by Paul J. Hannig, Ph.D., MFCC

The dialectic process states that for every truth there is an equally plausible opposite truth. Two viewpoints can be on opposite ends of the same pole and still be equally true. There is a North Pole and a South Pole and an equator that meets in the middle. For every thesis, there is an anti thesis and a synthesis of the two opposites. For every up there is a down that synthesizes into a middle ground. There is a heaven and a hell with an earth in between that integrates the two. There is good and there is evil. The average person synthesizes those two polar aspects into an integrated life. There is a bright side and a dark side of human consciousness. There is God and angels on one side and the devil and his demons on the other. Guess who is in the middle trying to resolve what those symbols represent? There is a night and there is a day. The earth turns towards the sun and then away from it. In between that process, we have dawn and dusk. Every day is a new day and must come to an end, in order for a totally new day to appear.

There had been several different words for this phenomenon: Paradox, contradiction, the opposing force, polar opposites, dualism and the dialectical process. So, what does that have to do with anything? When you begin to think in dialectical terms, you begin to see that there are two opposite sides to the same coin, the same question and the same dilemma. A person may be rich in emotions, spirit and interpersonal relationships, but poor in finances and material goods. These two equally opposite realities create a tension that seeks synthesis and resolution. A paranoid person sees persecution where none exists. He claims that something outside of himself is trying to harm him. You look around and you don't see it. It exists and yet it doesn't exist. A healthy, happy marriage may slip to its polar opposite and become a hell on earth. For every depression there is a hidden ecstasy. For each panic attack there is its opposite, a peace that knows no bounds. For every tension there is a release. Holding back is opposed by letting go. An integrated person knows the difference and can choose when it's appropriate to hold back or let go. The place in between is a synthesis. The opposite of denial is acknowledgment. Nothing new can happen or change until acknowledgment opens the door for transformation. Bipolar disorder has a depression and a manic state. Somewhere in the middle is a functional person trying to learn how to hold on to normalcy. What would fear be without its opposite companion courage?

A person who suffers from schizophrenia may experience extensive disorganization of thought, feelings and action. This has been called schizophrenia, disorganized type. The recovery of the capacity to become organized signals steps toward wellness. A person who was once well organized, can break down into disorganization and disease. Learning how to restore one's capacity for organization, signals a step towards wholeness. Schizophrenia is a disorder of fragmentation and disintegration of the mind and the self. For every self there is a non self. Effective psychotherapy and healing is intended to restore a healthier and more integrated self. For every break down there is an equally true buildup. For the pessimist and the person with paranoia, there is an equally positive and optimistic truth lying somewhere in the gray area, between black and white.

Psychiatric medications are like angels of mercy. To a certain extent, they restore chemical balance to a brain that has been disordered. But, there are distressing side effects that spell the downside of powerful antipsychotic drugs. Thus, you have a plus and a negative side; a pro and a con. Many people who suffer from mental illness have a hard time integrating these powerful drugs into their systems. Most medications are like that. They offer a very positive healing side, along with distressing side effects. Individuals who have to take these drugs can learn how to integrate and synthesize them into their system. For example, meditation, catharsis, abreaction, relaxation techniques etc. can lessen and ameliorate the side effects of very powerful drugs. At the same time, these healing techniques provide many wonderful benefits such as; insight, wisdom, symptom relief, spiritual knowledge, mood correction; plus a host of other benefits. Like I have said, the synthesis and integration of thesis and antithesis, creates something new and more evolved.

Joanne: A Personal Story

Hi! my name is JoAnne and I can't believe what's happening to me. I am in the middle of a meditation session with my coach, on the telephone. He is meditating with me as if he is inside of me, feeling all of my emotions. He picks up on everything that I can't even talk about, myself. We are breathing deeply as if we are on the same wavelength. He picks up on every nuance, every contradiction! He puts into words those parts of me that are in direct opposition to each other. He takes apart the labels that others have inflicted on me and that I have put on myself. He gently guides me into the hidden strengths behind those labels. He finds the caring and love buried deep within the word, "stupid." He finds the strength in my vulnerability, aloneness and fear. He searches my "bad" label and finds " confusion, searching and not having appropriate solutions." He touches the clarity in my anxiety and the freedom lurking in my stress. He sees the label, "you're not good enough, you're wrong" and finds "I am only human. I make mistakes. I am doing the best I can. I may be wrong, sometimes; but I'm not wrong as a person. I'm learning."

He finds the power in my weakness and the optimism in my negativity. He even finds the single lover, girlfriend and sweetheart in the married woman and the mother. He keeps me breathing until I feel my opposing forces beginning to integrate. He tells me it's all right to have my anger and be able to express it on a punching bag and pillows, instead of on myself and other people who don't deserve it. I can feel my guilt dissolving into self-acceptance and a sense that I am a very decent person who deserves the very best in life. Self-hatred blends into self-love and fear melts into peace and tranquility. He guides me to accept and commit to the internal principal of removing whatever I do that hurts my husband and myself, out of our lives. He explains that I have a love fund, love reservoir, love garden, love bank inside of me and that there is one inside of my husband. He coaches me on how to keep those love reservoirs filled with love. He also coaches me on how to guard against creating love withdrawals from the love garden, that have caused me grief in the past. I now protect and guard my love reservoir from becoming a hate reservoir.

I am astounded as to how effective this is, since I have not gotten anything out of any other therapy. I needed to experience what was inside of me, rather than staying in my head and blaming other people. I also needed his empathy and his understanding. He pointed out how I convinced my ex therapists and other people of my ex-husband's "badness." That was my dilemma. I could talk about his "badness." But, inside, I was aware of his "goodness." These two opposing forces were flip-flopping inside of me and causing me distress. When I went through the meditation, the tears coming out of my eyes, were integrating me into a new experience and appreciation of myself and my lover, husband. On the surface, I was one thing, while being the total opposite on the inside. Coach guided me to see that I split people into two camps, one good and one bad, helpful and not helpful. He even suggested that I might be doing that to him; putting him in the "good camp" while placing my ex therapists into the "not so good camp." I remember as a kid, being told that I was not good enough and that my parents saw me as being bad. I didn't measure up; therefore, I was a failure and that was unacceptable to them. I took that disrespectful, judgmental criticism into myself and inflicted it onto my husband, my therapists and other people. I learned early how to split myself into extreme opposites. It was just a short step, to splitting people into opposing camps.

I have been diagnosed as having borderline personality disorder and that people with this disorder, suffer from similar dialectical dilemmas. People like myself are capable of suddenly switching intense opposing feelings of love to hate, great passion to cold rejection, attraction to repulsion, worship and admiration to disrespectful judgments and criticism. I can be accepting and agreeable one minute, provocative and rejecting, the next. There is no middle ground, no integration of extremes, and no awareness that these polar opposites can be integrated into something new. I'm either functioning at a super high level or completely burnt out and overwhelmed. Sometimes, I appear to be completely self-sufficient and independent. Then, I become helpless, inadequate and needy. These polar opposites make my life very unstable and drive other people crazy. The sad part is that each one of my opposite extremes is equally true. But, I have no control at the time; nor am I aware of the opposing emotions. My coach/therapist is making me aware of my paradoxical dilemmas. He's got me thinking dialectically. Through our mutual meditative interaction, I feel my extremes melting into a very calm, peaceful place. I feel good again, centered and grounded. I no longer feel like running away or being unfaithful. Stability is returning to my inner life as I learn to handle my stress and repressed feelings. Knowledge passes from this man's lips and touches a very deep, understanding part of my heart. I can start living again, without fear and with joy and pleasure.

How does he do it? He's willing to go inside of me and be with those parts that I have cut off. He's not afraid and his determination gives me courage. I know that I can switch feelings from one moment to the next. So, I am being careful not to idealize him or denigrate him, when he fails. Like myself, he's a person; a human being and we are all allowed to make mistakes from time to time. I don't want to ruin this therapy or attack this therapist as I have in the past. I must be willing to mend bridges that I have burned. So many people, like myself, burn their bridges and then try to come back and fix them, when it's too late. I will watch my extremes! I will steadfastly try to recognize my dialectical dilemmas. I will seek and achieve the middle, integrated ground. I will stabilize!

Professional Polarism

While conducting research into orthomolecular psychiatry and holistic healing methods, I ran into a very florid dialectical conflict. The controversy surrounds the therapeutic use of niacin therapy in the treatment of schizophrenia and other disorders. One school admirably voiced by Hoffer and Osmond staunchly supports and proclaims the power of massive doses of megavitamin therapy; especially niacin/niacinamide. The diametrically opposed school is supported by writers Werbach and Turner. They claim that niacin therapy is ineffective in the treatment of schizophrenia. Well, how do you explain this paradoxical dilemma? One school proclaims that it is the supreme, effective treatment for severe mental illness, while the other claims that niacin therapy is useless.

I don't know about you, but I prefer the middle ground, a synthesis of these two polar extremes. I want a cure, an integration of the two possibly, equally true positions. The dialectical dilemma posits a thesis that niacin is almost a miracle cure for severe mental illness. The antithesis proclaims that it is completely ineffective in the treatment of schizophrenia and bipolar disorder. My position is that there can be a synthesis of this paradox. At present, I am willing to look at a possible use of vitamin C, ascorbic acid and spiritual healing techniques, as a middle ground integration for these diametrically opposed positions. I will not rule out the possibility that the two extreme positions are equally true. Every researcher is entitled to their enthusiastic support for their position. I will continue to explore every avenue and every possibility for finding effective strategies for treating these very painful disorders.

At present, I am very aware of the dialectical dilemmas in the use of typical and atypical psychiatric medications. On the one hand, they are like angels of mercy that create some semblance of abnormality and healthy functioning. On the other hand, I am aware that these medications do not provide a cure and in most instances, there are disturbing side effects. If the orthomolecular approach is combined with psychiatric medication regimens, we may find ourselves in possession of a more integrated strategic approach in the treatment of mental illness and personality disorders. At present, I am observing the effects of the use of these approaches and their accompanying dialectical dilemmas. I feel very optimistic and hopeful that the key to treatment for these disorders, lies in the construction of effective strategies that are well-planned, organized and implemented.

Constructing Effective Strategies

In schizophrenia and to a certain lesser extent in other disorders, there is a loss of executive functioning. The left hemisphere becomes increasingly dysfunctional as disorder spreads through the brain. In many cases, there is a significant loss of an executive "I" leadership capability. This loss renders the self to be somewhat incapable of forming executive decisions, planning, strategy implementation and goal seeking. Because of this loss of brain function, the executive function must be activated and taken over by others, such as parents, relatives, spouses, teachers, coaches and health professionals. When someone else, beside the patient, assumes the executive role, that person should plan to work with other people towards finding enthusiastic mutually satisfying strategies and solutions. I call this the Planning and Research department. The people in this department should assume some responsibility for implementing and monitoring health promoting strategies. In the old-style mental hospital facility, the executive functions were taken over by hospital staff. Each department would be responsible for involving patients in the activities formulated in those departments. For example: the nursing staff would dispense psychiatric medications to each patient. The art therapy department would involve patients in therapeutic art activities. The problem with this system is that hospitalized patients were inadequately coached to take responsibility for assuming their own therapeutic executive activities. This problem shows up in the failure/success rate for patients complying or not complying with routine taking of medications and keeping therapy appointments.

The failure of patients to assume executive "I" functions has been attributed to the disease. Therefore, if a patient successfully reassumes executive functions, we may assume that recovery is taking place. Executive functioning implies that an operating self is taking full responsibility for taking medications, complying with treatment and assuming other proactive activities.

Those people who are involved in the planning and research department usually implement the Personnel Department. This department consists of all the people and agencies, with their combined skills and talents, which will be involved in promoting the goal of optimum health. The Personnel Department will define structured activities, monitor behavior, schedule appointments and communicate with different members of the personnel department. The Personnel Department will also be responsible for defining and calculating improvement and regression. The Finance Department will include those people that implement programs involving insurance companies, community financial resources, monies for treatment, education and vocational rehabilitation. The Promotion Department is responsible for promoting the healing advocacy, the elimination of stereotypes, stigmas and negative labels attached to these disorders. This department is also responsible for finding and promoting the hidden strengths and resources in the afflicted person and his/her's social and familial networks. The Production Department is responsible for helping the client/patient produce optimum performance, good health, rehabilitation and social contribution. Psychiatrist Hoffer describes the production of cure as consisting of the person's ability to pay taxes, be employed, getting on well with family and community and be free of symptoms and signs of disorder. Hoffer's homepage can be reached at www.islandnet.com/~hoffer/hofferhp.htm.

Allow me to reiterate the model for constructing effective strategies and overcoming dialectical dilemmas:

1.Planning and Research Department

2.Personnel Department

3.Finance and Accounting Department

4.Promotion Department

5.Production Department.

Nathan: A Personal Story

Hello! My name is Nathan. I suffer from schizophrenia. I also accept this disorder as a challenge to grow and heal. Many people deny that they have a disorder. But, I understand the concept of paradoxical opposites. To deny is to claim that something does not exist. In medicine and psychiatry, to admit and accept that one suffers from a disorder, is a step towards recovery. Acknowledgment is the opposite of denial. Once I started to acknowledge that something had gone wrong, I began to accept the full responsibility for facilitating my recovery into something new. During my illness, I would sleep 12 hours a day; whereupon when I was well, I was very active, socially, academically and athletically. Part of my cure consisted of instituting a daily plan of sports and exercise. The results were immediate! Instead of being inactive and asleep, I became empowered through sports and exercise. This gave me a feeling that I could gain power over my schizophrenia, rather than having it having power over me. I like the feeling of power in my soul, my mind and my body. I don't like the tiredness and social withdrawal of my disorder. By pitting the positive activity of sports and exercise against listlessness and oversleeping, I face the prospect of a new beginning, a new creation of a new "Me."

I broke down at the age of 18 when I left home to go to college. I went away perfectly healthy and feeling on top of the world. I came back a year later in the midst of a total breakdown into paranoid schizophrenia. At school, I was under incredible stress, academically, socially and athletically. I started taking drugs and one night I overdosed on LSD. My life would never be the same. All my dreams, hopes and future plans went down the drain. I was shattered by mental illness. When I got home, I was hearing voices and accusing my father of beating me when I was a child. All my delusions were untrue. But that's what the disease is all about! You take one reality and turn it to its total opposite. I lost all sense of a real self and caused pain to my family. But they would not give up on me. With schizophrenia, you don't have a self that is real. That's the dilemma! Situations are either real or they are not. I lived in an extreme world and my family was determined to help me find reality. When you lose reality, you must struggle to find your way back to a real world, with real people in it and a real self.

My father has taken on the principal executive function in my cure and rehabilitation. He is very instrumental in organizing my family, my friends and my doctors. I am keeping daily records of my vitamin therapy and psychiatric medications, plus all of my other activities. I am currently taking the antipsychotic drugs Zyprexa and Lithobid in conjunction with orthomolecular therapy. I understand that psychiatric medications can facilitate my recovery. I also understand the side effects. I will take these drugs consistently and regularly, until my doctors feel if and when I can reduce them. This requires a lot of monitoring on my part and my father's. The orthomolecular approach has been both panned and praised by opposing psychiatric schools. I intend to resolve and synthesize these two approaches, in combination with other healing methods. Everybody claims to be right and that their opponents are wrong. But, synthesis requires the creation of something new; the ' me' that is emerging from all of this.

Today, my mother and I are going to a session with a psychologist. He is another member of my team and I can get something positive from him. Next week, I will visit my psychiatrist, with my family, and we will discuss my medications and other things. Communication is so important between myself and the other people who are involved in my rehabilitation. I still have some trouble being out of public, in social situations. I cannot presently handle a very demanding job or academic schedule. I must be careful not to overload myself. I need to keep things simple. I did some work over the weekend and I began to lose my sense of self. My coach instructed me how to meditate beforehand on "I am, I exist, I am a person, I have an identity, and I can maintain my sense of self in any situation." The other night I did this meditation and did it again the following morning, before I went out into a public place. I was, successfully able to hold onto and maintain my sense of self in a very busy crowd. I use a' sound' meditation technique, where I follow and observe my breath, while I mentally focus on what I wish to happen. This method works wonders and I can take it at my own pace. It also empowers me emotionally, spiritually and mentally. My coach also uses a hands-on healing/prayer technique that works wonders. Whenever I feel anything negative or strange, he lays on his hands to wherever he intuitively feels I need it. I can feel his healing energy passing through to me and my despair and discomfort lifts.

This hands-on technique is also combined with direct prayer and deliverance techniques taken from exorcism technology. He also uses remote healing techniques that I find extremely healing. There are several names for this type of energy healing. I call it the Healing Power of God. Others call it Higher Power, chi, universal life force, cosmic energy, the tao, orgone energy, prana, Holy spirit, primal feelings. I recognize that there is an underlying primordial, healing energy that permeates everything and that I can tap into it, at its core. My coach is teaching me how to heal myself in cooperation with so many other people and methods. At this moment in time, we have enthusiastically mutually agreed that no relapses will occur and that progress will be maintained with passionate adherence to our plan. I know that healing is not a simple matter and that it requires a very comprehensive, well rounded supervised approach. Nothing should be left to chance! Organization and intelligent cooperation is the key.