illustrate spiritual emergence phenomena. Innumerable friends offered suggestions and encouragement. Thank you all for your love and attention.
Introduction: David Lukoff, Ph.D.
Just as the ink is drying from the newly issued fourth edition of the Diagnostic and Statistical Manual (DSM-IV), which for the first time contains the category of spiritual problems, here appears the first-ever book devoted exclusively to the diagnosis and treatment of spiritual problems. Religious problems, which make up the other half of the official DSM-IV diagnostic category, "Religious or Spiritual Problem," have received much more attention in the clinical and research literature. There's a handbook (Wicks, Parsons, and Capps, 1985) and four journals devoted to pastoral counseling, several more to "Christian psychiatry," as well as professional organizations and conferences that address religious problems. Unfortunately, there is nothing comparable for spiritual problems. The Journal of Transpersonal Psychology has published several articles on spiritual problems (Lukoff, 1985; Ossoff, 1993; Waldman, 1992), but there is no journal devoted to this topic. This is surprising since surveys have shown that mental health professionals routinely see clients with spiritual problems. In one survey, psychologists reported that 4.5% of their clients brought a mystical experience into therapy within the past year (Allman et aI., 1992). Thus mental health professionals often work with spiritual problems, but many do not have appropriate training. Scott Peck, a psychiatrist who has written several books on the spiritual dimensions of life, including the best selling The Road Less Traveled, gave an invited address which drew a standing-room only crowd at the 1992 Annual Meeting of the American Psychiatric Association. He pronounced that psychiatrists are "ill-equipped" to deal with either religious /spiritual pathology or health. Continuing to neglect religious/spiritual issues, he claimed, would perpetuate the predicaments that are related to psychiatry's traditional neglect of these issues: "occasional, devastating misdiagnosis; not infrequent mistreatment; an increasingly poor reputation; inadequate research and theory; and a limitation of psychiatrists' own personal development" (Peck, 1993, p. 243).
Fortunately, in addition to the incorporation of spiritual problems as a diagnostic category in the DSM-IV, progress is occurring on other fronts. Francis Lu, M.D., has been working with the American Psychiatry Association and the Residency Review Committee to develop new guidelines for the Essentials for Psychiatry Residency Training, which sets forth the criteria used in the accreditation of all residency programs in the U.S .. These proposed criteria would be used to assess whether psychiatry residency programs are providing training in current American cultures and subcultures, especially related to gender, ethnicity, sexual orientation, and religious/spiritual beliefs. The adoption of these criteria would mandate that training programs for psychiatrists explicitly address religious and spiritual problems. In psychology, others such as Vaughan (1991), Krippner and Welch (1992) and Shafranske and Maloney (1990) have been bringing spiritual issues to the attention of clinical psychologists. Reviews of the research on psychoreligious and psychospiritual dimensions of healing (Lukoff, Turner, & Lu, 1992; 1993) indicate that recognition of these factors has been increasing in all of the allied mental health professions including rehabilitation, addiction counseling, nursing, and social work.
Like Dr. Bragdon, I also underwent the type of spiritual problem known as a spiritual emergency which temporarily impaired my ability to function in consensual reality and everyday social life. Also, like Dr. Bragdon, I was able see the experience through to a positive resolution with the support of my friends and family, obviating the need for traditional psychiatric intervention that might have resulted in hospitalization or medication. Since becoming a licensed psychologist and working at Camarillo State Hospital, the UCLA Clinical Research Center for Schizophrenia and its associated clinic, and currently at the San Francisco VA Day treatment Center, I have often found myself face-to-face with individuals in the same state of consciousness that I had been in: convinced that they were reincarnations of Buddha and Christ (or similar great spiritual figures), reporting communication with many spiritual and religious figures, believing they had a messianic mission to save the world, and preparing a "Holy Book" that would form the basis for a new religion. Since writing about this experience in Shaman's Drum (Lukoff, 1991), and giving workshops on "Psychosis; Mysticism, Shamanism or Pathology?" at the Ojai Foundation with Joan Halifax, I have been contacted by many other mental health professionals and ones in training who have told me about their similar experi-ences. As in my own case, these spiritual emergencies served as "callings" into their vocations as psychologists, social workers, etc. Dick Price, co-founder of Esalen, who seeded the development of the Spiritual Emergency Network by providing staff support and office space for its founding at Esalen, also had such experiences. However, he was not as lucky as Dr. Bragdon and I were, and twice landed in a psychiatric hospital. The harsh treatment he received at these facilities led to his support for creating SEN. Similarly, Christina Grof, who founded SEN, underwent a spiritual emergency.
However, most spiritual problems are related to spiritual emergence rather than emergency. Many spiritual practices have been observed to induce some distress as part of the process, (e.g. kundalini as part of yogic practices; anxiety, derealization and depersonalization during meditation practice.
In these instances, individuals might choose to consult a spiritual teacher about these problems rather than a mental health professional. It should also be mentioned that spiritual experiences are not spiritual problems per se Most spiritual experiences do not require diagnosis or intervention by mental health professionals. Some people who have mystical experiences or intense opening experiences during meditation, for example, do not experience distress. They may be able to immediately integrate these spiritual experiences into their lives. However, research on near-death experience (NDE) , which is the most wellresearched spiritual problem, shows that most individuals experience anger, depression, and interpersonal difficulties after the NDE, and therefore could benefit from therapy with a sensitive and knowledgeable clinician.
Many of the founders of psychology and psychiatry have been "wounded healers" whose "creative illness" involved intense spiritual problems that ultimately were transformative (Goldwert, 1992). The sensitive treatments for spiritual problems, as outlined in Dr. Bragdon's book, can be administered in any setting, whether a therapist's office, a 24-hour residential facility, family home or ashram. This book will enable readers and those they are helping to survive the perils of the spiritual path and reap the benefits of a consciously lived spiritual life.
Preface
This sourcebook was written for professionals and paraprofessionals in the field of human services as a guide for helping someone with spiritual problems. Spiritual Problems is a new diagnostic category in the Diagnostic and Statistical Manual (DSM-IV) arising out of the profound disorientation and instability that sometimes accompany spiritual experience. In its most intense manifestation, lasting between minutes and weeks, spiritual problems can create a crisis. In this case, spiritual emergency, it appears similar to an acute psychotic episode excepting that the episode eventually has a positive transformative outcome (Dabrowski, 1964; Grof, 1985; Lukoff, 1986). People with spiritual problems or in spiritual emergency have needs for care usually unavailable from therapists, doctors, or in hospitals dealing with more well-known mental disorders.
Although this sourcebook is written for medical practitioners, healers, professional therapists, pastoral counselors, paraprofessional people working in crisis situations, and students in training for these positions, it will also be useful to leaders and teachers in spiritual and religious communities who are faced with the care of people with spiritual problems catalyzed, in part, by their spiritual practice. The sourcebook is written from a "transpersonal" orientation - it assumes that beyond our normal ego functioning there are dimensions of superior perception and function. [See Appendix E for a glossary of terms]. When we enter the transpersonal domain we can access intuitive wisdom, creativity, brilliance, compassion as well as extraordinary energy,
