When psychiatrists are trying to figure out whether someone is crazy, they ask two different kinds of diagnostic questions. Some questions are about fearful fantasies, of the sort we call paranoia. They ask whether someone has been spying on you, following you, or in general making things hard. The psychiatrists also ask about other kinds of out-of-line fantasies, like being an unusually important person (psychiatrists call this grandiosity). But then there are questions about whether someone experiences thought as a substance. They ask whether someone experiences thoughts as being put into the mind or taken out of the mind, as if the mind were a honeypot and Eeyore was playing with his balloon. They ask whether someone finds that their thoughts are broadcast aloud, as if the mind were a radio and someone else threw on the switch, and they ask whether someone experiences a real radio as if it were a person speaking directly to them and them alone.
That second set of questions usually seem pretty weird to healthy people. The first set does not. People without psychiatric distress sometimes don’t realize that the first kind of question asks about pathology. When you ask them those questions, (“has someone been spying on you?”) they sometimes launch into accounts of being followed in a strange city. But most people do not get confused when you ask them whether they have felt thoughts removed from their minds. They think that you are asking them whether they are crazy. They stare hard at you and say no.
What is interesting about this is that in fact, many spiritual practices actually teach you to experience your thoughts as substance. That’s what meditation does. You are supposed to detach from your own thought process. You sit, eyes closed, and focus on a word or sound. When other thoughts obtrude, as they usually do, you surround them in little soap bubbles and watch them float away.
It’s also what much Christian prayer does. The evangelical church I attended as an anthropologist taught people to think about their minds differently--not as a private container of fleeting thoughts, but as the place in which one met God. People learned to pray with “quiet time”—to take time out of the day to talk casually to God in their minds, as if they were talking to a friend in a daydream, and to pay attention in their minds in order to identify the way God might respond. So they had to learn which thoughts or images or sensations counted and how to pick them out. In general, they looked for “not-me” experiences—thoughts that felt different from the everyday, maybe more charged with feeling, or stronger. They had to learn to think about their thought as a substance that could be put into the mind—by God.
To be sure, the church also taught congregants to discern God’s voice by the quality of the thoughts and images. Congregants learned that thoughts or images which came from God were more likely to be different from whatever they were thinking about at the time, and that such thoughts and images must be consistent with God’s character. (God doesn’t tell you to hurt yourself, they would say). They learned that you should test your own interpretation—that you shouldn’t take for granted that what you thought God had said to you was, in fact, God’s voice. And they learned that when God speaks, the person who hears should feel peace. If you didn’t feel peace, it probably wasn’t God.
That doesn’t sound like being crazy. Moreover, the actual experiences people have when they are ill with, say, schizophrenia are very different from spiritual experiences. When people struggling with schizophrenia hear voices, they hear harsh, horrifying, condemning voices, and they hear them frequently, sometimes all the time. Healthy people who heard God speaking usually aren’t having auditory experiences. When they do hear what they call God’s voice with their ears, that experience is rare, brief, and usually good (if a little startling).
And yet in both cases, there is a changed relationship between the thinker and the thought, in which the thinker thinks about the thought as not generated out of his or her own mind. That happens automatically in psychosis; it needs to be taught within the church. The obvious difference lies in the sense of personal efficacy, control over rather than control by. In spiritual practices like prayer or meditation, you learn to exert authority over your own scampering thoughts—even if you are doing so to look for the spontaneous presence of God. People with schizophrenia can feel that their mind is managed by another, external force, and that is terrifying.
It makes you wonder whether teaching spiritual disciplines to persons with psychosis would be useful. There are some experimental programs that teach mindfulness to people with schizophrenia, and a European movement (the Hearing Voices movement) that teaches people to interact deliberately with their voices. Both approaches show promise. The important take home point at this juncture, however, is that many psychologists and psychiatrists believe that one should ignore the distressing voices people hear in schizophrenia because to pay attention to them can imply, to the patient, that they are real. It is possible that the reverse is true: that if patient learn to treat their voices as having substance deliberately, they may be able to gain some sense of agency over them.
