Psychiatry: Accepting of Spiritual Phenomena?
“Western civilization is unique in history in its failure to recognize each human being as a subtle energy system in constant relationship to a vast sea of energies in the surrounding cosmos”. –Dr. Edward E. Mann
Psychiatry’s theories around diagnosing psychosis have changed radically since 2013. It’s time now to put practical feet on these theories and update the way we identify and treat individuals who are in extreme states.
Psychiatry: Perceptions of Voices and Visions
Just because someone is hearing voices, seeing things others don’t see, or out of touch with consensual reality (i.e., restricted to the perceptions of the 5 senses)—doesn’t mean they are crazy. Instead, that person may be in a process of awakening, aka “spiritual emergence”, and breaking through limitations that have held them in bondage to a small sense of self.
If that person is distressed by the transformative experiences they are having, they may need support for the duration of the “spiritual crisis”, aka “spiritual emergency”. The appropriate support involves a cautious use of psychiatric medication and both trauma-informed psychotherapy and spiritual emergence coaching. This replaces the one size fits all approach which has typically advocated anti-psychotics for psychosis.
In 2014, the British Psychological Association, published a report, “Understanding Psychosis and Schizophrenia,” revised in 2017 [link]. This was the origin point for a new way of perceiving what had been held as symptoms of psychosis. A quote:
“Hearing voices or feeling paranoid are common experiences which can often be a reaction to trauma, abuse or deprivation. Calling them symptoms of mental illness, psychosis or schizophrenia is only one way of thinking about them, with advantages and disadvantages.”
Psychiatry: Respect for Diverse Cultures
In 2013, the American Psychiatric Association released the 5th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-V). It included a V-code for “Spiritual or Religious Problem” defined as a marker of issues related to culture that are not by themselves indicative of mental illness. The DSM-V also includes a “Cultural Formulation Interview” [link] to be used by clinicians to better understand the cultural roots of anomalous experiences a patient might have. This is a first!
In many cultures hearing the voices of the dead, or seeing visions of the future is considered a possible marker of a shaman in the rough. The individual would be encouraged to be in training with an elder, effective medicine man or woman, to harness their abilities to benefit the community.
That practice lives on in today’s Spiritist Psychiatric Hospitals and community centers in Brazil—used by 20% of Brazilians [link]. Since 1870 Spiritists recognize those gifted with mediumistic abilities or abilities to be exceptional healers. Spiritists offer support, free training with elders who have successfully harnessed their own abilities, and a respected role in the community.
New Zealand has clinics in which gifted Mãori shamans work with conventionally-trained psychiatrists to benefit patients with mental distress. The shaman can discern if an individual’s distress comes from spiritual origins or is driven by psychological trauma. Both can be addressed successfully within the collaborative relationship of the shaman and the psychiatrist [link].
Thus, some countries today have found a way to effectively support spiritual emergence without unnecessary, stigmatizing diagnosis and treatment of mental illness. It’s time we use these models more widely. Education of clinicians is key. We are moving in the right direction to ask clinicians to use the Cultural Formulation Interview when they make assessments and be more respectful of spiritual experiences.
Update from Dr. Lu: October 10, 2024.
In a personal email to me Dr. Lu wrote: “The big picture is that some very good activity is happening, but the accreditation standards for US psychiatry residency training programs are still weak in this area. There are so many requirements that Religion and Spirituality content is just pushed to the margins.”
Teaching Spiritual and Religious Competencies to Psychiatry Students is an 11 page article available at : teaching_spiritual_and_religious_competencies_to.33-2.pdf
Author Bio: Emma Bragdon, PhD, is the Executive Director of Integrative Mental Health University (IMHU.org) in Vermont, USA. She is the author of 7 books on the relationship between spirituality and optimal mental health. She if offering several open house talks, ½ day workshops, and a course on Effective Support for Someone in Spiritual Crisis at ALEF Trust in 2024-2025.
Thank you for this article. Part of me says “it’s about time”. However, when the DSM-5 first came out and I saw the V code for “Spiritual or Religious Problem”, I was rather dismissive of this inclusion because of the use of the word ‘problem’. That terminology still keeps this phenomenon inside the medical model. Reading this article today, a decade later, and I can see my attitude in response was not as constructive as possible. I could have been appreciative of the progress while recognizing ongoing limitations.
In the meantime, I have begun to find articulation for my role in facilitating spiritual emergence/spirituality as a normative part of life in the Western world, the Western mind.