Enlightened or Delusional?

Abstract

Psychological diagnosis faces unique challenges when used to differentiate nonpsychopathological religious/spiritual/transpersonal (R/S/T) experiences from those that might evidence psychopathology, particularly considering the diversity of such experiences and the value-laden assumptions inherent in most diagnostic practices. Theoretical and pragmatic problems related to the diagnostic category, Religious and Spiritual Problem, as contained in the Diagnostic and Statistical Manual of Mental Disorders are discussed. Attention is paid to identifying potential biases and errors in using, or failing to use, this diagnostic category, particularly as related to developing culturally sensitive diagnoses. Specific methods, including psychometric approaches, for evaluating R/S/T experiences that may range from healthy to psychopathological are reviewed and recommendations are presented for improving current diagnostic practices and furthering needed research.

Psychosis or Spiritual Emergency: The Potential of Developmental Psychopathology for Differential Diagnosis

“…However, the Diagnostic and Statistical Manual of Mental Disorders introduced the category Religious or Spiritual Problem in its fourth edition (APA, 1994) due to increasing cultural sensitivity towards the issue of spiritual and religious experiences (Johnson & Friedman, 2008). Motivation for the development of this category derived from the Spiritual Emergence Network (at the time called the Spiritual Emergency Network) which was troubled by the default, pathological stance adopted by most mental health professionals towards challenging spiritual experiences (Lukoff, Lu, & Turner, 1998).…”

“…Examples include distressing experiences that involve loss or questioning of faith, problems associated with conversion to a new faith, or questioning of other spiritual values that may not necessarily be related to an organized church or religious institution. (APA, 2013, p. 725) The inclusion of this category in the DSM has opened clinicians to the possibility of assessing religious and spiritual experiences as part of their psychological or psychiatric assessments without prejudging such experiences as inherently pathological (Johnson & Friedman, 2008;Menezes & Moreira-Almeida, 2010). …”

“…For example, a person experiencing distress related to his or her religion might consider consulting with clergy (Johnson & Friedman, 2008). Similarly, a person may experience a purely spiritual problem, such as an individual experiencing unusual perceptual phenomena while meditating.…”

“…Although it is commendable that increased sensitivity toward the spiritual and transpersonal dimensions of human experience (see Johnson & Friedman, 2008) has expanded our clinical lexicon, accurate diagnosis of religious or spiritual problems remains a challenge due to surface level, symptomatic similarities between certain spiritual experiences and the acute psychotic reactions associated with psychotic disorders (Grof & Grof, 1989. That is, the atheoretical approach of the DSM and the classic medical model affords clinicians limited conceptual resolution to accurately make this distinction.…”

“…That is, the atheoretical approach of the DSM and the classic medical model affords clinicians limited conceptual resolution to accurately make this distinction. However, it is essential that clinicians be able to do so, as harm may result from inappropriate treatment of a misdiagnosed spiritual experience (Johnson & Friedman, 2008;Lukoff, 2005). Consequently, the purpose of this paper is to elucidate how a holistic, developmental model, encompassing the continuum from pathology to advanced wellbeing, may afford clinicians with a more nuanced framework to accurately distinguish psychotic reactions indicative of psychopathology from nonpathological, though potentially distressing, spiritual experiences.…”