Psychosis, Psychiatry and Psychospiritual Considerations

This book is heartily to be welcomed and well overdue. It makes a powerful and unequivocal claim, backed up by the author’s own research and citations that range widely across time and across cultures; it is a claim that has been made before – but not heeded in what can almost be seen as a collusion of deliberate deafness. The book’s theme needs to be heeded. The health and recovery, the life and hope, of countless individuals suffering under crushing mental health diagnosis, depend on its being heard. My hope is that this thorough restatement, has some chance of getting through.

The claim I refer to can be summarised as follows:

Framing psychosis as a biological illness is fallacious, and it should rather be seen as an aberrant variant of a universally available psycho-spiritual dimension of human experience.

This is a statement I can only heartily endorse.

Spittles sets out systematically what I regard as a demolition of the conventional psychiatric understanding of psychosis. The first section takes the hatchet to the current diagnostic apparatus, from its founding fathers, to the vacillating course of the DSM diagnostic manuals, wavering between psychodynamics and biology; latterly propelled in the biological direction by a symbiotic relationship with the pharmaceutical companies; ‘science’ ultimately reliant on an end of the rainbow belief in a definitive biological foundation for Schizophrenia.

The second section introduces the psychospiritual dimension which is the major theme of the book. Spittles uncovers a fascinating minority report within the heart of the American Psychiatric Association (APA) on psychospiritual lines, along with other relevant authorities such as Bucke, Deikman and Dean, who explored the phenomenology of mysticism and psychosis. He brings this discourse up to date with Lukoff’s valiant, but ultimately hopelessly watered down, efforts to get wayward spirituality recognized in DSMs 4 and 5.

The next section was the one to get my heart racing, where he forensically dismantles a succession of taxonomies purporting to distinguish spiritual from psychotic experiences. This lies at the centre of my own enterprise (more later), but he approaches it with a thoroughness that I can only marvel at.

The fourth section boldly asserts, (hear my applause from the sidelines), that the psychospiritual and psychopathological are indistinguishable. This position in no way diminishes a recognition of the real suffering and deficit of functioning that psychosis generally entails, nor the pressing need for healing and support by those who find themselves in a hellish unreality. However, it simultaneously acknowledges the strong link with the human capacity for accessing non-ordinary states of consciousness which have the potential to be life-enhancing and indeed transformative. This uncompromising examination poses a stark challenge to psychiatry; the strong likelihood, that it is the nature of support and frameworks for understanding given to those venturing beyond normal reality, that is critical in determining which way it goes; enduring psychosis or, even in the case of extreme experience, a life-enhancing outcome. There is indeed an extensive body of research, emanating from South London and Maudsley (SLAM), that reinforces this conclusion (e.g. Peters 2010, quoted by Spittles, and Heriot Maitland et al 2012, not quoted).

This section further lays bare the contradictions inevitably encountered as psychiatry is forced to accommodate diverse and multicultural populations, by adding in cross-cultural considerations. These inevitably involve accepting as culturally normative experiences that would be summarily diagnosed as psychotic in a Western population. Added to which is a fascinating exploration of Tibetan Buddhist understandings of mental health and the spiritual realm, which essentially turns Western psychiatry on its head.

Lured by the overall section heading of ‘Understanding psychosis’, I was by this time at the edge of my seat for the denouement – what was Spittles’ conclusion about what is going on in this fascinating area of overlap between spiritual and psychotic experience? I wanted to hear his conclusions about this and how they compared with mine. I wanted to know ‘whodunnit’.

I must here declare my interest. As already indicated, I too have delved in these areas, and Spittles quotes me and from chapters of my edited books (Clarke 2001 and 2010). I too rejected the prevailing wisdom in the 1990s when my investigations started, that distinguishing psychosis from spiritual experience was ‘the question’. My interest was founded in my practice as a clinical psychologist in a psychiatric rehabilitation service, where therapy with people with long-term diagnosis of Schizophrenia revealed earlier experiences that matched those of the mystics whose testament I encountered in my earlier career, in medieval history. In the cases of my patients, what had gone wrong?

I pondered the phenomenological roots of the experiences they told me about. What was the commonality between being able to read thoughts; thoughts beamed into the mind from a satellite; demon possession, and the TV relaying personal information? I came to the conclusion that it was a sense of boundarilessness of the mind, leading both to the accessibility of other’s consciousness and total vulnerability to invasion; however, boundarilessness is also behind the mystic’s apprehension of unity with the universe or the divine.

I searched for frameworks for this phenomenon, and found one in Interacting Cognitive Subsystems, which offered a model of the individual as process, moving between being founded in individual self-consciousness, and a state of relationship. There is more on this in Clarke (2008), as well as chapters in the two books already quoted, but this is not something Spittles picked up on. For me, it has provided a foundation, both for clinical work in the NHS, and as a founder member of the Spiritual Crisis Network (www.spiritualcrisisnetwork.uk), where we provide support to those who frame their anomalous experiencing in this manner.

After recovering from bedazzlement at the breadth and depth of highly relevant erudition throughout the book, and then my disappointment in the rather vague way it fizzled at the end, just with a plea for more research, I did note another couple of omissions, more significant than that of my own insights. A notable omission is Gordon Claridge and collaborators’ monumental work on elucidating the dimension of openness to anomalous experiencing in Schizotypy research. A related area is the role of trauma in facilitating that openness. The research demonstrating the high incidence of trauma in those presenting with psychosis to the services is another nail in the coffin of conventional psychiatry, as it provides an environmental, as opposed to, a biological cause. The last omission is less well evidenced, but I think crucial in understanding the mechanism of the ‘psychospiritual’ that is at the heart of Spittles’ book. This is the experience of relationship with that which is beyond precise knowing that lies at the heart of spirituality, and the chalk and cheese relationship between knowing through experience, which is how we know relationship, and factual, scientific knowing.

These last are comments rather than criticisms. My overwhelming feeling, on reflection, is one of heartfelt gratitude that Spittles has come up with such a thorough argument for a re-alignment that takes the spiritual dimension seriously. This raises the hope that those who get lost on their ‘hero’s journey’ through the depths of the psyche, might be helped on the path to growth and transformation wherever possible, as opposed to being stigmatised with a label that demolishes sense of self and thus, a future.

Clarke, I. (2010) Psychosis and spirituality: the discontinuity model. In Psychosis and Spirituality: Consolidating the New Paradigm, 2nd edn: pp. 101–115. Wiley.

Clarke, I. ( 2008) Madness, Mystery and the Survival of God. Winchester:'O'Books.

Clarke, I. (Ed.) (2001) Psychosis and Spirituality: exploring the new frontier. Chichester: Wiley.

Heriot-Maitland, C., Knight, M. and Peters, E. (2012). A qualitative comparison of psychotic-like phenomena in clinical and non-clinical populations. British Journal of Clinical Psychology. 51, 37-53. doi: 10.1111/j.2044-8260.2011.02011.x

Peters, E.R. (2010). Are Delusions on a Continuum. The Case of Religious and Delusional Beliefs. In I. Clarke, Ed. Psychosis and Spirituality: consolidating the new paradigm. (2nd Edition) Chichester: Wiley