Pathology, Religios, Spiritual or Transpersonal experience?

S O C I E T Y   F O R   H U M A N I S T I C
P S Y C H O L O G Y
D I V I S I O N   3 2   O F   T H E   A M E R I C A N   P S Y C H O L O G I C A L   A S S O C I A T I O N .
M O N D A Y ,   M A R C H   2 3 ,   2 0 0 9
What Distinguishes Psychopathology from Religious, Spiritual
and Transpersonal Experiences?
Most people have some kind of experiences that would be considered religious, spiritual
and/or transpersonal in nature. However, clinicians are often faced with the problem of
identifying when these experiences indicate something may be wrong and perhaps
actually an expression of psychopathology. In a recent review article in Journal of
Humanistic Psychology, Chad V. Johnson and Harris L. Friedman (2008) make several
recommendations for clinicians to help them in the differential diagnosis of
religious/spiritual/transpersonal (R/S/T) experiences from psychopathology:

1. Accept reality of spiritual and transpersonal experiences.
2. Obtain through understanding of client's religious history and background.
3. Realize that psychopathology cannot be determined solely by content in clients' R/S/T
experiences.
4. Assess adaptive functioning preceding and following R/S/T experience, whether
symptoms are acute or chronic, and level of openness to exploring spiritual experiences.
5. Assess quality of clients' R/S/T orientation.
a. Does current behaviors/practices exceed religious injunctions?
b. Does client overemphasize certain practices or beliefs and neglect others?
c. Do beliefs and practices promote wholeness, relatedness and full humanness?
6. Compare idiosyncratic behavior and beliefs to normative practices in religious/
spiritual community (e.g., speaking in tongues, hearing the voice of God).
7. Determine nature of religious or spiritual problem (Lukoff et al., 1992, 1996).
a. Purely religious or spiritual problem.
b. Religious or spiritual problem concurrent with mental disorder.
c. Religious or spiritual problem not attributable to mental disorder.
8. Recognize and understand spiritual emergency versus spiritual emergence (Grof &
Grof, 1992).
9. Recognize that psychopathology is often characterized by greater intensity, terror, and
decompensation than genuine spiritual experience.
10. Consider markers of religious psychopathology (Lovinger, 1996).
a. Self-oriented display: Narcissistic displays of being religious.
b. Religion as reward: Using religion to explain assistance with ordinary
difficulties in life (e.g., God helping one find a parking space)
c. Scupulosity: Intense focus on avoiding sin or error
d. Relinquishing responsibility: Feeling responsible for events beyond one's
control and neglecting responsibility for manageable things
e. Ecstatic frenzy: Intense, erratic emotional expression often containing religious
content or occurring in religious contexs that may signal impending
decompensation
f. Persistent church-shopping: Suggests difficulties in maintaining stable
relationships.
g. Indiscriminate enthusiasm: Religious enthusiasm frequently expressed to
people who do not welcome it.
h. Hurtful love in religious practice: Expressions of love that unnecessarily cause
harm to oneself or others (e.g., setting unrealistic expectations for a child out of a
notion of love based on strict Biblical interpretations)
i. The Bible as moment-to-moment guide to life: Applying scripture in concrete
ways to direct one's daily experiences (much like a daily horoscope)
j. Possession: May reflect underlying pathology such as hysteria, dissociative
reactions, paranoia, psychosis, and borderline disorders.
11. Consider intrapsychic conflicts manifested as religious pathology (Spero, 1985).
a. Person integrates religious beliefs and practices into overall lifestyle (not
pathological, but a necessary criterion)
b. Relatively rapid and recent onset of religious affiliation or increased religious
fervor with associated severing of significant social and professional relationships.
c. Person's religious history includes frequent and repetitive spiritual crises and
changes sin religious affiliation or degree of belief.
d. Person demonstrates fixation or regression to early sages of object-relations
development marked by decompensation in psychosocial functioning,
predominant primitive thematic material in dreams, fantasy, and thiking, and
conflict between religious expression and adaptive ego functioning.
e. Person preoccupied with fear of backsliding (consciously or unconsciously) and
reaction formation of overly rigid and scrupulous religious expression.
f. Person displays continued depressed moods and lack of productivity following
religious conversion or awakening.
g. Personal inappropriately idealizes religious leaders or movement and applies
this to resolving psychological issues such as autonomy, identity, and impulse
control.
h. On occasion, an analysts's carefully interpreted countertransference may
indicate the client is using religion to manage neurotic impulses.
12. Consider assessment tools for identifying adaptive from maladaptive spirituality--for
example, the SELF (Friedman, 1983). (p. 523)
C O N T R I B U T O R S
Harris
Brent Robbins, PhD
Susan Gordon, PhD
Chad JohnsonSociety for Humanistic Psychology: What Distinguishes Psychopathology from Religious, Spiritual and Transpersonal Experiences?

DSM V changes...

Religious and Spiritual Issues in Psychiatric Diagnosis: A Research Agenda for DSM-V examines the role of spiritual and religious considerations in the DSM revision process. The volume includes chapters on each major category of psychiatric disorder, with an analysis of the implications of religion and spirituality for their diagnosis, course, and outcome. Based on the work presented by the prominent clinicians and researchers who participated in the 2006 Corresponding Committee on Religion, Spirituality, and Psychiatry of the American Psychiatric Association, the volume addresses the spiritual and philosophical issues involved in distinguishing a psychiatric disorder from a spiritual condition.
This volume is unique in reviewing the literature on spirituality and major psychiatric disorders with the objective of clarifying where existing descriptions of diagnostic criteria and of the course and outcome of these disorders require revision. In addition, the contributors identify areas that demand further research. Only in this book can clinicians find a comprehensive treatment of this important topic, as well as features that enhance understanding and encourage future scholarship.

• Each chapter makes specific recommendations for revising the wording of the DSM, and each is followed by two commentaries that contextualize, analyze, and critique the chapter’s recommendations.
  
• Other chapter contributors make the case for updating the V Code for a Spiritual or Religious Problem, and discuss the place of spiritual and religious considerations in the Outline for a Cultural Formulation.
  
• Mental health practitioners from all disciplines who seek to practice in a more integrated, holistic fashion will find in this volume a foundation for including religious and spiritual considerations in their cases, as well as recognition and validation that these problems are worthy of clinical attention.

Psychiatry has often been viewed as hostile to religion, and the DSM has been criticized for neglecting this vital dimension of human experience. As interest in the intersection between spirituality and mental health continues to grow, Religious and Spiritual Issues in Psychiatric Diagnosis: A Research Agenda for DSM-V will become an ever more relevant and necessary resource for addressing these concerns in a positive, practical, and systematic way.

DSM IV Code V62.89

DSM Code V62.89 Phase of life Problems

V62.89 Religious or Spiritual Problem

This category can be used when the focus of clinical attention is a religious or spiritual problem. Examples include distressing experiences that involve loss or questioning of faith, problems associated with conversion to a new faith, or questioning of spiritual values that may not necessarily be related to an organized church or religious institution.

Here is a short description of the type of religious and spiritual experiences that a patient may have experienced.

Spiritual emergencies are crises during which change becomes chaotic and overwhelming. The proposal for this new diagnostic category came from transpersonal clinicians
concerned with the misdiagnosis and mistreatment of persons in the midst of
spiritual crises.

* Mystical experience*New Religious Movements and cults
* Psychic opening            * Visionary experience
* Kundalini awakening             * Near-death experience
* Possession experience                     * Shamanic crisis
*Loss of faith           * Alien encounters
*Terminal & life-threatening illness
*Changes in membership, practices & beliefs