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Guide VII-004

Residential crisis houses for spiritual emergency (Diabasis)

John Weir Perry1970San Francisco
A 35 · L 36 · M 2912 interventions in the Trinity explorer
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[source: …] where a claim comes from[uncertain] not confirmed in a primary source[synthesis] the writer's reconstruction

1. Introduction

Version followed: John Weir Perry's own account of Diabasis (San Francisco, 1970s) as given in The Far Side of Madness (1974) and Trials of the Visionary Mind (1999), reached through secondary quotations and case extracts, plus the account of Michael Cornwall (a former Diabasis-tradition clinician and Perry analysand, 2022). The books themselves are not drawn on. [uncertain]

This is a historical programme, not a current, manualised therapy. Diabasis (Greek for roughly "crossing through") was an unlocked, home-like residence for young adults in an early, acute psychotic episode. It used no antipsychotics as routine, no electroshock and no locked doors. Perry, a Jungian psychiatrist, founded it in the 1970s and it closed in the early 1980s. No Diabasis house operates today. [source: Spring Publications; IMHU review; SCRC lesson 3.7] The location is given as San Francisco by Cornwall and in material quoted from Perry, and as Berkeley by Spring Publications. [uncertain] Cornwall says the city's community mental health service funded it. [source: Cornwall 2022; Perry quoted in forum post 1375066]

Core idea of change. Perry, following Jung, held that some acute psychotic episodes in young people are a purposive "renewal process". In his view, the psyche withdraws energy from the outer world, takes apart a damaged and compensatorily inflated self-image, and reorganises around a new centre. The person lives this through mythic imagery of death and rebirth, cosmic conflict and the union of opposites. Perry held that how the surroundings respond decides whether the process becomes growth or a chronic disorder. Empathic, affirming accompaniment lets the episode run its course and integrate. Invalidation, isolation and suppressive medication "freeze" it unfinished. These are Perry's theoretical claims, attributed to him, not established fact. [source: SCRC case extract from Far Side of Madness pp. 10–11, 130–136; SUNY Press description of Trials; SCRC lesson 6.1]

Related model: for the better-documented, research-evaluated medication-sparing first-episode house, see Soteria (Loren Mosher, 1971 onward), covered in Domain V if present. [source: SCRC lesson 3.7]

How a clinician uses this today: you cannot run Diabasis as it was. What remains usable is its stance and accompanying skills, applied inside current first-episode psychosis care, crisis houses and spiritual-emergency consultation, alongside psychiatric assessment. [synthesis]

2. Framework

Perry published no staged session protocol. The phases below are put together from his case reports and summaries. [source: SCRC case extract; IMHU review; forum post 840436 quoting Trials] [uncertain on exact boundaries]

Phase 0: Selection and admission

  • Goal: admit people for whom the renewal process is judged most likely.
  • Who: young adults in an early, acute episode rich in imagery. Perry reported that third or fourth episodes, chronicity and heavy prior medication gave much weaker results. [source: Perry quoted in forum post 1375066]
  • Other features: acute onset and relatively intact prior functioning. [source: IMHU review]
  • Diagnosis: residents carried a schizophrenia diagnosis. [source: Perry quoted, forum post 1375066] Cornwall writes that Perry aimed to resolve episodes before the six-month mark at which schizophrenia would be diagnosed. [source: Cornwall 2022] The two accounts differ. [uncertain]

Phase 1: Acute visionary phase

  • Goal: provide sanctuary, constant empathic company and engagement with the imagery.
  • Course: speech may at first be fragmented, or the person mute. With attentive presence over a few sessions, the fragments come together into a story that moves forward. [source: forum post 840436 quoting Trials]
  • Pace: Perry reported that early acute clients often became coherent and oriented within two to six days without medication. [source: Perry quoted, forum post 1375066] The first few weeks are described as critical. [source: IMHU review]

Phase 2: Working through the renewal imagery

  • Goal: let the mythic sequence complete: death and dismantling, then rebirth ("new birth"), then a reorganised centre.
  • Format in Perry's case example: staff present round the clock, Perry seeing the resident individually three times a week, and drawing of images. [source: SCRC case extract]
  • Duration: about six weeks in Perry's view. More intense episodes seemed to move faster. [source: forum post 840436; SCRC case extract]

Phase 3: Integration while still resident

  • Goal: make the experience meaningful and bring it into ordinary life before discharge.
  • Format: the person stays on at the house after the acute imagery settles. [source: SCRC case extract]

Length of stay

  • Reported as an average of 40 days. [source: IMHU review]
  • Cornwall estimated "probably between 1 and 2 months" and said he was not sure. [source: Cornwall 2022] [uncertain]

Criteria for moving on or changing course

  • Signs of renewal: archetypal content, some capacity for relationship, movement toward integration, and the person finding the experience meaningful.
  • Signs of fragmentation: chronic deterioration, loss of contact or self-care, mainly paranoid content and increasing disorganisation.
  • Time limit: if integration has not begun within about 6–8 weeks, conventional psychiatric care is indicated. [source: IMHU review; SCRC lesson 3.7] This review is secondary, and its attribution of the exact criteria to Perry is unverified. [uncertain]

Medication

  • Kept in reserve for rare situations that could not be managed, after psychological approaches had been tried. [source: Perry's conclusions as quoted in forum post 1375066]
  • One review says it was used minimally, for overwhelming anxiety or sleeplessness. [source: IMHU review] [uncertain]

Staffing format

  • About twenty paraprofessionals filled seven paid positions, some working part-time; others were volunteers.
  • They did both attendant work and counselling.
  • Perry provided psychiatric and Jungian oversight. [source: Perry quoted, forum post 1375066]

Reported outcomes (claims only, not verified)

  • Perry claimed 85% of clients improved without medication. [source: forum post 1375066]
  • A later review gives 60–70%. [source: IMHU review]
  • The figures conflict and come from no controlled Diabasis study in the sources. [uncertain]

3. Guiding principles

Each principle is followed by its practical meaning. [source: as tagged]

  • The episode may be purposive, a renewal and not only a breakdown. Assess for meaning and direction as well as for symptoms. [source: SCRC case extract; SUNY Press]
  • The response of the surroundings shapes the outcome. Make your first job affirming, not invalidating, the person's experience. [source: SUNY Press description of Trials]
  • Facilitate, don't halt. Perry held that the helper should support the process rather than try to stop it, and actively encourage it in a person whose psyche is activated. Don't argue the person out of the imagery. [source: SCRC lesson 6.1, quoting Perry]
  • "You work with what the psyche presents." Follow the person's spontaneous material session by session rather than imposing an agenda. [source: SCRC case extract, p. 136]
  • Distinguish therapy from treatment. Perry contrasted work with the underlying process against efforts to stop symptoms. Ask "what is this image doing?" before "how do I reduce it?" [source: forum post 840436 quoting Trials]
  • Medication as back-up, not as the first response. Perry argued that suppressive medication blunts the inner work and leaves the process "frozen". Today the prescriber decides, with informed consent; your role is to make sure the psychological route is tried and the risks are weighed. [source: SCRC lesson 6.1; Perry quoted in forum post 1375066] [synthesis for the modern role]
  • Symbolic, not literal, engagement. You need not agree the person is Christ or that the world is ending. Take seriously what the symbol is saying psychologically. [source: IMHU review]
  • A sanctuary (temenos), not a ward. The setting is homelike, unlocked, calm and protected. [source: Spring Publications; IMHU review]
  • Emotional presence and "loving receptivity". Perry asked staff for honest feeling and person-to-person connection that can hold intense, affect-charged imagery. Presence matters more than technique. [source: Cornwall 2022; Perry quoted in forum post 1375066]
  • Affect is the medium of change. Perry redefined archetypes as "affect images". Watch for and welcome returning feeling and connection ("Eros") as signs of progress. [source: Cornwall 2022, citing Perry 1970; SCRC case extract]
  • Early is better. First, imagery-rich episodes respond best. Bring people in early; don't promise the same outcome in long-standing illness. [source: Perry quoted in forum post 1375066]
  • Choose staff for empathy, not credentials. Staff were picked for warmth and comfort with deep psychological material, then trained on the job. [source: Perry quoted in forum post 1375066]
  • Helpers need their own inner work and peer support. This prevents projecting onto, or being destabilised by, the material. [source: IMHU review]
  • Keep watching the trajectory. Openness to the process never replaces ongoing judgement of whether the person is integrating or deteriorating. [source: IMHU review; SCRC lesson 3.7]

4. Intervention inventory

Diabasis was a milieu with a stance, not a set of named techniques. Below are the procedures the sources describe, with the context they were used in. All example language is illustrative unless quoted. Applications to present-day practice are marked [synthesis].

4.1 Selecting and admitting residents

  • Purpose: focus the house on people most likely to be in a self-limiting renewal process. [source: Perry quoted, forum post 1375066; IMHU review]
  • Steps (as the sources describe):
    1. Take referrals from the county system of young adults in an early, acute episode.
    2. Prefer first episodes that are acute in onset, rich in imagery and in people who functioned well beforehand.
    3. Weigh chronicity, several prior episodes and heavy prior medication as reasons the approach is likely to help less.
  • Steps (today) [synthesis]:
    1. Carry out a full psychiatric and medical assessment first. Rule out delirium, intoxication or withdrawal, neurological and endocrine causes, and post-partum onset.
    2. Assess risk to self and others, and how dependable the person's supports are.
    3. Discuss treatment options, including antipsychotics, as part of informed consent.
    4. Document the person's own preference and any advance statement.
  • Example language (illustrative): "What has been happening to you feels enormous and full of meaning. Before anything else, we want to check your body and your safety, so that we can give the experience the room it needs."
  • Watch for:
    • Signs of fragmentation rather than renewal (see section 2).
    • Substance-induced states.
    • Any risk that cannot be held in an unlocked setting. [synthesis]

4.2 Creating the sanctuary (temenos)

  • Purpose: offer a protected, homelike, unlocked space where the episode can unfold without coercion or the trauma of a ward. [source: Spring Publications; IMHU review]
  • Steps:
    1. Use an ordinary house rather than a ward.
    2. No locked doors and no routine seclusion.
    3. Staff present 24 hours. [source: Cornwall 2022; IMHU review]
    4. Keep the atmosphere calm and low in stimulation, with a predictable daily rhythm. [synthesis]
    5. Have a single, clearly named person on duty as the resident's companion at any time. [synthesis]
  • Example language (illustrative): "This is a house, not a hospital. Someone will be with you day and night. You can tell us anything you are seeing or feeling here."
  • Watch for:
    • Agitation set off by noise, crowding or conflict between staff.
    • Wandering at night.
    • Overstimulation. [synthesis]

4.3 Continuous empathic presence ("being with")

  • Purpose: the central intervention. A steady human relationship that can hold intense, affect-laden imagery so the ego can tolerate it. [source: Cornwall 2022; Perry quoted, forum post 1375066]
  • Steps:
    1. Sit with the person for long stretches. Follow their lead about talking or silence.
    2. Respond with honest feeling rather than clinical distance.
    3. Don't label or dismiss what they say.
    4. If speech is fragmented or the person is mute, stay quietly attentive over several sessions until the fragments begin to form a story. [source: forum post 840436 quoting Trials]
    5. Hand over between staff with continuity, so the person isn't retelling to strangers. [synthesis]
  • Example language (illustrative): "I'm here. You don't have to make sense for me. I'm listening for whatever comes." Or: "When you said the world is ending, I felt how frightening that is."
  • Watch for:
    • Signs it is working: increasing coherence, eye contact, returning warmth, and the person seeking contact. Perry reported coherence within two to six days in early episodes. [source: Perry quoted, forum post 1375066]
    • Signs it is not working: deepening withdrawal, no self-care, mounting fear or paranoia. [source: IMHU review]

4.4 Symbolic engagement with delusional and visionary content

  • Purpose: treat mythic content (messianic identity, world destruction, cosmic battle, death and rebirth) as meaningful psychological communication rather than errors to correct. [source: IMHU review; SCRC case extract]
  • Steps:
    1. Ask the person to tell you more about the image or identity.
    2. Explore its feeling tone and what it does for them.
    3. Don't reality-test, argue or collude. Neither confirm nor deny the literal claim. Respond to its psychological meaning. [source: IMHU review]
    4. Notice how the theme changes over days, for example from grandiose identities to death imagery to new-birth imagery. [source: SCRC case extract]
  • Example language (illustrative): "You feel chosen to save the world. What would it mean to have that kind of importance right now?" Or: "Being buried and clawing out sounds terrible and also like a beginning. What is ending for you?"
  • Watch for:
    • Content turning into plans to act in the world, such as messianic missions, driving or giving money away. Answer that with safety measures, not interpretation. [synthesis]
    • Paranoid content that is getting worse rather than changing. [source: IMHU review]

4.5 Individual psychotherapy sessions with the psychiatrist

  • Purpose: regular depth-psychological sessions alongside the milieu. [source: SCRC case extract]
  • Steps:
    1. In Perry's case, he saw the resident three times a week throughout the stay.
    2. Follow "what the psyche presents" in each session. [source: SCRC case extract, p. 136]
    3. Formulate the prepsychotic problem, in Perry's case a damaged, then compensatorily inflated, self-image.
    4. Track how the imagery works to rebalance conscious and unconscious life. [source: SCRC case extract]
  • Example language (illustrative): "Let's look at where the pictures have taken you since Tuesday."
  • Watch for:
    • Growing affect and relatedness in the room, which Perry read as awakening Eros. [source: SCRC case extract]

4.6 Drawing and painting the imagery

  • Purpose: let images too intense or fragmented for words be expressed and worked with. [source: SCRC case extract]
  • Steps:
    1. Early on, invite the person to draw.
    2. Provide simple materials and no instructions about content.
    3. Look at the pictures together in the next session. In Perry's case the images showed cremation, burial and clawing out of a grave.
    4. Keep the images as a record of how the process moves. [source: SCRC case extract; step 4 partly synthesis]
  • Example language (illustrative): "Would you put some of what you're seeing onto paper? It doesn't need to be good, just there."
  • Watch for: sequences that move from destruction toward birth, union or a centred design, which Perry read as renewal going ahead. [source: SCRC case extract; IMHU review]

4.7 Mythic amplification (recognising the renewal themes)

  • Purpose: help staff and, later, the person see the episode's imagery as part of a recognisable archetypal pattern. Perry compared it to the ritual dramas of sacral kingship and New Year renewal in ancient cultures. [source: SCRC case extract; Spirituality Studies 2016, citing Perry 1974]
  • Themes named in the sources:
    • death and dismantling of the old structure
    • world destruction and recreation
    • cosmic conflict between good and evil, and opposites
    • apotheosis and messianic identity
    • sacred marriage or union of opposites
    • new birth (of a superhuman child or of oneself)
    • reorganisation around a new centre [source: IMHU review; SCRC case extract]
    • Perry's fuller, numbered list of themes in Roots of Renewal in Myth and Madness (1976) is not drawn on. [uncertain]
  • Steps:
    1. Staff learn the motifs, so that what they hear sounds meaningful to them rather than bizarre.
    2. Mostly hold the amplification silently during the acute phase.
    3. Offer parallels from myth gently, and mainly in the integration phase, when the person can reflect. [synthesis on timing]
  • Example language (illustrative): "Many cultures tell a story of a king who dies and is reborn at the turning of the year. Your experience has some of that shape. Does that fit?"
  • Watch for:
    • Amplification feeding inflation, where the person takes the parallel as confirmation of literal special status.
    • If that happens, stop and come back to feeling and to ordinary relationships. [synthesis]

4.8 Holding medication in reserve

  • Purpose: protect the inner process from suppression while keeping a safety option. [source: SCRC lesson 6.1; Perry quoted, forum post 1375066]
  • Steps:
    1. Try psychological and milieu approaches first.
    2. Keep medication as a back-up for rare situations that cannot be managed.
    3. One later review says medication was used minimally, for overwhelming anxiety or sleeplessness. [source: IMHU review] [uncertain]
  • Steps (today) [synthesis]:
    • Prescribing decisions belong to the medical team.
    • Agree in advance, with the person and family, the specific triggers for offering medication, for example several nights without sleep, dangerous behaviour, or inability to eat or drink.
    • Record consent.
  • Example language (illustrative): "We'd like to give your mind room to work this through. If you go several nights without sleep, or are in danger, we'll talk about medication with the doctor. That's our agreement."
  • Watch for: sleep loss, exhaustion, dehydration and escalating agitation. These are medical red flags. [synthesis]

4.9 Selecting, training and supporting paraprofessional staff

  • Purpose: the staff are the treatment. [source: Perry quoted, forum post 1375066; Cornwall 2022]
  • Steps:
    1. Recruit for empathy and comfort with deep psychological material, not for degrees.
    2. Combine attendant and counselling roles.
    3. Train on the job in a mainly Jungian frame, together with other methods. [source: Perry quoted, forum post 1375066]
    4. Ensure staff have their own psychological work and collegial support. [source: IMHU review]
    5. Hold regular team supervision focused on staff members' own reactions. [synthesis]
  • Example language (supervision, illustrative): "What did sitting with her death imagery stir in you last night?"
  • Watch for:
    • Burnout.
    • Staff becoming swept up in, or frightened by, the material.
    • Splitting within the team. [source: IMHU review; partly synthesis]

4.10 Tracking the trajectory (renewal versus fragmentation)

  • Purpose: decide day by day whether to keep accompanying the process or to move to conventional care. [source: IMHU review; SCRC lesson 3.7]
  • Steps:
    1. Review daily against the indicators in section 2.
    2. Note sleep, food and fluid intake, and self-care.
    3. Note whether imagery is moving or static.
    4. Note whether the capacity for relationship is growing.
    5. If integration hasn't begun by about 6–8 weeks, or fragmentation signs dominate, refer to psychiatric care. [source: IMHU review]
  • Example language (team, illustrative): "Is the imagery going somewhere, or is he getting more lost and less related?"
  • Watch for: relying on the time limit while risk rises. Risk overrides the timeline. [synthesis]

4.11 Integration before discharge

  • Purpose: make the experience meaningful, consolidate the reorganised sense of self, and prepare for ordinary life. [source: SCRC case extract; IMHU review]
  • Steps:
    1. Keep the person resident after the acute imagery settles.
    2. Review the drawings and the story of the episode together.
    3. Link the themes to the life problems that came before the episode, for example a damaged self-image or affect shut off. [source: SCRC case extract]
    4. Plan for continuing growth after leaving. Perry reported that most clients kept developing. [source: Perry quoted, forum post 1375066]
    5. Arrange outpatient therapy, a relapse-signature plan and family meetings. [synthesis]
  • Example language (illustrative): "Looking back over these weeks, what died, and what was born? What do you want to carry into your life now?"
  • Watch for:
    • The person dismissing the episode as "just madness", which loses its meaning.
    • The person holding on to grandiose conclusions.
    • Either way, aim for a humble, usable meaning. [synthesis]

4.12 Present-day adaptation for an outpatient therapist [synthesis]

None of this is from Perry or Diabasis. It is my own guidance for applying the stance today.

  • Purpose: use Diabasis's stance safely when a client presents with an acute visionary or psychotic-like state, or a "spiritual emergency".
  • Steps:
    1. Arrange urgent psychiatric and medical assessment, and early-intervention-in-psychosis referral where available.
    2. Agree a safety and sleep plan with the client and supporters.
    3. In sessions, use 4.3, 4.4 and 4.6: presence, symbolic listening and drawing.
    4. Coordinate with the prescriber rather than opposing medication.
    5. Look for a crisis house, peer-respite or Soteria-type service where available.
    6. After the acute phase, use 4.7 and 4.11 for integration.
  • Watch for: any sign that outpatient containment is not enough. If so, step up care.

5. Handling problems

The sources say little about problem-handling. Unless tagged otherwise, the guidance below is my own [synthesis], in line with current standard practice for acute psychosis.

Mute, fragmented or withdrawn resident ("stuck" early)

  • Perry's material advises staying quietly attentive over several sessions until the fragments cohere. [source: forum post 840436 quoting Trials]
  • Add simple offers, such as drawing, a walk or tea.
  • Check food, fluid and sleep every shift.
  • Catatonic features or refusal to eat or drink need medical review the same day. [synthesis]

Imagery static, or paranoia worsening (process not moving)

  • Treat this as a fragmentation sign. [source: IMHU review]
  • Review at team level, ask for psychiatric review, and bring forward the 6–8-week decision point. [synthesis]

Overwhelm: terror, panic, sleeplessness for several nights

  • Increase one-to-one presence and lower stimulation.
  • Ground the person: name the room, the time and who is there.
  • Use the pre-agreed medication triggers (4.8). Perry himself kept medication for situations that could not be managed. [source: Perry quoted, forum post 1375066] [synthesis for the rest]

Risk to self: suicidal ideation, death imagery turning literal, self-harm

  • Death imagery is central to Perry's model, so staff must tell symbolic death themes apart from intent to die.
  • Ask directly about intent and plans every time death imagery appears.
  • Use a standard suicide risk assessment.
  • Remove and secure means in the house: medicines, ligature points, sharps.
  • Move to a higher level of care if needed. Never interpret imminent risk as symbolism. [synthesis]

Risk to others, or dangerous enactment (messianic missions, driving, absconding, giving money away)

  • Respond with safety first: increase staffing, agree limits, and involve family.
  • If the risk cannot be held in an unlocked house, transfer under current mental health law. [synthesis]
  • Perry's sources do not describe how Diabasis handled violence. [uncertain]

Non-adherence or refusal (of the house routine, of medication, of leaving)

  • Negotiate, and record the person's preferences.
  • Respect capacity-based refusal of medication within the law.
  • Where the person wants medication, the house's ethos must not pressure them to go without it. [synthesis]

Rupture: the resident experiences a staff member as persecutor or as part of the delusion

  • Swap in another companion where possible.
  • The staff member owns any lapse in honesty or presence. Cornwall stresses honest feeling. [source: Cornwall 2022]
  • Repair later, in the integration phase. [synthesis]

Inflation persisting after the acute phase

  • Gently link grandiose meaning back to the person's own wounded self-image. This is Perry's formulation of compensatory inflation. [source: SCRC case extract]
  • Avoid confirming special status. [synthesis]

Staff destabilised, swept up in the material, or burnt out

  • Use supervision, the staff member's own therapy and rotation. [source: IMHU review; synthesis]

Modality-specific: mistaking another condition for a "renewal process"

  • Possibilities include:
    • delirium, intoxication or withdrawal
    • organic illness
    • mania with physical exhaustion
    • post-partum psychosis
  • Medical work-up comes first, and the medical team re-checks it if the picture changes. [synthesis]

Modality-specific: chronic or repeated episodes

  • Perry reported much weaker results here. [source: Perry quoted, forum post 1375066]
  • Don't promise renewal. Offer the full range of current treatments. [synthesis]

Modality-specific: outcome claims and expectations

  • Perry's 85% figure and later reviews' 60–70% are uncontrolled claims. [uncertain]
  • Don't cite them to clients or families as established evidence. [synthesis]

Modality-specific: client or family wants an "anti-medication" path at all costs

  • Explain that Diabasis was a 24-hour supervised house for selected first episodes, not a model for going without care at home.
  • Support access to medication-sparing services where they exist, within shared decision-making with psychiatry. [synthesis]

Spiritual framing

  • Phrases such as "spiritual emergency" and "renewal" are Perry's and the transpersonal tradition's interpretive frame.
  • Use the client's own language. Don't impose a spiritual reading, and don't dismiss one either. [synthesis]

Sources

Sources

Books and papers cited (not drawn on directly)

  • Perry, J. W. (1974). The Far Side of Madness. Prentice-Hall; later editions from Spring Publications.
  • Perry, J. W. (1976). Roots of Renewal in Myth and Madness. Jossey-Bass.
  • Perry, J. W. (1999). Trials of the Visionary Mind: Spiritual Emergency and the Renewal Process. SUNY Press.
  • Perry, J. W. (1953). The Self in Psychotic Process: Its Symbolization in Schizophrenia (foreword by C. G. Jung).
  • Perry, J. W. (1970). Emotions and object relations. Journal of Analytical Psychology, 15(1). (cited via Cornwall 2022)
  • Cornwall, M. (2002). Doctoral dissertation on the Diabasis staff way of being. Not drawn on. [uncertain]
  • Rappaport, M. et al. (1978). Agnews State Hospital first-episode study. Cited via Cornwall 2022; not drawn on.
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