The Differentiation of Psychosis and Spiritual Emergency (2008)

While I keep myself grounded in a biopsychosocial model of psychosis and schizophrenia these days (mainly because of my almost pathological tendency to seek an overly mechanical wordview that lets me analyse the shit out of it…), my late prodromal/FEP days pulled me in a different direction – towards the spiritual. While I didn’t think it was well received by psychiatrists at the time, I don’t see spiritual interpretations and approaches to dealing with psychosis to be bad. That said, I don’t want to stop anyone from continuing under the care of a doctor/psychiatrist, on the condition that they have respect for one’s spiritual beliefs. Here is a thesis from Adelaide of all places…

The differentiation of psychosis and spiritual emergency.

Psychosis has long been recognised as a severe mental disorder characterised by derangement of personality, disorganised thought, and a loss of contact with reality. Certain mystical and alternate states, which have been practiced throughout history by various cultures, have also been deemed as pathological through the lens of western psychiatry even though many of these states provide beneficial contributions to the individual and their community. A number of similar states have been found in modern society and have been termed “Spiritual Emergencies”. The aim of this research was to determine whether “spiritual emergency”. (SE) is a valid concept and to outline the differences between SE and psychosis. One-hundred-and-nine participants from the general public completed a questionnaire developed for this research, comprised of measures of psychosis and ten spiritual emergency subscales. Results indicated that participants who were prescribed medication or previously experienced a psychotic episode scored higher on the SE subscales. One strong factor was found to underlie all the SE subscales and a significant relationship was found between this factor and the measure of psychotic experience. It is open to interpretation as to whether psychosis is nothing more than SE or whether SE is nothing more than psychosis. The implications of these findings are discussed.


Well worth checking out is the Spiritual Competency Resource Center

From LESSON 6.1 Therapeutic Interventions: Spiritual Crises

The Mystical, Near-Death, Meditation and Spiritual Practice, Visionary and Shamanic types of spiritual problems have been associated with crises (“spiritual emergencies”) where a person has difficulty functioning. Each of these problems has a section on Therapy

Mystical experiences
Near-death experiences
Meditation and Spiritual Practice
Visionary experiences
Shamanic experiences

There are also a number of therapeutic strategies that apply to all spiritual crises. Stanislav Grof, MD, and Christina Grof, founders of the Spiritual Emergence Network, describe a spiritually-sensitive approach:

“The most important task is to give people in crisis a positive context for their experiences and sufficient information about the process that they are going through. It is essential that they move away from the concept of disease and recognize the leading nature of their crisis…

Whether attitudes and interactions in the narrow circle of close relatives and friends are nourishing and supportive or fearful, judgmental, and manipulative makes a considerable difference in terms of the course and outcome of the episode…

[Therapy] should not be limited to talking and should allow full experience and direct release of emotion. It is absolutely essential to respect the healing wisdom of the transformative process, to support its natural course, and to honor and accept the entire spectrum of human experience”

(Spiritual Emergency: When Personal Transformation Becomes a Crisis, p. 195)

Interventions can range from support for a time-limited crisis, with possible involvement of relatives, friends, support groups, and medical persons, to intensive long-term psychotherapy. Choice of specific interventions depends on the intensity, duration, and type of spiritual problem, and also on the individual and their support network.

Therapeutic Interventions for Acute Crises

Therapy with spiritual emergency patients in crisis (“spiritual emergency”) can include the following 9 interventions.

An exploration of “how further spiritual development can occur when the spiritual ideal and the linear nature and trajectory of the practitioner’s ego structure are disrupted and their foundations destroyed, making space for the individual to live in an expanded state of consciousness” can be found here and how “variation in an individual’s characterisation of anomalous experiences is nuanced by pre-existing beliefs and affective factors” here

I was profoundly depressed (to the point of ECT two times) for many years and can relate to this “Spiritually integrated treatment of depression: a conceptual framework

Depression Research and Treatment
Table 1 outlines a general framework for intervening at the interfaces between emotional, existential, and spiritual distress in the domains of depressed individuals’ core concerns, to foster a more healthy spirituality. Whereas insight-oriented and cognitive behavioral approaches can help depressed individuals to distinguish distressing emotions from their actual basis in life experience, spiritually oriented interventions can help them use their knowledge and experience of their spirituality (in its ultimate sense, where God or morality are involved) to put these experiences into a larger perspective.

“Table 2 suggests ways that specific spiritually informed interventions can address the existential dimension of depressive concerns. For example, patients whose existential concerns center around identity, and who are therefore vulnerable to experiencing doubt or disorientation when depressed, may benefit from a humanistic emphasis on connecting with what most fulfills and best defines them. If religious, they may also benefit from grounding their identity in their relationship to God, for example, through a process of spiritual direction.”

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