Emergency or Psychosis?

‘Psychosis’ is a commonly understood descriptive term for the profound altered state of a person who is showing radical changes in behaviour and personality, and a significant loss of touch with consensus reality.

“There is no way of establishing absolutely clear criteria for differentiation between Spiritual Emergency and psychosis since such terms themselves lack objective scientific validity.” “Psychiatric labels such as ‘schizophrenia’, ‘bipolar disorder’ and ‘paranoia’ are ways of categorising particular experiences and behaviours which have no supporting evidence of any biological cause.” *1

“Since traditional psychiatry makes no distinction between psychotic reactions and mystical states, not only crises of spiritual opening, but also uncomplicated transpersonal experiences often receive a pathological label…”

“Under present circumstances, the use of diagnostic labels obscures the issues and interferes with the healing potential of the process. In addition to its socially stigmatizing and psychologically damaging effects, it creates a false impression that the disorder is a precisely identified disease and serves as a justification for suppressive medication as a scientifically indicated approach.”

There is much evidence to show that when people’s experiences are rejected and invalidated as random symptoms of illness, they are more likely to go on to become chronic conditions.*2 In contrast, many tribal cultures would view the same experiences as an important process that has benefits for the tribe. *3

Some transpersonal writers take the view that psychosis occurs in people whose ego has been greatly disturbed at some point and has not yet fully formed – often due to early trauma. These altered states are sometimes described as being ‘pre-personal’, and are not considered genuine mystical experience. It is believed that the person is experiencing mental illness which needs to be stopped as soon as possible. *4

Transpersonal altered states are thought to occur in people with more intact egos that are temporarily let go of, or transcended. These altered states are described as mystical experience, unitive consciousness, spiritual opening, spiritual crisis or spiritual emergency (SE). The recommendations here are for the process to continue unimpeded.

Transpersonal theorists designed tables with the similarities and distinctions between psychosis on one side, and SE on the other side. However more recent case-study research has shown that clear distinctions between these cannot be made. “Rather most of these participants experienced some degree of both categories of experience – both mystical and psychotic. Some expressed having experiences that fit mostly in one category while still occasionally or subtly having experiences in the other category; and others seem to have experienced no clear division at all, having experiences from both sides relatively equally and even simultaneously”.*5

It is probable that the same process underlies psychosis and SE. As there is increasing research that demonstrates a direct relationship between trauma and psychosis – it is likely that the differences in how a crisis manifests, correlates with a person’s level of previous trauma. Factors include the degree of personal or intergenerational trauma, outsider status and multiple adverse childhood/teenage experiences. *6

There is also correlation between extreme state experiences and current ‘irreconcilable’ conflict. In other words “…conflicts and anxiety which are too great for the individual to bear and at the same time are insoluble on any other level”.*7 Unusual perceptions, beliefs and experiences can be very confronting and may conflict with a person’s worldview or that of the people around them. Occurrences such as psychic opening or shamanic experiences can be very hard for people to cope with who have had little or no prior cultural knowledge or preparation.

The form that the altered states take and their outcome, also depend on whether the person has access to ‘sanctuary’ – a place with a warm, compassionate atmosphere.

The Jungian psychiatrist, John Weir Perry, founded the residential facility ‘Diabasis House’. Patients were diverted there from the Emergency Department of the state hospital in their first, second or third episodes of psychosis. They were given the space to go through the extreme state experience in a safe, understanding environment mostly without the use of anti-psychotic medication. They shared their experiences with the same one or two staff daily.

Perry wrote a book ‘Trials of the Visionary Mind: Spiritual Emergency and the Renewal Process’. In it he described the visionary experiences that people went through, where many identified with archetypal themes such as such as birth, death and rebirth, a spiritual figure or saviour, the sacred marriage, the birth of the divine child. He found that when the experiences were received by a non-judgemental and interested listener, the ‘renewal process’ was able to progress toward completion.

The support given at Diabasis House resulted in a remarkable improvement on pre-episodic functioning and wellbeing. The same outcomes have been found in places using similar approaches.*8

Rather than trying to decide whether someone is ‘psychotic’ or is experiencing a ‘legitimate’ spiritual emergency, the more important questions concern appropriate, responsive support. Appropriate support involves the inclusion of the existential-spiritual-transpersonal dimension, whenever it arises.

We in SEN Australia think it imperative to regard any such process as purposeful rather than as meaningless symptoms of illness….and to work with the process as meaningful, symbolic, archetypal, developmental, initiatory, transformative, relational, social and transpersonal.

Criteria of a Medical Nature

It is important to recognise that altered states of consciousness can also be caused by medical conditions, such as a brain tumour, infection, drug reactions, diseases of other organs, or an electrolyte imbalance. Appropriate medical examinations are recommended to rule out biological causes before the Spiritual Emergency (SE) framework can be considered.

Medical Criteria

  1. Clinical examination and laboratory tests detect a physical disease that causes psychological changes
  2. Impairment of intellect and memory, clouded consciousness, problems with basic orientation (name, time, place), poor coordination
  3. Confusion, disorganization, and decreased intellectual functioning interfere with communication and cooperation.

Spiritual Emergence Criteria

  1. Negative results of of clinical examinations and laboratory tests for physical causes
  2. Intellect and memory qualitatively changed but intact, consciousness usually clear, good basic orientation, coordination not seriously impaired
  3. Ability to communicate and cooperate. Deep involvement in the inner process might interfere with this, and some people experience the need to be silent for short or long periods


 This quote and the following three quotes are from Stanislav and Christina Grof authors of ‘The Stormy Search for the Self’.
2. Loren Mosher and Voyce Hendrix, ‘Soteria: Through Madness to Deliverance’, and John Weir Perry, ‘Trials of the Visionary Mind: Spiritual Emergency and the Renewal Process’. Resource List (on the webpage) for Michael Cornwall.
3. SEN webpage ‘Forms of Spiritual Emergence’ – ‘Shamanic Crisis’.
4. John E Nelson, ‘Healing the Split.’
5. Paris Williams “Rethinking Madness: Towards a Paradigm Shift in Our Understanding and Treatment of Psychosis”
6. The number and degree of ‘Adverse Childhood Experience’ is also shown to have an effect. John Read ‘Childhood Adversity and Psychosis: From Heresy to Certainty’. ‘Trauma, Psychosis and Dissociation’ by Richard Bentall, Anthony Morrison, John Read. (On the website madinamerica).
7. Rollo May. ‘The Meaning of Anxiety’
8. Arnold Mindell ‘City Shadows; Psychological Interventions in Psychiatry’