What is ‘psychopathology’ from a transpersonal or psychospiritual perspective, and how might that influence ways of working in the counselling room?

What is psychopathology?! Definitions online are largely from the medical model and imply a departure from a perceived ‘normal’. For example, ‘abnormal mental states’ (Schultze-Lutter, et al. 2018) leading to ‘behavioural dysfunction’ (ND1). Attempts to define psychopathology have brought about a splitting based on subjective notions of what ‘normal’ and ‘abnormal’ look like. Already, questions surface from this: if, in a postmodern society it is true that there are many truths, not just one objective truth then there may be as many definitions of ‘normal’ as there are people. What if we posit the ‘ultimate’ human psyche? There are difficulties here too, as Jordan Peterson states, “Everything looks terrible when you compare it to the best thing you can possibly imagine.” (Bite-sized philosophy, 2017). 

 

            Alternatively, we could derive a definition of psychopathology from its Greek roots: ‘psyche’ meaning ‘soul;’ pathos meaning ‘suffering’ (Rudd, 2013:2). This evokes the transpersonal perspective. Dargert explains further that ‘soul-suffering’ symptoms are the ‘voice of unconscious processes which are announcing their presence to the consciousness of the client’ (2016:30), contrary to the medical model where symptoms are something to remove ‘quickly and cost effectively’ (Ibid:29). So, a transpersonal definition of psychopathology could be: the voice of the unconscious as expressed through suffering. A ‘transpersonal’ perspective also means looking beyond (trans) one person’s psyche (hereafter used interchangeably with ‘soul’): ‘the psyche is not only a personal but a world problem.’ (Jung, 1995:153).

 

            The difficulty with the transpersonal perspective, and with talking about soul, is that the connection with psychopathology isn’t one that’s easily related to, largely due to the consensually agreed ‘conquest by scientific method’ (Murphy and Klüver, 1999:XV), and its ‘concrete facts and their historical background’ (Jung, 1995:91). Certainly, I have had many clients who have disregarded any allusion to the transpersonal or ‘soul’, brushing it aside absent-mindedly like a fruit-fly. Culturally, in the West, we have become comfortable with what the medical model offers: an assertive stance and resolution, which can be seen in other domains too. Films, for example, often conclude with happy endings, and music frequently reaches its ‘resolution’ with an authentic cadence. What the transpersonal offers - learning through suffering - was anathema to my clients; suffering was to be got rid of, not invited in. But, as Houston describes, ‘Soulmaking requires that you die to one story to be reborn to a larger one’ (1997:104).  In other words, suffering is necessary for soul expansion. She goes on:

            

          …the process and practice of soulmaking…begins with the wounding of the psyche by the Larger Story…In this wounding, the psyche is opened up and new questions begin to be asked about who we are in our depths. (Ibid.)

 

‘Wounding’ here echoes psychosynthesis’ ‘primal wounding’, where ‘our supportive mileau…does not see us as we truly are, and instead forces us to become the objects of its own purposes’ (Firman and Gila, 1999:1).  Combining these perspectives helps us see not only the inevitability of primal wounding, but the necessity of ongoing wounding for soul expansion; suffering is simultaneously the cause, symptom and transformational agent to a deeper relationship with soul.  From this transpersonal perspective, my definition of psychopathology would be ‘a benevolent invasion’: as natural as the explosion that precipitated the formation of our universe; the inferno that germinates the eucalyptus seed; the frost that sweetens the parsnips. 

 

            But often the invasion is all that is felt, as work with one client illustrates. Diagnosed with post-natal depression, she presented with anxiety, centring around fears of another decent into the episodic depression. One day, she noticed the colouring pencils and paper I had in the room. I asked if drawing was something she enjoyed; her affirmative answer prompted me to suggest she illustrate the cycle of her anxious and depressive episodes. Once drawn, I invited her to describe the cycle, to help me understand her perception of it. She described her “overwhelming” anxiety as an experience of “waking up” to the reality of her new existence as a mother, asking herself “Who am I now?” Then, an “unbearable” sense of everything “crashing down” would ensue before a state of numbness. I asked her to describe the experience when everything ‘crashed down’. She described feeling blind to everything else; shut down, like she has to “play dead – lie on the bed in the dark and do nothing”. Echoing Houston’s words, she was describing dying to one story, an old story her psyche no longer needed. My way of working transpersonally with her has been to explore this ‘dying’ whilst looking for the ‘larger story’ her psyche is working towards. This has presented challenges, of course, because, initially at least, she wanted to get rid of the symptoms rather than explore them. 

 

            ‘Getting rid’ of symptoms, and an expectation of return to a previous state is part of the medical model’s legacy. This is, generally speaking, a process by which a doctor evaluates someone who has come to them with a complaint that they, usually, wish to have diagnosed and treated. Psychiatrist R.D. Laing elucidates:

 

One listens to the complaint, takes a history, does an examination…arrives at a diagnosis, makes a prognosis if one can, and having done all that, one prescribes treatment…. Diagnosis includes aetiology, where aetiology is thought to be known…In all cases it determines treatment. (1999:39)

 

This was originally a general medicine model, but Laing feels the theory behind the work he does as a psychiatrist ‘is based upon, or heavily influenced by, a medical model derived from psychiatry that psychiatry has itself derived from general medicine.’ (Ibid:24).

 

            Describing the models already invites comparison, largely because, as the quote above suggests, they are interrelated; just as the psyche isn’t ringfenced within the individual, it is always in relationship with external elements.  Laing explains: ‘As soon as one is presented with any situation one is interacting with elements of it, and hence, willy-nilly intervening in one way or another.’ (Ibid:40) In other words, the relationship changes the field the minute contact begins. And it changes the therapist as well as the client:

 

Our intervention is already beginning to change us, as well as the situation. A reciprocal relationship has begun. The doctor and the still predominantly medically oriented psychiatrist use a non-reciprocal static model. (Ibid:40)

 

For medical doctors and psychiatrists, the problem remains within the individual; anything beyond the person (trans-personal) isn’t considered part of the work. You might even say anything beyond the symptom isn’t considered part of the work. It’s not that the transpersonal isn’t happening, it’s just not consciously included.

 

In contrast, the medical model is considered part of the work in transpersonal models such as psychosynthesis.  Firman and Gila’s theory of ‘primal wounding’, mentioned above, can be directly related to the ‘cause’ and ‘effect’ stages of the medical model. Based on the cause and effect, a diagnosis/hypothesis is formed from which a working strategy can be developed. This is where transpersonal psychology departs from ‘medicine’s demand to fight against’ (Dargert, 2016:46) the psychopathology.  Psychosynthesis adds the dimension of bi-focal vision, where the ‘counsellor perceives the client as a Being who has a purpose in life and challenges and obstacles to meet in order to fulfil that purpose.’ (Whitmore, 2014:78) ‘In order’ are the pivotal words here; the psychopathological symptom, dying to an old story, is to be honoured, not fought against. 

 

            Returning to my client above, working bi-focally means integrating some of the medical model into the transpersonal approach. I asked her about the anxiety she’d been diagnosed with, trying to understand her current methods to ‘get rid’ of it. She said she would obsessively plan. I asked her if this was new to her. She named the OCD she developed during sexual abuse experienced as a child, and the planning she did to try to stop the “unbearability of unplanned things”- the attacks. So, in medical model terms, I hypothesised a cause (anxiety stemming from the abuse) and an effect (the obsessive planning), which she still experiences, even though the abuse is long over. I asked her if she could relate to this hypothesis. Her response was a tearful agreement; she said it was a link she had not made, and it helped her to understand herself a little better. We could now try to ‘treat’ the anxiety somehow, to get rid of it, but this approach would miss a crucial aspect of her experience. Bi-focal vision means giving equal attention to her question, “Who am I now?” and the emergence of her ‘larger story’. With this in mind, I asked her to revisit the moment where she ‘plays dead’, to explore what this soul-suffering might be trying to tell her. Describing it again, she remembered something new: the enforced cessation of activity following the ‘crashing down’ – numbness of body, feelings and mind – brought with it a momentary sense of wellbeing. I asked what this might mean for her. After consideration, she pronounced a need for more time where she ‘plays dead’, but where she chooses it, rather than having it forced on her. Had we stuck with the medical model approach, identifying symptoms and their cause, labelling them diagnostically, then attempting to silence them, we would have missed the potential for growth - the question, “Who am I becoming through these ‘challenges and obstacles’?” that bi-focal vision invites.

 

             One implication for clients of the medical model approach stems from diagnostic labelling based on subjective assessments and diagnoses. For my client, ‘depression’ had no value, apart from being something to blame for things that felt wrong in family life, and hand over to others to ‘solve’. Laing considers labelling to be detrimental in psychopathology, particularly in the light of patients’ relationships. He suggests it ‘is not merely a medical diagnosis. It is a social prescription.’ (1999:42) From then on, relationships reformulate around the diagnosis of the individual, who, Laing believes, will often have been a scapegoat for the psychopathologies of the others. It’s a shocking thought that some diagnoses might be unconscious coercive practices; gaslighting endorsed by the medical profession. It gives weight to Jung’s belief that it is every human beings’ moral and ethical responsibility to examine his or her unconscious (1995:218).

 

            This need to label suggests to me a need for control. But what is the medical model attempting to control? To my mind, fundamentally, it attempts to control mortality. Death, however, is “not some kind of medical disaster, it’s an inevitable part of life” (Sheldrake, 2021). In fact, as we have seen, in terms of psychopathology, dying is a necessary part of the process of ‘soul-making’. So, in attempting to silence symptoms and rewind to a previous state, the medical model impedes natural psychological growth. Sheldrake talks about the medical model having a somewhat unjustifiable orthodoxy: “What we’ve had through the triumphs of mechanistic medicine is the assumption that medicine’s potentially all powerful” (Ibid). But the notion of it being potentially ‘all powerful’ means if the medical model treatment fails, it can seem as though everything is lost. 

 

            The transpersonal approach can be the medical model in disguise however, in an unconscious process where the soul’s emerging purpose becomes the ‘fix’ the therapist is prescribing. I fell into this trap myself. One of my clients, previously a nurse immersed in the medical model for over thirty years, was looking forward to beginning anti-depressant medication which she saw as a “crutch” that would “flick the switch” and take her out of depression. She was expecting the combined ‘treatment’ of medication and me to “fix” her. When the antidepressants failed, I thought, “now I will be her ‘crutch’. All we need to do is unearth her soul’s emerging purpose and work towards fulfilling it.” I had become enmeshed, caught in her story that only the medical model exists, and that she needed to be elevated from her symptoms as expediently as possible. I had fallen into ‘a psychology without depths, whose deep words remain shallow because transcendence is its aim.’ (Hillman, 1992:64) The humility required to accept this in myself was part of my own soul-suffering. I had to accept that I had been unconscious of the countertransference (my responses to the client’s material) (Casement, 1988). At the same time as I began to acknowledge it inwardly, my client began to speak of her soul sorrows, discovering for herself what I had momentarily forgotten.  As well as showing how the transpersonal model can ‘catch’ the medical model fantasy, this example illustrates Laing’s point about therapy changing the therapist as well as the client. It is a shared experience of soul that doesn’t need to be spoken to be felt. 

            

In conclusion, my definition of transpersonal psychopathology stems from etymology: soul-suffering as the voice of the unconscious bringing something to consciousness in the only way it knows how – a benevolent invasion. But when we hand over our suffering for someone else to solve, as the medical model offers, not only do we disempower ourselves, we disable a natural growth process.

 

What the medical model has given us is a logical way of approaching psychopathology. But logic can only go so far. A more in-depth look at the etymology of the word ‘psyche’ expands its meaning, for not only does it translate to ‘soul’, but also to ‘breath’ and ‘butterfly’ (Dargert, 2016); it is not something you can easily catch and pin down, and once you think you have, it is no longer living. In other words, soul-suffering is metamorphosing, but we destroy the chance for soul to transform us when we label its voices in order to silence them. As Mary Oliver depicts in her poem, ‘facts’ and ‘certainties’ aren’t comfortable bedfellows with possibilities and mystery (2004:5), so it’s unsurprising that the medical model has barred its doors against the transpersonal. But as soul is ‘in the everyday lives of us all’ the medical model cannot escape its benevolent invasion, seen in the outcomes of clinical trials where the placebo effect is often as effective as the treatment (Dargert, 2016). The transformative power of belief is a transpersonal phenomenon. The implications of this when working with clients is to understand that ‘gaslighting’ can work in the opposite direction. With bi-focal vision, when ‘we meet them in an act of faith, regarding them as authentic, real, and valuable as they are’(Hillman, 1992:75) clients may grow to believe it of themselves. 

 

            References

 

Bite-sized philosophy (2017) Jordan Peterson - Mental Illness, a Social Construct? – Foucault. Available at: https://www.youtube.com/watch?v=wxvljjNxI-E (Accessed: 29th April 2022).

 

Author unknown (ND1) Definition of Psychopathology. Available at: https://www.merriam-webster.com/dictionary/psychopathology (Accessed: 29th April 2022).

 

Casement, P. (1988) On Learning from the Patient. London: Routledge. 

 

Dargert, G. (2016) The Snake in the Clinic. London: Karnac.

 

Firman, J. & Gila, A. (1997) The Primal Wound: A Transpersonal View of Trauma, Addiction, and Growth. Albany, NY: State Univ. of New York Press.

 

Frater, A. (2021) Waking Dreams: Imagination in Psychotherapy and Everyday Life. Glasgow: TransPersonal Press. 

 

Hillman, J. (1992) Re-visioning Psychology. New York: Harper Perennial.

 

Houston, J. (1997) The Search for the Beloved: Journeys in Mythology and Sacred Psychology. New York: J.P. Tarcher/Putnam.

 

Jung, C.G. (1995) Memories, Dreams, Reflections. London: Fontana Press.

 

Laing, R.D. (1999) The Politics of the Family, and other essays. [PDF] London: Routledge. Available at: https://b-ok.cc/book/785492/cd1cee (Downloaded: 20th February 2022). 

 

Moore, T. (2005) Dark Nights of the Soul: A Guide to Finding your Way Through Life’s Ordeals. [ePub] New York: Gotham Books. Available at: https://b-ok.cc/book/2820953/503d8b (Downloaded: 23th February 2022).

 

Murphy, G. & Klüver, H. (1999) An Historical Introduction to Modern Psychology. [PDF] London: Routledge. (First published 1928) Available at: https://api.taylorfrancis.com/content/books/mono/download?identifierName=doi&identifierValue=10.4324/9781315009964&type=googlepdf (Downloaded: 8th May 2022). 

 

Oliver, M. (2004) Why I Wake Early. Boston: Beacon Press.

 

‌Rudd, B. (2013) ‘Understanding Psychopathology’ from Introducing Psychopathology. Available at: https://www.sagepub.com/sites/default/files/upm-binaries/58633_Rudd.pdf (Downloaded: 7th May 2022).

 

Schultze-Lutter, F., Schmidt, S. J., & Theodoridou, A. (2018) Psychopathology—a Precision Tool in Need of Re-sharpening. Available at: https://www.frontiersin.org/articles/10.3389/fpsyt.2018.00446/full (Accessed: 9th May 2022)

 

Sheldrake, R. and Vernon, M. (2021) ‘Matters of Life and Death’ from The Sheldrake Vernon Dialogues. Apple Podcasts. (Accessed: 22nd March 2022)

 

Whitmore, D. (2014) Psychosynthesis Counselling in Action. 4th edition. London: Sage.