Australian and New Zealand Journal of Family Therapy 2016, 37, 397–399 doi: 10.1002/anzf.1164
Response to Sonja Bar-Am’s Paper: First Episode Psychosis: Magical Realism as a Guide through Liminal Terrain Maggie Carey Narrative Practices, Adelaide, South Australia
Madness or reality? Sane or insane? Real or unreal? What if there was a world we could enter where there was not the need for so sharp a distinction to be drawn between the hard and fast ‘reality’ of symptoms seen in a person’s ‘behaviour,’ and what is happening inside their head? What if we could entertain a therapeutic practice where the ability we all have to imagine and to fantasise, to evoke experiences of other lives and other worlds, and to traffic in uncertainties and ambiguities were drawn upon? In the work we do with those who have or are experiencing psychosis, what if we were able to support them to draw threads of meaning from an otherwise disturbing and even terrifying place? What if we were able engage in therapy as a journey of exploration of the fantastical world of psychosis, and through entering it, be able to find a path to what is significant to the people themselves? In this work of supporting Eva to make sense of a first-episode psychosis, Sonja Bar-Am treads a therapeutic path that enables meaning to emerge for Eva from a place of liminality, and in doing this, Sonja puts Eva at the centre of the process of meaning making. Although it might be seen by some as radical in its willingness to enter the territory of psychosis, the approach taken in this paper is one that is grounded in both theory and practice and above all in ethical reflection. For Sonja to respond to Eva as a person having knowledge about herself, and for Eva to experience being consulted and listened to in regard to what was going on for her, has contributed to significant healing. Recognising and appreciating that psychosis can have links to a reality of what she has experienced in the past makes sense to Eva, and may not have become visible without having had the opportunity to be accompanied in revisiting the psychosis. To get to know and understand the psychotic episode has added to a sense of Eva then being able to have some influence in relation to the psychosis, and having influence (or agency) is at the heart of a Narrative Therapy approach. Practitioners in all domains of the mental health field are increasingly incited to be cautious and to stay with what can be known and evidenced and measured against an objective account of human experience and wellness. The current manual of human psychological unwellness, the Diagnostic and Statistical Manual of Mental Disorders (DSM5) purports to hold the objective reality of psychological experience within its 947 pages. And yet each day there are findings from the ever-expanding realm of neuroscience that tell us that there is so much more going on than what can be seen by reading and measuring symptoms. The wonder of the organisation that is the brain is that it is a system of interconnected relationships of abstract conceptual Address for correspondence:
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experience and bodily sensations that we use to create our experience of our psychological ‘selves’ (Damasio, 1999, 2003). We are all meaning makers. Meaning cannot be objectively ascribed to experience but is rather ongoingly constructed from our past experiences and imagined future experiences and the stories that we have developed about who we are and what life is about (White, 2007). To accept this is to enter the reality of what it is to be human. We are complex creatures and we have this facility to traffic in conceptual thought, and conceptual thought has the capacity to be fluid and ambiguous and at times fantastical and even magical. The work described by Sonja Bar-Am in this paper demonstrates an ability to respond to the fluidity of meaning making and to be in this place of liminality. The work with Eva is clearly reflecting a stance of seeing meaning not as something that is set in cement or that is inherent in an event or experience, but instead, appreciating the fluidity of meanings that can be made from any experience, including psychosis. Re-visiting the conversations between Sonja and Eva connects me to the excitement of the possibilities of engaging in new ways of experiencing and reflecting upon what it is that we are doing in our therapeutic work. The magical realist listening position that is described in this paper is resonant with a position of ‘not knowing’ that is familiar in post-structuralist and collaborative approaches to therapy. It is a position of not being the one who comes to the conversation from a position of knowing and expertise about what is wrong with the client and what they should do. It is grounded in an understanding that only the person themselves can know what meanings they are giving to what they are experiencing, and that we can come to know these meanings through careful and curious enquiry. This is a position of respect and not judging and one of holding that the story being described by Eva has profound meaning for her. It is staying close to the world that she is inhabiting, and accompanying her so that the paths of what is meaningful to Eva can be made visible and she can follow them to what is relevant to her everyday existence. To be able to relate to the psychosis as meaningful is to engage in practices that directly contribute to the person’s own agency and in so doing fulfils the brief of therapy. Increasingly the experiences of people who are clients of the mental health system are speaking out in the hope of informing our practice. Auditory hallucinations have come to be determined by members of the Hearing Voices Network as profoundly meaningful by many Voice Hearers, and there is an expanding volume of research that demonstrates that to have these experiences explored in a non-judgemental way has enabled healing to occur. The approach outlined in this paper, of rendering psychosis meaningful in the person’s own terms, aligns with the role of a narrative therapist to support the person to make sense of their experience. It also aligns with the call from users of the mental health system for us as practitioners to listen to what people who are experiencing psychosis are saying about what is meaningful to them. This opportunity to hear from Eva is a valuable contribution to the field. References Damasio, A. (1999). The Feeling of What Happens. Body and Emotion in the Making of Consciousness. San Diego, CA; New York, NY; London: Harcourt, Inc..
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Damasio, A. (2003). Looking for Spinoza: Joy, Sorrow, and the Feeling Brain. Orlando, FL; London; New York, NY: Harcourt Inc.. Hearing Voices Network. (2016). www.hearing-voices.org/ White, M. (2007). Maps of Narrative Practice. London: WW Norton & Co.
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