There is a moment in the descent that most people recognise before they know its name. The moment when everything that defined you — your roles in life, your certainty, your sense of who you are in the world — begins to fall away. Not always gradually, nor gently. But gate by gate, layer by layer, until you arrive somewhere you cannot name and cannot leave. Stuck and feeling stripped of everything you thought you were.
If you have been through a psychotic episode, a dark night of the soul, a spiritual emergency, or a profound collapse — you may know this place very well. You may have been told it was a breakdown. A symptom, or a malfunction of the brain to be corrected (often with medications) and moved past as quickly as possible.
What if it was something else, something older than that? What if it was a descent — one that has a map?
The oldest story of going under
Inanna is the Sumerian goddess of heaven and earth — the most powerful figure in the ancient Mesopotamian pantheon. Worshipped in the city-states of Sumer more than four thousand years ago, she presides over love, war, beauty, and justice. She is not a minor deity. She is, in her world, everything.
And she chooses to descend.
The myth — preserved on clay tablets discovered in the ruins of ancient Nippur and translated by scholars in the twentieth century — tells the story of Inanna’s journey into the Great Below, the underworld ruled by her sister Ereshkigal. The reasons for the descent are not entirely clear, even in the original text. She goes, the poem says, with ear open to the Great Below. Something calls her downward. Something she cannot ignore.
At the first gate of the underworld, the gatekeeper demands that she remove her crown. At each of the seven gates that follow, she must surrender another of her divine attributes — her lapis lazuli necklace, her double strand of beads, her breastplate, her gold ring, her lapis measuring rod, and finally her royal robe. She passes through each gate diminished, stripped of another layer of what made her Inanna.
When she arrives at the throne of Ereshkigal, she arrives naked and bowed low. And Ereshkigal — wild with grief and rage — kills her. Hangs her body on a hook. And leaves her there. Auch.
Seven gates: a map of what the descent actually feels like
The seven gates are not incidental. They are the structure of the thing — the precise, sequential nature of what happens when someone goes under.
It is rarely one loss that undoes a person. It is the accumulation. The identity goes first — the sense of knowing who you are, what you stand for, what your place in the world is. Then the relationships shift — the people who knew you as you were struggle to recognise you as you are becoming. Then the body changes — sleep, appetite, the felt sense of being at home in your own skin. Then the cognitive scaffolding loosens — the capacity to think clearly, to sequence, to plan. Then the language fails — the ability to explain what is happening, to make yourself understood to the people who want to help. Then the meaning dissolves — the stories you told about your life stop holding.
And then, at the last gate, the final layer is surrendered — the belief that you will come back from this. That there is a self to return to. That what is happening has an end.
This is where psychosis often lives. And it is where the myth meets the clinic with a precision that four thousand years have not diminished.
Ereshkigal: what lives in the underworld
The figure of Ereshkigal is one of the most psychologically rich in the myth. She is Inanna’s sister — her shadow, her double, the part of herself that has been banished to the depths. Ancient mythology did not invent the unconscious, but it mapped it with extraordinary accuracy.
Ereshkigal is wild. She is in pain. She is not evil — she is the one who was given the underworld to rule, who has been down here in the dark while her sister had heaven and earth, who has never been seen or honoured or brought into the light. Her grief is real. Her rage is real. And her power over anyone who enters her domain is absolute.
In the language of Internal Family Systems therapy, Ereshkigal is an exile — a part that has been locked away, carrying the unbearable weight of everything that could not be integrated into the functioning self. In the language of depth psychology, she is the shadow — the sum of what was split off, disowned, pushed underground in order to maintain the identity that the upper world required.
She cannot be reasoned with. She cannot be managed. She can only be witnessed — which is precisely what happens in the myth’s resolution, and precisely what effective therapy tries to do.
Ninshubur: the one who goes for help
Before Inanna descends, she does something essential: she instructs her most loyal companion, Ninshubur, to wait for her. If she has not returned in three days, Ninshubur is to go to the gods and ask for help. To mourn her publicly. To refuse to let the descent go unwitnessed.
This detail is not small. It is, in many ways, the most clinically significant element of the entire myth.
Inanna knows that the descent requires a witness who remains above — someone who stays regulated while the descender goes into the unregulated depths, who holds the memory of who the person is when they cannot hold it themselves, who refuses to abandon the search even when the underworld tries to keep what it has claimed. Someone who goes for help.
This is the role of the therapist. The companion. The Wisdom Keeper. The Care Circle. The person who sits with someone in crisis and does not need them to be other than they are — who can tolerate the wildness of Ereshkigal without either rescuing prematurely or abandoning the field.
Polyvagal Theory gives us the neuroscience for why this matters so much. A regulated nervous system in the presence of a dysregulated one creates the conditions under which co-regulation becomes possible. The presence of Ninshubur — stable, faithful, refusing to stop looking — is not metaphorical support. It is neurobiological medicine.
Go deeper
If you recognise the descent
Chapter 5 of Wisdom of Psychosis explores crisis as catalyst — and what post-psychotic growth actually looks like in practice. The Care Circle is where we practice finding our way through together.
Death and return: what the underworld does
Inanna hangs on the hook for three days. The myth does not hurry this. There is no escape, no shortcut, no way to avoid what the underworld demands. The death is real — not literal, but complete. The person who went down cannot come back unchanged. She is not repaired. She is transformed.
The rescue, when it comes, is indirect and strange. Enki — the god of wisdom — creates two tiny beings from the dirt under his fingernail and sends them into the underworld with explicit instructions: find Ereshkigal, and do nothing but witness her pain. Do not fix. Do not advise. Do not offer solutions. Simply be present to what she is feeling.
Ereshkigal, who has never been witnessed, who has been alone with her grief for as long as the underworld has existed, is undone by this. She offers the tiny beings anything they want. They ask for Inanna’s body. And Inanna is released.
This is the resolution of the myth, and it is almost unbearably precise as a description of what heals the unhealable. Not intervention. Not correction. Not diagnosis. Witnessing. The willingness to be present to the pain that has never been seen — the grief of the part that was exiled, the rage of the self that was split off — without needing it to be different.
Post-psychotic growth: what comes back
Inanna does not return from the underworld as she went down. She is changed — irrevocably, and in ways that are not only loss.
What she carries back is something that could not have been acquired any other way: direct knowledge of the depths. The capacity to move between worlds. The authority of someone who has been to the place that most people fear above all others, and who came back — not intact, but alive, and carrying something.
This is what I mean by post-psychotic growth — the concept I have developed across twenty-eight years of clinical work and which sits at the heart of Wisdom of Psychosis. It is not the idea that breakdown was worth it, or that everything happens for a reason, or that suffering is secretly a gift. It is something more precise and more honest than that.
It is the observation that people who survive the descent — who are accompanied well, who have the time and the container to integrate what happened — frequently arrive on the other side carrying something that was not there before. A depth. A capacity for presence with suffering that does not flinch. A sensitivity that, rightly understood, is not a wound but a form of intelligence.
Inanna could not have become who she becomes without going under. That is not a consolation. It is simply what the myth records — with the accuracy of a tradition that had been watching people descend and return for thousands of years before the first psychiatric ward was built.
What this changes in clinical practice
Working with the myth of Inanna’s descent does not mean asking people on the spectrum of psychotic sensitivity to engage with ancient Sumerian poetry. It means holding a different question about what is happening — one that opens toward meaning rather than closing toward management.
The DSM asks: what is wrong? The myth asks: where are you in the descent? Have you passed the first gate or the seventh? Who is your Ninshubur? Has anyone been sent to witness Ereshkigal yet?
These are not poetic substitutes for clinical questions. They are clinical questions — asked in a language that many people in crisis find more accurate to their actual experience than any diagnostic category has ever been.
In my clinical work, I use mythological frameworks not as metaphor but as map. When someone can locate themselves in the structure of the descent — when they can say I am at the fifth gate or I think I am hanging on the hook — something shifts. The experience becomes legible. It has a shape, a direction, a logic. It has happened before, to others, who came back. The isolation that is one of the most devastating features of psychotic experience begins, fractionally, to soften.
This is one of the original medicines: story. The oldest technology for making the unbearable survivable.
A note on the myth’s limits
The myth of Inanna’s descent can be a map, not a guarantee. Not everyone who descends, also returns. Not every dark night has a dawn within a reachable timeframe. Not every crisis carries the seeds of growth, and saying otherwise to someone in acute suffering is a form of violence.
What the myth offers is not reassurance. It offers company. It says: this has a shape. Others have been here. The underworld has been navigated before. And there are things that help — a Ninshubur who stays, beings who witness without fixing, a tradition that takes the depths seriously enough to have mapped them.
That is not nothing. In the right moment, in the right hands, it can be everything.
Further reading
Wolkstein, D. & Kramer, S.N. (1983). Inanna: Queen of Heaven and Earth. Harper & Row. The primary scholarly translation of the myth.
Perera, S.B. (1981). Descent to the Goddess: A Way of Initiation for Women. Inner City Books. A Jungian reading of the Inanna myth.
Schwartz, R. (1995). Internal Family Systems Therapy. Guilford Press.
Grof, S. & Grof, C. (1989). Spiritual Emergency: When Personal Transformation Becomes a Crisis. Tarcher.
Sips, A. (2026). Wisdom of Psychosis: Navigating the Intelligence of Altered States. Terrapy Press.
