Resources

ROLE OF PSYCHOTHERAPY
Psychotherapy can help post spiritual emergency patients shape their experience into a coherent narrative, see the "message" contained in their experiences, and create a life-affirming personal mythology that integrates their spiritual emergency. Each of these three phases of psychotherapy is described below. Spirituality plays a special role in psychotherapy with spiritual emergency patients. Appropriate interventions are described below.

PHASE 1:
TELLING THE STORY OF THE SPIRITUAL EMERGENCY
People who have had spiritual emergencies often do not receive validation for their experiences, or even the opportunity to talk about them. In the 3 case studies I have researched and published (Case Library), the hospital records did not mention any of the spiritual content present in these patients' mental life. The inpatient chart notes simply described them as delusional, as having religious hallucinations, being preoccupied with space aliens, and making claims of having special powers. That much information was sufficient to make the diagnosis of a psychotic disorder. In the medical model, further exploration of person's experiences would be unnecessary and could even exacerbate symptoms by reinforcing his/her "delusional system." Yet they all 3 reported that working with me to put their story into writing was very helpful to them.

Psychotherapy can be seen as a process of helping clients construct a new narrative, a fresh story of their lives. In this narrative understanding, psychotherapy does not consist in the cathartic healing effect of releasing traumatic repressed events and their emotions, but in reconstructing a person's authentic story (see What is narrative therapy?). In making interpretations, the therapist retells the patient's stories, and these retellings progressively influence the what and how of the stories told by patient. The end product of this interweaving of texts is a radically new, jointly authored story. Or as Hillman [1] describes it, the client comes to therapy to be "restoryed":

The patient is in search of a new story, or of reconnecting with her old one. . . .The story needed to be doctored, not her. (pp. 17-18).

The inherently disjointed quality of many spiritual emergencies has led therapists, patients, and society to devalue such experiences. Further exploration is believed by many mental health professionals to be unnecessary and even to run the risk of exacerbating symptoms.

This conventional practice is not therapeutically productive. The spiritual emergency itself isolates the individual from others. Then the subsequent devaluation and condemnation of the experience as "only the product of a diseased mind" results in further isolation, just when the person needs to reconnect to the social world. The word myth comes from the Greek mythos, meaning speech. Putting such experiences into words is usually the first step in developing a life-affirming personal mythology that integrates the spiritual dimensions of the crisis.

At the turn of the century, Kurt Jaspers, MD, one of the founders of the nomenclature and methods used in understanding psychotic disorders, argued that there was an "abyss of difference" between psychosis and "normal" consciousness:

The profoundest difference in man's psychic life seems to exist between that type of psychic life which we can intuit and understand, and that type which, in its own way, is not understandable and which is truly distorted and schizophrenic . . . we cannot empathize, we cannot make them immediately understandable, although we try to grasp them somehow from the outside (Jaspers [2] p. 219).

Yet understandability is the result of a two-way interaction. Laing [3] has criticized the placing of all emphasis on the presumed patients' responsibility for making their realities understandable to others.

"Both what you say and how I listen contribute to how close or far apart we are" (p. 38).

Work with spiritual emergency patients requires reaching across this abyss to connect with their reality.

One of the first objectives in narrative therapy is to find a mutually acceptable name for the problem. This is a continuation of the work in the acute phase to Normalize the experience (see Lesson 5). The term spiritual emergency is one that describes and normalizes such crises. It provides a non pathological understanding for patients, family and friends to the rapidly developing literature on these types of problems, and it can become the basis for a new personal mythology.

It often helps to have the patient talk about and write out a full account of all they experienced. I have found that even constructing a simple time line marked with ages and key events serves a therapeutic ordering function. Then the work of phases 2 and 3 can move toward integrating the experience.

PHASE 2:
TRACING ITS SYMBOLIC/SPIRITUAL HERITAGE
In Ken Wilber's [4] spectrum model of consciousness, psychosis is neither prepersonal (infantile and regressive) nor transpersonal (transcendent and Absolute); it is depersonal — an admixture of higher and lower elements:

"[Psychosis] carries with it cascading fragments of higher structures that have ruinously disintegrated" (p. 64). Thus, psychotic persons "often channel profound spiritual insights" (p. 108).

But they are incapable of differentiating the transpersonal from the regressive prepersonal at the time of the experience. However afterwards, they are often able to sort thorough their experiences and separate the wheat from the chaff, particularly with the help of psychotherapy.

Jungian analyst John Beebe, MD [5] has noted that,

Minimally, the experience of illness is a call to the Symbolic Quest. Psychotic illness introduces the individual to themes, conflicts, and resolutions that may be pursued through the entire religious, spiritual, philosophical and artistic history of humanity. This is perhaps enough for an event to achieve (p. 252).

In my own spiritual emergency, I spent 2 months firmly convinced that I was a reincarnation of Buddha and Christ and was on a mission to write a new "Holy Book" that would unite all the peoples of the world. And I had been raised as a Jew! So once I was back with both feet on my ground, this gave me great cause to explore these forms of spirituality which I'd had minimal contact with. In retrospect, I consider this period to be my spiritual awakening. In Seduction of Madness, Ed Podvoll, MD, observed that,

"Many who have come through psychotic episodes describe them as the most fantastic time of their lives."

It was so for me, but I could only integrate it after several years of therapy and work with traditional healers (See Lukoff's Shamanic Crisis).

The treatment literature documents that there is much therapeutic value in addressing a person's religious delusions [6]. In cases where the person developed the grandiose delusion that they were god or the messiah, these stereotypical delusions of grandeur, inflation, and possible inappropriate or demanding behavior could be embarrassing to the person. But the valid religious/spiritual dimensions of the experience can be salvaged through psychotherapy:

What remains . . . is an ideal model and a sense of direction which one can use to complete the transformation through his own purposeful methods (Trials of the Visionary Mind: Spiritual Emergency and the Renewal Process, by John Perry, MD, p. 38).

This is how I now view my own experience of having been Buddha and Christ — as ideal models for my spiritual life. The experience has given me a sense of direction. My career as a psychologist researching spiritual crises, and my spiritual path — all derive from this experience. I concur with John Beebe: that is enough for one event to achieve!

James Hillman, Ph.D., [7] maintains that,

Recovery means recovering the divine from within the disorder, seeing that its contents are authentically religious (p. 10).

This recovery often involves helping patients reconcile their idiosyncratic personal symbols with parallels in symbolism and religious imagery. Eliade [8] pointed out, the personal unconscious and "private mythologies" (which are part of spiritual emergencies) cannot awaken an individual. It requires:

The general and the universal symbols [to] awaken individual experience and transmute it into a spiritual act, into metaphysical comprehension of the world (p. 213).

Much of my work in Jungian analysis consisted of learning how to explore the meaning of my personal symbols as they appreared in dreams and in my own spiritual emergency. This search for meaning by exploring parallels in traditional myths and religious texts has also played a role in the integration of many of the spiritual emergency patients with whom I have worked.

PHASE 3:
CREATING A NEW PERSONAL MYTHOLOGY INCORPORATING THE SPIRITUAL EMERGENCY
People want more from therapy than a clear account and chronology (phase 1) and symbolic analysis (phase 2). They want an expanded and deepened sense of the meaning of their lives. Weaving the spiritual emergency into a life affirming personal mythology is essential for positive transformation and integration of the experience.

Personal Mythology (Definition)
Each of us has a personal mythology — beliefs about life that make up our view of the world. Stanley Krippner, Ph.D., co-author of The Mythic Path: Discovering the Guiding Stories of Your Past — Creating A Vision for Your Future, defines a personal mythology as an individual's system of complementary and contradictory personal myths. A personal myth is a cognitive-affective structure consisting of strongly ingrained beliefs with potent emotional components. Personal myths shape our expectations, and guide our decisions. They influence the way we behave with other people. They address life's most important concerns and questions, including

Personal Mythology in Psychotherapy
Unfortunately many of the personal myths that people develop around an episode of spiritual emergency are "dysfunctional" myths that emphasize pathological qualities. They are not attuned to the person's actual needs, capacities, or circumstances. The therapist's task is to help transform the spiritual emergency into a new personal mythology. This is a narrative approach to psychotherapy in that it focuses on the shared construction of the patient's story, and how that story can be reconstructed to the patient's benefit.

In addition to:

biological sources (e.g, physical limitations, genetic endowments)

cultural sources (e.g., economic and political systems, books, movies, folklore)

personal history (e.g., experiences with one's family, romantic relationships and friendships, work)

spiritual sources often play a significant role in shaping personal mythologies. These can include non-consensual reality experiences such as visions, past-life experiences, parapsychological experiences, and also spiritual emergencies. Such spiritual sources involve transcendence of ordinary life concerns and an experienced contact with a "higher" or "deeper" reality. Spiritual emergencies often involve experiences of this type which can become the foundation for a new personal mythology. The therapist can help post spiritual emergency patients build a new personal mythology with spiritual sources drawn from their crisis.

For many, recovery from a spiritual emergency is experienced as a spiritual journey, which is a type of personal myth. People may reframe their crisis as a process of overcoming certain handicaps — which may involve their family or subculture of origin as well as a spiritual crisis. Sally Clay, who spent two years hospitalized and now works as a patient advocate, has written that,

For me, becoming "mentally ill" was always a spiritual crisis, and finding a spiritual model of recovery was a question of life or death (Clay [9]).

Not only are people who have had such a crisis challenged to compensate for weaknesses, but they are also invited to integrate their unique set of concerns, interests, temperament, and imagery, which may give clues to future vocational and avocational choices, social affiliations, and ideologies.

My spiritual emergency set me on the path of becoming a "healer," and provided me with a vocational calling as a psychologist working with serious mental illness and with spiritual emergency. The Jungian analyst John Perry, MD, who developed Diabysis, an innovative treatment center for persons in an acute psychotic crisis, observed that,

It is also probable that those persons who come through their journey enriched and gifted may turn out to be the best source of congenial therapists, who would be able to react with unusual understanding to others going through their psychosis (The Far Side of Madness, p. 158).

Jeanne Achterberg, Ph.D., [10] also noticed the prevalence of "wounded healers" in the health professions.

The books, The Mythic Path: Discovering the Guiding Stories of Your Past Creating-A Vision for Your Future by David Feinstein, Ph.D. and Stanley Krippner, Ph.D., and Your Mythic Journey: Finding Meaning in Your Life Through Writing and Storytelling by Sam Keen, describe a variety of methods that facilitate the deepening of life-stories and the illumination of a person's personal mythology. It isn't always necessary for a person to work with a therapist to find the myth at the center of his/her life story. But the symbols encountered in spiritual emergencies are often idiosyncratic without a coherent cultural context. Jung noted that fragments of mythic themes and symbols occur frequently in the experiences of psychotic persons, but:

the associations are unsystematic, abrupt, grotesque, absurd and correspondingly difficult if not impossible to understand. They are further distorted by their chaotic randomness. (Psychogenesis of Mental Disease, pp. 262-263)

For example, Howard's "key" drawn while in the midst of his spiritual emergency crossed many cultural and historical boundaries. Thus only a therapist with competence in spiritual issues and psychological problems can help a patient weave a coherent and meaningful personal mythology based on the spiritual emergency.

SPIRITUAL INTERVENTIONS IN PSYCHOTHERAPY
The evidence for a positive relationship between religion and spirituality and better mental health is documented in over 1600 articles (see Fact Sheet on Spirituality and Mental Health). A therapist who is competent in religious and spiritual issues is likely to occasionally use spiritual interventions with patients. But with spiritual emergency patients, spiritual interventions are essential to facilitate recovery and change. At times these could include:

CASE EXAMPLE
I written a case study of how one person who was hosptiatlized with a spiritual emergency went on to integrate his experience by tracing its symbolic heritage and building a personal mythology around it.

Howard Case Study (full version)
Howard Case Study (summary)

REFERENCES
Hillman, J. (1983). Healing fiction. New York: Station Hill Press.

Jaspers, K. (1963). General psychopathology. Manchester: Manchester Univ. Press.

Laing, R. D. (1982). The voice of experience. New York: Pantheon.

Wilber, K. (1980). The pre/trans fallacy. Re-Vision, 3, 51-72.

Beebe, D. (1982). Notes on psychosis. Spring, 233-252.

Eisenbruch M. (1992) Commentary: Toward a culturally sensitive DSM: Cultural bereavement in Cambodian refugees and the traditional healer as taxonomist. J Nerv Ment Dis 180(1): 8-10.

Hillman, J. (1986). On culture and chronic disorder. In R. Sardello and G. Thomas (Eds.), Stirrings of culture. Dallas: The Dallas Institute Publications.

Eliade, M. (1960). Myths, dreams, and mysteries. New York: Harper & Row.

Clay, S. (1987). Stigma and spirituality. Journal of Contemplative Psychotherapy, 4, 87-94.

Achterberg, J. (1988). The Wounded Healer. Shaman's Drum, 11, 18-22.