A Literature Review and Discussion paper
Dr. Patte Randal and Dr. Nick Argyle
When spiritual development is gradual and occurs in a context which can support the personal changes in worldview that it brings, there should be no crisis of transition. When it is sudden, or the higher stage is experienced intermittently there can be uncertainty or crisis. In this context, Grof and Grof [35, 36] write about spiritual development using the term "spiritual emergence". By this, they mean "the movement of an individual to a more expanded way of being that involves enhanced emotional and psychosomatic health, greater freedom of personal choices, and a sense of deeper connection with other people, nature, and the cosmos". They go on to make a distinction between this natural process, and a more difficult and sometimes traumatic experience, ".When spiritual emergence is very rapid and dramatic, however, this natural process can become a crisis, and a spiritual emergence becomes a 'spiritual emergency'". Episodes of this kind have been described in the sacred literature of all ages as a result of meditative practices and are signposts of the mystical path.
Recovery from psychosis and care for spiritual emergency
In a psychosis formulated as a spiritual emergency best care will both use the spiritual sphere to speed recovery and avoid iatrogenic damage. There are some similarities to general crisis intervention that sees crisis as a time of opportunity. Psychosis appropriately framed as "spiritual emergency" can be seen as an opportunity for further personal growth, if responded to in appropriate ways.
Treatment of spiritual emergency is supportive, does not usually involve medication (other than occasional use of a minor tranquilliser or hypnotic to ensure sleep if necessary). Care is usually undertaken by people who have a transpersonal understanding and some experience themselves of these phenomena. It involves "being with" the person, usually in a tranquil environment, doing everyday things to help "ground" the person. Reception of the altered state is characterized by trust rather than fear, with the expectation that healthy, natural resolution will occur in time, with a beneficial outcome in terms of personal growth. Sometimes constant supervision can be necessary to help prompt care of basic needs, such as eating and drinking, if these are being neglected. Cessation of intense spiritual practices at this time is usually recommended, but prayer support may be offered. Explanation of the psychotic experience in terms of the spiritual domain is helpful. The person is supported in expressing the content of their inner world at their own pace, and when
appropriate, the psychospiritual roots of the problem can be addressed. For this type of care to become available within general mental health services, clearly appropriate staff selection and training would be required [65, 66].
The danger for people being diagnosed as having a serious form of psychotic disorder is that they will be subjected to perhaps unnecessary, suppressive antipsychotic medication, with its potentially serious side effects. If psychosis can be seen as "a state of aberrant salience", and a central role of dopamine is to mediate the "salience" of environmental events  it may be that the "salience" of the experience of spiritual emergency is inappropriately suppressed by dopamine blockade. In addition, there may be the social isolation, stigmatisation and self-stigmatisation associated with the label of mental illness. This may leave the person not only with the need to integrate the spiritual emergency experience without a context in which to understand it, but also having to recover from the trauma of these consequences.
On the other hand there are risks associated with not treating psychosis with medication soon enough related to on-going distress, potentially unwise or dangerous behaviour, and effect on prognosis. Current best practice recommends early use of antipsychotics for all acute psychosis in an attempt to prevent the deteriorating pattern of chronicity . With the burgeoning of early intervention programmes this balance of risks is an aspect which needs urgent attention. The concept of spiritual emergency is a potentially useful explanatory model which might assist in the recovery process because it is normalising and not stigmatising. It remains unclear how large the sub-group of patients is for whom this explanatory model, and an approach which supports spiritual development and understanding of the psychotic phenomena in this light, might be more useful either in the acute management phase or recovery phase. Further research is recommended in order to assess whether the notion of spiritual emergency might have diagnostic utility in improving clinical outcome for this sub-group and how cases can be identified in terms of past history, phenomenology, continuity with prior spiritual life, and personal explanatory model. To what extent spiritual emergency may be 1) a separate diagnosis strongly related to causal factors and best treatment or 2) an explanatory model that is useful for some people recovering from psychosis, regardless of cause, which can be included along with other treatment approaches, are important questions to be answered.
35. Grof C, Grof S. The Stormy Search for the Self - A Guide to Personal Growth through Transformational Crisis. New York: Jeremy P Tarcher, 1990.
36. Grof S. Spiritual Emergency. When Personal Transformation becomes a crisis. Los Angeles: Jeremy P. Tarcher, 1989.
65. Nelson J. E. Healing the split: Integrating spirit into our understanding of the mentally ill (Revised ed.). New York: State University of New York, 1994.
66. Grof S. Psychology of the Future. Albany, New York: State University Press, 2000.
68. Remington G; Kapur S, Zipursky RB. Pharmacotherapy of first-episode schizophrenia. British Journal of Psychiatry 1998; 172 (Suppl. 33), 66-70.
Spiritual Crisis Network
Spiritual Emergency Resource Centre
'Psychosis or Spiritual Emergence?
Spiritual Competency Resource Centre