Two accounts of psychological change

How should growth take place?

Mainstream psychological theories tend to explain our inner struggles through gaps in our thinking and emotional development. To change, we must alter our erring thoughts and some patterns. Growth is about new, stable responses following psychological distress.

But distress exists in a wide range and many contexts. Extreme experiences are defined as illness, most often diagnosed, and treated. They push the concepts of hardship and growth into the physiological plane. Responses to distress are questions of health, and treatment is also about choices. I wanted to explore the distinct choices people make, particularly considering new mental health trends and conceptualization.  

The first choice: The embodied mind

In many places, if I cannot sleep for a few nights, I can be prescribed sleeping medication, before trying any other way. The same applies to anxiety symptoms. Medication is not envisaged as a last resort. Pharmacology is a dominant tool of the so-called biomedical approach to mental health care. We use it to treat even our slightly deviating selves.

The widespread application of this model is not without controversy and carries a lot of stigma, not only due to some of the known side effects. It has been viewed as a more serious method suited to severe disorders, as the history of psychiatry shows, which I will not get into here.

A key function of the biomedical model is that it provides relief without burdening the health system. It is aimed at mass results, which somewhat depersonalizes psychological problems. Here, the individual is passive in the treatment of her anxiety – just as she is when taking painkillers for a toothache.

A physical change – a reaction, takes place in our body, but at a level where we don’t have much ownership to claim. Though it is our bodies, our genes, our brains’ electromagnetic fields. Since these bodily attributes are autonomous, we cannot control or be aware of their hard work. In these treatments, we are mostly aware of symptom relief, up to remission, in the best case.

Such interventions change our bodies, but also our personalities, just like illness can. But our lack of phenomenal awareness and thus lack of personal involvement renders them technical and non-experiential. Because they work at a level that escapes language and awareness, they do not acquire much meaning.

Take transcranial magnetic stimulation (TMS) – a machine that interacts with the brain’s magnetic field to target certain structural activity that helps to reduce signs of depression (as well as others). This procedure typically requires 45 minutes per session and produces few to no sensations. During these sessions, the person and her technician are not in the business of explaining away or making sense of any personal emotional obstacles relating to depression.

The body does learn, it changes, it improves right then and there and afterward. It decreases activity or ramps it up – functional imaging shows the brain alive and moving. But these changes that take place are not under the scrutiny of awareness. We need an external image to be able to see them. What we feel is the result – preferably one of less pain.

The second choice: The conscious mind

What lies on the other side is almost a true parallel: the change we achieve through conscious thought and feeling. The ways humans use language and movement towards another course of psychological change.

Psychotherapy, self-care, any other non-medical approach, work with the active innermost. These approaches use language and awareness to rebuild ideas about the self, others, and the in between. They penetrate public life much easier because of their non-technocratic nature. They appeal to unique experiences through the universal human narrative: suffering through.

These ‘non-physical’ processes, as it were, can in fact affect both behavior and neural constitutions. Just like the medical model: they change the psyche AND the body. After cognitive behavioral therapy, some people with panic symptoms had less activity in the emotional, limbic system, and more activity in the frontal, known as the more rational part of the brain.

The non-medical care industry can still be clinical, and partakes in the discourse that sees pain and emotional problems as related to faulty structures of the self. Most types of psychotherapy and even self-help courses are designed to change models of negative thinking cycles, emotion regulation processes, and decision-making.

These attributes, unlike our neural structures, are interactive (to us) at the psychological level. It is possible to recreate stories, discover obsessive negative thinking, and understand our avoidant behavior. When we try to change our condition, whatever that may be, we work with these assumptions, challenging them and building new ones if need be. This posits us no longer as responsive chemical composites, but now as thinkers, choice-makers, and for many people, as believers. Because it involves an experiential level, it allows for more personalized accounts of pain and distress, of unhappiness. It is strictly about active, personal change.

Self-actualization is a private, hard-earned sacrifice. The narrative of self-improvement through arduous change has been ever present. In psychotherapy, it materialized somewhat in the original psychoanalytic ideas. But what strikes me as a methodical example came later in the 70s – the age of the self, when the person-centered school of Carl Rogers appeared. This famous psychotherapeutic model described a seven-stage, individual, laborious psychological process with the aim of – becoming a person. The final stage of self-realization is described as one that may take years, and that many people never achieve.

In fact, these notions recur across multiple approaches. To achieve the ideal self, to achieve wellness – we must engage in self-discovery and active transformation. And all this change is to be vividly experienced, and often, endured.

Many worlds

In many ways, all approaches can achieve their goal to make people happier, to reduce pain. But their striking contrast poses the question, does psychological change necessitate awareness?

In the up-and-coming psychedelic assisted psychotherapy, we’ve caught glimpses of the many worlds.

These approaches require people to experience the effect of psychedelics (e.g. MDMA, psilocybin). Very often this is done along with psychotherapy, which benefits from the deeper self-awareness that is facilitated by the substances. In this practice, and in psychedelic use in general, self-awareness is thought to be heightened through the so-called mystical experience, which was linked to psychological improvements.

Back in 1902, in “The Varieties of Religious Experience: A Study in Human Nature”, William James had described mystical experiences, among other things, to be ineffable: uncommunicable (to others), and noetic: producing individual intelligence (insight about the self). James’ account was about the power of introspective experience. That which cannot be transcribed for others to read, and helps to overcome inner struggle.

But some modern trials have looked at survey responses and therapy outcomes and found different results. Having this experience is not indispensable to the final positive outcomes. For many people, yes, but not all. This is also the basis for microdosing, where taking low doses of the drugs is done to reap the benefits without the vivid psychoactive experiences. The research is new – and it links to changes in a few known neural structures (i.e. in the prefrontal cortex) that are associated with many conditions.

What if the drugs would work well, with or without the mystical experience? For now, there is a sort of resistance in place, not necessarily repelling, between changing as an impersonal process, and changing as a private experience. But since they also meet very often, we cannot speak of delineation.

What plays the biggest role is the notions that frame our pain and distress. This is what has historically determined how we confront it. For illness, there is treatment and cure. For hardship, there is overcoming. Their processes, and the change they create take place across all levels. Some cellular that we never meet, and some as conscious as celebration.

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