Abstract: This article suggest that increasing numbers of people diagnosed as having mental illness may have needs that are not being fully met by mental health professionals. Psychosocial rehabilitation primarily addresses the residential, vocational, socialization and case management needs of the individual with long-term mental illness, and structures programs to provide services around these needs. An important area that is often overlooked by most practitioners relates to a person's spiritual needs. This article examines spiritual needs in terms of emerging perspectives, and reviews theory, research findings, and appropriate interventions that can be made by the psychosocial rehabilitation professional. Introduction Karl Menninger stated "Some patients have a mental illness and then get well and then get weller... This is an extraordinary and little realized truth (cited in Silverman, 1980, p. 63). An impressive number of other clinicians and researchers have also suggested that for some individuals undergoing psychiatric episodes, the experience may actually be positive and reconstructive (Boisen, 1962; Dabrowski, 1964; Ellenberger, 1970; Grof & Grof, 1985; Mosher & Menn, 1979; Perry, 1977). In the field of psychiatric rehabilitation, Soteria House was established to provide a home4ike alternative for young people with schizophrenia who would otherwise have been hospitalized. Conceptually, Soteria House adhered to the perspective that the psychotic crisis state can be growth-enhancing. Schizophrenia was identified as an altered state of consciousness that represented a unique potential for reintegration and reconstruction, if not aborted with medication prematurely. Thus, the clinical symptoms-including irrationality, terror, and mystical experiences were considered purposeful and real and the clients were assisted so that they could integrate these experiences into their lives. Results of a four-year experimental research study of this model demonstrated that most ex-Soteria residents gave little evidence of the mental patient identity; they were more psychosocially competent than they had been before their psychoses; and were actively engaged in living; their passion had not been suppressed. (Mosher & Menn, 1978). But despite the frequency of these clinical observations, the DSM Ill (APA, 1980) representing current psychiatric practice does not attempt to differentiate between psychotic episodes with growth potential and those which indicate a long-term mental illness (Lukoff, 1985). Laing (1967) has noted the difficulty of differentiating between "unusual experiences" and mental illness. He suggests "Experience may be judged as invalidly mad or as validly mystical...The distinction is not easy." Carl Jung (1954) hypothesized that the individual unconscious is but one dimension of human existence, and that the collective unconscious is shared by all humanity and is representative of creative forces. Many of the spiritual phenomena that people experience which are diagnosed as pathological may, Jung suggested, reflect variations of the collective unconscious, which have been considered perfectly normal and acceptable by various cultures throughout human history. Abraham Maslow (1964), whose term self-actualization may be thought of as the initial point at which a person may begin the process of surpassing ordinary experience (transcendence), suggested that mystical experiences or the "peak experiences" as he called them-should not be confused with mental illness. Ken Wilber (1980) notes that when the ego's normal barriers against attack by unconscious forces are broken down by stress, biochemical factors, or spiritual striving, the ego is then invaded by regressive impulses (from the personal unconscious) and by mystical ideas (from the collective unconscious). His theory recognizes a spiritual crisis as a condition that can incorporate symptoms of mental illness and at the same time mystical aspects that represent contact with realities beyond our ordinary senses. These writers and others suggest that when some persons going through a spiritual crisis do not have the go strength to handle this growth process, they tend to be labelled as mentally ill, and may be hospitalized and treated with drugs. Moreover, they propose that such individuals with appropriate assistance can achieve a higher level of personal integration than they had experienced before the crisis. As we approach the twenty-first century, radical changes are occurring in a variety of scientific disciplines that may point to a new understanding of health and human behavior. These changes are taking place in such fields as psychology, physics, anthropology, and medicine. An increasing interest in Eastern mysticism indicates peoples' needs for understanding that goes beyond the limiting materialistic, mechanistic viewpoints of our Western culture. Concurrently, holistic medical practices that affirm the interconnectedness of mind, body, and spirit are beginning to strongly influence our ways of looking at health and disease. It is common for many psychiatric rehabilitation professionals to scoff when they hear the terms spiritual crisis, transpersonal psychology, or other terms they perceive to be "new age" jargon. It is the thesis of this paper, however, that practitioners should begin to consider the possibility that some of the spiritual and paranormal dimensions of life that people experience are in fact legitimate concerns of psychosocial rehabilitation. Moreover, psychosocial providers should be open to expanding their vision so that they can differentiate between clients who can benefit from current psychiatric treatment and/or rehabilitation practices and those whose needs go beyond what is currently being offered. Current Psychiatric Views Regarding the Nature of Consciousness, Mental Health, and Mental Illness It is generally agreed that mainstream thinking in psychiatry reflects the medical model. Symptoms and disorders for which no specific etiology have been found are described and treated as psychiatric conditions. Community mental health centers and many psychosocial rehabilitations providers often must establish a diagnosis for each client to acquire federal or state funding and to be considered "legitimate." Persons who suffer from such disorders receive socially stigmatizing labels that frequently hamper their functioning. These labels can prove to be unreliable; studies have demonstrated that they often are related to a particular clini-cian's orientation, a client's gender and/or socioeconomic status, as well as other idiosyncratic factors (Rosenhan, 1973). At the same time, in standard psychiatric practice, a confusion exists over the use of the term "psychotic." The DSM Ill offers two meanings for the term psychotic; one suggesting a temporary state, and the other a mental disorder with lifelong implications: Psychotic - A Term indicating gross impairment in reality testing. It may be used to describe the behavior of an individual at a given time, or a mental disorder...(APA, 1980, p. 367). There are few fields in which the lack of professional consensus is as great as in mental health. We are confronted with different theories regarding how and why psychopathology develops, what mental illness actually is, and which therapeutic approaches are effective. The traditional scientific view focuses increasingly on the biochemical conditions of human experience. Schizophrenia and, by extension, mysticism are regarded as resulting from abnormal biological deficiencies. What this perspective overlooks is that frequently the fear (and the often accompanying rage) experienced by persons undergoing an emotional and/or spiritual crisis may produce biochemical effects in the brain and the rest of the body. Medical doctors however, opt toward interpreting this physio-logical change as the primary cause of mental disorder, rather than as a possible secondary result, brought on by strong emotions (Perry, 1986). Psychiatry also will suggest, more often than not, that mysticism of any kind is part of a primary process (using Freud's construct) and/or a primarily defensive adjustment pattern that individuals may use to resolve certain personal problems. Such a view was presented in a monograph prepared by the Group for the Advancement of Psychiatry (1976) after questioning 300 psychiatrists on the subject. At the same time, however, Andrew Greeley of the National Opinion Research Center (NORC) conducted a survey in 1973 that included approximately 1460 respondents in a national stratified sample. In this study, 359 of the sample (or about 25%) responded positively to having been involved in a mystical experience. Greeley found that persons having mystical experiences tended to be college-educated and in a state of "psychological well-being" that was substantially higher than the national average, as measured by the Brad-burn (1969) psychological well-being scale. In addition, Oates (1970) demonstrated in several studies that the statistical incidence of religious concern among psychiatric patients is about the same as among the general population. Thus, while there are no definitive data currently available regarding the percentage of psychoses related to spiritual crises, the results of these aforementioned research studies would suggest the importance of this topic and its heuristic value. Further, Horton (1973) notes that more recent forms of therapy used by contemporary religious leaders are meditation, retreat centers, and specific emphasis upon mystical experience. He recognizes as a psychiatrist the importance of a mystical state that along with other therapies will tend to offset the possibility of depression and suicide. Characteristics of Spiritual Crises and Transpersonal Phenomena 1. Spirituality: Two Perspectives Pastoral Counseling. The concept of spirituality has different meanings for different people. The common usage typically implies something that is uplifting or beyond nature. From a theological or religious perspective, spirituality encompasses love of oneself, others, and God. The field of postoral counseling traditionally has assisted individuals in finding personal meaning in relation to their spiritual concerns. Oates (1978) expounds on this by describing the clinical approach used in postoral counseling that evaluates symptoms in terms of what they mean to the individual, what they mean in light of the history of the individual, what they mean in relation to the immediate stress the individual is under, and what they mean in terms of the individual's future hopes and ongoing spiritual integrity. Oates also differentiates between authentic spiritual experience and more conventional or superficial religious concerns. He describes an authentic spiritual crisis as one in which a person is acutely ill and seeks a genuinely meaningful interpretation of the chaos that exists. The individual works at trying to resolve such major problems as deliverance from old patterns of life and discovery of new patterns of existence, the problem of integrity before God in a world that places more values upon appearance than reality, and recovery from never being able to achieve a much-cherished goal in life. These existential issues call for broadening one's own interpretation of life to encompass these problems. Pruyser (1976) suggests that the first duty of any professional whether in the field of religion or psychiatry is to achieve clarity about the problems that individuals bring before him or her. Pastoral counselors clearly strive to differentiate between authentic religious experience and more commonplace religious concerns. Transpersonal Psychology. Perry (1986) describes "spiritual" from both historical and psychological perspective. He notes that the ancient words for spirit mean "breath" or "air in motion" in Hebrew and Latin as well as in Far Eastern languages. Many individuals who experience a spiritual crisis refer to spirit as feeling like a strong energy that moves through them with almost a "quality of mind." From a psychological perspective, Perry identifies spirit as "constantly striving for release from its entrapment in routine or conventional mental structures" (p. 33). He believes that therapists should work with such clients, to help them free this dynamic energy so that it will be liberated from the following kinds of patterns: enmeshed family systems, problematic interpersonal relationships, beliefs concerning the nature of human life, changing values, and cultural conditioning. He states that "during a person's developmental process, if this work of releasing spirit becomes imperative but is not undertaken voluntarily with knowledge of the goal and with considerable effort, then the psyche is apt to take over and overwhelm the conscious personality with its own powerful processes." (p. 34). Perry calls this the "renewal process"; Jung (1980) had suggested that there are often periods of very uncomfortable deadaptation of episodes of altered states of consciousness, called transitory psychosis; and Grof & Grof (1985) have referred to this type of experience as "spiritual crisis" or "spiritual emergency." Transpersonal psychologists believe that higher realms of reality exist beyond sensory data and that in this realm, each person experiences a deep relatedness to what has been called the cosmos, the universal mind or God. Transpersonal psychology is based upon direct, subjective experiences. The existence of the transpersonal dimension rests primarily upon the descriptions of those individuals who have undergone mystical experiences, which as William James (1929) pointed out, show impressive similarities from one individual to another and from one culture to another. Transpersonal psychology, as a philosophy and as a method of psycho-therapy, focuses on an individual's ability to change and grow. However, this "new direction" in psychology is really not new. It reflects both the great philosophies that have existed throughout human history and contemporary psychological thought. 2. Examples of Spiritual/Transpersonal Experiences Synchronicity and its Relationship to New Physics. As individuals experience transpersonal phenomena, they often start to perceive their environments in a synchronistic manner, first recognized by Jung (1952) and described in his essay "Synchronicity: A Causal Connecting Principle." Synchronistic events link elements of the unconscious world of feelings, dreams, or visions to events from external reality. Synchronicity is identified as a process in which "cause and effect" are replaced by meaningful coincidences. A single example of the concept Of synchronicity involves an individual who turns on his car radio and hears words of a song that provide him with an answer to a particular problem in his life with which he had been wrestling at the moment he turned on the radio. These kinds of experiences can be frightening for many people. The person encountering synchronicity comes to view life primarily in terms of his or her subjective understanding, as opposed to the more usual objective, external ones. As a result, such an individual may become confused as to what constitutes the real world the inner, subjective experiences or the outer, objective world. This confusion is often exacerbated by the mental health practitioner who works at helping his or her client to rationally deal with "reality." Peat (1987) suggests that synchronicities occur when internal restructuring produces bursts of mental energy onto a physical world. Jung, at the time of his writing (1952), realized that the concept of synchronicity was completely contradictory to the views of both the medical and scientific establishments. Therefore, he sought out and received support from several European scientists including Albert Einstein and Wolfgang Pauli, who agreed that synchronicity converges "new physics" with mysticism when an individual feels at one with mankind and the cosmos and time and space become irrelevant. The thinking underlying new physics has evolved from Einstein's relativity theory (1923,1.950) and present day quantum physics, as well as from Bohn's holonomic physics (1980) and Pribram's brain theory (1976). Although new physics became known in the early 1900's, the medical and academic communities have tended to ignore this perspective and have adhered instead to the Newtonian-Cartesian paradigm, a three hundred year old system of though based on the work of the British scientist Isaac Newton and the French philosopher Rene Descartes. The Newtonian-Cartesian paradigm adheres to the belief that consciousness is directly related to the physiological processes in the brain. As a result, this conceptual framework seeks to explain such phenomena as human intelligence, creativity, art, religion, ethics, and science itself as products of physical processes of the brain. Although close correlations between consciousness and cerebral structures exist, the limited interpretation offered by mechanistic science is open to question. The relationship of new physics concepts to the nature of consciousness and mental processes is made by David Bohm, a former con-worker of Einstein. In his holonomic theory of the universe, he described the world that we observe in our ordinary state of consciousness as representing only one partial aspect of reality. He identified another level of reality that cannot be observed directly except possibly in nonordinary consciousness such as deep meditative and mystical states. In so doing, Bohm challenges the Newtonian-Cartesian system of thought and opens new perspectives for speculations about mystical states, spiritual awakenings and other areas that were previously excluded from the study of human psychology. Wilder Penfield (1976), an internationally recognized neurosurgeon, in reviewing his life's work in his book, The Mystery of the Mind, expressed a deep disbelief that consciousness is a direct product of the brain, one which can be explained solely in terms of neurophysiology. In sum, the concepts inherent in hew physics are relevant for psychiatric rehabilitation professionals in so far as they allow them to question the existing scientific disciplines that identify with British Empiricist John Locke who believed "nothing comes into the mind without first entering the senses." Activation of the Central Archtype. Perry (1987), a Jungian psychiatrist who works mainly with psychotic individuals, observed that a majority of his patients manifested standard patterns and stages that could be growth-producing if the processes were not suppressed by psychotropic medication. His observations were based in large part on his involvement in the Agnew Project, a study funded in the late 1960's by the National Institute of Mental Health (NIMH). This study examined persons many of whom were young and involved with psychedelic drugs and/or other combination of street drugs who were going through what could be described as psychotic episodes (much like the profile of what we identify as the "young chronic" today). It investigated eighty cases in a three-year follow-up study and sought to identify who would do well without phenothiazine medication as well as who required the medication in order to recover from a psychic upheaval too hard to handle. Results demonstrated that persons on psychotropic medication had roughly the same rate of recurrence of mental illness as the national average of persons in mental hospitals, i.e., 73%; those off medication showed only an 8% recurrence. As a result of these findings, Perry and a colleague, Howard Levene, designed and operated a drug-free therapeutic residential facility which they names Diabesis for young persons experiencing psychoses. From this experience, Perry identifies the following recurring mythic themes that are present in individuals who have a positive prognosis: the perception of themselves in the middle of a world process in which they were the center of all things; a preoccupation with death; a sense of being on a journey or mission; a sense of rebirth: new identity or resurrection; a focusing on opposites that included issues related to culture, ethics, politics, religions, attitudes, beliefs, and sex (particularly by gender and homosexual panic); cosmic conflict: good/evil; magical powers: telepathy, clairvoyance, etc.; and new society, radical changes in society (e.g., religion, "new age," Utopia, world peace) Additionally, Perry (1966) had found that the basic patterns and themes experienced by individuals involved in such a process have appeared in the mythologies of many great cultures throughout history. He found evidence that annual holiday festivals focused on these themes in Egypt, Israel, India, Iran, Greece, Rome, China, and the Nordic lands. Lukoff (198.5) also identified these same themes as being experienced by numerous persons going through transpersonal episodes. Unfortunately, the meanings underlying psychotic thought patterns are not acknowledged by the psychiatric community as anything more than projections of confused thinking onto outer reality, thus meeting prevailing criteria for delusions. As a result, most of these mythic themes are suppressed during the first few days of treatment with medication. To better understand the thrust of Perry's concerns, the following comments are enlightening: "It is a matter of great grief now in the 1980s to behold the sharp decline in the quality of care of persons undergoing the acute episode. There is ever less funding, and therefore little patience at the administrative level, for innovative programs that keep persons in a facility for more than a few days. Conveniently for the profession, this can be rationalized plausibly enough by an explanation for the occurrence of such episodes in terms of faulty brain chemistry to be corrected by counter-chemistry...In this way, a lifetime of rejection becomes repeated where one is most poignantly needful of its opposite, a caring reception and affirmation (1986,pp. XVI, XVll)." The Mystical Experience. Psychotic and religious experiences have been associated with each other since the earliest recorded history. The relationship between psychotic symptoms and aspects of mystical experiences has also been acknowledged in the psychiatric literature (Arieti, 1976; Buckley, 1981; James, 1961). Lukoff (1985A) suggests that if a new diagnostic category Mystical Experience with Psychotic Features (MEPF) were to be included in the DSM Ill, it could reduce inappropriate hospitalization and use of medication for individuals who could be treated with less invasive methods which have fewer side effects. Such a diagnosis could be used for persons having genuine religious experiences concomitant with a mental disorder. Buckley (1982) makes a similar such point by suggesting that overlap exists in some aspects of the acute mystical experience and acute schizophrenia, and urges that careful discrimination be used by psychiatrists in deciding which individuals should receive medication. He further notes in differentiating between persons with schizophrenia and persons having mystical experiences, that persons diagnosed as having schizophrenia typically have cognitive deficits that affect their basic thought processes. Systematic comparisons of mystical experiences have found that "thought blocking and other disturbances in language and speech do not appear to accompany mystical experience" (1981), p. 527). In an effort to describe the mystical experience, James (1961) noted that it is difficult to express in words. Neumann (1964) stressed that the psychological effects of mystical experience results in a transformation in the personality. Wing, Cooper, &: Sartorius (1974) identified the following criteria as being necessary for defining a mystical experience: Ecstatic mood Sense of newly-gained knowledge Perceptual alterations (from heightened sensations to auditory and visual hallucinations) Delusions (if present) have themes related to mythology No conceptual disorganization The difficulty in understanding aspects of religion was noted by Freud (1927) when he stated "The truths contained in religious doctrines are after all so distorted and systematically disguised, that the mass of humanity can not recognize them as truth" (pp. 44-45). At the same time, it should be acknowledged that some individuals have spontaneous religious or mystical experiences and are able to integrate them into their lives without the intervention of psychiatric or religious professionals. The Mythological Experience. Joseph Campbell, identified as the world's leading expert on comparative mythology, developed a systematic study of patterns constant in mythology across time and culture. In this classic treatise, The Hero with a Thousand Faces (1949), he identified three stages in the Hero's journey: Separation initiation return..."A hero ventures forth from the world of common day into a region of supernatural wonder: fabulous forces are these encountered and a decisive victory is won: the hero comes back from this mysterious adventure with the power to bestow boons on his fellowman" (p. 30). The relevance of myth to psychosis is enhanced by Campbell's thesis that the hero's journey although told in terms of external events such as battles and dragons is actually a metaphor for the venture into the psyche. Campbell (1972) states "To my amazement...t he imagery of schizophrenic fantasy perfectly matches that of the mythological hero's journey" (p. 216, emphasis added). Further, he suggests that the individual with psychosis, the mystic, the yogi, and the LSD taker are all plunged into the same deep inward sea. However, "the mystic endowed with native talents for this sort of thing and following stage by stage the instruction of the master, enters the waters and finds he can swim; whereas the schizophrenic unprepared, unguided and ungifted has fallen or has intentionally plunged and is drowning" (p. 216). Applicability and Relevance for Psychiatric Rehabilitation 1. The Relationship Between Mental Illness and Spiritual Crisis Perry (1976) states that the primary function of the acute psychotic episode is to enable a person to understand symbolic meanings as they pertain to his or her life. He states "... in the psychotic state, the symbolic concerns belong to a subjective reality. And although these concerns are usually totally out of keeping with objective reality, they are meaningful and not merely random disorder." He believes that when medication is avoided and the imagery coming from the psychic depth is needed, it may be found that "nature's own healing process is thereby allowed to do its work for the reorganization of the self" (pp. Ix-x). Jung (1964) believed that mental health professionals should receive education in mythology to provide them with a "comparative anatomy of the psyche." Clearly, this has not been the case. Practitioners are customarily cautioned never to encourage such symbolic talk, but instead to engage in supportive counseling and provide behavioral approaches, both of which avoid uncovering and instead strengthen the defenses in an effort to help the individual cope with "reality." The above contributions suggest that understanding the connections between psychosis, myth and mystical ideation, and experience can assist psychosocial practitioners not only in relating to a post-psychotic client more effectively, but also in promoting the client's higher functioning. At the same time, it is important to emphasize that these perspectives are not opposed to modern psychiatric rehabilitation practice. Clearly, psychosis without spiritual and/or transpersonal influences does exist. There are also individuals who suffer from schizophrenia and spiritual crisis concurrently, as well as persons who experience transpersonal phenomena and are not mentally ill. It is therefore important for the field of psychiatric rehabilitation to at least be aware of these differences so that all clients can receive appropriate treatment either by the psychosocial practitioners or through referral elsewhere. An important first step for the psychosocial rehabilitation practitioner is to try to become familiar with the criteria that differentiate a spiritual crisis from schizophrenia. Grof & Grof (1986) proposed the following two major criteria that must be present to identify such a crisis: that the individual has episodes of unusual experiences that involve changes in consciousness and in perceptual, emotional, cognitive and psychosomatic functioning, in which there is a significant transpersonal emphasis such as dramatic death and rebirth sequences, mythological and archetypal phenomena, as well as out-of-body experiences, incidence of synchronicities or extrasensory perception, intense energetic phenomena, states of mystical union and a sense of cosmic consciousness. that the individual has the ability to see the spiritual crisis as an inner psychological process and the capacity to form an adequate working relationship and maintain a spirit of cooperation with the practitioner. These criteria exclude people with severe paranoid states, persecutory delusions and hallucinations, and those who consistently use the mechanisms of projection, exteriorization, and acting out (p. 8). In related view, Lukoff (1985A) suggests that if two out of the following four criteria are satisfied, a psychotic episode is likely to have a positive outcome: good pre-episode functioning as evidenced by no previous history of psychotic episodes, maintenance of a social network of friends, intimate relationships with members of the opposite sex (or same sex if homosexual), some success in vocation or school; acute onset of symptoms during a period of three months of less; stressful precipitants to the psychotic episode such as major life changes, e.g., a death in the family, divorce, loss of job. Major life passages which result in identity crises, such as transition from adolescence to adulthood, should also be considered. a positive exploratory attitude toward the experience as meaningful, revelatory, growthful. Such as positive attitude toward the psychotic process facilitates integration of the experience into the person's post-psychotic life (p. 170). 2. Providing Therapeutic Assistance Relevance for the client with long-term mental illness. Much of what has been said to this point has related to spiritual crises as part of acute psychotic states. Since psychiatric rehabilitation focuses primarily on persons in a post-psychotic state or those who are diagnosed as experiencing long term mental illness, what relevance does this have for them? First, it is important to note that the psychotic experience itself isolates the individual from others. The subsequent devaluation of the experience by others then results in more isolation just when the person needs to re-connect to the social world. But reconnecting to the world may necessitate more than engaging in socialization and vocational activities. Many long-term mental patients with marginal lives demonstrate that once they have traveled into the depths of their psyches they have difficulty coming back. The mental health field has recognized that a large group of clients exist who "wish to be crazy," preferring the psychotic state with its intense experiences and grandiose powers (Estroff, 1981; VanPutten, et al., 1976). Therapists typically fear that discussion of the symbolic or mythic dimensions of the experience might encourage clients to become preoccupied with their inner life and consequently precipitate a relapse. What they may not realize, however, is that the clients who return from their psychic journeys do not feel complete or resolved until they have the opportunity to put their experiences into words; to tell their stories. The following case study refers to a client who was hospitalized fifteen years ago for what was then diagnosed as a psychotic episode and who l am now seeing in nay practice. Bob M., a 23-year-old "hippie" in the 1960's had been taking LSD and other drugs for several months prior to an accident he had, during which he "fell" off the balcony of his apartment, which he shared with several friends. Over the last fifteen years, Bob now 38, has entered college, dropped out, married, had two children, and divorced. He is now living with another woman, has worked intermittently in various jobs, and has never quite achieved the satisfaction he is looking for. His IQ is over 150. The chart below relates differing themes and aspects of Bob's psychotic experience to many of the criteria that have been identified as characterizing a spiritual crisis. The following are some excerpts from his experience that he has shared with me: Excerpts of Bob's Experience Characteristics of Spiritual Crises Bob: "There's a certain other energy that I can experience even now in contemplation of my experience at the time. The energy is very powerful and quite unlike other energies I experience or have heard others describe. Grot & Grot: "intense energetic phenomena" Bob: "I felt a strong idea of duality good or evil could never be totally reconciled, they would always be in a state of tension. The Book of Revelations came alive for me. In order for good to be there, there always had to be evil the more that evil was pushed aside, the more concentrated it became idea was to bury evil at the center of the earth it could never be eternally contained eventually it would leak out. Wanted to sacrifice myself by willfully going to the center of the earth and taking on the suffering of others so they could be set free. I wanted to perform this mission for the good of all mankind. I wanted to be a living sacrifice." Perry: "cosmic conflict good/evil" Perry: "a focusing on opposites that included issues related to ... religion Campbell "... the imagery of schizophrenic fantasy perfectly matches that of the mythological Hero's Journey" Perry: "a sense of being on a mission" Perry: "the perception of himself in the middle of a world process where he was the center of all things" Bob: "A great transformation process began occurring in my body. I began an intense effort that lasted through the entire night. I was moved to undergo the process of death and rebirth. Grof & Grof: "death and rebirth sequences" Perry: "a preoccupation with death" One of the last "delusions" that Bob experienced during his psychotic. episode was expressed as follows: "I looked up at the sky and saw an infinity symbol. One half was red and the other was blue. I was aware that I had experienced one half of the infinity symbol in my visions, now I hoped at the hospital I could work through the other half." Instead of working through the other half, Bob was put on heavy doses of medication. His visions stopped, the psychiatrist at the hospital did not discuss with him the meaning or content of his experiences, and he went home three months later. During my current discussions with Bob, he recounts how he feels that this episode he experienced some twenty years ago is still impinging on his life. "For me the lid was blown off during that time. It opened up all these worlds and it has never quite gone totally back on. There's always that knowing that something else is going on, and that's made it difficult for me to get into anything in the world again. It's very distressing my visionary experience is still a dilemma in many different ways. It's a kind of mythology that's deep in my system. It's very present, and it's something very meaningful for me. One of the images that is always with me...is my going all the way to the edge of the universe, all the way to the edge and then having to turn away. I'm wondering if that feeling has stayed with me over all these years and has kept me from completing tasks and projects in my life...If I could have seen the whole picture then, l feel I'd be different today." The clarity and recall he demonstrates as he recounts the details of the episode experienced fifteen years ago illustrates how important this event has been and still is in his life today. Although the description of this man's psychotic episode bears close similarity to the characteristics of a spiritual crisis, it must be acknowledged that he is but one individual. At the same time, I would note that my professional experiences over the last decade including my work at Horizon House as a counselor and clinical supervisor and at Matrix Research Institute as a consultant helping to develop psychosocial rehabilitation services across the country, as well as university teaching, have supported the following major perspectives that underlay this article: For some individuals undergoing psychotic episodes, the experience may be positive and reconstructive. Many of the spiritual phenomena that people experience are not psychopathological. A spiritual crisis is a condition that can incorporate symptoms of mental illness and at the same time mystical and mythological aspects that represent contact with realities beyond our ordinary senses. The mental health system, including psychiatric hospitals, should support and affirm the acute psychotic episode for some individuals without aborting it prematurely through medication. Psychosocial rehabilitation practitioners can help clients tap into the current meanings that their past psychotic episodes have as they attempt to live independently in the community. The field of psychiatric rehabilitation should be open to acknowledging the natural healing processes inherent in all individuals. Psychosocial interventions. There are various approaches that can be utilized in a psychiatric rehabilitation center to assist clients in understanding the individual meanings of their previous psychotic episodes. One such approach would be to develop groups in which clients could discuss the different mythological and religious patterns of their experiences. Another group of clients might focus on a topic such as "the hero's journey" and discuss the personal meaning this theme carries for them. Expressive therapy techniques (i.e., music, arts dance) can help clients integrate and ultimately begin to resolve the powerful religious and mythological dimensions of their experiences that were suppressed by medication early in the process. Through group sharing and matter-of-fact acceptance of all experience, clients can become hopeful, open, and more alive. Laing (1982) has criticized the placing of all responsibility on the clients for making their realities understandable to others. "Both what you say and how I listen contribute to how close or far apart we are" (p. 38). If a client feels that a helper supports his or her process-whatever that may be there is clearly more opportunity for help. Role of the psychosocial rehabilitation practitioner. What can the practitioner do to help a person in spiritual crisis? It should be emphasized that the expectation is not for the helper to undertake in-depth clinical intervention. Rather, it is hoped that the following basic psychosocial principles currently prevalent in the field will be applicable in helping clients integrate such experiences: normalization of the crisis; affirming the client's strengths; recognizing and respecting the client's subjective experiences; balancing these experiences with the outer world; conveying hope and acceptance. In addition, the following processes and methods may be particularly helpful in assisting a client to work through this kind of crisis: the development of mutual trust and honesty between counselor and client; labeling and identifying what the client has described: for example, "the connection between what is happening in your mind with what is happening in your environment may be more than coincidence it's known as synchronicity, and it often occurs when people are going through a major change in their life"; providing bibliotherapy and reading material related to a person's particular experience; facilitating grounding through reassurance, by staying in contact, by affirming the person's boundaries, by supporting creative expression; exploring the cognitive, emotional, and spiritual nuances that the client incorporated into the experience; encouraging discussion and expression of symbolic imagery in small groups and through expressive therapies such as art, music, and movement. Conclusion Currently, there are few if any practitioners, psychosocial rehabilitation centers, other facilities or resources working with persons with long-term mental illness around issues related to spiritual crises. The work that is being done in this area is targeted primarily toward emotionally healthy persons who voluntarily find themselves moving into higher states of consciousness through meditation or other spiritual practices. The need exists, therefore, for the psychiatric rehabilitation field to maintain its current values and approaches while expanding its scope to address an additional vital need in clients that has yet been unmet. The pioneer (but now defunct) residential treatment programs at Diabesis (Perry, 1974), Soteria House (Mosher & Menn, 1979), and Kingsley Hall (Laing, 1967) developed techniques which allowed clients a wide latitude of freedom for expressing their beliefs, affects, and symbolic imagery. Lamb (1979) also noted that clients going through acute episodes could be treated by friends and relatives who would be willing to provide 24-hour care in a sanctuary-type environment, as well as in non-hospital "inpatient units," religious communities, etc. Regrettably, however, what has been lacking is the recognition by the field of psychiatric rehabilitation that certain types of psychotic episodes may lead to positive, growth-producing outcomes. If this theoretical perspective would be incorporated as a legitimate aspect of the field, then treatment programs and methods could evolve from this perspective that wold achieve a higher degree of success than programs have in the past. Finally, staff training and development should be implemented around basic concepts underlying symbolic and related mythological themes; particularly useful would be efforts to identify criteria which differentiates spiritual crises from long-term mental illness. Patricia Deegan (1988), a clinical psychologist and ex-mental patient likens her own personal recovery to that of an individual with a physical disability: "But one day something changed in us. A tiny fragile spark of hope appeared and promised that there could be something more than all of this darkness...This is the mystery. This is the grace. This is the birth of hope called forth by the possibility of being loved. All the polemic and technology of psychiatry, psychology, social work, and science cannot account for this phenomenon of hope. But those of us who have recovered know that this grace is real. We lived it. It is our shared secret." (p. 14). The field of psychiatric rehabilitation has enabled the individual with long-term mental illness to achieve successes that a few decades ago were deemed impossible. It may serve us well to continue this achievement by expanding our vision as we look to the future. REFERENCES
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She is on the faculty of Beaver College.