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How to Hold Space for a Mental Health Crisis

By Jonathan Davis on Thursday October 20th, 2016

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Supporting Loved Ones Who Are Near the Edge

We live in a world where more and more people are medicated for mental health problems every year, yet the situation doesn’t seem to be getting any better.  There is however, an alternate model to the current system of mental health care which has seen success, especially for those experiencing their first mental health crisis. In simple terms, it’s an approach that steers away from labeling these involuntary states of non-ordinary awareness as sickness and instead works towards allowing the time and space for a natural process to unfold, whereby the person has the opportunity to emerge from the experience in a better state than before it started.

Conservative estimates suggest that one in five people will suffer some kind of mental health crisis during their lifetime, so it can be helpful to understand that there is a way of perceiving many of these challenges which doesn’t necessarily have to involve incarcerating your loved one or having them medicated (often for the rest of their life) to suppress these experiences. According to experts and teachers such as Stan Grof, Carl Jung, Joseph Campbell, Alan Watts, JW Perry and RD Liang, a break with consensus reality can be a dramatic re-ordering process that occurs as a natural response to the real sickness, the state of the person’s life before the ‘psychosis’. According to Grof, many, if not most occasions such as these are misdiagnosed as psychosis instead of what he and others refer to as Spiritual Emergency, Psycho-Spiritual Crisis or sometimes Kundalini Awakening Syndrome.

The Analogy of Birth

Let’s imagine someone coming across a woman in labour. Now, also imagine that both the woman in labour and the helper have no prior knowledge that labour and birthing even exist! The first instinct would be to get them to a hospital and make whatever is happening stop as quickly as possible because there is clearly something terribly wrong with the woman – which is actually not the case. This is the perspective used by Christina Grof, founder of the Spiritual Emergence Network, and it’s also a model that Ella Goninan, who runs a peer carer network called First Light in my local area, discovered for herself during her own crisis situation and now uses to help others. Much of the content in this article is applied by First Light.

Peer carers and health care practitioners who take a more spiritual or transpersonal approach to mental health, often perceive the experience more like a midwife or doula would, creating a safe space for a natural process to complete itself.  Soteria houses, Open Dialogue, the Spiritist Psychiatric Hospitals in Brazil and Diabasis clinics, are all examples of organizations who have worked with a similar approach. More details on these kinds of perspectives can be found in the UPLIFT article The Shamanic View of Mental Health.

It is similar to believing there is something wrong with labour.It is similar to believing there is something wrong with labour. Image: Moa Karlberg

‘Fit Your Own Oxygen Mask Before Helping Others’

The golden rule for caring for loved ones in crisis isn’t even about caring for others – it’s about self-care. Perhaps the most important thing to keep in mind at all times is that caring for people in crisis tends to be far more taxing than people realise, and that if you as the carer become depleted and/or destabilized then you aren’t actually able to help your loved one anyway. This can even include the very sensible decision to not attempt to be a primary carer at all for a loved one during their crisis.

Assemble a Team of Peer Carers

Some people going through an intense crisis will often require someone to be with them at all times, while others may only require regular phone calls and visits. For those who require constant supervision and care, having a variety of different people coming and holding space can be helpful both the carers and the person in crisis, as it’s always nice to feel supported and cared about by one’s community. A balance needs to be found to ensure that this doesn’t become a source of agitation. 

Sometimes people experiencing a spiritual emergency, or psychosis, won’t sleep for extended periods of time and it’s good to make sure someone is with them, as their ability to make good decisions for themselves can be diminished, to say the least.  In cases such as these, working in shifts to hold space, allows carers to follow the golden rule of attending to self-care as the number one priority.  It can be helpful to check in, leave a note or have a book for keeping track of when the person ate, drank fluids and, most importantly, slept – and for how long, if at all. This info needs to be passed on at shift changes.

Sometimes the variety of different people coming and holding space can be helpful in itself.Sometimes the variety of different people coming and holding space can be helpful in itself.

Assemble a Team of Practitioners

The best case scenario is to also assemble a team of therapists, doctors, and practitioners of other healing modalities who are aligned with and supportive of taking a more transpersonal approach.  This could involve a counselor or therapist, a massage therapist, a Traditional Chinese Medicine practitioner etc., as well as a family medical doctor, and/or psychiatrist. The point is for you all to be on the same page about what kind of approach you wish to take, instead of having doctors with strong opposing opinions to the other practitioners you feel are important and vice versa. It’s also important for your team of peer carers to have the contact details of these people for support, as well as for appropriate handover if things ever happen to get too challenging for members of the peer carer team.

The Power of Lived Experience

Sometimes a team of peer carers can be brought together from friends and loved ones, but also friends of friends. In particular, seek people who are strong, resilient, calm, peaceful, friendly, compassionate, and best of all, people who also have experienced the challenges the person is going through.  These are the true experts in our community: those who have made it through to the other side and are now strong, stable, and centered enough to offer insight, guidance and support to others.

These are the true experts in our community: those who have made it through to the other side.These are the true experts in our community: those who have made it through to the other side.

Remove All Agitating Influence

The importance of this point cannot be overstated. If there are people that cause the person agitation, including the closest of family members, it is very often better for them to be removed from the situation.

This is also true of the space that the person is in. Wherever possible, reduce stimulation and create a space that the subject feels safe in.  Sometimes noise and stimulation like loud music can be a tool to try to avoid actually going through the process that is occurring and can in the short term be of benefit, however in the long-term, this avoidance can be a hindrance. Perhaps the best environment is in nature, out of the noise of traffic and the potential concerns of what neighbors might think. Numerous studies now show the benefits of nature immersion on the human body and mind.  For those experiencing crisis, the peace of being in nature for extended periods of time is one of the most healing things that can be arranged for them.

Deep Compassionate Listening

There’s often an urge to try to fix people.  It can be helpful to recognize that this may be more about your own discomfort than theirs.  Perhaps the best approach of all is to accept them as they are.  Listen deeply with compassionate acceptance.  Do your best to avoid telling them what to do and giving advice if it wasn’t asked for.  And if it was, do your best to keep it distilled to something potent but brief. Try encouraging them to answer their own questions for themselves.  Help them to trust their own inner guidance.  If they say they feel like they need to go outside and scream, then let them (see why being out in nature can be a good idea?). Of course, if their inner guidance is leading them to something that could lead to harm or serious negative consequences then use discretion. For more info on the power of deep listening practices check out An Indigenous Approach To Healing Trauma.

Help them to trust their own inner guidance.Help them to trust their own inner guidance.

Avoid Invalidating Their Experience. Instead, Witness and Allow Possibility.

When you encounter a loved one who is having experiences outside consensus reality, there are a number of possibilities regarding what is happening.  Mainstream medical science says that though the person thinks what they are experiencing is real, it is in fact delusion.  The person having the experience will often feel completely sure their experience is definitely real.  When taking an approach more aligned with transpersonal psychotherapy, traditional indigenous perspectives, or spiritual perspectives there is another option.  This is to simply avoid invalidating, without confirming or denying.  It’s an approach used in the western world by hostage negotiators – to basically never disagree with the person who has become unhinged, but in this application, it is disingenuous.  The negotiator says anything they need to, in order to get the desired result, but in our case there are no hostages, only a loved one struggling with their experience.  For those taking a more spiritual approach to mental health crisis, the choice to avoid invalidating your loved ones experience isn’t disingenuous and isn’t so rigid about agreeing with the person either.  It can instead be rooted in a humble awareness that the universe is far more complex place than science can yet measure and understand.

It can be a tricky to find balance between not invalidating a person’s internal experience, and not feeding and contributing to delusion.  Perhaps the best approach is to simply remain impartial. Simply allow what Jung refers to as something like the content of a waking dream to unfold and allow the possibility that it is, on some level, real. At the same time, however, allow the possibility that it may be delusion.  Refrain from choosing one or the other, and when your loved on tries to convince you that their experience is real, you might try being honest in telling them that you’re not having the same experience, but this doesn’t mean their experience isn’t real.  It may be real and it may not.  Honest, without invalidating.

This can be a much more effective approach to helping them understand that they are not experiencing consensus reality.  As a person comes back into self-awareness and understands that they aren’t experiencing things in the same way as everyone else but they are not judged for that, there can be a tangible improvement in the situation as this means some insight has returned.

Everything you can imagine is real. – Pablo Picasso

Taking a head on approach and telling them that their experience isn’t real, on the other hand, can have a counter-productive effect as it can be a source of agitation, and as we’ve learned, removing agitation is a primary focus. It can also cause their circle of trust to contract to the point where you are no longer in it, which is a problem that can take a lot of time and effort to overcome.

Allow the possibility that it is, on some level, real.Try allowing the possibility that their experience is, on some level, real – without believing.

Help Them Remember What They Already Know Works For Them.

Depending on what kind of state they are in, sometimes it can be helpful to ask them to try to remember what kind of things have been helpful to them in the past, particularly if they have been in crisis before. If you manage to find things that have worked before it can be helpful to gently remind them of these things from time to time.

It could be as simple as knowing that having a hot bath helps them feel calmer and more relaxed.  Once you know this is a tool that is helpful, suggesting it later when needed can really help a lot, particularly because it is wisdom that originated from the person who is struggling and this is much more empowering for them than them trying to take on everyone else’s ideas of what they might need to do next.

Don’t Take Anything Personally… Ever

This can be one of the most challenging aspects.  Often when a person is in crisis, they have emotional pain and discomfort that needs to come out.  Unfortunately for carers, this can mean this pain can end up being purged all over the person who is on the front line providing support.

Don’t let people pull you into their storms, pull them into your peace. – Kimberley Jones

Whatever happens, it’s really important to respond instead of reacting.  This perhaps is the most crucial skill of all.  By observing without judgment, accepting, and allowing, you’ll be able to avoid getting upset or offended. More importantly, it allows you to not get tangled in the drama. When you witness the drama, you remain outside it. When you judge any of it as good or bad, you are suddenly inside the drama on one side or the other.

When things are at their worst, the person may try to push everyone away.  Patiently waiting for the storm to pass with a tone of loving kindness is the best possible way forward, even when you’re being emotionally battered by the storm. For an excellent summary on holding space for people in general check out the UPLIFT article ‘What It Really Means To Hold Space For Someone’

Whatever happens, it’s really important to respond instead of reacting.Whatever happens, it’s really important to respond instead of reacting.

There is a Limit: Danger To Self or Others

A carer can be the most patient and compassionate person in the world but if the person being cared for makes you feel unsafe, or you feel that you are unable to keep them safe, it is time to find someone else who can, which in many cases means calling emergency services and getting help from a mental health team.

The Decision to Offer Care Shouldn’t Be Made Lightly

The truth is that this approach may, in fact, be a much more ideal way to deal with many, or most forms, of mental health crisis. It is my contention that this may be the very reason why the World Health Organisation has found that non-western countries that still practice folk medicine, and who believe in spirit in some way, have tangibly better mental health outcomes than western medicine.

The decision, however, to care for a loved one in such a state can be akin to deciding to do a home-birth for a labour that could last much longer than expected. A mental health crisis could last days, weeks, months, or even years. It’s easy to see why the western medical profession doesn’t readily explore this approach, partly because the large amount of hours required for 24hr care, making it something that is often only achievable through the generosity of volunteers, or by setting up Soteria Houses or other similar systems. In short, doing it right and focusing on genuine healing is not as financially as viable as temporarily suppressing symptoms with drugs. It is also easy to see that as mental health crises increase in our culture, the long and slow approach may, in the long run, be the approach that actually starts to heal the situation and turn the epidemic around.

You and your team may have little experience, but to some this may seem like a better option than taking your loved one to a system that, to use the birth analogy once more, doesn’t even acknowledge that birth exists and whose only approach is to use drugs to suppress the contractions and make them cease.  It should be noted here once again that even if the western medical profession is not your preference, it is important to call them anyway if the person you are caring for is ever a danger to themselves or others.

If you’re seeking community support from people who are aligned with this perspective check out The Shamanic View Of Mental Illness on Facebook.

Feature Image: Artist Unknown

Read Next: What it Really Means to Hold Space for Someone

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Jonathan Davis

Amplifying personal healing and growth for collective evolution.

 

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3 Responses to How to Hold Space for a Mental Health Crisis

  1. Related to the birth analogy: “For a seed to achieve its greatest expression, it must come completely undone. The shell cracks, its insides come out and everything changes. To someone who doesn’t understand growth, it would look like complete destruction.”- Cynthia Occelli

  2. Great article, and potentially helpful for a lot of people! I believe another common misconception regarding mental illness is believing psychosis in itself is the problem. It is not. Whatever amount of pressure led to the psychotic break was the real problem. Psychosis is only the resulting collapse, and it is important to note that collapse equals shedding the unbearable load that had been carried before. Expecting the collapsed person to pick the debris of dysfunctional habits and relationships back up and resume life exactly as it had been before would be pushing them back into the same old, destructive treadmill that made them fall in the first place. As horrifying as the experience of psychosis is, it is also an opportunity for rebirth within the same lifetime. Psychosis should never be stigmatized as a dooming diagnosis, but considered as the possible starting point for a fresh go at life. Someone in psychosis needs loving help and understanding to move through their crisis, not judgment and isolation.

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