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Schizophrenia – waking realityprocessed through the dreaming brain
For further information about schizophrenia, psychosis and the dreaming brain read: DreamingReality: How dreaming keeps us sane or can drive us madYou can find out more about psychosis and schizophrenia at the followingMindFields College events:
Psychosis: and positive strategies for recovery workshopOne curious research finding, which has been confirmed by several major studies in five-year follow ups, shows that about 64 per cent of people in third world countries recover fully after a firstschizophrenic breakdown. Yet the comparative figures for the developed world show that onlyabout 18 per cent recover fully.By looking at these findings from the human givens perspective, however, we can deduce somevery significant things from them.For example, in third world countries, there is a much stronger tradition of emotional and familysupport and greater tolerance for personal psychological crisis, which may therefore be less likely tospiral out of control. There are also more low-stress manual and handicraft jobs, and moremeaningful tasks that people need to perform for their subsistence, that facilitate recovery in aclose-knit community.It is much easier, therefore, for people to meet their emotional needs for intimacy, support, statusand validation in these situations, than in the culture we have made for ourselves. Clearly, anenvironment whereemotional needsare met is a potent aid for helping people recover from psychological disorders, even ones as seriously incapacitating as schizophrenia.An additional factor is that, in third world countries, the use of modern neuroleptic drugs to treat psychosis is minimal, whereas in the Western world they are the main treatment offered by the psychiatric profession, despite the strong evidence that these heavily promoted drugs hinder recovery, increase the rate of relapse and have a significant risk of causing severe brain damage.Psychiatric theorists are at a loss to explain schizophrenia. The various simplistic ideas that it wascaused by specific deficiencies in brain chemistry, such as ‘overactive dopamine systems’, have not been supported by research, despite the strident and misleading claims of some drug companies tothe contrary.In our book,Human Givens: A new approach to emotional health and clear thinking, we describedhow the REM brain state, which underlies dreaming, is separate from the process of dreaming anddream content. It is also clear that the healthy brain is organised to keep the dream process separatefrom the waking state, which is why we find it so difficult to remember dreams. We have shownhow the behaviour of a person in a hypnotic state clearly mirrors phenomena of the REM state, suchas muscle paralysis, dissociation, imperviousness to pain, and amnesia for the event after ‘waking’.
 
A psychotic breakdown is almost always preceded by an overload of stress and severe depression ina person’s life, which, as we know, results in excessive REM sleep. We are now convinced that,when people are in psychosis, they are in fact trapped in the REM state, a separate state of consciousness with dreamlike qualities. In other words, schizophrenia is waking reality processedthrough the dreaming brain.To illustrate this, we only have to look at a number of typical schizophrenic behaviours andexperiences and see how they relate to the REM state.Patients in a psychotic state often describe weird relationships with bodily feelings. One said thather legs felt empty: another that her arms didn’t belong to her. This is a well-known REM state phenomenon and is also noted in hypnosis: patients may feel that their bodies are dissolving because, in the dream state, most sensory perceptions about the body are shut out.It is also known that people with schizophrenia are unusually resistant to pain: even more so duringsevere psychotic episodes. One patient jumped out of a second storey window of a hospital, broke both his ankles, and walked to the shops oblivious of the damage he had done — damage thatwould have caused excruciating pain for any person in a normal state of mind.Again, this imperviousness to pain occurs in the REM state while dreaming, as we are cut off fromsensory information. (Anyone who has woken up in agony because a limb, or ear, has been lain onin an unnatural way for a long period during dreaming will recognise this. The pain this causes isonly noticed after you wake up.) It is this fact that is exploited when hypnosis is used for paincontrol or anaesthesia during surgery.Psychotic patients may also talk about hearing voices. In the dream state, which is the province of the right hemisphere of the brain, people are not usually capable of independent thought, the province of the left hemisphere, because the mind is ‘locked’ into the metaphorical script of thedream. But if an individual is trapped in a waking REM state, with waking reality happening aroundthem, there is still likely to be activity in the left hemisphere of the brain.We suggest that, because the REM state operates through metaphor, the only way it could makesense of these independent left brain thoughts would be to create the metaphor of hearing voices, or  being watched, or spied upon by aliens — which easily becomes paranoia.The visual illusions or delusions associated with schizophrenia are totally characteristic of thedream state, which generates hallucinatory realities that we believe in unquestioningly for theduration of the dream. Stage hypnotists make use of this when they put subjects into what is ineffect a psychotic state, and induce them to believe that they are someone else or that non-existent people and objects exist.Rapid eye movements are often seen to occur in psychotic states, which, of course, are the definingsign of the REM state. Psychotic patients also very quickly convert thought into sensory experience,with the result that they can become highly emotional almost instantly. When recalling a distressingmemory, for example, they can be instantly transported right back into that memory and re-experience the emotions connected with it. That phenomenon, too, is a characteristic of the dreamstate, when arousals from the emotional brain trigger a thought pattern, in the cortex, which isimmediately converted into a sensory metaphor — the dream.It is not surprising, then, that psychotic patients not only talk in metaphors but live them out, whichexplains their often bizarre speech and behaviour.The REM state, as we have explained, is in effect a reality generator. It creates all kinds of  perceptions in our dreams, but these are illusory perceptions — vivid metaphors. One psychotic patient actually described herself as “being trapped in the land of illusion”. Indeed, we know from
 
talking to psychotic patients in their saner moments that they readily recognise that they are trappedin a dreaming state.We suggest that we can use this insight to help people make sense of their psychotic experience.Ordinarily, there is ongoing interplay between the left and right hemispheres of the brain.We can help psychotic patients dip out of the dream state into the more analytical side of their  brains by the type of questions we ask them and by talking about what is concerning them; and byconnecting with their metaphors and attempting to change the meanings these have for them. Theycan then start to better understand what is happening to them and spend more time in normal,waking reality.When we have made these sorts of observations about psychosis at MindFields College seminars,they have on occasion been heard by people who themselves have had a psychotic breakdown andrecovered. These people have all responded extremely positively, even thankfully, to thisunderstanding of their experience. (Indeed, we published a remarkable letter, sent to us by someonewho had had a psychotic breakdown and heard of this explanation in our book,Human Givens
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)In our preliminary investigations, using these concepts, we have found that psychotic patients calmdown when they realise there is an explanation for what is happening to them. When calm, the psychotic phenomena become less threatening and less intense. Then we can start doing what manytraditional third world countries seem to do so much better — re-orientating people towards gettingtheir emotional needs met and creating strong support structures for them.Being unhappy, stressed and depressed is a strong predictor of later mental illness. This newunderstanding of what psychosis is, means we can set out practical guidelines for treating it andthereby reduce the prevalence of severe breakdowns and increase the recovery rate dramaticallywhen they do occur.We are saying, then, that extreme stress, anxiety and depression lead to psychosis, where the patient’s brain can no longer distinguish between the metaphorical reality of the dreaming processand the way a brain normally manages to order reality. If we are right, it follows that, if people weretreated more effectively for stress overload and depression by psychotherapists trained to beeffective using the human givens approach, the depression would lift in most cases and notdegenerate into psychosis.Because psychotic people are so hypersensitive to metaphor, health workers need to know whenworking with them how to use metaphorical language that encourages left hemisphere activity.They need to know how to reduce their patients’ arousal levels with calming metaphors.Conversely, they need to consciously avoid metaphors that may remind patients of their  predicament, flipping them back into their right neocortex and psychosis. This is a specialist skillthat can be taught. They also need to consider that their psychotic patients’ metaphorical languageand behaviour represent emotional needs not being met, or that they are attempts to express what itfeels like to process waking reality directly through the REM state.In addition, the skills of occupational therapists need to be given much greater prominence in thetreatment of these patients, who need to connect to reality in disciplined, concrete, purposeful ways: by gardening, cooking, making things, doing craftwork etc. Their daily routine also needs a clear structure and discipline.But, above all, as a society we need to ensure these vulnerable people receive effective psychotherapy more quickly — before stress, anxiety and depression completely overload their dreaming mechanism and too much damage is done. Prevention is the better course wherever 
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