Diagnosis of Spiritual Emergency

 

When we emphasize the need to recognize the existence of psychospiritual crises, this does not mean indiscriminate rejection of the theories and practices of traditional psychiatry. Not all states that are currently diagnosed as psychotic are crises of psychospiritual transformation or have a healing potential. Episodes of nonordinary states of consciousness cover a very broad spectrum from purely spiritual experiences to conditions that are clearly biological in nature and require medical treatment. While modern psychiatrists generally tend to pathologize mystical states, there also exists the opposite error of romanticizing and glorifying psychotic states or, even worse, overlooking a serious medical problem.

 

Many mental health professionals who encounter the concept of psychospiritual crisis want to know the exact criteria by which one can make the “differential diagnosis” between a crisis of this kind (“spiritual emergency”) and psychosis. Unfortunately, it is in principle impossible to make such differentiation according to the standards used in somatic medicine. Unlike diseases treated by somatic medicine, psychotic states that are not obviously organic in nature - “functional psychoses” or “endogenous” psychoses - are not medically defined. It is actually highly questionable whether they should be called diseases at all.

 

Functional psychoses certainly are not diseases in the same sense as diabetes, typhoid fever, or pernicious anemia. They do not yield any specific clinical or laboratory findings that would support the diagnosis and justify the assumption that they are of biological origin. The diagnosis of these states is based entirely on the observation of unusual experiences and behaviors for which contemporary psychiatry lacks adequate explanation. The meaningless attribute “endogenous” (literally “generated from within”) used for these conditions is tantamount to admission of this ignorance. At present, there is no reason to refer to these conditions as “mental diseases” and assume that the experiences involved are products of a pathological process in the brain yet to be discovered by future research.

 

If we give it some thought, we realize it is highly unlikely that a pathological process afflicting the brain could, in and of itself, generate the incredibly rich experiential spectrum of the states currently diagnosed as psychotic. How could possibly abnormal processes in the brain generate such experiences as culturally specific sequences of psychospiritual death and rebirth, convincing identification with Christ on the cross or with the dancing Shiva, an episode involving death on the barricades in Paris during the French revolution, or complex scenes of alien abduction?

 

When similar experiences manifest under circumstances in which the biological changes are accurately defined, such as administration of specific dosages of chemically pure LSD-25, the nature and origin of their content remain a deep mystery. The spectrum of possible reactions to LSD is very broad and includes reliving of various biographical events, experiences of psychospiritual death and rebirth, episodes of mystical rapture, feelings of cosmic unity, sense of oneness with God, and past-life memories, as well as paranoid states, manic episodes, apocalyptic visions, exclusively psychosomatic responses, and many others. The same dosage given to different individuals or repeatedly to the same person can induce very different experiences.

 

Chemical changes in the organism obviously catalyze the experience, but are not, in and of themselves, capable of creating the intricate imagery and the rich philosophical and spiritual insights, let alone mediating access to accurate new information about various aspects of the universe. The administration of LSD and other similar substances can account for the emergence of deep unconscious material into consciousness, but cannot explain its nature and content. Understanding the phenomenology of psychedelic states necessitates a much more sophisticated approach than a simple reference to abnormal biochemical or biological processes in the body. It requires a comprehensive approach that has to include transpersonal psychology, mythology, philosophy, and comparative religion. The same is true in regard to psychospiritual crises.

 

The experiences that constitute psychospiritual crises clearly are not artificial products of aberrant pathophysiological processes in the brain, but manifestations of the deeper levels of the psyche. Naturally, to be able to see it this way, we have to transcend the narrow understanding of the psycheoffered by mainstream psychiatry and use a vastly expanded conceptual framework. Examples of such enlarged models of the psyche are the cartography described in my own books and papers (Grof 1975, 2000, 2007 a), Ken Wilber's spectrum psychology (Wilber 1977), Roberto Assagioli’s psychosynthesis (Assagioli 1976), and C. G. Jung's concept of the psyche as identical with the world soul (anima mundi) that includes the historical and archetypal collective unconscious (Jung 1959). Such large and comprehensive understanding of the psyche is also characteristic of the great Eastern philosophies and the mystical traditions of the world.

 

Since functional psychoses are not defined medically but psychologically, it is impossible to provide a rigorous differential diagnosis between psychospiritual crisis (“spiritual emergency”) and psychosis in the way it is done in medical practice in relation to different forms of encephalitis, brain tumors, or dementias. Considering this fact, is it possible to make any diagnostic conclusions at all? How can we approach this problem and what can we offer in lieu of a clear and unambiguous differential diagnosis between psychospiritual crisis and mental disease?

 

A viable alternative is to define the criteria that would make it possible to determine which individual, experiencing an intense spontaneous holotropic state of consciousness, is likely to be a good candidate for a therapeutic strategy that validates and supports the process. And, conversely, we can attempt to determine under what circumstances using an alternative approach would not be appropriate and when the current practice of routine psychopharmacological suppression of symptoms would be preferable.

 

A necessary prerequisite for such an evaluation is a good medical examination that eliminates conditions, which are organic in nature and require biological treatment. Once this is accomplished, the next important guideline is the phenomenology of holotropic state of consciousness in question. Psychospiritual crises involve a combination of biographical, perinatal, and transpersonal experiences that were described in another context, in the discussion of the extended cartography of the psyche (Grof 1975, 2000, 2007 a). Experiences of this kind can be induced in a group of randomly selected “normal” people not only by psychedelic substances, but also by such simple means as meditation, shamanic drumming, faster breathing, evocative music, bodywork, and variety of other nondrug techniques.

 

Those of us who work with holotropic breathwork see such experiences daily in our workshops and seminars and have the opportunity to appreciate their healing and transformative potential. In view of this fact, it is difficult to attribute similar experiences to some exotic and yet unknown pathology when they occur spontaneously in the middle of everyday life. It makes eminent sense to approach these experiences in the same way they are approached in holotropic and psychedelic sessions - to encourage people to surrender to the process and to support the emergence and full expression of the unconscious material that becomes available.

 

Another important indicator is the person's attitude to the process and his or her experiential style. It is generally very encouraging when people who have holotropic experiences recognize that what is happening to them is an inner process, are open to experiential work, and interested to try it. Transpersonal strategies are not appropriate for individuals who lack this elementary recognition, use predominantly the mechanism of projection, or suffer from persecutory delusions. The capacity to form a good working relationship with an adequate amount of trust is an absolutely essential prerequisite for psychotherapeutic work with people in spiritual crisis.

 

It is also very important to pay attention to the way clients talk about their experiences. The communication style, in and of itself, often distinguishes promising candidates from inappropriate or questionable ones. It is a very good prognostic indicator if the person describes the experiences in a coherent and articulate way, however extraordinary and strange their content might be. In a sense, this would be similar to hearing an account of a person who has just had a psychedelic session and intelligently describes what to an uninformed person might appear to be strange and extravagant experiences.