Meaning-Making View of Extreme States

The concept of mental disorder that accompanies extreme states that is widespread today both in public discourse and the paradigm in which most mental health systems operate, is based on epistemological premises which may be unconstructive for the person undergoing the experience of extreme states. These epistemological premises function as a certain kind of knowledge construction—a biological scientific paradigm that looks at mental distress by taking it out of the social context and by solidifying it in the body of the sufferer while simultaneously interpreting it as a preexisting biological malfunction. This widespread perspective can potentially be unconstructive for the person experiencing mental distress for multiple reasons. First, the concept of biological malfunction ignores the wholesomeness of the process of mental distress in the extreme states and how they can make meaning when looked at contextually. Furthermore, reducing suffering into a malfunction makes it devoid of meaning. The implication of this way of understanding mental distress can then be a deprivation of the accompanying insights and the loss of the value that the process, albeit painful, can simultaneously potentially contain. Third, the idea of the biological malfunction is usually accompanied by corresponding labels in the form of diagnosis. This is not without social consequences, since the labels of diagnoses can become a self-fulfilling prophecy in the social context that can start to determine the further life of the individual in a limiting manner.

It is proposed that mental distress and extreme states can instead be seen as pointing toward the neglected aspects of one’s sense of being. Rollo May argues that the being cannot be reduced to introjection of social and ethical norms—it is instead the precondition for the ego and it presupposes “Eigenwelt,” the “own world”—the relation of a person to herself or himself (May, 1983, p. 102). In other words, while the ego is only the part of the personality, the sense of a being relates to one’s whole experience (May, 1983, p. 103). In this manner, the ego tends to be weak in childhood in proportion to the child’s relatively weak assessment of and relation to reality, while the sense of being might already be very strong later in life, when the child learns to diminish himself in the encounter with social conformist tendencies, the ego tends to grow stronger, while the sense of being tends to weaken (May, 1983). As May (1983) puts it:

My sense of being is not my capacity to see the outside world, to size it up, to assess reality; it is rather my capacity to see myself as a being in the world, to know myself as the being who can do these things. It is in this sense a precondition for what is called “ego development.” The ego is the subject in the subject-object relationship; the sense of being occurs on a level prior to this dichotomy. Being means not “I am the subject,” but “I am the being who can, among other things, know myself as the subject of what is occurring.” (p. 104)

What if extreme states are conceptualized as the states that have the potential of bringing one closer to the wholesomeness of one’s being?

While existing within the existential–humanistic tradition of psychotherapy and some other traditions such as Jungian, this view is not common in the mainstream perception of extreme states. The mainstream perception of extreme states operates on the premises built on a certain way of knowledge construction, originating in the period of Enlightenment—an objectivist epistemology that perceives reality as solidified externally outside of the human mind and social reality. Mental distress is within this tradition also viewed as malfunction unrelated to the context of one’s existence and as a phenomenon solidified in the person suffering, with possible biological origins, to be cured through medications. This process of medicalization of human experience operates through medical language and through research which tries to discover genetic and biological causes of so-called “mental disorders” (The British Psychological Society, 2018, p. 19). There are several problems with this conceptualization. There seem to be low levels of agreement among clinicians making diagnoses and lack of validity of diagnostic categories within their own conceptual terms as well as extensive production of “comorbidity” (Bentall, 2003; Boyle, 2002; Kirk et al., 2013; Moncrieff, 2008; The British Psychological Society, 2018). Research studies also increasingly fail in finding genes that can be isolated as predictive of the emergence of various distressing experiences known as depression, affective disorders, or schizophrenia (Balakrishna & Curtis, 2020; Curtis, 2021; Culverhouse et al., 2017).

It is also often overlooked that this view of mental distress and the horizon it opens or closes for a person is a product of social systematization and not solely a neutral external phenomenon observable without any prior knowledge construction. It is a result of a social consensus of viewing mental phenomena in a certain manner. The experience of mental distress as organized within diagnoses-system is an attempt of systematization of mental distress that can be seen as what Adorno and Horkheimer (2002) have termed formalization of reason based on the model of natural science, in which all that is not based on the level of utility and calculability is subjected to suspicion, which can consequently sacrifice the meaning in the process. Mental distress is in this kind of understanding solidified in categories that are taken out of concrete subjective specific contexts and seen as separate phenomena, without meaning or relatedness to the context. In this manner, it is easy to overlook some aspects of the process of mental distress. Following this, the extreme states are observed according to the normativity of understanding rooted in the aforementioned objectivist epistemology. The distress is handled by numbing the pain with medications that are seen to have an impact on its alleged biological origin. While this kind of approach might reduce the suffering by numbing some of the pain, within this approach, there is a risk of overlooking and silencing the expression of being in the extreme states. The extreme states might in epistemological confinements of this kind be equated with irrationality and meaninglessness, all the while it is disregarded that these interpretations are happening within a certain way of knowledge construction. The perception of extreme states is seen as nonconstructive from this kind of stance which is presupposed, and which takes no notice of their meaning-making aspect.

Following the footsteps of Ronald Laing (2010), we can posit that the extreme states should not be viewed as a sign of certain disease solidified in the body, but as an expression of one’s existence. Behaviors that might seem erratic or meaningless without acknowledgment of the context might start looking meaningful when the perceived context is taken into account. The extreme state can then be understood as an attempt of the being to voice its freedom. It can be proposed that extreme states are an expression of a being that finds its existence within a certain context—a reaction of the being to that particular context. In this kind of reaction, there might be an accumulated perceived feeling of the needs of the being as violently crushed, oppressed, or denied, while their expression is perceived as not possible within that particular context. All of this might result in the perceived threat of non-Being, as understood in existential tradition. Certain contexts more than others give rise to the threat of non-Being for certain human beings. In existential–developmental terms, it is seen that those human beings that in childhood lack stability of the context necessary for opening to the world might be more prone to the threat of non-Being than the ones whose coming to existence has been happening in the more stable context (Adams, 2018). They might thus be more sensitive to the threat of non-Being as a starting point. Extreme states thus have to be viewed also within the context of the current existence of a human being, which may be provoking further threat of non-Being or might be lessening it. In the case of the repeated experience in which the threat of the non-Being is constantly provoked, one can retreat to an extreme state as a response. This can be the consequence of the long-term existence of a human being in the context which feels as neglect of its needs and as participation in an unbearable situation containing danger of the loss of being. The retreat into the extreme state might be seen as a defense against what would be felt as a loss of being.

For the reasons stated above, the attempt to understand extreme states is more constructive when done from this perspective. Namely, bringing the process of extreme state to a halt by completely numbing it with medications, as often is the case within the paradigm of biological malfunction, might be a seemingly easier way of dealing with extreme states. However, by taking this path the opportunity of guidance toward new ways of being might be lost.

To provide an example of this, extreme states which would in the mental health paradigm of medicalization be termed depressive, are accompanied by conditions manifesting as loss of energy and interest, slowing down of physical movement or thinking processes. This is then viewed as a biological malfunction in need of treatment with medication. However, what if these conditions are instead viewed as an expression of the suffering of a being that is not able to find another way of voicing distress in the circumstances that might be felt as too overwhelming? The freezing of the body and the lack of energy and interest while slowing down movement and thought processes might be viewed as an expression of the existence that finds certain conditions unbearable to the point where the cessation of all activity seems like the only way left to shield itself. By making a halt to functioning within these circumstances, a being is forced to stop participating in this kind of situation.

If aided respectfully, with presence, and with the acknowledgment of the neglected aspects of one’s experience, the process of extreme states can potentially be turned into a process where the exploration of a need for new possible ways of being in the world is brought to the forefront, rather than the idea of malfunction. As Laing (2010) proposed, it is the therapeutic relatedness that should be used to this purpose, the potential of a person to feel the therapist’s presence and to experience someone’s acknowledgment of one’s suffering and existence—the therapist acts on the principle that relatedness is potentially present in everyone and so that he “may not be wasting time in sitting for hours with a silent catatonic who gives every evidence that he does not recognize his existence” (p. 48). As Rollo May (1958) proposed, the therapist is what Socrates has seen as a “midwife” in the sense of the realness in “being there” to help the other person to bring to birth something within himself (p. 84).

There is also another potential in the process of extreme states that often goes unrecognized. As Paul Tillich (2000) argues, since the closeness to non-Being opens up the mystery of being, the potential for the creativity of people who are closer to non-Being can be greater—it can open up levels of reality that are normally hidden, proved by the history of human culture. Sometimes halting extreme states can also represent a halt to insights that can accompany them. This is not to underestimate the level of suffering and pain experienced in extreme states, but to stress the importance of aiding the person through this process in a way that highlights the meaning-making aspect of the experience which has the potential to open these realms.

This perspective of looking at extreme states emphasizes their transformational aspect. It accentuates a need to explore possible new ways of being that are felt meaningful. In this perspective, the highlight is on the need to hold the space for the person undergoing the experience, while simultaneously navigating her or him through the process in a nonoppressive manner, yet in a manner that will make it possible for new ways of being to emerge through relatedness with the person holding the space. This is a different way of handling mental distress than the one that focuses solely on numbing the process in the name of malfunction. To numb this process and to leave it at that would from this perspective be to contribute to the repression of being.

This is not to say that the process of going through extreme states is not painful or that one does not need to lessen the pain. The process of extreme states can be excruciating and if the pain is too much for the person to bear it is advisable to relieve pain. It is however important not to let numbing the pain cause oversight of the meaning-making aspect of the extreme state.

This kind of understanding of mental distress and extreme states adds value to the process of mental suffering, instead of emptying it of meaning, as is the risk of interpretations of mental distress as a malfunction and disorder. It cannot be emphasized enough how important this is for the person having the experience. As Viktor Frankl (1992) argued, it is the experience of meaning in the suffering that can make suffering more bearable. In a similar manner, it is precisely seeing the meaning within the process of an extreme state that may drive the exploration of new ways of being where one’s freedom can be experienced in a new way.