Read an Excerpt
but then to go on to deny the reality of the forest
is a more serious matter.
The patient I'm referring to you," said my psychiatrist colleague, "has received several different psychiatric diagnoses, been treated with a variety of psychotropic drugs and been institutionalized a few times, but she continues to be refractory. Her persistence in claiming that she has all sorts of paranormal experiences, suggests that a diagnosis of Schizotypal Personality Disorder, among others, is definitely in order. I'm making this referral outside the medical system because you appear to be knowledgeable about weird beliefs."
Knowledgeable I was, because, in my role as a clinical hypnotherapist, many clients had shared with me their experiences of such things as Extra-Sensory Perception (ESP), PsychoKinesis (PK), past-life recall, apparitions, spirit possession and alien contact. "Weird" and "paranormal," however, were not terms that I used, in that they seemed unnecessarily pejorative. Moreover, I did not apply traditional psychiatric diagnoses to people who had such experiences because I felt that those experiences were not well enough understood to be definitively characterized as evidentiary of psychopathology.
Those whose stock-in-trade is psychiatric diagnoses, however, have plenty of support for their use of the label "Schizotypal Personality Disorder" in such cases. The Diagnostic and Statistical Manual of Mental Disorders-Fourth Edition (DSM-IV), in its list of key diagnostic criteria for Schizotypal Personality Disorder, includes: ideas of reference, unusual perceptual experiences and odd beliefs that are inconsistent with subcultural norms.
Several other criteria need to be met for the diagnosis to be legitimately applied, but a contemporaneous article in the periodical Perceptual and Motor Skills seemed to exemplify the standard way of dealing with such experiences. In much abbreviated form, that article read:
Belief in extra-sensory perception (ESP) is associated with a...bias for right-hemisphere processing. [This is especially] significant when viewed in the light of current theories of hemispheric asymmetries in schizophrenia. Belief in ESP has...been recognized as a variable relevant to schizophrenia, ...especially with respect to positive symptomatology [hallucinations, delusions and thought disorders]...[and] may therefore be construed as a behavioral feature [characteristic of] schizotypy....
[S]ubjects scoring high on scales assessing schizotypy...show an increase in leftward lateral eye movements, a loss of the regular right-ear advantage in dichotic shadowing and a "sinistral shift" in handedness. A pathological overactivation of the right cerebral hemisphere [is]...the neurological basis of positive symptoms in schizophrenic patients. ...[and an] overactivation of the right hemisphere [also appears]...in normal subjects scoring high on scalesassessing positive symptoms of schizophrenia-like thoughts and behaviors.
[The primary] questionnaire [item] used to assess schizotypy reads "do you believe in telepathy?" [S]chizotypal personality disorder is characterized by belief in clairvoyance, telepathy, or "sixth sense" [B]oth pathological (schizophrenic) and institutionalized (parapsychological) belief systems share a common neurological basis [which]comprise[s] a release of right-hemisphere function from left-hemisphere control.
Reproduced with permission of authors and publisher from: Brugger, P., Gamma, A,. Muri, R.., Shäfer, M., & Taylor, K. I. Functional hemispheric asymmetry and belief in ESP; towards a "neuropsychology of belief." Perceptual and Motor Skills, 1993, 77, 1299-1308. ©Perceptual and Motor Skills 1993
The statement made in the last paragraph seemed to be tantamount to defining schizotypy as "belief in ESP"-in other words, having such unconventional beliefs, in and of itself, supposedly constituted a mental disorder. That argument was allegedly bolstered by the neurologically based theory that belief in ESP results from an over-activation of the right cerebral hemisphere. Perhaps that theory was valid and perhaps it wasn't, but the pathologizing nature of the underlying definition of schizotypy seemed inappropriate.
Defining and pathologizing a belief in Extra-Sensory Perception as the primary symptom of a mental disorder appeared to me to be a way of brushing ESP under the rug and precluding, by dismissal, any study of ESP that might lead to a better understanding of it. Perhaps the adherents of this approach were not so much trying to understand ESP as they were trying to debunk it-so as to bolster an entrenched worldview that did not allow for the possible genuineness of such experiences. Maybe those who were doing the diagnosing, pathologizing and debunking believed that by defining ESP experiences as nothing more than symptoms of mental illness -something they believed they understood-they could keep their worldview intact and not have to deal with something they did not understand (and perhaps even feared).
These thoughts were very much on my mind when I first met the referred client. Liza,† as I shall call her, was a young, attractive, intelligent woman with red hair, blue eyes and a very fair complexion. When it came to anomalous (a value-neutral term, meaning "unusual," used instead of the value-laden term "paranormal") experiences, Liza had much to relate. She reported one Near-Death Experience; several experiences of apparitions, spirit guides, past-life recall and Out-Of-Body journeying; and innumerable instances of PsychoKinesis (PK) and Extra-Sensory Perception (ESP) including psychic dreams, clairvoyance, telepathy and precognition. She stated, however, that she had no beliefs, one way or the other, about the objective reality of those experiences. Given that beliefs are central to the Schizotypal Personality Disorder diagnosis, it is small wonder that she presented a conundrum to those who were diagnostically oriented-she had the experiences, but hadn't invested herself in any beliefs about them.
Working with Liza gave me an opportunity to engage in a challenging theoretical exercise-one of determining how many different credible psychiatric diagnoses could be employed to pathologize her experiences and dismiss them as illusory. Her detailed case history included the following highlights:
o Liza often experienced what are generally labeled as "illusions," "delusions," and "hallucinations." The list of anomalous experiences already mentioned, is illustrative.
o She had "odd beliefs" and engaged in "magical thinking." One could argue that, despite her claim to the contrary, had she not believed that such things as ESP and PK were, in some sense, real, she would not have reported experiencing them.
o At times, she felt detached from herself, as if she were an outside observer. She also experienced episodes in which she perceived the external world as strange, distorted, or unreal.
o Occasionally, she spontaneously entered Altered States of Consciousness (ASCs) in which she experienced her mind as being absorbed into mystical realms of unity, light and energy.
o Interpersonally, she was extremely sensitive. Her relationships tended to be intense and unstable. She frequently experienced feelings of isolation and abandonment.
o She exhibited uncertainty about her self-image, her choice of friends and her goals.
o She exhibited a high level of emotionality, experiencing marked mood swings characterized by recurrent depression with occasional episodes of high energy and enthusiasm.
o She often experienced periods of considerable anxiety and worry, over which she had no control.
o She was subject to a variety of sleep disturbances including insomnia, nightmares, lucid dreams and myoclonic jerks (sudden, involuntary muscle contractions).
o At times, her thinking could become disorganized. She had periods of forgetfulness and inattentiveness. Despite her obvious intelligence, she also had difficulty with reading and with mathematics.
o Her speech tended to be digressive and abstract. She was inclined to express concepts in unusual ways and to use words in a novel manner.
o She had a variety of physiological symptoms that occurred episodically. These included fevers, headaches, flu-like symptoms, pains and gastrointestinal problems. She also experienced periods of restlessness, tremulousness and spatial disorientation.
o Unusual bodily sensations were commonplace for her-such things as tingling, numbness, rushes of energy, extremes of heat and cold, "pins and needles," and "electric currents."
o She was unusually sensitive to environmental stimuli, especially lights and sounds; she often experienced sensory synesthesias (the spontaneous association of a sensaton being activitated by external stimuli with another sensation of a different kind); and she appeared to have an exaggerated startle response.
Based on the above (and other) information, detailed research in the DSM-IV revealed that eleven psychiatric diagnoses in six different categories were excellent fits. They were:
o Personality Disorders: (1) Schizotypal Personality Disorder and (2) Borderline Personality Disorder;
o Dissociative Disorders: (3) Dissociative Disorder Not Otherwise Specified;
o Mood Disorders: (4) Bipolar II Disorder (With Rapid Cycling);
o Anxiety Disorders: (5) Posttraumatic Stress Disorder and (6) Generalized Anxiety Disorder;
o Disorders Usually First Diagnosed in Childhood: (7) Reading Disorder, (8) Mathematics Disorder and (9) Attention Deficit/Hyperactivity Disorder (Predominantly Inattentive Type);
o Somatoform Disorders: (10) Somatization Disorder and (11) Conversion Disorder.
The conventional biomedical model considers each of these diagnoses to be a separate and distinct psychiatric disorder. Given their rates of occurrence in the general population, Liza's degree of comorbidity was extremely unusual. The probability of these eleven disorders occurring simultaneously in one individual is less than 2.3 x 10-17. To put it another way, the odds are ten thousand to one against there being a single person on the entire planet having all eleven disorders-and yet I knew a couple of other people whose "symptomatology" was quite similar to Liza's.
Liza had also been diagnosed as having a host of chronic general medical conditions including: Systemic Lupus Erythematosus, Hypothyroidism, Chronic Fatigue Syndrome, Fibromyalgia, Chronic Epstein-Barr Virus, Lyme disease, recurrent Bronchitis/Pneumonia and recurrent Streptococcus infections. Collectively, these eight different medical diagnoses were highly suggestive of a severely compromised immune system.
Eleven psychiatric diagnoses and eight chronic general medical diagnoses-Liza clearly had more than her share of problems, but statistically it was highly improbable that all of the diagnoses could be correct. Conversely, it also seemed absurd to select one-or two, or even three-of these diagnoses as the explanation for what was going on with her. The evidence definitely suggested the appropriateness of directing further inquiries toward finding a more encompassing condition or syndrome that could truly explain-not just explain away-most, if not all, of her symptoms.