Bill Swartley was one of the less well-known figures involved in the early days of the human movement, although he started one of the earliest growth centres, the Centre for the Whole Person in Philadelphia in 1962,1962, and later was a founder of the International Primal Association. Writing in 1971, Swartley reflected on the formation of the human potential movement as follows:
"In general, psychotherapy has ignored normal people and has exhibited even less interest in people who have super-normal mental health, or who I call super-sane. This has left a scientific gap which during the last eight years has begun to be filled by members of a new profession. The practitioners of the new profession do not even have a generally accepted name yet. Usually we are called encounter group leaders. Our infant science is usually called the Human Potential Movement. The place we practice our new profession is called a growth centre. The normal people with whom we work are called group members. I like to call myself a humanologist or one who practices the science of humanology. Humanology, I define as the science of becoming fully human. In statistical terms, humanology is the science of helping average people continue to mature into a state of super-normal mental health ...
[The client] who is attempting to grow (or mature) psychologically retains the responsibility for her own growth ... To make the contrast with psychotherapy as clear as possible, humanologists do not even try to make a diagnosis and have no therapy to offer." (Swartley, 1971)
The human potential movement fostered opening and release rather than suppression. It favoured 'experiencing it' and catharsis - 'letting it out', with both bodily and vocal expression rather than just verbal 'talking about'. Screaming and vigorous expression tended to be encouraged rather than inhibited.
The human potential movement pioneered numerous techniques that have subsequently gained more mainstream acceptance and have been adopted in areas such as business management, the school system and in psychotherapy training institutes - although the more expressive techniques do not necessarily fit too snugly with conventional institutions.
Some of the methods used in the human potential movement were revivals of active and body-oriented approaches that had been discarded in the early days of psychoanalysis as the latter movement sought recognition and respectability (just as many parts of the humanistic world are doing today). Catharsis, touch, bodily approaches and direct work with primary processes were not methods that could readily be fitted into the respectable version of psychoanalysis.
Such active, expressive techniques may be taken to be hallmarks of the human potential movement, but they do not represent its essence. Its essence is more a question of the particular model espoused, the model of 'self-actualisation' or 'personal growth', a model which we will refer to as the 'holistic growth model'. This is a model which stands in marked contrast to what is commonly referred to as the 'medical model' (or metaphor) and its analytic and behaviourist associates.
The medical model
The 'medical model' presupposes a state of 'sickness', 'illness' or 'disorder' on the part of the 'patient', a state of 'disease', as it is fashionable to emphasize. The 'patient' is 'unwell'. The practitioner will make a 'diagnosis' of the patient's condition on the basis of his or her 'symptoms' and apply an appropriate 'diagnostic label' to the 'disorder' or 'syndrome'. The practitioner will then 'treat' the patient by administering an appropriate 'therapy' as a 'remedy', thereby hopefully 'curing' the condition or counteracting the disease process and restoring the patient to normal health - seen as the absence of the 'disease' or 'disorder'. This is a model which is about 'normalising' and carries an implicit or explicit notion of 'normality'. The absence of any proven disease process underlying many so-called 'mental illnesses' (Breggin, 1991; Grof, 1985; Parker et al., 1995) means that the treatment of them under a medical model will often be a question of treating the 'symptoms' rather than the disease. That is, suppressing or counteracting them in some way.
Under the medical model, the patient is not expected to have full adult responsibility in relation to his (or her) treatment. Some of this is passed over to the practitioner - the patient does not treat himself. Either his illness renders him incapacitated, or the treatment of his illness involves procedures that he may not fully understand or be able to carry out for himself. There is likely to be some form of legal or 'official' recognition of this special status of being 'unwell' in the form of eligibility for treatment under the state or private health insurance and also the possibility of being relieved of the need to work via a 'sick note' from a doctor. The patient's role here is quite passive. He is 'in the care of' the practitioner with whose treatment he is expected to co-operate. By contrast the practitioner's role is rather more active in the sense of it being he who diagnoses, prescribes, advises and does things to and for the patient to make the patient better. He has the status of an expert, who takes responsibility for the patient; takes care of the patient (Parsons, 1953). 'The doctor-patient relationship as defined by the medical model ... reinforces the passive and dependent role of the client. It implies that the solution of the problem depends critically on the resources of the person in the role of scientific authority, rather than on the inner resources of the client' (Grof, 1985: 319). This authoritative status is typically endorsed by the state in the form of statutory registration of the practitioner's profession (Mowbray, 1999: 206).
Elements of a medical model attitude, as regards both symptoms and the practitioner-client patient relationship, are to be found in numerous forms of psychotherapy including psychoanalysis, behaviour therapy and hypnotherapy (see, e.g., Rowan, 1983: 3, 57). Given their pervasiveness, medical model attitudes are also to be found in the minds of many practitioners and clients/patients, whatever the approach, even when a different premise appears to be involved in the approach in question. Witness the widespread adoption of the Diagnostic and Statistical Manual of Mental Disorders (DSM), modelled on the International Classification of Diseases (ICD), even by humanistic practitioners. The DSM also provides the basis for the majority of psychotherapy outcome research (Roth and Fonagy, 1996: 26-9).
In addition to underlying medical metaphors, our Western culture is saturated with conceptions of mental ill health which have an underlying malfunctioning machine metaphor. A person is as likely to be referred to as having 'maladaptive' responses or 'dysfunctional' behaviour these days as they are to be labelled as suffering from a 'neurosis' or 'nerves'. Along with this is an associated ethos of problem-solving and 'repair' - the 'technical fix' - for a machine needing repair or 'adjustment' to deal with patterns of faulty learning In our secular, machine- and computer-dependent age, the medical model of 'cure' (with earlier echoes of salvation and Jesus performing miracles) coexists with this model of us as machines or computers in need of fault correction and restoring to smoothly efficient functioning. Behaviourist approaches that, in the extreme, bypass the issue of consciousness altogether are particularly prone to such a mechanistic conception, as apparently also are cognitive approaches (Rowan, 1988: 243).
These medical and mechanistic metaphors merge and overlap and indeed they have common roots in a Newtonian world-view. The notion of the psyche being generated by organic processes which may fail, leading to psychological disorders (biodeterminism), mates with the machine metaphor to produce an incestuous offspring - the 'human bio-computer'. Your computer has 'crashed' - is it a hardware problem (genetic, neural or biochemical abnormalities) or a software conflict (bugs in your early 'programming')?
Whether of the 'cure', 'repair' or 'reprogramming' variants, the remedial world-view informed by these sorts of model is so culturally ingrained that it is often very hard for people to think outside of it in relation to what may emerge from the psyches of themselves and others. The self-actualising orientation is all too easily occluded by the prevailing cultural norms. The terminology that people adopt or drift into using, and the associations that those terms have in the culture, can exacerbate this tendency. Terms such as 'clinical', 'treatment', 'symptoms', 'diagnosis', 'disorder', 'psychopathology' and 'therapy' associate to prevailing medical metaphors, as do phrases like 'getting better'.
The holistic growth model
The holistic growth model offers an alternative perspective which assumes that everyone has an inherent potential to experience processes of inner development resulting in a continuous process of 'becoming'. Such a process of moving towards wholeness is known by many names, including: 'self-actualisation', 'individuation', 'self-realisation', the 'growth process' or the 'primal process'. It is concerned with the process of 'emergence' or 'unfoldment', with experiencing as fully as possible, with expression and integration. The 'goal' in a holistic growth model is a path rather than an end-point; a journey rather than an arrival. It is about 'knowing yourself more; about fulfilling more of the potential to be who you really are, rather than narrowly focusing on the cure of a 'disorder', the relief of symptoms or the resolving of a problem. It is about B' (for Being) values rather than 'D' (for Deficiency) values' (Maslow, 1968).
A holistic growth model usually involves the acceptance of an existing state of being. Acceptance of that state is what is usually required for growth to occur anyway. The sort of psychological or emotional phenomena which under a medical model would be labelled as 'symptoms' would under a holistic growth model be regarded as manifestations of consciousness and part of the 'self and their meaning for the person explored rather than efforts being made to cure, suppress or eliminate them. Thus at any level such phenomena can be seen in the light of a growth model and 'owned', opened to and experienced, or seen through the lens of a medical model, regarded as defects to be got rid of and disowned, 'treated', 'cured' or suppressed. In the absence of sound indications that such experiences are indeed manifestations of a true organic disease process, their designation as symptoms should be regarded as presumptive and due to an application of the medical metaphor rather than as 'fact' (Parker et al., 1995). From a holistic growth model point of view, many such 'symptoms' would be seen as forms of communication, means of defence, signs of regression, 'altered states', or as 'stages of a transformative process in which the client has become arrested' (Grof, 1985: 329) - rather than illness.
The holistic growth process is spontaneous and unfolds in a unique way for every individual. It has its own dynamic pressure and pace. Caron Kent (1969) has referred to 'growth forces' driving the process. The question of change is one of allowing these inherent forces to function more fully. The question of facilitation is largely one of providing an environment that is conducive to the spontaneous emergence of these 'growth forces' and which maximises the opportunities for their expression - rather than the application of elaborate technique.
There are arguably two basic levels of this facilitation consistent with a holistic growth orientation: work that assumes and requires adequate adult functioning on the part of the client and work that does not.
Human potential work - facilitation with SAFAA
We will refer to the first of these levels as 'human potential work', though it may be practised under various labels of greater or lesser appropriateness to its nature. This is a form of work intended for 'average maturing adults' to use Swartley's phrase (Swartley, 1975), or 'autonomous functioning adults' to use Kelley's phrase (Kelley, 1989). That is, it is a form of work for people who are regarded and regard themselves as 'normal', or 'ordinary' rather than in some way less autonomous than the average level prevailing in the society. This of course begs the question of whether 'normal' is 'healthy', but does correspond to society's recognition of the status of 'adulthood' with respect to responsibility and choice, except in certain specified cases such as when one is 'sick' and a degree of diminished responsibility is usually allowed. Thus it is a necessary pre-condition for human potential work that clients have Sufficient Available Functioning Adult Autonomy (SAFAA) At and beyond this level of functioning, healing could be said to become 'wholing' and it is to this that human potential work addresses itself (Mowbray, 1995: 265-6; 1997: 40).
The SAFAA criterion is not determined by the presence of intensely experienced feelings or distress but rather by the absence of access to a functioning 'adult' self. The requirement of a sufficiently available 'adult' in the sense of 'here-and-now-self and ability to be in contact with 'here-and-now' and 'consensus' reality does not, for example, preclude the exploration of states of regression and of projections and transference feelings. The trick is that such feelings are explored on a 'twin-track' basis, that is, on the basis of an adult-directed journey - exploring things from the past while maintaining contact with the present and allowing one's 'inner child' (or whatever) out, in the presence of one's 'adult'. Being an 'average maturing adult' engaged in a 'wholing' process does not preclude having deep life issues that may be addressed thereby.
In consequence of the combination of these two criteria, the roles of client and practitioner in human potential work differ markedly from those in a medical model activity. First, the decision as to whether the SAFAA requirement is met is one for mutual agreement between potential client and practitioner. Furthermore, unlike in the case of activity operating from a medical model where the practitioner is the expert who takes responsibility for the treatment of the patients, in human potential work the practitioner does not apply treatments to the clients. Instead, whilst the practitioner may have experience of a general nature, the clients are seen as the 'experts' - on themselves. Hence the client directs the exploration -the process is one of self-exploration and the client does the 'work'. In human potential work clients retain responsibility for their growth process, their actions and their feelings - which they are encouraged to 'own'. The practitioner's role is to facilitate, to 'be with', to sit alongside. As Swartley put it, in human potential work the practitioner is to be the 'patient', the one who waits with calmness (Swartley, 1971).
The relationship between practitioner and client is a non-hierarchical partnership between adults with differential roles rather than the practitioner having the status of a 'healer' and the client being regarded as in need of the practitioner's healing actions. Clients are not regarded as being sick or unwell, rather they are 'average maturing adults' concerned to 'know themselves', capable of taking responsibility for themselves and of being self-directing. They have sufficient 'adult' functioning - a good-enough adult, as Winnicott might have said. In human potential work the client is not 'in the care' of the practitioner. That does not mean that the practitioner does not care about the client or has a licence to be 'careless' but rather that the practitioner is not in any sense 'in charge' of the client. The basis for relationship is one of 'informed agreement to explore' rather than 'informed consent to treatment' as in the 'new' medical model. The 'client' role is equal, contractual and more active than that of the 'patient', however well informed the latter's 'consent to treatment' may be.
The practice of Primal Integration provides an example of the practical application of these principles. The work typically takes place in a group environment, which is highly unstructured and free and yet has very firm ground rules and boundaries for participation. To ensure safety for all concerned, terms and conditions apply. A wide range of avenues for expression is available and allowable - verbal, vocal and physical and artistic. A high degree of self-responsibility and self-regulation is called for on the part of the participants, who by and large retain the initiative in their self-exploration. The work is not even labelled as 'therapy' or 'psychotherapy' lest potential clients are misled as to what is expected of them by the assumptions commonly adhering to those terms. The role of the facilitators is not to direct or lead in the conventional sense but rather to 'follow' and not get in the way. Ideally the application of active techniques by the facilitators is kept to a minimum. All participants are interviewed before being admitted to ensure that they meet the SAFAA criterion. Participants need to be willing and able to respect and abide by the preconditions for attendance and to contain strong feelings when necessary rather than act them out destructively towards others or themselves. Subject to participants meeting these requirements, the broad range of experiences which may emerge is welcomed, including deeply traumatic ones. The setting is inclusive of such experiences but not exclusively focused upon them (Brown and Mowbray, 1994, 1996).
When the process of growth becomes so intense and rapid that it interferes with normal daily functioning, a state of what Christina and Stanislav Grof have termed 'spiritual emergency' exists. 'Spiritual emergencies' are 'critical and experientially difficult stages of a profound psychological transformation that involves one's entire being' (Grof and Grof, 1990: 31). By default, such states do not meet the SAFAA criterion.
Spiritual emergencies can be triggered by a wide range of events including near-death experiences, strong emotional experiences such as the loss of a loved one, childbirth, the use of mind altering drugs and involvement in various spiritual practices.
A wide range of phenomena may emerge in the course of such crises, such as the awakening of kundalini, shamanic crises, peak experiences, near death experiences, past life memories, visionary states and possession states. Despite a lack of adult containment, all of these experiences would be regarded from this perspective as indicative of an intense period of personal transformation rather than pathological phenomena (Grof and Grof, 1989: 13-26).
The 'emergency' exists more in relation to the person's outer life than the inner process, which though it may be stormy, frightening, painful and pro-longed, remains in essence a positive healing one - a process of renewal (Perry, 1974). Risks that await someone in such a state include those that await anyone who is not in sufficient contact with their adult mode of consciousness to safely and effectively negotiate the physical world and 'consensus reality'. There are dangers, amongst others, of accident and involvement with the police. There is a risk of hospitalisation and the abortion of the unfolding process by drug-based interference which can make the process more difficult to complete (Perry, 1974, 1999) and lead to psychiatric labelling, dependence on medication with harmful side effects, social stigma, reduced job opportunities and reduced access to financial services such as insurance.
There are also internal risks, however. Not everyone can 'trust the process' or sustain the pain. The various forms of addiction are a significant hazard for anyone in the throes of such a transformational crisis who lacks appropriate support and understanding and who succumbs to temptation.
In cases where there is evidence of acting out, excessive projection, delusions of persecution or active attempts at bodily self-harm or suicide then, whether or not a spiritually emergent process is under way, a medical approach involving medical treatment aimed at suppression may be inevitable if not preferable since whatever inner process may have been involved has been detrimentally 'hooked' onto the outer world. In a sense there may be too much outer orientation and involvement for whatever inner healing process there is in play to function with safety. As with dreaming, such an inner process at this level works most safely when the active capacities of an adult body are temporarily withdrawn from involvement in what is a highly symbolic inner journey.
In sum, the inner process may be trustworthy so long as it remains an inner process that does not get too confused with the current outside world and so long as it can be borne. However, there are problems for the person undergoing it regarding the social and political context in which it occurs and the extent of supportive resources available.
Holistic growth on the 'NAS'?
Practical forms of assistance for people undergoing spiritual emergencies that support rather than suppress such processes may be hard to come by. There is arguably a great need for alternatives to hospitalisation and/or medication for people going through an intense growth experience who are out of touch with an 'adult mode' and cannot therefore be assumed to be capable of self-responsibility and safe functioning in 'here and now' reality. Likewise, to some extent, for people who are just about able to so function, but want to opt out for a while because they are too preoccupied with pain and suffering -with 'problems of being'.
It is possible to go through a spiritual emergency at home with the support of friends and relatives (Podvoll, 1990). However, the helpers in such ad hoc arrangements can easily become exhausted by the intensity and duration of such episodes which may go on for days, weeks or months and have scant respect for conventional patterns of living.
The ideal arrangement for addressing spiritual emergencies would seem to be the establishment of non-hospital 'blow out' centres ('episode centres'?) specifically intended to meet this need: 'This service would provide a unique atmosphere based on the attitude that the Individual's experience is an "altered state of consciousness" to be explored, and not a sickness to be immediately put to a finish' (Perry, 1974: 154). Such 24-hour care centres would provide a genuine sanctuary for people in these crises - an environment where the process could be allowed to proceed unhindered (Grof and Grof, 1989, 1990).
Similar such centres have existed before, for example the Laingian experiment at Kingsley Hall in the east end of London in the 1960s (Berke, 1979) or 'Diabasis', John Weir Perry's Jungian-oriented facility in Berkeley, California during the 1970s (Perry, 1974, 1999). Some, such as the Arbours Centre in London, still remain (Berke, 1979). Most however have tended to founder on the rock of financing (Breggin, 1991; Grof, personal communication, 1988). The DSM now recognises the existence of spiritual and religious problems which it does not classify as mental disorders and it is conceivable that medical insurance might extend to cover them. However, this would involve the practice of psychiatry and allied professions taking on quasi-spiritual or religious functions. It seems more appropriate that funding (and hence control) should involve separate public or private institutions which accept that the fostering of the evolution of our consciousness by this route is a valuable concern and no less vital to the well-being of our society and culture than, say, public funding of the arts.
Such residential and non-residential retreat centres - genuine asylums with medical support staff but not necessarily subject to medical authority - would provide a service that is accepting of people in an 'altered state of consciousness' or 'non-ordinary state of consciousness'. People benefiting from this service would be funded by others and looked after by others through state or other third party funding. Staffing could be largely on the basis of a 'non-credentialed' registration system since conventional licensing systems based on academic qualifications will be of little relevance to effectiveness in this milieu and unnecessarily exaggerate the cost of service provision (Mowbray, 1995: 209-12; 1997). Those who are most suitable to support others going through such 'crises of renewal' may well be people who have been through such crises themselves rather than 'licensed professionals' who have not (Perry, 1974: 152-7).
Such a 'National Asylum Service' (NAS) would be a service for 'holistic growth' below the SAFAA margin (Mowbray, 1995: 189; 211-12). Human potential work ('wholing') being above that margin requires no state involvement and indeed its provision is liable to be adversely affected by state intervention in the usual form of the statutory licensing of practitioners (Mowbray, 1995, 1999).
Just as the human potential movement can be seen as occupying a distinct societal area between other conventional institutions (education, the health service/medicine, the arts and religion) for activities involving participants who fulfil the SAFAA criterion (Brown and Mowbray, 1990) so such an NAS could be a separate form of public service, somewhere in between education and the health service rather than subsumed by either.
Questions of choice - spiritual emergency or a SAFAA route?
There is an issue of choice in relation to spiritual emergency. Why do some people's inner journeys involve total preoccupation with the outpourings of their unconscious day and night for weeks, requiring others to take responsibility for their care with all the attendant risks and burdens, whilst other people manage to grow without letting go of responsibility for their daily lives?
In the more accepting social climate that now exists for spiritual emergencies in some quarters, some people may unconsciously take permission for this type of path without sufficient resources really being in place to sustain it. Others may consciously yearn for it as a hopefully more rapid alternative to their current path - usually in vain in our experience. However, to embark on such a process in a cultural environment which is generally antipathetic if not hostile to it may in itself represent an acting out of self-destructive urges. How can the emergent urge be steered towards less hazardous paths? Whilst giving due attention to the inner process going on, how can one temporarily contain it when necessary, in order to maintain one's outer life? How can one live in two worlds at once? How can one integrate the experience with the rest of one's life?
A partial answer lies in familiarity. Whilst differing modes of consciousness are best kept boundaried, like waking and dreaming, acquainting oneself with the deeper aspects of one's nature and finding space for the deeper aspects of the growth process in one's daily life allows for an ease of movement between these states in a way that a practice of rigid separation and exclusion does not. Hence deliberate 'working on/with oneself at depth with a SAFAA criterion can cultivate a familiarity with negotiating different modes of consciousness which allows for a true self-regulation that encompasses deep levels of being as well as an outer adult orientation. The emergent process can thereby be grounded in both forms of reality.
Some pitfalls on the growth path
The pursuit of personal growth can too easily become corrupted into an exercise in advanced self-centredness. Any personal growth that does not increase the capacity for love of others and for relatedness and social responsibility is not worthy of the label and is merely self-inflation.
Idealism and unrealistic expectations
Once fulfilling potential is accepted as an option, what we are (and have) may seem inadequate and lacking in value compared with what we now aspire to. Setting over-ambitious standards can easily slide into a pursuit of perfection at the expense of acceptance of one's self as one is and others as they are. Compared with the possible, we are all rather poor shadows of what we might be for ourselves and those we relate to. Over-avid pursuit of the possible may undermine the ability to live an ordinary life with balance and with the grace to accept and appreciate the available. Moreover, human potential assumptions adopted with naiveté can lead to confusion between how things in the world might possibly be and how things actually are now, leading to unrealistic decisions and major errors of judgement.
Mistaking disease for growth
It is unwise to assume that all psychological and emotional 'symptoms' are simply expressions of consciousness rather than signs of a genuine physical disease process. The consequences of such an assumption are regarded by Striano as: 'the foremost hazard of faulty therapy: the neglect of physical illness (for example diseases of the endocrine glands, notably the thyroid) as the source of 'mental' symptoms' (Striano, 1988: 4).
In the case of spiritual emergencies, although the concept of mental disease may have been inappropriately extended to include many states that, strictly speaking, are manifestations of a natural and evolutionary process rather than a disease process, it is a mistake to assume that all those who are labelled psychotic are really in the throes of a spiritual opening and that mental conditions requiring psychiatric treatment and care do not really exist. It is thus important to differentiate between spiritual emergencies and genuine psychiatric disorders - is this a disease process going on or one of meaningful emergence? Is this a medical matter or a case for 'transformational crisis' facilitation (Grof and Grof, 1990: 252-7)?
Pitfalls aside, rather than work of a psychological nature being the 'privilege' of a minority regarded as 'disordered' or in need of 'help', the benefits for society of 'average maturing adults' engaging in deep work to expand their awareness and to 'know themselves' better are potentially huge since the 'middle ground' of society is arguably where the real limits to political and social evolution lie. Likewise, providing possibilities for those in the throes of spiritual emergencies to resolve such crises in a way that is inclusive of their depths rather than suppressive of them would enhance their capacity for wholeness to the benefit of all.
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© Juliana Brown & Richard Mowbray 2002
[This piece first appeared in C. Feltham (ed.), What's the Good of Counselling & Psychotherapy? Sage 2002]