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Diagnostic Criteria

ARGUMENTS
FOR MAKING A DIAGNOSIS

Wing (1977), a respected authority on diagnosis, noted that:

"to put forward a diagnosis is, first of all, to recognize a condition, and then to put forward a theory about it. Theories are meant to be tested. The most obvious test is whether applying the theory is helpful to the patient. Does it accurately predict a form of treatment that reduces disability without leading to harmful side effects?" (p. 87)

Accurate diagnosis of spiritual emergency cases could reduce inappropriate hospitalization and use of medication for individuals who could be treated with less stigmatizing methods which have fewer side-effects. The proposed operational criteria are intended to allow cases of positively-transforming psychotic episodes to be recognized with a high degree of accuracy (referred to as validity) and consistency across different diagnosticians (referred to as reliability).Spitzer (1976), who headed the task force which developed the DSM-III, reminds us that "classification in medicine has always been preceded by clinicians using imperfect systems that have been improved on the basis of clinical and research experience" (p. 469).

The specific criteria proposed for spiritual emergency represent hypotheses. They must be subjected to reliability studies to determine whether they achieve acceptable levels of interrater agreement. Validation studies also need to be conducted to determine whether they accomplish the objective of accurately identifying individuals whose psychotic episodes represent positively transforming mystical experiences. Ideally a trial of this operational definition would use these (or similar) criteria in a screening instrument to make diagnostic decisions in situations where discriminating spiritual emergency experiences from psychotic disorders is the issue. Follow-up evaluations over several years would establish the outcomes of cases handled in this manner. This type of prospective study is the most valuable for yielding information which could lead to refine ments of the diagnostic criteria. In addition, studies of samples of individuals who retrospectively report such episodes could also yield information useful for honing the selection criteria.

In MADNESS OR TRANSCENDENCE? Looking to the Ancient East for a Modern Transpersonal Diagnostic System, JOHN E. NELSON, M.D. highlights the need for accurate diagnoses despite the potential for stigmatization and labeling: (see Self-Help Resources)

Transpersonal psychology has long been wary of traditional psychiatry and psychology's insistence on making diagnoses. Many feel that the process somehow
programs a therapist to follow predetermined lines of thought that may not reflect the essential reality of those who come to them for care. Diagnoses, they argue, are impediments to authentic I-Thou relatedness. Others follow the reasoning of R.D. Laing and his radical anti psychiatry movement of earlier decades. Laing argued that a diagnosis dehumanizes a person experiencing spontaneous alterations of consciousness, insidiously creating an iatrogenic disease by pressuring vulnerable psychiatric patients to conform to expectations that they assume a deviant role. A third and more synoptic line of reasoning is that orthodox diagnostic categories are simply not broad enough to encompass the astonishing range of experiences inherent within the full human potential, which includes mystical and transcendent states of consciousness. This latter argument moves away from the firsttwo, which would simply eliminate the practice of classifying clusters of symptoms, but which also cut off the therapist from the hard-earned experience of others who have treated similar maladies. More practically, therapists who refuse to diagnose their patients/clients remain hopelessly isolated from parties who pay the bills of all but the wealthy. If transpersonal psychology is to remain relevant to the real world in which therapists earn their living by treating people who suffer from a wide range of afflictions-from the primitive to the exalted-it follows that we cannot abandon the venerated diagnostic process. A holistic transpersonal view instead recognizes that we need more diagnoses rather than fewer, that we must expand our categories to include impediments to spiritual growth from the rudimentary consciousness of early childhood, through ego-based stages, to phases in which an individual struggles to free himself from personal and social obstacles to spiritual advance. Two important transpersonal philosophers, Ken Wilber (1983) and Michael Washburn (1988) have written cogently about discrete stages or levels of personal and spiritual growth. Although they disagree about several important details, both hold that an individual must develop a healthy and strong ego before he can successfully transcend that ego, and that failure to do so results in a pathological state, often accompanied by great subjective distress. Both also agree that a well-prepared individual can progress to trans-egoic states that foreshadow ultimate reunion with the Absolute.

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