DEFINITION
PATHOLOGIZING OF SPIRITUAL EXPERIENCES
HISTORICAL BACKGROUND
SPIRITUAL EMERGENCE AND EMERGENCY
MISDIAGNOSIS
SPIRITUAL EMERGENCIES IN DSM-IV
DEFINITION
Spiritual emergencies are crises during which the process of growth and change becomes chaotic and overwhelming. In such episodes, individuals often suddenly and dramatically enter into new realms of mystical and spiritual experience. However, they may also become fearful and confused and have difficulty coping with their daily lives, jobs and relationships. Spiritual emergencies are recognized within the DSM-IV category of Religious or Spiritual Problem. The impetus for proposing this new diagnostic category came from transpersonal clinicians whose initial focus was on spiritual emergencies. In the DSM-IV, spiritual problems are defined as distressing experiences that involve a person's relationship with a transcendent being or force but are not necessarily related to an organized church or religious institution.
Sometimes such experiences result from intensive involvement with spiritual practices such as meditation or yoga. The connection between spiritual practices and psychological problems was first noted by Assagioli [1] who described how persons may become inflated and grandiose as a result of intense spiritual experiences:
Instances of such confusion are not uncommon among people who become dazzled by contact with truths too great or energies too powerful for their mental capacities to grasp and their personality to assimilate (p. 36).
For most of human history, these experiences occurred only as rare, short-lived, spontaneous events, or even more rarely, as gradual shifts in awareness among individuals who devoted major portions of their life to contemplative, meditative, or religious disciplines. But beginning in the 1960s, interest in Asian spiritual practices such as meditation, yoga, and tai chi, and experimentation with psychedelic drugs led to an increase in the number of people experiencing related psychospiritual problems and crises.
When novices who don't have the proper education or guidance begin to naively and carelessly engage mystical experiences, they are playing with fire. Danger exists on the physical and psychological levels, as well as on the level of one's continued spiritual development. Whereas spiritual masters have been warning their disciples for thousands of years about he dangers of playing with mystical states, the contemporary spiritual scene is like a candy store where any casual spiritual "tourist" can sample the "goodies" that promise a variety of mystical highs. (Halfway Up the Mountain: The Error of Premature Claims to Enlightenment by Mariana Caplan)
Stanislav and Christina Grof coined the term "spiritual emergency" and founded the Spiritual Emergency Network in 1980 to identify and make referrals to therapists for individuals experiencing psychological difficulties associated with spiritual practices and spontaneous spiritual experiences.
The basic idea is that there exist spontaneous non-ordinary states that would in the west be seen and treated as psychosis, treated mostly by suppressive medication. But if we use the observations from the study of non-ordinary states, and also from other spiritual traditions, they should really be treated as crises of transformation, or crises of spiritual opening. Something that should really be supported rather than suppressed. If properly understood and properly supported, they are actually conducive to healing and transformation. (Interview with Stan Grof)
PATHOLOGIZING OF SPIRITUAL EXPERIENCES
Mental health theory has historically pathologized or ignored the spiritual dimension of life, and to view spiritual experiences as evidence of psychopathology Freud promoted this view in Civilization and Its Discontents, where he reduced the "oceanic experience" of mystics to "infantile helplessness" and a "regression to primary narcissism." In the 1976 report Mysticism: Spiritual Quest or Psychic Disturbance [2] by the Group for the Advancement of Psychiatry (GAP), the authors follow Freud's lead in defining the mystic perception of unity as a regression, an escape, a projection upon the world of a primitive infantile state. Other clinical literature has described the mystical experience as symptomatic of ego regression (Leuba [3]), a psychotic episode (Horton [4]), or temporal lobe dysfunction (Mandel [5]). This has resulted in cultural insensitivity towards individuals who present with spiritual problems and issues. Scott Peck, MD, author of The Road Less Traveled, highlighted the disastrous clinical consequences for all the mental health professions:
Traditional neglect of the issue of spiritually has led to five broad areas of failure: occasional devastating misdiagnosis; not in frequent mistreatment; an increasingly poor reputation; inadequate research and theory; and a limitation of psychiatrists own personal development.
HISTORICAL BACKGROUND
Parallels between psychiatric disorder and religious experiences have been noted since ancient times. The Old Testament uses the same term, in reference to madness sent by God as a punishment for the disobedient, and to describe the behavior of prophets (Rosen). Socrates declared,
"Our greatest blessings come to us by way of madness, provided the madness is given us by divine gift" (Dodds [6] p. 61).
Some genuine intense religious experiences can be awesome and frightening, preoccupy the individual for a period of time, and lead to the performance of private rituals, all of which can lead others to consider the person mentally ill.
There is also cross-cultural support for the overlap of psychosis and religious experiences. Anthropologists have observed that,
. . . highly similar mental and behavioral states may be designated psychiatric disorders in some cultural settings and religious experiences in others . . . Within cultures that invest these unusually states with meaning and provide the individual experiencing them with institutional support, at least a proportion of them may be contained and channeled into socially valuable roles. (Prince [7])
For example, in the late 1700s, during a prolonged psychotic episode in which he was totally dysfunctional for several months, the Iroquois Indian Handsome Lake had a series of "visions" that he later used to create a religious foundation for a new way of life among the Iroquois Indians (Wallace [8]).
SPIRITUAL EMERGENCE AND EMERGENCY
The clinical literature documents that psychotic-like episodes can result in improvements in an individual's functioning.
Some patients have a mental illness and then get well and then they get weller! I mean they get better than they ever were . . . . This is an extraordinary and little-realized truth (Menninger cited in Silverman [9], p. 63).
A researcher on schizophrenia similarly noted:
It is evident that acute schizophrenic disorganization can, at times, serve a constructive purpose (Epstein [10], p. 319).
Many clinicians and researchers who work with psychotic individuals have developed categories for episodes with the potential for positive outcomes: problem-solving schizophrenics (Boisen [11]); positive disintegration (Dabrowski [12]); creative illness (Ellenberger [13]); spiritual emergencies (Grof & Grof [14]); metanoiac voyages (Laing [15]); visionary states (Perry [16]). Wilber [17] also discusses the importance of distinguishing intense spiritual experiences from psychosis
These problems present with intensities ranging from a mild form of "spiritual emergence" (i.e., a gradual unfoldment of spiritual potential with little disruption in psychological/social/occupational functioning) to a severe form of "spiritual emergency" (i.e., an uncontrolled emergence of spiritual phenomena with significant disruption in psychological/social/occupational functioning). But David Steindl-Rast [18], a Benedictine monk who has served as a teacher of spiritual practices, has noted that both involve transitions that can be disruptive:
Spiritual emergence is a kind of birth pang in which you yourself go through to a fuller life, a deeper life, in which some areas in your life that were not yet encompassed by this fullness of life are now integrated . . . Breakthroughs are often very painful, often acute and dramatic.
Yet when the person is allowed to go through their experience, many positive personality changes result. Kenneth Ring [19] describes the changes that typically follow the near-death experience.
The typical near-death survivor emerges from his experience with a heightened sense of appreciation for life, determined to live life to the fullest. He has a sense of being reborn and a renewed sense of individual purpose in living . . . He is more reflective and seeks to learn more about the implications of his core experience, if he has had one. He feels himself to be a stronger, more self-confident person and adjusts more easily to the vicissitudes of life. The things that he values are love and service to others, material comforts are no longer so important. He becomes more compassionate toward others, more able to accept them unconditionally. He has achieved a sense of what is important in life and strives to live in accordance with his understanding of what matters. (p. 157-8)
Allen Bergin, Ph.D. [20] has observed that,
Some religious influences have a modest impact, whereas another portion seems like the mental equivalent of nuclear energy...The more powerful portion can provide transcendent conviction or commitment and is sometimes manifested in dramatic personal healing or transformation. (p. 401)
This nuclear analogy is apt for the spiritual emergency. It has tremendous healing power for the individual, and even for society, but can also be destructive if not channeled properly.
MISDIAGNOSIS
Unfortunately such experiences are often misunderstood by both the mental health and religious professions. Yet the clinician's initial assessment of powerful spiritual experiences can significantly influence the eventual outcome. As Greyson and Harris [21] point out, the clinician's response to a person's near-death experience can determine whether the experience is integrated and used as a stimulus for personal growth, or whether it is repressed as a bizarre event that may be a sign of mental instability. Similarly, with mystical experience, negative reactions by professionals can intensify an individual's sense of isolation and block his or her efforts to seek assistance in understanding and assimilating the experience.
Individuals undergoing powerful religious or spiritual experiences are sometimes at risk for being hospitalized as mentally ill. A number of such cases are presented in this course. Most religious professionals are unable to make the distinction between genuine and pathological experiences as well. A person who had had a near-death experience reported:
"I tried to tell my minister, but he told me I had been hallucinating, so I shut up" (Moody [22] p 86).
If a member of a typical congregation were to have a profound religious experience, its minister would very likely send him or her to apsychiatrist for medical treatment. (Stanislav Grof, Beyond the brain: Birth, death and transcendence in psychotherapy).
Zen Master Jakusho Kwong Roshi observed that powerful spiritual awakenings can have varied outcome,
Anybody with a body and mind can experience realization. Often they don't tell anybody because they think it is strange. They either keep it quiet, go crazy, or their search leads them to a teacher who can explain their situation.
SPIRITUAL EMERGENCIES IN DSM-IV
Spiritual problems are listed in the DSM-IV (together with religious problems) as distressing experiences that involve a person's relationship with a transcendent being or force but are not necessarily related to an organized church or religious institution. Spontaneous mystical and near-death experiences may lead to distressing experiences, as can the practice of mind/body techniques from non western spiritual traditions such as meditation and yoga. A spiritual emergency can present as a psychotic, dissociative, or depressive episode. The overlap in symptom presentation requires that mental heath be trained to make differential diagnoses between pathological and life-enhancing presentations of spiritual experiences. Its clinical features have been documented in many articles and are covered in this course.
Despite the consistency of these clinical observations, current mental health practice does not attempt to distinguish between psychotic episodes with growth potential and those which indicate a mental disorder. If these cases could be differentiated from cases of long-term psychotic illness, the prognosis of such individuals could be improved by providing appropriate treatment consistent with their need to express and integrate the physical, psychopathological and spiritual symptoms.
REFERENCES
Assagioli, R. (1989). Self-realization and psychological disturbances. In S. Grof & C. Grof (Eds.), Spiritual emergency: When personal transformation becomes a crisis, Los Angeles: Tarcher. 
Group for the Advancement of Psychiatry. (1976). Mysticism: Spiritual quest or mental disorder. New York: Group for the Advancement of Psychiatry.
Leuba J H (1929). Psychology of religious mysticism. New York: Harcourt and Brace.
Horton PC (1974). The mystical experience: Substance of an illusion. Am Psychoanalytic Assoc J 22(1-2):364-380.
Mandel A J (1980) Toward a psychobiology of transcendence: God in the brain. In RJ Davidson and JM Davidson (Eds), The psychobiology of consciousness. New York: Plenum Press.
Dodds, E. (1951). The Greeks and the irrational. Berkeley: Univ. California Press.
Prince, R. H. 1992 Religious experience and psychopathology: Cross-cultural perspectives. In J. F. Schumacher (Ed.), Religion and mental health, (pp. 281-290). New York: Oxford University Press.
Wallace, A. (1956). Stress and rapid personality change. International Record of Medicine, 169, 761-776.
Silverman, J.(1967). Shamans and acute schizophrenia. American Anthropologist, 69(1), 21-31.
Epstein, S. (1979). Natural healing processes of the mind: I. Acute schizophrenic disorganization. Schizophrenia Bulletin, 5(2), 313-321.
Boisen, A. T.(1962). The exploration of the inner world. New York: Harper and Row.
Dabrowski, K. (1964). Positive disintegration. Boston: Little Brown.
Ellenberger, H. (1970). The discovery of the unconscious. New York: Basic Books.
Grof, S. & Grof, C. (1985). Forms of spiritual emergency. The Spiritual Emergency Network Newsletter, Menlo Park, CA: California Institute of Transpersonal Psychology, 1-2.
Laing, R.D. (1972). Metanoia: Some experiences at Kingsley Hall, London. In H. M. Ruitenbeck (Eds.), Exploring Madness (pp. 113-121). Monterey, CA: Brooks/Cole.
Perry, J. (1974). The far side of madness. Englewood Cliffs, NJ: Prentice Hall.
Wilber, K. (1993) The pre/trans fallacy. In Walsh, R. Vaughan, F. (Eds.) Paths Beyond Ego. Los Angeles: Tarcher.
David Steindl-Rast cited in Bragdon, E. (1993). A sourcebook for helping people with spiritual problems. Aptos, CA: Lightening Up Press. p. 18.
Ring, K. (1990). Life at death: A scientific investigation of the near-death experience. NY: Coward, McGann & Geoghegan.
Bergin, A. (1991). Values and religious issues in psychotherapy and mental health. American Psychologist, 46(4), 394-403.
Greyson, B., & Harris, B. (1987). Clinical approaches to the near-death experience. Journal of Near-Death Studies, 6(1), 41-52.
Moody, R. (1975). Life after life. New York: Bantam.
