Supporting Someone in a Spiritual Emergency

The following is written from the experiences of people who have supported others in Spiritual Emergency or have been supported themselves. We recommend reading our webpage ‘Emergency or Psychosis’ before reading this one.

Before deciding whether to go ahead and support someone, a medical examination is highly recommended. It is important not to miss or neglect conditions that can require medical attention, such as infections, poisoning, tumours, or medication reactions.

When in some people Spiritual Emergence intensifies into an Emergency those who support them often feel unusually challenged. When meeting this challenge it is helpful to remember that you are potentially offering a person a profound opportunity to transform. That is to say, an opportunity to become a more loving, expanded whole person … one who is able to experience greater freedom of personal choices and a sense of deeper connection with other people, nature, and the cosmos.

Some people can come through a Spiritual Emergency with very little support or none at all. Even in the midst of radically altered states of mind there is a part of them that watches and notices what is going on – at least some of the time. They are able to communicate about what is happening for them and maintain contact with their everyday self. Sometimes all that is needed is a safe space whilst they go through these experiences.

Other people in Spiritual Emergency need a safe space and at least one supporter who can validate their experience, provide reassurance and ‘let them be’. Others again will need further help with such things as shopping, cooking, paying the bills. What starts out looking manageable has the potential to gradually or rapidly change into a more intense or extreme state. However, this is less likely if the person is feeling safe, in a loving atmosphere with people they can relate to, and getting adequate sleep.

The following is taken from Michael Cornwall’s article “Responding to Madness with Loving Receptivity: a Practical Guide”. Following his own Spiritual Emergency, Michael Cornwall has worked for over 30 years with people in psychosis, including in the alternative residential facilities, I-ward and Diabasis.

Michael Cornwall writes about the two basic principles in helping someone in a ‘madness process’:

1. Keep suspending your disbelief

“Every time you tell yourself or believe that the mad person you are being with, or you yourself has a tragic, lifelong, and threatening illness that has no inherent meaning or purpose- such as a neurobiological, genetically based diseased brain, an incurable thought disorder, or chemical brain imbalance- try to suspend your disbelief that another explanation may be possible.

Instead, hold the belief that they or you are going through a necessary, meaningful, developmental, initiatory, transformative, transpersonal/archetypal, symbolic and/or purposive natural process – one that is neither pathological nor indicative of a genetically inherited, neurobiological brain disorder.

Hold the belief that, as Dr. Karl Menninger famously said, it is possible to emerge from the madness process- “Weller than well!”

2. Be Receptive

“Begin by simply listening and receiving the person or your own experience with an open, compassionate heart. Let the gentle feelings of love that you would feel for a loved one who is frightened and suffering be present within you.

As this process unfolds, gently invite and encourage the expression of both the emotional and symbolic content. People in a madness process may need to use modalities such as drawing, painting, movement and evocative music to express themselves in addition to or instead of speech. Somatic modalities of touch and bodywork can be especially welcomed and grounding and soothing.

The common and overwhelming evidence from the Agnews project, Diabasis House, I-Ward, Soteria House and other alternative programs from all over the world, confirms the basic need for a person in such a madness process to be believed in, listened to and lovingly received and responded to in this way.

This view was also expressed by R.D. Laing when asked- “Dr. Laing, I still don’t understand the theoretical basis of your approach to schizophrenia. Could you please explain?”

“Certainly,” said Laing- “The basis is love. I don’t see how you or I can be of any help to our clients in a visionary state unless we are capable of experiencing a feeling of love for them. Therapy, as opposed to mere treatment requires that we have a capacity for loving kindness and compassion.”

So, in that spirit of risking to call what we may feel for ourselves or others in a madness process as being in fact love, here are observations I slowly learned for myself the past 30 years about how to more specifically make yourself available to anyone in a madness process. The list is only an attempt to begin a conversation and exploration of all the possible ways we can be of service.

  • To be most helpful try and feel like your inner subjective state is more emotional than mental.
  • ​Create a physical and emotional state of receptivity. Let warm feelings of caring be present in you.
  • With your feet flat on the floor, hold the awareness that there is now a solid base and foundation beneath you.​
  • Keep a focus of energy in the hara chakra below your navel.
  • With your stomach muscles relaxed, feel yourself do deep and slow belly breathing,
  • Drop down your shoulders.
  • Let your face become calm and relaxed–not becoming pensive or quizzical.
  • Let your voice come up from your hara in lower octaves, emerging with the energy of your heart chakra as you speak…
  • Let your kindly, gentle, even loving and tender feelings of empathy and compassion arise in your heart chakra for a fellow human being in distress and suffering who is sharing the room with you.
  • Allow silences.
  • Don’t seek direct eye contact if it seems to make the person uncomfortable.

Adapted from For the full article go to and click on BEST: Being with Extreme States Training

Thoughts on Relating

It is important to speak to the person with the same respect that you normally would, knowing that they are ‘still in there’ and will probably remember all that happens, no matter how bizarre.

Listening in an interested way communicates the message that what is happening for them is meaningful and purposeful. Sometimes listening in silence is what is needed, at other times it is useful to ask open questions about what matters to them at that time. Reflecting back what you heard them say can let them know that they have been heard.

The important thing is relationship connection and ‘being with’ the person where they are. Connection is easily broken where there are attempts to dispute and prove that they are ‘mistaken’. Attempts this way can lead to distrust and retreat. When the person is ‘coming down’ or back to consensus reality, it may be useful to reality test beliefs that are at odds with the everyday world.

Emma Bragdon, author of “The Call of Spiritual Emergency” and many other books on the subject, describes an overview of what is needed for support:

“Create a space…protect the space…allow a transformative process…like a hen who provides protection to the eggs and allows chicks to peck their way out of their tight space when they are ready and able (she doesn’t referee or do it for them)…. No need to cluck or brood..but do protect the space and BE THERE (be present). When chick is on its feet, offer it a protected space and some conversation but also be happy with its gains for independence. No need to sit on it, as in squash it, just provide warmth. It’s also not about meeting your own personal needs for intimacy and/or control or connection with a newly born being…it’s about the newborn having a safe space in which to go through transition as it’s growing out of being a gelatinous raw egg into a totally different kind of being, standing on its own two legs and following its own biological design.”

British psychiatrist, Russell Razzaque, describes a mindful approach:

My mindfulness training has had a big impact on my ability to work in the Open Dialogue framework. It enables you to sit and be present with what’s happening before you… and so that will include my own reactions to what is happening, so I can observe all of it…. and I’ll feel, when somebody is suffering, the desire in me to go forward and try and do something to remove it right now. These are all the slip-roads that we take to try to reflexively shut down people’s experiences rather than enable them to have it. And what we’re learning, and there ‘s lots of psychological research now, that shows that experiential avoidance, avoidance of our emotions, is what predisposes us to having greater vulnerabilities, and deeper and more troubling experiences mentally.

I think if we can develop our own awareness of the fact that we are trying to do that, then we can actually be more compassionate because we can be aware of their pain, we can be aware of our pain, and we can sit with both of those things because they’re both calling us. By paying attention to that it can really help both of us grow.

Dealing With A More Intense Spiritual Emergency

In a more intense Spiritual Emergency, a person is speaking or behaving out of character and is significantly out of touch with consensus reality.

In this situation supporters are faced with choices that may appear to conflict. Feelings of frustration and worry give rise to a natural wish to get the person to stop acting so strangely and return to normal as soon as possible. On the other hand there is the desire to support the transformative purpose of the process, however difficult that is.

Sharing this dilemma with other supporters may help to diminish frustration and liberate energy to continue the process.


Not sleeping at all or greatly reduced sleep is often an aspect of Spiritual Emergency. When a person hasn’t been sleeping enough they become unpredictable, irritable, confused, and generally harder to be with and to support. The supporters may become overwhelmed.​

Sedative medication might be all that is needed to slow the process, and offer much relief to all – without completely freezing or suppressing the process.

Some people may be sleeping enough, but in a different pattern. For example, some people stay up all night being creative, and sleep in the day.


Twenty four hour supervision is necessary for particularly intense forms of Spiritual Emergency. There can be regretful consequences if supervision is inadequate. The person may damage social relationships, become lost, lose their job, spend too much etc…. or even cause serious harm to themselves or others.

If you have a lucid conversation, that doesn’t mean that ‘it’s all over’ as people may go in and out of extreme states. A person may seem, or claim that they are doing ‘just fine’, but when left to their own devices, unsupervised for a short time, go off and do regretful, or even dangerous activities in the neighbourhood.

Dreaming States

When a person is in a Spiritual Emergency they are likely to be partly or fully in dreaming consciousness rather than in everyday reality. Dreaming occurs beyond everyday awareness, not only in the dreams of night-time but in the day as well. Dreaming underlies and manifests in emotions, body symptoms, relationships, synchronicity, incongruence and disturbances in general. For example, a person saying and doing strange things!
It is easier and more beneficial to be with a person acting strangely when the Dreaming process is welcomed and appreciated. If a person who is in a sense ‘dreaming’ is met in their reality, then what is trying to emerge can more easily come to the fore. In other words, instead of requiring that they be where you are (in rational reality) be with them wherever and however they are.

A common trait attributed to people in an intensely altered state is their lack of affect or emotion. J.W.Perry says that the images being described are equivalent to emotions just as is the case in dreams. He described these as affect-images. Being aware of this can give meaning to odd communications and help progress the Spiritual Emergency. (see: Books)

Voice Hearing

A  person may be speaking and behaving strangely because they are responding to voices that sound real to them but are not able to be heard by others. The Hearing Voices Network is a network of voice hearers  and professionals who work with voices in a compassionate way. This is a very healing and integrative approach and can be done when the voices are actively causing distress. It is also for people who experience visual hallucinations or are experiencing ‘paranoia’. (  )

Awareness of Transpersonal Mind

Transpersonal is defined as ‘meaning and connection beyond the personal identity. This is at odds with mainstream culture that teaches that an individual’s mind is confined to their brain. During Spiritual Emergency people are having transpersonal experiences such as psychic opening or episodes of unitive consciousness. (See “Forms of Spiritual Emergence”). As a supporter, even if one has not experienced or does not ‘believe in’ a collective mind, it can be important to relate to the person as if this were the case.​

The thoughts and emotions of a person in a profoundly altered state may not even entirely belong to them. They may in fact be responding to the thoughts and emotions of the people around them – a phenomenon that also occurs with people in everyday states of mind. Without their usual ego, the person can function like a magnet attracting iron filings, picking up the unconscious or disowned feelings and thoughts of others.​

Where there are high levels of intergenerational trauma, the pain and shame of previous generations can be present in the background atmosphere of the family. Troubling relationship and family dynamics can surface, and the person in the intensely altered state is often the vehicle for this.

Open Dialogue

Open Dialogue with the family and/or members of the person’s friendship network can be very effective. In this approach the issues that are causing concern are worked with as occurring ‘between people’ rather than residing solely ‘within’ a person. Their focus is on solving problems rather than making the person or ‘illness’ the problem.

When the information and emotions in the background are openly discussed, the person of concern as well as others involved, tend to feel relieved … more

​Anxiety and Extreme Fearfulness

Similarly to sedative medication, anti-anxiety medication can reduce suffering for a person experiencing great anxiety, fear or paranoia – and does so without completely stopping the process.

It can be very difficult to support someone who is experiencing paranoia. Not only is the person suffering intensely, they can also become suspicious of the supporters… whom they incorporate them into their fearful story. The supporters can feel (and be) unsafe as well.​

Some people who work with Spiritual Emergency recommend that a person experiencing ongoing extreme fear, suspiciousness, or hostility, be given medication early in the episode. Others will work with people having this experience as they would with any other extreme state of mind. (Ref. last part of the Michael Cornwall excerpt beginning with “If the person is hostile”).​

One way to be with someone in a fearful state is to listen to their story and respond, to the emotional aspects of it. For example…. “Are you feeling really frightened about…?”​

It is helpful to hold the awareness that peculiar thoughts have a meaningful basis in the person’s life – there will be a kernel of truth in what the person is saying. Symbolic communication can seem irritatingly ‘wrong’, but it may be the person’s way of expressing something important that they find difficult to talk about. For example, a woman who was experiencing a lizard attacking her, was later found to have been sexually abused as a child by a man who had a lizard tattoo on his arm.

Number of Supporters and Other Considerations

It may be possible to consult with the person as to who they want with them, and on what terms. At the very least they need to have the right of veto. Immediate family may be unwanted by the person at this time whereas complete strangers may be welcomed.

People in extreme forms of SE need a lot of supporters, with a minimum of two present at a time. When there are too few supporters lapses on the security front are more likely – patience and compassion may suffer, and the supporters may burn out.

There may be more people available to support than is first apparent….and potential supporters can be found who have the necessary personal qualities.

Some people willing to offer support may not wish to have direct contact with the person but may prefer to ‘support the supporters’ by cooking, shopping or providing emotional support.

Consider calling in specialist practitioners. For example, a clairvoyant, medium, spiritual healer or shaman if the person is concerned about, or feels that they are being taken over by an ‘entity’. (See ‘Possession States’ in ‘Forms of Spiritual Emergence’)

Approaches for Reducing the Intensity of the Process

At times it may be useful to slow down the process and help ground the person. Some of these suggestions will be regarded by some as ineffective and having no scientific basis at all, while other people have found great benefit from them. Please be aware of the limitations of any of these practices. If the situation is becoming unsafe then stronger measures will need to be taken.

With all these suggestions, it is necessary to follow the person’s lead as to what has energy for them, and notice when it is no longer working for them.

The following suggestions are in no particular order of importance:

  • Temporarily discontinue all meditation and other forms of spiritual practice

  • Avoid situations and people that tend to stress or overstimulate the person

  • Herbal carminatives, anti-anxiety or sedative medication

  • Acupuncture, Reiki, prescribed Homeopathic or Flower Remedies

  • Engage with the person in their spiritual practice

  • Co-create a relevant ritual or ceremony 

  • Physical activity can help dissipate disturbing emotional and physical energies. Examples might include hard manual work, jogging, vigorous dancing. Walk in nature as often as possible

  • Form an Open Dialogue team (as close an approximation as you can manage), involving the person’s family, social network and if possible like-minded professionals, to process issues and problem-solve etc   

  • Sessions with a bodywork practitioner

  • Sessions with a clairvoyant, medium, spiritual healer or shamanic healer

  • Work with a professional in such modalities as Process Oriented Psychology (Process Work), Sandplay, Dreamwork or other practitioner who works with the Dreaming/Unconscious

  • Take walks in nature or spend time in natural settings. Standing or walking barefoot on the earth or on a beach is grounding

  • Engage in simple manual work such as gardening, house cleaning, etc.

  • Baths: a warm bath with Epsom salts and/or appropriate aromatherapy oils

  • Attention to diet: stop all processed food, refined carbohydrates and sugars, including fruit. A higher protein intake, especially animal protein can have a grounding influence on some people

Approaches to Facilitate the Process

At other times it will be useful to facilitate the transformational process –  usually when the person feels blocked, lost, or extremely depressed.

  • Initiate a conversation about life issues that have been triggered.

  • Dancing, singing, toning, art, and other forms of creative expression

  • Visual or written diary

  • Physical activity such as jogging, vigorous dancing

  • Acupuncture, Reiki, Prescribed Homeopathic and Flower Remedies

  • Massage and bodywork

  • Co-create a relevant ritual or ceremony

  • Work with a professional in modalities such as Gestalt, Voice Dialogue, Process Oriented Psychology (Process Work), Transpersonal or Holotropic Breathwork, Sandplay, Emotional Release, Dreamwork, Psychodrama, Spiritual Healing, Shamanic Healing etc.

When All Else Fails

The Spiritual Emergency may well continue beyond the limitations of the supporters, and in such situations it is not a failure to call in conventional services.  Even if the person is hospitalised, they will have benefited from being listened to and having their process validated. Some of their process will have unfolded. Ongoing support during the hospitalisation and afterwards is very important as well.