Ed Podvoll and Jeff Fortuna
Dear Friends,
This Journal entry features a seminal paper by Edward Podvoll, MD, titled “The History of Sanity in Contemplative Psychotherapy.” It was first published in 1983 in the Naropa Journal of Psychology, and was republished in Recovering Sanity (2003) as Appendix II. Presented here is an edited portion of the full paper (also included here), which presents the key points with a special emphasis on a subsection, “The Urge For Discipline.” Dr. Podvoll was very proud, in his humble way, of developing the history of sanity perspective in the psychotherapy for persons in extreme states. He felt this was his most significant contribution to the world of healing, and to Windhorse theory and practice… Professor Manfred Bleuler, a dean of international psychiatry, wrote to Dr. Podvoll after reading this paper:
May I mention some particular points in regard to which I found your presentation particularly excellent: the importance of ‘the history of sanity’ is rarely mentioned in the psychotherapeutic literature. As far as I know you are the first who describes this in such a convincing way. It plays also a great role in my psychiatric work. The need to become free from the prejudice that a person who has become insane will always be so, is extremely urgent and you are formulating it very well. (Recovering Sanity, p. 5)
Having participated in therapy situations with Dr. Podvoll, I saw he had an extreme sensitivity to the personal disciplines embedded in the lives of persons in recovery. He was able to pick up the scent of those disciplines a mile away. He was skilled in inspiring the person to explore those often-obscured disciplines and how they could strengthen the process of recovery. “Discipline” here refers to a practice of joining mind with body and environment, with no connotation of harsh self-control.
Thank you for your interest in this revolutionary perspective, and I am certain you will appreciate Dr. Podvoll’s explication of this. May your instinct of sanity directly meet the author’s own finely-honed discipline and clarity.
Thank you,
Jeffrey Fortuna
The History of Sanity
Edward M. Podvoll, MD
Introduction:
The history of every being’s suffering and entrapment by forces of circumstance seems irresistible. We cannot help but feel therein lies the formative truth of our existence. This is understandable, as it is both a natural tendency of ego to find fault in others, and is culturally reinforced by almost all therapeutic belief systems.
Thus, the history of sanity has been obscured, or overlooked, or thought to be too simplistic. But, in Windhorse work, I have found that turning my own and everyone else’s attention to the history of sanity has the remarkable effect of loosening the tight hold of such neurotic identity.
Understanding the landmark events of the history of sanity is something of a paradigm shift that changes fixation on past (and present) suffering into an open view of basic goodness. In this view, the “instinct of sanity,” that which gives rise to all experiences of islands of clarity, is seen to be preeminent among the other instincts that drive our intentions and behavior, and is raised to its proper place in our ability to care for people.
In my own Windhorse treatment and teaching, the history of sanity has become the basis for all clinical case descriptions; the guide for developing a treatment program of basic attendance; and means for creating the treatment team.
History of Sanity:
There are two kinds of psychological history that we come to know when working with people. One of them is the history of pain, discouragement, missed opportunities, the continual accumulation of unfulfilled hopes, and the consequences of unrealized actions in relationships. Such a history of neurosis has a compelling quality that can capture and freeze a psychotherapeutic relationship into an endless dissection, searching for the origin of an inhibited development. On the other hand, embedded within the history of neurosis is another kind of history whose subtlety and evanescence make it more difficult to explore: it is the history of sanity. In order for a healthy development to begin within the psychotherapeutic relationship, it is necessary that both therapist and patient shift their allegiance toward the history of sanity. That shift of allegiance might be more possible if we can identify and clarify the landmarks in the historical development of health or sanity.
Marks of Sanity
The signs or trademarks of the history of sanity can be recognized in both the development and the current experience of all neurosis and psychosis. They could be divided into several categories. It should be noted that these categories are not derived from a conceptualization about relationships or a theory of development traced onto the psychotherapy; neither do they come from any technique or proposed strategy. This view stems from direct clinical experience and the categories are abstracted from a variety of clinical phenomena of patients during the phases of recovery. Interestingly enough, the therapist’s act of recognizing signs of recovery, whether within the person’s life cycle or on a moment-to-moment level, has the subtle effect of turning the psychotherapeutic relationship into an allegiance toward sanity.
[Editor’s note: the six landmarks of the history of sanity are reviewed in the following section. Five are briefly summarized and the entire section of #3 “The Urge for Discipline” is included here, as this was of special interest to Dr. Podvoll and shows the depth of his presentation.]
Repulsion
First, there is a sign of repulsion:fundamental estrangement and a feeling of nausea about one’s way of living. One is simply sick and tired of unceasing daydreams, instantly manufactured hopes and fears, and the endless repetition of habitual patterns of thought and action.
Beyond Self
The first hint of a longing to transcend self and an urge toward a fresh start can be provoked by experiences of body-mind synchronization. People in morbid states of mind, even in the grip of self-hatred, have said that their nihilistic depression dissolved in a moment while somehow “engrossed in activity.”
The Urge for Discipline
From the point of repulsion or nausea and then a longing to transcend one’s conditioned personality, there usually develops a desire for action toward making things more straightforward: a sense of pruning or paring down. A natural movement develops that has the quality of renewed energy. With it one feels a sense of urging toward simplicity and discipline. It could be as simple as beginning to make schedules for daily activities or meeting a therapist regularly; it could happen in a moment of cleaning one’s desk before working. The urge for discipline may develop over a long period or it may appear in a moment.
From the point of view of the history of sanity the therapist would be particularly curious about the details of the experiences of discipline that have taken place in another person’s life. The reasons why the history of discipline should be so precise are twofold: first, to find out exactly what another person understands by the nature of discipline and what his or her relationship has been to it, and second, because there is a possibility that within that discipline, there has occurred some insight into how mind and body work.
Everyone seems to have a basic curiosity about how mind works and this can be provoked even in periods of extreme disinterest or distraction. On looking into the nature of discipline, one often finds that one has learned more than one realizes. The practice of a discipline might have sharpened one’s accuracy to perceive smaller moments of psychological time. It might be exactly that quality of precision that will allow for the recovery of health.
An episode of discipline often stands out. One woman, who for several years drifted around the country and wandered from one source of entertainment to another until her aimlessness ended in despair and suicidal preoccupation, recalled a year of her otherwise futile college experience during which she went swimming every day, not a very dramatic memory, but the daily discipline had become a focus of her life; she had a sense of “taking care” of herself properly. Consequently, she studied in a more orderly way and felt some sense of development taking place. Rejection by a boyfriend ended all this. Her statement, “If only I had that kind of energy again,” turned out to be a comment on the accuracy and effort that resulted from her simple discipline. Within such episodes of personal discipline people often talk of a feeling of dignity, not necessarily because they were happy, but because there was a sense of doing something correctly and relating straightforwardly and pointedly to the rest of their lives.
Each seemingly mundane attempt at discipline carries within it the urge to work with one’s state of mind, by directly connecting or synchronizing physical and mental activity. It might be athletics, survival disciplines, art forms, cooking, collecting stamps, any of which can become highly discriminating disciplines that sharpen the senses and create further vividness and appreciation for the sensory world.
The history of the experience of discipline and “settling down” can give us important clues about working with people. How does a person relate to that discipline? What is the experience of effort? Is there a love-hate relationship with the discipline? What did they learn from it about cutting daydreams and taming the mind? How do they expand that to other activities? Who were their teachers and what were they like? These experiences can become intertwined directly with the psychotherapeutic relationship. The discipline of the relationship itself can become a prototype of how one works with one’s state of mind and with life situations in general. When the aforementioned musician in the state of mania became irritated by even the most simple daily structure that might harness his energy, he said, “It’s too much for me. I can’t do it.” When asked what he would reply to his young music student who had voiced the same hesitation many times, he said, “I would tell him to start again and take it very, very slowly.” His own advice soon became a useful guideline in his psychotherapy.
Yet any discipline can become perverted into the service of neurosis, providing all the possibilities for escape, avoidance, and trance states. That is, the discipline may be distorted into an activity that causes disconnection between body and mind, leaving mind unanchored, out of control, and free to hallucinate. From this point of view, the relevant history of neurosis involves curiosity about how such disciplines were lost, where and why they broke down, how they were perverted, and how the feeling of dignity was lost.
Compassion
Experience shows that people recover when their compassion is developed more fully. This is why the unfolding or the journey of compassion within the psychotherapeutic relationship is such a crucial factor in the awakening of one’s history of sanity.
Environment of Clarity
The clarity of the therapeutic environment is crucial to the practice of psychotherapy. The qualities of wakefulness, crispness, simplicity, and dignity provide an important environment for patients to observe shifts in their state of mind. It is that kind of atmosphere that might be the provocation that awakens one to the natural history of sanity.
Courage
The experience of psychotherapy teaches us about aspects of courage, both of the patient and of the therapist. The patient’s courage takes many forms, such as the effort to follow a path out of addiction, or the weaning from chronic psychoactive medications. The therapist’s courage also takes diverse forms, but the most comprehensive of all is the ability to be in a relationship beyond memory, repetition, or transference.
The practice of psychotherapy involves a therapist in the whole sequence of events, from revulsion to courage, just as it does the patient. The conventional psychotherapies have attempted to describe in detail the history of neurosis or pathology, but even the most useful, such as the concept of “developmental lines,” described by Anna Freud, neglect the developmental line of mind: wakefulness, inquisitiveness, and curiosity.
A genuine contemplative psychotherapy adds that crucially missing dimension, the training and study of mind. The various disciplines of contemplative psychotherapy can extend our understanding of mind and relationships. When one trains in this way, one naturally becomes interested in history from the point of view of sanity, and that gives rise to the development of compassion. From the perspective of the history of sanity, it is apparent that the pathway of psychotherapeutic training has the same form as the pathway to recovery from illness.
Jeff received his MA in Contemplative Psychotherapy at Naropa University in 1980, and served on the Naropa faculty until 1989. In 1981, he co-founded the first Windhorse center, Maitri Psychological Services in Boulder, CO. From 1989 to 1992, Mr. Fortuna founded and directed a Windhorse group in Halifax, Nova Scotia. In 1992, he co-founded Windhorse Associates, Inc., and served as Executive/Clinical Director. In 2002, Jeff returned to Boulder as a co-director of Windhorse Community Services,Inc. He retired from his co-director role in 2013, yet continues to serve as a senior clinician and educator. He has taught widely, and written a book chapter and journal papers in the area of Windhorse treatment.