Introduction
What is psychosis?
In everyday language, a person is said to be psychotic when the things they do or the things they believe can't be grasped by others and can't be put into a context meaningful to others. Then others say that the behavior or beliefs of this person are crazy or insane, and that this person themself is crazy or insane. People encountering a psychotic person face two major problems blocking communication: an easy problem and a hard problem. The easy problem is trying to understand what this person is doing or what he or she believes or claims to experience. The hard problem is trying to understand why this person behaves the way he or she does or why this person has such strange thoughts, feelings, sensations or anticipations.
In clinical terms, psychosis can be defined most generally as «a weakened or distorted relationship to or attitude toward collective reality». Depending upon a clinician's field of specialization, clinic or research, he or she develops a particular understanding of the phenomenon psychosis. Here I differentiate between a phenomenological and a functional understanding of psychosis. (See my presentation below.) My personal approach understands psychosis as a «functional disturbance» at the bioneurological level. It is based upon two related, empirically-founded hypotheses stemming from the domains of chaos and quantum theory.
Before delving into details, it is helpful to consider a simple metaphor:
Mental awareness is composed of many different perceptive and apperceptive experiences or, figuratively speaking, of countless pieces of a picture puzzle comprising an overall mental impression. I hypothesize that mind-brain processes and the corresponding qualitative experiences of the individual are - figuratively speaking - also put together like the pieces of a mental puzzle. However, in the "psychosis picture puzzle", each individual piece may sparkle and shine, but, the overall composition makes little or no sense, it is weakened or distorted: The puzzle pieces comprising the afflicted person's impressions are individually experienced, separately, that is, not recognizably as belonging together as in the case of the nonpsychotic person.
Scientifically, I speak in the case of psychosis of «linear information processing in the mind-brain», because the normal, nonlinear networking involving biochemical and bioelectrical feedback loops between certain regions of the brain or between certain neuronal ensembles seem to be weaker during psychotic as compared to the remitted ("healthy/normal") states of mentation. Borrowing terms from the science of consciousness, I can call this a problem of «binding». In other words, I hypothesize that
- Psychosis is a consequence of disturbance to the ("normal") nonlinear information processing ("hand-shaking") between various cell ensembles in the mind-brain. This results in pathologies of associated coherence and synchronization also called «binding» in the mind-brain: Afferent and efferent signals, in particular, those corresponding to the usual sensory and apperceptual channels become confusingly disorganised in psychosis (Schmid, 1997a), (Schmid, 1997b).
This hypothesis can be augmented with a second hypothesis, namely, that the «psychosis binding problem» has formal parallels to certain nonlocal effects which have long been proven to exist in atomic physics in connection with a phenomenon called «quantum communication»:
- «Binding» is sustained by quantum correlations playing an orchestrating role of instantaneous synchronisation of brain processes over widely separated regions of the brain. A qualitative «mental state of ego-awareness» leading to an unambiguous ego-identity might be synonymous with the synchronization resulting from a quantitative «highly coherent, local quantum brain state». (This justifies the use of the dyadic concept «mind-brain».)
The first hypothesis has been derived from empirical evidence and experience with persons suffering from psychosis, namely, EEG-measurements (Schmid & Dünki, 1996), (Dünki et al., 1996), (Schmid & Koukkou, 1997), (Dünki & Schmid, 1998), (Dünki, Schmid, & Stassen, 2000) and Phantasy Therapy (Schmid, Eisenhut, Dämpfle, Frei, & Ito, 1997), (Schmid et al., 2000), (Schmid, 2001a), (Schmid et al., 2002). I emphasize in passing that Phantasy Therapy - see the corresponding chapter in this website - has been gradually developed and optimized over a period of several years of hands-on clinical experience with psychotic persons in psychotherepeutic groups employing direct feedback from the patients themselves. This experience has led to the evidence-based Binding Hypothesis mentioned above and not the other way around: Phantasy Therapy is not the product of any theoretical concept nor is it dependent upon one or another psychiatric, psychological, or psychotherapeutic school of thought.
The second hypothesis is based upon theoretical considerations following from medical reports on the phenomenon of psychogenic death (death by imagination - see (Schmid, 2002), (Schmid, 2001b)).
Literature
Dünki, R. M., & Schmid, G. B. (1998). Unfolding dimension and the search for functional markers in the human electroencephalogram. Physical Review E, 57(2), 1-8.
Dünki, R. M., Schmid, G. B., Scheidegger, P., Stassen, H. H., Bomben, G., & Propping, P. (1996). Reliable Computer-Assisted Classification of the EEG: EEG Variants in Index Cases and Their First Degrees Relatives. American Journal of Medical Genetics (Neuropsychiatric Genetics), 67, 1-8.
Dünki, R. M., Schmid, G. B., & Stassen, H. H. (2000). Intraindividual specificity and stability of Human EEG: Comparing a Linear vs. a Nonlinear Approach. Methods of Information in Medicine, 39, 78-82.
Schmid, G. B. (1997a). Chaostheoretische Betrachtungen zu Psychiatrie, Psychologie und Psychotherapie. Teil 1: Die Sechs Grundeigenschaften des Chaos und eine Prozess-Orientierte Psychiatrie (POPSY). Forschende Komplementärmedizin / Research in Complementary Medicine, 4(3), 146-163.
Schmid, G. B. (1997b). Chaostheoretische Betrachtungen zu Psychiatrie, Psychologie und Psychotherapie. Teil 2: Neue Hypothese zur Natur der Psychose. Forschende Komplementärmedizin / Research in Complementary Medicine, 4(4), 194-208.
Schmid, G. B. (2000). Tod durch Vorstellungskraft: Das Geheimnis psychogener Todesfälle (1. ed.). Wien-New York: Springer-Verlag.
Schmid, G. B. (2001a). Die Bedeutung Benedettis für die Therapie der Schizophrenie. Zu Ehren von Gaetano Benedetti. Forum für Kunsttherapie, 1/2, 3-19.
Schmid, G. B. (2001b). Tod durch Vorstellungskraft: Das Geheimnis psychogener Todesfälle (2. ed.). Augsburg: Bechtermünz.
Schmid, G. B. (2002). Psychosis Therapy with a New Approach: Special Treatment of Psychotic Patients in General Psychiatry. Manuscript ready for submission.
Schmid, G. B., & Dünki, R. M. (1996). Indications of nonlinearity, intraindividual specificity and stability of human EEG. The unfolding dimension. Physica D, 93, 165-190.
Schmid, G. B., Eisenhut, R., Dämpfle, S., Frei, K., & Ito, K. (1997). Phantasietherapie: In der Phantasie die Realität wieder finden. Tandem, 2, 21-23.
Schmid, G. B., Eisenhut, R., Rausch, A., Ito, K., Dämpfle, S., Frei, K., & Giacometti Bickel, G. (2000). Phantasietherapie: In der Phantasie die Realität wieder finden. «Das praktische Gerüst». Forum für Kunsttherapie, 2, 34-49.
Schmid, G. B., Eisenhut, R., Rausch, A., Ito, K., Dämpfle, S., Frei, K., & Giacometti Bickel, G. (2002). Phantasy Therapy in Psychiatry: Rediscovering Reality in Fantasy. A Special Treatment for In- and Outpatients in General Psychiatry. Forschende Komplementär Medizin, accepted for publication.
Schmid, G. B., & Koukkou, M. (1997). Die Dimensionale Komplexität des EEG in psychotischen und remittierten Zuständen. In G. Schiepek & W. Tschacher (Eds.), Selbstorganisation in Psychologie und Psychiatrie (pp. 151-170). Braunschweig: Vieweg.