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Part V
Transpersonal Approaches to

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Transformation, Healing

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and Wellness

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23
Transpersonal Perspectives on

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Mental Health and Mental Illness

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Jacob Kaminker and David Lukoff

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A distinctive feature of transpersonal psychology is its attention to and acceptance of
non-ordinary states of consciousness, including spiritual crises. A medical model of

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mental health often pathologizes such states without discernment, potentially stig-
matizing unique but potentially meaningful experiences that fall outside of consensus
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reality. While the importance of spirituality to mental health is gaining recognition,
as evidenced by the wide acceptance of the recovery model (Surgeon General, 1999),
there is a still much progress to be made.
Transpersonal psychology recognizes the significant evidence that many of these
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states of consciousness are not only quite common in the population at large (Gallup,
2002), but often lead to greater realization of human potential (Lukoff, 2007). Knowl-
edge of such experiences, as well as of religious and spiritual diversity issues, can be
considered a necessity for clinicians in order to for them to offer appropriate guidance
to clients, and also to raise awareness of their own biases and thereby limit the impact
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that these biases might otherwise have (O’Connor & Vandenberg, 2005).
This chapter offers a transpersonal perspective on non-ordinary states of conscious-
ness as they relate to mental health. This entails a discussion of the commonalities
and differences among transpersonal theorists on the nature of extraordinary human
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states, as well as on how a transpersonal view relates to mainstream psychology.

The discussion is framed within a clinical perspective that allows for the diversity of
human experience.
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Pathologizing Spirituality

The mental health professions have a long history of ignoring and pathologizing
religion and spirituality in all forms (Lukoff, Lu, & Turner, 1992). For instance,
Sigmund Freud described religion as an obsessional neurosis (Freud, 1927/1989), and

The Wiley-Blackwell Handbook of Transpersonal Psychology, First Edition.

Edited by Harris L. Friedman and Glenn Hartelius.
© 2013 John Wiley & Sons, Ltd. Published 2013 by John Wiley & Sons, Ltd.

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420 Jacob Kaminker and David Lukoff

Albert Ellis (1980) asserted that “the less religious [patients] are, the more emotionally
healthy they will tend to be” (p. 637). These statements exemplify what has been a
general dismissiveness towards religiosity throughout the history of psychology. There

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has also been a strong tendency to pathologize extraordinary human experiences.
While the intention of diagnosis is to provide structure and comfort, the result is often
to the contrary. According to James Nelson (2009),

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While a view of mental disorder as illness was designed to remove guilt and restore the
dignity of people with problems, in fact it dehumanizes them, picturing individuals as
pathological or underdeveloped and in need of outside manipulation from an expert.
(p. 349)

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This trend is slowly transforming. Beginning in the 1990s and with increasing vigor,
mainstream psychology has begun to recognize the relationship between spirituality
and mental health (Nolan, Dew, & Koenig, 2011). However, the focus of research
has largely been on the connection between spirituality and the “less debilitating
mental illnesses such as depression and anxiety,” while “severe mental conditions such

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as chronic psychosis are rarely examined” (p. 384). One result of this omission is a
lack of attention to the potential risks and benefits of non-ordinary states, including
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both those fostered through spiritual practice and spontaneous states. According to a
review of the literature,

reasons for this deficit may include: the belief that religion or spirituality are part of
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the pathology of mental illness . . . ; lack of interest in or education about religion and
spirituality among mental health professionals . . . ; and possible competition for clients,
as both clergy and mental health professionals are experts on human suffering. (Nolan
et al., 2011, p. 386)
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These gaps in the literature are unfortunate in light of the commonness of such
experiences. Surveys have consistently found that over one-third of the people in
the United States report intense religious experiences that in some sense lifted them
outside of themselves (cf. Greeley, 1974; Hay & Morisy, 1978). Another study by
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David Yamane and Megan Polzer (1994) found that about one half of Americans
surveyed had experienced religiously-related ecstasy, with significant differences in
percentage based on denomination, region, and race. These differences can likely be
accounted for by the diversity of goals in spiritual practices and of the language for
describing the experiences. In any case, the overwhelming evidence points to the
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commonality of perceiving something that was understood to be outside of oneself.

In addition, much of the scripture throughout world religions contains descrip-
tions of prophets whose experiences of ecstasy and religious experiences contained
visions and imagery, which some mental health professionals may erringly diagnose
as pathological. Auditory and visual hallucinations have played an essential role in
religion for thousands of years. Accounts range from Biblical prophets and saints to
shamans, as well as the famous Daemon voice guide of Socrates. Modern psychiatrists
have retroactively diagnosed all of them as having had mental disorders (Leuder &
Thomas, 2000).
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Transpersonal Perspectives on Mental Health and Mental Illness 421

The DSM-IV-TR (American Psychiatric Association, 2000) specifically notes that

clinicians assessing for schizophrenia in socioeconomic or cultural situations different
from their own must take cultural differences into account: “In some cultures, visual

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or auditory hallucinations with a religious content may be a normal part of religious
experience (e.g., seeing the Virgin Mary or hearing God’s voice)” (American Psy-
chiatric Association, 2000, p. 306). For example, in a study of visual hallucinations

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among Hispanic clinic patients, Juan Lata (2005) found that phenomena typically
deemed as psychotic may occur in connection with spiritual experiences. Common
examples include visions of loved ones, saints, angels, Jesus, and Mary.

Transcending Egoic Boundaries

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This potential for pathologizing non-ordinary experiences, despite content and out-
come, derives from the commonalities between transpersonal phenomena and psy-
chosis as well as some dissociative diagnoses. One reason for these commonalities is
the shared characteristic of transcending of the usual boundaries of the self. Creative

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pursuits and spiritual practices represent attempts to willingly deconstruct or transcend
the normal boundaries of the self for the purpose of psychospiritual growth or new
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creative possibilities (Akkach, 1997; Peters, 1989; Swan, 2008).
Throughout recorded history, there have been accounts of the muse in the creative
process (Nachmanovitch, 1991) and spiritual traditions have described the transcend-
ing of ego boundaries in the forms of spontaneous visions or revelations (Kornfield,
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1993), psychic experiences (Caplan, 1999), and spiritual awakenings such as kun-
dalini experiences (Sovatsky, 1999). Popular culture, spiritual communities, and many
notable figures from the artistic and literary worlds have acknowledged both the fre-
quency and the potential benefits of transcending egoic boundaries. Transpersonal
psychology attempts to reconcile the differences between the long history of spiritual
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wisdom and modern science. Newberg, ’d’Aquili, and Rause (2001) have even gone
so far as to suggest that the need to transcend the self is a basic neurobiological need.
This can be experienced as euphoric and transcendent, or it can be terrifying when it
is experienced as a sort of death of the acquired sense of self.
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Research has shown that spirituality helps to foster coping skills, which, in turn,
improves prognosis for people with schizophrenia (Shah et al., 2011). One explanation
for this phenomenon is that spirituality provides a roadmap for the unknown territory
beyond the individual human experience. In other words, it helps to make sense of
the realms glimpsed through psychosis and may provide a structure for reintegration.
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In this regard, it is particularly helpful to understand spirituality in its diversity, since

traditions that are unfamiliar may be more readily pathologized.

Diversity Issues

While diversity issues have become a mainstay in clinical theory, the recognition of
spiritual diversity issues by the psychological community has lagged behind. Chad
Johnson and Harris Friedman (2008) have pointed out that the values of the clinician
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422 Jacob Kaminker and David Lukoff

weigh heavily on differential diagnosis of these issues. Issues that are likely to impact
diagnosis of mystical experiences include clinician theoretical orientation and openness
to spirituality (Allman, De La Roche, Elkins, & Weathers, 1992). According to David

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Greenberg and Eliezer Witztum (1991), therapists can only responsibly diagnose
clients after becoming familiar with their religious tradition.
A study by Shawn O’Connor and Brian Vandenberg (2005) presented clinical

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vignettes to 110 mental health professionals from a variety of settings. Each vignette
represented a client from a different religious denomination, namely Catholic, Mor-
mon, and Nation of Islam. Participants were randomly assigned to one of four con-
ditions, each with slightly different vignette packets. In each, “the religious beliefs
of the individuals in the vignettes were identified as either being integral to a reli-
gious tradition or not and also as either resulting in a threat to harm another or not”

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(O’Connor & Vandenberg, 2005, p. 610). They found that “nonreligious clinicians
may be more likely to impute pathology to religious ideation than religious clinicians”
(p. 613). In addition, pathology rating were significantly higher for the Nation of
Islam vignette than the Mormon and higher for the Mormon that the Catholic. What
the researchers termed “beliefs not explicitly identified as belonging to an established

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religion” were considered significantly more pathological (p. 613). Finally, and more
clinically appropriately, when the vignettes included harmful consequences, ratings of
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pathology were higher. The results of this study demonstrate the effect on clinician
bias with regard toward more culturally marginal religious traditions as well as toward
unfamiliar presentations of spirituality.
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Transpersonal Perspectives on Mental Health

Some transpersonally-oriented treatment centers have focused on the ability of the

client to make meaning of the experience. Victor Frankl (1959/1984), one of the
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intellectual forefathers of transpersonal psychology, believed that meaning-making is

a distinctly human characteristic that allow us to triumph in the face of suffering. His
own discoveries on this subject developed during his internment in a Nazi concentra-
tion camp. One of Abraham Maslow’s (1969) major contributions to the field is the
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concept of self-transcendence, which he understood in his later years as being at the

top of the developmental hierarchy of needs. Some of the states experienced in spir-
itual practice, including those with psychotic features, can help to foster this stage of
self-transcendence. These two contributions from Frankl (1959/1984) and Maslow
(1969) can be understood as creating the foundation for transpersonal psychology’s
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perspective on non-ordinary states.

Freud (1930/1961) influenced modern psychology’s explanation of mystical states
by reducing them to an “oceanic experience” marked by “infantile helplessness” and
a “regression to primary narcissism” (p. 21). In contrast to Freud, other theorists
have opened the door to viewing mystical experiences as a sign of health and a
powerful agent of transformation, including Carl Jung (1952a) and Evelyn Underhill
(1955). Additionally, studies have found that people reporting mystical experiences
scored lower on psychopathology scales and higher on measures of psychological well-
being than controls (Hood, 1974; Hood, Hill, & Spilka, 2009). Within transpersonal
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Transpersonal Perspectives on Mental Health and Mental Illness 423

psychology, there are various understandings of the nature of non-ordinary states of

consciousness. Each understanding has different implications for the understanding of
mental health and mental illness, especially when it comes to the nature of regressive

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states, the linear nature of spiritual growth, and how to relate to the mainstream forces
of the medical model of mental health.
Of the theorists who can be identified as transpersonal, some descend from the

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Jungian tradition and believe that something essential is being discovered through
regressive states (Jung, 1952b). Roberto Assagioli (1965/1989), Jung’s contempo-
rary, also noticed the link between transpersonal experiences and the healing of trauma
through regressive states. Stanislav Grof and Christina Grof (2010) joined them in
recognizing the healing power of regression. They developed holotropic breathwork
practices designed to invoke these states in the interest of transformation. Michael

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Washburn, who has identified with the psychodynamic tradition, has called this type
of pursuit “regression in the service of transcendence” (Washburn, 1994, p. 242).
From this perspective, it is important to explore regressive states with awareness in
order to heal trauma and to grow spiritually.
Ken Wilber (1980) has argued that this prizing of regressive states reflects a pre/trans

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fallacy, one that erroneously understands regressive, or pre-personal states as offering
spiritual wisdom in the same way as transpersonal states. While Wilber validly points
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to the need for discrimination in the valuing of non-ordinary states, a number of
scholars have argued against the notion that lines can be drawn so simply (Grof,
1998; Schavrien, 2008; Taylor, 2009; Washburn, 1998). More practical distinctions
may emerge as the study of non-ordinary states matures.
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R. Elliot Ingersol (2002) has suggested an integral approach to diagnosis that avoids
the “disease model” in the DSM (p. 115) and instead looks at consciousness through
Wilber’s (1995) All Quadrants All Levels (AQAL) model. This model views conscious-
ness through four quadrants, with each being focused either internally or externally and
either individual or collective. The interior-individual (I) quadrant contains subjective
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experience, interior-collective (we) represents paradigms and cultures, exterior indi-

vidual (it) describes the brain and physical body, and exterior-collective (its) includes
government, social systems, and the physical environment (Wilber, 2007). Within
each are developmental levels that describe the evolution of the human, societal, or
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cosmic dimensions of each quadrant. This model comes from Wilber’s understand-
ing of the commonalities between spiritual traditions and models of consciousness.
Washburn (2003) has described this view as structural-hierarchal in that it “stresses a
hierarchy of achieved structural abilities and capacities” (p. 1).
Phenomenological approaches, such as those of William James (1902/1958),
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Edmund Husserl (1913/1931), and Ron Valle (1998) focus on the structure of
experience in transpersonal phenomena. Attention is directed towards the lived expe-
rience, as free as possible from interpretation or metaphysical assumptions. Rather than
seeking objectivity, this approach denies that unmediated experience of an external
material world is possible, since subjectivity shapes every perception (Polkinghorne,
1989). The empirical focus of inquiry then shifts from observing the material world
to observing experience itself as it were, focusing on subjectivity rather than objectiv-
ity. Within transpersonal psychology, this has expressed itself as an ongoing interest
in examining and describing inner subjective experience in the way that attempts to
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424 Jacob Kaminker and David Lukoff

parallel how traditional science describes outer objects and events (e.g., Tart, 2004;
Welwood, 1979; cf. Ruzek, 2007). This stance developed in response to the fact
that much of mainstream psychology has dismissed consciousness and experience as

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valid objects of study (cf. Tart, 2004), especially in earlier decades. The interest in
subjective experience, shared by humanistic psychology, has represented a significant
contribution to the larger field.

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Yet examining human experience within the subjective category it was assigned
by science created its own set of problems that early transpersonal scholarship at
times overlooked: Accepting the subject–object divide of modernist thought placed
transpersonal research in a scientifically indefensible position. In response to this
dilemma, Jorge Ferrer (2000, 2002) proposed that the transpersonal field rely instead
on participatory thought (Skolimowski, 1994; Tarnas, 1991), which challenges the

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reality of the notion of dividing reality into categories of subject and object. In Ferrer’s
(2000; Ferrer & Sherman, 2008) participatory view, transpersonal states and spiritual
experiences are transforming encounters with the world, not private delusions. Because
these events are not intrapsychic or confined to an individual, but rather transcend
subject–object dualism, this approach allows events such as the auditory hallucinations

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of schizophrenia to be reframed as potentially meaningful encounters—either with
repressed or dissociated parts of the psyche, or, in a Jungian sense, with aspects of the
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collective unconscious (Suri, 2011).
David Lukoff (2011) has advocated integrating acceptance of spirituality into the
mainstream by depathologizing extraordinary human experiences whenever possible.
This does not mean that spiritual and religious problems do not require clinical
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attention, but rather that it is important to correctly diagnose the problem, so as to

encourage potential psychospiritual growth and to avoid attaching undue stigma or
unnecessary psychopharmacological intervention.
In recent history, one of the most significant shifts on this issue in the mental
health field has been marked by the addition to the DSM-IV of the V-code for
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Religious and Spiritual Problems. The acceptance of this new category by the American
Psychiatric Association Task Force on DSM-IV was based on a proposal documenting
the extensive literature on the frequent occurrence of religious and spiritual issues in
clinical practice, the lack of training provided to mental health professionals, and the
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need for a diagnostic category to support training and research in this area of clinical
practice (Lukoff, et al., 1992). Lukoff, Francis Lu, and C. Paul Yang (2010) have
proposed the following categories based on a review of the literature:

r Religious problems
a Loss or questioning of faith
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a Changes in membership, practices, and beliefs (including conversion)

a New Religious Movements and cults
a Life-threatening and terminal illness
r Spiritual problems
a Anomalous experiences (i.e. mystical experiences, near-death experiences, psy-
chic experiences and alien abduction experiences)
a Meditation and spiritual practice-related experiences
a Possession experiences
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Transpersonal Perspectives on Mental Health and Mental Illness 425

Regardless of the belief of the mental health professional in the validity of these
anomalous phenomena, studies have shown that experients show physiological reac-
tions when describing the phenomena that demonstrate the subjective truth of the

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experience (Cardeña, Lynn, & Krippner, 2002; McNally et al., 2004). Therefore,
the appropriate therapeutic stance is to respect this subjective experience and treat
the resultant trauma and help the experient to integrate the insights. Among the

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most commonly described phenomena in transpersonal psychology that requires this
therapeutic stance is the spiritual emergency.

Spiritual Emergency

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Spiritual emergency must be differentiated from spiritual emergence in that the latter
involves a slower integration of a spiritual experience into the worldview, whereas
the former comes in the form of a crisis, a sudden explosion of consciousness that
often resembles psychosis (Grof & Grof, 1992). A vivid demonstration of spiritual
emergency comes in the form of Lukoff’s (1991) self-case study. At 23 years of age,

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Lukoff experienced a spiritual emergency that met the DSM-II criteria in effect at
the time for an Acute Schizophrenic Episode and meets the DSM-IV criteria for a
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Hallucinogen-induced Delusional Disorder.
For two months, Lukoff (1991) was convinced that he had uncovered the secrets of
the cosmos, and that he was both Buddha and Christ in a new reincarnation. This was
triggered by taking LSD for the first time. He described how the experience began:
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I awoke just after midnight. Although I had slept for only two hours, I felt rested—in
fact, I was full of energy and eager to get back to writing in my journal. But first a quick
trip to the bathroom. While there, I stopped in front of the mirror and gazed at my
reflection. Suddenly I noticed that my right hand was glowing, giving off a white light.
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My thumb was touching my forefinger in the ancient mudra position of the meditating
Buddha. Immediately the meaning of this sign was clear to me: I had been Buddha in a
previous life. Then another thought came: Buddha had been reincarnated as Jesus Christ.
Therefore, I had also been Jesus Christ. Now, in this moment, the luminous image in
the mirror was awakening me to my true purpose: to once again bring the human race
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out of its decline. My journal writing was actually the creation a “new Bible”, a Holy
Book which would unite all people around the common tenants of a single belief system.
Instead of unifyng just one social group, as Buddha and Christ had, my mission was to
write a book that would create a new worldwide society free of conflict and full of loving
relationships. (p. 25)
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During the most acute stage, which lasted a week, he slept little and held conversa-
tions with the “spirits” of eminent thinkers in the social sciences and humanities. He
had discussions with contemporary persons including R. D. Laing, Margaret Mead,
and Bob Dylan, as well as individuals no longer living, such as Jean-Jacques Rousseau,
Freud, Jung, and—of course—the Buddha and Christ. Based on these conversations,
he produced a 47-page “Holy Book” that he expected would unite all the peoples of
the world in the project of designing a new society. He sent xeroxed copies to friends
and family so that they too could be enlightened.
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426 Jacob Kaminker and David Lukoff

As the grandiosity began to fade over the next two months, Lukoff began to read
Jung and Joseph Campbell to find some perspectives on his experience. Then he
spent four and a half years in Jungian analysis and also worked with Wallace Black

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Elk, a Lakota Medicine Man, to integrate the experience and incorporate it into his
personal mythology. He finished his graduate studies in clinical psychology and now
understands this experience as a form of a shamanic initiatory crisis. Today, he is a

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leading voice in the movement to bring awareness to the spiritual benefits of these
states and to reform the pathologization of spirituality in mental health. If he had
been directed to a medical model mental health practitioner at the time, it is likely
that his life would have taken a very different turn, possibly involving medication and
hospitalization.

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Differential Diagnosis

Paul Jerry (2003) has pointed that “diagnosis is a dynamic and on-going process
with revisions and changes occurring throughout the therapeutic process,” but that

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differential diagnosis is essential before prescribing treatment. According to him, “one
would likely intervene with medication and hospitalization for the psychotic, a course
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of treatment that could be disastrous for the transcending client” (p. 45). However,
researchers such as John Perry (1974), Loren Mosher and Alma Menn (1979), and
John Bola and Mosher (2003), have demonstrated the effective treatment of psychosis
with limited psychopharmacological intervention, through helping clients to make
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meaning of their experiences.

It is also necessary to rule out any substance-related causes including intoxication
and withdrawal. Differential diagnosis between a substance-induced experience and a
psychotic break is also important, as there are both similarities and differences (Nelson
& Sass, 2008). Though differential diagnosis with substances is important, clinical
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trials of psilocybin, the active ingredient in hallucinogenic mushrooms, have shown

lasting positive effects similar to that of a mystical experience (Griffiths, Johnson,
Richards, McCann, & Jesse, 2011). In light of this data, the value of a substance-
induced experience should not be disregarded though abuse or dependency on the
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given substance should be assessed.

Pathological and spiritual experiences cannot be always distinguished from each
other in form or content, but need to be assessed in the light of the values and beliefs
of the individual, as well as the social context. Similarities exist between transpersonal
experiences and pathological experiences, but there are diagnostic features that neces-
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sitate different case conceptualizations and clinical interventions. However, Johnson

and Friedman (2008) have pointed out that psychopathology generally has higher
levels of decompensation and terror than mystical experience.
Lukoff (2005) has presented criteria for differential diagnosis between what he has
called visionary spiritual experience (VSE) and psychotic disorders. Unlike psychotic
disorders, VSEs have “good pre-episode functioning, acute onset of symptoms during
a period of three months or less, [a] stressful precipitant to the psychotic episode,
[and] a positive, exploratory attitude toward the experience” (Lukoff, 2005, p. 242).
Further, a VSE must be without “significant risk for homicidal or suicidal behav-
ior,” and typically includes “ecstatic mood, a sense of newly gained knowledge, and
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Transpersonal Perspectives on Mental Health and Mental Illness 427

delusions with spiritual themes (which most psychotic disorders do not include)”
(Phillips, Lukoff, & Stone, 2009, p. 8).
Aside from diagnosing experiences, another dimension of differential diagnosis is

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religious pathology. Some theorists have formalized their observations into diagnostic
models (Spero, 1985; Lovinger, 1996). The primary themes of these models can be
simplified into highlighting how much the client’s spirituality brings them hope over

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despair and helps them connect, rather than distance themselves from others and
from life.

Treatment

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In treatment, Jerry (2003) has observed that it is first important to ask whether the
transpersonal material is being pursued for the therapist’s interest or whether it is cen-
tral to the client’s goals in therapy. If it is important to the therapy, there are two ques-
tions in treatment planning: (1) “how do the clients’ psychological/characterological
structures of personality affect their interpretation of the experience?” (Jerry, 2003,

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p. 50), and (2):
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given the constellation of symptoms, interpretations and orientation to the experience,
which of these psychological distortions will become the grist for the therapeutic mill? In
other words, having a sense of the nature of the reaction to the experience (say, paranoia),
will this become the focus of therapy because it is the most likely to transform itself (say
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from paranoia to security)? (p. 51)

Some residential treatment approaches have addressed the spiritual dimensions of

psychosis. Perry (1974), who founded Diabysis, a Jungian-oriented group treatment
home for people experiencing a first psychotic episode, found themes including the
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destruction of the world, a cosmic fight between good and evil, the appearance of a
messiah that the client identifies with, and a sense of a rebirth of the world into a more
loving place. Perry encouraged clients to express and explore the symbolic aspects of
their psychotic experiences. Therapy, conducted thrice weekly, consisted of listening
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to clients and helping them to interpret the powerful and spiritual symbols within
their hallucinations and delusions. Medications were rarely used. Perry reported that
severely psychotic clients became coherent within two to six days without medication.
The outcomes appeared better for those who had had fewer than three previous
psychotic episodes. Diabysis closed down in 1980 due to budget cutbacks in the
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mental health system.

A similar program, Soteria House, located in San Jose, California, provided more
empirical support for this model (Mosher & Menn, 1978). Soteria House ran from
1971 to 1983, roomed six clients, with three to four staff on the premises at one
time. The staff was trained to view psychotic experiences as a developmental stage
that can lead to growth, and which often contain a spiritual component of mystical
experiences and beliefs. Medication was typically not prescribed unless a client showed
no improvement after six weeks (only 10% of clients used medication at Soteria), since
it was believed to stunt the possible growth-enhancing process of the psychotic episode
(Mosher & Menn, 1979).
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428 Jacob Kaminker and David Lukoff

Outcomes from Soteria were compared to a traditional program: a community men-

tal health center inpatient service consisting of daily pharmacotherapy, psychotherapy,
occupational therapy, and group therapy (Mosher, Menn, & Mathews, 1975). Clients’

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length of stay was longer at Soteria than in the comparison program (mean of 166 days
versus 28 days), but most patients recovered in six to eight weeks without medication
(Mosher, Hendrix, & Fort, 2004). A recent meta-analysis of data from two carefully

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controlled studies of Soteria programs found better two-year outcomes for Soteria
patients in the domains of psychopathology, work, and social functioning compared
with similar clients treated in a psychiatric hospital (Bola & Mosher, 2003).
Lukoff led the development of a holistic program for patients with diagnoses of
schizophrenia that addressed the spiritual side of their lives (Lukoff, Wallace, Liber-
man, & Burke, 1986). He contrasted the effectiveness of a 12-week holistic health

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program with a social skills training group, randomly assigning inpatients at a state
mental hospital to either treatment. The holistic program consisted of 20 minutes each
of daily yoga and meditation. Clients also attended a weekly “Growth and Schizophre-
nia” session examining the positive, and especially the spiritual dimensions of their
hallucinations and delusions. Overall, the study provided some support to the idea

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that spiritual interventions can be used in persons with schizophrenia without causing
harm, and with possible benefits.
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Conclusion
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With its focus on describing symptoms and making diagnoses, the medical model of
psychology leads anomalous or non-ordinary human experiences to become pathol-
ogized. Many of these states of consciousness can be better understood as the tran-
scending of egoic boundaries, bringing both risks and benefits. With a therapeutic
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focus on helping the client to make meaning of the experience, clients can show
improvement in many areas, even when compared to their pre-episodic functioning.
Diagnosis is a crucial first step in treatment planning. Differential diagnosis should
discern substance-induced, psychotic, and dissociative states from spiritual problems.
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These need to be diagnosed with attention to the clients’ values, beliefs, and social
context. Treatment of psychosis without medication is often possible in a highly
controlled environment, but the support does not currently exist for these types of
facilities. Greater public awareness of the efficacy of this approach should foster both
the perceived need for and funding of this type of treatment center.
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Knowledge of religious and spiritual beliefs and practices is an important diversity

issue in clinical practice. It is crucial for clinicians to familiarize themselves with their
clients’ religious and spiritual problems, religious traditions, and spiritual practices in
order to avoid bias and to help them utilize their experience in service of psychospiritual
growth. As the mental health community is beginning to accept the importance of
these issues to clients, clinical training programs should incorporate more education
on these topics.
Given their potential for enhancing well-being and their known pitfalls, spiritual
practices should be more central to the field of psychology for understanding of the
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Transpersonal Perspectives on Mental Health and Mental Illness 429

mind, psychospiritual development, and mental health. Future research can focus on
the risks and benefits of specific practices in the context of traditional spiritual wisdom.
The DSM-IV V-code for Spiritual and Religious Problems has expanded public

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consciousness of spiritual diversity issues in clinical practice and has guided clinicians
on how to approach these common human experiences. Further popular acceptance
would allow for these issues to be acknowledged as primary, rather than secondary

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reasons for seeking treatment.

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