DSM-IV Religious and Spiritual Problems

Case Example: John Perry, MD's Case from Diabysis

In Far Side of Madness, John Perry, MD described his treatment of a 19-year-old male who presented with a number of grandiose delusions including that he was an "ace airman" and a second George Washington leading the defense of the country against the Russian communists who were trying to capture the world. At other times, he was Emperor of the Germans, Prince Valiant, and Christ. Yet Perry viewed these grandiose delusions as part of a positively transformative process in which the psyche is engaged in a mythic process.

Are we to write off this ideation as just gibberish or just the distortions of the mundane world by a diseased mind? Is it merely an archaic mode of thinking, a so-called primary process gone berserk and of no use in the modern mind? It might seem so, at first glance, if it were not a close replica of the highest myth and ritual forms of the central religious practices of archaic times (p. 10).

Perry noted that the themes and motifs that emerged in the experiences of psychotic patients paralleled the ancient mythic dramas of sacral kingship in which the king is reborn at a New Year's festival.

In Perry's view, a psychosis can be a renewal process in which "components of the psychotic individual's make-up are undergoing change" (p. 133). A psychosis can serve,

as the psyche's own way of dissolving old states of being, and of creatively bringing to birth its new starts-its own way of forming visions of a renewed self and of a new design of life with revivified meanings in one's world (p. 11).

Perry formulated the presenting problem of this patient in terms of a severely damaged self-image that became "compensatorily aggrandized and exalted" (p. 131). Thus it is the prepsychotic psyche that is in need of help, and the journey into psychosis is an attempt to bring the conscious and unconscious into better balance. To achieve this, the psyche withdraws energy from relationships and invests it all in activating the inner world's central archetypes.

Even though a psychiatrist, Perry did not prescribe any antipsychotic medication to squelch the psychotic symptoms. Rather than suppress or ignore the expression of the patient's psychotic experiences Perry encouraged it since "therapy should follow the psyche's own spontaneous movements...you work with what the psyche presents" (p. 136). While the patient was in residential treatment at Diabysis, he met with Perry three times a week. In an early session, Perry had this patient draw, and a number of images of death emerged including being cremated, and being buried and clawing his way out of the grave.

I [Perry] interpret these images of death as signifying the dismantling of a certain psychological structure that the psyche finds no longer tenable or favorable to life and growth (p. 133).

Then the apotheosis into Prince Valiant involves one of the central mythic motifs which Perry terms "New Birth":

New Birth: A new birth takes place or is expected of a superhuman child or of oneself (ideas of rebirth; Divine Child, Infant Savior, Prince, or Reconciler of the division of the world). (p. 30)

As treatment focused on verbal and artistic expression of the mythic imagery proceeded, Perry observed a strengthened Eros principle evidenced by increased connection and affect during the therapy sessions "reach[ing] those affective potentialities thus far existing only in a state of dormancy" (p. 136). The whole psychotic renewal process took about 6 weeks, although some additional time was spent at the residential treatment center integrating the episode.

Today Diabysis, while no longer in existence, still serves as a model of residential treatment for individuals in the midst of a spiritual emergency who need a sanctuary to allow their inner process to unfold.

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