The following article has been reprinted from the PJSA. It is old and although checked for accuracy (using spelling in British English!) it is possible that reference numbers or other typographical errors have arisen. Nevertheless, as this paper reflects the pioneering work in the area of subjective anomalous experience in relation to clinical psychiatric frameworks, it may be of enormous importance to phenomenologists and researchers and it is reprinted here for academics.
Vernon M. Neppe BA, MB, BCh, MMed (Psych), PhD (Med), DPM, FF Psych (SA)
Parapsichiatry Ego-boundary disturbance Subjective paranormal experience Psychodynamics Delusion Psycho-organic states Hallucinations Phenomenology
Abnormal symptoms in the psychiatric model may be perceived as no subjective experience to the parapsychologist. An attempt to reconcile these poles and guiding principles suggested for differentiation of subjective paranormal experience from psychotic hallucinatory, delusional and ego-boundary disturbance. The possible explanatory models of the psychodynamic acid psycho- organic schools are then examined. A shift of perspectives at the content-form and biopsychosociocultural level is suggested.
Phenomena, a are generally perceived from within the framework of one’s training. A person who describes waking up and finding himself outside body such that he ‘could see his physical body’ and could not move it would be described by the parapsychologist as having had 'an out-of- body experience’. The psychiatrist may record the experience as extreme ego-splitting with sleep paralysis'. Both these specialists cave described a single experience within the perspective of their discipline. From the parapsychological standpoint, frequent 'out-of-body experiences would be described as normal; the psychiatrist may delve deeper into frequent episodes of 'extreme ego- splitting with sleep paralysis': he will generally regard this as a ‘symptom' of underlying abnormality. There appears to be a need to reconcile these poles.
This paper is concerned with phenomena generally classified as ‘psychic’ ('psi', 'paranormal'). It is not concerned with whether such experiences are objectively paranormal or not. It analyses only the phenomenological facets of such experience. These are essentially subjective. Examination of such 'subjective paranormal experience' (SPE)' can allow psychiatric
* (At that stage) Dept of Psychiatry, University of the Witwatersrand
Parapsychological; J. of S.A. 1982, 3:1, 6-16.
7
interpretation of SPEs. This appears to prejudice the issue as the-psychiatrist is labelling such phenomena along a psychopathological continuum.
Psychiatric understanding of SPE is base on the medical model. This perceives subjective experience as 'symptoms', and phenomena which one elicits via examination of the patient/subject as 'signs'. Because the majority of SPEs are perceptual in nature, these would be symptoms Those SPEs which involve objective change in objects or events (i.e. the psychokinetic groups of experiences) may theoretically allow the eliciting of positive physical signs because environmental change would have occurred. In practice, information obtained is almost always retrospective and, even ostensible psychokinetic phenomena would be elicited via taking and thus could technically be regarded as a symptom. This paper deals exclusively with the perceptual facets of SPE ( i.e. subjective paranormal perception); it does not discuss the motoric aspects of SPE ( i.e. alleged psychokinesis).
Although a fair amount of literature deals with psi psychopathology, particularly the writings of Ehrenwald, Ullman, and Eisenbud, there is very little literature discussing specifically the psychiatric interpretation of subjective paranormal experience. One useful perspective, however, is Reed’s excellent treatise on ‘Anomalous Experience’. This book outlines the cognitive psychological explanations of several kinds of claimed 'psychic' experiences. Although there are certain psychiatric guiding principles to this problem psychiatry itself is not a discipline which allows unanimous consensus in either eliciting or interpreting such 'Symptoms'. The major psychiatric principles which require no elaboration are the concepts of ‘hallucinations’, ‘delusions’, and 'disturbed ego-boundaries'.
A hallucination is a false sensory perception occurring in the absence of any relevant stimulation of the sensory modality involved 8, p3330. Hallucinations may involve any perceptual type - auditory, visual, olfactory, gustatory, kinesthetic, somatic, vestibular or tactile; occasionally they even be synaesthetic - where one modality is perceived as another (e.g. hearing a colour). Hallucinations are generally regarded as 'abnormal' by psychiatrists except when they occur during certain physiological altered
Neppe, V.M.
states of consciousness e.g. just prior to sleep (i.e. hypnagogic) and while waking from sleep (i.e. hypnopompic).
Generally, hallucinations are regarded as regarded psychotic conditions - in these cases they occur spontaneously; they are often frequent, or are of long duration; they are complex in character involving content; they involve the whole personality and refer to the percipient himself; they have cognitive or emotional significance; their content can frequently be interpreted within the context of the experient's needs or fears; they occur suddenly, are fully formed and clear; they involve a conviction as to their being outside the person's own space (i.e. they are external and objective), and they are regarded as concrete reality'. Usually they are not under voluntary control. Thus hallucinations in the psychotic have a special form.
Hallucinations, however, have been described in a significant proportion of ostesibly normal people. Two British surveys, fifty years apart, the first very large (Sidgwick and Committee in 1894 involving 17000 not quite randomly. chosen subject 5) and the second smaller but still substantial (West's one in 1943 involving 1519 subjects) yielded a population life-time incidence of 9.9% and l4.3% respectively. Sidgwick's study, although limited methodologically by today's standards, found that the number of unexpected death coincidences involving hallucinations exceeded chance probability by a factor of 440. Because of this, parapsychological hypotheses have been suggested.
Hallucinations are common forms of SPEs. They may particularly involve extrasensory perception (ESP) occurring while awake, and the perception of ‘presences', of which 'apparitional experiences' constitute presences of well-developed visual kind. Hallucinations occur as a detailed form of waking ESP when a paragnost to see or hear or otherwise experience perceptions from outside himself which relate to events in the past, present or future. He may interpret such a spontaneous phenomenon as 'paranormal' if it were unusual and of a non-inferential character, and if it had a close temporal manifest and meaningful relationship to, the actual event . Thus, a dichotomy, exists pertaining to hallucinations in the parapsychological-psychiatric psychiatric context. The two poles of criteria listed may, theoretically, easily differentiate such subjective experiences.
Parapsychological...J. of S.A. J. of S.A. 1982, 3:1, 6-i6.9
The problem of interpretation would arise when a paragnost has a hallucinatory experience which post hoc, turns out to have only dubious or no meaningful relationship to real events. Such phenomena would best be interpreted in the context of the whole clinical picture - as reflected by both history-taking and examination, and examination; particularly of the mental status. Hallucinatory experience influencing or referring to the percipient himself and intruding into his personality such that his functionality is impaired, must be perceived to a high functioning person who has had numerous SPEs some of which he has validated.
Experiences in which ‘apparitions’ are allegedly seen, or the ‘presence’ of an unseen being has been alleged are hallucinatory in that there is no relevant external stimulus to induce such a perception. They appear to occur to 'normal' people, particularly in the elderly: thus Neppe found that 59.6% of his 57 generally 40-70 year old subjects had perceived ‘presences’ 14% frequently; and Heraldsson’s Icelandic survey showed that 31% of his population (N-902) had experiences of apparitions of the dead and the living.
The psychiatric interpretation of ‘presences’ usually relates to an increased level of suggestibility which fulfills a need within the generally depressed elderly, widowed percipient. The sense of ‘presence’ is culturally perpetuated by the legend of such occurrences, is predisposed to by fatigue and loneliness, and pertains to an apparent cognitive set of impressions resulting from above7. The experience may not necessarily be hallucinatory instead, it may invoice an illusion - in this instance, there is a special perceptual stimulus (such as a curtain moving in the dark) which is misinterpreted. It is highly probable that the hallucination-illusion explanation of the 'sense of presence' is the most suitable one for the majority city of such experiences. However, it is more difficult to explain cases of collective apparitions (40% according to Tyrell) - and some of the detailed cases described by Tyrrell13, and later by Green and MacCreery.
In contrast to the hallucination, is the 'pseudohallucination': is this an unprovoked perception is experienced within the percipients' inner space (i.e. in his head), it is subjective, does not appear to be part of the external reality and is non-substantial. The 'pseudohallucination' is probably the most common kind of psychiatric equivalent to the
Neppe, V.M.
10
ESP ‘feeling’ or ‘impression' or the paragnost suddenly and often spontaneously obtains an impression inside his head of an event which turns out to be contemporaneous (i.e. in the present.), precognitive (i.e. in the future) or rarely retrocognitive (i.e. in the past). This is usually auditory or visual, but is sometimes just described as 'meaningful', not involving specific modalities.
Frequently, such an 'impression' has a great deal of conviction. It is usually fragmentary and it is often coloured by the conscious or unconscious images, memories or emotions of the percipient 7. As with the hallucination proper, the interpretation of such a pseudohallucination should be in holistic context.
An 'impression' or 'feeling' nay become strongly fixed in the experients belief system. It may become a belief, the truth of which is firmly held, despite others regarding such a belief as patently untrue or extremely unlikely. The experient may, further, not regard such an impression as illogical. In this instance, the 'impression’ may apparently fulfill qualities of a delusion. To other members of his culture it would regarded as a 'false’, fixed belief that is held against objective and obvious contradictory proof to the contrary.
Delusional thinking is a hallmark of psychosis, as its content indicates the experient is cut of touch with reality. In the context of the paragnost, his hallucinatory or pseudohallucinatory perception may lead to interpretations in which he firmly believes; alternatively, he may develop a vague knowledge (a 'feeling') of some kind of impending event, or about a particular object or person, which appears irrational - this may therefore, be a delusional idea; similarly the 'psychic' may describe first ‘a sinister, awry sense of something being different' and this delusional atmosphere may lead him onto being 'aware' of certain specific or vague information. 15 Thus, such awareness, interpreted as psychic, may alert the experient to certain information on which he 'may act. The situation may be further complicated by the 'psychic' believing' that outside agencies such as dead spirits or a higher power are guiding him.
The fixed ideas of the ‘psychic’ may therefore appear delusional to the psychiatrist. Alternatively, the latter may argue that such beliefs,
Parapsychological. J. of S.A. 1982, 3:1, 6-16
11
although aberrant within the larger culture, are not deviant within the spiritualistic or other cult micro-culture to which the 'psychic' may belong. This micro-culture may consequently validate the paragnost’s beliefs which may therefore be functional and meaningful. The situation is even more complicated, however: Rogo stresses how psychotics may be drawn into the psychic community and have their delusions reinforced16. On the other hand a normal functioning 'psychic' who is not a member of any cult micro-culture may have belief systems which contradict his wider culture: would this imply he is psychotic? Nor can post hoc events be interpreted as necessarily assisting. Thus, if the psychic’s 'delusion' comes true, doctors cannot by the fact unlabel it to 'non-delusional' : psychiatrists must base their interpretations on the here-and-now, realizing that future objective validation of the ostensibly strange ideas may never occur.
In my opinion, a prime differentiator of psychotic from psychic delusions must relate to the degree to which the experience interfere with the experients functioning. The degree of self reference and influence these ideas have most probably will parallel the actual degree of psychopathology. For example, a patient presents for the first time with the awareness that she will die that year in December and who is able to elaborate numerous previous subjective paranormal experiences will most probably become extremely anxious, because of, or concomitant with, her awareness. Such awareness is in my opinion, delusional irrespective of whether the self-fulfilling prophecy of Dying in December occurs, and irrespective of whether she has influenced her micro-culture to accept her awareness.
The third guiding principle in analyzing SPEs psychiatrically is the concept of ‘ego-boundary’ disturbance’. The ‘ego' is that part of ones psychological functioning which mediates between the person, his instincts, needs and moral behaviour and the external reality of the real world. Intactness of the ego-boundary relates to the ability of the ego to differentiate the real from the unreal and to discriminate between self and not-self.
Ego-boundaries are characteristically greatly disturbed in schizophrenia. In schizophrenia, the patient has a disorder in which his thoughts, emotions, drives and instincts may be perceived by him as controlled or influenced by external agencies; the patient may believe his thoughts are not private, that they are being extracted from him, or being broadcast.
Neppe, V.M.
12
or being interfered with or blocked. Greyson points out how such ego-boundary disturbances could be regarded as disturbances of extra-sensory communication and, in fact, how commonly schizophrenics believe they have. telepathic abilities (40% ; N-20)17. Such impressions may be falsely based as numerous studies of psi abilities in psychotics have indicated that the incidence is no higher than in the general population using conventional test methods. However, it is possible that the measuring instruments and procedures adopted should have been differently adapted to the psychotic; Ullman, in fact, stresses his clinical impression of pre-psychotic being more sensitive to ESP than the normal . It is such a finding that led Greyson to question whether telepathy in mental illness was the deluge causing illness or the delusion - a result of illness 17.
A second condition in which the ego-boundaries are grossly disturbed is in hysterical dissociation. In dissociative states, there is a sudden temporary alteration in consciousness, identity or motor behavior. The subject may not remember what he has done during this period, and one extreme example of dissociation (either hysterical or schizophrenic) may be the multiple personality. The relevance of such phenomena to the trance state is mediumship is obvious. Trance mediumship can be explained as an altered state of consciousness in which dissociation occurs such that a group of unconscious mental processes in the medium may be verbalize or otherwise expounded, and yet is denied by the medium as having its source in his unconscious. It is easy to see how such phenomena ran be attributed: to outside agencies such as discarnate spirits.
The explanation of material deriving from the unconscious in trance. mediumship received a filip from the ‘Philip experiments' in Canada1 and similar replications elsewhere25. In these the sitters developed a fictitious 'discarnate' personality. They found they could communicate with him suggesting that the sitter a unconscious was playing a major role.
The idea of ego-splitting can also be conceived as an ego-boundary disturbance. In this instance one may feel detached from one’s -body and outside oneself. This out of body experience psychiatrically be explained as a result of ego-splitting due to a defense against anxiety. Thus basic terminology in psychiatry -hallucinations, delusions' and ego-
Parapsychological J. of S.A. 1982, 3:1, 6-16
13
boundary disturbance - is useful in explaining how subjective paranormal experience can be conceived medically. However, such explanations should be understood in the context of a hierarchy of explanatory levels, as conceived elsewhere by the author21 and George Devereux22. Table 1). Only two of these have psychiatric relevance: the ante-familiar and pseudo' -familiar levels.
| KINDS OF FAMILIARITY | BASIC DESCRIPTION |
|---|---|
| A. NON-FAMILIARITY 21 | Unmeaningful coincidence - pure chance |
| B. REAL FAMILIARITY 21 | Ordinary physical explanations e.g. fraud |
| C. QUASI -FAMILIARITY 21 | Inclusive term for 6 subtypes below; these require explanations of special kind: |
| LATENT FAMILIARITY 22 | Sensory hyperaesthesia explained in ordinary physical framework |
| PSEUDO-FAMILIARITY 21 | Due to Some brain disturbance in the percipient (experient) |
| ANTE-FAMILIARITY 21 | Explainable via unconscious (particularly psychoanalytic explanations) |
| PARA-FAMILIARITY 22 | Modification of conventional physics required |
| META-FAMILIARITY 22 | Modification of conventional physics is insufficient; radical alterations of one's world view are necessary |
| QUERY FAMILIARITY 21 | At this point which kind of quasi-familiarity is involved is uncertain |
Ante-familiar explanations of SPE conceive of such experience as being due to explanations which are rooted deeply in one’s unconscious mind. This explains such phenomena as telepathy or clairvoyance by means of psycho-dynamics - unconscious motivations influence one's personality and behavior: this is misunderstood as telepathic. Some, such as the Jungian school, imply that such paranormal phenomena may be possible because a 'collective unconscious' on the other hand, the classical psychoanalysts could explain all such phenomena by finding associations with such experiences deep in one’s unconscious. The modern day psychoanalysts, particularly Eisenbud , Schwarz23, Servadio24 and Ullman5 have argued that telepathic information intrudes into psychoanalytic treatment. These ideas are strongly supported by Tornatore’s finding (from a much larger sample) of ostensibly psi phenomena at certain turning points in psychotherapy in 47% of psychiatrists reporting psi in therapeutic Situations.
Using the ante-familiar explanation of psi21, ESP has been attributed to several different psychodynamic mechanisms: "defective reality testing, exceptional imagery, regression to narcissistic omnipotence or to symbiotic fusion, escape from existential isolation, projection of aggressive or sexual impulses, flight from reality and compensation for personal deficiencies, unconscious perceptions accompanied by identification and a desire to acquaint forbidden knowledge"17. These explanations may co-exist. The major feature they illustrate is how ESP can be regarded as a 'symptom' within a model of abnormal psychology. Exactly which symptom is hypothesized may well depend more on the psychotherapist than on the subjectively telepathic experience.
It is particularly in the context of subjectively paranormal dreams that that the psychodynamic (ante-familiar) explanation of psi is valuable. Dreams are perceived as states in which primitive, primitive prelogical thinking abounds. They provide an outlet for a disguised for of unconscious thinking. The dreamer may, by mistake, easily come to regard his needs, desires, or fears of a particular person or event as revealed in a dream as psychic.
Pseudo-familiarity may be regarded as 'the brain abnormality explanation of psi phenomena'; SPE phenomena is due to some brain disturbance in the experient. Under this category, fall those features of functional psychosis such as the hallucination, delusion and ego-boundary disturbance. However, pseudo-familiar explanations of SPE also include the numerous range of possible explanations for SPE. For example the author has shown that SPE in some way be related to the temporal lobe6. One method of interpreting these results would be that 'psychics' have dysfunction (or even epilepsy) of their temporal lobes and their experiences are based within the brain. Similarly, Ehrenwald pointed out how the distortions of telepathic pictures resemble those of parietal lobe damaged patients: thus, parietal lobe dysfunction would be a possible explanation (although in my view the evidence is weak).
Parapsychological. J. of S.A. 1982, 3:1, 6-16
15
This article has suggested numerous psychiatric explanations for SPEs implying that it claimed psychic experiences are abnormal. Such a conclusion should be viewed very carefully because of the remarkably high incidence of all kinds of if SPE in the general population demonstrated in at least six countries. In my opinion, labeling all such SPEs 'pathological' would result in most of the population being regarded as abnormal. The most fundamental dichotomy appears to be the emphasis of parapsychology on content of the experience, and phenomenological psychiatry on the form of the SPE. A shift1 of orientation would probably be worthwhile. So would the appreciation of the predominantly biopsychological model of the sick patient in medicine as contrasted with the more sociocultural model of the normal paragnost in parapsychology.
Neppe, V.M.
16
57
PJSA 1985, 6:1, 57-72
Copyright ©1997- 2002 Pacific Neuropsychiatric Institute