Spiritual Emergence and the Mental Health Profession 
The psychological effects of spiritual emergence have been known for thousands of years in countries such as India
and China and yet are still relatively unknown here in the West. Even today psychiatrists and psychologists are
largely unaware of the kundalini and unfortunately this leads to many patients having an incorrect diagnosis. Some
estimates put the number of patients in mental hospitals who have symptoms of spiritual emergence rather than a
mental problem as high as 20 per cent.
There is a need for a more culturally sensitive approach to the classification and diagnosis of mental health problems.
The tendency has often been to ignore or psychopathologise spiritual experiences classifying mystical experiences,
for example, as symptoms of ego regression, borderline psychosis, psychotic episode or temporal lobe dysfunction.
This approach has often shown an insensitivity to the religious and spiritual dimensions of culture that are "among
the most important factors that structure human experience, beliefs, values, behaviours and illness patterns"
(Lukoff, Francis and Turner 1992. p.673). What is needed therefore is an appropriate classification system and
adequate training of mental health professionals to diagnose and appropriately deal with issues of a psychospiritual
nature.
It can be said that religion refers to an adherence to the beliefs and practices of an organised church or religious
institution, whereas spirituality describes the transcendental relationship between a person and a Higher Being,
it goes beyond religious affiliation. Mystical experience can be defined as:
"a transient, extraordinary experience marked by feelings of unity, harmonious relationship to the divine
and everything in existence, as well as euphoric feelings, noesis, loss of ego functioning, alterations in time
and space perception, and the sense of lacking control over the event" (Lukoff, et al., 1992. P.678).
In the history of the theory, research and practice of psychiatry there has been a view that religion is associated
with psychopathology. Freud viewed religion as a "universal obsessional neurosis." Skinner's behaviourism
focused exclusively on observable behaviour, Ellis viewed religion as equivalent to irrational thinking and emotional
disturbance and that the less religious a patient is the more emotionally healthy he is likely to be. Recent studies
have shown that, although this may be the case with the seriously mentally ill, for most people religiosity is
associated with mental health (Lukoff, et al., 1992, p.674). Jung and Maslow have viewed mystical experiences as
a sign of health and transformation while Grof (1989) refers to spiritual emergency, a psychosis like experience,
as being self healing leaving the individual better health wise after the experience than he was before. Gopi Krishna
(Krishna, 1993) and some other researchers believe that there is also an underlying bioenergy behind some mystical
and spiritual experiences that involve the kundalini, but as yet little research has been done to look into this.
At the other end of the spectrum there are religious groups who are up in arms over psychology's encroachment into
spiritual matters, even psychology itself, "True spirituality has nothing to do with psychology (1 Cor. 2:11),
a fake science based primarily on man's rationalisations; i.e., self-deceptions" (McMahon, 1994).
R.D. Laing (1989) took a closer look at the transcendental experiences that sometimes break through in psychosis.
He analysed schizophrenia, manic-depressive psychosis, and intuitional depression and stated that "When a
person goes mad, a profound transposition of his position in relation to all domains of being occurs. His centre
of experience moves from ego to self [Self]" (p.53), and yet he is confused, he muddles ego with Self, inner
with outer, natural and supernatural. He believes that in many cases of "madness" one is tapping into
the transpersonal realm, albeit uncontrolled, and should therefore be looked at as breakthrough rather than breakdown.
Wilber (1996) gave a transpersonal view of human evolution dividing it into prepersonal (before egoic consciousness
developed) personal (egoic consciousness) and transpersonal (beyond egoic consciousness). Each stage in one's evolution
must of necessity include but transcend the previous stage. In addition the potential for future growth is always
present, as proven by those individuals, forming the advanced tip of human consciousness, who have been able to
reach the higher realms of consciousness.
Consequently, during states of "madness" when the different levels of consciousness become confused,
the personal awareness may tap into the prepersonal as well as the transpersonal levels of awareness. In effect,
three levels of awareness are confused together. This becomes a very complex issue and will form the basis of some
very interesting future research for the mental health profession.
This is difficult to analyse scientifically. The problem, therefore, is how can spiritual experiences be accepted
and understood within the area of mental health? Currently the medical model is still the mainstay of psychiatric
theory and practice, while treatment or therapy is determined by the diagnosis of the psychiatrist. Grof states,
"organically oriented psychiatrists may prescribe electroshock therapy for neurotics, while psychologically
oriented psychiatrists may use psychotherapy with psychotics" (1993, p.205). Surely it is not appropriate
for a patient to be prescribed medication and labelled schizophrenic simply because the psychiatrist does not accept
the concept of spiritual emergency.
Research has shown that although mental health professionals are less religious than the general public and psychiatric
patients, when it comes to spirituality there is no appreciable difference (Lukoff, et al., 1992, p.675). A 1975
survey by the APA Task Force on Religion and Psychiatry showed about half of psychiatrists considered themselves
as agnostic or atheist as opposed to a Gallup Poll in 1985 (cited in Lukoff, et al., 1992, p.675) which showed
1% - 5% of the general public considering themselves as such. The same poll found that one third of the population
considered religion the most important dimension of their life and one third considered it very important. Bergin
and Jensen, (1990), cited in Lukoff, Turner and Lu, (1993, p.14), found that 68% of mental health professionals
expressed a need to "seek a spiritual understanding of the universe and their place in it." The authors
named this "spiritual humanism" and felt it could provide a cultural bridge between clinicians and the
more religious public.
At present spiritual needs and concerns are still very much divorced from accepted mental health training and practice.
The perception is often that spiritual matters are the concern of the church and not relevant to psychiatry or
psychotherapy. If we separate religious from spiritual concerns and acknowledge that spirituality goes beyond the
boundaries of religion, then matters of a spiritual nature could be addressed by mental health practitioners, with
the care and delicacy required to be careful not to encroach uninvited into the beliefs of the patient. The mental
health practitioner's role is to approach the subject of the mind from a scientific perspective, but also a caring,
understanding and human perspective, and to co-operate with the inner healing forces of the client.
Overview of the successes and difficulties experienced in this particular
area
Transpersonal psychology is gaining ground rapidly and has been accelerated by the work of researchers such as
Stanislav Grof and Ken Wilbur. Grof (1993) has done much research into non-ordinary states of consciousness. In
particular, researching spiritual emergency he has come to the conclusion that during a spiritual emergency unconscious
material with strong emotional charge emerges into consciousness. This has powerful, spontaneous healing potential
and therefore needs to be supported. Spiritual emergency usually shows the client to have, as Grof and Grof (1995)
state, "A history of reasonable psychological, sexual and social adjustment preceding the episode, the ability
to consider that the process might originate in one's own psyche, enough trust to co-operate, and a willingness
to honour the basic rules of treatment" (p313 & 316). More recently he has utilised Breathwork and has
developed a therapy called "Holotropic Breathwork" using breathing to release unconscious material into
conscious awareness for its acceptance and dissolution. He has noted that as a result of this people gain a new
appreciation of spirituality. Wilbur (1996) has really "stirred the pot" with his thought provoking work
on the evolution of consciousness which is thoroughly referenced and incorporates eastern and western sources.
It is noticeable though that mainstream clinical literature has "either understated the incidence and significance
of spiritual experiences or ignored studies that indicate their positive impact on mental health" (Lukoff,
et al., 1992, p.674). Studies show that there is no association between religiosity and psychopathology in nonpatients,
rather the opposite, there is a positive relationship between religiosity and mental health. Taking the example
of the near-death experience (NDE), several studies have shown that it is nonpathological and that people who have
had a NDE have reported increased well-being, a sense of purpose, and greater acceptance of universalistic spiritual
values (Lukoff, et al., 1992, p.674-5).
As mentioned, understanding and treating psychospiritual problems by mental health professionals is hindered by
two main factors, the focus on biological factors and the historical biases against religious and spiritual experiences.
At least this is the case in western culture. Non-western Societies and ethnic minorities have far greater reliance
on nonallopathic systems of medicine (World Health Organisation statistics give 70% of the world's population)
and traditional healers who operate from a spiritual perspective (Mahler, 1977 as cited in Lukoff et al., 1992,
p.676). Shamans are often persons who have undergone a psychospiritual crisis leaving them with greater wisdom
and understanding and yet are likely to have been classified as psychotic in the western system of psychiatry.
Lukoff et al., (1992) recommended that a nonpathological category be added to the diagnostic nomenclature of psychiatry.
They suggested three different classifications to incorporate religious and psychospiritual problems.
· Purely religious or spiritual problems · Mental disorders with religious or spiritual content ·
Psychoreligious or psychospiritual problems not attributable to a mental disorder
Where religious problems are concerned these generally involve questions of faith and doctrine. In these circumstances
it is better that these problems are handled by clergy, priests or other officials within the religion concerned.
Some mental disorders present themselves with a religious content where religion may form an attachment onto which
the disorder works itself out, for example excessive devoutness may result as a response to an obsessive-compulsive
disorder. Another example is the psychotic who has delusions of being Christ or receiving direct communication
from God. In these cases there is therapeutic value in acknowledging the person's religious ideas.
Psychoreligious problems that are attributable to a person's beliefs or religious life but not to a mental disorder
can probably be resolved through therapy. These problems could include, for example, the loss of a firmly held
faith or intensifying adherence to religious practices. In both these extremes there is a challenge to the person's
stability in some way.
Spiritual problems involve conflicts about a person's relationship to the transcendent or may arise from a spiritual
practice. Assuming they have arisen due to a spiritual practice then those under whom they are being guided in
the spiritual practice are usually able to help.
If the problem is a mental disorder with spiritual content, such as frequently found in manic and psychotic episodes,
then the spiritual conflicts are related to or attributable to an Axis I disorder and can be diagnosed with the
existing DSM-IV diagnostic categories.
When the psychospiritual problems are not attributable to a mental disorder, then they are likely to come under
one of two categories listed in clinical and research literature. These will either be due to a mystical experience
or to a near-death experience. These problems can be found under Axis II of DSM-IV "Religious or Spiritual
Problems," the category proposed by Lukoff et al., (1992) and now accepted by the American Psychiatric Association
(APA).
In particular the "near-death experience" has been widely researched and established as an identifiable
psychological phenomenon. It is a profound subjective event experienced by a person who comes close to death, recovers
after being considered dead or escapes uninjured from a potentially fatal situation. Such an experience may include
detachment from the physical body, seeing a brilliant light, and passing through the light into another realm of
existence.
There has also been research into the social dimensions of healing such as spiritual support, healing groups, and
the role of spirituality in family crisis resolution (Lukoff, et al., 1993, p.22). Various scales have been devised
for attempting to assess spirituality and all are described in Lukoff, et al., (1993) in their revue of articles
including such scales. These include:
· Spiritual Orientation Inventory (SOI) · Mystical Experience Scale · Spiritual Well-Being
Scale (SWBS) · Intrinsic-Extrinsic Religious Orientation Scale · Spirituality Self-Assessment Scale
(SSAS) · Spiritual Perspective Scale (SPS)
All but the first scale on the list are more measures of religiosity than spirituality and many are designed for
specific types of patient such as recovering alcoholics, terminally ill adults, persons experiencing extraordinary
events and so on. The Spiritual Orientation Inventory, however, is particularly aimed at the spirituality of those
not affiliated with traditional religion.
In 1993 there were at least 12 workshops, courses and symposia in the scientific programme at the APA Annual Meetings
addressing religious or spiritual issues in clinical practice. Scientific literature generally shows an increasing
recognition of the relevance of religiosity and spirituality to mental health. The media now gives greater coverage
to these issues (Lukoff, et al., 1993, p.12).
Another step forward has been the setting up of The Spiritual Emergence Network world-wide by Grof to provide information
and access to specialist help including a directory of appropriate therapists.
A case for the introduction of certain requirements or regulations that are appropriate to psychospiritual problems
Considering the value of religion and spirituality in peoples' lives there is very little, if any, training given
to psychiatrists and psychologists to deal with these realms. As most will address these issues at least occasionally
during clinical practice, without having had adequate training, ethical and clinical concerns are raised.
When is insanity, divine madness? When does mental illness become mysticism? When is a psychopathological crisis
a psychospiritual crisis? These are topics that the mental health practitioner would be wise to know about. Of
course interpretation may be viewed from a religious perspective, but is not exclusive to religion. If a patient
is experiencing a psychospiritual crisis then it is the role of the mental health practitioner to know the symptoms,
the likely course and duration of the crisis, and the most appropriate therapy, assuming therapy is required. Research
shows that 30% to 40% of the population have had mystical experiences while about 4.5% of clients brought a mystical
experience into therapy (Spika et al., 1985, cited in Lukoff et al., 1992, p.678).
A study by Allman, de la Roche, Elkins and Weathers (1992), cited in Lukoff et al., (1993, p.14), found that 66%
of psychologists surveyed rated spirituality as "important," while it was found that 50% reported personally
having a mystical experience as opposed to 30-40% in the general population (Lukoff & Lu, (1988) cited in Lukoff,
et al., 1993, p.14).
The emergence of symptoms in non-organic mental illness is not the onset of disease but the beginning of its resolution
(Grof, 1993, p.206). It is, therefore, important to take a balanced approach and to be able to differentiate spiritual
emergencies from genuine psychoses. Grof & Grof (1989) stated "While traditional approaches tend to pathologize
mystical states, there is an opposite danger of spiritualizing psychotic states and glorifying pathology or, even
worse, overlooking an organic problem" (p. xiii). Also, "Many of the states that psychiatry considers
to be manifestations of mental diseases of unknown origin are actually expressions of a self-healing process in
the psyche and in the body" (p. xiv).
When a person is experiencing a psychoreligious or psychospiritual problem the question of whether there is an
adjustment disorder arises. Adjustment disorder is only appropriate when the symptoms are in excess of what would
be normal and expectable in reaction to a stressor. In the case of near-death experiences which are followed by
anger, depression, and interpersonal difficulties, these are actually common responses to an NDE and are thus normal
and expectable reactions to the stressor. Most mystical and psychoreligious problems do not have such obvious stressors.
Despite the greater psychological health that may result from mystical and near-death experiences, the individuals
involved may still seek treatment. Due to their lack of understanding of these experiences some individuals may
fear for their mental stability, particularly when the experiences appear almost psychotic in nature. Others may
have difficulty in reconciling the experience with their religious beliefs, values or lifestyle. Alternatively,
they may have difficulty reconciling new attitudes with the expectations of family or friends or they may suffer
ongoing anger and depression at losing the altered state of awareness associated with the experience. It is essential
therefore that professionals are adequately trained to help or make appropriate referral.
The mental health profession has acknowledged the existence of spiritual problems with "Religious and Spiritual
Problems" now an accepted category under Axis II of DSM-IV. Psychospiritual problems need to be adequately
distinguished from mental illness and consequently there is a need for mental health professionals to have adequate
training to distinguish between the two. Inability to do so will become more and more of an ethical issue. With
transpersonal psychology slowly becoming more accepted by western psychologists it will hopefully not be too long
before a holistic approach to mental health will be the rule rather than the exception.
Copyright © Charles Attfield, 1999
- 2003