[Access article in PDF]
Psychosis Good and Bad:
Values-Based Practice and the Distinction Between Pathological and Nonpathological Forms of Psychotic Experience
IN TWO PAPERS in this issue of Philosophy, Psychiatry, and Psychology, Marek Marzanski and Mark Bratton (2002) and Caroline Brett (2002) develop important critiques, from the perspectives respectively of Christian theology and Eastern philosophy, of our 1997 analysis of the distinction between pathological and nonpathological forms of psychotic experience (Jackson and Fulford 1997).
In this response, we briefly summarize the main points from our 1997 analysis; we consider, separately, the important although very different challenges to that analysis from the perspectives of our two critics; and we briefly indicate the main lines of recent developments in policy, practice, and research in mental health as they relate to this important area of human experience.
The Jackson and Fulford (1997) Analysis
In our 1997 paper, we presented three case studies from a larger series (Jackson 1991, 1997, 2001) selected with the express aim of bringing into focus the conceptual difficulties that arise at the borderline between psychotic illness and what we called benign spiritual experience. On the basis of these case studies we argued that
We then proposed a cognitive problem-solving model of psychotic experiences. This model suggests that such experiences can be a normal and adaptive psychological response to existential crises, such as loss of meaning or purpose in life, coming to terms with death or bereavement, and so on (Batson and Ventis 1982; Jackson, 1991, 1997, 2001). The model is consistent with a subsequent position paper published by the British Psychological Society arguing the case for a psychological formulation of psychotic experiences and cognitive-behavioural methods in their management (2000).
In the case of nonpathological psychotic experience, the psychotic elements of the experience promote a paradigm shift in the individual's underlying assumptions, which effectively resolves their impasse and allows them to move forward. This is normally a self-limiting process, in that when the individual is able to utilize their insight, it acts to resolve the stress which triggered it. In pathological psychosis, this process fails for various possible reasons, which were not explored in any depth in that paper (but see Jackson 2001 for a more detailed discussion).
The Challenge From Marzanski and Bratton
Marek Marzanski and Mark Bratton reexamine the questions raised by our cases from a Christian theological perspective (Marzanski and Bratton 2002). They suggest a theologically based definition of spiritual experience according to which the criteria for "genuine" experience concerns its context within the development of the individual's religious faith. In Bratton and Marzanski's account, these criteria are based on a Christian value system.
They present three cases of their own, which, in contrast to the three cases in our 1997 paper, vividly illustrate how phenomena that may be valued negatively from a medical perspective (i.e., as defined by us in terms of their consequences for action), may, at one and the same time, be valued positively from a religious perspective (i.e., in terms of their consequences for the...