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DSM-IV Religious and Spiritual Problems

LESSON 3.5 Meditation and Spiritual Practices
Table of Contents

Description Associated Clinical problemsTreatmentCase ExamplesWWW Library

Problems Related to Spiritual Practices
In the DSM-IV, spiritual problems are defined as distressing experiences that involve a person's relationship with a transcendent being or force, but are not necessarily related to an organized church or religious institution. Sometimes such experiences result from intensive involvement with spiritual practices such as yoga. The impetus for proposing this new diagnostic category came from transpersonal clinicians whose initial focus was on crises triggered by meditation and other spiritual practices.

The connection between spiritual practices and psychological problems was first noted by Assagioli [1] who described how persons may become inflated and grandiose as a result of intense spiritual experiences:

Instances of such confusion are not uncommon among people who become dazzled by contact with truths too great or energies too powerful for their mental capacities to grasp and their personality to assimilate (p. 36).

Beginning in the 1960s, interest in Asian spiritual practices such as meditation, yoga, and tai chi, and experimentation with psychedelic drugs led to an increase in the number of people experiencing related spiritual problems and crises.

    When novices who don't have the proper education or guidance begin to naively and carelessly engage mystical experiences, they are playing with fire. Danger exists on the physical and psychological levels, as well as on the level of one's continued spiritual development. Whereas spiritual masters have been warning their disciples for thousands of years about the dangers of playing with mystical states, the contemporary spiritual scene is like a candy store where any casual spiritual "tourist" can sample the "goodies" that promise a variety of mystical highs. (Halfway Up the Mountain: The Error of Premature Claims to Enlightenment by Mariana Caplan)

Stuart Sovatsky, PhD, Director of the Kundalini Clinic, notes that difficulties can accompany valid spiritual experiences: "That some problems arise as a result of the most auspicious of spiritual experiences, long documented in diverse religions, must, in such cases, also be considered. (Word from the Soul: Time, East/West Spirituality, and Psychotherapeutic Narrative)

Stanislav and Christina Grof coined the term "spiritual emergency" and founded the Spiritual Emergency Network in 1980 to identify individuals experiencing psychological difficulties associated with spiritual practices and spontaneous spiritual experiences. SEN also makes referrals to therapists for such problems.

    There exist spontaneous non-ordinary states that would in the west be seen and treated as psychosis, treated mostly by suppressive medication. But if we use the observations from the study of non-ordinary states, and also from other spiritual traditions, they should really be treated as crises of transformation, or crises of spiritual opening. Something that should really be supported rather than suppressed. If properly understood and properly supported, they are actually conducive to healing and transformation. (Interview with Stanislav Grof)
Meditation-Related Problems

Intensive meditation practices can involve spending many hours each day in meditation for weeks or months meditating. Asian traditions recognize a number of pitfalls associated with intensive meditation practice, such as altered perceptions that can be frightening, and "false enlightenment," associated with delightful or terrifying visions. Epstein (1990)[2] describes a "specific mental disorder that the Tibetans call 'sokrlung':

a disorder of the 'life-bearing wind that supports the mind' that can arise as a consequence...of strain[ing] too tightly in an obsessive way to achieve moment-to-moment awareness. (p. 27)

When Asian meditative practices are transplanted into Western contexts, the same problems can occur. Anxiety, dissociation, depersonalization, altered perceptions, agitation, and muscular tension have been observed in western meditation practitioners (Walsh R, Roche L. Precipitation of acute psychotic episodes by intensive meditation in individuals with a history of schizophrenia).. Yet Walsh and Roche point out that "such changes are not necessarily pathologic and may reflect in part a heightened sensitivity" (p. 1086). The DSM-IV emphasizes the need to distinguish between psychopathology and meditation-related experiences:

Voluntarily induced experiences of depersonalization or derealization form part of meditative and trance practices that are prevalent in many religions and cultures and should not be confused with Depersonalization Disorder. (p. 488)


Intensive meditation practices can lead to

a) feelings of depersonalization
b) anxiety
c) disorientation
d) all of the above

Record your answers for later insertion into the Quiz.

Yoga and Kundalini
In the Hindu tradition, kundalini is spiritual energy presumed to reside at the base of the spine. When it is awakened by practices such as yoga, it rises like a serpent up the spine, and opens the chakras' psychic centers situated along the spine from the tailbone to the top of the head.

As each chakra opens, new levels of consciousness are revealed. Since the consciousness of most people is fairly restricted, the opening of the chakras is accompanied by consciousness expansion and purification of the limitations or impurities that correspond to each chakra.
(Brant Cortright, PhD, Psychotherapy and Spirit, p. 161)

As kundalini rises, it is associated with physical symptoms including:

sensations of heat
involuntary laughing or crying
talking in tongues
nausea, diarrhea or constipation
rigidity or limpness
animal-like movements and sounds

Kundalini arousal most commonly occurs as an unintentional side-effect of yoga, meditation, qi gong. or other intensive spiritual practices. Some theorists consider psychotherapy, giving birth, unrequited love, celibacy, deep sorrow, high fever, and drug intoxication to be triggers. Some believe kundalini awakening can occur spontaneously without apparent cause.

Bonnie Greenwell, Ph.D., is a transpersonal therapist whose work focuses on kundalini awakening problems. I concur with her view that the term kundalini is most applicable to problems specifically associated with spiritual practices. When Dr. Greenwell was queried about a case which included symptoms such as shaking at night, which can occur in kundalini awakening, she responded,

If the person had presented me with a description of an awakening experience, if he did exercises such as meditation, yoga, or a martial art regularly, or if he experienced strong meditative states where he went beyond concentration into stillness or a sense of unity, then I would be more likely to consider it Kundalini. Kundalini Quest

Associated Clinical Problems
Derealization and depersonalization have been reported with intensive meditation. Usually the symptoms cease if the practice is discontinued, as in the case example in the Treatment section below. Meditation has been reported to trigger psychotic episodes in schizophrenic patients with active psychotic symptoms.

Walsh R, Roche L. Precipitation of acute psychotic episodes by intensive meditation in individuals with a history of schizophrenia. Am J Psychiatry. 1979 Aug;136(8):1085-6

However this course author developed a multimodal holistic health program for schizophrenic patients at a state psychiatric hospital which incorporated meditation without any adverse effects, and also used meditation with patients at the San Francisco VA for 14 years.

Lukoff D, Wallace CJ, Liberman RP, Burke K. A holistic program for chronic schizophrenic patients. Schizophr Bull. 1986;12(2):274-82.

Kundalini awakening can resemble many disorders, medical as well as psychiatric. The symptoms can mimic conversion disorder, epilepsy, lower back problems, multiple sclerosis, heart attack or pelvic inflammatory syndrome. The emotional reaction to the awakening of kundalini can be confused with disorders involving anxiety, depression, aggression, and organic syndromes.

Bonnie Greenwell, Ph.D. did her dissertation study on individuals who had a kundalini awakening. She summarizes the clinical issues that she observed in her book, Energies of Transformation: A Guide to the Kundalini Process. She describes a number of key features of kundalini awakening which were experienced by people in her study:

Pranic movements or kriyas
Prana is the Hindu word for vital energy. As intense energy moves through the body and clears out physiological blocks, some people experience intense involuntary, jerking movements of the body, including shaking, vibrations, spasm and contraction.

Yogic Phenomena
Some people find themselves performing yogic postures or hand mudra gestures which they have never learned or could not do in a normal state of consciousness. Unusual breathing patterns may appear with either very rapid or slow, shallow breathing.

Physiological Symptoms
Kundalini awakening often generates unusual physiological activity which can present as heart, spinal, gastrointestinal, or neurological problems. Internal sensations of burning, hypersensitivity to sensory input, hyperactivity or lethargy, great variations in sexual desire, and even spontaneous orgasm have been reported.

Psychological Upheaval
Emotions can swing from feelings of anxiety, guilt, and depression (with bouts of uncontrollable weeping) to compassion, love, and joy.

Extrasensory Experiences
Some people experience visions of lights, symbols, spiritual entities. Auditory sensations may include hearing voices, music, inner sounds or mantras. There may also be disruption of the proprioceptive system, with loss of a sense of self as a body, or an out of the body experience.

Psychic Phenomena
A person may experience precognition, telepathy, psychokinesis, awareness of auras and healing abilities.

Mystical States of Consciousness
A person may shift into altered states of consciousness where they directly perceive the unity underlying the world of separation and experience a deep peace and serenity. (see Karin Hannigan, PhD for additional description)

The sudden onset of these experiences led many in Greenwell's study to become confused and disoriented. Kundalini awakening is probably the most common type of spiritual emergency. The Spiritual Emergence Network Newsletter reported that 24% of their hotline calls concerned kundalini awakening experiences. [3]

The DSM-IV, in Appendix I: Culture Bound Syndromes, includes "qi-gong psychotic reaction," which is similar to kundalini awakening. (Qi-gong or chi kung is an ancient Chinese moving meditation practice).

Unlike those suffering from psychosis, individuals experiencing kundalini,

typically much more objective about their condition
communicate and cooperate well
show interest in sharing their experiences with open-minded people
seldom act out
(Stanislav and Christina Grof, Spiritual Emergency: When Personal Transformation Becomes a Crisis)

Lee Sannella, MD's book Kundalini: Psychosis or Transcendence (Copyright © 1976) is online for free downloading.

Treatment involves discontinuation of the spiritual practice, at least temporarily, and engaging in alternative "grounding" activities. Kornfield (1993), a psychologist and experienced meditation teacher, described what he termed a spiritual emergency that took place at an intensive meditation retreat he was leading.

An "overzealous young karate student" decided to meditate and not move for a full day and night. When he got up, he was filled with explosive energy. He strode into the middle of the dining hall filled with 100 silent retreatants and began to yell and practice his karate maneuvers at triple speed. Then he screamed, "When I look at each of you, I see behind you a whole trail of bodies showing your past lives." As an experienced meditation teacher, Kornfield recognized that the symptoms were related to the meditation practice rather than signs of a manic episode (for which they also meet all the diagnostic criteria except duration). The meditation community handled the situation by stopping his meditation practice and starting him jogging, ten miles in the morning and afternoon. His diet was changed to include red meat, which is thought to have a grounding effect. They got him to take frequent hot baths and showers, and to dig in the garden. One person was with him all the time. After three days, he was able to sleep again and was allowed to started meditating again, slowly and carefully.
(adapted from   A Path With Heart : A Guide Through the Perils and Promises of Spiritual Life by Jack Kornfield pp. 131-132)

While in some cases, the psychological upheaval is so acute that it resembles a psychotic episodes, medication can further complicate the process (see medication). Dr. Greenwell suggests that it would be therapeutic for the individual to study some of the Eastern theories and descriptions of kundalini. Her other recommendations follow the basic treatment guidelines for all spiritual emergence processes (see Lesson 6.1 Spiritual Crises),

Look for ways to discharge this energy by running, exercising, gardening, or working with something solid, like wood or clay. I would suggest doing a regular meditation practice, and letting the process develop and teach him. . .The best support is a balanced lifestyle and a commitment to live one's life in alignment with the vision it brings — that is, if you have a heart-opening or a visionary experience, instead of being attached to holding onto it, ask yourself what you can bring into the world as service to it. . .Think of it as if the amps have been raised in your electrical system. This is why balance, taking care of ourselves, being in nature, and regular physical exercise all help. We may have to change old patterns to meet the invitation to a new kind of energy flow and engagement with spirit in our lives. (Nighttime Shakes)

She also suggests creative activities such as art, music, or writing for expressing it.

Since this type of spiritual problem is related to a type of practice, consultation with a teacher of the practice who also has mental health training would be advisable. Dr. Greenwall indicates that learning some basic yogic breathing practices, under the supervision of a knowledgeable yoga teacher, can help guide this energy.


A person experiencing symptoms related to a spiritual practice should be told to continue their practice until the symptoms subside.


Record your answers for later insertion into the Quiz.

Case Examples

Overzealous Meditator
by Jack Kornfield,PhD

WWW LIBRARY on Religion and Spirituality
The WWW LIBRARY on Religion and Spirituality contains articles on meditation and kundalini and guides to online resources on meditation..

Meditation in Mental Health -an Spiritual Competency Resource Center course which goes into more depth about the effects of meditation and its clinical applications.

1 Assagioli, R. (1989). Self-realization and psychological disturbances. In S. Grof & C. Grof (Eds.), Spiritual emergency: When personal transformation becomes a crisis, Los Angeles: Tarcher.
2 Epstein, S. (1979). Natural healing processes of the mind: I. Acute schizophrenic disorganization. Schizophrenia Bulletin, 5(2), 313-321.
3 Lukoff, D. The SEN Hotline: Results from a telephone survey. SEN Newsletter, March 1988.




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