learned about a living Buddhist archetype filled with symbolic teachings and real life experiences. The teachings will continue to shape me as a therapist and as a human being.

My study at Naropa has helped, as well, to free me from personal suffering. I can begin to understand how my learning translates to Western psychology, through Jungian techniques, art therapy, mandala therapy, among many other modalities. The mandala principle is universal in

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all cultures. I realize the mandala principle is but one method, one drop in an ocean of universal teachings and techniques that can help alleviate the suffering of others and our own. To discover that others in the fields of Eastern and Western psychology have had similar experiences to mine as therapists and have helped lay the foundation for future therapists is particularly exciting to me.

Finally, in a world full of war, chaos, and suffering, it is inspiring to know that such methods and modalities are accessible to a wide range of human beings. To realize that the archetypes and symbols arising out of human unconsciousness are found in all cultures gives me hope as a therapist and a global citizen. If we as therapists and spiritual practitioners can preserve and translate Tibetan Buddhist teachings for the benefit of future clients, generations, communities, and for the world community at large, then perhaps little by little, person by person, we can help address the universal suffering of humanity.

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References

Arguelles, J. & M. (1972) Mandala. Berkeley, CA: Shambala Publications, Inc.
Campbell, J. (1991)
The power of myth with Bill Moyers. New York, NY: Doubleday.
Evans, J., Shenpen, A., Townsend, P.(2008) Maitri space awareness: Developing the therapist within. In F.Kaklauskas, S. Nimanheminda, & M. Jack (Eds.), Brilliant sanity (pp. 195-211).Colorado Springs, CO: University of the Rockies Press.
Freemantle, F., & Trungpa, C. (trans.) (2000). The Tibetan book of the dead: The great liberationfrom hearing in the bardo by Guru Rinpoche according to Karma Lingpa. Boston, MA:Shambhala.
Jung, C, (1987) Translated by R.F.C. Hull, In H. read, M. Fordham, G. Adler, W. & McGuire(Eds.), The symbolic life. Vol. 18, Princeton University Press. Moacanin, R. (1986) Jung’s psychology and Tibetan Buddhism: Western and eastern paths to the heart. London, England: Wisdom Publications.
Preece, R. (2006) The psychology of Buddhist tantra. New York, NY: Snow Lion. Trungpa, C. (2000) Journey without goal: The tantric wisdom of the buddha. Boston, MA:
Shambhala. Trungpa, C. (1991) Orderly chaos: The mandala principle. Boston, MA: Shambala. Von Franz, M. (1994) Archetypal dimensions of the psyche. Boston, MA: Shambala.

Contemplative Mandala Therapy

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