! "Our greatest blessings come to us by way of madness, provided the madness is given us by divine gift.! Socrates

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1 "Our greatest blessings come to us by way of madness, provided the madness is given us by divine gift. Socrates

2 The Old Testament uses the same term, in reference to madness sent by God as a punishment for the disobedient, and to describe the behavior of prophets.

3 Spiritual Crises in History: Initiatory crises of shamans Overwhelming experiences of the yogis (Ramakrishna, Muktananda) Visionary experiences of the founders of the great religions of the world (Buddha, Jesus, Mohammed) Trials and tribulations in the life of Buddhist teachers (Padma Sambhava) Torments of the saints and Desert Fathers (St. John of Patmos, St.Paul, St. Anthony, John of the Cross, St. Teresa of Avila) Challenging experiences of famous mystics (Jacob Boehme, Meister Eckhart, Hildegarde von Bingen)

4 Highly similar mental and behavioral states may be designated psychiatric disorders in some cultural settings and religious experiences in others...within cultures that invest these unusually states with meaning and provide the individual experiencing them with institutional support, at least a proportion of them may be contained and channeled into socially valuable roles. Raymond Prince

5 Positive Transformational Episodes positive disintegration (Dabrowski) creative illness (Ellenberger) spiritual emergencies (Grof & Grof) mystical experiences w/ psychotic features (Lukoff) metanoiac voyages (Laing) visionary states (Perry)

6 A system of wishful illusions together with a disavowal of reality, such as we find nowhere else...but in a state of blissful hallucinatory confusion. Future of an Illusion

8 Spirit and soul is horseshit of the worst sort. Obviously there are no fairies, no Santa Clauses, no spirits. What there is, is human goals and purposes.but a lot of transpersonalists are utter screwballs. Albert Ellis

9 an explanatory fiction, of a miracle-working mind superstitious behavior perpetuated by an intermittent reinforcement schedule Walden II BF Skinner

10 Spiritual Emergency Crisis related to sudden spiritual emergence during which the process of growth and change becomes chaotic and overwhelming. In such episodes, individuals often suddenly and dramatically enter into new realms of mystical and spiritual experience. However, they may also become fearful and confused and have difficulty coping with their daily lives, jobs and relationships. Stanislav & Christina Grof

11 Spiritual Emergency: Psychosis or Transcendence? In 1980, Christina Grof founded Spiritual Emergency Network (SEN), connecting people undergoing psychospiritual crises with professionals who are able and willing to provide useful assistance Esalen Institute Institute of Transpersonal Psychology (ITP) California Institute of Integral Studies (CIIS). Now exists as a web site only. Filial branches of SEN now exist in many countries of the world

12 The most subjectively frightening aspect of their experience was psychiatric hospitalization itself. Jackson (2001)

13 ATP Founded 1971 Abraham Maslow Anthony Sutich Miles Vich Stanislav Grof Michael Murphy James Fadiman

14 Core Assumption of Transpersonal Psychology Individuals are essentially spiritual beings rather than simply a self or a psychological ego.

15 DSM-IV Dx Rationale Lukoff, Lu & Turner (1992) JNMD improve diagnostic assessments reduce iatrogenic harm stimulate clinical research encourage clinical training

16 Religious Practices of the U.S. Population and Psychologists 75% of Americans report religious faith is the most important influence in their life 60% attend church or synagogue weekly 18% of psychologists agreed that organized religion was an important dimension in their life

1990: 85% APA psychologists reported having discussed religious and spiritual

17 Training in Religious/Spiritual Issues 1990: 100% APIC directors no education or training in religious or spiritual issues during their formal internship 1990: 85% APA psychologists reported having discussed religious and spiritual issues during their own training rarely or never 2004: 34% had prior training

18 Religious or Spiritual Problem (V62.89) 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 other spiritual values which may not necessarily be related to an organized church or religious institution. (DSM-IV, American Psychiatric Association, 1994, p. 685, 2000 p.712 )

19 Number of Medline-Indexed English Articles by Year, with Keywords RELIGION, RELIGIOSITY, RELIGIOUS or RELIGIOUSNESS

20 Number of Medline-Indexed English Articles by Year, with Keywords SPIRITUAL or SPIRITUALITY

21 The published empirical data suggest that religious commitment plays a significantly beneficial role in: preventing mental and physical illness improving how people cope with mental and physical illness facilitating recovery from mental and physical illness

22 JCAHO mandates that the spiritual component of a person s life must be considered in health care. A spiritual assessment should at least ascertain a patient s religious preference, beliefs, and any spiritual practices. The assessment must be documented in the patient record.

24 Spirituality: "Degree of involvement or state of awareness or devotion to a higher being or life philosophy. Not always related to conventional religious beliefs" Religion: "is associated with religious organizations and religious personnel" Walker, A. (Ed.) (1991). Thesaurus of psychological index terms (2nd ed.).

25 Remen, N. (1993). On defining spirit. Noetic Sciences Review, 27, 41. The spirit is not the religious. A religion is a dogma, a set of beliefs about the spiritual and a set of practices which arise out of those beliefs. There are many religions which arise out of those beliefs, and they tend to be mutually exclusive. That is, every religion tends to think that it has 'dibs' on the spiritual--that it's 'The Way.'

27 Rilke If you think going to church will make you a Christian, then sit in your garage and you'll become a car.

28 I believe deeply that we must find, all of us together, a new spirituality. This new concept ought to be elaborated alongside the religions, in such a way that all people of good will could adhere to it. Dalai Lama

29 Assessing Religious/Spiritual Functioning Research Question: Has the level of clinical attention given to religious/spiritual issues by clinicians increased since religious or spiritual problem accepted in DSM-IV? Survey: 333 APA psychologists 6.2% had ever used Religious or Spiritual Problem as part of a diagnosis 75% military psychologists Wm Hathaway et al. (2004)

30 Nearly one-third of the college students seeking help from university counseling centers report experiencing some distress from religious or spiritual problems. Students who struggle with religion and spirituality were more likely to be homesick, suicidal, victims of sexual assault or distressed over a break-up. (Johnson & Hayes, 2003)

31 More Results from the GSS for 1998 The 1998 sample was also asked asked: Think about how you try to understand and deal with major problems in your life. To what extent is each of the following involved in the way you cope: Percentages Not Some- Quite A great Don t at all what a bit deal know I wonder whether God has abandoned me I feel that God is punishing me for my sins or lack of spirituality Nat l Opinion Research Ctr, U of Chicago

of adherence to beliefs and practices Loss or questioning

32 Types of Religious Problems Change in denominational membership or conversion to a new religion Intensification of adherence to beliefs and practices Loss or questioning of faith New Religious Movements and Cults Serious or Terminal illness

36 52 seriously mentally ill patients who were diagnosed with major depression, schizophrenia, manic episodes, personality disorder, and anxiety disorder 23% thought that their illness was a result of their sins Sheehan and Kroll (1990)

37 Types of Spiritual Emergency: 1. Shamanic crisis 2. Awakening of Kundalini 3. Peak experiences (Abraham Maslow) 4. Renewal process (John Weir Perry) 5. Crisis of psychic opening 6. Emergence of a karmic memory 7. Communication with spirit guides and channeling 8. Near-death experiences (NDEs) 9. UFOs, close encounters, and alien abduction experiences 10. Possession states 11. Alcoholism and drug addiction

38 Types of Spiritual Problems Visionary Spiritual Experiences Mystical experience Near-death experience (NDE) Psychic experiences Alien abduction experience Spiritual-practice related Possession

39 It is very likely, indeed almost certain, that these older reports [of mystical experiences], phrased in terms of supernatural revelation, were, in fact, perfectly natural, human peak experiences of the kind that can easily be examined today. (Maslow, 1964, p. 20, Religion, Values, and Peak Experiences)

40 Gallup Poll: Have you ever been influenced by a presence, power, God? 1973: 27% 1986: 42% 1994: 54% 2001: 67%

41 Near Death Experiences Elements of a typical NDE: A tunnel An OBE A brilliant white or golden light Positive and loving emotions Visions of another world Meetings with other beings A life review The decision to return Some are peaceful, some are hellish

43 Alien Abduction Features Capture Examination Communication with abductors Tour Transport Theophany Return

44 Diagnostic Criteria for VSE 1) Absence of medical illness 2) Phenomenological overlap with one type of VSE 3) Prognostic signs indicative of a positive outcome 4) No significant risk for homicidal or suicidal behavior

45 Phenomenological Overlap with a Mystical Experience A. Ecstatic mood B. Sense of newly-gained knowledge C. Perceptual alterations D. Delusions with religious/mythical themes

46 Good Prognostic Indicators a) good pre-episode functioning b) acute onset of symptoms during a period of 3 months or less c) a stressful precipitant d) a positive exploratory attitude toward the experience. e) absence of conceptual disorganization and confusion

47 Religious and Spiritual Problems Concurrent with Mental Disorder Substance Abuse Disorders Obsessive-Compulsive Disorder Mood Disorders Psychotic Disorders

48 P - Religious/Spiritual Problems What aspects of your religious community and their beliefs are helpful and not so helpful to you? Do you feel you have spiritual needs in your life that are not being met? Does what is happening to you now change your relationship to God (closer to God, more distant, no change) Is your spirituality challenged by what is happening to you now?

49 Spirituality White Paper Group Religious and Spiritual Issues in Psychiatric Diagnosis: Considerations for a Revised DSM American Psychiatric Publishing Personality Disorders C. Robert Cloninger, MD Adjustment Disorders and PTSD Samuel B. Thielman, MD Anxiety Disorders Gerrit Glas, MD Depression Dan G. Blazer II, MD Psychotic Disorders Harold Koenig, MD Topics and Authors

50 Substance Use Disorders Marc Galanter, MD Linda Glickman, PhD Disorders of Children and Adolescents Alex Mabe, PhD Mary Lynn Dell, MD Allan Mark Josephson, MD Religious and Spiritual Problems David Lukoff, PhD Francis Lu, MD Outline for Cultural Formulation Francis G. Lu, MD David Gellerman, M.D. Philosophical Considerations Bill Fulford, M.D John Sadler, M.D.

51 Development of an agenda for future research on religious and spiritual issues in diagnosis Expand the current DSM text on "Age, Gender and Cultural Considerations" and "Differential Diagnosis" for the major categories of mental disorders to include the impact of religious/spiritual factors on phenomenology, differential diagnosis, course, outcome, and prognosis.

52 Religious and Spiritual Issues in Psychiatric Diagnosis: A Research Agenda for DSM-V by John R. Peteet, Francis G. Lu, William E. Narrow

53 Recommendation to Task Force V62.89: This category can be used when the focus of clinical attention is a religious or spiritual problem. Examples of religious problems include distressing experiences that involve of loss or questioning of faith, changes in membership, practices and beliefs, cults, lifethreatening and terminal illness. Examples of spiritual problems include intense spiritual experiences, anomalous experiences, spiritual practice-related experiences, possession experiences and questioning of other spiritual values which may not necessarily be related to an organized church or religious institution.

54 SURVEY OF COUNTY BH DIRECTORS Phone interviews Conducted Nov 2008 to Mar of 59 counties participated

More than 90% of the County Behavioral Health Directors surveyed responded strongly agree or agree to the following statements: Spirituality is an important recovery resource in mental health

56 More than 90% of the County Behavioral Health Directors surveyed responded strongly agree or agree to the following statements: Spirituality is an important recovery resource in mental health treatment. (92%) Spirituality is an important wellness resource in mental health prevention. (94%) Spirituality is an important element of multicultural competency for mental health providers. (98%)

Faith, Mental Health and DSM-5

Faith, Mental Health and DSM-5 Rania Awaad, MD Clinical Assistant Professor Director, Muslims and Mental Health Lab Department of Psychiatry and Behavioral Sciences Stanford University School of Medicine