The enlarging domain of psychiatric intervention is frequently associated with the undue medicalization of unusual experiences. In such a climate, it becomes of utmost importance to carefully choose appropriate candidates for the psychiatric gaze. This suggests a need to draw a distinction between religious experiences (with psychotic form) and pathological psychotic experiences. As Jackson and Fulford (1997) maintain, “spiritual experiences, whether welcome or unwelcome, and whether or not they are psychotic in form, have nothing (directly) to do with medicine. It (...) would be quite wrong, then, to “treat” spiritual psychotic experiences with neuroleptic drugs, just as it is quite wrong to “treat” political .. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Philosophy, Psychiatry, & Psychology 9.4 (2002) 343-347 [Access article in PDF] Mysticism and Psychosis:Descriptions and Distinctions Michael McGhee IT IS REFRESHING to read a paper that manages at once to be interdisciplinary and intercultural in its range of reference, and that also confronts a difficult and controversial question about how we are to assess the similarities and differences between psychotic and mystical experiences. Many psychiatrists have been skeptical about (...) whether there are any genuine differences, and not, mostly, because they thought that psychotics were in reality mystics. But mystical is pretty vague, as is spiritual, and that does not bode well for the enterprise of making comparisons, unless we can tie these latter terms down with some precision. How vague psychosis is I must leave others to judge, but one of the conclusions I have drawn from reading this paper is that the crucial questions turn not on agreed definitions, but on agreed judgments about what are to count as the examples or cases that fall under the definitions. I have some doubts about Caroline Brett's approach to these questions, in the first half hesitant doubts, in the second part less so. Her leading claim appears first in the Introduction:... spiritual or mystical experiences are those states in which the form of experience is altered from normal consciousness, resulting in a new understanding of the basic nature of reality, life, and the individual. Psychotic experiences are those states that also flow from alterations of the form of experience, but result in a pathological interaction between the individual and the world. Therefore, according to these definitions, phenomena occurring in a spiritual context may be identical to those traditionally viewed as symptoms of psychosis, but cannot be seen as psychotic in themselves. (Brett 2002, 322) What I was struck by in reading this passage was not so much the claim that "phenomena occurring in a spiritual context may be identical to those traditionally viewed as symptoms of psychosis, but cannot be seen as psychotic in themselves." What struck me was its implication: that psychotic experiences cannot be seen as psychotic in themselves, either. In other words, the claim is that there is a neutral core of common experience shared by psychotic and mystic alike. I do not know how controversial this is in the psychiatric literature that deals with delusion and hallucination, but I should like to explore the claim a little in what follows. Brett expands on it near the end of her paper: The pathology that differentiates the psychotic from the benign mystical state lies not in the content of beliefs, or even in the broad form of experience, but in a few interrelated commonsense factors. It consists of an inability to return to the ontological framework of consensus reality; in psychological isolation, and inability [End Page 343] to accommodate to the subjectivity of others; in a focus of interest in the mental realm and loss of practical concerns that leads to paucity of action and neglect of self-care. (Brett 2002, 336) This pushes the pathology away from the experience that might have been thought to constitute the psychosis. I wonder whether there are problems with this. The fact, if it is one, that both mystic and psychotic alike undergo "an altered state" clearly does not imply that there is a (common) altered state that they both undergo, so what are the grounds for the claim that the core or central experience is the same? What kind of experiences are claimed to be common? How are we to conceive delusion on this scenario?What makes psychotic experiences psychotic on the present pushed back view seems to be that they "result in a pathological interaction between individual and world" (my italics), which thus exonerates the experience itself of pathology, pushing it back to one possible set of consequences for someone who reacts badly to the experiential phenomena (e.g., their inability to return from it). It seems to suggest that someone can be comfortable or well adapted to their voices and visions (and surely there are such people around, for whom the boundaries... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Commentary on “Spiritual Experience and Psychopathology”Roland Littlewood (bio)Keywordsreligion, innovation, psychosis, culture, diagnosisThis is an ambiguous though clinically valuable paper. Jackson and Fulford suggest that the distinction between their two categories, spiritual experience and mental illness, is conventional, yet their emphasis on issues of correct practice from the medical perspective threatens to return both into distinct ontological categories, albeit with a shared phenomenology. I do not understand why any single (...) instance must either be pathological or spiritual, except through clinical and clerical demands for clarity and order.Mental illness and spirituality are not two distinct natural phenomena “out there,” existing independently of human volition. They are both social—cultural if one prefers—ascriptions. Neither has some substantive core whose elucidation through psychophysiological, phenomenological or ultrahuman procedures could enable us to define its essence and thus differentiate it from the other. Neither experience is a self-evident datum. Both are easily susceptible to critiques, either that they do not exist as natural categories, or else that they should more properly be described as something else—as the workings out of social exclusion in the case of mental illness, as cosmological understanding or mass hysteria in the case of spirituality. Neither, I would suggest, can be specified by physiology or ultrahuman interventions respectively, but rather through shared cultural meanings which in turn are experientially validated by the biosocial phenomena themselves. It is not that we need to exclude the possibility of concurrences in brain states, but rather that these cannot specify the meaning and experience of the phenomena.Note that I emphasize “experienced through cultural meanings,” not “influenced by” culture: I do not accept that psychophysiology can have any existence independent of the social world through which it occurs. The psychiatrists’ form/content distinction, an optimistic proxy for nature/culture (Birnbaum 1923; Schneider 1928) may remain a convenient heuristic device, but it has a curious, perhaps doubtful, intellectual history (see the Endnote following).Cross-cultural comparisons argue that local idioms which we might approximate to current Western notions of mental illness and religion are quite varied. And the validity of particular instances of both “spiritual experience” and “psychopathology” may be contested in any society. While the social consequences of a pattern may determine the approbation accorded to a pattern such that patterns recalling chronic schizophrenia [End Page 67] are regarded as a deficit (and here I agree with James [1902] and the two authors), they are not necessarily aligned to categories of physical illness, but may be seen as a spiritual failure or obstruction. Unsuccessful or inappropriate shamanic practice among Amerindian and circumpolar societies is the classic instance (Eliade 1964). Within Western societies, demonic possession may be read by doctors as mental illness. (It is just as much a “spiritual experience”: why introduce the religionist’s distinctions between different types of ultrahuman agency? Compare Maslow on “peak” experiences. The terms “spiritual” and “religious world view” are naturalized idioms of late Christianity rather than cross-culturally valid terms [Tambiah 1990].) But also the converse (Koch 1972). And this depends on our professional interests. Clearly, psychiatrists prefer to perceive the world in a psychopathological idiom, while religious enthusiasts and clergy may favor divine intercession or demonic possession; and a Christian psychiatry not surprisingly may claim to act as arbiter (Sims 1991). Any specific instance may be perceived differently by individuals in accordance with their interests and affiliations.The paper’s terminology—“spiritual psychotic experience,” “genuine spiritual experience”—is confusing in that it does imply realist, not conventional claims (cf. Endnote 1, Jackson and Fulford). It is not necessary. A less laden idiom—such as “statistically or normatively unusual brain states and their experiential correlates” (Littlewood 1993, 257)—may be just too unwieldy for repetition, but I would propose that at this level of detail we need rather four categories depending or not on concordance with (i) something close to psychiatry’s recognition of a major mental illness, and (ii) something like an anthropological notion of religious or spiritual experience (cf. Littlewood 1991):[Table 1]PsychosisReligious ExperiencePresentAbsentPresentABAbsentCDSo Jackson and Fulford’s three cases fall into group “A” if the PSE was scored... (shrink)

Especially troublesome in this dispute is the status of the natural sciences, and this is where Hacking finds some of his most telling cases, from the conflict ...

In lieu of an abstract, here is a brief excerpt of the content:Spiritual Experience and PsychopathologyMike Jackson and K. W. M. Fulford (bio)AbstractA recent study of the relationship between spiritual experience and psychopathology (reported in detail elsewhere) suggested that psychotic phenomena could occur in the context of spiritual experiences rather than mental illness. In the present paper, this finding is illustrated with three detailed case histories. Its implications are then explored for psychopathology, for psychiatric classification, and for our understanding of (...) the concept of mental illness. It is argued that pathological and spiritual psychotic phenomena cannot be distinguished by 1) form and content alone (as in traditional psychopathology), 2) by their relationship either with other symptoms or with pathological causes (as in psychiatric classification), or 3) by reference to the descriptive criteria of mental illness implied by the “medical” model. The distinction is shown to depend, rather, on the way in which psychotic phenomena themselves are embedded in the values and beliefs of the person concerned. This in turn is shown to have implications for diagnosis (it shows the need for clinicians to attend to the values and beliefs of individual patients), for treatment (it points to a cognitive problem-solving model), and for research in psychopathology (especially as related to the emerging sciences of dynamic brain imaging and cognitive neuroscience).Keywordsfirst rank symptoms, schizophrenia, delusion, hallucination, thought disorder, religious experience, mystical experienceIntroductionThis paper explores some of the conceptual and practical implications of the finding that phenomena which in a medical context would probably be diagnosed as psychotic symptoms, may occur in the context of non-pathological, and indeed essentially benign, spiritual experiences.The existence of non-pathological psychotic experiences of this kind (we will call them “psychotic phenomena” as distinct from “psychotic symptoms”—see also Endnote 1, terminology) was a key finding in a study carried out by one of us (MJ) at the Alister Hardy Research Centre (AHRC) in Oxford. Details are given elsewhere both of the overall empirical findings of the study, including the relationship between spiritual experience and personality variables, and of a hypothetical cognitive problem-solving model of these phenomena (Jackson 1991, and forthcoming a and b). In the present paper, 1) the background to the study is described briefly in relation to earlier work on the possible links between spiritual experience and psychopathology; 2) some of the psychotic phenomena identified are illustrated with three detailed case histories; 3) the significance of these phenomena is reviewed for our understanding respectively of psychopathology, of diagnostic syndromes, and of the concept of mental illness; and 4) some of the practical implications of the study for clinical work and research in psychiatry are indicated.BackgroundIt has long been recognized that there are similarities between spiritual and psychotic experiences. [End Page 41] William James (1902), for example, argued that “in delusional insanity, paranoia as they sometimes call it, we may have a kind of diabolical mysticism, a sort of religious mysticism turned upside down” (426). Other commentators have noted a wide variety of phenomena, such as time distortion, synesthesias, loss of self-object boundaries and the transition from a state of conflict and anxiety to one of sudden “understanding,” all of which are reported in both spiritual and psychotic experiences (Buckley 1981; Watson 1982; Wapnick 1969; and Wootton and Allen 1983).Yet the similarities notwithstanding, the distinction between these two kinds of experience can be crucially important. Spiritual experiences, whether welcome or unwelcome, and whether or not they are psychotic in form, have nothing (directly) to do with medicine (Fulford 1996a). It would be quite wrong, then, to “treat” spiritual psychotic experiences with neuroleptic drugs, just as it is quite wrong to “treat” political dissidents as though they were ill (Fulford, Smirnoff and Snow, 1993). Pathological psychotic experiences, on the other hand, or psychotic symptoms, are by definition a proper object of medical treatment, sometimes even against the wishes of the person concerned. Hence it would be both negligent and, as Wing (1978) put it, morally “repellent,” to leave untreated someone who is genuinely ill (244).Given how much turns on the distinction between spiritual experience and psychopathology, it is perhaps not surprising that scholarly discussion of the relationship between them has at times... (shrink)

Previous analyses of descriptively defined psychotic phenomena have concluded that they can occur in benign spiritual experiences as well as pathological states. Attempts to forge a distinction between psychotic experiences in spiritual and pathological contexts on the basis of the form or content of the experience (broadly described) can be disproved by counterexample; distinguishing on the basis of negative or positive consequences of the phenomena for the individual can be seen to beg the question. In the present paper, it is (...) argued that examining the fundamental conceptual organization of psychotic and mystical mental states not only elucidates the observed similarities between them, but can highlight the differences, and the processes by which negatively evaluated pathological features can be seen to emerge. Oriental philosophical systems such as Tibetan and Zen Buddhism, and Tantric Hinduism, provide conceptualizations of mystical states of mind, from which a model can be drawn, while the epistemologies of these systems provide an illuminating metaphysical perspective on both psychotic and mystical experiences. It is concluded that mystical and psychotic experiences can be distinguished not only by emotional and behavioral consequences, but by real differences in the states themselves; certain features, such as loss of subject/object boundaries and loss of the relative dimensional structure of perception, are common to both processes. (shrink)

The essence of religion was once widely thought to be a unique form of experience that could not be explained in neurological, psychological, or sociological terms. In recent decades scholars have questioned the privileging of the idea of religious experience in the study of religion, an approach that effectively isolated the study of religion from the social and natural sciences. Religious Experience Reconsidered lays out a framework for research into religious phenomena that reclaims experience as a central concept while bridging (...) the divide between religious studies and the sciences. Ann Taves shifts the focus from "religious experience," conceived as a fixed and stable thing, to an examination of the processes by which people attribute meaning to their experiences. She proposes a new approach that unites the study of religion with fields as diverse as neuroscience, anthropology, sociology, and psychology to better understand how these processes are incorporated into the broader cultural formations we think of as religious or spiritual. Taves addresses a series of key questions: how can we set up studies without obscuring contestations over meaning and value? What is the relationship between experience and consciousness? How can research into consciousness help us access and interpret the experiences of others? Why do people individually or collectively explain their experiences in religious terms? How can we set up studies that allow us to compare experiences across times and cultures? Religious Experience Reconsidered demonstrates how methods from the sciences can be combined with those from the humanities to advance a naturalistic understanding of the experiences that people deem religious. (shrink)

The boundary between spiritual experience and mental disorder remains unclear and should invite collaboration between psychiatry and other disciplines, including theology. Jackson and Fulford (1997), using the tools of analytic philosophy, have proposed a model allowing principled differentiation between spiritual experience and psychotic symptoms based on the personal values of the subject, a cognitive problem-solving model. Spiritual experience is described as positively evaluated psychotic experience, which enables the subject to do more than he or she normally does. In the present (...) paper, it is claimed that values and actions cannot alone always discriminate between religious experience and psychopathology. With reference to three case studies, drawn from the practice of one of us, it is argued that spirituality is not all about experience and that it cannot be understood without reference to the subject's personal history and spiritual tradition, however implicit or fragmented. This approach would allow an account of ordinary religious experience in those who have suffered ego disablement during mental illness. Drawing primarily on the Christian tradition, we argue that the use of theological criteria may allow levels of discrimination between spiritual experience and mental disorder not allowed for by philosophical psychopathology. (shrink)