MENTAL ILLNESS AND SPIRITUAL CRISIS:

Implications for Psychiatric Rehabilitation

Abstract: This article suggest that increasing numbers of people diagnosed as having
mental illness may have needs that are not being fully met by mental health
professionals. Psychosocial rehabilitation primarily addresses the residential,
vocational, socialization and case management needs of the individual with long-term
mental illness, and structures programs to provide services around these needs. An
important area that is often overlooked by most practitioners relates to a person's
spiritual needs. This article examines spiritual needs in terms of emerging
perspectives, and reviews theory, research findings, and appropriate interventions that
can be made by the psychosocial rehabilitation professional.
Introduction
Karl Menninger stated "Some patients have a mental illness and then get well and then
get weller... This is an extraordinary and little realized truth (cited in Silverman, 1980, p.
63).
An impressive number of other clinicians and researchers have also suggested that for
some individuals undergoing psychiatric episodes, the experience may actually be
positive and reconstructive (Boisen, 1962; Dabrowski, 1964; Ellenberger, 1970; Grof &
Grof, 1985; Mosher & Menn, 1979; Perry, 1977).
In the field of psychiatric rehabilitation, Soteria House was established to provide a
home4ike alternative for young people with schizophrenia who would otherwise have
been hospitalized. Conceptually, Soteria House adhered to the perspective that the
psychotic crisis state can be growth-enhancing. Schizophrenia was identified as an
altered state of consciousness that represented a unique potential for reintegration and
reconstruction, if not aborted with medication prematurely. Thus, the clinical
symptoms-including irrationality, terror, and mystical experiences were considered
purposeful and real and the clients were assisted so that they could integrate these
experiences into their lives. Results of a four-year experimental research study of this
model demonstrated that most ex-Soteria residents gave little evidence of the mental
patient identity; they were more psychosocially competent than they had been before
their psychoses; and were actively engaged in living; their passion had not been
suppressed. (Mosher & Menn, 1978).
But despite the frequency of these clinical observations, the DSM Ill (APA, 1980)
representing current psychiatric practice does not attempt to differentiate between
psychotic episodes with growth potential and those which indicate a long-term mental
illness (Lukoff, 1985). Laing (1967) has noted the difficulty of differentiating between
"unusual experiences" and mental illness. He suggests "Experience may be judged as
invalidly mad or as validly mystical...The distinction is not easy." Carl Jung (1954)
hypothesized that the individual unconscious is but one dimension of human existence,
and that the collective unconscious is shared by all humanity and is representative of
creative forces. Many of the spiritual phenomena that people experience which are
diagnosed as pathological may, Jung suggested, reflect variations of the collective
unconscious, which have been considered perfectly normal and acceptable by various
cultures throughout human history. Abraham Maslow (1964), whose term
self-actualization may be thought of as the initial point at which a person may begin the
process of surpassing ordinary experience (transcendence), suggested that mystical
experiences or the "peak experiences" as he called them-should not be confused with
mental illness. Ken Wilber (1980) notes that when the ego's normal barriers against
attack by unconscious forces are broken down by stress, biochemical factors, or
spiritual striving, the ego is then invaded by regressive impulses (from the personal
unconscious) and by mystical ideas (from the collective unconscious). His theory
recognizes a spiritual crisis as a condition that can incorporate symptoms of mental
illness and at the same time mystical aspects that represent contact with realities
beyond our ordinary senses.
These writers and others suggest that when some persons going through a spiritual
crisis do not have the go strength to handle this growth process, they tend to be
labelled as mentally ill, and may be hospitalized and treated with drugs. Moreover, they
propose that such individuals with appropriate assistance can achieve a higher
level of personal integration than they had experienced before the crisis.
As we approach the twenty-first century, radical changes are occurring in a variety of
scientific disciplines that may point to a new understanding of health and human
behavior. These changes are taking place in such fields as psychology, physics,
anthropology, and medicine. An increasing interest in Eastern mysticism indicates
peoples' needs for understanding that goes beyond the limiting materialistic,
mechanistic viewpoints of our Western culture. Concurrently, holistic medical practices
that affirm the interconnectedness of mind, body, and spirit are beginning to strongly
influence our ways of looking at health and disease.
It is common for many psychiatric rehabilitation professionals to scoff when they hear
the terms spiritual crisis, transpersonal psychology, or other terms they perceive to be
"new age" jargon. It is the thesis of this paper, however, that practitioners should begin
to consider the possibility that some of the spiritual and paranormal dimensions of life
that people experience are in fact legitimate concerns of psychosocial rehabilitation.
Moreover, psychosocial providers should be open to expanding their vision so that they
can differentiate between clients who can benefit from current psychiatric treatment
and/or rehabilitation practices and those whose needs go beyond what is currently
being offered.
Current Psychiatric Views Regarding the Nature of Consciousness, Mental
Health, and Mental Illness
It is generally agreed that mainstream thinking in psychiatry reflects the medical model.
Symptoms and disorders for which no specific etiology have been found are described
and treated as psychiatric conditions. Community mental health centers and many
psychosocial rehabilitations providers often must establish a diagnosis for each client
to acquire federal or state funding and to be considered "legitimate." Persons who
suffer from such disorders receive socially stigmatizing labels that frequently hamper
their functioning. These labels can prove to be unreliable; studies have demonstrated
that they often are related to a particular clini-cian's orientation, a client's gender and/or
socioeconomic status, as well as other idiosyncratic factors (Rosenhan, 1973). At the
same time, in standard psychiatric practice, a confusion exists over the use of the term
"psychotic." The DSM Ill offers two meanings for the term psychotic; one suggesting a
temporary state, and the other a mental disorder with lifelong implications:
Psychotic - A Term indicating gross impairment in reality testing. It may be used to
describe the behavior of an individual at a given time, or a mental disorder...(APA,
1980, p. 367).
There are few fields in which the lack of professional consensus is as great as in
mental health. We are confronted with different theories regarding how and why
psychopathology develops, what mental illness actually is, and which therapeutic
approaches are effective.
The traditional scientific view focuses increasingly on the biochemical conditions of
human experience. Schizophrenia and, by extension, mysticism are regarded as
resulting from abnormal biological deficiencies. What this perspective overlooks is that
frequently the fear (and the often accompanying rage) experienced by persons
undergoing an emotional and/or spiritual crisis may produce biochemical effects in the
brain and the rest of the body. Medical doctors however, opt toward interpreting this
physio-logical change as the primary cause of mental disorder, rather than as a
possible secondary result, brought on by strong emotions (Perry, 1986).
Psychiatry also will suggest, more often than not, that mysticism of any kind is part of a
primary process (using Freud's construct) and/or a primarily defensive adjustment
pattern that individuals may use to resolve certain personal problems. Such a view was
presented in a monograph prepared by the Group for the Advancement of Psychiatry
(1976) after questioning 300 psychiatrists on the subject. At the same time, however,
Andrew Greeley of the National Opinion Research Center (NORC) conducted a survey
in 1973 that included approximately 1460 respondents in a national stratified sample. In
this study, 359 of the sample (or about 25%) responded positively to having been
involved in a mystical experience. Greeley found that persons having mystical
experiences tended to be college-educated and in a state of "psychological well-being"
that was substantially higher than the national average, as measured by the Brad-burn
(1969) psychological well-being scale. In addition, Oates (1970) demonstrated in
several studies that the statistical incidence of religious concern among psychiatric
patients is about the same as among the general population. Thus, while there are no
definitive data currently available regarding the percentage of psychoses related to
spiritual crises, the results of these aforementioned research studies would suggest the
importance of this topic and its heuristic value. Further, Horton (1973) notes that more
recent forms of therapy used by contemporary religious leaders are meditation, retreat
centers, and specific emphasis upon mystical experience. He recognizes as a
psychiatrist the importance of a mystical state that along with other therapies will tend
to offset the possibility of depression and suicide.
Characteristics of Spiritual Crises and Transpersonal Phenomena
1. Spirituality: Two Perspectives
Pastoral Counseling. The concept of spirituality has different meanings for different
people. The common usage typically implies something that is uplifting or beyond
nature. From a theological or religious perspective, spirituality encompasses love of
oneself, others, and God. The field of postoral counseling traditionally has assisted
individuals in finding personal meaning in relation to their spiritual concerns. Oates
(1978) expounds on this by describing the clinical approach used in postoral
counseling that evaluates symptoms in terms of what they mean to the individual, what
they mean in light of the history of the individual, what they mean in relation to the
immediate stress the individual is under, and what they mean in terms of the
individual's future hopes and ongoing spiritual integrity. Oates also differentiates
between authentic spiritual experience and more conventional or superficial religious
concerns. He describes an authentic spiritual crisis as one in which a person is acutely
ill and seeks a genuinely meaningful interpretation of the chaos that exists. The
individual works at trying to resolve such major problems as deliverance from old
patterns of life and discovery of new patterns of existence, the problem of integrity
before God in a world that places more values upon appearance than reality, and
recovery from never being able to achieve a much-cherished goal in life. These
existential issues call for broadening one's own interpretation of life to encompass
these problems. Pruyser (1976) suggests that the first duty of any professional
whether in the field of religion or psychiatry is to achieve clarity about the problems
that individuals bring before him or her. Pastoral counselors clearly strive to
differentiate between authentic religious experience and more commonplace religious
concerns.
Transpersonal Psychology. Perry (1986) describes "spiritual" from both historical and
psychological perspective. He notes that the ancient words for spirit mean "breath" or
"air in motion" in Hebrew and Latin as well as in Far Eastern languages. Many
individuals who experience a spiritual crisis refer to spirit as feeling like a strong energy
that moves through them with almost a "quality of mind."
From a psychological perspective, Perry identifies spirit as "constantly striving for
release from its entrapment in routine or conventional mental structures" (p. 33). He
believes that therapists should work with such clients, to help them free this dynamic
energy so that it will be liberated from the following kinds of patterns: enmeshed family
systems, problematic interpersonal relationships, beliefs concerning the nature of
human life, changing values, and cultural conditioning. He states that "during a
person's developmental process, if this work of releasing spirit becomes imperative but
is not undertaken voluntarily with knowledge of the goal and with considerable effort,
then the psyche is apt to take over and overwhelm the conscious personality with its
own powerful processes." (p. 34). Perry calls this the "renewal process"; Jung (1980)
had suggested that there are often periods of very uncomfortable deadaptation of
episodes of altered states of consciousness, called transitory psychosis; and Grof &
Grof (1985) have referred to this type of experience as "spiritual crisis" or "spiritual
emergency."
Transpersonal psychologists believe that higher realms of reality exist beyond sensory
data and that in this realm, each person experiences a deep relatedness to what has
been called the cosmos, the universal mind or God. Transpersonal psychology is
based upon direct, subjective experiences. The existence of the transpersonal
dimension rests primarily upon the descriptions of those individuals who have
undergone mystical experiences, which as William James (1929) pointed out, show
impressive similarities from one individual to another and from one culture to another.
Transpersonal psychology, as a philosophy and as a method of psycho-therapy,
focuses on an individual's ability to change and grow. However, this "new direction" in
psychology is really not new. It reflects both the great philosophies that have existed
throughout human history and contemporary psychological thought.
2. Examples of Spiritual/Transpersonal Experiences
Synchronicity and its Relationship to New Physics. As individuals experience
transpersonal phenomena, they often start to perceive their environments in a
synchronistic manner, first recognized by Jung (1952) and described in his essay
"Synchronicity: A Causal Connecting Principle." Synchronistic events link elements of
the unconscious world of feelings, dreams, or visions to events from external reality.
Synchronicity is identified as a process in which "cause and effect" are replaced by
meaningful coincidences.
A single example of the concept Of synchronicity involves an individual who turns on
his car radio and hears words of a song that provide him with an answer to a particular
problem in his life with which he had been wrestling at the moment he turned on the
radio. These kinds of experiences can be frightening for many people. The person
encountering synchronicity comes to view life primarily in terms of his or her subjective
understanding, as opposed to the more usual objective, external ones. As a result,
such an individual may become confused as to what constitutes the real world the
inner, subjective experiences or the outer, objective world. This confusion is often
exacerbated by the mental health practitioner who works at helping his or her client to
rationally deal with "reality."
Peat (1987) suggests that synchronicities occur when internal restructuring produces
bursts of mental energy onto a physical world. Jung, at the time of his writing (1952),
realized that the concept of synchronicity was completely contradictory to the views of
both the medical and scientific establishments. Therefore, he sought out and received
support from several European scientists including Albert Einstein and Wolfgang Pauli,
who agreed that synchronicity converges "new physics" with mysticism when an
individual feels at one with mankind and the cosmos and time and space become
irrelevant. The thinking underlying new physics has evolved from Einstein's relativity
theory (1923,1.950) and present day quantum physics, as well as from Bohn's
holonomic physics (1980) and Pribram's brain theory (1976). Although new physics
became known in the early 1900's, the medical and academic communities have
tended to ignore this perspective and have adhered instead to the
Newtonian-Cartesian paradigm, a three hundred year old system of though based on
the work of the British scientist Isaac Newton and the French philosopher Rene
Descartes. The Newtonian-Cartesian paradigm adheres to the belief that
consciousness is directly related to the physiological processes in the brain. As a
result, this conceptual framework seeks to explain such phenomena as human
intelligence, creativity, art, religion, ethics, and science itself as products of physical
processes of the brain.
Although close correlations between consciousness and cerebral structures exist, the
limited interpretation offered by mechanistic science is open to question. The
relationship of new physics concepts to the nature of consciousness and mental
processes is made by David Bohm, a former con-worker of Einstein. In his holonomic
theory of the universe, he described the world that we observe in our ordinary state of
consciousness as representing only one partial aspect of reality. He identified another
level of reality that cannot be observed directly except possibly in nonordinary
consciousness such as deep meditative and mystical states. In so doing, Bohm
challenges the Newtonian-Cartesian system of thought and opens new perspectives for
speculations about mystical states, spiritual awakenings and other areas that were
previously excluded from the study of human psychology. Wilder Penfield (1976), an
internationally recognized neurosurgeon, in reviewing his life's work in his book, The
Mystery of the Mind, expressed a deep disbelief that consciousness is a direct product
of the brain, one which can be explained solely in terms of neurophysiology.
In sum, the concepts inherent in hew physics are relevant for psychiatric rehabilitation
professionals in so far as they allow them to question the existing scientific disciplines
that identify with British Empiricist John Locke who believed "nothing comes into the
mind without first entering the senses."
Activation of the Central Archtype. Perry (1987), a Jungian psychiatrist who works
mainly with psychotic individuals, observed that a majority of his patients manifested
standard patterns and stages that could be growth-producing if the processes were not
suppressed by psychotropic medication. His observations were based in large part on
his involvement in the Agnew Project, a study funded in the late 1960's by the National
Institute of Mental Health (NIMH). This study examined persons many of whom were
young and involved with psychedelic drugs and/or other combination of street drugs
who were going through what could be described as psychotic episodes (much like the
profile of what we identify as the "young chronic" today). It investigated eighty cases in
a three-year follow-up study and sought to identify who would do well without
phenothiazine medication as well as who required the medication in order to recover
from a psychic upheaval too hard to handle. Results demonstrated that persons on
psychotropic medication had roughly the same rate of recurrence of mental illness as
the national average of persons in mental hospitals, i.e., 73%; those off medication
showed only an 8% recurrence. As a result of these findings, Perry and a colleague,
Howard Levene, designed and operated a drug-free therapeutic residential facility
which they names Diabesis for young persons experiencing psychoses. From this
experience, Perry identifies the following recurring mythic themes that are present in
individuals who have a positive prognosis:
the perception of themselves in the middle of a world process in which they were
the center of all things;
a preoccupation with death;
a sense of being on a journey or mission;
a sense of rebirth: new identity or resurrection;
a focusing on opposites that included issues related to culture, ethics, politics,
religions, attitudes, beliefs, and sex (particularly by gender and homosexual
panic);
cosmic conflict: good/evil;
magical powers: telepathy, clairvoyance, etc.; and
new society, radical changes in society (e.g., religion, "new age," Utopia, world
peace)
Additionally, Perry (1966) had found that the basic patterns and themes experienced by
individuals involved in such a process have appeared in the mythologies of many great
cultures throughout history. He found evidence that annual holiday festivals focused on
these themes in Egypt, Israel, India, Iran, Greece, Rome, China, and the Nordic lands.
Lukoff (198.5) also identified these same themes as being experienced by numerous
persons going through transpersonal episodes.
Unfortunately, the meanings underlying psychotic thought patterns are not
acknowledged by the psychiatric community as anything more than projections of
confused thinking onto outer reality, thus meeting prevailing criteria for delusions. As a
result, most of these mythic themes are suppressed during the first few days of
treatment with medication. To better understand the thrust of Perry's concerns, the
following comments are enlightening: "It is a matter of great grief now in the 1980s to
behold the sharp decline in the quality of care of persons undergoing the acute
episode. There is ever less funding, and therefore little patience at the administrative
level, for innovative programs that keep persons in a facility for more than a few days.
Conveniently for the profession, this can be rationalized plausibly enough by an
explanation for the occurrence of such episodes in terms of faulty brain chemistry to be
corrected by counter-chemistry...In this way, a lifetime of rejection becomes repeated
where one is most poignantly needful of its opposite, a caring reception and affirmation
(1986,pp. XVI, XVll)."
The Mystical Experience. Psychotic and religious experiences have been associated
with each other since the earliest recorded history. The relationship between psychotic
symptoms and aspects of mystical experiences has also been acknowledged in the
psychiatric literature (Arieti, 1976; Buckley, 1981; James, 1961). Lukoff (1985A)
suggests that if a new diagnostic category Mystical Experience with Psychotic
Features (MEPF) were to be included in the DSM Ill, it could reduce inappropriate
hospitalization and use of medication for individuals who could be treated with less
invasive methods which have fewer side effects. Such a diagnosis could be used for
persons having genuine religious experiences concomitant with a mental disorder.
Buckley (1982) makes a similar such point by suggesting that overlap exists in some
aspects of the acute mystical experience and acute schizophrenia, and urges that
careful discrimination be used by psychiatrists in deciding which individuals should
receive medication. He further notes in differentiating between persons with
schizophrenia and persons having mystical experiences, that persons diagnosed as
having schizophrenia typically have cognitive deficits that affect their basic thought
processes. Systematic comparisons of mystical experiences have found that "thought
blocking and other disturbances in language and speech do not appear to accompany
mystical experience" (1981), p. 527).
In an effort to describe the mystical experience, James (1961) noted that it is difficult to
express in words. Neumann (1964) stressed that the psychological effects of mystical
experience results in a transformation in the personality. Wing, Cooper, &: Sartorius
(1974) identified the following criteria as being necessary for defining a mystical
experience:
Ecstatic mood
Sense of newly-gained knowledge
Perceptual alterations (from heightened sensations to auditory and visual
hallucinations)
Delusions (if present) have themes related to mythology
No conceptual disorganization
The difficulty in understanding aspects of religion was noted by Freud (1927) when he
stated "The truths contained in religious doctrines are after all so distorted and
systematically disguised, that the mass of humanity can not recognize them as truth"
(pp. 44-45). At the same time, it should be acknowledged that some individuals have
spontaneous religious or mystical experiences and are able to integrate them into their
lives without the intervention of psychiatric or religious professionals.
The Mythological Experience. Joseph Campbell, identified as the world's leading
expert on comparative mythology, developed a systematic study of patterns constant in
mythology across time and culture. In this classic treatise, The Hero with a Thousand
Faces (1949), he identified three stages in the Hero's journey:
Separation initiation return..."A hero ventures forth from the world of common day
into a region of supernatural wonder: fabulous forces are these encountered and a
decisive victory is won: the hero comes back from this mysterious adventure with the
power to bestow boons on his fellowman" (p. 30).
The relevance of myth to psychosis is enhanced by Campbell's thesis that the hero's
journey although told in terms of external events such as battles and dragons is
actually a metaphor for the venture into the psyche. Campbell (1972) states "To my
amazement...t he imagery of schizophrenic fantasy perfectly matches that of the
mythological hero's journey" (p. 216, emphasis added). Further, he suggests that the
individual with psychosis, the mystic, the yogi, and the LSD taker are all plunged into
the same deep inward sea. However, "the mystic endowed with native talents for this
sort of thing and following stage by stage the instruction of the master, enters the
waters and finds he can swim; whereas the schizophrenic unprepared, unguided and
ungifted has fallen or has intentionally plunged and is drowning" (p. 216).
Applicability and Relevance for Psychiatric Rehabilitation
1. The Relationship Between Mental Illness and Spiritual Crisis
Perry (1976) states that the primary function of the acute psychotic episode is to enable
a person to understand symbolic meanings as they pertain to his or her life. He states
"... in the psychotic state, the symbolic concerns belong to a subjective reality. And
although these concerns are usually totally out of keeping with objective reality, they
are meaningful and not merely random disorder." He believes that when medication is
avoided and the imagery coming from the psychic depth is needed, it may be found that
"nature's own healing process is thereby allowed to do its work for the reorganization of
the self" (pp. Ix-x).
Jung (1964) believed that mental health professionals should receive education in
mythology to provide them with a "comparative anatomy of the psyche." Clearly, this
has not been the case. Practitioners are customarily cautioned never to encourage
such symbolic talk, but instead to engage in supportive counseling and provide
behavioral approaches, both of which avoid uncovering and instead strengthen the
defenses in an effort to help the individual cope with "reality." The above contributions
suggest that understanding the connections between psychosis, myth and mystical
ideation, and experience can assist psychosocial practitioners not only in relating to a
post-psychotic client more effectively, but also in promoting the client's higher
functioning. At the same time, it is important to emphasize that these perspectives are
not opposed to modern psychiatric rehabilitation practice. Clearly, psychosis without
spiritual and/or transpersonal influences does exist. There are also individuals who
suffer from schizophrenia and spiritual crisis concurrently, as well as persons who
experience transpersonal phenomena and are not mentally ill. It is therefore important
for the field of psychiatric rehabilitation to at least be aware of these differences so that
all clients can receive appropriate treatment either by the psychosocial practitioners or
through referral elsewhere.
An important first step for the psychosocial rehabilitation practitioner is to try to become
familiar with the criteria that differentiate a spiritual crisis from schizophrenia. Grof &
Grof (1986) proposed the following two major criteria that must be present to identify
such a crisis:
that the individual has episodes of unusual experiences that involve changes in
consciousness and in perceptual, emotional, cognitive and psychosomatic
functioning, in which there is a significant transpersonal emphasis such as
dramatic death and rebirth sequences, mythological and archetypal phenomena,
as well as out-of-body experiences, incidence of synchronicities or extrasensory
perception, intense energetic phenomena, states of mystical union and a sense
of cosmic consciousness.
that the individual has the ability to see the spiritual crisis as an inner
psychological process and the capacity to form an adequate working relationship
and maintain a spirit of cooperation with the practitioner.
These criteria exclude people with severe paranoid states, persecutory delusions and
hallucinations, and those who consistently use the mechanisms of projection,
exteriorization, and acting out (p. 8).
In related view, Lukoff (1985A) suggests that if two out of the following four criteria are
satisfied, a psychotic episode is likely to have a positive outcome:
good pre-episode functioning as evidenced by no previous history of psychotic
episodes, maintenance of a social network of friends, intimate relationships with
members of the opposite sex (or same sex if homosexual), some success in
vocation or school;
acute onset of symptoms during a period of three months of less;
stressful precipitants to the psychotic episode such as major life changes, e.g., a
death in the family, divorce, loss of job. Major life passages which result in
identity crises, such as transition from adolescence to adulthood, should also be
considered.
a positive exploratory attitude toward the experience as meaningful, revelatory,
growthful. Such as positive attitude toward the psychotic process facilitates
integration of the experience into the person's post-psychotic life (p. 170).
2. Providing Therapeutic Assistance
Relevance for the client with long-term mental illness. Much of what has been said to
this point has related to spiritual crises as part of acute psychotic states. Since
psychiatric rehabilitation focuses primarily on persons in a post-psychotic state or those
who are diagnosed as experiencing long term mental illness, what relevance does this
have for them?
First, it is important to note that the psychotic experience itself isolates the individual
from others. The subsequent devaluation of the experience by others then results in
more isolation just when the person needs to re-connect to the social world. But
reconnecting to the world may necessitate more than engaging in socialization and
vocational activities. Many long-term mental patients with marginal lives demonstrate
that once they have traveled into the depths of their psyches they have difficulty coming
back. The mental health field has recognized that a large group of clients exist who
"wish to be crazy," preferring the psychotic state with its intense experiences and
grandiose powers (Estroff, 1981; VanPutten, et al., 1976). Therapists typically fear that
discussion of the symbolic or mythic dimensions of the experience might encourage
clients to become preoccupied with their inner life and consequently precipitate a
relapse. What they may not realize, however, is that the clients who return from their
psychic journeys do not feel complete or resolved until they have the opportunity to put
their experiences into words; to tell their stories.
The following case study refers to a client who was hospitalized fifteen years ago for
what was then diagnosed as a psychotic episode and who l am now seeing in nay
practice.
Bob M., a 23-year-old "hippie" in the 1960's had been taking LSD and other drugs for
several months prior to an accident he had, during which he "fell" off the balcony of his
apartment, which he shared with several friends. Over the last fifteen years, Bob now
38, has entered college, dropped out, married, had two children, and divorced. He is
now living with another woman, has worked intermittently in various jobs, and has never
quite achieved the satisfaction he is looking for. His IQ is over 150.
The chart below relates differing themes and aspects of Bob's psychotic experience to
many of the criteria that have been identified as characterizing a spiritual crisis. The
following are some excerpts from his experience that he has shared with me:
Excerpts of Bob's Experience Characteristics of Spiritual Crises
Bob: "There's a certain other energy that
I can experience even now in
contemplation of my experience at the
time. The energy is very powerful and
quite unlike other energies I experience
or have heard others describe.
Grot & Grot: "intense energetic
phenomena"
Bob: "I felt a strong idea of duality good
or evil could never be totally reconciled,
they would always be in a state of
tension. The Book of Revelations came
alive for me. In order for good to be
there, there always had to be evil the
more that evil was pushed aside, the
more concentrated it became idea was
to bury evil at the center of the earth it
could never be eternally contained
eventually it would leak out. Wanted to
sacrifice myself by willfully going to the
center of the earth and taking on the
suffering of others so they could be set
free. I wanted to perform this mission for
the good of all mankind. I wanted to be a
living sacrifice."
Perry: "cosmic conflict good/evil"
Perry: "a focusing on opposites that
included issues related to ...
religion Campbell "... the imagery of
schizophrenic fantasy
perfectly matches that of the mythological
Hero's Journey"
Perry: "a sense of being on a mission"
Perry: "the perception of himself in the
middle of a world process where he was
the center of all things"
Bob: "A great transformation process
began occurring in my body. I began an
intense effort that lasted through the
entire night. I was moved to undergo the
process of death and rebirth.
Grof & Grof: "death and rebirth
sequences"
Perry: "a preoccupation with death"
One of the last "delusions" that Bob experienced during his psychotic. episode was
expressed as follows:
"I looked up at the sky and saw an infinity symbol. One half was red and the other was
blue. I was aware that I had experienced one half of the infinity symbol in my visions,
now I hoped at the hospital I could work through the other half."
Instead of working through the other half, Bob was put on heavy doses of medication.
His visions stopped, the psychiatrist at the hospital did not discuss with him the
meaning or content of his experiences, and he went home three months later.
During my current discussions with Bob, he recounts how he feels that this episode he
experienced some twenty years ago is still impinging on his life.
"For me the lid was blown off during that time. It opened up all these worlds and it has
never quite gone totally back on. There's always that knowing that something else is
going on, and that's made it difficult for me to get into anything in the world again. It's
very distressing my visionary experience is still a dilemma in many different ways. It's
a kind of mythology that's deep in my system. It's very present, and it's something very
meaningful for me. One of the images that is always with me...is my going all the way to
the edge of the universe, all the way to the edge and then having to turn away. I'm
wondering if that feeling has stayed with me over all these years and has kept me from
completing tasks and projects in my life...If I could have seen the whole picture then, l
feel I'd be different today."
The clarity and recall he demonstrates as he recounts the details of the episode
experienced fifteen years ago illustrates how important this event has been and still is
in his life today.
Although the description of this man's psychotic episode bears close similarity to the
characteristics of a spiritual crisis, it must be acknowledged that he is but one
individual. At the same time, I would note that my professional experiences over the
last decade including my work at Horizon House as a counselor and clinical
supervisor and at Matrix Research Institute as a consultant helping to develop
psychosocial rehabilitation services across the country, as well as university teaching,
have supported the following major perspectives that underlay this article:
For some individuals undergoing psychotic episodes, the experience may be
positive and reconstructive.
Many of the spiritual phenomena that people experience are not
psychopathological.
A spiritual crisis is a condition that can incorporate symptoms of mental illness
and at the same time mystical and mythological aspects that represent contact
with realities beyond our ordinary senses.
The mental health system, including psychiatric hospitals, should support and
affirm the acute psychotic episode for some individuals without aborting it
prematurely through medication.
Psychosocial rehabilitation practitioners can help clients tap into the current
meanings that their past psychotic episodes have as they attempt to live
independently in the community.
The field of psychiatric rehabilitation should be open to acknowledging the
natural healing processes inherent in all individuals.
Psychosocial interventions. There are various approaches that can be utilized in a
psychiatric rehabilitation center to assist clients in understanding the individual
meanings of their previous psychotic episodes. One such approach would be to
develop groups in which clients could discuss the different mythological and religious
patterns of their experiences. Another group of clients might focus on a topic such as
"the hero's journey" and discuss the personal meaning this theme carries for them.
Expressive therapy techniques (i.e., music, arts dance) can help clients integrate and
ultimately begin to resolve the powerful religious and mythological dimensions of their
experiences that were suppressed by medication early in the process. Through group
sharing and matter-of-fact acceptance of all experience, clients can become hopeful,
open, and more alive.
Laing (1982) has criticized the placing of all responsibility on the clients 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). If a client feels that a helper supports his or
her process-whatever that may be there is clearly more opportunity for help.
Role of the psychosocial rehabilitation practitioner. What can the practitioner do to help
a person in spiritual crisis? It should be emphasized that the expectation is not for the
helper to undertake in-depth clinical intervention. Rather, it is hoped that the following
basic psychosocial principles currently prevalent in the field will be applicable in
helping clients integrate such experiences:
normalization of the crisis;
affirming the client's strengths;
recognizing and respecting the client's subjective experiences;
balancing these experiences with the outer world;
conveying hope and acceptance.
In addition, the following processes and methods may be particularly helpful in
assisting a client to work through this kind of crisis:
the development of mutual trust and honesty between counselor and client;
labeling and identifying what the client has described: for example, "the
connection between what is happening in your mind with what is happening in
your environment may be more than coincidence it's known as synchronicity,
and it often occurs when people are going through a major change in their life";
providing bibliotherapy and reading material related to a person's particular
experience;
facilitating grounding through reassurance, by staying in contact, by affirming the
person's boundaries, by supporting creative expression;
exploring the cognitive, emotional, and spiritual nuances that the client
incorporated into the experience;
encouraging discussion and expression of symbolic imagery in small groups and
through expressive therapies such as art, music, and movement.
Conclusion
Currently, there are few if any practitioners, psychosocial rehabilitation centers, other
facilities or resources working with persons with long-term mental illness around issues
related to spiritual crises. The work that is being done in this area is targeted primarily
toward emotionally healthy persons who voluntarily find themselves moving into higher
states of consciousness through meditation or other spiritual practices. The need
exists, therefore, for the psychiatric rehabilitation field to maintain its current values and
approaches while expanding its scope to address an additional vital need in clients that
has yet been unmet.
The pioneer (but now defunct) residential treatment programs at Diabesis (Perry,
1974), Soteria House (Mosher & Menn, 1979), and Kingsley Hall (Laing, 1967)
developed techniques which allowed clients a wide latitude of freedom for expressing
their beliefs, affects, and symbolic imagery. Lamb (1979) also noted that clients going
through acute episodes could be treated by friends and relatives who would be willing
to provide 24-hour care in a sanctuary-type environment, as well as in non-hospital
"inpatient units," religious communities, etc. Regrettably, however, what has been
lacking is the recognition by the field of psychiatric rehabilitation that certain types of
psychotic episodes may lead to positive, growth-producing outcomes. If this theoretical
perspective would be incorporated as a legitimate aspect of the field, then treatment
programs and methods could evolve from this perspective that wold achieve a higher
degree of success than programs have in the past.
Finally, staff training and development should be implemented around basic concepts
underlying symbolic and related mythological themes; particularly useful would be
efforts to identify criteria which differentiates spiritual crises from long-term mental
illness.
Patricia Deegan (1988), a clinical psychologist and ex-mental patient likens her own
personal recovery to that of an individual with a physical disability: "But one day
something changed in us. A tiny fragile spark of hope appeared and promised that
there could be something more than all of this darkness...This is the mystery. This is
the grace. This is the birth of hope called forth by the possibility of being loved. All the
polemic and technology of psychiatry, psychology, social work, and science cannot
account for this phenomenon of hope. But those of us who have recovered know that
this grace is real. We lived it. It is our shared secret." (p. 14).
The field of psychiatric rehabilitation has enabled the individual with long-term mental
illness to achieve successes that a few decades ago were deemed impossible. It may
serve us well to continue this achievement by expanding our vision as we look to the
future.
REFERENCES

American Psychiatric Association (1980). Diagnostic and statistical manual of mental
disorders (3rd ed.). Washington, D.C.
Arieti, S. (1976). Creativity: The magic synthesis. New York: Basic.
Assagioli, R. (1981). Self-realization and psychological disturbances. Mandalama,
August, 4-11.
Bohm, D. (1980). Wholeness and the implicate order, London: Routledge and Kegan
Paul.
Boisen, A. T. (1962). The exploration of the inner world. New York: Harper and
Brothers.
Bowers, M. (1979). Psychosis and human growth. In J. Fadiman & D. Kewman (Eds.),
Exploring madness. Monterey, CA: Brooks/Cole.
Bradburn, N. (1969). The structure of psychological well-being. Chicago: Aidine Press.
Bragdon, E. (1987). A sourcebook for helping people in spiritual emergency. Menlo
Park, CA: Institute of Transpersonal Psychology.
Buckley, P. (1981). Mystical experience and schizophrenia. Schizophrenia Bulletin, 17,
516-521.
Buckley, P. (1982). Identifying schizophrenic patients who should not receive mediation
Schizophrenia Bulletin, 8(3), 429-432.
Campbell, J. (1949). The hero with a thousand faces. Princeton: Princeton University
Press.
Campbell, J. (1972). Myths to live by. New York: Viking.
Dabrowski, K. (1964). Positive disintegration. Boston: Little Brown.
Deegan, P. (1988). Recovery: The lived experience of rehabilitation. Psychosocial
Rehabilitation Journal, Vol. 11, No. 4, 11-20.
Einstein, A. (1923), The principle of relativity. New York: Dover.
Einstein, A. (1950). Out of my later years. New York: Philosophical Library.
Eisenbud, J. (1970). Psi and psychoanalysis. New York: Grune and Stratton.
Ellenberger, H. (1970). The discovery of the unconscious. New York: Basic Books.
Estroff, S. (1981). Making it crazy. Berkeley: University of California Press.
Freud, S. (1972/1961). The future of an illusion. London: The Hogarth Press.
Greeley, A. (1975). The sociology of the paranormal: A reconnaissance. Sage
Research Papers in the Social Sciences. 3, 90-023. Beverly Hills: Sage Publications.
Grof, S. (1985). Beyond the brain: Birth, death and transcendence in Psychotherapy.
New York: State University of New York Press.
Grof, S. & Grof, C. (1985). Forms of spiritual emergency. The Spiritual Emergency
Network Newsletter. Menlo Park, CA: California Institute of Transpersonal Psychology,
1-2.
Halifax, J. (1979). Shamanic voices. New York: Crossroads.
Hall, J. A. (1977). Clinical uses of dreams: Jungian interpretations and enactments.
New York: Grune and Stratton.
Horton, E, (1973). The mystical experience as a suicidal prevention. American Journal
of Psychiatry, 130(3), 294-297.
James, W. (1929). Varieties of religious experience. New York: Random House.
Jung, C. G. (1952/1980). Synchronicity: An accusal connecting principle. In Collected
Works, Vol. 8, Princeton, NJ: Bollingen Series XX, Princeton University Press.
Jung, C. G. (1954). On the nature of the psyche. In Collected Works, Vol 8. Princeton,
NJ: Bollingen Series XX, Princeton University Press.
Jung, C. G. (1960). The psychogenesis of mental disease. Princeton: Princeton
University Press.
Jung, C. G. (1964). Flying saucers: A modern myth. In Collected Works, Vol. 10.
Princeton: Princeton University Press.
Laing, R. D. (1967). The politics of experience. New York: Ballantine.
Laing, R. D. (1982). The voice of experience. New York Pantheon.
Lamb, H. R. (Ed.) (1979). Alternatives to acute bospitalization. San Francisco:
Jossey-Bass.
LeShan, L. (1966). The medium, the mystic and the physicist. New York: Ballantine.
Lukoff, D. (1985A). The diagnosis of mystical experiences with psychotic features.
Journal of Transpersonal Psychology, 17(2), 155-181.
Lukoff, D. (1985B). The myths on mental illness. The Journal of Transpersonal
Psychology, 17(2), 123-152.
Maslow, A. (1964). Religious, values and peak experiences. Cleveland, Ohio: State
University of Ohio Press.
Mintz, E. (1983). The psychic thread: paranormal and transpersonal aspects of
psycho-therapy. New York: Human Sciences Press.
Mosher, L. & Menn, A. Z. (1978). Lowered barriers in the community: The Soteria
Model. In L. Stein and M. A. Test (Eds.), Alternatives to Mental Hospital Treatment.
New York: Plenum Press.
Mosher, L. & Menn, A. Z. (1979). Soteria: An alternative to hospitalization for
schizophrenia. In H. R. Lamb (Ed.), Alternatives to acute hospitalization, San
Francisco: Jossey-Bass.
Neumann, E. (1964). In the mystic vision: Papers from the Erattos Yearbooks.
Princeton: Princeton University Press.
Oates, W. (1955). Religious factors in mental illness. Associated Press.
Oates, W. (1970). When religion gets sick. Philadelphia: The Westminster Press.
Oates, W., (1978). The religious care of the psychiatric patient. Philadelphia: The
Westminster Press.
Pauli, W. (1971). The influence of archetypal ideas on Kepler's construction of
scientific theories in Heisenberg, W. Physics and beyond. New York: Harper and Row.
Peat, ED. (1987). Synchronicity: The bridge between matter and mind. New York:
Bantam Books.
Penfield, W. (1976). The mystery of the mind. Princeton: Princeton University Press.
Perry, J. W. (1966). Lord of the four quarters: Myths of the royal father. New York:
Brayiller.
Perry, J. (1974). The far side of madness. Englewood Cliffs, N J: Prentice Hall.
Perry, J. 1976). Roots of renewal in myth and madness. San Francisco: Jossey-Bass.
Perry, J. (1977). Psychosis and the visionary mind. J. Altered States of Consciousness,
3(1), 5-13.
Perry, J. (1986). Spiritual emergency and renewal. In S. Grof (Ed.), Revision, 8(2),
33-38.
Perry, J. (1987). The self in the psychotic process. Dallas, Texas: Spring Publications.
Pribram, K. (1976). Problems concerning the structure of consciousness, in G. Globus
(Ed.), Consciousness and the brain. New York: Plenum.
Pruyser, P. (1976). The minister as diagnostician. Philadelphia: The Westminster
Press.
Ring, K. (1984). Heading toward omega. New York: Win. Morrow and Co.
Rosenhah, D. (1973). On being sane in insane places, Science, 179, 250.
Silverman, J. (1980). When schizophrenia helps. Psychology Today, September.
VanPutten, T., Crampton, E., & Yale, C. (1976). Drug refusal and the wish to be crazy.
Archives of General Psychiatry, 33, 1443-1446.
Wilber, K. (1980). The atman project. Wheaton, IL: Theosophical Publishing House.
Wing, J. K., Cooper, J. W., & Sartorius, N. (1974). Description and classification of
psychiattic symptoms. Cambridge, MA: Cambridge University Press.
~~~~~~~~
By Judith S. Miller
Judith S. Miller, Ph.D., is a licensed psychologist. She is President of the Board of
Directors of TRIS, a psychosocial rehabilitation agency in New Jersey, and is on the
National Board of Directors of the International Association of Near-Death Studies. Dr.
Miller has a clinical practice that specializes in helping individuals cope with spiritual
and psychological crises. She is on the faculty of Beaver College.

Source: Psychosocial Rehabilitation Journal, Oct90, Vol. 14 Issue 2, p29, 19p
Item: 9609192429