Overview
of Treatment
The Mystical, Near-Death, Meditation and Spiritual
Practice, Visionary and Shamanic types of spiritual
problems have been associated with crises ("spiritual
emergencies") where a person has difficulty
functioning. Each of these problems has a section
on Therapy
Mystical
experiences
Near-death
experiences
Meditation
and Spiritual Practice
Visionary
experiences
Shamanic
experiences
There are also a number of therapeutic strategies
that apply to all spiritual crises. Stanislav Grof,
MD, and Christina Grof, founders of the Spiritual
Emergence Network, describe a spiritually-sensitive
approach:
The most important task is to give people in crisis
a positive context for their experiences and sufficient
information about the process that they are going
through. It is essential that they move away from
the concept of disease and recognize the leading
nature of their crisis...
Whether attitudes and interactions in the narrow
circle of close relatives and friends are nourishing
and supportive or fearful, judgmental, and manipulative
makes a considerable difference in terms of the
course and outcome of the episode...
[Therapy] should not be limited to talking and
should allow full experience and direct release
of emotion. It is absolutely essential to respect
the healing wisdom of the transformative process,
to support its natural course, and to honor and
accept the entire spectrum of human experience
(Spiritual Emergency: When Personal Transformation Becomes a Crisis,
p. 195)
Interventions can range from support for a time-limited
crisis, with possible involvement of relatives, friends,
support groups, and medical persons, to intensive
long-term psychotherapy. Choice of specific interventions
depends on the intensity, duration, and type of spiritual
problem, and also on the individual and their support
network.
Therapeutic
Interventions for Acute Crises
Therapy with spiritual emergency patients in crisis ("spiritual emergency")
can include the following 9 interventions.
Normalize
People in the midst of intense spiritual experiences need a framework of
understanding that makes sense of them. Mental health theory has provided
little guidance in this area, and has often pathologized religious and
spiritual experiences. Often it is the lack of understanding, guidance
and support that allows such experiences to go out of control. Jung described
how providing a normalizing framework helped in the following case:
I vividly recall the case of a professor who had
a sudden vision and thought he was insane. He came
to see me in a state of complete panic. I simply
took a 400-year-old book from the shelf and showed
him an old woodcut depicting his very vision. "There's
no reason for you to believe that you're insane," I
said to him. "They knew about your vision
400 years ago." Whereupon he sat down entirely
deflated, but once more normal (Man
and His Symbols, p. 58).
In a similar way, Ram Dass, a spiritual teacher,
originally trained as a clinical psychologist, helped
a person in distress by framing his experience as
a kundalini reaction. He recounted a telephone call
from someone saying he thought he was going crazy.
After the caller described uncontrollable tearfulness
and so much energy he couldn't sleep, Ram Dass said,
Brant Cortright, PhD, describes the clinical value
of educating the patient and significant others:
Education about spiritual emergency serves two
primary functions. First, it gives the person a
cognitive grasp of the situation, a map of the
territory he or she is traversing. Having a sense
of the terrain and knowing others have traveled
these regions provides considerable relief in itself.
Second, it changes the person's relationship to
the experience. When the person (and those around
him or her) shifts into seeing what is occurring
as positive and helpful rather than bad and sick,
this changes the person's way of relating to the
experience. To know that this process is healing
and growthful permits the person to turn and face
the inner flow of experiences, to welcome them
rather than turning away or trying to suppress
them (Psychotherapy
and Spirit, p. 173)
The term spiritual emergency is one that
describes and normalizes such crises. It provides
a nonpathological understanding and is a gateway
for patients, family and friends to the rapidly developing
literature on these types of problems.
Ed Podvoll, MD, a psychiatrist who has used Buddhist
approaches including compassion and mindfulness training
with patients, points out that this is not an easy
process:
The difficult task becomes the need to shift one's
view from seeing the experience as a totally destructive
cataclysm to being able to see and appreciate the
constructive attempt at self-transcendence, to
see that its conscious goal is not a relinquishing
of life but an attempt at renewal. The
Seduction of Madness, p. 587).
Usually, the patient's family and friends play a
critical role in implementing and maintaining the
spiritual and grounding interventions described below.
Therefore, they also need to be educated about the
potential for positive transformation and how to
support a person in spiritual crisis.
Create
a therapeutic container
John Perry, MD, who founded Diabysis, a residential treatment center for working
with people in visionary psychotic states, emphasized that when a person's
psyche in energized and activated, what he or she needs is contact with a person
who empathizes, who actively encourages the process, who provides a loving
appreciation of the qualities emerging through the process, and who facilities
the process rather than attempting to halt or interfere with it. Brant Cortright, PhD
highlights the qualities required of the therapist:
In spiritual emergency, the personal presence
of the therapist is key. Although some people are
able to sail these waters successfully by themselves,
for many people the presence of one or more wise
compassionate guides on this journey can be of
enormous help...Warmth and compassion combined
with a degree of softness and gentleness are essential,
for hardness, coldness, or insensitivity can be
highly jarring to the delicate and refined perceptions
of a person undergoing these consciousness changes.
Additionally, a certain calmness and quiet confidence
serves to energetically reassure and soothe the
apprehension and alarm that are frequently present
(Psychotherapy
and Spirit, p. 174).
Help
patient to reduce environmental and interpersonal
stimulation
The person undergoing a spiritual emergency needs to be shielded from the psychic
stimulation of the everyday world, which is usually experienced as painful
and interfering with the inner process. The therapist needs to work with the
patient to determine the specific people and situations that exacerbate the
dysfunctional aspects of the spiritual emergency.
Have
patient temporarily discontinue spiritual practices
Meditation has triggered many reported spiritual emergencies. Meditation teachers
who hold intensive retreats are familiar with this form, and have developed
strategies for managing such occurrences (case
example). Yoga, Qi gong, and other spiritual practices can also be triggers.
Usually teachers advise ceasing the practice temporarily. It can be reintroduced
as the person becomes more stable.
Use the therapy
session to help ground the patient
Therapy sessions can be used in various ways depending on the phase of spiritual
emergency, and its specific features. In the case vignette below, Stuart
Sovatsky, PhD, Clinical Director of the Kundalini Clinic, gives an example
from his psychotherapy practice of grounding a patient in a spiritual emergency
into the present during the therapy session:
Client: I'm, overwhelmed, (crying, sobbing) with
this kundalini, I can't take it anymore, I don't
know what to do.
Therapist: (Talking right over the client, simultaneously). You have an amazingly
musical voice, I hear it as you are sobbing.
Client: I have been a singer, I want to be one."
Therapist: Then that will be a big part of our goal. That goal will channel
a lot of this energy into a creative outlet, the vishuddha chakra, the throat
wants to sing, you want to sing.
The client listened for half of what I said, then eyes went down and sobbing
returned.
Therapist: Please, look back at me, you slipped back out of rapport with
me and into your cycling thoughts of despair. Look. See, I am actually admiring
you, which I do. I admire how courageous you are, coming to a stranger out
of the hope that he could help. I admire your ability to trust, yes, yes,
NOW you are growing in your trust of me, I see it in your eyes as you look
(Client smiles).
This is our cooperative relationship....This "looking" is
the beginning of open-eyed meditation that grounds
the client in time/space, so she won't drift back
into her mind-chatter of despair.
Suggest
the patient eat a diet of "heavy" foods
and avoid fasting
Grains (especially whole grains), beans, dairy products, and meat are considered
grounding ("heavy") foods as opposed to fruit and fruit juices, salads.
Sugar and stimulants like caffeine are also not advised.
Encourage the
patient to become involved in simple, grounding,
calming activities
Gardening is one such activity, or any simple tasks, such as knitting, housecleaning,
shoveling, sorting. Encourage the patient to participate in regular exercises.
Walks are probably the best way to help a person bring their consciousness
back into their body. Walks in nature have the added benefit of enhancing tranquility
and a calm mind. If the patient is a regular participant in other activities
such as swimming or biking, they could engage in that. However, competitive
sports would be too stimulating.
Encourage the patient
to draw, paint, mold clay, make music, journal,
write poetry, dance, both in the sessions and at
home.
These creative arts can help a person express and work through their inner
experience. The language of symbol and metaphor can help integrate what can
never be fully verbalized.
Evaluate
for medication
Some practitioners, such as John Perry, MD, have argued that medication only
inhibits a person's ability to concentrate on the inner work and it mutes the
psychic energy needed to sustain the effort to move the process forward. When
medication is used to simply repress the inner process, it becomes frozen in
an unfinished state. Suppression can impede the potential for a complete working
through to a point of resolution.
Sometimes the process is so intense that the person
is overwhelmed and becomes very anxious. That person
could benefit from slowing down the process. Bruce
Victor, MD, a psychiatrist and psychopharmacologist,
uses low doses of tranquilizing or antipsychotic
medication to alleviate some of the most distressing
feelings and allow the person to better assimilate
the experience.
The resolution of this seeming contradiction lies
in the assessment of whether the presence of the
debilitating state serves the function of psychological
growth. Although the experience of pain, whether
psychological or physical, can be a powerful motivator
for personal change, its persistence beyond a certain
point can retard it...
It becomes a challenge to determine whether the
person can actively work with the pain therapeutically
toward further psychological growth...One important
role of pharmacotherapy is to titrate the level
of symptoms, whether they be pain, depression,
anxiety, or psychotic states, so that they can
be integrated by the person in the service of growth.
(Textbook
of Transpersonal Psychiatry and Psychology,
p. 332)
Some psychiatrists with a sensitivity to the spiritual
emergency process have discussed their methods at
conferences. Their approach is to prescribe dosages
of medication that dampen down the inner process
so the patient can continue work on an outpatient
basis instead of an inpatient basis (e.g., Robert
Turner, MD). Medication practices have already been
influenced by new understandings of spiritual emergencies.
For example, Bruce
Greyson, MD reports that persons in intensive
care units (ICU) who report out-of-body experiences
and encounters with angels are no longer seen as
having "ICU psychoses" requiring treatment
with antipsychotic medication.
The major criterion I use in deciding whether to
make a referral for medication evaluation is whether
the person is in a situation which can support his/her
involvement in intensive inner process. A person
living in a communal setting, such as a spiritual
retreat center, can go much deeper while being cared
for physically and supported in working through the
crisis. I observed this at The Ojai Foundation, a
retreat center, when a person went into a spiritual
emergency that required round-the-clock attention.
The community provided full-time support for 2 weeks
until she could maintain on her own.
However, people living in less supportive environments
often do need to maintain themselves at a higher
level of functioning. Otherwise, they risk hospitalization,
loss of their livelihood, living situation, and other
essentials. I have referred such individuals for
medication if I assessed that they were a risk to
themselves in this way. I would always refer for
a medication evaluation if I thought a patient might
be a risk to others, but this is rare in a spiritual
emergency. However, spiritual emergency patients
can engage in risky behaviors such as driving recklessly,
which does endanger others. Therefore, a risk assessment
is part of an assessment for medication and must
take into account the spiritual emergency patient's
support system. Of course, any use of medication
should be with the full understanding and consent
of the person, who should be an active participant
in the decision-making.
Case
Example
Emma
Bragdon describes her personal crisis which involved questioning
of spiritual values.
Separating
From a Spiritual Teacher can lead to a loss
of spiritual connection as the individual questions,
and then severs, the social support for that belief
system and set of practices.
 REQUIRED
QUIZ ITEM 29
Meditation
Meditation is always a helpful intervention
for spiritual crises.
True
False
Record your answer for later insertion
into the Quiz. |
REQUIRED
QUIZ ITEM 30
Medication
Medication is always contraindicated
in spiritual crises.
True
False
Record your answer for later insertion
into the Quiz. |
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