From Spiritual Emergency to Spiritual Problem
In this 1998 article, David Lukoff details the history and rationale behind the inclusion of the diagnostic category “Religious or Spiritual Problem” (V62.89) in the DSM-IV.
Origins and Advocacy
The push for this new category originated within the transpersonal psychology movement, particularly from clinicians working with the Spiritual Emergence Network (founded by Stanislav and Christina Grof). Their goal was to reduce the pathologizing of intense spiritual crises — spiritual emergencies — by providing a non-pathological diagnostic code (a “V Code”), similar to the code used for uncomplicated bereavement.
Types of Spiritual Problems
Lukoff outlines several types of spiritual emergencies and problems that often present in clinical settings, including:
- Questioning or loss of spiritual values (often triggering grief-like symptoms)
- Meditation-related problems (e.g., anxiety, depersonalization, or “false enlightenment” from intensive practice)
- Mystical experiences that become disruptive or are misdiagnosed as psychotic episodes (e.g., mania or schizophrenia)
- Near-Death Experiences (NDEs) whose aftereffects are difficult to integrate
- Leaving a spiritual teacher or cult (often involving feelings of betrayal and psychological abuse)
- Kundalini awakenings and shamanic initiatory crises
Clinical Implications
The inclusion of this category marks a significant shift in mainstream mental health, acknowledging that profound spiritual and religious experiences are normal, prevalent, and sometimes require culturally sensitive therapeutic integration rather than anti-psychotic medication.
See Also
- Spiritual_Emergency — the transpersonal concept this DSM category attempts to accommodate
- Spiritual_Emergency_The_Understanding_and_Treatment — the Grofs’ original framework
- The_Grofs_Model_of_Spiritual_Emergency_in_Retrospect — retrospective evaluation
- Differentiating_Spiritual_and_Psychotic_Experiences — Greyson’s clinical differential
- Kundalini — the most common trigger for spiritual emergencies
- Dissociation — the psychological mechanism that can accompany spiritual crisis