Spiritual Emergency - A Useful Explanatory Model?
Introduction:
A major complaint from service users is that mental health services,
and especially psychiatrists, ignore or pathologise the spiritual
aspect of life. There has recently been an increased interest in
spirituality and religion in the Australasian psychiatry literature,
and the first British Mental Health, Well-being and Spirituality
conference was held in Scotland in 2004. In these contexts, the term
"spirituality" is understood in a number of ways. It includes a
personal sense of ultimate purpose, meaning and values; a sense of the
holy or sacred; a sense of connectedness. It can encompass belief in,
and relatedness to, a transcendent reality, higher being or higher
power. It can be, but is not necessarily, experientially synonymous
with religious ritual, belief and practice, which tends to involve
more of an institutional context and a more or less identifiable
community of believers.
There has not, however, been an understanding of the relationship
between spirituality and mental health within mainstream Psychiatry to
guide service providers in supporting the recovery movement in this
respect, despite (in New Zealand) the National Mental Health
Standard's provision for valuing spirituality, and the identification
of the vital role of "the S-Factor" by the Royal Commission on Social
Policy, and (in Britain) the increasingly explicit exploration of the
spiritual/transpersonal dimension in healthcare (Turvey in press).
Maori culture has always recognised an understanding of Taha Wairua,
Tapu, Mate Maori, and Makutu as an integral part of hinengaro (mental
health), but in the context of Psychiatry spiritual experiences and
religion have historically tended to be pathologised or ignored.
A major contribution to this field was made when, in 1994, "Religious
or Spiritual Problem" became a new diagnostic category (code V62.89)
in the Diagnostic and Statistical Manual of Mental Disorders (DSM IV).
This is not a pathological category, but 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 organised church or religious institution".
Inclusion of this category followed a number of publications by
professor of psychology, David Lukoff, who has also written a personal
account of his own experience of believing himself to be a
reincarnation of Buddha and Christ, and his subsequent call to "become
a healer", which he interprets as a form of spiritual emergency he
identifies as a Shamanic Crisis. Lukoff et al documented evidence of
the "religiosity gap" between clinicians and patients, and suggested
that this represents a type of cultural insensitivity toward
individuals who have religious and spiritual experiences in both
Western and non-Western cultures. They subsequently pointed out that
the impetus for the proposal had come from transpersonal clinicians
whose initial focus was on "spiritual emergencies", arising from
clinical and personal experience, but this notion was not ultimately
included in the DSM IV description, because of the difficulties
relating to diagnostic issues.
Anecdotally, the content revolves around spiritual themes,
including sequences of psychological death and rebirth, encounters
with mythological beings, feelings of oneness and other similar
motifs.
The phenomenology of what might be interpreted as a "spiritual
emergency" by the person or by an informed clinician, can be identical
to other psychoses; people can present as disoriented, fearful,
hallucinated, delusional, affectively dysregulated, and having
interpersonal difficulties thus making differential diagnosis
difficult. Anecdotally, the content revolves around spiritual themes,
including sequences of psychological death and rebirth, encounters
with mythological beings, feelings of oneness and other similar
motifs. Many of these states can be extremely distressing and
sometimes terrifying.
People who see themselves as experiencing "spiritual emergency" are
usually open to exploring the experience, and have no conceptual
disorganisation. Good prognostic signs are the same as for other forms
of psychosis. Recent debate has distinguished between validity and
utility in psychiatric diagnosis. The notion of diagnostic utility
might be more helpful in this context in terms of the capacity for the
concept of "spiritual emergency" as an explanatory model to more
effectively support the recovery journey of some people because of its
normalising and destigmatising potential. Kleinman has written
extensively about the process of selecting and using explanatory
models in therapy and the value judgements, implicit and explicit,
that this implies. Clinician and patient may not have similar
explanatory models; this difference is extreme if the patient's model
is itself seen as evidence of psychosis by the clinician.
It may be that there does not need to be an either/or approach taken
here, but that both/and explanations might help bridge the 'gap'
between "explanation" and "understanding". It is possible both for the
clinician to hold a pathological explanation for the phenomenology
(e.g. a clearly ictal event) and for the patient to hold an
explanation involving spiritual meaning. More research attention is
being paid to the importance of the patient's explanatory models in
recovery. The notion of "narrative competence", "the ability to
absorb, interpret, and act on the stories and plights of others" is
helpful here. This concept is gaining increasing credibility and
applicability within clinical medicine, but has not yet found a place
within Psychiatry, which has tended to focus more on the form than the
content of the person's narrative.
Source: Spiritual Emergency [PDF File]
See also:
Defining Spiritual Emergency
The Far Side of Madness
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