DSM-IV Religious and Spiritual Problems

'Scuse Me While I Kiss the Sky by Russell Shorto, author of Saints and Madmen: Psychiatry Opens Its Doors to Religion. Reprinted from the August 1999 issue of GQ Magazine with permission of the author.

The first thing to note is something the doctors and textbooks don't exactly broadcast: it feels very, very good. He hikes through redwood forests and strolls Pacific beaches, feeling clean and powerful, positively brimming with health. He is never tired, always alert. He enjoys exquisite physical pleasure without resorting to sex: the air touching his skin is an outright joy.

Second, it sharpens your vision. He sees things he never saw before; he makes connections. They come upon him over time, each with a peal of discovery and the force of inevitability. Head bent, he follows a crack in the sidewalk, and as it branches and extends outward and onward and at the same time doubles back on itself it speaks to him, quite clearly; it makes a statement about extending outward in life while also looking inside oneself in deeper ways. He thinks of his family: branching back into the past and sending tentacles out into the future; he one of its conduits, the now of its totality. Nature branches like this; so does society. Sidewalk cracks, leaf veins, the ever-reblending spread of clouds in the sky. Chaos theory. Complexity. Oneness. He is on the verge of a great understanding Û of a transformation.

Third: it revises your idea of who you are. One evening, at a party, he overhears someone making a reference to Jah Rastafari, the God of the Rastafarians, and suddenly he realizes it is a reference to him. The people at the party know something about him; they see it. Time goes by, and this initial hint of his own specialness blossoms. His sense of power increases. He notices that when he is in a good mood the sun comes out, and when his mood sours the weather does as well. A thought suddenly strikes him: "Am I the Sun God, Ra?"

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He was not always a god.

It came on him in New York City. It was the summer of 1996, and Wayneua , diligent undergraduate at the University of California at Santa Cruz, traveled to Manhattan to do a summer internship at Citicorp. Up to then Wayne had been a perfectly normal twenty year old. He'd grown up in Honolulu, bodyboarding, playing tennis, doing ceramics, getting solid grades in school. His family was ambitious and moderately well-to-do; his father is a successful management consultant, his uncle, Larry , is an ESPN sportscaster. Wayne attended the Iolani School, considered one of the most exclusive and rigorous prep schools in the nation. He was a member of UCSC's Division III national championship tennis team. He excelled academically.

The banking internship was his father's idea. On arriving in New York, however, beach dude Wayne came over all dazed and confused. He missed his girlfriend. He could give a fuck about banking. He goofed off on the job, was reprimanded and reassigned. He felt stressed, out of place, cut off from his world. The Diagnostic and Statistical Manual of Mental Disorders (DSM), the bible of the psychiatric profession, which defines billable ailments, notes that psychotic episodes are often ignited by an increase in stress, and that the typical age of onset is adolescence or early adulthood. When Wayne quit his job two weeks before it was to end, leaving him with unstructured days in a landscape of dizzying freedom, he untied the last rope holding him to the ground. One push, and he would take to the air.

He wandered alone in Manhattan for a few days, enjoying the lightheaded feeling. One night he found himself in a nightclub called Wetlands. There, in a subterranean room, he encountered a drumming circle: a couple dozen strangers banging on tribal-looking objects, being cool, reaching for something. Wayne picked up a drum and joined in, and within a few minutes he shot past them all Û he entered what he describes as a "mystical trance," a feeling that the rhythm being pounded out by all of these people was emanating from him, that he was its source.

By the time he got back to his apartment he was convinced that he was undergoing a spiritual awakening. He sat down and tried to "make something happen." It proved easy to do. As he watched, the walls around him began to wave, picture frames shimmied. He believed he could see the individual molecules in objects. He extended his arms out to the sides and watched particles of light shoot through his body.
A fruit had sprung into existence inside his being: rare, sweet, ripening fast.

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Lunatic. Insane. Demented. What happened in the downtown club was simple: Wayne began losing his mind. Wayne will grant you that Û he'll insist on it. That's the easy part. But he'll also insist that while he was in that mad, mad world he was in another place as well: the place of the mystic, the zone of spiritual transcendence. He was where St. Paul was when he had his vision on the Road to Damascus, where the Buddha was when, sitting cross-legged under a tree, things clicked in the most profound way.

There is nothing special about such a claim on its own: lots of madmen have believed themselves to be divine. But Wayne himself isn't the entire point. What makes his situation remarkable is that more and more these days, psychiatry Û the profession that used to marched in lock step under Freud's pro-science/anti-religion banner Û is beginning to agree with Wayne. Psychiatrists and psychologists around the country, at major universities and hospitals, are studying religious experience as a natural, complex human phenomenon, and many of these professionals, noting the seeming similarities between religious ecstasy and psychosis, have concluded that psychosis and mysticism are closely related conditions, maybe so close that the differences lie only in the way society judges them.

David Lukoff, PhD, a professor of psychology at the Saybrook Graduate School and Research Institute in San Francisco, is one of the leaders of this movement. In 1994, he and two of his colleagues steered it straight into the mainstream of the profession when they succeeded in getting a new diagnostic category, "the religious or spiritual problem," added to the DSM. That accomplishment makes this new psycho-mystical perspective at least technically billable to insurance companies, but even more it indicates the willingness of psychiatry to extend beyond its longstanding boundaries and venture into the no-man's-land of religion.

To Lukoff, however, what matters most is that it helps patients: "This perspective is important because people with psychosis often get trapped into the career mental patient role. The system tells them they're sick, and so they are. But what we're doing shows them that they can not only bounce back but can actually be strengthened by the experience. The psychosis can be a transformative experience."
This seemingly counterintuitive movement has some of the hallmarks of a revolution. It doesn't result from some new drug or piece of equipment but from a change of perspective. Its scope is about as vast as you can get because it explodes the very definition of the human being that the mental health field has long worked with. It may eventually constitute the most thoroughgoing overhaul of the psychotherapeutic profession since Freud set about convincing European gentlefolk that little girls wanted to be ravished by their fathers and little boys had a secret lust for the dark mystery between mommy's thighs.

As it happened, David Lukoff came to play a crucial role in Wayne 's recovery. To Lukoff Wayne's voyage through the country of the madexquisitely illustrates the radical idea that he and his colleagues promote: that there are things we can learn from psychotics; that, in some mysterious, subterranean way, the psychotic might be clearer, truer, saner than the rest of us.

The only glitch being, of course, that he is also completely off his nut.

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By the time Wayne got back to Santa Cruz from New York, ready to begin his junior year of college, his condition had advanced. Inside him, the fruit had ripened. For one thing, he could now see auras. Most people had thin haloes of light emanating from their head and shoulders. A few, however, such as a professor in an environmental studies class, exhibited blinding cascades, eruptions of color that blasted from the top of their head straight into the sky.

The word angel, he says, is poor, trivialized, inadequate, but he uses it as a shorthand: at least people have an idea of what it means. He discovered that the universe was bifurcated into dark and light, good and evil; these people with the expansive auras were creatures of light.
But with this realization came responsibility. A constant cosmic struggle was taking place, and he had a duty to align himself Û but with which side? The light beckoned, but it occurred to him that perhaps it is the balance that matters; tip it too far in favor of one side and the universe goes careering into chaos. Hosts of angels, arrayed on either side of the cosmic divide, were watching him, sirening him, waiting for the action that would tip the scales their way. Anything might be a signal of his intentions: which shoe to put on first, what color shirt to wear. He became rigid with fear of making the wrong move. It now took him hours to dress in the morning.

He knew that Hebrew was a holy language, and that it is read backwards from English. It made perfect sense therefore that he should begin to read English backwards (and, for good measure, upside down). In this way he found secret messages in newspaper articles, textbooks, his own lecture notes. His consciousness would vanish for hours at a time while he sat with a notebook transforming a passage about welfare reform into cosmic runes. His course work fell off fairly dramatically.

Six or seven weeks into the madness, he stopped bathing and changing clothes. He rarely slept. Such things no longer seemed important. He scared dorm mates with ravings about angels who hold humans in psychic manacles. Friends backed off, wondered what they should do.
Finally, all of his energy became focused on a wrestling match taking place in some transcendental arena. On one team were himself, his father and his uncle. On the other side were the forces of darkness and chaos. The contest was a tag team event; when he was in the ring, his body literally flung itself on the ground and wrestled.

After three or four days in which he did not sleep but stayed tuned into the exhausting struggle, and at the end of which he "finally accepted the fact that I was also Christ," he heard a knock on the door of his dorm room, opened the door and saw a police officer. Apparently at least part of the wrestling match had taken place in public.

He was arrested pursuant to California Code 5150, being a danger to oneself, and taken away in handcuffs and ankle restraints. He struggled with the police, trying to bend his arms and legs, still doing his part in the wrestling match. He did not feel it necessary to speak, however, since "anyone of importance could read my mind."

He had reached a lofty summit: stark raving madness. In the emergency room of Dominican Santa Cruz Hospital, the attending physician noted: "Patient does not respond appropriately to questions Û howls."

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"We are going to give you a little test. It's very simple. It's called 'Draw a Person.' I'm going to give you a sheet of paper and a pen, and ask you to draw a figure of a person. Can you do that?"

Chuckling inwardly, he swiftly supplies what they ask for: a perfect outline of a human figure. But the divine flame roaring inside him is not so easily stifled. He grabs another sheet of paper and swiftly creates a series of interlocking infinity symbols that link into a madcap figure, an infinity cartoon. He gazes upon his testers, his inquisitors; he is a Zen master, imperious before initiates. "This is what you want me to draw," he says, handing them the first drawing. Then he brandishes the second. "But this is what it is."

He is transferred to a psychiatric hospital, given a preliminary diagnosis of schizoaffective disorder. A course of psychiatric medication is begun. School, career, future, sanity: all are gone, sacrificed to the godhead. It is, he thinks with satisfaction as they lock the door on him, remarkably like the sacrifice that Jesus made.

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Seeing visions, hearing voices, torturing yourself for the sake of the divine: it's as old as the saints. Name a religion and with little effort you can tease out from its history a long train of twisted, blissed-out figures who are not only tolerated but venerated. A medieval hermit named Peter of Alcantara mortified his flesh by allowing himself only an hour and a half of sleep per night for forty years Û and was made a saint for his trouble. The Jesuit saint Aloysius of Gonzaga would not smell a flower or be in the same room with a female lest he derive an instant of pleasure from the encounter and thus gratify Satan. For good measure, he surrounded himself with rancid odors. This supremely distorted individual became the object of a cult of veneration in the church: a role model for youth.

Or consider the Hasidim, the mystical sect of Judaism. "If you look at the personalities of many of the Hasidic teachers, you see people who were basically incoherent much of the time," says Dr. Tony Stern, a psychiatrist in Westchester County, New York, who, like David Lukoff, believes that psychosis and mysticism are overlapping states. "You could certainly say these people were transiently psychotic. If you look at the great mystics of any religion, I can't think of one who has not clearly shown signs of what today would be severe psychosis or profound manic-depressive illness." Shrinks like Lukoff and Stern aren't in the business of pathologizing saints or sanctifying madmen. All insist that they do not confuse the job of psychiatrist with that of priest or rabbi. They might, however, work with a patient's religious leader; they might suggest meditation as a way to help someone deal with the throbbing hallucinations of psychosis. They do psychotherapy in a broader way: patients can range beyond the what-my-parents-did-to-me zone and into wilder, woolier terrain of voices and visions. At bottom, they are introducing a note of humility into a profession that once thought it had all the answers. "I think psychology has always had this pretense that it is a science," said Lukoff. "It has this allegiance to the laboratory ideals of the natural sciences. The problem is these issues don't fit in a test tube."

Lukoff has the best of credentials for helping psychotic sufferers deal with what happens to them. Twenty-eight years ago, he embarked on a mad voyage of his own. It was 1971, he had just dropped out of an anthropology graduate program at Harvard and set off across the country to catch the remaining waves of the Sixties. Along the way he met some wild people, did LSD, listened to a lot of Grateful Dead and Janis Joplin, and felt his personality morphing. He made it to California just as the crisis came. One night he woke up in a Palo Alto apartment, looked in the bathroom mirror and saw that, in his reflection, the thumb and forefinger of the right hand were touching in "the ancient mudra position of the meditating Buddha." At once he realized that he was "the reincarnation of both Buddha and Christ."

As he descended into madness he became convinced that he was divine and charged with a mission to save the planet by means of a holy book that he was writing. He eventually recovered, and later went on to a career in psychology. He hooked into a body of literature Û extending back to William James, the father of American psychology Û that explores the links between psychosis and mysticism. He has devoted his career to spelunking in this subterranean region, despite the fact that such a focus was out of sync with the prevailing biomedical emphasis.
"I think most therapists give off the message that this is not something we talk about," Lukoff says. "We don't talk about thinking you're Jesus Christ. We talk about what you're going to do when you get discharged, where you're going to live. Well, I don't. I make a point of honoring that experience."

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In a perfect world, a professional like David would have been there waiting for Wayne when he was taken into custody. Instead, Wayne went on a fairly stereotypical trip through the psychiatric system. Naturally, his parents were devastated at the news that their son was in a mental hospital. "We were out having dinner, and we got this call," said his father, Drake . "We were stunned, like we were kicked in the stomach." Wayne's mother, Jude, immediately flew to Santa Cruz and found her son in a locked-down ward, looking and acting like a perfect madman. By this time Wayne was convinced that he was being held prisoner so that researchers could isolate and extract the secret of his supernatural abilities. "It was absolutely frightening to think that we had sent off into the world a gifted kid and what came back was a vegetable," said Drake . "We were overcome by guilt. Did we fail in preparing him to deal with the real world? And through it all was the thought that he might not come back, that this might last forever."
That fear was eventually put to rest. A sequence of hardcore psychiatric drugs Û Haldol, lithium, Risperdal Û created various short-term difficulties Û stiffening of the fingers, a general stupefaction, a near-constant need to sleep Û but also ended the neurochemical hailstorm. Three months after Wayne entered the mental health system he came out the other side: wobbly, weak, broken, but more or less recovered in his mental abilities. The breakthrough happened fairly suddenly. He was sitting with his father watching television; "Wheel of Fortune" came on. "All of a sudden Wayne started guessing the puzzle and goofing on the contestants," Drake said. "Then he turned to me and said, 'Wayne has entered the building.'" Shortly after, he was sent home with his parents, and set about rediscovering basic skills Û reading, writing, driving Û that had been burned out of working memory by the flame of madness.

What makes Wayne remarkable, emblematic, is not his psychosis or his recovery Û by one estimate, sixty percent of people who experience a schizophrenic breakdown recover from it. What distinguishes Wayne is what he did next. In a sense, he went back to the madness. Most psychiatrists will tell such patients to put the experience behind them, bury it and move on, and perhaps most patients are more than happy to leave it behind like the charred remains of a wrecked auto they have miraculously crawled out of alive. But Wayne couldn't forget: that joy, the way the air had tasted, the sense of the essential goodness and deep interconnectedness of things.

Eventually, after the madness had left him but while he was still in recovery, he found a shrink who agreed with him. He had been searching through the literature on the topic of psychosis and mysticism when he came across the name of David Lukoff. He wrote to Lukoff, and received a reply. A relationship formed. You may have been insane, Lukoff told him, but you weren't crazy. You were alive. Most of us subsist on mashed potatoes and gravy; for a brief time the universe's cafeteria screwed up and served you a diet of caviar. Don't forget that taste Û savor it.

Confirmation was what Lukoff provided, not therapy. He functioned not as a shrink but more like a Buddhist master, nudging the initiate toward the elusive nonrational goal. In addition to his teaching and his private practice, Lukoff works as staff psychologist at the San Francisco Veteran's Administration's day treatment program, which puts him in touch with a great many people who inhabit different regions of the vast and nebulous territory of insanity. But because Wayne's magical mystery tour was so similar to his own, Lukoff felt a particular affinity for him. He has taken Wayne on the road, giving a presentation on mysticism and psychosis to receptive psych grad students. The warm response their talk has received is indicative of how certain parts of the mental health field have caught up with Lukoff in recent years. Over the past decade, several studies Û of epileptics, of meditating Tibetan monks, of schizophrenics Û have focused on the neurochemistry of religious experience and/or psychosis, and point to a similar underlying mechanism. "It may well be that the underlying biological strata for psychosis and religious experience are the same," says Dr. Joseph Deltito, a lecturer in psychopharmacology at Harvard Medical School.

"That may be uncomfortable for some people, both in this profession and in religious professions, but there is some evidence to support it."
If that proves correct, then one could indeed say (as some people do) that the religion itself - belief in something invisible yet all-powerful - is a kind of madness. But the opposite would hold too: that some madmen are also custodians of the universe's deepest mysteries.

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Wayne is not alone. Mention to one or two such people that you are researching the subject and within a short time the word spreads Û the calls and emails start coming. People want to tell their stories: screwy stories, stories that you suspect never got spilled to the little man with the pointy beard while lyingon a naugahide couch.

Margaret lives outside Boston. She is 63, and worships Jesus Christ through mathematics. Her lifelong psychotic condition took a turn when a new antipsychotic drug suddenly worked where others had failed: the demon that controlled her mind vanished. Curiously, inexplicably to shrink or priest, in its place was left a thirst, a passion, an ecstatic longing for differential calculus.

Pam is a 23 year old who was sexually abused as an infant, in the midst of an intense evangelical upbringing, and grew into a young woman with strong Christian beliefs and full-blown gender identity disorder (she called herself Sam, wore jockey shorts and used a urinal). After several disastrous treatments, she fell in with a psychiatrist who has a graduate degree in New Testament studies. They both speak the same language: of psychotherapy and sin, of antipsychotic drugs and heavenly salvation. Under her new psychiatrist, Sam has become Pam again.

In 1994 Carl had what a psychiatrist considered a schizophrenic break but what he calls a kundalini awakening. Since then he has lived in his parents' basement, avoiding sunlight and M.D.'s and communing with something called the White Brotherhood, whom he says are healing him by means of flower essences.

This last case raises a crucial point. Just because someone says your psychosis has a mystical side to it doesn't mean you aren't still fucked up. It also doesn't mean that you aren't a danger to yourself, or prone to violence. Religious experience itself has a dark underside Û viz. the Crusades, or the Heavens Gate cult. There are surely legions of people out there who, like Wayne, believe they are undergoing a spiritual awakening but who are in hiding from the medical establishment, who live on the margins, who shun all professionals with "psych" in their titles the way convicts on the lam shun badges. Some of them are dangerous.
Most of these people, these new psychotics, however, are not so, shall we say, paranoid. They see a doc. They take some meds. They go along with the program Û up to a point. "Traditional psychiatrists aren't evil or anything, just, maybe, blind in one eye," says Wayne.

Wayne represents these people well. Unlike many, he has come through the other side. He remembers the acid-like washes of color and rushes of liquid joy, the instants of total lucidity, but he has passed out of the zone of terror and confusion, the not knowing if it would end. He can tell you plainly, lucidly, about the landscape that the saints trod, the purple visions that led Aldous Huxley to write Doors of Perception, which launched a generation of trippers.

The bottommost question, as yet unanswered, is whether there is any difference at all between a mystic who founds a religion and a raving psychotic locked in a padded room. One person who admits to having been the latter gave me a possible insight into the matter: control. The mystic has some ability to turn the transcendence machine in the mind on and off. For the psychotic, the switch is stuck in the on position. And that may explain the nightmarish aspect of the experience. Being trapped anywhere Û even heaven Û is one definition of hell.

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Grateful Dead posters, bunk beds, a stack of blocky textbooks threatening to collapse an Ikea table. I'm in an undergraduate dorm room, and one of its inmates, a long-haired dude with the kind of babysoft skin that is the envy of every Oil of Olay customer, is plugging the bowl of a cranberry-colored bong while carrying on a staccato conversation with his roommate. "...so awesome..." "...never leave..." "...I'd go back in a flash..." They each take a hit and then pass the plexi orb to me.

I ask where it is that they've just come back from. Both turn to me and cry in unison: "Phish in Vegas!" I grin to show that I can appreciate the ironic juxtaposition: a neo-hippie band performing in the capital of glitz-kitsch. Then I turn to Wayne , who's sitting next to me. We had talked a lot on the telephone but have only just met in person; despite the rational sound of his voice I had been expecting to find a face with a dangerous jiggle in the eyes, but there is no trace of lunacy. He's fit, sharp and awfully wise for a 23 year old. With a deep tan and well-etched pectorals, he's something of a magnet for beach babes, whether in Honolulu or Santa Cruz. He seems as in-control as anyone I know.

Just now, his eyes are scanning the room; he hasn't been paying attention to the scintillating conversation of his younger friends. His gaze settles on me. "This is it," he says reverently. "This is the place." Not this very room his room was down the hall but this dormitory, cinder-blocked and stuccoed, redolent of unwashed socks, nestled into the redwoods in the center of the U.C. Santa Cruz campus Û this was where his madness flowered, where his transcendence manifested itself. He has led me to his friends' room as a way to relive his own days here.
By now he has rejoined the human race in all the usual senses. He went back and finished school, got a job in software sales. But he still tends the little fire that ignited somewhere in his brain during that summer in Manhattan; he stokes it. He doesn't know what he's going to do with it Û become a monk? a psychologist? Û but he keeps it alive. He treats it the way you would treat an artifact of supreme importance the Mona Lisa, an original copy of the Constitution that had, through some accident, been left to your care.

Maybe what sets Wayne apart most clearly from your average post-psychotic is the longing. "There are times when I miss it," he admits. "Times when I want to be there again." His longing is infectious. I love travel, but I'll probably never go where he's been, and just now, despite the horrors he has recounted, I want to go. One of David Lukoff's favorite points about his profession is that where a lot of his colleagues would have you believe that mental health is a clearcut thing, in fact many of their diagnoses are a matter of perspective. If I asked whether you'd like to become psychotic you'd back away fast, but let Wayne recount his trip through the universe Û the doors of perception thrown open before you, power and health exploding inside you, polychromatic landscapes unfurling, 'scuse me while I kiss the sky and tell me you don't feel curious, envious even. Psychosis is a living nightmare, a loss of control of the most profound sort, and if somebody actually offered it to me I'd surely pass. But what David Lukoff wants you to know, what Wayne holds inside him, is that it has also truth to it. It's a real place. It's a kind of knowledge.

We've left his comrades to their bong and strolled outside into a clearing in the redwoods. It's late afternoon in the Santa Cruz mountains: a golden time in a soft, easy patch of the earth. Wayne stands on this grassy sward, looking down into a veritable bowl of nature: a green mesa in the center-distance, surrounded by erect, exuberant, life-proud trees, the sun irradiating everything tree trunks, rocks, seemingly the air itself with orange light. Clearly, he's seeing this vista with the eyes he once had for it: the eyes of madness.

Suddenly, on an impulse from deep within, he holds his arms out, as if to gather the whole business nature itself in his embrace. It's a slightly crazy gesture, but I check myself from using the word. I hold back and let him stand there. Like a god dethroned, remembering his kingdom.

Wayne's Experience
Wayne has written his own account of the experience, particularly his recovery.

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