Spirituality or psychosis?—an exploration of the criteria that nurses use to evaluate spiritual-type experiences reported by patients
Introduction
In Britain, The USA and Australia, around one-third of the population have been reported to have spiritual-type experiences (Argyle, 2000). However, many difficulties exist in forming a coherent understanding of this type of experience. Such experiences are rare within an individual, tend to be short in duration (Argyle, 2000) and many different views exist about the nature, interpretation and value of these experiences.
Donovan (1998) identified four subtypes of spiritual experience: mystical, paranormal, charismatic and regenerative. Donovan proposed that mystical experiences are those in which individuals experience periods of heightened awareness, a sense of oneness and of existence beyond the physical world and attach a sense of profound importance to these feelings. Paranormal experiences include such things as psychic or out of body experiences, which tend to conflict with the Western scientific understanding of the world. Charismatic experiences are those which are sometimes interpreted as manifestations of a spirit or divinity working within an individual. One example of this would be the experience of speaking in tongues. Regenerative experiences are those which bring a new way of being to an individual through religious enlightenment or conversion. In Donovan's taxonomy, the differences between these categories lie in the subject's interpretation of their origins and the physical sensations or behaviours central to the experience.
It has been argued that spiritual-type experiences tend to reinforce subjectively desirable aspects of religious belief (Donovan, 1998). However, experiences which fit within Donovan's four categories are not confined within the boundaries of organised religion or restricted to religious believers. Hay and Heald (1987) found that between 20% and 68% of transcendent and mystical experiences were not interpreted religiously. Maslow (1964) suggested that the emotional and intellectual content of spiritual-type experiences were accessible and important to all people regardless of their religious beliefs, given a common human need to realise meaning and fulfilment in life. However, as Argyle (2000) has determined, the occurrence of these experiences seems restricted to a minority of approximately one-third of the population and they are subject to many possible interpretations including purely physiological explanations of their origin (Saver and Rabin, 1997).
A study of the literature reveals a number of different types of explanation that have been used to account for the occurrence of the phenomena of spiritual-type experiences. In the field of physiology, temporo-limbic seizures, hallucinogenic drug use and near-death events (i.e. cerebral-hypoxia) have all been reported to produce spiritual-type experiences (Saver and Rabin, 1997).
Psychological researchers have related personality traits, including schizotypy (theoretical psychosis-proneness) to the occurrence of unusual perceptual experiences and ‘magical thinking’ in the general population (Bentall et al., 1989; Chapman and Chapman, 1987). On a dimensional view of psychosis, spiritual-type experiences occurring in ostensibly normal subjects could be considered to be a form fruste of the religious hallucinations and delusions experienced by psychotic patients (Appelbaum et al., 1999; Peters, 2001). Sociologically and anthropologically, the occurrence of spiritual-type experiences have been identified with participation in groups and rituals which heighten arousal (Tuzin, 1984) and encourage the acting out of beliefs (Argyle, 2000). Lastly, it is possible to take the position that spiritual experiences are simply spiritual events innovated by the divine or through an individual's own supernatural spirit.
In clinical practice, standard operational diagnostic criteria often leave doubt as to whether spiritual-type experiences are pathological in nature. Jackson and Fulford (1997) explored the form and content of spiritual experience and reported that distinctions between spiritual and psychotic-type experiences could not be made with any reliability using standardised diagnostic tools such as the Present State Examination (Wing et al., 1974). This was because spiritual and psychotic-type phenomena were often qualitatively identical.
Despite the difficulties illustrated by Jackson and Fulford, mental health professionals do make distinctions between those spiritual-type experiences they consider to be pathological and those they consider to be non-pathological (Sanderson et al., 1999). Such evaluations are important because they may directly and significantly impact on diagnostic and treatment decisions. Sanderson et al. (1999) reported an experiment in which mental health professionals were presented with a range of vignettes describing religious-type experiences. These subjects were asked to indicate how authentic they thought these experiences were and whether they considered them to be pathological. Those experiences which the health professionals considered to be more pathological were also judged by them to be less authentic. Pathology also correlated with the experience being considered unconventional. Sanderson proposed that this showed that the evaluations of the mental health professionals were made primarily with reference to their own cultural norms and questioned the legitimacy of this process within a multi-cultural society.
Thus far, the scientific exploration of spiritual-type experiences has proven inconclusive, giving little direction for those who attempt to understand how these phenomena may relate to an individual's health or illness. The occurrence of spiritual-type experiences in people experiencing mental illness cannot be ignored since it may give insight into the individual and their illness; remaining an important issue regardless of any direct link with pathology (Warner and Nicholls, 2000). Nurses face difficulties in making evaluations of spiritual experiences since diagnostic criteria are unhelpful in this area and nurses themselves are undoubtedly affected by a variety of biases and personal values. However, evaluations need to be made since assessment forms the basis of nursing care-planning and intervention (Ash, 1997).
Section snippets
Aims of the study
This study had three aims; firstly to elicit the specific features that mental health nurses consider to be significant when they interpret spiritual-type experiences reported by patients. The second aim was to explore how these features were used by nurses in forming evaluations about the mental health of patients. The third aim was to examine whether the personal religious beliefs of nurses significantly affected the conclusions they drew in their evaluation of patients experiences.
Subjects
Fourteen nurses took part in the study, 13 were UK registered mental health nurses and one was a nurse in training. Nine of these nurses responded to presentations given on the wards and five volunteered in response to posters or personal contacts. The gender balance was exactly equal with seven male and seven female participants. Eleven participants described themselves as white British, one as white Scandinavian, and two as Afro-Caribbean (one Jamaican, one Barbadian).
The participants spanned
Results
At baseline, nine participants stated that spiritual-type experiences were definitely not pathological in nature, two that they were probably not pathological, one each stated that spiritual-type experiences were probably or definitely pathological and one subject expressing conflicting views. One participant was confident of being able to discriminate spiritual from psychotic experiences, nine thought that they could probably do this and four that they probably could not.
The thematic analysis
Discussion
Jackson and Fulford (1997) examined the form and content of spiritual experiences, finding them indistinct from psychotic phenomena and argued that this called into question traditional phenomenological psychopathology. Participants in the current study made reference to the form and content of experiences in their evaluations; however, in their discussion of the aesthetic qualities of the experience, wider evaluative strategies were uncovered. Their discussion drew upon outcome, negative and
Conclusions
Participants in the study drew upon a variety of features in their evaluations of the mental health of individuals who describe spiritual experience. These features were given different values and meanings by different participants, thus producing different evaluations of mental health. It is likely that these differences arise from the value and belief systems of the participants and the equivocal characteristics of both psychotic and spiritual experiences.
Participants’ evaluations did not
Acknowledgements
We would like to thank Peggy Morgan at The Alistair Hardy Religious Experience Research Centre, Oxford, UK for her help and support. We would also like to thank all the participants in the study for their help and co-operation.
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