The area of Spiritual Emergence/Spiritual Emergency [SE] is not well-known - either by the general population or within the field of mental health. I believe that it is of paramount importance that people are made aware of the similarities between Spiritual Emergence/Spiritual Emergency and psychosis. To put it very bluntly, being able to distinguish between the two and to treat accordingly, means the difference between a life made richer by the experience and a life as a mental health patient.
The Spiritual Emergence Network Spiritual Emergence Network provides information and support to individuals experiencing difficulties with psychospiritual growth. With the vast array of and ready access to all-things-spiritual in our world today, it is wise to be aware of the potential difficulties and dangers of this area of life as well as the great beauty and power.
The following is an essay I wrote as part of my studies in Art Therapy. Writing it gave me a greater understanding of my own Spiritual Emergence which ultimately became Spiritual Crisis. It also made me supremely grateful that I had chanced upon a practitioner [eternal gratitude to Jocelyn Clayton in Townsville] who was aware of the existence of SE. If I had not sought treatment for depression after my mother's death and been pointed in the direction of the works of Roberto Assagioli, Stanislav and Christine Grof and Carl Jung, I would have a very different life than I have now. It's been a long, long road to understanding and acceptance and ultimately, gratitude, for my experience. I have emerged richer for the experience, yes, but I would not wish an unguided journey through the deeper, darker realms of the unconscious on anyone.
‘I heard voices and they told me that I was the chosen one. So I had to leave my work and my family and live here under this bridge in sackcloth and ashes because that is the way I will know the meaning of the universe and my place in it.’ Describe 2 scenarios in which this statement is heard and responded to by, 1. a mainstream psychiatric or psychological practitioner; 2. a shaman. Contrast the 2 strategies and the outcomes and analyse just where art therapy might fit.
James Foley is 50 years old, stylishly cut grey hair, suntanned skin, blue eyes. He has been brought into the police station of Wangaroonie, a small country town in NSW. The police were called in by the local milkman, Paul Weeks, who had been supplying milk and bread to Foley for the past 8 days. Weeks had been trying to get information from Foley so that he could contact his family. An anti-authoritarian, Weeks was at first reluctant to contact the police but as he has been unable to gain any information and Foley is becoming more agitated, he felt compelled to call Constable Crystal-Blue Jones.
Constable Jones was able to ascertain from Foley that he had dropped acid with his 27 year old son at a rave party two weeks ago. This was his 50th birthday present to himself and a misbegotten attempt to rediscover his lost youth which was, much to his surprise, not in the place he’d left it. Apart from this snippet of information, Foley’s only other response to questioning is that, ‘I heard voices and they told me I was the chosen one. So I had to leave my work and my family and live here under this bridge in sackcloth and ashes because that is the way I will know the meaning of the universe and my place in it.’
Wangaroonie Police Station’s policy re. matters of this nature is to contact the Psychiatric Unit of the local hospital. However, on this occasion, as Constable Jones was the initial point of contact, she decided to bring her mother’s friend, Jeanie Upton, the local shaman, to the Station before contacting the hospital.
Jeanie is 70 years old and has spent most of her adult life in close contact with different indigenous cultures. She has been accepted into Australian Aboriginal and Hawaiian tribes, has been initiated into their shamanic tradition and has studied other cultural healing beliefs extensively.
Jeanie’s approach to shamanic healing is firmly based on pragmatism. She is appalled at the misappropriation of indigenous cultural ways by upstart Westerners who have no respect for and no real notion of what is required to train as a shaman. An intelligent and feisty old woman, she has married her shamanic training to basic common sense. Jeanie knows that in a functional tribal culture, a shaman would be called at a very young age and there’d be special schooling and ongoing nurturing. Otherwise, later in life, a person would be chosen because of qualities seen by the elders as being those of a shaman. Alarm bells would go off if an adult came to an elder shaman with a dream or vision of being the chosen one – as is the case with James Foley. A careful examination of the person’s history would be necessary before a decision to journey with the person is made.
After creating a sacred space, Jeanie centres herself and calls on her spirit guides to be with them during the session. Jeanie does not automatically see James’ idea of being ‘the chosen one’ as a calling to be a shaman, especially taking into account his acid trip. She does, however, take into account that the hallucinogenic may have opened up the space between worlds and this may be an explanation for what he is experiencing. She ascertains if James’ intentions are grounded, as he may merely be expressing a desire to run away from his current situation as the result of a midlife crisis. She asks about his family and cultural background, tries to get clarity as to how his family feels about him taking off and looks closely at his spiritual beliefs.
After gathering the necessary information, Jeanie decides to journey with James to open him up to the Divine will. Jeanie knows that if a person wears sackcloth and ashes, it signifies repentance, remorse or grief. In Christian tradition, the wearing of sackcloth and ashes signified a public display of remorse and humiliation, a debasing of self as unworthy before God. It was an ancient Hebrew custom to wear sackcloth dusted with or accompanied by ashes as a sign of humbleness in religious ceremonies. In Hinduism, devotees of Shiva rub ashes on their faces as a symbol of the death of the old self and as a link with the element of fire.
Jeanie has decided to journey with James only after extensive questioning which has satisfied her that James’ intention is grounded and that he has the necessary level of humility. If she decides to initiate James, it would only be if both he and she were certain that this was his life purpose. This would necessitate asking open questions and finding out what James’ idea of being ‘the chosen one’ means. Jeanie knows that many mature shamans would say ‘Get back to your family, that’s why you’re here, that’s your life purpose.’
As part of the initiation, Jeanie would work with the element of fire and take James into the bush to build a fire and get more ashes. She would then conduct a ritual with the ashes as a way of rebirthing him into the role of the chosen one. She would take him on a vision quest, which would consist of seven days fasting, journaling, meditating. Jeanie states that in a traditional shamanic framework, the shaman would stay with the initiate, would give them a totem animal, initiate them into being the chosen one, into being a healer. After the vision quest, the shaman would ask what qualities has the initiate found within themselves that they need to embrace and bring back - e.g. wisdom, strength, compassion.
Jeanie knows that the descent is about being able to embody the qualities and bring them back in a way that is fully integrated - head, heart, body/mind. Part of Jeanie’s thinking would revolve around the possibility of a ‘sacred contract’. Jeanie believes that we either embrace who we truly are in this lifetime - i.e. find our life’s purpose via these sacred contracts, who we’re meant to be - or we hit the wall via disequilibrium, dis-ease. She would want to ascertain if James’ present situation is him tapping into cellular memory in an attempt to remember his life’s purpose.
If James is indeed called to be a shaman, Jeanie would initiate him into the necessary and essential protocols of a life as a healer. www.dontpaytopray is a blogspot started by indigenous people warning against the bastardization of indigenous cultures by either naïve or dishonest westerners. They warn that ‘The counterculture shuns rationality, accountability, sacrifice, discipline and protocol and embraces narcissism and self indulgence. These were never indigenous values. When people reject our protocol out of ignorance and arrogance and try to take the empty form of our spiritual practices, they will harm themselves. They will remain empty. They will lose their integrity, they will lose their money and some of them will lose their lives.’
Being under the bridge, Jeanie sees as a metaphor of the transition between his old and new life. Tapping into Jungian symbolism, she sees the bridge as a powerful image for James – e.g. bridging between the worlds, a bridge between the higher and lower self. She would use art as a means of dissolving James’s social mask, getting him up and out of the river – i.e. from his lower self feelings - and onto the bridge. She would ask him to draw himself wherever he sees himself on the bridge, what are his emotions as ‘the chosen one’? – happy, sad, ecstatic, thoughtful, strong, etc.
The art would provide James with the bridge he needs from deep inside himself back into the world. It would also enable his rational mind to have some input into his state of being rather than being potentially overwhelmed by either his own unconscious or the collective unconscious.
Mainstream Psychiatrist/Psychologist Scenario:
A mainstream psychiatrist or psychologist – let’s call him Dr. Wes Coast – would first gain a detailed medical history from James, focusing on the precipitating factors and the duration of the symptoms. If James was in an agitated state or an altered state that he didn’t recognize, he would possibly prescribe a mild sedative.
Dr. Coast would use the DSM-IV in diagnosing Foley’s behaviour. Using the DSM-IV as a guide, he would look at the presence of non-bizarre delusions [bizarre delusions?], the presence of auditory hallucinations, how long have the delusions and hallucinations persisted, the severity of the symptoms – mild, moderate, severe - and if there is any resulting impairment in occupational or social functioning. To make a diagnosis, Dr. Coast would choose between categories by looking at how many items on the list of symptoms for each category the patient presents with. He would also try and ascertain if there is any prior history of other symptoms.
A practitioner’s map of reality – i.e. what is perceived as being possible/not possible in the world – determines, to a very large extent, how they view the world and therefore, how they interpret symptoms.
If Dr. Coast’s map of reality does not include the possibility of Spiritual Emergence/y, he would see James’ voices and behaviour as symptomatic of a ‘breakdown’ rather than a ‘breakthrough’ and caused by his ingestion of LSD. Dr. Coast would look up the Criteria for Substance-Induced Disorders in the DSM-IV which states that it is ‘often difficult to determine whether presenting symptom-atology is substance induced – i.e. the direct physiological consequence of Substance Intoxication.’ It is necessary to see if there ‘is evidence from the history, physical examination or laboratory findings [that] … the symptoms developed during or within a month of Substance Intoxication or Withdrawal – or – is not better accounted for by a disorder that is not substance induced.’
Dr. Coast would see this as the most hopeful, most positive diagnosis for James as ‘the essential feature of Substance Intoxication is the development of A REVERSIBLE substance-specific syndrome due to the recent ingestion of [or exposure to] a substance.’ [DSM-IV, p199] The reversibility of a Substance-Induced Disorder would bode well for James’ future as opposed to a diagnosis of some form of psychotic illness such as schizophrenia or bipolar disorder.
The next level of illness which would fit James’ presenting condition would be a Substance-Induced Psychotic Disorder. The essential features are ‘prominent hallucinations or delusions that are judged to be due to the direct physiological effects of a substance – hallucinations that the individual realizes are substance induced are not included here – disorders arise only in association with intoxication or withdrawal states but can persist for weeks rather than preceding the onset of substance abuse … the substance is judged to be etiologically related to the symptoms.’ [DSM-IV, p338, p341]
While I am unclear as to the essential difference between a Substance-Induced Disorder and a Substance-Induced Psychotic Disorder – whereas I assume that the good Dr. Coast would be – I think that the basic difference is the level of insight the patient has into the basis of the hallucinations, delusions. The key phrase is ‘hallucinations that the individual realizes are substance induced are not included here.’
Therefore if James was able to link his present state to his LSD experience, then Dr. Coast would opt for the Substance-Induced Disorder. If James persisted with his ‘chosen one’ scenario, Dr. Coast would more than likely go with the Substance-Induced Psychotic Disorder. From the medical perspective, the level of insight and the patient’s interpretation is the key factor in diagnosis.
Dr. Coast would also look at the Diagnostic Criteria for Schizophrenia. The characteristic symptoms of schizophrenia are delusions, hallucinations, social/ occupational dysfunction ‘for a significant portion of time since the onset of the disturbance, one or more major areas of functioning such as work, interpersonal relations or self-care are markedly below the level achieved since the onset … BUT [symptoms] cannot be due to ‘direct physiological effects of a substance, e.g. drug of abuse.’ [DSM-IV, p312]
From these criteria, it is evident that a diagnosis of schizophrenia is something that could only be reached over a prolonged period of time rather than when Dr. Coast first saw James. Other possible diagnoses would include Delusional Disorder and Brief Psychotic Disorder. Overall, Dr. Coast’s diagnosis would be dependant upon his determination as to the duration of James’ symptoms and whether or not both he and James ascribed his symptoms to the ingestion of LSD.
On a purely superficial level, the content of James’ hallucinations would suggest to Dr. Coast delusions of grandeur. The Encyclopedia of Mental Health states that ‘Most people at some time think small lies to themselves or indulge in a moment of wishful thinking to protect themselves from anxiety. However, when a person can no longer distinguish between fact and fiction, he is having a delusion. To the delusion sufferer, his fantasy is real and no amount of information will change his attitude.'
Dr. Coast’s treatment of James would revolve around these issues. Medication would be prescribed accordingly. Depending on Dr. Coast’s map of reality, the possibility of Spiritual Emergence may be looked at. Likewise art therapy.
It strikes me that the most significant impact of these two different types of treatment rests with the long-term affects on the client. Obviously.
Lukoff states, ‘Had I been diagnosed with a psychotic disorder, hospitalized and medicated, I'm sure that a positive integration of my experience would have been much more difficult to attain.’
In direct contrast to Lukoff, the sufferers of bipolar disorder who tell their stories on the DVD produced by Monkey See Productions thank God for the diagnosis and therefore the medication which enables them to function in the world and makes their lives livable. One section of the DVD deals with the importance of support groups, at which they discuss different doctors, the effects of medication, managing their illness, etc.
I believe that self-fulfilling prophecies come into play in many areas in life. And while I am wary of RD Laing’s 'madness as a valid response against a society gone wrong' theory of psychosis, I am trying to imagine what a support group for people who had had a diagnosis of Spiritual Emergency rather than Bipolar Disorder would be like. And it seems to me that the difference is a life and what that life consists of, whether the ongoing emphasis is on health or on illness. If I had been diagnosed with BD rather than SE twenty two years ago, chances are that I would not be writing this essay. I would think of myself as the unfortunate sufferer of an illness that requires life-long medication and management rather than as someone who ‘saw the light’, if only for a short time.
Mijares and Khalsa state that, ‘The similarity between psychotic symptoms and mystical experiences has received acknowledgement and discussion in the mental health field. … Research has confirmed the overlap between psychotic and spiritual experiences.’ They further mention the publication of ‘Detailed cases showing that psychotic symptoms can occur in the context of spiritual experiences rather than mental illness.’ [Mijares and Khalsa, p235]
The long-term key factor for the patient of the difference in diagnosis and therefore the difference in treatment, is how they come to view themselves and their capabilities. This difference in self-concept results in a difference in world views, what the world consists of, the multi-dimensionality of our world, the interpenetration of the unseen into the seen. A breakthrough is different from a breakdown but may be equally as difficult to deal with and live through. The virtue of the former is that it restores a sense of magic and mystery to the world and that, in itself, is a great gift.
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Encyclopedia of Mental Health definitions –
Hallucinations - ‘Seeing, hearing, smelling, tasting something that is not there. They are sources of anxiety and stress because these perceptions cannot be reinforced by anyone else. Hallucinatiosn may be disturbing to sufferers as well as to those who are trying to understand what they are feeling. … They also occur in some severe mental disorders, such as schizophrenia.’
Delusions - ‘A strong but false mental conception of an event or image. Delusions are classified as non-bizarre [events that could happen but did not, such as being followed] and bizarre [totally impossible, such as visits from Martians]. Most people at some time think small lies to themselves or indulge in a moment of wishful thinking to protect themselves from anxiety. However, when a person can no longer distinguish between fact and fiction, he is having a delusion. To the delusion sufferer, his fantasy is real and no amount of information will change his attitude. … delusions of grandeur which arises from feelings of insecurity or inferiority.’
DSM4 – ‘the narrowest def. of psychotic is restricted to delusions or prominent hallucinations, wth the hallucinations occurring in the absence of insight into their pathological nature.’ previous def’s focused on the severity of functional impairment – ‘… a mental disorder was termed ‘psychotic’ if it resulted in ‘impairment that grossly interferes wth the capacity to meet ordinary demands of life … loss of ego boundaries … or a gross impairment in reality testing.’ In Psychotic Disorder Due to a General Medical Condition and in Substance-Induced Psychotic Disorder, psychotic refers to delusions or only those hallucinations that are not accompanied by insight.’ p297-8.