This review discusses the relationships between religion, spirituality, and psychosis. Based on the DSM-IV, we comment on the concept of spiritual and religious problems, which, although they may seem to be psychotic episodes, are actually manifestations of nonpathological spiritual and religious experiences. Studies reporting that hallucinations also occur in the nonclinical population and thus are not exclusive to the diagnosed population are presented. Then, other studies pointing to the strong presence of religious content in psychotic patients are also presented. Finally, the criteria that could be used to make a differential diagnosis between healthy spiritual experiences and mental disorders of religious content are discussed. We conclude that the importance of this theme and the lack of quality investigations point to the necessity of further investigation.

Background: Non-pathological psychotic and dissociative experiences are frequent in the general population, particularly in religious groups. There are few studies on the profile of non-clinical populations with these experiences, and on criteria for differential diagnosis. Objectives: To identify the sociodemographic profile and anomalous experiences (AE) among people who sought help in spiritualist groups. Methods: We interviewed 115 people who sought assistance in six spiritualist groups in the city of Juiz de Fora/MG due to psychotic and/or dissociative experiences. Semi-structured interviews investigated sociodemographic data, AEs reported and presence of criteria that have been proposed to identify non-pathological spiritual experiences. Results: sample was mostly composed by women (70%), middle age, high educational level, whose AEs started in childhood (65%) and adolescence (23%). The most frequent AEs were visual (63%) and auditory (54%) hallucinations, "spiritual perception" (53%), "paranormal dreams" (38%) and out-of-body experiences (31%). Most of the sample reported that these AEs were not related to socio-occupational impairments, were short, episodic, and beneficial; however, reported emotional distress and lack of control over the experiences. Discussion: The high frequency and diversity of AEs reported, as well as their theoretical, clinical, and public health implications point to the urgency need of more attention to this topic.

rESUMo introdução: Há alta prevalência de Experiências Anômalas (EAs), como as vivências chamadas de psicóticas, na população geral. Existe pouca informação a respeito das caraterísticas de pessoas que apresentam EAs de caráter não patológico e que buscam auxílio em instituições religiosas. objetivos: Investigar os perfis de personalidade, a qualidade de vida (QV) e a religiosidade em pessoas que apresentam EAs. Métodos: Cento e quinze sujeitos que procuraram centros espíritas de Juiz de Fora/MG e que apresentavam EAs foram entrevistados: dados sociodemográficos; ITC-R (140) -(Inventário de Temperamento e Caráter, revisado e reduzido); DUREL-P (Duke University Religious Index, versão em português), e WHOQOL--BREF (Avaliação da Qualidade de Vida da Organização Mundial da Saúde -versão brasileira abreviada). resultados: Cooperatividade foi a dimensão de personalidade que obteve a maior média (77,0 ± 11,2); Religiosidade Não Organizacional obteve médias altas em 77% da amostra; 58,9% dos sujeitos eram Espíritas; QV psicológica obteve a média mais baixa (61,1 ± 19,4) e a mais alta foi QV física (67,1 ± 18,2). Conclusões: Os indivíduos com EAs que buscam auxílio parecem constituir uma população de risco para transtornos mentais ou problemas emocionais em geral, sendo preciso desenvolver abordagens adequadas e mais estudos sobre o tema. aBStraCt introduction: There is a high prevalence of Anomalous Experiences (AEs), as psychotic experiences, in the general population. There is little information about characteristics of people with non-pathological AEs seeking religious institutions. objectives: To investigate personality profiles, quality of life (QoL) and religiosity in people with EAs. Methods: One hundred and fifteen subjects who sought Spiritist Centers in Juiz de Fora/MG, Brazil, and who had AEs were interviewed: sociodemographic data; ITC-R (140) -(Temperament and Character Inventory, revised), Durel-P (Duke Religious Index, Portuguese version), and WHOQOL-BREF (Assessment of Quality of Life of the World Health Organization-Brazilian

ResumoContexto: Algumas experiências religiosas e/ou espirituais apresentam um caráter dissociativo. Há carência de estudos que indiquem critérios diferenciais entre a dissociação patológica e saudável em contexto religioso. Objetivo: Este estudo pretende observar as experiências dissociativas sob diferentes perspectivas: uma ligada à psicopatologia e a outra, à saúde. Método: Ensaio temático com a literatura disponível sobre o assunto. Bases de dados: Pubmed e PsychINFO. Também foi feita busca manual de artigos relacionados ao assunto. Resultados: 1. Historicamente, alguns autores se debruçaram sobre as relações entre dissociação e fenômenos religiosos, mas os dados não são conclusivos; 2. A dissociação acontece em um continuum entre saúde e doença; 3. A psiquiatria transcultural oferece aporte para a compreensão de experiências dissociativas, como o transe de possessão, contextualizando-as culturalmente; 4. Há uma série de estudos feitos no Brasil, que exploram o diagnóstico diferencial entre experiências religiosas saudáveis e patológicas. Conclusões: Experiências religiosas/espirituais de caráter dissociativo (como a possessão), podem ser consideradas saudáveis se apresentarem ausência de sofrimento, controle, forem contextualizadas e trouxerem benefício para o indivíduo. Indivíduos sem Autodirecionamento e com experiências autocentradas mostram maior probabilidade de desenvolver patologia. Futuros estudos deverão explorar empírica e longitunalmente estas questões. Palavras-chave:Religiosidade, Espiritualidade, Dissociação e Possessão. AbstractContext: Some religious and spiritual experiences present dissociative characteristics. There are few studies showing criteria to distinguish pathological and healthy dissociation in religious context. Objective: This study aims to observe dissociative experiences from different perspectives: one linked to psychopathology and the other to mental health. Method: Thematic Essay with available literature on the topic. Databases: Pubmed and PsychINFO. Moreover, a manual search for articles related to the subject was performed. Results: 1. Historically, some authors studied the relationship between dissociation and religious phenomenawithout conclusive results; 2. Dissociation happens on a continuum between health and disease; 3. Transcultural psychiatry contributes to understand dissociative experiences such as trance possession, culturally contextualized; 4. There are many studies in Brazil exploring the differential diagnosis between healthy and pathological religious experiences. Conclusions: Religious/spiritual experiences with dissociative characteristics (such as possession), can be considered healthy if individual have no suffering, is able to control the experience, can contextualize it and when the experience brings benefit to the individual. Low Self-Directedness and self-centered individuals show higher probability to develop pathology. Future studies should explore empirically and longitudinally these issues.

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