5. Non-Medical Models: schizophrenia as a spiritual/mystical emergency

Many people are diagnosed with schizophrenia when they're in the midst of an intense, inner experience that is loaded with religious content. It is quite common for schizophrenics to report that they have been in communication with God or a higher being, and have been given some kind of messianic mission to fulfil.[1] Personalised religious beliefs and fantastic stories of internal conversations with deities and saints are common signs that lead to diagnoses. But the psychiatrists who make these diagnoses are mistaken. These are not signs of mental illness, they are signs of spiritual/mystical emergency. Unfortunately, psychiatrists are not trained to understand this phenomena.

In fact, psychiatrists are poorly equipped to understand any kind of speculative thinking about the meaning of life. This psychiatric knowledge deficit is particularly evident in areas associated with religious thinking, and it presents distinct dangers for naive patients. Some psychiatrists have recognised this and written despairingly about their colleagues.

I am quite convinced that a most certain way for a person to acquire a label of schizophrenia is to come before a clinician and talk about certain kinds of topics, these include the occult, ESP, religion, God, and the general range of metaphysical phenomena. I do not really think that how one talks about these things has much to do with whether or not he is given the diagnosis. He can be quite coherent and ordered in his speech, follow the rules of grammar and logic, and yet if he expresses serious concern with, or some kind of excitement in, these topics, he is on his way to winning the label.[2]

Many traditional mystical practices, and even conventional religious observances, can easily fit the symptoms of schizophrenia. It is quite common, for instance, for ordinary Christians to demonstrate thinking patterns and behaviours that are very similar to schizophrenic symptoms when they hold conversations with God in the form of prayer. This raises questions about the competency and the consistency of psychiatrists when they are required to make assessments of peoples' religious beliefs.

Psychiatrists are scientists, or so they claim, and their professional training could be expected to lead them to the view that all religious beliefs are irrational superstitions hanging over from pre-scientific times. But a closer look at psychiatric attitudes shows the profession is deeply confused on the issue of religion. On the one hand there is evidence that individual psychiatrists are strongly influenced in their professional decision-making by their own religious upbringing.[3] On the other hand there are indications that, despite having respect for religious institutions, psychiatrists remain true to their scientific identity and show little respect for the beliefs that drive those institutions.

A survey of Melbourne psychiatrists has found that religious upbringing influences psychiatrists in their treatment decisions. Researchers set out to determine whether the differing theological perspectives of the Catholic, Protestant and Jewish faiths might be reflected in decisions by psychiatrists when choosing between somatic or talking forms of therapy.

Their hypothesis argued that if the psychiatrists’ religious beliefs included a source for the control of human experience that is external to the individuals concerned, these psychiatrists would be disinclined to encourage patients to take personal responsibility for their mental state by using talking therapy. Instead they would use somatic treatments such as drugs and electroconvulsive therapy.

In comparing theological perspectives about internal and external controls for human behaviour the researchers found ‘that both Protestantism and Judaism are paradoxical here, whereas Roman Catholicism much more clearly places the locus of responsibility as external to the individual’.[4] They predicted that Catholic psychiatrists would therefore favour somatic forms of treatment, while Jewish and Protestant psychiatrists would prove to be statistically ambivalent in their choices of treatment. The survey covered 74 per cent of all Melbourne psychiatrists. Of those surveyed it found that 100 per cent of Catholics, 53.3 per cent of Jews and 55.5 per cent of Protestants practised somatic forms of treatment.

If psychiatrists are so dramatically influenced by religious affiliation in their treatment decisions it is fair to assume they are also influenced in their diagnostic decisions. However, in regard to diagnosing schizophrenia, neither DSM-IV nor the ICD-10 make any provision to safeguard against this bias. There are no differential diagnostic guidelines to distinguish normal religious/mystical practices from schizophrenia.[5] That is, the manuals do not give detailed descriptions of authentic religious beliefs and mystical experiences and show how these differ from the symptoms of schizophrenia.

The only attempt at differentiation in DSM-IV is a definition of 'delusion' which excludes beliefs which are ordinarily accepted by the person's culture as articles of religious faith. It seems that if religious beliefs are ordinarily accepted by others, then the person's mind is healthy; if they are not, it is diseased. In distinguishing mental health from mental disease in this way, by the popularity of religious beliefs instead of by the authenticity of the ideas behind the beliefs, psychiatrists imply that the substance of mainstream religious beliefs is indistinguishable from schizophrenic delusions.

They also imply they are unwilling to antagonise mainstream churches by diagnosing ordinary followers and that they are only interested in diagnosing solitary individuals. This means that the relationship of candidates-for-diagnosis to their churches is sometimes critical. It puts people who undergo mystical experience directly in line for diagnosis.

Historically, mystics have had ambivalent relationships with the religious movements to which they've been affiliated. This is particularly true of monotheistic religions like Christianity. Mystical experience has been traditionally associated with spiritual guidance, the discovery/uncovery of religious knowledge, communion with a deity, healing, the arts, and prophecy. But perhaps more often it has also been viewed as heresy.

Reports of mystical experience to religious peers can be greeted alternatively as a welcome refreshment for collective faith or a threatening sign of corruption. The reception seems to depend more on the place and the time, and the preparedness of peers to receive, than with the content of the experience. This perennial ambivalence towards mystics makes the psychiatric test of soundness—whether religious beliefs are ordinarily accepted by the person's culture as articles of religious faith—somewhat arbitrary. Should a disease be indicated by whether or not Christianity is currently in need of mystical inspiration? This type of test, which is implicit in the diagnostic procedures for schizophrenia, isn't the way hard-nosed scientists normally go about their work.

But having said that, the point should also be made early on in this discussion that most people who come in contact with psychiatry, and who are subsequently diagnosed with schizophrenia, usually do so because they are undergoing acute psychological distress, and/or they are causing distress to others. It is probably fair to assume, therefore, that most people who are diagnosed and treated when they are undergoing a spiritual/mystical emergency demonstrate a low level of competency in handling a mystical experience. But this concession still doesn't mean they have a mental disease, or that they require any form of psychiatric attention.

In comparing modern schizophrenics with mythological heroes, Joseph Campbell, the great mythologist, summed up his opinion this way: ‘our schizophrenic patient is actually experiencing inadvertently that same beatific ocean deep which the yogi and saint are ever striving to enjoy: except that, whereas they are swimming in it, he is drowning’.[6]

Swimmers and non-swimmers might both be in the same waters, and their splashing might look the same to an untrained observer, but what is pleasurable exercise to one could be a life-or-death struggle for the other. The modern tragedy, however, for both swimmers and non-swimmers alike, is that all of them are now routinely drowned by the rescue efforts of an over-zealous and incompetent life-guard. This incompetence is largely due to ignorance about the nature of mystics and the mystical experience.

[1] M. Goldwert, ‘The Messiah-Complex in Schizophrenia’, pp. 331–5.

[2] Kenneth E. Lux, ‘A Mystical-Occult Approach to Psychosis’, p. 95.

[3] Gillian Fulcher and Gary D. Bouma, ‘Appendix A: the religious factor and modes of psychiatric treatment’, pp. 221-231.

[4]  Ibid., p. 226.

[5] For a proposal to add this differential diagnosis to the DSM see, David Lukoff, ‘The diagnosis of mystical experiences with psychotic features’, pp. 155–82.

[6] Joseph Campbell, ‘Schizophrenia—the Inward Journey’, in Myths to Live By, pp. 219–220.