Hwy 321 is a very pleasant drive connecting the college town of Boone NC with the resort area known as Blowing Rock. Just outside of Blowing Rock travelers will find a theme park that has been around for decades. The 'House on Mystery Hill' is a remarkable little structure wherein, it is promised, visitors will experience a mystery force. Per the theme park's website:
Explore our mysterious Natural Gravitational Anomaly and watch a ball roll upwards and water flow uphill!
This quaint amusement park awoke the psychological muse in me. Permit me to explain.
Adults entering the house are understandably skeptical that there is anything mysterious going on. They will have noticed that the structure is pitched upon a hill and is not level. What is mysterious is the sensation one will eventually develop after spending some time in the building. The flooring of the building is aligned with the hill at an angle of roughly 30 degrees. In contrast, all visual references within the structure are aligned perpendicular to the floor, including stiffened curtains and painted scenery that appear perfectly aligned with what one would expect were the interior level. This creates a cognitive dissonance. Ones eyes are telling the visitor that he is in a straight up and down world, yet gravity and the inner ear are telling him otherwise.
Adults entering this strange space are understandably cynical over the notion that there is anything mysterious going on- after all, they can see how the house is constructed with reference to the outside. They expect that things will be odd. Once inside, they feel off balance and stumble. This is expected and hardly surprising.
The fun starts for those visitors who allow themselves to feel that there is a mysterious force that suspend them at an odd angle. Accompanying the experience of the mysterious force the visitor also notices his coordination returning as muscular movements get in synch. The visitor begins to move about with ease.
The sensation coming from the mystery force is strong, strong enough to support the body at an odd angle. One begins to trust this force. Once this happens it allows for the restoration of coordination. The latter is liberating.
So what can we clinicians learn from witnessing the developing of a delusion on Mystery Hill, the transformation from a feeling of imbalance, to the experience of a liberating external, though delusional, force? First off, while the evocation of a magical external force is only a metaphor, it invites us to think of delusions. The evocation of the feeling of a delusional force on Mystery Hill is due to physical and structural issues in the construction of the mystery house. This is equivalent to the structural problems in the brain of a patient who develops a psychosis.
We can use this metaphor clinically in our interactions with patients in constructive ways. To begin with, the visitor on Mystery Hill is not at all anxious over the bizarre external sensation because he knows where it is coming from. He has the house from the outside, knows that it is at an odd angle, and rapidly relates the transition from feeling a lack of balance when first entering the space to the emergence of the delusion of the external force. to what he knows before entering the space. That is, in understanding what is happening he is spared distress and anxiety.
With psychotic patients I try to help them understand that subtle structural problems in the brain can lead to profound disturbances in sensations. One can even normalize this to a degree. After all, if we think about it, we all hallucinate. I explain to my patients, as an example, that when two people have a conversation, the only real interaction between the two is that they are making one another's eardrums wiggle. This simple interaction leads to a rich experience, from the melodious sound of another's voice, to its interpretation and evocation of meaning. All of which is constructed in our brain and mind. That is, while the wiggle of ear drums is the only real interaction, the remainder of the experience is an hallucination, albeit one that is highly adaptive to successful living. It doesn't take much imagination to understand that in the absence of the wiggling of eardrums it is possible to. experience maladaptive hallucinations. The tremendously complicated apparatus within the brain need only have the slightest imbalance in its circuits for this to occur.
Beyond explaining to a patient the 'hows' of his delusional experience, our next effort should be to try and correct the brain disturbance leading to the delusions. This is largely a function of medications. If the latter work well, it is the metaphorical equivalent of leveling the house on Mystery Hill.
Finally, we are often left with patients who have persistent or residual symptoms, despite our best efforts to correct the problem medically. What to do?
Psychotherapeutically we strive to help the patients find behavioral coordination despite their altered sense of reality. There is a famous example of this. Freud wrote about the19th century case of Daniel Paul Schreber. Schreber was a well know and successful jurist who in this 40s developed a profound paranoid psychosis. For a few years he was hospitalized with anguishing symptoms. He felt tortured by sensations of being raped and was plagued by the notion that a divine ordinance would force him to change gender in order to save the world.
He was treated psychologically during a time in which there were no medicines or biological options, yet he improved. Just prior to being released from hospital care he had recovered his high level of intellectual and social functioning despite having a persistant delusion of being a select and privileged individual destined to greatness. He kept this largely secret in his social interactions. Psychologically he had found the means to integrate his perceptual disturbance so that it didn't interfere with his external functioning.
The house on Mystery Hill invites us to reflect. First, psychotic symptoms can be thought of as a means to try and reestablish psychic coordination in the face of perceptual disturbance. Second, in encourages us to think that if we can help patients understand the biological basis of their disturbance that it can help make their symptoms less disturbing and increase motivation to explore treatment options.
Finally, the little house on Mystery Hill reminds us that we all are not far from being mad. Or to state it more positively, the mad are not far from being sane. We all experience a wondrous and rich experience of life invoked in our brains from the sparse input of our 5 senses.