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Religious Experience and Psychiatry:

Analysis of the Conflict and Proposal for a Way

Forward

Mohammed Abouelleil Rashed

Abstract: Attempts to distinguish religious from pathological psychotic states have received considerable attention in the recent literature. It has been proposed that the distinction can be drawn in terms of subjects’ evaluation of their experiences and ultimately outcome, conceived of as action enhancement or failure. Such an approach does not take in to account the contexts where the meaning of ‘good’ or ‘bad’ outcome are defined and hence are an overriding factor in subjects’ evaluations of psychotic experiences. This suggests a need to examine the contribution of these contexts to the process of evaluation. In this paper, and with reference to an illus- trative case study, I attend to psychiatry—an authority on unusual experience and belief—demonstrating an essential conflict between religious experiences and the assumptions and procedures of psychiatric practice. It is argued that the theoretical commitments of psychiatric science, the values embedded in the social dysfunction criterion, and a deficient understanding of culture promote the pathologization of unusual experiences and contribute to the generation of negative outcomes. I conclude with a proposed solution: by adopting an open-ended process of communication with the aim of achieving a degree of linguistic resonance among the involved parties, clinicians would be fostering mutual change rather than one-sided judgment. This would in- crease the chances of securing agreement and would put us in a better position to plan noncoercive intervention. Implications of the proposed approach for diagnosis and management of risk are discussed.

Keywords: spiritual experience, psychosis, harm, values, social dysfunction, cultural congruence, com- munication, linguistic resonance

The enlarging domain of psychiatric intervention is frequently associated with the undue medicalization of unusual experiences. In such a climate, it becomes of ut- most importance to carefully choose appropriate candidates for the psychiatric gaze. This suggests a need to draw a distinction between religious experiences (with psychotic form) and pathologi- cal psychotic experiences. As Jackson and Fulford (1997) maintain, “spiritual experiences, whether welcome or unwelcome, and whether or not they are psychotic in form, have nothing (directly) to do with medicine. It would be quite wrong, then, to “treat” spiritual psychotic experiences with neuroleptic drugs, just as it is quite wrong to “treat” political dissidents as though they were ill” (p. 42). The distinction, however, is a difficult one to make.

As early as 1902, William James recognized that certain varieties of religious experiences share im- portant areas of correspondence with psychotic ill-

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ness (James 1902). He considered mystical experi- ences and insanity to spring from the same “mental level,” where “seraph and snake abide there side by side” (p. 411). He wrote that there are certain features common to both states, such as a sense of ineffable importance in otherwise insignificant events, voices, visions, and control by external powers, but whereas in the former the dominant emotions are consoling, the meanings optimistic and the powers ultimately benevolent, in the latter the emotions are negative, the meanings dreadful and the powers malevolent (p. 410). James consid- ered religious experience to come from a “wider self,” a self-conscious, non-human life. A strategy James employed to support this notion was to consider the fruits of religious experience. On this account, the positive fruits of religious experience are an indication of its divine origin, and serve to separate these experiences from those associated with what he called ‘insanity.’

The issue was revisited by the philosopher and psychiatrist M. Drury (1996), who acknowledged the similarity between some religious states and ‘madness.’ Drury, however, did not consider the ‘fruits of the experience’ to be sufficient for making the distinction, because that brings forth the in- tractable difficulty of deciding what consequences count as positive and according to whom.

We could consider the recent debate on this is- sue, specifically the influential account of Jackson and Fulford (1997), as an attempt to solve the intractable difficulty Drury alluded to. Jackson and Fulford (1997, 2002) maintain that we can- not make the distinction between spiritual and pathological psychotic phenomena (good and bad psychosis) by appealing to form or content of the experience and an account that places the experi- ence in the agent’s field of action becomes neces- sary. Good or bad from that perspective “concerns the way in which [the phenomena] are embedded in the structure of the values and beliefs by which the actions of the subjects concerned are defined” (2002, 388). In spiritual psychotic phenomena action is enhanced, whereas in pathological states there is a radical failure of action (Jackson and Fulford 1997, 55).

An important critique of Jackson and Fulford’s account was put forward by Marzanski and

Bratton (2002). They argue that spiritual experi- ence should not be confined to the “benign and supportive” because that eliminates the suffering that, in some theological traditions, is recognized as an essential part of the (ultimately good) spiri- tual journey (p. 367). Spiritual experience, then, need not be action enhancing (in a materialist manner) and may in fact be associated with dis- empowerment of the subject. Furthermore, even if an anomalous experience is action enhancing that does not necessarily make it spiritual. The distinction between spiritual experience and “men- tal disorder,” therefore, requires a “theological criterion” (p. 368). However, restricting such a judgment to theological criteria, as Jackson and Fulford (2002) maintain, “begs the question of whose theology we are to bring to the task—the client’s, the clinician’s, that of the wider culture, or that of the subculture?” (p. 389). This is a valid criticism, but the essence of Marzanski and Bratton’s argument prevails: understanding what constitutes a good or bad outcome—in fact, the very meaning of good and bad—requires an appeal to consensual (and relative) values, and these val- ues are—ultimately—over and above the subjects’ evaluation of their own experiences. Even if an experience is action enhancing—within the frame- work of the subject’s values and beliefs—we are still left with overarching contextual factors that determine how the consequences of these actions will be received, and whether such consequences will be considered ‘good’ or ‘bad.’

Essentially, then, whether an experience is spiritual or pathological transcends the confines of individuals’ incorporation of experiences in their framework of values and beliefs and involves a process of communication with their (sub)cultural group and—crucially—the relevant authorities (theological, medical, etc.). If we accept that, then the question is not “whose theology we bring to the task” but, more generally, what interpreta- tive frameworks are available for the subject and how the aforementioned parties respond to those interpretations and to the consequent outcomes. In other words we must attend to context and to the process of communication as it is there that the ex- perience is evaluated and the outcome determined. To the extent that this process is open ended and

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aimed at securing some common ground among the involved parties, we can expect a convergence of values, a potential for positive outcomes, and— in a clinical context—the possibility of noncoercive intervention.

This paper, therefore, takes off where the afore- mentioned debate ends: the realization that an appeal to some independent authority (theological, medical, etc.) is an inevitable aspect of the process whereby experiences and actions are evaluated. Insofar as this is true, it becomes important to ex- amine the assumptions and procedures underlying the practices of these authorities with the purpose of ascertaining their effects on the process. In writing this paper, I have two purposes in mind. The first is to examine psychiatry, an authority on unusual experience and belief. The diagnostic process in psychiatry frequently hampers the possibility for an open-ended process of commu- nication for reasons to do with (1) the implicit prioritization of materialist values embedded in the psychiatric manuals’ social dysfunction criterion, (2) a theory that remains secure in an empiricist/ positivist framework, thus devaluing claims of alternative origins to (psychotic) experience, and (3) a misapplication of the cultural congruence criterion. These three factors—if not explicitly at- tended to—may be implicated in the generation of negative outcomes, of harm. Preceding the above is a brief case study of a young man undergoing what he believed to be religious experiences; the case will serve as a constant reference point to the ensuing discussion.

The second purpose in writing this paper is to propose a way out of this conflict. This requires a shift from assessing a verbal report of an ex- perience in terms of its representational truth to thinking of it as a description that stands or falls according to how well it resonates with the wider community generally and the involved parties specifically. Within such a perspective, an open- ended process of communication conducted with the purpose of achieving a degree of linguistic resonance among the involved parties becomes an essential prerequisite for noncoercive, respectful intervention.

The Case of Femi Femi is a 29-year-old man who was born in a

West African country. He has been living with his father in the United Kingdom for the past 15 years. Two years before this episode, his mother left the family and returned to Africa, an incident that he insisted had no negative bearing on him. Before coming to the attention of mental health services, he was reportedly in good health and had no past medical or psychiatric history. His circumstances are no different from many other people of his age and social standing: after completing high school, he did a number of jobs until he finally settled in the sales section of a department store. He has several close friends and recently had been in a relationship. According to both Femi and his father, he has always been religious. He attended weekly sermons at a Pentecostal church in London, his father’s church, and seemed inclined to adjust his life to Christian teaching.

Two months before admission, he began miss- ing the weekly sermons and instead would spend long hours reading the Bible. He became disillu- sioned with his church, describing their sermons as “empty” and “uninspiring.” Around that time, he got in touch with another church in his native country, one that emphasized a personal under- standing of God through experience. He began a gradual process of isolating himself, engrossed in reading and listening to recorded sermons. He got rid of many of his possessions, justifying that by saying he wants to purify himself of material needs. He stopped going to work and made a habit of daily extended walks. He avoided going to his father’s church, claiming that there is no point or value in going there anymore. Four weeks before admission, he began to have intense experiences where he would hear God talking to him, consol- ing, advising, and at times ordering him to get rid of his possessions. He began having a direct expe- rience of the ‘Spirit’ in his body, to the point—at times—of feeling “taken over.” He surrendered to these experiences and did not doubt their au- thenticity at any moment. His father was hugely concerned by these experiences and by what he described as an unexplainable and sudden change in behavior. He tried to dissuade him from pursu-

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ing these new-found practices and appealed for support from the London-based church. His father and the church pastor considered Femi’s behavior to be harmful, excessive, and not endorsed by the church. A few days before admission, he began a prolonged fasting episode to “further cleanse his soul.” He was physically challenged by the fasting and was found confused and disoriented in a pub- lic place, upon which—after police intervention— an ambulance was called and a mental health act assessment arranged.

When he was assessed by the psychiatrist and social worker he said that for the past 4 weeks he had been in direct communion with God, that God had spoken to him telling him to get rid of his belongings, give up his job, fast, and change his life as a way of getting closer to ‘Divine truth.’ When the clinicians challenged the authenticity of the voice, he responded that he has no doubts it is from God, that he hears it in the space around him, and that it is entirely separate from his self. He also reported, upon direct questioning, that he sometimes experiences his actions as directly controlled by God, that occasionally his actual movements cease to be under his volitional con- trol and are ‘imbued with the Spirit.’ This was particularly so on his extended walks: he would suddenly find himself embarking on a walk, and would literally feel the ‘Spirit’ moving his body. He said that he finally understands what God is and felt on to something significant in his life. He was considered to present with second-person auditory hallucinations, command hallucinations, volitional passivity, and significant risk to self in the context of recent social/occupational deteriora- tion and in the absence of validation by his father and the church and was consequently placed under section ‘2’ of the mental health act.

After admission, he continued to resist all forms of treatment. He was unable to grasp the reason for his incarceration and considered the whole process to be a test from God. One week into the admission and after mental state assessments and nursing observations confirmed the persistence of the previously mentioned psychotic symptoms, the clinicians were convinced that a diagnosis of ‘acute psychotic episode’ is justified, upon which treatment was enforced on him. A number of days

later, he finally accepted treatment, and 2 weeks after that he acknowledged, for the first time, that he might have been ill. In terms of his symptoms, he no longer heard the voice of God, no longer felt the expectancy of a major change in his life, and was transformed to an unsure young man: unmotivated and apathetic.

Justifying Psychiatric Intervention: Social Dysfunction and the Absence of Cultural Congruence

According to the DSM-IV (American Psychi- atric Association [APA], 1994) the

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