With psychosis, the therapist can often
deduce a compass interpretation from the structure and function by reasoning
backwards from the symptoms of the psychosis itself to the Self Compass. Noting
whether the distinctive features include anxiety, depression, paranoia, violence,
withdrawal, grandiosity, or obsessive-compulsive symptoms helps you find which
compass points are over-functioning and which ones are under-functioning. These
observations help you form a treatment strategy of growth stretches into unused
compass points and better modulation of exaggerated compass points.
The thickest ring in the Compass
Model diagram indicates the severe constriction and dissociation from reality
that psychosis brings. This “ring of fear” represents an episodic or chronic
crisis of personality sufficiently acute that the spiritual core succumbs
almost entirely to anxiety, depression, schizophrenia, bipolar mood swings, or
other Axis I syndromes. Not only the core, or
nucleus of the self, but one’s whole human nature—Mind and Heart, Body and
Spirit—are uniformly disturbed.
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| How The Self Compass Explains Psychosis |
I once worked with a young woman who
had spent three years in a psychiatric ward. Her primary diagnosis during that
time was paranoid schizophrenia. The doctors had given her little hope of
recovery because of the recalcitrance of the symptoms and her determination to
outsmart everyone who treated her. Mary’s presenting façade when she came to
the university counseling center where I worked was that of a demure,
well-dressed, and compliant person. I immediately recognized the dependent
Pleaser pattern at work. But when she described the auditory and visual hallucinations
of a demonic figure named Mary Lou, who would appear in mirrors and scream
vulgar names and vicious threats at her, I recognized the presence of the
paranoid Arguer and antisocial Rule-breaker patterns.
By the second month of therapy I had
conveyed to Mary that her fragmented Self Compass had split into warring
factions. Mary Lou represented her anger, assertion, and strength of identity,
while Mary (her presenting self) constituted her love, vulnerability, and many
fears.
For the next several months I took
special interest in Mary Lou, the wild and aggressive dimension of her personality.
I encouraged Mary to pay attention to the hallucinations so we could invite
Mary Lou into a creative dialogue. This terrified her at first, but because I
wasn’t afraid of Mary Lou, she gradually developed curiosity instead of fear
toward this alien part of herself. A turning point came in the tenth month when
she spontaneously told me, “I think I get it now. Mary is the part of me that
wants to please everybody because my dad is a senator and that’s how he brought
me up. But Mary Lou wants to give everyone the finger and say, ‘Screw you! I
want to be a real person!’”
I commended her for this brilliant
deduction, and was even more fascinated by what she said next: “You know what?
I don’t think I need Mary Lou to fight the world for me anymore. I can tell
people if I disagree with them, or I can agree with them if I choose. I don’t
need to split myself in half any longer.”
Over the next two months the
auditory and visual hallucinations faded away as Mary’s sense of integrated
identity and genuine connection to people increased. Her Strength and Weakness
compass points gave her a relaxed confidence, and the integration of Love and
Assertion balanced caring for others with standing up to them when needed. When
Mary stopped by to visit me several years later, I felt amazed at the maturity
and stability of this young woman, and was pleased that she gave me permission
to tell her story in the hope that it might help others.
People catastrophically stuck on the
Love compass point become especially
vulnerable to major depression and suicidal ideation. They also are prone to
develop generalized anxiety and even the kind of disorganized schizophrenia
that Mary exhibited. These symptoms often arise as a consequence of an
irreparable loss of a significant other upon whom they have profoundly
depended. In Mary’s case, the event that precipitated her psychotic break at
the age of eighteen was the loss of boyfriend who, though he had severely abused
her, was the only source of love she had ever known. Without external security,
dependent-fixated individuals can regress into infantile dependency, coiling
into a fetal position, or histrionically pouting, giggling, and seducing in
attempts to capture people’s attention and approval, all of which Mary had done
in the psychiatric hospital.
Persons severely stuck on the Assertion compass point have learned to
cope with threat by acting out aggressively. They can decompensate into
paranoid schizophrenia, both discharging anger and projecting it onto others.
Now they vent their hostility through wild rages and explosive assaults (antisocial),
or in smaller doses of being secretive, touchy, and irritable (paranoid).
Because of Mary’s split personality, she had exhibited many of these traits as
well.
Schizophrenia, particularly
catatonic withdrawal, is the psychosis that arises from extreme rigidity on the
Weakness compass point, creating a
world inhabited solely by one’s self. Mounting evidence suggests the
identification of avoidant, schizoid, and schizotypal personality patterns as
schizophrenia-spectrum disorders. In compass terms, it is the isolating effect
of social anhedonia (interpersonal aversion) in addition to genetic factors
that renders individuals vulnerable to the onset of schizophrenia.
The Strength compass point manifests psychosis as the manic striving
often linked to bipolar syndromes. In the manic phase, narcissists seek an
exalted and pompous state of euphoric excitement, as though striving to
recapture the glory of an earlier time in which they knew they were admired and
invincible.
Bipolar patients exhibit narcissistic pattern characteristics while in the
manic phase. On the other hand, compulsives are more prone to develop
control-oriented symptoms like obsessive-compulsive syndromes that strive to
manage anxiety through rituals, counting, tics, hoarding, obsessive doubting,
compulsive thoughts, and insisting on cleanliness and order.
While medical compliance to
pharmacological treatment contributes to a counselee’s recovery from psychosis,
the psychiatric patient can benefit from a compass overview of the personality
pattern(s) they adopted earlier in life, and what they can do now to expand
their personality toward the health psychology embedded in the Self Compass.
Redemptive hope, then, provides a vision for transforming chronic suffering
into the wisdom and balance of a renewed life. The psychiatric patient has as
much right to this prospect as any person, and needs this hope to make forward
progress.
