Psychosis as a Dialectic of Aha- and Anti-Aha-Experiences

Psychosis From a First-Person Perspective

In this article, I offer my first-person perspective on psychosis. To help clarify the devastating impact psychosis can have, I use notes I took during my psychotic episodes and combine them with my training as a philosopher. I describe psychosis as a dialectical process of aha- and anti-aha-experiences that destabilizes and completely undermines a personal framework.

Loosing Grip on Perspectives

The onset of my first psychotic episode started distinctively with changes in perspectives, gradually undermining my position. At first, this started with sudden new perspectives on problems I had been struggling with, later the world appeared in a new manner. Even the places and people most familiar to me did not look the same anymore. Yet, it was not a matter of hallucinations or delusions but implied changes in my lived world as a meaningful whole: the perspective I held on things and people.

The well-known account of the schizophrenic patient Anne, that the German psychiatrist Blankenburg describes, illustrates that losing grip on perspectives is not unique to my own experience with psychosis.

“ I can’t find personal rest, as if I had no point of view… I have no firm position faced with the thing… The others see only the right questions… the natural problems… I don’t know how to manage with other men and with this flaw … others, life and so on, it’s always like that… in a framework… What I lack, it’s according to what we behave …”¹

From a Cognitive Perspective

Arguably, our everyday perspective on the world is not an objective representation of reality, but is on the contrary very selective, subjective, and dependent on life experience. The way we interpret the world around us depends on a framework, formed over time. This framework offers a more or less stable and consistent perspective, while giving us the feeling that our perspective is an objective point of view. For instance, how we interpret the behavior of others is dependent on our knowledge of the situation, the behavioral patterns of others, and the connection of these patterns to ourselves in a commonsensical manner. We have different interpretations of the same situation. In a healthy state of mind, we are aware of different modes of interpretation, but we have a sort of core interpretation around which these other possibilities circle, tied up closely to our personal identity. These habitually formed patterns of interpretation put constraints on how we interpret the world and how we interact with others, or in other words, structure our experience, action and interaction in such a way that we do not have to reflect on everything constantly. In a psychotic state, this pre-reflective framework appears to break down and give rise to a multiplication of perspectives. As a result, the own “core” interpretation loses its place as an “objective” ground. In other words, other perspectives invalidate or undermine this former centre of interpretation. Important to understand, I believe, is that psychosis affects this pre-reflective framework that makes the world appear as familiar, stable, and trusted.

From a Perceptual Perspective

Looking at things from a new perspective is an important process that accompanies growth, learning, and development. What is salient in one’s perceptual point of view results largely from life experience. Different (aspects of) objects are salient for different persons. If an architect and a mason look at the same building, they will visually notice other things. An educated musician compared to a layman will not have the same auditory experience when they hear the exact same song. The musician will, for instance, recognize the guitar, the amp, the effects or the type of snare drum. When tasting a good wine, a sommelier will have a different olfactory experience than someone without knowledge and experience of different wines, being able to differentiate more. Salience is thus highly subjective, not a direct correlate of the world, and there is no such thing as “neutral” stimuli. All these different perspectives have similarities, but in a way constitute different worlds. Although one can argue that a more developed view on the world is more “accurate” compared, for example, to the perspective of a child, both perspectives are real and have in this sense an equal sense of realness. In this way, there are different gradations of perceived reality.

During psychosis, I could suddenly notice things that had never grabbed my attention before. I perceived the world anew as if awaking from a dogmatic slumber. In part, this implies a realization and seeing of complexity in things that we normally take for granted, which makes one literally question everything. It is like an opening up to different perspectives without being able to understand what is going on. It is not purely and inseparably perceptual, but also concerns social and interpersonal elements, like one’s sense of identity, how one looks at past and present and how one sees others, social structures and roles. Not only was this sensitivity directed outwards, it also became focused on my experience itself. This process was extremely devastating because it felt as if the way I conceived people, roles, situations, time, my own convictions, identity and so on suddenly seemed enormously insufficient in every possible manner to understand this world before me.

The Aha-Experience

A notion that can help to make sense of the process of losing grip on perspectives is the aha-experience. The aha-experience is often defined as the experience of a sudden insight, a solution to a problem that presents itself, a sudden moment of clarity or a breakthrough. The aha-experience can be both of cognitive and of perceptual nature. One can suddenly interpret or literally “see” a situation in a new light. For instance, one can think of the well-known bistable images that require a perceptual shift to see either a young girl or an old woman, a duck or a rabbit.² An example that combines cognitive and perceptive aspects of the aha-experience could be a game of chess, whereby after a moment of insight, the game is “seen” in a new light; the pieces on the board do not move (the “objective” world does not change), and yet the game is seen from a new perspective. In literature, the aha-experience has earlier been connected to psychosis by several authors, most often in relation to the phase of onset or delusional mood.^3,4

The notes I took 9 years ago during the onset of my first psychosis illustrate this feeling of clarity and sudden insight. I started to take notes because the insights followed one another in an unprecedented manner. I had the feeling that if I would not write down my thoughts, they would be lost in the accelerating stream. These insights or sudden perspective changes in the first instance concerned my personal and interpersonal life and did not result from hallucinations. The following quote is an illustration of the feeling of the aha-experience at the onset or “breakthrough”:

“I don’t know if I will be able to explain, but I believe to have understood the essence of my existence… The word to which it all seems to come back, and what I believe makes me different from most people, is goal… Many people do not explicitly ask themselves what their existence is about, and why they want to reach certain goals apart from the happiness that is acquired by this, or furthermore, what this happiness is apart from a feeling, something that can’t be touched, something that is actually in their brains.”

From this point on, it took less than 2 weeks before I was acutely psychotic and admitted to a psychiatric ward. Further on in these notes, I described the feeling accompanying this onset as finding a key for something that had been locked. Compare the feeling described in the quote below to the aha-experience that can be like suddenly finding a solution for a problem one has been struggling with.

“It is a super weird feeling, from one day to the next, even from one moment to the next, it is as if I can think and reason clearly again… It even kind of seems as if I have found a key to something that has been locked for a long time.”

A quote from the same notes clearly illustrates the suddenness and the switch in perspectives:

“It really feels as if I am suddenly capable of putting things in perspective, that the light has suddenly switched on inside of my head and that because of this I am capable of reasoning again”.

The Anti-Aha-Experience

To better understand my experience in its entirety, I devised the concept of anti-aha-experience. The anti-aha-experience, as I define it, is an experience of a sudden insight that does not fit within one’s framework, convictions, or worldview. The anti-aha-experience refers to the same process of insight or shifts in perspectives but has a destabilizing effect that invalidates how one perceived things before. Anti-aha-experiences undermine one’s existential position in, and perspective on the world. While the aha-experience connects and reorients, the anti-aha-experience shatters into pieces and is literally and figuratively a disorienting experience.

This feeling can be related to everyday experience. Think of a fierce discussing with a friend, a family member or a colleague in which the other strongly opposes your point of view or opinion on a topic. You both defend a conviction with strong confidence and a strong feeling of certainty of one’s point of view, or of how one “sees” it. Now imagine the feeling that a sudden insight clearly disproves your point of view. The conviction you defended strongly and passionately is suddenly proven wrong. The entire framework that comprises this point of view is abruptly contradicted and needs to be reconsidered. What I label as the anti-aha-experience is the feeling that accompanies this process: a sudden realization that disconfirms how one looked at the world before, without offering new, solid ground.

In psychosis, this process unravels with much larger force. What happens is not just a deconstruction of a conviction or a perspective. This process, in my experiences, was wrecking what I considered to be my “personal worldview”. Like a conviction proven wrong, it felt as if evidence kept piling up against my entire view of the world. These insights and changing perspectives undermined or “derealized”⁵ how I looked at things before. In contrast to the positive feeling that accompanies the aha-experience, the anti-aha-experience is shocking, terrifying, utterly destructive, disorienting, painful, and difficult to understand or to explain to others.

The process I try to grasp with the aha- and anti-aha-experiences did not immediately result in delusional ideas, but led to a deconstruction of a personal framework first, only after that serving as a matrix for delusions. These aha-experiences and anti-aha-experiences were not just wrong or delusional but often showed the world from so many different perspectives that my own position had to be reconsidered over and over.

Where at first this dialectic process of changing perspectives concerned mostly personal and interpersonal matters, this expanded to more fundamental aspects of my existence and being in the world. Consider the quote below, where this expansion is exemplified by a reflection on time.

“The entire world runs on a time that people have invented. They did this by seeing a certain logic in things... (day, night, morning, evening, midday → half of a day) There is a recurrent logic in the way we reason about time… To really realize what time is, you arrive at the eternal questions, namely why does it become dark and light... In this you can go further again. Why does the sun move in front of the moon... And then (I think) you arrive at gravity... Then you can ask, why is there gravity... and then you can try to explain gravity... like this, you can keep going on until you’re not able to grasp things anymore, or someone else sees the logical connections and you are able to understand them. PI in mathematics? How far can one contain PI, or the absolute truth?”

The anti-aha-experiences, mixed in, were like a backlash of this shifting reality and resulted from the impact of seeing these sudden new perspectives. In my notes, I described this process as the feeling of a breaking of a dam, flooding the lands behind and leaving the landscape unrecognizable.

Aftermath and Recovery

Especially after my first encounter with psychosis, what I found most devastating was the feeling that I did not comprehend the world, myself or others anymore. It was as if experiencing psychosis completely destroyed the landscape that I once knew. After my first psychotic episode, I described this feeling as having lost “the right way” of looking at things, of acting and interacting with others. This experience has earlier been described as a “loss of common sense”.⁶

While delusions and the consequences thereof are embarrassing and frightening, it is not that aspect of psychosis that is so devastating. It is the complete loss of perspective on the world, and how one looked at things before: oneself, one’s friends and family, literally “everything” in the world. As I have tried to show, an important consequence for recovery is that there is not “one fixed reality” or perspective that one can return to after psychosis. Recovery was, for me, less a matter of losing delusional convictions than of actively rebuilding my comprehension of the world and regaining my trust in how I perceive myself and others.

Although I have gone through 5 psychotic episodes, resulting in 2 psychiatric admissions, recovery (and growth) was not the result of finding the right medication. For me, neuroleptics were even a hindrance in recovery; something I would not have discovered if I had not been studying and working. They impeded the return of natural fluency in my action, interaction, and thinking, and had adverse effects on working, reading and studying. Instead, people close to me patiently took me in tow in the world familiar to them, hereby offering me time and support to recover, rediscover, and re-establish my relation to the world I shared with them. At first, I was finding refuge in the world of other people, while the world I knew before had been torn apart. After later episodes, however, recovery was facilitated greatly because the roles, structures, and relations I had built were still standing. This enabled me to recover in real-world action and interaction: as a brother, a friend, a colleague, a student, a musician, a runner, and so on.

Recovery, in my experience, implies an active task in which abilities and taking up roles should be stimulated and developed. Much can be achieved by physical, interpersonal and cognitive challenges that appeal to the capacities of individuals and take place in real-world settings. This process does not happen overnight or without stumbling and falling. One needs to accept that the impact will hurt for a while, and just get up again and again, eventually becoming an expert getting-upper.

Funding

This work was supported by the FWO Odysseus grant to Prof. Inez Myin-Germeys (G0F8416N).