Reflections on 25,000 Hours of Being With People in Extreme States

I’ve been face to face with people in extreme states as a caregiver for over 25,000 hours, beginning in 1980 until now.

I began that journey serving at a traditional private psychiatric hospital for a year and then on to a medication and diagnosis-free extreme state sanctuary. I also worked in community clinics, and on an outreach team on the streets with people in extreme states, all the while at a large public sector mental health system for 28 years. I’ve always had a private practice where I have also specialized in serving people of all ages in extreme states.

The central research finding of my doctoral research follow-up study on Diabasis House¹ — John Weir Perry’s Jungian medication-free extreme state sanctuary — found that there is a discernible and very helpful “way” of being with people in extreme states that basically involves caregivers being openhearted and receptively compassionate while at the same time not imposing the pathologizing approach of the disease model of psychiatry.

In this essay I’ll try and share how that alternative  “way” of being with people in extreme states has expressed itself in my many hours with them, as I’ve personally attempted to practice my own idiosyncratic form of that “way” for almost 40 years.

I still spend time every week with people in extreme states and in all of the myriad forms of human emotional and spiritual/soul-depth suffering.

But I was surprised at that large 25,000 hour figure adding up when I made the estimate recently, as I prepared to lead a workshop called  “Compassionately Being With People in Extreme States.” I’ve often given that workshop during the past 20 years at places like Esalen Institute, graduate schools and for Peer Counselor training groups.

As a dissident Jungian/Laingian oriented therapist with a history of my own harrowing year of being in a childhood trauma-induced and archetypal-fueled extreme state in the 1960’s as a young man, I have never been able to understand myself or the people I was with who were in extreme states, or relate to them based on the theory and practice of the psychiatric disease model of human emotional suffering.

In some ways it might have been easier on me if I had been able to adopt that dominant paradigm that claims to know the causation of emotional and spiritual/soul-depth suffering by reducing it all down to bio-genetic psychopathology. I could have been more shielded and justifiably detached from encountering the intense emotional pain, and the often uncanny archetypal, psychic, spiritual/paranormal energies and presences that I instead opened my heart and psyche up to receiving. My heart opened up both unbidden and with devoted intention.

Tragically the psychiatric disease model approach creates and insures an inherently distancing and dehumanizing clinical response to the complex, multi-dimensional human emotional, archetypal and spiritual suffering that happens during extreme states — or during any of the kinds of emotional suffering that we all might experience at times.

There are good reasons why I never have viewed other people or myself through that objectifying, pathologizing lens.

First off, I can’t do it because I believe the psychiatric disease model is not valid or true, but moreover, the imposition of it constitutes an enormous, injurious failure of its own proclaimed mission. While that model claims the publicly sanctioned mission to alleviate the emotional suffering of everyone in society, it has enormously failed to deliver on that obligation. Instead it has harmed countless people, as I’ve reported her, as part of the chorus on madinamerica.com since 2012. In the name of professional medical assistance, countless lives have been dramatically shortened and lost, sometimes 25 years earlier than the national average. Human rights abuses such as ECT, forced treatment and medicating children have been carried out for many decades and continue to be inflicted every day.

Also, a huge reason why the injurious psychiatric disease model is so starkly exposed is because it stands out against the backdrop of irrefutable evidence about being with people in extreme states from the Agnews Project, Diabasis House, I-Ward, Soteria, Laing’s Kingsley Hall, Windhorse, and Open Dialogue.  All of those alternative services embrace a humanistic, compassionate way of being with people that also takes into account the impacts of the toxic social, economic and stratified matrix of the alienating and unjust social Darwinism surrounding us all.

Those alternative services clearly have supported the healing of the trauma that plays such a central role in the emotional and spiritual suffering that happens during extreme states.

But what I also want to share in this brief essay is something I’ve long kept to myself that I finally believe needs sharing.

It’s a confession of sorts, about me serving as a licensed mental health professional for almost 40 years while not truly being one at heart. I’m not an imposter, but when the door closes and I’m alone with someone who has come to me in an extreme state or other emotional pain, I never feel like I did when I was an army medic and felt sure about what my very defined scope of medical practice was in treating physical pain and injury.

In fact, before I sit down together with someone in emotional pain, I’m always anxious before we begin, because I’m always concerned that I won’t know what to do or say to be helpful.

I’ve never been able to internally adopt the role of being a trained mental health professional with an established treatment orientation that relies on a defined set of familiar, often codified interventions and “best practice” modalities.

I believe that taking on that kind of usual professional identity would have unavoidable negative consequences for me and the people I see.

Instead, when I’m with someone in an extreme state or other emotional pain who I want to be with to comfort and listen to, it feels to me just like being with a friend or family member who reaches out to me in their emotional pain. I’ve never been able to not feel that kind of very personal caring for the person I’m with who is suffering. Even when I’m with people who start off being angry at me, I just feel like I’m with a friend who is angry with me.

It’s strange but at 73 years now, I feel that same way more and more, as I listen intently to the unfolding story that someone in emotional suffering shares with me. I feel a personal caring for them in the face of the painful emerging emotional feelings and mysterious archetypal and psychic energies that find their way into words, imagery and dreams. I don’t want them to have to be alone during their suffering.

In writing this, I imagined it almost feels to me something like we’re two young friends who have ridden our bikes to a quiet place by the river and my friend turns to tell me about awful things happening at home — and they cry or pound their fists and yell in anger while I just sit there and wonder what to say or do, and realize that just being quiet is okay.

Yesterday I sat with a “client” like that in their 60’s, tears running down my cheeks freely as they haltingly let their story of grief and despair well up and overflow in their tears and naked anguished words.

But in that raw outpouring, for all of their sophistication and mature age, there emerged the childlike camaraderie between us of friends together by the river when truths bigger than our understanding slipped out into the world we shared of trust and emerging emotional truth.

So in conclusion I’ll say that it feels strangely paradoxical that I’d experience such a young inner feeling of tenderhearted kindness when with another’s emotional suffering after all these years of witnessing and opening myself up to the often horrific outpourings of a great many people’s experiences of their abuse, even sustained torture. Their abject inescapable terror, unfathomable grief and loss, heartbreaking betrayal, suicidal hopelessness, murderous rage — all of that plus being with both grown people and innocent boys and girls while hearing of them being stabbed, shot and beaten, of them wanting to show me their ragged scars and me seeing those scars, of being told of them being victims of incest and rape, addictions to every single possible drug. All of that plus hearing of the soul-killing lost years of people trapped in the psychiatric system where their very identity was stripped from them and replaced with a label and an endless supply of emotion-numbing drugs.

It seems paradoxical to me that I haven’t retreated into a world-weary despair and the isolation of emotional burnout.

How can the shy and gentle childlike kindness deep in our souls survive in any of us, I often wonder?

But I see in myself and others that it does survive, and possibly can live alongside the awareness of the tangible heart of darkness horrors that often traumatize our lives.

It also seems there is a growing darkness of the human spirit moving in the world. But in truth there is a growing power of merciful love on the move too.

I’ll meet you by the riverside, my friend.