I would like to take a day off from work, but am afraid I will look bad. Should I, Can I?
In this structure, subjective experience is bound to and constrained by social law. Therefore, decisions reference social conventions, rules and expectations. Since there is a clear response path to life's questions, the person who inhabits the neurotic structure experiences guilt, anxiety and concerns about doing the right thing.
What's the point? It won't help me! I'll just have to pretend to be someone that I'm not. Everyone else has it easy. They're given jobs and just do whatever they want and are rewarded for it, but I get nothing!
The psychotic experience is birthed from a person's attempt to anchor himself or herself within a structure that has little to no reference to a pre-existing structure. While the person is aware of guiding social constraints and laws — often acutely so — he or she has no sense of attachment to them. Psychotic individuals experience something fragmented and disjointed as they struggle to constantly create a structure for themselves. They construct a world that was not previously given to them psychologically.
"Technically," I'm supposed to be at work today. But, I've worked overtime lately so I'll call in sick. After all, I deserve it.
Within this structure, a person's psychological experience is bound to, but not constrained by, social law. In fact, the strategy is to be close to the law without getting stuck in it or trapped by it. The response path completely avoids societal expectations.
Words structure our very existence. Try to convey to someone your experience of hunger without any of the words, forms of speech, or euphemisms related to hunger. How did you do? Now, imagine that your difficulty in communicating your hunger is not solely due to the fact that you do not have access to the words for hunger but that you have no concept of hunger! You feel hunger, but you have no way of knowing what this strange bodily sensation is or means. Under these circumstances, we might expect that you would experience this sensation as completely foreign, alien, strange and even terrifying. You might even come up with an explanation that seemed to account for your experience, but it would be an explanation devoid of any reference to "hunger" in the agreed-upon sense. Perhaps it would go something like, “My body is turning against me,” or “I think I am dying,” or "I'm possessed," or "Someone has poisoned me." What if this is exactly what happens at the origin of psychosis? What if some fundamental concept is excluded from our language and, therefore, from our psychology?
Most clinicians admit the importance of a multipronged approach to psychosis, including speech. But few consider talking to be the most essential mechanism of change. We do. Talking squarely puts us on the road toward stabilization and recovery. Indeed, it requires the commencement of a specific discourse and the training required to recognize the missing concept. This is the expertise that we at the MendCenter offer.
Our goal is not to impose a structure but rather to help individuals create a structure for themselves. We are here to walk through life experiences with them, helping them construct a safe and desirable space within which to experience their lives.