Pathology, Religious, Spiritual or Transpersonal experience?

What Distinguishes Psychopathology from Religious, Spiritual and Transpersonal Experiences?

Most people have some kind of experiences that would be considered religious, spiritual and/or transpersonal in nature. However, clinicians are often faced with the problem of identifying when these experiences indicate something may be wrong and perhaps actually an expression of psychopathology. In a recent review article in Journal of Humanistic Psychology, Chad V. Johnson and Harris L. Friedman (2008) make several recommendations for clinicians to help them in the differential diagnosis of religious/spiritual/transpersonal (R/S/T) experiences from psychopathology:

1. Accept reality of spiritual and transpersonal experiences.
2. Obtain through understanding of client’s religious history and background.
3. Realize that psychopathology cannot be determined solely by content in clients’ R/S/T experiences.
4. Assess adaptive functioning preceding and following R/S/T experience, whether symptoms are acute or chronic, and level of openness to exploring spiritual experiences.
5. Assess quality of clients’ R/S/T orientation.
a. Does current behaviors/practices exceed religious injunctions?
b. Does client overemphasize certain practices or beliefs and neglect others?
c. Do beliefs and practices promote wholeness, relatedness and full humanness?
6. Compare idiosyncratic behavior and beliefs to normative practices in religious/spiritual community (e.g., speaking in tongues, hearing the voice of God).
7. Determine nature of religious or spiritual problem (Lukoff et al., 1992, 1996).
a. Purely religious or spiritual problem.
b. Religious or spiritual problem concurrent with mental disorder.
c. Religious or spiritual problem not attributable to mental disorder.
8. Recognize and understand spiritual emergency versus spiritual emergence (Grof & Grof, 1992).
9. Recognize that psychopathology is often characterized by greater intensity, terror, and decompensation than genuine spiritual experience.
10. Consider markers of religious psychopathology (Lovinger, 1996).
a. Self-oriented display: Narcissistic displays of being religious.
b. Religion as reward: Using religion to explain assistance with ordinary difficulties in life (e.g., God helping one find a parking space)
c. Scupulosity: Intense focus on avoiding sin or error
d. Relinquishing responsibility: Feeling responsible for events beyond one’s control and neglecting responsibility for manageable things
e. Ecstatic frenzy: Intense, erratic emotional expression often containing religious content or occurring in religious contexts that may signal impending decompensation
f. Persistent church-shopping: Suggests difficulties in maintaining stable relationships.
g. Indiscriminate enthusiasm: Religious enthusiasm frequently expressed to people who do not welcome it.
h. Hurtful love in religious practice: Expressions of love that unnecessarily cause harm to oneself or others (e.g., setting unrealistic expectations for a child out of a notion of love based on strict Biblical interpretations)
i. The Bible as moment-to-moment guide to life: Applying scripture in concrete ways to direct one’s daily experiences (much like a daily horoscope)
j. Possession: May reflect underlying pathology such as hysteria, dissociative reactions, paranoia, psychosis, and borderline disorders.
11. Consider intrapsychic conflicts manifested as religious pathology (Spero, 1985).
a. Person integrates religious beliefs and practices into overall lifestyle (not pathological, but a necessary criterion)
b. Relatively rapid and recent onset of religious affiliation or increased religious fervor with associated severing of significant social and professional relationships.
c. Person’s religious history includes frequent and repetitive spiritual crises and changes sin religious affiliation or degree of belief.
d. Person demonstrates fixation or regression to early sages of object-relations development marked by decompensation in psychosocial functioning, predominant primitive thematic material in dreams, fantasy, and thinking, and conflict between religious expression and adaptive ego functioning.
e. Person preoccupied with fear of backsliding (consciously or unconsciously) and reaction formation of overly rigid and scrupulous religious expression.
f. Person displays continued depressed moods and lack of productivity following religious conversion or awakening.
g. Personal inappropriately idealizes religious leaders or movement and applies this to resolving psychological issues such as autonomy, identity, and impulse control.
h. On occasion, an analysts’s carefully interpreted countertransference may indicate the client is using religion to manage neurotic impulses.
12. Consider assessment tools for identifying adaptive from maladaptive spirituality – for example, the SELF (Friedman, 1983). (p. 523)

C O N T R I B U T O R S
Harris, Brent Robbins, PhD; Susan Gordon, PhD; Chad Johnson Society for Humanistic Psychology: What Distinguishes Psychopathology from Religious, Spiritual and Transpersonal Experiences?