History of the attempt to organize spirituality with psychology

By Rev. Karen E Herrick, PhD, LCSW (NJ & Nevada), LMSW (NY), CADC, ACMP (National)

Because my clients coming from alcoholic and drug addicted homes were more predisposed to spiritual experiences, due to their ability to disassociate easier as children, I studied and researched heavily in the areas of psychology that believed in God and the possibility of these experiences. Due to the confusing lack of religious training in my family of origin, I became ordained in the Interfaith Religion in June 1995, at the Cathedral of St John the Divine in New York City. My goal was to help legitimize spiritual experiences for myself and my clients. 

I attended a nine-month training program at the Headlands Institute in Sausalito, California traveling from New Jersey on a long weekend, entitled Spiritual Emergence Syndromes. Her main professor was Dr. Robert Turner, one of the creators of a new V-Code, Religious & Spiritual Problem, published in the DSM-IV in 1994 (More on that later). 

This training stressed that not all psychological upheavals are evidence of a mental disorder. They can be evidence of a deeper profound transformation which potentially raises someone to a whole new level of functioning. During this training period, there was a spiritual process unfolding in me, of which I had no awareness. Little did I know that ten years later I would be getting a PhD in the subject of Spiritual Psychology hoping to teach other therapists the difference between a spiritual experience and mental illness. 

Just as the split of church and state during the time of Rene Descartes (1596-1650), often called the Father of Modern Philosophy, there has also been a split between psychology and religion. Many therapists and mental health professionals believe in God; however, this is a subject the field of psychology that is traditionally to be avoided. In fact, those therapists that practice in the field of spiritual experiences and/or the paranormal are considered a bit “weird” and not held in the highest of esteem by their peers. 

DIFFERENCES BETWEEN MENTAL ILLNESS AND SPIRITUAL EXPERIENCES (SEs)

1. A person having a SE is usually humbled by the experience even if at the time they do not understand what is happening. 
2. A person having an SE can choose to move in and out of the spiritual states. They can repeat their same story to you over and over. 
3. With psychosis or mental illness, this is not the case. The person usually is having delusions of being Christ or receiving direct communication from God. They cannot repeat the same story over and over to you. However, even in these cases, the literature documents that there is often therapeutic values in addressing a person’s religious ideation (Bradford, 1985, Hoffman et al., 1990). 

I interviewed Dr Robert Turner, one of the creators of this 1994 V-Code, about the possibility of having a diagnostic code regarding spirituality. Dr. Turner explained that applying for the V-Code in 1991-1994 from the Committee on Religion of the American Psychiatric Association (APA) had been a three-year process. In 1993, the Committee had approved the “V-Code presented to the Committee on Religion.”

V-CODE PRESENTED TO THE COMMITTEE ON RELIGION OF THE APA (1993)

In 1993, The Committee had first approved the following:

Religious Problems:  Conflicts over questions of faith and doctrine. These should generally be handled by a trusted religious professional. 

Mental Disorders with Religious Content:  A. Some mental disorders are present with religious content. Ex: Some individuals with Obsessive Compulsive Disorder have reported scrupulous devoutness but the religion is used as a metaphor for the expression of compulsive requirements (Salzman, 1986). B. Some individuals with psychotic disorders present with delusion of being Christ or receiving direct communication from God. Even in these cases, the literature documents that there is often therapeutic value in addressing a person’s religious ideation (Bradford, 1985, Hoffman etal. 1990). 

Psycho-Religious Problems Not Attributable to Mental Disorder:  Psycho-religious problems involve conflicts that concern a person’s religious life and beliefs and that are not attributable to a mental disorder. Ex:  A frequently reported type of psycho-religious problem involves loss of a firmly held faith. Both religious and psychiatric issues are associated with such a loss. Another type of psycho-religious problem involves patients who intensifies their adherence to religious practices and orthodoxy. If a patient is newly religious, the therapist needs to help determine what potential conflicts exist between his former and current lifestyle, beliefs, and attitudes. 

Psycho-Spiritual Problems: A. Those related to the practice of institutionalized religion. B. Involve conflicts about a person’s relationship to the transcendent being (to be separate from or beyond the experience of the material universe). C. Problems that arise from a spiritual practice. D. Conflicts that arise from spiritual experiences and are not attributable to a mental disorder. Spiritual problems are usually handled by individuals proficient in the relevant spiritual teachings and practices. 

Types of Psycho-Spiritual Problems: A. Mystical experiences and B. Near-Death Experiences. 

Mystical Experience: is a transient extraordinary experience marked by feelings of unity harmonious relationship to divine and everything in existence as well as euphoric feelings, loss of ego functioning, alterations in time and space perception and the sense of lacking control over the event. 

A typical Mystical Experience: A. Includes a state of ecstasy B. A sense of union with the universe C. A heightened awareness transcending space and time. D. A greater sense of meaning and purpose in life. 

Previously numerous studies assessing the incidence of mystical or spiritual experience Back and Bourque (1970), Greeley (1974), Hood (1974), and Thomas and Cooper (1970), all support the conclusion reached by Gallup as reported in the New York Times (Smith, January 22, 1995, XII-N), 3:1, that 30% to 40% of the population have had mystical or spiritual experiences, which suggests that they are normal rather than pathological phenomena. (Please note this statistic is now 40% to 50% of the population as of 2000). (Cardena, Lynn & Krippner, 2000, p. 429). 

Near-Death Experience (NDE): is a profound subjective event experienced by persons who come close to death or who are believed dead and unexpectedly recover as a result of serious injury or illness, or who confront a potentially fatal situation and escape uninjured. 

A NDE includes:  A. Detachment from physical body. B. Peace and contentment C. Entering a transitional region of darkness D. Seeing a brilliant light E. Passing through the light into another realm of existence. 

A Mystical Experience includes:  A. ecstatic moods, B. Sense of newly gained knowledge. C. Perceptual alterations D. Delusions (if present) have themes related to mythology such as: death, rebirth, journey, encounters with spirits, demonic forces, and/or helping spirits, cosmic conflict, magical powers such as telepathy, clairvoyance, ability to read minds, move objects, radical change in society and divine union with God or Christ and E. No conceptual disorganization (Lukoff (1985) pp 166-169.

It was stated that the nursing profession in 1983 had already established a diagnostic category of spiritual distress to cover two treatment situations:  A. When religious or spiritual beliefs conflict with a prescribed health regimen B. When there is distress associated with a patients’ mental or physical inability to practice religious or spiritual rituals (Carpenito, 1983). 

The purpose of the new V-Code category would redress cultural insensitivity currently surrounding the treatment of religious and spiritual issues in the following ways:  A. Increase the accuracy of diagnostic assessments B  Reduce the occurrence of harm from misdiagnosis C. Result in improved treatment of such problems by stimulating clinical research D.  Encourage clinical training centers to address the religious and spiritual dimensions of human experience. 

It was also stated that a positive therapist response could determine whether the experience is integrated and used as a stimulus for personal growth or whether it is repressed as a bizarre event that may be a sign of mental instability. 

The new theory was created to put forward a non-pathological diagnosis to first-of-all recognize a condition, and then to put forward a theory about it. Theories are meant to be tested, and the most obvious test is whether applying the theory is helpful to the patient. 

However, when this V-Code was published, it was published only in this short one-inch form underlined and shown below. Also, the word Psycho was removed since it is not used to describe any other V-Code designation. 

V-62.89 Religious or Spiritual Problem was published in the 1994 DSM-IV:

Examples include distressing experiences that involve loss or questioning of faith problems associated with conversion to a new faith or questioning of spiritual values that may not necessarily be related to an organized church or religious institution. 

The APA essentially watered down all the research these three psychiatrists had proposed to them originally. The psychiatrists had the statistics that NDEs and Mystical Experiences were happening, which was a requirement to be published in the DSM-IV in 1994. However, the APA, as you can see, did not publish the research given to their Committee on Religion regarding the statistics or names of the two spiritual experiences – Near-Death & Mystical Experiences. 

The APA did not explain at the time of publication of the DSM-V so that psychiatrists, psychologists, therapists, or other professionals could understand the meaning of this V-Code. Neither was the 30-40% statistic explained that it was responsible for the acceptance of this material by the Committee on Religion. The reduction of this V-Code to a one-inch appearance in the DSM-IV saddened Herrick and all of those who were attending the nine-month psycho-spiritual training in California. Also, creating it as a V-Code instead of a diagnosis code indicates that therapists won’t necessarily use it because V-Codes are not reimbursable to them in their work. 

i and those attending the training were taught to provide a psycho-spiritual framework for a crisis after assessing with a differential diagnosis. These include:  A. Absence of organic cause B. Usually good pre-episode function C. Preservation of an observing ego. D. Sufficient inner strength E. Improved post-episode functioning (retrospective). 

Treatment Guidelines:  A. Provide spiritual framework B. Little or no medication C. Place in a sanctuary, if possible, rather than a hospital D. Decrease or discontinue the spiritual practice that might be worsening their condition E. Dietary changes (add heavier foods – more protein if they are vegetarians). F. Physical exercise G. Contact with nature H. Body therapy I. Team approach if possible. 

Individuals undergoing powerful Religious or Spiritual problem V62.89 diagnosis are at risk for being hospitalized as mentally ill. Some of the Varieties of Spiritual Emergencies (SEs) warrant this V62.89 diagnosis:

Religious or Spiritual Problem diagnosis (Lukoff, Lesson 3.1, p.3). These SEs are: A. Episodes of unitive consciousness peak experiences or mystical experience B. The awakening of Kundalini C. NDE’s D. Emergence of past-life memories E. Psychological renewal through return to the enter F. The shamanic crisis G. A synchronistic event H. Awakening of extrasensory perception (psychic opening). I. Communication with spirit guides and channeling J. Experiences of close encounters with UFOs K. Possession states. 

i was pleased that there were people who wanted the V-Code V62.89 put in the DSM-IV considering that it followed in the footsteps of Wiilliam James, Carl Jung and Abraham Maslow and the many others who have since come to say that there is something in all of us that is connected to the universe or God and that we must listen to individual experiences, which are real and which will provide proof to others that they are happening.

On August 12, 2005, I interviewed Robert Turner, PhD, of San Francisco California. Dr Turner was one of the writers and creators of the V-Code V62.89 Religious or Spiritual Problem that was placed by the American Psychiatric Association (APA) in the DDSM-IV in 1994. Dr. Turner was also my instructor in the nine-month training program in spiritual emergence syndromes in Sausalito, California in 1993-1994.

Dr. Turner told me that his group “presented a thirty-five-page paper in our proposal. We gave them all the literature reviews and statistics for Mystical Experiences and Near-Death Experiences, but they decimated the definition. They allowed the word spiritual to be used and were uncomfortable enough having to accept this category, but they completely deluded the whole meat of the V-Code by dropping the words mystical and near-death experiences.”

Dr. Turner continued, “I would have to engage clinicians on a personal level to help them see that they have had these experiences, that it would be important to get this out in the open and integrate this new awareness. That without this, it’s just another V-Code that they could care less about.” 

I stated, “It is discouraging to be asking an authority to validate something that the authority doesn’t believe in.” The conversation ended with him being emphatic about the following points:

1. “The APA people are going to hold onto their old beliefs. 
2. They will become more and more entrenched as the whole globe gets closer and closer to shifting to a new model. 
3. It’s a matter of seeing the bigger picture and adding as much energy as we can to this bigger picture. 
4. The new will eventually take over.
5. It will probably supersede our lifetime and by 2050 it will be well-established.”