Religion and Spirituality in Psychiatry

184 Ralph L. Piedmonteye, valid mystical experiences may appear aspsychotic-like episodes, and to treat them as suchclinically would be inappropriate.Only one study to date has empirically examinedmystical experiences among psychotic inpatients,religious contemplatives, and normal adults.(56) Interestingly, it was found that psychotics andcontemplatives could not be discriminated on thebases of their scores on a mystical experiencescale. Both groups reported experiences that werephenotypically comparable. However, the twogroups were differentiated on the basis of theirscores on a narcissism scale; the psychotic groupscoring significantly higher. Selfishness, self-involvement,and grandiosity are clear characteristicsof a nonspiritual orientation. (50) However,positive signs of a real transcendent experienceinclude a sense of wholeness, perfection, joy, andacquired insight. Psychotic experiences will havethe effect of promoting psychological fragmentation,while true mystical experiences result in anenhanced sense of personal integration. Lukoff(57) provided a useful orientation for differentiatingbetween a true “spiritual emergency” and apsychotic episode.But spirituality can also be a useful therapeuticresource for those with a schizotypal PD, regardlessof whether their “mystical experiences” arevalid or not. Lukoff outlined a number of usefultechniques for managing such clients, such asmindfulness and promoting a connection to thetranscendent. Building a personal relationship toGod can be helpful in building an identity, creatinggreater self-responsibility, and promotinghope. Keks and D’Souza (58) also believed thatnuminous constructs can help individuals gain asense of self and develop a better sense of personalsupport for themselves. Involvement insupportive religious communities can help tomelt stigmas associated with having a psychiatriclabel and provide increased personal meaning.7.2. Borderline and Narcissistic PDsKhalsa (51) believed that psychospiritual interventionscan help clients with these PDs createfor themselves an inner mental state thatis dynamic, attractive, peaceful, and creative.Spiritual techniques help to promote moreinternally stable emotional states. This is accomplishedby using a blend of Dialectical-BehaviorTherapy (DBT) in conjunction with variousyoga and meditative practices. The goal is tohelp individuals identify their core personalityand to embrace it as a first step in making a personaltransformation. The meditative practiceshelp clients to sit with their thoughts and to seehow they initiate emotions.Lawrence (53) viewed the narcissistic PD asmuch of a spiritual issue as a psychological one.Using more Western religious techniques, sheargued that a developing relationship with Godcan serve as a useful intrapsychic object that canprovide personal security to the client enablinghim or her to counter the inner vulnerabilitiesthat compromise the narcissist from developingand maintaining healthy interpersonal relationships.Lawrence relies on an explicitly Christianframework for providing the basis to the interventionprocess. Spiritual growth is linked directlyto psychological growth and maturity, with theclient-God relationship being the core elementto the treatment process. Of course, the generalizabilityof this model is limited to those whoaccept established views of Christian theology.7.3. Antisocial PDMartens (52) argued that spiritually orientedpsychotherapy could be a powerful interventionfor antisocial and psychopathic personalities.Spirituality can be useful in promoting authenticity,moral and social capacity, and a greater faithin life. Martens’ approach uses more eclectic strategiesthan those outlined in the previous two sections.His “spiritual psychotherapy” is “intendedfor patients with spiritual interests and latentabilities to develop spiritual activities. Duringspiritual psychotherapy, spiritual themes like gettingwisdom … coping with loneliness … authenticity… development of personal ethics will bediscussed” (p. 207). The goal of this approach istwofold: (1) to help clients find a way out of theirpsychosocial problems and (2) to create a healthy