Differential Diagnosis Between Mental Disorders and Spiritual Emergencies

From: http://www.sonoma.edu/psychology/os2db/lukoff1.html

Making the differential diagnosis between a spiritual emergency and psychopathology can be difficult because the unusual experiences, behaviors and visual, auditory, olfactory or kinesthetic perceptions characteristic of spiritual emergencies can appear as the symptoms of mental disorders: delusions, loosening of associations, markedly illogical thinking, or grossly disorganized behavior. For example, the jumbled speech of someone trying to articulate the noetic quality of a mystical experience can appear as loose associations. Or the visions of a NDE can appear as hallucinations. Or the need for solitude and quiet of a person in a spiritual emergency can appear as catatonia or depression-related withdrawal (Bragdon, 1993) . Wilber (1993) argues that the distinction between spiritual emergencies and psychopathology hinges on the critical distinction between pre-rational states and authentic transpersonal states. The "pre/trans fallacy" involves confusing these conditions, which is easy to do. " Since both prepersonal and transpersonal are, in their own ways, nonpersonal, then prepersonal and transpersonal tend to appear similar, even identical, to the untutored eye" (Wilber, 1993, p. 125).

Lending further credibility to the existence of spiritual emergency as a valid clinical phenomenon, there is considerable overlap among the criteria proposed by different authors for making the differential diagnosis between psychopathology and spiritual emergencies. These constants include: 1) cognitions and speech thematically related to spiritual traditions or to mythology; 2) openness to exploring the experience; 3) no conceptual disorganization (Buckley, 1981; Grof & Grof, 1989; Lukoff, 1985; Watson, 1994) . Lukoff (1985a) suggested using good prognostic signs to help distinguish between psychopathology and spiritual emergencies, including: 1) good pre-episode functioning; 2) acute onset of symptoms during a period of three months or less; 3) stressful precipitants to the psychotic episode; and 4) a positive exploratory attitude toward the experience. These criteria have been validated in numerous outcome studies from psychotic episodes (reviewed in Lukoff [1985a]), and would probably also identify individuals who are in the midst of a spiritual emergency with psychotic features that has a high likelihood of a positive outcome.