The Madness of Carl Jung: a dangerous method

Carl Jung was one of Freud’s earliest supporters and in many respects rivaled him in terms of influence. Some of their interactions provide the basis for the story behind the book and recent movie – A Dangerous Method. Just as Freud did, he famously analyzed himself and while doing so apparently became psychotic. His psychosis was however seen as a way to sanity – a forerunner of 1960s thinking about psychosis. It was also viewed in semi-spiritual terms.

This was all of interest when we came to explore another condition we found in the North Wales hospital records, a condition that made us keenly aware we were playing with fire. Against the background of a major strike in the quarries and mines of North Wales, in the autumn of 1904 and through to the summer of 1905, a preacher called Evan Roberts toured Wales stimulating the Great Revival – and stimulating into madness some of those who gathered in North Wales to hear him preach. There was a spike of admissions to the Asylum for psychoses that looked like schizophrenia or bipolar disorder (see Linden et al 2010).

Fire from Heaven

There is a well-known condition – Jerusalem syndrome, which affects Christians who go to the Holy Land. They go mad, but no-one knows what happens to them because they are sent home to the 4 corners of the globe. But we know what happened in 1905 because our patients had nowhere else to go. What happened was that they recovered and did not become unwell again. Today if recognized, these conditions can be called acute and transient psychoses in Europe and brief reactive psychoses in North America.

If recognized. Today a schizophreniform psychosis is likely to lead to a diagnosis of schizophrenia and treatment with antipsychotics for life. Or if the admission has a manic flavor, North American clinicians are obliged by DSM to diagnose a bipolar disorder, which is a sentence to a life of “mood-stabilizers”.

We ran into trouble with our article on religious psychoses – there were many in North Wales who read the research as critical of religion. Stay away we were warned darkly. This caught us completely by surprise. At the time the paper was being written, Lehman’s Brothers was collapsing and the threat of a Great Depression was very real. We saw the religious fervor of 1905, allied to the stress of a general strike, as producing the kind of conditions that any society can throw up from time to time, and that any of us can generate in our personal lives.

these are the patients who recover

One of currently fashionable ideas is Recovery. We are all supposed to have a recovery orientation. And of course it is helpful always to see the person rather than just the illness, but repeating this mantra is often aspirational rather than useful. These are the patients with psychoses who recover – who need to be recognized.

An important message from the historical record is that these patients recover without drug treatment. The worry today is that they will be slapped on medication and will be unable to get off it because of physical dependence or unhelpful advice from the mental health services that they have schizophrenia or bipolar disorder and need to remain on treatment for life.

These are the patients who now often give clinicians the impression that treatments work well, when in fact they were likely to recover anyway, and the real risk is they will be kept on treatments they don’t need. Is there any harm in staying on an antipsychotic just in case? Well in our data, older patients with acute and transient psychoses are particularly prone to heart attacks and strokes – much more so than younger patients with schizophrenia.

A second message from the modern records is these patients make every effort to have no further contact with the mental health services. If they escape physical dependence on drugs, their clinicians are never likely to see them again. This means that most doctors end up with a misleading impression as to how many patients with psychoses actually recover fully – they underestimate the possibility of recovery.

the once and future psychoses

When the asylums opened in the early nineteenth century, there were few if any cases of schizophrenia. Patients with psychoses who were admitted recovered and asylums were institutions geared toward recovery by giving patients a structured daily routine and opportunities for work on the farm and other activities. They were not the warehouses they later became when schizophrenia emerged. If schizophrenia – chronic psychosis – were to vanish, these brief reactive psychoses would be psychoses that are left. But these schizophreniform psychoses are a disorder that we barely understand. There are vanishingly few case series published to give us even the average age of onset or gender ratio of the patients affected. The biggest studies there are have 40 or so patients. Our databases contain hundreds of cases.

In this mix there may be psychogenic psychoses – mental rather than physical disorders. This may be something like the condition Jung induced in himself that many see he portrayed as a semi-spiritual state or stage of growth. There may be other personality based conditions. Yet other brief psychoses may be more physical in nature but still open to recovery.

These are conditions we need to learn more about because as we shall see in our records it looks like schizophrenia or at least chronicity is vanishing, and we are going to have to re-orient our services much more toward recovery than before.


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Comments

  1. I agree that services need to be more recovery focused and not so entrenched in diagnoses and lifelong labels. It’s been the experience of me and my family that our episodes of psychosis can’t just be that but have to be pathologised, written indelibly in our medical notes and then come back to haunt us at inopportune moments. For example at other medical appointments which is very irritating.

    For me to recover in 2003/4 took a lot of assertion and a determination not to listen to the psychiatrist, when he spoke about the DSM and lifelong mental illness. This was when I had decided to come off the lithium, which I should never have been on in the first place. A piece of nonsense.

    I see lots of folk in everyday life who are nearly and all but psychotic, have paranoid thoughts, think there are conspiracies and people are out to get them, plot and scheme in religious settings, think that they are not accountable even though public servants. And yet none of them have been near a psychiatric institution or been forcibly injected with brain altering chemicals.

    Revival in the Christian church is something to be sought after and what many are praying for. In charismatic or pentecostal churches there will be all sorts of happenings that would look very out of place in another type of community meeting. But as it’s happening in a group or fellowship situation then there is strength in numbers and a sharing of experiences. Maybe the isolated psychotic experience is more prone to interference from psychiatric professionals?

    I’m glad I looked through all of this blog post for the title had put me off me a bit, making me think it was more about the roots of psychology or psychoanalysis. For, although we have clinical psychologists all over the place in Scotland, it’s still very difficult or even impossible to get access to one if psychotic or mentally distressed. It’s still drugs or nothing where I live. And nothing isn’t an option.

  2. Very true. And it’s not easy to recover from being on the receiving end of a rigid application of the medical model: a stigmatising label, heavy drug treatment and electric shock therapy.

  3. A psychotic episode, if caused by an adverse drug reaction (ADR) to corticosteroid, sulfonamide or antibiotic drugs or following anaesthetic should be treated with kindness and attention to the person’s safety. They may need a sedative for a few days only (to avoid addiction). I always warn people who contact me via the charity to try to stop the over-drugging of their family member in such a crisis.

    When my daughter Karen suffered a sudden onset of psychosis following terrifying nightmares (missed as an early sign of intolerance to sulfasalazine), she was given Haloperidol.

    The adverse reaction to Haloperidol was terrifying for her and for me. She had to be totally sedated and I was barred from seeing her. I suspect if she had not been given antipsychotics, we would not be grieving for her now.

    Your findings about the patients in Wales, will I hope enter psychiatric and medical education and more awareness of the harm caused to so many.

    Thank you for the immense contribution to common sense and I hope you are being listened to by some health professionals.

  4. Most people who argue for schizophrenia as a modern disease date its appearance to sometime in the nineteenth century, right? So by 1905 the North Wales Asylum must have housed both people with brief reactive psychoses and people with “chronic schizophrenia.” Did the medical staff make any distinctions between them? Or did they just treat both groups in a more normalized way, expecting them to go home and putting them to work, etc.? If so, maybe they could teach us something about the capacities of the so-called chronically ill people as well. Not to mention a perspective on the true human cost of some of the medication “advances” of the past fifty years.

    I interned as an occupational therapist in the old state mental hospital in Milwaukee in the late ‘80’s. Even then you could catch glimpses (mainly in disused equipment and shuttered facilities) of a system that must have allowed for more “normality” than the current one. There were pictures of baseball teams and choirs, fields that used to be vegetable gardens, a bakery, a real pottery and a woodshop with a respectable collection of power tools. It did look far more in tune with the adult world than the infantilizing crap we usually offered patients as “therapeutic activity” by the 1980’s.

    It also must have been replete with “sharps” and other everyday hazards we were taught to assume were utterly impossible to have in a psychiatric hospital. This must have been true at Denbigh too – you can’t run a kitchen, garment shop or farm without lots of dangerous tools. Yet if the other reports from North Wales are right, there was less suicide in the old days than currently…

    • Good point Johanna.

      I remember being a psychiatric inpatient in 1978, having come out of the puerperal psychosis after eventually voluntarily taking the chlorpromazine. Going to craft activities which included knitting, with metal knitting needles, 12 inches long. Patients from open and locked wards all sitting in a room together, supervised by occupational therapists. Pins and needles surrounded us. Potential weapons but I don’t remember any incidents. Apart from being grabbed and jagged by nurses that is.

  5. Johanna,
    ” the infantilizing crap we usually offered patients as “therapeutic activity” by the 1980’s.”

    That infantalizing crap was alive and well at CAMH in Toronto in 2002. My son must have been panicked and humiliated. A promising university student one day, and doing stick drawings two weeks later in “art therapy” in a locked ward eight floors above the ground. What does the infantalizing crap tell a parent? That their child is brain damaged, that’s what. Thanks so much for hitting the nail on the head.

  6. Thanks for this post, David.

    In my psychiatric practice in an inner-city emergency department we see lots of non-specific psychotic symptoms related to the consequences of childhood trauma and abuse, “brief psychotic episodes” (which often very neatly fit the criteria for old-fashioned diagnoses like “hysterical psychosis” and “Bouffée délirante”) and drug-induced psychoses. In fact probably more of these than actual episodes schizophrenia or bipolar I. Yet many of these patients arrive having been on pharmacotherapy for the chronic functional psychoses for months or years, to no apparent beneficial effect.

    It then becomes difficult to “undiagnose” or “untreat” because there is heavy moral pressure to keep the drugs going “just in case” or “in case there is an underlying psychotic illness”. And that to “deny” treatment is unethical. This is perhaps most powerful around those who have been “diagnosed” with First Episode Psychosis, which of course is not really a diagnosis at all. The claim made for FEP is that it is agnostic as to what the diagnosis is, but the treatment algorithms are implicitly based on expectation of chronic illness, so one drug induced episode (say) leads to anywhere between 3 and 12 months of antipsychotics being considered the minimum “ethical” intervention.

    I am lucky that in my setting we can get almost full resolution of psychosis in an inpatient setting using mainly psychosocial interventions (and non-specific sedatives) prior to any referral to chronic services, but most services are not like ours. It’s a funny kind of “recovery” these patients are offered in many other places.

  7. Bruce Charlton says:

    In my book Psychiatry and the Human Condition (2000) I speculated that many of these episodes of acute and short-lived over-active psychoses (which at the time I wrongly believed were diagnosable as mania) were due to sleep deprivation (in a predisposed personality); and I have seen several confirmations since, here and there.

    http://www.hedweb.com/bgcharlton/psychhuman.html#chap10

    The episodes were terminated by inducing sleep.

    • If that is the case, it would revive the attitude of many psychiatrists and institutions in the early part of the twentieth century. Sleep cures were quite predominant.

      I suspect that there is a good measure of truth in that.

  8. In regards to Jung’s “psychotic” break, I don’t buy it. You don’t have a psychotic episode and still manage to see patients and adhere to family responsibilities in the midst of psychosis. I don’t dismiss the importance of his argument regarding the importance of “listening” to the patient and making an earnest attempt to understand what is happening on the level of affect and the viability of their ego strength, or the importance of the “Red Book”, but I truly doubt he was psychotic (I say this after more than 25 years of working with people diagnosed with “chronic schizophrenia”).
    I have suspicions that he was taking medication for a period of intense anxiety and the med of choice at that time would have been a “hypnotic”. That would explain how he could move in and out of the altered state of mind (delirium) and bring him closer to the unconscious. I have only circumstantial evidence of this but it would make sense that he was experimenting with some mood/mind altering chemical. If not the treatment of choice from Burgholzi, then something else. Heck, I’ve even been scouring his work for references to Homeopathy which was known to him as it came out of Switzerland. An improperly prescribed Homeopathic could easily induce an altered state (Belladonna for example). Its an backburner project right now but I intend to dig into this more in the future.

  9. I have always been appalled at how some psychiatrists (and G.P.’s) tell their patients that their psychiatric diagnosis could be life-long or forever.

    It is completely dis-empowering when you hear that- I know, because I was told it myself. It’s also untrue…

    The entire discourse on mental health needs to be re-thought.
    It should be geared towards empowerment for the sufferer, not dis-empowerment.

    There is no evidence that all psychiatric disorders are destined to be life-long afflictions- many people overcome these issues- and ironically it’s usually after they move away from psychiatry and psychiatric treatments and when they begin to take control of their own health, that things start improving…

    . I did this- and I’m psych drug free over 10 years… Courage is what should be encouraged…and you don’t need a prescription to endorse that!..

  10. i went into psychosis 3 years ago from taking magic mushrooms and got diagnosed with bipolar 1 .i was told i would need to take meds for my whole life so i knew all of it was lies and i took mushrooms again to induce mania to try fix my unconscious because i knew when it happend the first time i was closer to the hidden observer(id)than i could be in regular consciousness .it was a mess of beauty and a battle of biblical perportions but it worked im more sane and in control than i could hav wished for and the problem is its like a sickness the meds keep from passing i think you need to face your shadow or should i say our shadow and understand the dualistic nature of the mind and free it from religion and inner persicution also attachment to conform to the parents and all will be revealed as a pasing storm to water the self.its a matter of perspective i have bipolar? psychiatrists claim to know about it but its like trying to explain motzarts music .it cant b done you have to hear it yourself and see what all the madness is about and because of this i think im in a better position than anyone to diagnose bipolar as a spiritual,individuality,and lack of perspectives and knowledge crisis rather than a chemical problem.one question if someone won the lotto while depressed would their chemicals change?or if their lover died? yes they would so its all perspective.

  11. I’m not sure that I have a point here, but rather, I hope to share some insight. I experienced what amounted to about 6 months of acute psychosis followed by about 18 months of a lessening of symptoms. It was definitely transient, it was without question a spiritual experience, very much akin to a death-rebirth process. This was spurred by overuse of psychedelics and cannabis, and I immediately ceased use and still have to this day (8 years later). I also reached a healthier state, returned to my baseline, and climbed higher and better than I’ve ever been, all without medication. It was hard, but it was the introspection that was required that provided the cure. Something to think about.

  12. Very important discussion and close to my heart too. I was diagnosed with psychosis after a traumatic experience involving my child becoming sick and mysel, a doctor, missing signs that could have lead to an early diagnosis and a better outcome. I had manic symptoms. More visual hallucinations which lead to erratic behaviour and heavy antipsychotic treatment and section. ACT therapy and antipsychotic treatment helped with symptoms but after weaning myself off medication, I relapsed. I too started taking note of these hallucinations. Trying to understand the underlying message. For me I interpreted it as a spiritual thing and that helped me see the bigger picture. I accepted that I could have Bipolar and that recovery was out of my hands. But I never stopped trying to understand and work through unresolved guilt and trauma. Religious, mystical, philosophical and existential writings became my bread and butter. And the concept of non-duality helped. Really appreciating that there was no wrong or right and that some of this was out of my hands. I learnt to self soothe and practice mindfulness and found that centering myself on he breath and the hear and now really helped take the sting of being so sick out of the equation. I didn’t relapse again. Came ofd the MEDS. I care for my son who shows the impact of that illness, yet I had the courage to have another child thanks to a very understanding psychiatrist. Like jung said, you can recover from most ailments of the mind like addiction, but perhaps one must consider the spiritual aspect of recovery when all else fails. And by spiritual I mean, not ego centric or even religion centric but the flexibility of thinking that comes with accepting what happens and taking the good with the bad and living from a centre of completeness or wholeness outside of our broken lives.

  13. Thanku everyone for your writings.
    Stopped antidepressants three weeks ago.
    I love carl jungs work.
    Currently experiencing the puer/senex
    archetypes of the play and responsibility
    functions. Thought I was going mad and
    I am waiting for appointment to see a
    psychiatrist. Going to cancel it because I
    know if I sleep and meditate this will help to
    de-stress me and I will b able to manage myself
    better. I have to stop taking on the
    responsibilities of others and have more fun.
    I know the task isn’t as simple as that but it is
    a safer way to go forward than meds. Medical book
    would probably say I biopolar one.

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