Spiritual Issues in Psychosis

Further reading related to the presentation by:Ron Unger LCSW 541-513-1811

Psychosis and Spirituality: Exploring the New Frontier edited by Isabel Clarke. “Spirituality and psychosis both inhabit the region where ordinary reason ceases to function and barriers break down. The connection between them is evident – what is remarkable is how conventional thinking obscures the connection. This book challenges conventional understandings with a radical new perspective. The interface between psychosis and spirituality is explored, drawing on key research and latest developments from a wide spread of disciplines…”

Various books and papers by Isabel Clarke are either referenced or available at her website,

“Mysticism and madness: Different aspects of the same human experience?” by Charles Heriot-Maitland, in Mental Health, Religion & Culture, Volume 11, Issue 3, 2008. Abstract: Associations between mysticism and madness have been made since earliest recorded history, and the striking resemblance between self-reports of both mystical and psychotic experience suggests that similar psychological processes may be involved in their occurrence. By exploring the similarities, and proposing a common element to mystical and psychotic experience (referred to here as the experience of 'oneness'), this paper aims to place mysticism and madness onto the same experiential continuum. However, in contrast to much of the previous literature, the intention is not to pathologize mystical experience, but rather to normalize psychotic experience. The paper argues not only that the experience of oneness is entirely genuine and available to all humans, but also that it has an important psychological (and evolutionary) function. Using cognitive terminology, it then attempts to explain the processes determining whether an individual enjoys a fulfilling mystical experience, or suffers a debilitating psychotic breakdown (i.e., how 'oneness' is experienced). Finally, this paper turns to look at some of the important implications such an approach might have for clinical practice and for the mental health of people in general.

“INTEGRATING THE SPIRIT WITHIN PSYCHOSIS: ALTERNATIVE CONCEPTUALIZATIONS OF PSYCHOTIC DISORDERS” by Phillips, Russell E, Lukoff, David, Stone, Mary K. “This literature review integrates theory, research, and treatment regarding spiritual experiences in persons with psychosis. The goal of this article is to further communication amongst mainstream and transpersonal psychologists regarding their approaches toward spirituality and psychosis. Perspectives presented in this paper include Anton Boisen's pastoral counseling approach, John Weir Perry's Jungian approach, StanislavGrof's and David Lukoff's transpersonal approaches, research and treatment in mainstream psychology on religious coping and ways to incorporate religious and spiritual issues into therapy. The article also provides a framework to integrate this diverse body of knowledge, and affords some suggestions for future research.”

“Spiritual aspects of psychosis and recovery” by Dr Susan Mitchell. From the paper: “When working with people suffering from psychosis, a practical, grounded, ‘recovery-oriented’ spirituality that incorporates humanity and compassion while accepting the integrity of personal experience is invaluable.”

The Royal College of Psychiatry Spirituality and mental health webpage. An overview of how to bring more spirituality into mental health care. See also The Royal College of Psychiatrists Spirituality and Psychiatry Special Interest Group or their official position paper at

“The relationship between schizophrenia and religion and its implications for care.”Mohr S,Huguelet P. Swiss Med Wkly.2004 Jun 26;134(25-26):369-76. “This paper focuses on the relationships between schizophrenia and religion, on the basis of a review of literature and the data of an ongoing study about religiousness and spiritual coping conducted among outpatients with chronic schizophrenia.”

Unshrinking Psychosis: Understanding and Healing the Wounded Soul by John Watkins, contains a well researched chapter on Psychosis and Spirituality.

Rufus May on using mindfulness with voices: or catch him on a great youtube talk, part 1 and part 2!

Michael Cornwall, who once worked with John Weir Perry, wrote a great summary of how to approach someone with psychosis with spiritual openness: How to best serve clients with a psychotic/visionary experience

Introducing Compassion Focused Therapy is an article that is free on the web. There are also lots of free resources and other information at websites like The Compassionate Mind Foundation (which links to some articles related to psychosis specifically), The Compassionate Mind Foundation USA, and Mindful Self Compassion. Applications of this approach to psychosis are quite new, but are explored in articles like Johnson, D. P., D. L. Penn, et al. "A pilot study of loving-kindness meditation for the negative symptoms of schizophrenia." Schizophr Res 129(2-3): 137-40 and Mayhew, S. L. and P. Gilbert (2008). "Compassionate mind training with people who hear malevolent voices: a case series report." ClinPsycholPsychother 15(2): 113-38. There is also a book out called “A Compassionate Approach to Recovering from Psychosis : A Self-Help Guide Using Compassion Focused Therapy Techniques” by Ian Lowens.

Trials of the Visionary Mind: Spiritual Emergency and the Renewal Process by John Weir Perry. Perry writes from the unique perspective of having overseen a successful program for people experiencing early psychosis that used a spiritual perspective – the program called Diabasis. “Stress may cause highly activated mythic images to erupt from the psyche's deepest levels in the form of turbulent visionary experience. Depending on whether the interactions between the individual and the immediate surroundings lean toward affirmation or invalidation, comprehension of these visions can turn the visionary experience into a step in growth or into a disorder, as an acute psychosis. Based on his clinical and scholarly investigations, John Weir Perry has found and formulated a mental syndrome which, though customarily regarded as acute psychosis, is in actuality a more natural effort of the psyche to mend its imbalances. If the upset is received in the spirit of empathy and understanding, and allowed to run its course, an acute episode can be found to reveal a self-organizing process that has self-healing potential.”

Also see “A CONVERSATION WITH DR. JOHN WEIR PERRY” available at

The Primordial Mind in Health and Illness: A Cross-Cultural Perspective by Michael Robbins. “The universal quest to create cosmologies – to comprehend the relationship between mind and world - is inevitably limited by the social, cultural and historical perspective of the observer, in this instance western psychoanalysis. In this book Michael Robbins attempts to transcend such contextual limitations by putting forward a primordial form of mental activity that co-exists alongside thought and is of equal importance in human affairs.”

The California Mental Health & Spirituality Initiative web site contains a directory to online resources, scientific literature, and books. It also incorporates web 2.0 features to allow you to participate by posting resources and contributing to online discussions.

Some resources Brian Koehler recommended – I haven’t looked at these yet :

  • “Spirituality and Psychiatry” edited by Chris Cook, Andrew Powell & Andrew Sims (2009) published by RCPsych Publications (The Royal College of Psychiatrists).
  • “Wrestling with Our Inner Angels: Faith, Mental Illness, and the Journey to Wholeness” by Nancy Kehoe (2009) published by Jossey-Bass (A Wiley Imprint).
  • “Religion and Spirituality in Psychiatry” edited by PhillipeHuguelet & Harold G. Koenig (2009) published by Cambridge University Press (Cambridge, UK).

The International Network for Philosophy and Psychiatry lists some resources that I also haven’t checked out yet,

Whitson, J. A., & Galinsky, A. D. (2008). Lacking control increases illusory pattern perception. Science, 322(5898), 115-117.This article reports on research showing that as people attempt control in situations where it is not obvious how to get control, they open their mind to seeing many more possible patterns, which then makes it more likely that patterns will be seen where they don’t exist, paranoid or superstitious beliefs will be endorsed, etc.

Invisible Guests: The Development of Imaginal Dialogues, by Mary Watkins. One description of this book: “An eloquent critique of developmental and clinical psychologies and their insistence on listening to only one voice per person. Dr. Mary Watkins is the only person now writing on imagination who knows the field completely, thinks beautifully, and can teach just how to proceed with interior dialogues with imaginal personages.”

The Web of Life: A New Scientific Understanding of Living Systemsby Fritjof Caprais a good introduction to complexity theory, emergence, and self organization, for those of you who may be unfamiliar with this way of thinking.

Historical, religious and spiritual perspectives, from a Hearing Voices Network website.

Myths, Shamans and Seers: Phil Borges at TEDxRainier is a video that covers cultures around the world that see “mad” experiences as an indication of possible abilities outside the norm.

Silverstein, S. M. (2007). Integrating Jungian and Self-Psychological Perspectives Within Cognitive-Behavior Therapy for a Young Man With a Fixed Religious Delusion. Clinical Case Studies, 6(3), 263-276. From the abstract: “This article demonstrates how the Jungian technique of archetypal amplification was modified and used within the structure of CBT treatment of a young man with schizophrenia with a religious delusion who refused to engage in standard CBT. His case demonstrates that schizophrenia patients who initially refuse to question the validity of their delusional beliefs can nevertheless be successfully engaged in CBT when the focus promotes alternative understandings of the self and preserves self-esteem.”

In Case of Spiritual Emergency: Moving Successfully Through Your Awakening by Catherine G. Lucas, 2011 Personal stories of spiritual crises are presented alongside practical and effective guidance in this exploration of a fascinating phenomenon. When spiritual emergencies, such as mystical psychosis and dark nights of the soul, are understood, managed, and integrated, they can offer enormous potential for growth and fulfillment, and this book offers three key phases for successful navigation. Encouraging, supportive, and life-saving, this resource is essential for avoiding the mental, emotional, or spiritual paralysis or exhaustion that can result from underestimating the current age of increased individual and global emergencies.

The Theory of Positive Disintegration by KazimierzDabrowski is a theory that has been around for a number of decades, for an overview of how disintegration can contribute to higher levels of integration, go to

It isn’t published yet, but Insanity and Divinity: Studies in Psychosis and Spirituality edited by John Gale, should be out by summer and looks promising! It’s an ISPS sponsored book.

Religious Trauma Syndrome: How Some Organized Religion Leads to Mental Health Problems

What happens if we listen to psychosis?tells the story of 2 young women who believed God spoke to them and promised they would give birth to the second savior, one where the person was listened to with some humility on the part of the mental health worker, one where the person wasn’t…..

Ed Knight Dharma Talk: Anxiety as the Enlightened Path – talks about how mindfulness can be used to deal with many “psychiatric” problems, from his perspective as someone who has struggled with issues including psychotic experience.

Paul Levy’s story is told at “Madness” as a spiritual and awakening journey

During the seminars I mentioned the San Francisco Suicide Club, a group I participated in during my youth, and my friend John Law, who I mentioned had assaulted the staff person who tried to proselytize him while he was in a psychiatric hospital: John became a leader in the Suicide Club and then in the Cacophony Society which in many ways followed in the footsteps of the Suicide Club: John is coauthor of a book on the Cacophony Society which will be released mid May of 2013. (These groups were more bizarrely creative than obviously “spiritual” but were on that cusp of insanity, spirituality, and creativity…….

Questions to ask each of your clients:

  • Do you have religious or spiritual beliefs which are a source of support for you? If so, how?
  • Do you have religious or spiritual beliefs which cause you stress or conflict? If so, how?
  • Do you have any religious or spiritual beliefs that might conflict with treatment? What are they, and how do you see the conflict happening?
  • Are you a member of a religious or spiritual community that provides you with support? What sort of support are you getting from that community?
  • Can you identify specific spiritual needs related to your current problems that need to be addressed?

(These questions are a paraphrase of questions suggested in a talk by Harold G. Koenig, MD)