How to Talk to Crazy People
Part I: We and Crazy People Inhabit the Same Planet
We are frightened of crazy people, for a variety of reasons.
We want to show—if only to prove we are normal—that we know that they are crazy and to reject them. This is a mark of civilization, in that people in societies anthropologists study often don’t separate themselves from non-normal people the way that we do.
I once sat in a Williamsburg café with a woman who had substance abuse issues. A woman came up to us making no sense when she spoke. After she left, the people next to us—a young urban couple—spoke to my friend disparagingly about the crazy woman. I was shocked when my friend nodded in agreement. She (my friend), I thought, should be able to empathize with that woman. But perhaps my friend had the greatest need of all to reject her.
To say to someone, ‘Your reality is crazed, it can’t be tolerated, I won’t even listen to it’ is to assign them a non-human identity… it isn’t helpful.-Stanton Peele
But all of us do this all the time. And psychiatry does it the most of all. To say to someone, “Your reality is crazed, it can’t be tolerated, I won’t even listen to it” is to assign them a non-human identity. And it isn’t helpful. Just as I listed the traits and skills required for someone to play a therapeutic role with substance abuse/addiction issues in the 21st century (e.g., you must be able to accept drug use and drinking), you must be able to listen to crazy people to be a therapist.
This issue raises its head because of a remarkable document released by the British Psychological Association.
As summarized by T.M. Lurmann in the New York Times:
The report says that there is no strict dividing line between psychosis and normal experience: “Some people find it useful to think of themselves as having an illness. Others prefer to think of their problems as, for example, an aspect of their personality which sometimes gets them into trouble but which they would not want to be without.”
Remarkable, true and effective therapeutically—but entirely foreign to our American, biological psychiatry view of, and way of dealing with, mental illness. The BPA says normal and psychotic experiences are part of the same continuum. And, I add, the opportunity to return a person to the more typical, functional part of the spectrum (the non-psychotic part) requires that we recognize and work within this continuum.
…when we talk to a psychotic person we need to make sense of their vision—and to see why it is satisfying to them.-Stanton Peele
This means that when we talk to a psychotic person we need to make sense of their vision—and to see why it is satisfying to them. This is the same issue involved in working with addicted people—they are relying on the drug or other total immersion in an involvement to provide sustenance that they are not yet capable of deriving from leading a non-addicted, non-psychotic life.
As Ilse Thompson and I point out in Recover! Stop Thinking Like an Addict, addiction and mental illness have strong experiential similarities. For example, a manic episode resembles a drug high. The person welcomes, enjoys it—the experience gives them an intense feeling of being alive that they don’t want to give up. And the depressive part of the bipolar cycle is like narcotic use for those who rely on both types of drugs, like renown surgeon William Halsted (and his counterpart on television’s “The Knick,” Dr. John Thackery). People seek aliveness and peace of mind through extraordinary means when they can’t find these experiences in ordinary life.
…addiction and mental illness have strong experiential similarities. For example, a manic episode resembles a drug high.-Stanton Peele
What is essential in this realization, for both addiction and mental illness therapists, is that people have their reasons for using substances, even addictively, and for departing from reality. We may fairly judge that a better life is possible for them, one with less chaos, more human contact, better health, more constructive engagement with the world. But we need to accept their place on earth, their reality—as conveyed in the Buddhist concept of radical acceptance—if we are to help people improve their connections to life. That is, before we help them, we have to respect their and our common humanity. Only in this way can treatment expand their visions and enhance their lives.
How to Talk to Crazy People is a three-part article series by Stanton Peele. Check back for Part II: The Continuum from Normal to Crazy.
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