Dream or reality? A Cartesian based meditation for managing hallucinations in psychosis

Since I was introduced to Descartes in my first philosophy class he has been my favorite philosopher. He has a poetic style of writing that to me has always reflected the natural course of human thought and was not as rigid as some of the other philosophers we were made to look at. As much as I admired him, I never realized how useful his philosophy would be in my life, until I went crazy.

In his book ‘first meditations’ he sets out to find out what he really knows. Like really. What does he know about reality that escapes all doubt? He strips himself of his knowledge about the world, claiming that things based on experience cannot exist beyond doubt as the senses are subject to error. For example, visual illusions and hallucinations are produced by the senses, and yet they don’t reflect anything that exists in the external world. How do you know the difference between reality and a hallucination if they are both presented to you through the same medium? In addition to this, dreams often feel as though they are real, and while you are in them, you are not aware that you are dreaming. How do you know if what you are seeing and experiencing is real, or if really you are asleep and dreaming? Is it possible to differentiate between the two experiences?

hobbes

 

Having to distinguish between a dream and reality is not something I thought I’d ever have to practically encounter, until I experienced psychosis, the experience of living inside a waking dream. Psychosis is commonly understood in the West as a mental illness (although in other cultures it is an experience tied to spiritual awakening) and is characterized by the sorts of sensory errors that Descartes describes i.e. hearing and seeing things that are not experienced by others in the common reality.

The first time this happens to you, it’s very disorienting. It is hard to find the line between reality and dream-like delusions and it is unlikely you will be able to completely navigate it. You get swept up in the magic of it all. Rationalization may be difficult as delusions will interfere with your regular reasoning ability, but once you go through it once, subsequent events such as ‘relapses’ or resurfacing of symptoms should be easier to manage. I know medication is often suggested as the main way to manage the symptoms, but I have found in my own experience that Descartes can also help!

I went to a conference last week that encouraged us to think about how we make it easier for people to talk about and manage their ‘madness’ and I brought up the fact that I had felt like philosophy had really helped me through my episodes. From that I came up with a Cartesian style meditation that I hope will help you to manage some of the symptoms of psychosis and help you to differentiate the real from the not-real. The steps of this meditation I outline below:

  1. Breathe

    Sit in any regular meditation or comfortable pose. Although you can do this standing up, or in any position, sitting down will help you to find stillness during your episode of psychosis and help you to manage some of the mania if that’s what you are experiencing. Before you rush off to do anything, just sit down. It is useful to close your eyes, and begin to breathe deeply and focus on the breath. (This assumes some prior experience with meditation practices – however if you have no experience with such practices it is fine, and this is a great place to start!)

  2. Accept Uncertainty 

    Start the meditation with acceptance of the idea that everything around you is unsure. Since you are not sure of what you can trust, trust nothing. You can know nothing. You don’t know if the bottle in front of you on the table is really there. You don’t know if the river in front of you is real or a mirage. Most perceptions are illusory, become comfortable with that. One of the reasons I suspect that these experiences are so troubling for people is that they do not usually need to consider whether something they see is real or not and it throws them off. Become comfortable with that thought sitting inside your mind.One of the things Descartes brings up in his book is the fact that he cannot be sure if he is being deceived by an ‘evil demon’ or not – he cannot be sure whether an evil demon is making him believe things that are not true. This type of belief is common in psychosis. The idea that a demon, or the CIA or aliens are trying to deceive you and are interfering with your thoughts etc. Instead of acting on these thoughts, and engaging in a high speed chase against yourself, suspend all belief and embrace doubt. Since you don’t know what thoughts or ideas to trust at this point, it is safe to trust nothing. Just sit down, admit and accept that you are confused and go back to the basics. Ask yourself, so I don’t know what’s going on around me or inside my head, what do I know?

  3. Affirm knowledge of yourself 

    After you’ve suspended all belief, and you’ve accepted that you don’t know what’s real around you, the next step is to assert what you do know and that is: yourself. Assert your own existence and your own personality. Acknowledge that over all doubt, you exist and whatever it is that you think of as ‘you’ – it exists.This is the most important step as during psychosis it is common to lose your sense of self. I would usually argue that ‘losing yourself’ is an important existential experience that precludes really finding oneself, but there are times when it is just not useful and that is when instead of losing yourself to find yourself, you just get lost. I don’t want you to get lost.So, if you are going to try to navigate your reality, you need to have a sense of self. According to Descartes, yourself is a thinking, experiencing soul. The line of argument Descartes uses is as follows ‘if there is an evil demon (insert other persecuting entity i.e. CIA agent/alien/bad neighbor) that is trying to deceive me, then there must be something that is ‘me’ that is capable of being deceived – thus there must be something that is intrinsically ‘me’ that experiences and that is experiencing all of this. That me is thinking, it is experiencing, it is aware, it exists, I exist’.

    Affirm this a few times, repeat to yourself ‘I am here, I exist’ and from this you can continue to build your image of self and affirm other qualities you have. Again, this is important because it is your sense of self that is going to be rocked during your psychosis and while that can be good, it can also be very bad and it is important that you have a reference point to turn back to. So for instance you can assert, ‘I am a teacher’, ‘I am smart’ ‘I am a skilled cook’, ‘I am a mother’, ‘I am (insert-name-here)’ etc. Again, affirm whatever this identifier is a few times until you start to become grounded in everyday reality.

  4. Affirm knowledge of your physical body 

    Once you’ve affirmed yourself, you then need to remind yourself that you exist as that identifier inside a physical body. That you cannot doubt. You exist inside a body. That part is always real – the whole point of this exercise to help you build yourself up from being unsure to being certain. You are unsure if the bear in front of you is a hallucination or not, but what you can be sure of, is your body. Even if you are being deceived about your experiences by your senses, without your senses you wouldn’t perceive anything. Your senses are attached to your body, thus you would know nothing of yourself without your physical body. If somebody came out of nowhere to punch you in the face, you would feel it. Your body is real.Spread your awareness through your body to affirm this. This is useful to help you regain control and connect yourself and your thoughts to your body, it is useful to help you ground yourself in physical reality through physical sensation. You might focus your awareness in your left hand and then in your right hand, then in your left leg, and so on, moving awareness around your body until you feel connected. This will help you to focus on internal sensations and acknowledge how your body feels and what is happening inside it and help you to be sure that your experience is real. You can also include some small physical movements to help so perhaps rolling your neck or your wrists etc to help ground yourself in the physical world.

  5. Affirm knowledge of the physical world 

    The next step is to affirm the external world and to readjust to your physical reality. Tell yourself ‘I exist > I exist as (name and personal qualities here) > I exist inside a physical body > that body exists inside a physical world’.At this point, open your eyes. Adjust slowly. Just look around. You don’t need to do anything, just look. Whatever thoughts come, don’t act upon them, just look around and see what you see. Try to see the world as it is. Descartes reminds us that the physical world that we are in is subject to certain laws and has a certain coherence. Just how Hobbes as he’s falling tells himself ‘well if this were a dream, I would expect X to happen’, ask yourself ‘is there anything that I am experiencing or that is happening around me that is contrary to the normal laws of the physical world’.If there is something in your visual field that you don’t expect there to be or that you are not sure of, just look at it, look at how it might be different from the other things you are seeing, look at whether it deviates from usual experience. If you are somewhere familiar, ask yourself ‘does this building usually slant this way? or are my eyes just doing a funny thing? If you are seeing a hallucination, try to remain calm, acknowledge it as such and just try to be comfortable with it. Acknowledge that sometimes your senses get things wrong, and it is not something to worry too much about. You should still be in your seated position so you can continue to breathe deeply so you do not get too stressed.

     

    Ask yourself

    1. Do I know where I am?
    2. What am I currently doing?
    3. What am I currently experiencing?
    4. Is there someone I can contact?

     

    Again this to reinforce the current physical reality you are in. Sometimes we can let our consciousness take us so far, and we need to be able to bring ourselves back into the present moment and ground ourselves in reality. In times of uncertainty you can be sure that your body and all it’s connotations exist. It doesn’t matter if the world around you is changing or your perception of it is, it doesn’t matter if the world around you seems like a dream, you need to know that you are not part of it. You are not a dream. You are real. That which thinks inside of you, is real. That which feels, is real. Your soul and your body are real and you are in control over how your body acts in relation to the changing world. You are in control of how you respond and how you perceive. This is the point of realization that is aimed at and this is the point where you could try to contact someone that you know that you trust that can help you and take you to a safe place and then you can go from there.

 

This exercise is something I would recommend as a coping strategy once you’re at a point of starting recovery or you’ve already started it as it requires a sense of awareness which I’m not sure is present in first time episodes. This is something I found to be useful during my 3rd episode when I was unsure about what was happening around me but I was already used to reality bending itself around me.

I recall a time when I was walking to my aunts house and time began to slip around my thought. I was aware that this was not my normal perception of time, so I just found a bench, adjusted a little and I just sat and went through some of these things in my head. After a while my vision stopped swimming, my thoughts slowed down and I was able to continue on and catch the bus home. I would not have been able to go home in my prior state as there was too much going on mentally, I was too reactive and self-control was limited but after going through these steps and bringing myself back I was able to continue on with my day.

I would suggest that this is something that is done regularly, especially if hallucinations and illusions are a recurring problem that trouble you. It is incredibly useful to be able to deconstruct and re-construct your reality as in those moments where your reality is severely distorted and has broken down, it will be easier for you to build yourself back up.

Hopefully this is something that will help you. I would love to get feedback about whether it does or whether there is a step you would add or what improvements could be made. I have written this primarily for visual hallucinations, this would be somewhat appropriate for auditory hallucinations too, but I have different strategies for those that I would like to share with you later on.

For now, happy living
& may Descartes be with you.

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