Previous analyses of descriptively defined psychotic phenomena have concluded that they can occur in benign spiritual experiences as well as pathological states. Attempts to forge a distinction between psychotic experiences in spiritual and pathological contexts on the basis of the form or content of the experience (broadly described) can be disproved by counterexample; distinguishing on the basis of negative or positive consequences of the phenomena for the individual can be seen to beg the question. In the present paper, it is (...) argued that examining the fundamental conceptual organization of psychotic and mystical mental states not only elucidates the observed similarities between them, but can highlight the differences, and the processes by which negatively evaluated pathological features can be seen to emerge. Oriental philosophical systems such as Tibetan and Zen Buddhism, and Tantric Hinduism, provide conceptualizations of mystical states of mind, from which a model can be drawn, while the epistemologies of these systems provide an illuminating metaphysical perspective on both psychotic and mystical experiences. It is concluded that mystical and psychotic experiences can be distinguished not only by emotional and behavioral consequences, but by real differences in the states themselves; certain features, such as loss of subject/object boundaries and loss of the relative dimensional structure of perception, are common to both processes. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Philosophy, Psychiatry, & Psychology 9.4 (2002) 373-380 [Access article in PDF] Spiritual Experience and Psychopathology:Dichotomy or Interaction? Caroline Brett Keywords: mysticism, psychosis, values, phenomenology, spiritual emergence. THE PURPOSE OF Marzanski and Bratton's paper is to challenge Jackson and Fulford's (1997) treatment of the area of spiritual experience and psychosis, specifically the perspective of discriminating pathological from spiritual experiences on the basis of action enhancement in contrast to action failure. (...) In my opinion, they are partially successful in this aim, and in their analysis they further the discussion of this complex and controversial area in an interesting and potentially fruitful way. What the paper does not offer, or attempt to suggest, is an alternative way of making a distinction, and in the following discussion I intend to explain why I think that, on the one hand, the status of specific experiences is of practical importance, and on the other hand any distinction should not be conceptualized as mutually exclusive. I also hope to clarify those issues which I perceive as being raised by both Jackson and Fulford's and Marzanski and Bratton's papers. The Critique Marzanski and Bratton's first, and in my opinion strongest, point is to argue that "values and actions alone cannot always discriminate between religious experience and psychopathology." They demonstrate convincingly that the fact that an individual positively evaluates a certain anomalous experience and shows enhanced function as a result of it, does not in itself mean that the experience should be viewed as "spiritual." Their second and third points relate to the way spirituality ought to be regarded, suggesting that Jackson and Fulford are in error to identify spirituality with experience, and moreover that any judgment of genuine spiritual content or value requires reference to an individual's personal history, and also some spiritual tradition or authority. I believe that the former point, although certainly relevant to the issue, is in danger of broadening the debate too far from the consideration of particular anomalous experiences: namely, those that are phemenologically similar or identical to psychotic symptomatology. Marzanski and Bratton also mount an objection to the psychologization of spiritual experience by Jackson and Fulford, although I am not convinced that they represent these authors' opinions fairly. Whose Values? Action or Ethics? The first point, the refutation of the thesis that a spiritual experience can be distinguished from [End Page 373] psychopathology on the basis of a positive evaluation and preservation of functionality, succeeds in that it is shown both that (1) experiences accepted as spiritual within major religious traditions may actually be distressing and/or disabling; and (2) anomalous experiences that are both positively evaluated by the experient and action enhancing nevertheless may not have genuine spiritual characteristics. The argument proceeds through the use of counterexamples, and it is indeed a problem for the Jackson and Fulford account that suffering and periods of social withdrawal or distress do appear to be historically, anthropologically, and theologically associated with the spiritual journey. Bratton and Marzanski use, among other examples, the "dark night of the soul" of mystics, raising the very interesting point that a person may have experiences that, at least at the time of experiencing, are profoundly disturbing or even disabling, socially or functionally, and yet those same experiences may in some way set the scene for a profound transformation or spiritual renewal. To my mind this concept can be seen reflected in the "terrible" forms of the Wisdom Goddess in Advaita Vedanta (as expressed in my own paper), and can be related to the concept of "breaking down to break through" espoused by transpersonal psychologists such as Grof and Grof (1992).Therefore, on closer examination, it appears that Jackson and Fulford's notion of preserved functionality may play some role after all, even if it does require supplementation: if the breaking through aspect of the process is necessary to distinguish from simply breaking down, then action enhancement may remain a criterion determining the spiritual value of an experience. However, it will need to be observed in the longer term, and as such can only play a role... (shrink)

Ben Rich, J.D., Ph.D., presents a scholarly, passionate view of the ethics of the “barriers to effective pain management.” His manuscript is detailed, analytical, and compassionate. No reasonable sensitive person, especially a physician committed to caring for patients, can disagree with the proposal that human beings should have their physical, emotional, and spiritual pain tended to aggressively, meticulously, and compassionately. Similarly, the same individuals advocating for such pain management would agree that no one should go to jail unless he or (...) she is guilty of a serious crime, that decent people should not be robbed or murdered, that children should not be hungry or homeless, and that all citizens of the United States deserve healthcare. Our society attempts to achieve these goals. Laws are written, discussed, and approved by state and federal congresses, voted on by citizens, and theoretically upheld by the courts, churches, and decent individuals. But, unless the world suddenly becomes inhabited by virtuous, ethical humans who can unfailingly differentiate “good” from “bad,” then, in spite of an abundance of laws and lawyers, doctors, and nurses, this world will continue to have pain and suffering. And, although we want to hold our doctors, politicians, educators, champion athletes, and others to “higher standards” than the average citizen, it is best to remind ourselves frequently that all humans can be weak and are bound to make imprecise judgments, that there is not a homogenous definition of “good,” that values and religious beliefs are variable. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Philosophy, Psychiatry, & Psychology 9.4 (2002) 353-358 [Access article in PDF] The Application of Nondual Epistemology to Anomalous Experience in Psychosis Caroline Brett THE COMMENTARIES PROVIDED by Marzanski and Bratton, and McGhee have drawn my attention to several ways in which my analysis could benefit from clarification or supplementation, and the range of the specific phenomena to which it can be applied. Since writing this paper nearly 3 years (...) ago, my own views of the area have developed, and in some aspects, shifted; nevertheless, within this response I shall comment on the specific aspects of the original paper that I feel may have been misunderstood or overlooked by the commentators, and those aspects that benefit from the broader perspective they provided.To clarify the direction of the original paper: I would describe it as an attempt to make a deeper examination of processes involved in some kinds of anomalous experience than is provided by the "cognitive problem-solving model"; in other words, to supplement rather than challenge or undermine this perspective. Moreover, the focus is intended to be more on identifying the point at which the experience, or the response to the experience (more on the relation between these two below) becomes pathological, than on cleanly distinguishing a psychotic state from a mystical one. However, because I do use these terms contrastively throughout the paper, I concede that these aims become blurred and may in fact be indistinguishable.Third, the paper concerns only a relatively narrow arena of both mystical and psychotic phenomenology, selected for the purpose of a tight conceptual analysis and comparability, and possibly suffers a lack of generalizability or scope of application as a result. Most notably, I leave aside the paranoid or persecutory interpretative framework often seen as paradigmatic of the psychotic state (although a brief mention of how emotionally relevant themes may arise out of anomalous cognition is included), focussing instead on the more "Schneiderian" aspects of psychotic phenomenology, in which there is a self-observed alteration of normal experience. 1 It may be an important point of contrast that I do not specifically focus on "hallucinations, voices, and visions" as described by McGhee and, to an extent, Jackson and Fulford. It may also be worth [End Page 353] flagging up the fact that I do not focus on "delusional beliefs" at all, instead choosing to focus on the "delusional mood," which notably does not involve crystallized delusions as such. As a result, the main aim is not to compare two descriptively defined states of mind, as seems to be suggested by McGhee in his commentary, but rather to see to what extent a certain form of experience can be understood within a particular epistemological structure, and the implications of this.Further to this issue, Marzanski and Bratton raise an objection to a view in which a common core of mystical experience is posited; one which could be identified interculturally and independently of "the language and tradition in which the self is formed." They make an important point that the perspective gained by applying the epistemology of Zen Buddhism or Advaita Vedanta may have no authority in helping to understand the locus of pathology in anomalous experiences that have occurred in an individual who is not established in these cultures or traditions or for a person who does not accept these epistemologies in the first place. The issue of the existence of some core mystical experiences that are translated into religious experiences in different cultures is a matter of comparative religion and theology, and outside the scope of this paper (although my own opinion is that such a core exists). In the absence of any argument to support this opinion, it must be conceded that this may severely limit the applicability of my analysis, especially if irreconcilable differences are thought to exist between the epistemologies of, for example, theistic and monistic philosophies. However, I would suggest that whatever wisdom can be gleaned from the various spiritual doctrines in existence around the world with regard to unusual and/or distressing states of mind should be absorbed where... (shrink)

Ben Rich, J.D., Ph.D., presents a scholarly, passionate view of the ethics of the His manuscript is detailed, analytical, and compassionate. No reasonable sensitive person, especially a physician committed to caring for patients, can disagree with the proposal that human beings should have their physical, emotional, and spiritual pain tended to aggressively, meticulously, and compassionately. Similarly, the same individuals advocating for such pain management would agree that no one should go to jail unless he or she is guilty of a (...) serious crime, that decent people should not be robbed or murdered, that children should not be hungry or homeless, and that all citizens of the United States deserve healthcare. Our society attempts to achieve these goals. Laws are written, discussed, and approved by state and federal congresses, voted on by citizens, and theoretically upheld by the courts, churches, and decent individuals. But, unless the world suddenly becomes inhabited by virtuous, ethical humans who can unfailingly differentiate from then, in spite of an abundance of laws and lawyers, doctors, and nurses, this world will continue to have pain and suffering. And, although we want to hold our doctors, politicians, educators, champion athletes, and others to than the average citizen, it is best to remind ourselves frequently that all humans can be weak and are bound to make imprecise judgments, that there is not a homogenous definition of that values and religious beliefs are variable. (shrink)