September 23, I will present at the Too Mad to be True conference. The presentation will only be twenty minutes long, but might be one of my most personal so far.

Here’s the abstract. The final line, about how we need more research on coping mechanisms and strategies that have worked for various madpeople, could have added as well that many people aren’t much helped by medication. (Approximately 1/3 of all psychosis patients are “non-responders”, and many who do respond can’t stand the side effects.)

Two methods for dealing with bedrock loss

A person’s bedrock consists of a large and interconnected cluster of commonsensical beliefs (Wittgenstein 1969). Most people unthinkingly take this cluster for granted. Hume’s sceptic, whose worries about reality dissipates as soon as he leaves his study to play backgammon with his friends, might still experience his bedrock as firm enough, despite thinking his trust in it rationally unjustified (Hume 1739). Madness, however, can erode this very experience (Rhodes and Gipps 2008).

Everyone, not just madpeople, have a natural tendency to trust their perceptions and general impression of things (Maher 1999). Thus, mad experiences will naturally give rise to mad beliefs, unless something interferes with the process. With an intact bedrock, it is possible to engage in reality testing: to argue with oneself and disprove beliefs one would otherwise be inclined to embrace (e.g., Landa et al 2006). However, when said bedrock is lost, there is no longer anything to base arguments and counterevidence on (the author, forthcoming). This is a serious problem for the suffering madperson.

I will outline two different strategies for coping with bedrock loss, which I have both employed in my own struggle with madness.

The first is a Jamesian choice about what to believe. William James (1896) writes that we can choose which belief to embrace when we are presented with two live options, each of which exhibits some attraction, there is insufficient evidence to settle the matter, and the situation is such that we cannot remain neutral. When I first entered psychiatry, this was my situation concerning the options “accept the mad world as real” and “accept the normal world as real”. I had to decide whether to take my prescribed medication, but whether this was a good idea or downright dangerous depended, in turn, on which world was real. Eventually, I choose to trust the normal world and medication.

The second strategy is a more Pyrrhonian one: aiming for a kind of relaxed and accepting suspension of judgment. When my medication did not work anymore, I had to find a way to cope with an ongoing low-level madness (occasionally rising to higher levels). I found that when mad experiences constantly present to me, as a live possibility, the belief that the mad world is real, rejecting this belief requires a kind of ongoing choice, which eventually becomes mentally exhausting. A relaxed suspension of judgment, combined with methods for handling problems that work in both worlds, provides a more fruitful way forward.

There might be further strategies, figured out by other madpeople, for how to deal with bedrock loss. It is important to share and discuss our strategies and skills in this area, since reality testing cannot help the bedrock deprived.

References

Hume, David. 1739-40. A Treatise of Human Nature. Reprinted numerous times, 2004 by Dover Publications Inc.

James, William. 1896. The will to believe. Reprinted 1912 in The will to believe: and other essays in popular philosophy, which was again reprinted 2010 by the Floating Press.

Landa, Yulia, Steven Silverstien, Fred Schwartz, and Adam Savitz. 2006. Group cognitive behavioral therapy for delusions: Helping patients improve reality testing. Journal of contemporary psychotherapy. 36(1): 9-17

Maher, Brendan. 1999. Anomalous experiences in everyday life: its significance for psychopathology. Monist. 82 (4): 547-571.

Rhodes, John and Richard Gipps. 2008. Delusions, Certainty and the Background. Philosophy, Psychiatry & Psychology. 15 (4), 295-310.

Wittgenstein, Ludwig. 1969. On Certainty. Oxford: Basil Blackwell