Religious and Spiritual Issues in Psychiatric Diagnosis: A Research Agenda for DSM-V by John R. Peteet, Francis G. Lu, and William E. Narrow (American Psychiatric Publishing) The relationship between spirituality and mental health has been the focus of growing interest and research over the last decade. However, the implications for psychiatric classification are only beginning to be systematically explored. Religious and Spiritual Issues in Psychiatric Diagnosis: A Research Agenda for DSM-V gathers for the first time the collective contributions of the prominent clinicians and researchers who participated in the 2006 Corresponding Committee on Religion, Spirituality and Psychiatry of the American Psychiatric Association. The symposium was an attempt to expand the current DSM text on "Specific Culture, Age, and Gender Features" and "Differential Diagnosis" to include the impact of religious/spiritual factors on phenomenology, differential diagnosis, course, outcome, and prognosis. The philosophical issues at stake in the differential diagnosis of spiritual versus psychiatric conditions are explored at length, as is the case for updating the V Code for a Spiritual or Religious Problem. Two expert commentaries follow each chapter and seek to contextualize and extend the research, analysis, and recommendations presented. Mental health clinicians who seek to practice in a more holistic, integrative manner will find in this unique and important volume the theoretical and practical foundations to support and further their work.
Excerpt: More than 90% of adults in the United States say that they believe in God, and approximately 88% pray (Hoge 1996). For decades following Freud's attacks on religion as immature wish fulfillment, there was little exploration of the territory shared by psychiatry and spirituality. Recently, however, clinical and scholarly interest in the relationship between spirituality, religion, and mental health has grown steadily. Medline contains more than 650 citations to spirituality or religion and psychiatry or mental health in the past 10 years.
In 1994, DSM-IV introduced an "Outline for Cultural Formulation" that encouraged clinicians to consider cultural idioms of distress, explanations of illness, and preferences for care, as well as the role of religion in providing support (American Psychiatric Association 1994). In addition, a V code for Religious or Spiritual Problem was established to help clinicians categorize distressing experiences related to religion or spirituality that were not symptomatic of psychopathology and thereby broaden the differential diagnosis to reduce chances of misdiagnosis.
However, current descriptions of Axis I and II disorders take religious and spiritual considerations into only limited account. As preparations for DSM-V led to the 2002 monograph A Research Agenda for DSM-V(Kupfer et al. 2002) and a follow-up volume focused on age and gender issues (Narrow et al. 2007), the Corresponding Committee on Religion, Spirituality, and Psychiatry of the American Psychiatric Association (APA) proposed a review of the innovations in DSM-IV and of relevant recent research with a view to developing an agenda for future research in this area. The APA's Committee on Psychiatric Diagnosis and Assessment and Division of Research provided guidance for this project, which led to a well-attended APA symposium in 2006 that considered the spiritual and religious aspects of major diagnostic categories including psychotic disorders, depression, anxiety and substance use disorders, posttraumatic stress disorder, and disorders of childhood and adolescence.
This volume contains the contributions of the well-known clinicians and researchers who participated in this symposium as well as those of other distinguished scholars. Two expert commentaries follow each of their chapters, to add perspective. The principal charge to authors in addressing major diagnostic categories was to expand the current DSM text on "Age, Gender, and Cultural Considerations" and "Differential Diagnosis" to include the impact of religious/spiritual factors on phenomenology, differential diagnosis, course, outcome, and prognosis. For example, what about the disorder is important to understand in order to distinguish religious/spiritual experiences from psychopathology? What is the prevalence of psychopathological conditions that take a religious/spiritual form? Are these disorders overdiagnosed in people with religious/spiritual commitments? What difference in course or outcome is associated with the presence or absence of religious/spiritual commitments? What changes in the text does evidence support for inclusion in DSM-V?
Each contributor responds to this challenge with a review of existing literature, an analysis of the issues at stake, and suggested wording for a revised DSM. Harold Koenig considers religious issues in schizophrenia and other psychotic disorders. Dan Blazer examines the complex relationship between spirituality and depression. Linda Glickman and Marc Galanter discuss the religious and nonreligious use of substances. Gerrit Glas finds spiritual and existential elements in the phenomenology of anxiety disorders. Robert Cloninger contends that patients with personality disorders can be most clearly understood as having spiritual deficits—that is, deficits in the coherence of their fundamental assumptions and schemas about life. Sam Thielman reviews evidence that an individual's worldview and the moral context of trauma are relevant to coping and the development of posttraumatic stress disorder. Alex Mabe, Mary Lynn Dell, and Allan Josephson consider several ways in which spiritual and religious issues influence disorders of childhood and adolescence.
Three papers address additional ways that religious and spiritual issues have relevance for a revised DSM. Bill Fulford and John Sadler offer a novel approach to the philosophical challenge of distinguishing spiritual phenomena from psychopathology. David Lukoff, Francis Lu, and Paul Yang present evidence for expanding the V code for Religious and Spiritual Problem to include (among others) those presented by New Religious Movements and cults and by life-threatening and terminal illness as well as by mystical, near-death, and spiritual practice—related experiences. Finally, David Gellerman and Francis Lu present a practical framework for incorporating religious and spiritual information into the cultural understanding of the patient.
We recommend changes to the introductory section of the DSM in order to accommodate our consensus that diagnosis should take into account the psychological impact of patients' concerns with meaning, loss, isolation, autonomy, or guilt. Such existential concerns may be found not only in personality, depressive, adjustment, and anxiety disorders but also in nonpathological conditions such as demoralization or subsyndromal anxiety. PubMed now contains 110 references to existential distress. Consider the following proposed revised wording in the introduction to DSM-IV-TR (American Psychiatric Association 2000, p. xxxi):
Each of the mental disorders is conceptualized as a clinically significant behavioral or pathological syndrome or pattern that occurs in an individual and that is associated with present distress (e.g., a painful symptom) or disability (i.e., impairment in one or more important areas of functioning) or with a significantly increased risk of suffering death, pain, disability, or an important loss of freedom. In addition, this syndrome or pattern must not be merely an expectable and culturally sanctioned response to a particular event, for example, the death of a loved one. Whatever its original cause, it must currently be considered a manifestation of a behavioral, psychological or biological dysfunction in the individual. Neither deviant behavior (e.g., political, religious, or sexual) nor existential distress nor conflicts that are primarily between an individual and society are mental disorders unless the deviance, distress, or conflict is a symptom of dysfunction in the individual as described above.
In applying this definition of mental disorder, clinicians often find the distinction between normal and pathological experience confusing, especially when confronting experiences that human beings have, such as pain, suffering, existential distress, and religious, spiritual, or mystical experiences. Since DSM-III (American Psychiatric Association 1980), the manual has used the "clinical significance criterion" to make the distinction between normative experience and pathological experience. In assessing clinical significance (i.e., distinguishing normal from pathological experience), clinicians must elicit the individual's cultural and individual values and worldviews that crucially frame whether the patient's experiences are "for the worse" and impede the patient's seeking and fulfilling his or her own ideals. By making the patient's values explicit, the clinician can avoid pathologizing normal human experiences or overlooking evidence of psychopathology (American Psychiatric Association 2006; Josephson and Peteet 2004).
Given that pathology can only be clearly defined in relation to health, we further recommend that future research attempt to characterize important domains of normal human functioning that are impaired by psychiatric disorders, such as in the areas of thinking, feeling, and willing as well as in relating effectively to the individual's social, cultural, existential, and spiritual context.
As the commentaries to the chapters make clear, the challenge of incorporating religious and spiritual considerations into an increasingly evidence-based DSM is an iterative process. Yet these thoughtful and provocative contributions demonstrate several important reasons to continue pursuing the task. A DSM that more fully incorporates these ideas could help clinicians recognize their importance to the ways that patients understand and approach their emotional difficulties. It could help them to better appreciate how religious and spiritual concerns may impede—and spiritual resources may promote—recovery and how mental health and religious professionals can collaborate in identifying and achieving healthy goals. Finally, it could locate the diagnostic categories of contemporary Western psychiatry within a larger historical, philosophical, and cultural context.
Extreme Spirituality: Radical Journeys for the Inward Bound by Tolly Burkan (Beyond Words Publishing) By placing oneself in radical situations -- walking barefoot on broken glass, breaking bricks by hand, or simply practicing humble service to others -- one is forced to confront how ego distorts or diminishes knowledge of self and reality. Extreme Spirituality introduces practices that most readers have never heard of or contemplated doing. Whether they undertake these extreme acts or simply read about them, the book is designed to inspire individuals to experience their divine nature by revealing the clear distinction between the ego and the higher self. Readers will be challenged, shocked, and stimulated as they absorb the directives of a new spiritual paradigm. In many ways this work introduces people to recent modifications in asceticism or tapas. These rites of purification attempt to overcome fear or disgust by experiencing events one is reactive to. Supposedly familiarity breads indifference rather than contempt. Most mainline religious traditions still maintain a cautious place for extreme asceticism, and Wicca, shamanism, so-called left-handed Tantra, and its popular variations in the S/M community show that this trend in religion is hardly new. Burkans book does offer a justification for expressing symptoms of malaise and one could rightly question if expression of such extremes eventually leads to balance.
WORDS FROM THE SOUL: Time, East/West Spirituality, and Psychotherapeutic Narrative by Stuart Sovatsky ($19.95, paperback, 241 pages SUNY Series in Transpersonal and Humanistic Psychology, State University of New York Press; ISBN: 079143950X) HARDCOVER
This is a pioneering work that will be a fertile source of inspiration and innovation in holistic forms of psychology and psychotherapeutics into the twenty-first century. Draws from Buddhism-mystical Jewish mysticism, and Christianity-Yoga-Heidegger-Whitman-Laing-Laotse-Dostoyevski-Foucault- Rilke-Wittgenstein. Critiques pop/analytic therapies and offers another based in the powers of longing, awe, admiration, apology/forgiveness, gratitude and the poignancy of the impermanence of each moment (anicca in Buddhism). Spiritual theory of psychosis, suicidality, borderline, antisocial, depression, etc. DSM disorders. The most detailed view of the kundalini process in English and its impact on theories of development, the body, linguistics, music, art and religion. Vignettes from sessions drawn from 26 years of experience.
Accepting relentless impermanence as the ground of human experience, WORDS FROM THE SOUL derives a spiritual psychology from the mystery and poignancy of time passage itself. Drawing from Wittgenstein, Kierkegaard, Heidegger, Foucault, Dostoyevsky, Buddhism, kundalini yoga, and twenty-six years of clinical/meditation experience, Sovatskys epigrammatic insights into our struggles with mortality, gratitude, apology, and forgiveness make this book relevant to psychotherapy and conflict resolution in a wide range of professional settings.
In his exploration of the furthest reaches of human development, Sovatsky reveals the deepest potentials of the ensouled body, transforming our views of language, sexuality, ecstatic spiritualities, and of the human life cycle. This work will inspire some and confound others as it is a regular smorgasbord of mystical experience.
Introduction: Toward a Spiritual Psychotherapy
Ch. 1. Questioning Words - Reviving Time
Ch. 2. Revenge against Impermanence: Temporal-Spiritual
Ch. 3. Maturation of the Ensouled Body: Kundalini Yoga and the Far
Reaches of Human Development
Ch. 4. Spiritual Emergence: Toward a Spirituality-Inclusive
Glossary of Yogic Terms
Stuart Sovatsky is Assistant Professor at the California Institute of Integral Studies, Clinical Supervisor at John F. Kennedy University, and Director of Kundalini Clinic. He is the author of Passions of Innocence.
PRAYER AND TEMPERAMENT
Different Prayer Forms for Different Personality Types
by Chester P. Michael and Marie C. Norrisey
The Open Door, Inc. P. O. Box 855, Charlottesville, Virginia 22902
0-940136-02-3 out of print
With Isabel Briggs Myers' publication of the Myers-Briggs Type Indicator in 1962, followed in 1978 by the David Kiersey and Marilyn Bates book, Please Understand Me, a tremendous new interest in the differences in human personality has taken place. The possibility of a close connection between personality types and prayer and spirituality was conjectured by many persons. There has been much discussion on the topic, but topmost nothing has been published. The present volume is among the first in print on the relationship between human temperament and prayer. The conclusions in this book are based on a Prayer Project conducted throughout 1982 with more than four hundred participants from all over the United States and even from Canada and Australia.
The recommendations for the different forms of prayer appropriate for the different temperaments and personality types have been tested in a number of workshops, in parish retreats, and in spiritual direction of numerous persons. Without claiming to be the last word that can be said on this subject of prayer and temperament, the authors now offer their findings and conclusions to a wider audience. It is hoped that many others Will find the same help to their prayer life and growth in spirituality that hundreds of other women and men have received.
BELIEVING IN MAGIC
The Psychology of Superstition
by Stuart A. Vyse
University of Oxford Press
$25.00, hardcover, 257 pages, notes, references, index
Lucky numbers. Magic rituals. Wade Boggss obsessive eccentricities before each game. Astrology and the White House. Modern buildings without the "13th" floor. The lure of The X-Files and Steven King. Although we live in a technologically advanced society, superstition is as widespread as it has ever been. Far from limited to athletes and actors, superstitious beliefs are common among people of all occupations and every educational and income level. Why is superstitious behavior so prevalent? How is this behavior established and maintained? Is there a superstitious personality? How do otherwise rational people come to put their faith in such ephemera?
These are the provocative questions that Stuart Vyse addresses in BELIEVING IN MAGIC: The Psychology of Superstition. Superstitions, he writes, are the natural result of several well understood psychological processes, including our human sensitivity to coincidence, a penchant for developing rituals to fill time (to battle nerves, Impatience, or both), a fear of failure, our efforts to cope with uncertainty, the need for control, and more. Vyse examines current behavioral research to demonstrate how complex and paradoxical human behavior can be understood through scientific investigation; he explores both the personality traits that make us receptive to superstition, as well as the ways superstitious beliefs can determine our actions. Along the way, we meet a number of colorful characters, researchers, and scientists, including Russian pianist Shura Cherkassky, who always steps onto stage with his right foot first; Peter and Ione Opie, who first collected the lore and language of children, including many juvenile superstitions ("step on a crack, break your mother s back ), and a man plagued by irrational thoughts to the point of mental illness (he believed Pepperidge Farms products could cause earthquakes, since an earthquake had occurred one Thanksgiving, shortly after hed eaten a Pepperidge Farms turnover).
Although superstition is a normal part of our modern culture, Vyse argues that we must provide alternative methods of coping with lifes uncertainties by teaching decision analysis, promoting science education, and challenging ourselves to critically evaluate the sources of our beliefs. Written in a style that Is both entertaining and authoritative, BELIEVING IN MAGIC shows how an empowering acceptance of rational thinkingand a critical reassessment of the paranormalcan lead to a richer life.
WHY PEOPLE BELIEVE WEIRD THINGS
Pseudoscience, Superstition, and other Confusions of our Time
by Michael Shermer
Foreword by Stephen Jay Gould
W. H. Freeman and Company
$22.95, hardcover, 306 pages, bibliography, index, charts, diagrams
Why do so many people believe in mind reading, past-life regression therapy, abductions by extraterrestrials, and ghosts? What has led to the rise of "scientific creationism" and the belief that the Holocaust never happened? Why, in this age of supposed scientific enlightenment, do we seem to be more dangerously confused than ever?
In WHY PEOPLE BELIEVE WEIRD THINGS science historian Michael Shermer explores the very human reasons we find otherworldly phenomena, conspiracy theories, and cults so appealing. The editor of Skeptic magazine and the director of the Skeptics Society, Shermer shows how the eternal search for meaning and spiritual fulfillment often results in our thinking being led astray by extraordinary claims and controversial ideasparticularly in the realms of superstition and the supernatural.
But Shermer also reveals the darker and more fearful side of wishful thinking, including Holocaust denial, creationism, the recovered memory movement, alien abduction experiences, the satanic ritual abuse scare and other modern witch crazes, extreme Afrocentrism, and ideologies of racial superiority. As Shermer investigates these movements and the people behind them, youll be introduced to:
- The strange debating tactics of creationist Duane T. Gish as he goes toe-to-toe with the author over evolutionary theory
- The apocalyptic visions of a leading racial pseudoscientist ESP adherents who claim theyve proved the power of thought-control.
- Holocaust Denial. A small but vocal group of anti-Semites, neo-Nazis, and political radicals who would like to see the return of National Socialism and the elimination of the Holocaust from history publish their "findings" in a scholarly-looking journal called the Journal of Historical Review. Shermer goes inside the movement and shows precisely how we know the Holocaust happened.
- Race and IQ. Shermer shows how meaningless the concept of race has become at the end of the 20th century and why social policy should not be based on the implication that racial differences in IQ are primarily genetic and therefore unchangeable.
- Cults. Shermer uses the amazing story of Ayn Rand and her Objectivist movement to outline the characteristics of a cult and how cult leaders come to dominate their followers. and the difference between cults and normal belief systems.
- Alien Abductions and UFOs. is it really possible that aliens are traveling thousands of light years across the galaxy only to land in Farmer Bobs wheat field to make crop circles and abduct his daughter to implant alien babies in her? Not likely, says Shermer, who explains how and why this mass hysteria of sightings and abductions is occurring in our culture at this time in history.
- Repressed and False Memories. Many parents are rotting away in jail, convicted of sexual child abuse on nothing more than a "recovered" memory. Shermer shows that there is no evidence that memories can be "recovered" and that this movement is a tragic chapter in the history of psychology.
- ESP and Psychics. Shermer illustrates the mentalism trick of "cold reading" by psychics using lots of questions and educated guesses. Shermer also goes inside the 900-number hotline business.
- Near Death Experiences. Shermer shows how this can be explained through brain chemistry and what this desire tells us about human psychology.
Through wit, humor, and extensive research, Michael Shermer presents compelling and often disturbing details that explain the very reasons that make otherworldly phenomena, conspiracy theories, and cults so appealing. A bracing and often disturbing portrait of humankinds immense capacity for self-delusion, WHY PEOPLE BELIEVE WEIRD THINGS sheds new light on why our society is more dangerously confused than ever,
Michael Shermer is the publisher of Skeptic magazine, the director of the Skeptics Society, and the host of the Skeptics Lecture Series at the California Institute of Technology. He is the author of Denying History and teaches the history of science, technology, and evolutionary thought in the Cultural Studies Program at Occidental College in Los Angeles.
Expressions of Self, Expressions of Spirit
A Psychology of Contemporary Spiritual Choice
by Peter Tufts Richardson
$25.95, hardcover, 245 pages, notes, bibliography, index
In many ways Tufts work is an advance over Michael and Norrisey's insights into prayer. We tend to look at our own spirituality in terms of the religious tradition we have inherited. Yet similar patterns of faith and practice can be found in all the world's religions. These common patterns have something important to tell us. They tell us how our spiritual natures are formed and shaped by our very personalities. Distinguishing four spiritual paths corresponding to Jungian dimensions of personalitythe Journey of Unity, Journey of Devotion, Journey of Works, and Journey of Harmonythis book provides a framework for understanding the opportunities for spiritual growth found in every religious tradition. It is a valuable guide for finding your own path in the myriad of contemporary spiritual choices. Illustrated with inspiring quotations and examples from sources as diverse as the Bhagavad Gita and the Book of Job, Henry David Thoreau and Mother Teresa, Martin Buber and the Tao Te Ching, Four Spiritualities emphasizes the emotional, intellectual, spiritual, and psychological qualities that characterize each path. Additionally, the book:
Provides a sorting toola Rosetta stonefor understanding the many spiritual options before us
Illuminates the spiritual journey through Jungian concepts of personality and the self and provides mentors and favored practices for each journey
Shows that the way we perceive and respond to the world is directly connected to the spiritual path we find most personally satisfying
Offers a key for understanding the great religious sages and teachers of every age
Offers personal guidance as well as valuable insight for interfaith relations
"Peter Richardson has devised an ingenious way of using a combination of Jungian psychology and personality types to delineate four types of spiritual journeys. He brings intellectual insight and practical workshop experience to his subject." Dan Wakefield, author of Expect a Miracle
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