If we’re thinking paranoid thoughts, and are aware not only of the fact that we are thinking such thoughts but also of the fact that they are but thoughts, however infused with unpleasant feeling, we are still sane. Disturbed maybe, fearful almost for sure, but not insane.

But if we’re thinking paranoid thoughts and cannot step back from them enough to know that we in fact are thinking such thoughts (our capacity for self-reflection here being absent or severely crippled), then we’re likely more than knee-deep in insanity, regardless of our times of sanity. Insanity does not necessarily mean the absence of sanity, but rather too little anchoring time spent in sanity.

If you’re being paranoid and know that you’re being paranoid, you very likely can be worked with in therapeutic/spiritual contexts, usually quite effectively; but if you’re being paranoid and don’t know that you’re being paranoid (or refuse to admit it), then the odds are that you can’t be worked with very successfully, anymore than a religious fundamentalist can be persuaded that his or her certainties may not be so certain.

The ability to hold two or more perspectives in mind while remaining relatively intimate with each of them is a hallmark of sanity. After all, each of us is making an appearance not so much as a singularity as a kind of community, a collective of habits, every one of which, when given center stage, tends to refer to itself as “I” — and each of these personified habits, these crystallized complexes, these pretenders to the throne of self, possesses (and is possessed by) its own unique perspective, which needs to be recognized and known well, but not allowed to assume the role of overseer or master.

Our task is to become so intimate with each of these apparent selves that constitute us that we become incapable of identifying with any one of them to the degree that we lose sight of who and what we really are.

Real sanity is about recognizing and taking good care of all that we are, without letting any one aspect of us take over the others; this does not mean chaos or politically correct egalitarianism, but rather a functionally fitting positioning of each aspect, in the spirit of a parent who dearly loves his or her child, but does not let that child drive the car. Keeping our habits where we can keep a clear eye on them is an essential practice in our maturation.

To journey into our paranoid thoughts and feelings without getting significantly paranoid is basic sanity in the courageous crunch. To go into our madness without becoming unhinged is a sign of relatively advanced development. To enter our pain without turning it into suffering is a gift to all beings. To pass into our lovelessness without losing heart is a great art, out of which healing cannot help but arise. To move into the Unknown without having to know what’s going to happen once we’re “there” is real freedom in the making. The way toward basic sanity is not that of rising above, trying to transcend, marginalizing, or otherwise avoiding our insanity, but rather that of going into and through our insanity, letting all that arises, however hellish or scary, awaken us to who and what we really are.

The late R.D. Laing somewhere once said that when he looked through the DSM-III (psychiatry’s bible of diagnostic criteria for mental disorders, the latest incarnation of which is the DSM-IV), he recognized himself strewn all over its pages, “shredded to criteria.” And if we look deeply enough in the same manual, we’ll also see ourselves thus shredded to criteria there, the shakier dimensions of our selfhood pathologized on page after page in the deadening language of disembodied rationality.

However, recognizing the truth of “That too am I” doesn’t have to be an occasion for identifying with a particular condition or self-state, but can instead be an opportunity to further fill out the circle of our being, embodying a radical inclusiveness that requires no abandonment of our capacity for discernment. Through this, we can touch our own paranoia (and related dysfunctional states) with tenderness, taking an awakened attentiveness into it until it is but the contracted electricity of bare fear, and then not even that, but only undressed aliveness, now energetically available for something other than the hallucinogenic presentations of our paranoia.

When we thus relate to our paranoia — rather than from it — we feel our way past its endarkened edginess into its core of heightened sensitivity until it is nothing more than exquisitely responsive attunement to whatever is arising. In this, paranoia, or any other undesirable state, becomes but an entry point into what lies prior to and beyond all fear. All we have to do is move toward it when it arises, however counterintuitive that might seem at the time,while opening ourselves to whatever assistance we might need in order to do so. Each step thus taken, however small or halting, reinforces and deepens our basic sanity, giving us the ground we need for living a deeper life.

Psychiatry’s Diagnostic and Statistical Manual of Mental Disorders (fourth and most recent edition) —- commonly known as DSM-IV — is of central importance to the vast majority of psychiatrists (and, to a lesser extent, other health professionals as well) in assessing their patients. Bear with me, and you’ll see that it’s also of central importance that we all have some familiarity with what DSM-IV is and represents. In their Synopsis of Psychiatry, professors of psychiatry Kaplan, Sadock, and Grebb state that “DSM-IV is now the law of the land.” If it is indeed the law, then exactly what is it outlawing? Does the widespread — and generally unquestioning — use of DSM-IV necessarily validate it? What are its dangers? Does it have a right use?

Let’s start digging into these questions by looking — verbatim — at some of the DSM-IV diagnostic criteria for schizophrenia:

The above may seem straightforward, but poking through its apparent orderliness is a chaos of interpretive possibilities. Who doesn't have delusions? And what about the delusions we may have about others' delusions? Let us not forget that ego — the act of identifying with our personality — is essentially delusional, constituting a case of mistaken identity.

And hallucinations? A convincing argument can be made for status-quo reality being little more than a collective hallucination. Dreams are private hallucinations. Object-permanence is a hallucination. In fact, to view anything as being an object, a solid or autonomously existing something, is but a hallucination, as quantum mechanics (in close conjunction with the wisdom-teachings of mature spirituality) clearly demonstrate.

And, as for an inner voice keeping up a running commentary on our behavior or thoughts, who among us doesn't have something closely akin to this occurring more often than not? How often are we not busy talking to ourselves about ourselves? And how often are we even aware that this is happening? Furthermore, if our delusions are indeed “bizarre” — meaning apparently having no basis in reality — who can say for sure that they don't make sense in a different, yet arguably still relevant context?

And “affective flattening”? Sounds a lot like the emotional state that is valued — or even given top billing — in the sterilized “objectivity” still frequently made a virtue of in scientific enterprises. And so on. What's missing in DSM-IV -centered diagnostic practice is not only etiology (“etiology” being that branch of knowledge which deals with the causes and origins of particular phenomena), but also any emphasis on cultivating a perspective that can view symptoms without concretizing or pathologizing them. If we will not allow ourselves to enter into any significant dialogue with another's “delusions”— both specifically and contextually — how can we come to understand that other and the possible sense that his or her “delusions” may be making?

To its credit, DSM-IV does provide an exhaustive nuts-and-bolts lingua franca for mental health clinicians. This is an advantage insofar as it gives a consensual base or common ground, however insubstantial, from which a deeper, more humane language and understanding can emerge. However, the nosology (“nosology” means the listing or classification of diseases) of DSM-IV , with its reliance on descriptive rather than causal criteria, makes it too easy to look no further than the symptoms of the patient. Clinicians whose common habit it is to see many — or too many — patients in as short a time as possible are likely going to be very tempted by the “efficiency” of DSM-IV , with its neatly compartmentalized — that is, put into parts which are then mentalized — (and therefore insurance-friendly) descriptive criteria.

DSM-IV 's supposedly atheoretical approach — designed to show no favoritism to any particular diagnostic school — not only camouflages its theoretical allegiance to logical empiricism and literalism, but also leaves the clinician out of the picture, much like the hypothetically objective — and therefore fictional — observer conducting a scientific experiment. When clinicians just observe the “data”(patients' symptoms) and then classify it without any significant concern for what underlies it, they are, through such non-intimacy with their patients (and therefore also with the psychodynamics of their patients), actually in the way of the very healing — not a fashionable concept for DSM-IV — that needs to happen.

The advantage of DSM-IV 's purely descriptive approach, namely that of situational reliability — that is, high consistency in diagnostic labeling — is outweighed not only by its insensitivity to both patient and clinician, but also by its potential inaccuracy (brought about largely via omission and superficiality) with regard to the patient's actual situation.

In making reliability more relevant than validity, DSM-IV strands itself in the shallows of diagnosis (unless, of course, it's used in wise conjunction with other, more caring and integrated modes of attuning to what patients need). If diagnostic “efficiency”(read: speed ) — lining up under the time pressures of managed care — is given too much focus (as by assembly-line psychiatry with its drug-dispensing automaticities and excesses), then there is not enough time to explore roots and psychodynamics, not enough time to really hear the patient's story, to permit intuition to take its rightful course.

It's easier to medicate than to liberate. Taking insufficient time with a patient actually wastes time, leaving far too little room for those qualities — like compassion — that are supportive of the healing of that patient. Sometimes medication is called for, but it nevertheless tends to be overrelied on, since it is a lot quicker to give, say, Paxil or Ritalin than to actively work with what underlies the symptoms that signal the “need” for Paxil or Ritalin.

Like most other oversized centralizing systems — exemplified by the multinational corporations currently colonizing the world — DSM-IV is ecologically illiterate. It not only does not significantly address the familial or social context of patients' syndromes, but also does not take into account, in considering the factors affecting patients, the cultural/political madness that continues to devastate — and continues to rationalize the devastation of — the biosphere.

In fact, DSM-IV , whatever its virtues, is part of that madness. Suppressing patients' symptoms may offer temporary relief, but does not ultimately work; whatever it is that animates symptoms simply finds other outlets, other somatic and mental locales, through which to express itself. We can only bury so much garbage before it spills out, often far beyond its originating source. It is becoming more and more difficult to separate our individual troubles from our collective troubles, but DSM-IV , being bereft of ecopsychological and transrational awareness, tacitly supports the separation — and resulting alienation — of self from community (human and otherwise), thereby reinforcing the self-centeredness that largely fuels our runaway consumerism.

DSM-IV classification schemata squat in a moral vacuum, a sealed-in cultism governed by minds committed to the operational preferences of a disembodied, sterile rationality. Its language has no depth, no body, no color. This has its technical advantages — much like instructions found in a vehicle manual — but also is dangerous, in that it situates both patient and clinician in a flattened, dry, emotionally eviscerated, and exaggeratedly abstract terrain. Deadened language (which is also the predominant language of professional psychology) tends to deaden its users.

The language of DSM-IV , like that of most academically-corraled writing, has forgotten to breathe. If it did, it might start to notice that it displays many of the very symptoms that it associates with mental disorders: flattened affect, fragmentation of self, depersonalization, obsessive-compulsive behavior. One could even say that DSM-IV is intoxicated with its neatly partitioned sobriety, using its “scientific” tone and syntax to lend weight to its authority. Its supposed flexibility, its apparent openness to change ( DSM-II to DSM-III to DSM-IV ), superficially mask its actual rigidity and obsessive-compulsive labeling — it is no more flexible than is Exxon environmentalist or Marlboro concerned with smokers' health.

Nevertheless, in spite of its spiritless language and approach, DSM-IV does have the advantage of helping a clinician quickly get to what is needed in certain acute cases, when medication is clearly necessary. Unfortunately, though, if help stops here, healing will likely be obstructed. Though medication may provide a much needed leveling or braking for a while, it is meant, in most cases, to only serve as scaffolding for the next step, whatever that might be.

To the point: Health professionals who unquestioningly or too closely follow DSM-IV are in danger of placing too much emphasis on symptoms. They are likely to confuse the seeming disappearance (or suppression) of symptoms with actual cure (and, to thicken the plot, “cure” as a goal may at times be simply a denial of the need to more deeply enter one's woundedness). When a patient is reduced to being little more than a carrier of symptoms, overreliance on psychiatric drugs is not far behind. After all, in the short run — which has been until recently the only race in contemporary Western culture, a resources-exhausting sprint for maximum profit — isn't it much more cost-effective to classify and medicate depression than to actually explore it?

Let's get down into depression a bit: Depression, except in its debilitating or suicidal extremes, is not so much a feeling as a suppression of feeling, consuming an enormous amount of life-energy in its pressing-down or sinking of feeling. It could be said to be the weighted-down sensation of nearly-successful repression, minus any significantly satisfying compensatory lift. It is a pain that walls away a deeper or more primal pain. As the drugged yet wretchedly insomniac gatekeeper of incarcerated trauma — both on personal and collective scales — depression asks not for further drugging (except under extreme conditions), but for a compassionately integral exploration. And depression is spreading like a plague: Its incidence has reportedly increased tenfold since the late 1940s. Before then there was no threat of nuclear war, no obvious ecological crisis; in the face of such overwhelming concerns, the intensity of which has accelerated in the last few decades, depression or “psychic numbing” is quite understandable.

However, in numbing and turning away from our own pain, we're also turning away from our collective pain, too dulled, overloaded, or uncaring to take necessary action, our mantra being something like, “I can't be bothered.” (No wonder so many teens say “Whatever” when pain gets too close for comfort.) Unfortunately, DSM-IV only reinforces such numbing, both by ignoring (or only very superficially considering) its originating contexts, and by all too readily drugging it — numbing the numbness . As helpful and necessary as antidepressants are in some cases, their prolonged use may only postpone our entry into the very depths that could, if skillfully worked with, fuel our shift to a more Life-giving course.

The holism suggested by DSM-IV 's format (which pays lip service to psychosocial and environmental problems) cannot hide its fragmented, reductionist nature — its labels and exclusion/inclusion criteria for so-called disorders do not include the person being diagnosed, nor do they necessarily accurately describe that person's condition. By paying so much attention to surface phenomena and their categorization, and so little attention to actual human development and psychodynamics — let alone the spiritual dimensions of patients — DSM-IV simply perpetuates its psycho-ecological blindness. In its obsessively standardized approach to diversity and anomaly, DSM-IV displays a monocultural bias, in which the unusual easily becomes an endangered species.

Perhaps the key missing ingredient — other than depth — in DSM-IV is narrative. The neatly partitioned categories packing the pages of DSM-IV may appear to be simply guideposts for mental health professionals, but they carry far too much authority (being, after all, psychiatry's “law of the land”) to be given the benefit of the same logic as the National Rifle Association employs regarding gun possession — namely that guns aren't the problem, people are (thereby conveniently bypassing the actual relationship between people and guns, not to mention the ways in which the actual presence of a gun can affect or modify human behavior).

Yes, in the right hands DSM-IV can be a useful tool, but it is more than a tool, carrying in its very structuring and languaging a powerful operational bias that is going to be very appealing to clinicians who have put themselves in a position to be overly committed to cookie-cutter diagnosis.

So should we get rid of DSM-IV ? Not necessarily, but neither should we keep it as it is. First of all, it needs to be reworked so that it does not pathologize unusual behavior, and secondly, it needs to be given a less central consideration in diagnosis. That is, as much as it can be a factor in arriving at a diagnosis, it needs to be kept in much the same position as would one's left-brain thoughts in attempting to get to the heart of the matter in a personally crucial situation. This is not to suggest a right-brain bias in diagnosis, but rather a practice wherein left and right hemispheric input, rational and intuitive modes, scientific and poetic stances, are synergistically combined.

Then the “gnosis” — knowledge-transcending knowingness or wisdom — can be put back in “diagnosis.”