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PTSD

What to do in a spiritual emergency

Last month I organized an event on ‘what to do in a spiritual emergency’ –you can see videos of the talks here. Three of my friends spoke bravely and lucidly about their own experiences – psychotherapist and film-maker Anna Beckmann, poet and transformational coach Louisa Tomlinson, and Tai-Chi teacher Anthony Fidler – and Dr Tim Read, a wonderfully wise and compassionate psychiatrist, gave us his perspective.

I wrote about this topic in The Art of Losing Control, and it’s become particularly important to me after the mini-crisis I had last year, following my ayahuasca retreat. A friend referred to it as a ‘breakdown’ this week, which didn’t feel quite right, because it was also something beautiful and healing.

So what does ‘spiritual emergency’ mean exactly, and what can we do when they occur?

There is an overlap between spiritual / religious / ecstatic experiences, and psychosis. Psychiatry has historically viewed all religious experiences as pathological, labelling them ‘hysteria’, ‘ego-regression’ or ‘psychosis’ and ignoring any positive aspects. That’s partly because psychiatrists have tended to be anti-religious secular materialists, battling the church for authority over the care of souls.

However, some psychologists (and a few psychiatrists) have suggested an experience can be both spiritual and quasi-psychotic. This ‘transpersonal’ perspective was put forward by psychologists and thinkers like Frederic Myers, William James, Carl Jung, Aldous Huxley, Ram Dass and Stanislaf Grof – who coined the term ‘Spiritual Emergency’ and brought out an excellent anthology with that title in 1980.

A spiritual emergency involves the sudden collapse of one’s habitual ego and customary sense of reality, and an opening to a different reality (which one could call the subconscious, or the archetypal layer, or the dream-world, or alternatively the Self or God – it’s a movement both downwards and upwards). It can involve a powerful sense of connection to all things, perhaps a transcending of time, space and matter, and a deep sense of meaning and awe. And it can also be extremely messy, painful, terrifying and dangerous, and have psychosis-like features like mania, ego-inflation, insomnia, voices, visions, ontological uncertainty and emotional disturbance. But unlike a psychotic illness, it can be a transition to growth, if handled sensitively.

Anthony told us: ‘It’s easy to get an idea of the life journey as a tidy evolution. But there’s another way humans grow, through revolution. The personality structure that’s evolved through childhood builds up like a building. And at some point in life it can be healthy for that to collapse. It can be a moment of growth, a journey forwards. But it doesn’t look like that. It looks like a piece of shit.’

Anna told us of her experience in her twenties:  ‘It was the most horrifying experience I ever had, and also the most awesome.’ Louisa said: ‘A spiritual emergency is when there’s an opening between the two worlds – the spiritual and the material – but it happens without maps or guides. What could be a successful integration into a larger self and reality becomes instead intensely terrifying, a failed initiation, which instead of leading to transformation, leads to fragmentation and sometimes to annihilation.’

What are the triggers?

Both Anna and Louisa spoke of how unresolved trauma was a trigger for their spiritual emergencies. For me too, the turbulence I felt after my ayahuasca retreat was partly a resurfacing of trauma from my late teens and early 20s. Trauma seems to create an ego structure that is more prone to what Tim Read calls ‘high archetypal penetrance’ (HAP) states – the subconscious and the transpersonal or spiritual dimension gets through the cracks easier.

There may also be a genetic predisposition to altered states – you might have some genes in your family that predispose you to schizophrenia, or bipolar disorder, which make you schizotypal without necessarily developing into a psychotic disorder. One notes that in some cultures, shamanism is considered an inherited ability, as are psychic powers – a tendency to absorption or dissociation gets passed through the genes, and this can lead to creativity and insight as well as disturbance, eccentricity and illness.

More immediate triggers include being physically isolated from one’s friends and family. My crisis occurred when I was in South America, Lou’s when she was alone in Dartmoor, Anna’s when she was in New York, Anthony’s when he was in China. Tim has written about a near-crisis he had while travelling in India. Such crises can occur at moments of difficult transition – going to university, say, or breaking up from a long-term relationship.

And then there are triggers like not eating or sleeping properly, or going on a spiritual retreat, or taking drugs. Tim says he has often encountered people who’ve had spiritual crises after attending spiritual retreats – he writes about this in his excellent book Walking Shadows: Archtypes and Psyche in Crisis and Growth, and notes that retreats often shift people’s egos but fail to help them integrate their experience in the days and weeks afterwards.

What does a spiritual emergency feel like?

Both Lou, Anthony and Anna spoke of a feeling of ego dissolution accompanied by physical dissolution – they felt they went out of their bodies, and the material world seems to dissolve. I had a similar experience on ayahuasca, as many do. It is terrifying, because you don’t know if you’ll come back, so I can’t imagine what it’s like to experience that for several days or weeks. But I wonder, too, if this dissolution of the ego and material reality is an insight into the actual nature of things – Buddhists say we perceive the world as made up of separate solid things (me, the table) where actually there is a continuum of energy. Buddhist monks try to get to a state where you go beyond the perception of solid things. But it is terrifying if that happens when you’re not ready for it.

The Rebel Powers That Do Thee Assay by Charles Sims

There’s also a collapse of boundaries – between the self and other people (can you read my thoughts, can I pick up your feelings and thoughts?); between you and the world (‘I can control traffic lights or even world events with my mind, it’s all connected to me’); between dream and reality. Anthony suggests we have at least two types of consciousness – a movie camera that projects waking reality, and a movie camera that projects our dreams. And in psychotic episodes, these two movies overlap, so the mythical movie of the dream-world gets superimposed on reality. Both Anna, Lou and Anthony had strong archetypal aspects to their experiences – religious imagery, messages, a sense of cosmic significance to their thoughts and acts. There can be intense surges of energy, powerful gusts of emotion, lights, visions, voices.

And there’s a deep ontological uncertainty. Anthony says he didn’t know if he was dead, or in some sort of altered bardo state. That was the same for me – for a week, I couldn’t work out if I was dreaming or in the afterlife. In Tim’s book, some of his case studies also don’t know if they’re dead or in heaven. It’s common on powerful psychedelic experiences to think you’re either dead or about to die. The ego interprets its dissolution as actual death. You find yourself still conscious and in some reality, but you can’t take anything for granted about how it works. In psychological terms, it’s a profound de-automatization. Your habitual automatic expectations of reality are dissolved. I would get on a plane and wonder if it would really take off or not, as if I somehow had to will it to take off (it was my dream – I was making it all happen).

What helps?

In his book, Tim Read emphasizes the importance of ‘set, setting and integration’ for navigating this sort of spiritual turbulence. This is also one of the main conclusions of my book, The Art of Losing Control.

Set refers to the mind-set one brings to the moment. In ecstatic states of consciousness – like psychedelic consciousness – our mind becomes extremely sensitive. It can swing from euphoria to terror in a moment. So you need to foster certain attitudes, above all mindfulness. Don’t worry about the past or future, focus on what is happening now. We need to try to remember ‘I’m in a spiritual crisis’ or ‘I’m tripping’ rather than get swept away by the powerful thoughts and sensations. Feel whatever you’re feeling, and observe it without attachment or aversion.

The breath is very important for this. It grounds us in the present moment, it relaxes our emotions, and it connects us to our body. Lou speaks of the ‘silvery chord of my breath’ being the only thing that connected her to her body and to physical reality. Someone once said we’re spiritual beings having an in-the-body experience – we need to connect to the body, enjoy this sensual material reality (nature is good for this too, so are hugs). It was also hugely important for me, in moments of panic, to breathe slowly, and remind myself ‘this will pass’.

A second important attitude is humility – not giving way to ego-inflation and Messianic grandiosity. Anthony says: ‘If you think you’re Jesus or the Buddha, that’s OK. But you’re also this person. And if I’m the Buddha, so are you.’ You have a glimpse of the infinite Self within you. But it’s within everyone, not just you. Relax. Don’t take yourself or the experience too seriously. You’re not controlling the universe. Have a sense of playfulness. Anthony talks about having an open and curious attitude to one’s experience – what does it feel like? How does this reality behave?

Third, we need to take care of ourselves. Yes, you’re the infinite cosmos, but you’re also this particular being in this particular body. Have patience and compassion for your ego and body. Look out for yourself – make sure you eat and sleep, don’t put your body in danger. Be polite, pay for things, even if you think it’s all a dream. Self-compassion is the key – even when I felt very alone and frightened, I rooted for myself. I was on my side, no matter how much the volatility swept away my tidy life-plans.

Painting by the sectioned artist Louis Wain

Secondly, setting is crucial. It helps if you have loving, understanding friends to support you while you are ‘transitioning’. When I came back from South America, I couldn’t tell what was real, I could barely understand conversations, and luckily my friends were there for me, and weren’t freaked out, because they’d had similar experiences (Lou is one of my best friends).  I loved getting hugs from my friends, I loved stroking my brother’s dog and cat, I loved sitting by his fire – I grounded myself in love and touch. Getting out into nature was also really healing for me. I avoided seeing people who wouldn’t get what I was going through.

Third, integration is very important. I came back to this reality within a week or so, but worked on the integration for several months, and am still working on it. I started seeing a therapist who is open to the transpersonal perspective. I found a community where I could practice meditation with others. There are also communities like the Spiritual Crisis Network and the Hearing Voices Network which offer support.

Sadly, western psychiatry is often the worst setting or integration process for this sort of experience. As Tim told us, most psychiatry is meaningless – it doesn’t accept that these sorts of experiences could have meaning, could be a stage in a person’s growth. Tim writes: ‘the medical intervention often serves to entrench stasis and impede growth’. Anna really wanted support during her crisis, but was terrified of being locked up and treated as totally mad. She was lucky, probably, not to be sectioned – most secure psychiatric wards are horrible, harsh, loveless and soulless places. Tim, who led the Emergency Psychiatry Service at Royal London Hospital, writes: ‘It is one of the great tragedies of psychiatry that our most vulnerable people are placed in the most unsuitable settings.’

And western culture is also rather an inhospitable and even hostile setting for such experiences – we don’t talk about them, and we see messy breakdowns as awful, shameful and frightening, something to hide away, rather than potentially something painful but wonderful, like giving birth!

However, just as there is a risk of materialist fundamentalism, there is also a risk of religious or spiritual fundamentalism – Anna talks about how she would feel these ecstatic experiences and hunger for them, but she came to see this was a way of bypassing her pain. We can use our spiritual experiences as ways of not dealing with this reality, this body, this life with all its messiness. Tim Read writes about one case study of spiritual narcissism, a young man who focused so exclusively on his spiritual experiences that he lost the capacity to negotiate this world. We need to balance our life in this world with our yearning for the transcendent, so we don’t become a ‘total space-cadet’ as one ayahuasca facilitator put it to me. We also need to be open to ambiguity and uncertainty, to sometimes not knowing precisely where we are on the path.

None of this is meant to deny that there are psychiatric illnesses which are mainly physical in origin, and which are not transitions to higher selves. I also know that, for some people, psychiatric medication is helpful and even life-saving. And sometimes being sectioned is necessary to protect people and society.

Tim and I are now going to put together a book of people’s first-person accounts of spiritual experiences, to answer the questions – what are they like from the inside, and what did people find helpful? The focus is on the practical things that help people, the set and setting. If you’d like to contribute, more details can be found here.

Finally, I wonder what these experiences say about the nature of reality and God. I think evangelical Christians can have a naïve view of God and the tidiness of religious experiences. You meet Jesus, who is totally loving and good for you, and instantly both this life and the afterlife are better. In fact, spiritual awakenings often feel like death, and can totally mess up your life. They’re closer to the God of the Old Testament, the God of the Burning Bush and the Book of Job, the God who turned Nebuchadnezzar into a beast and made Ezekiel lie on his side for 430 days.

What does it say about God, or the Self, that sometimes spiritual awakenings can destroy a life, can actually lead people to starve themselves or jump off a building in their search for transcendence (two instances mentioned in Tim’s book).

To me it suggests that sometimes the dissolution of the ego and the opening to the Self is incredibly rough, sometimes fatal. It can be a confrontation with a Shiva-like god – the cosmic creator and destroyer. It makes me hope that reincarnation is real, so we can hope that, while the archetypal call of the Self is sometimes harmful and even fatal to the individual, eventually, over many lives, we move towards the light. Or maybe God / the Self / the Tao doesn’t care about individuals, only the awakening of the species. Or maybe there is no God. Even if there isn’t, we can still help people navigate these rough moments of ego-dissolution, so that they can move towards positive and fulfilling lives, as Lou, Anthony, Anna and I have done.

Nebuchadnezzar by William Blake

Nancy Sherman, the soldiers’ philosopher

20091102+Nancy+Sherman_0018Professor Nancy Sherman has worked with the US military for over 20 years, and has written several books on military ethics, including Stoic Warriors: The Ancient Philosophy Behind the Military Mind; and The Untold War: Inside the Hearts, Minds and Souls of Our Soldiers.

How did you come to teach philosophy in the military?

Through a crisis on their part. The US Naval Academy had a cheating scandal. Back, in the 1990s, 130 electrical engineering midshipmen were implicated in cheating on a major exam. They seemed to have got it in advance. These individuals were all brought before various kinds of honour boards, and as part of the ‘moral remediation’ they wanted an ethicist onboard. That was me. After two weeks they asked me to set up an ethics course. One thing led to another, and eventually I was selected as the inaugural distinguished chair of ethics at the Naval Academy.

How did you find teaching in the military?

My dad was a WWII vet, didn’t talk about it much. I was a child of the 60s, many of my friends were conscientious objectors. Now, I was in a place where there were marines and officers who had fought on the Mekong Delta. It was an eye-opener, to see the other side of a conflict that was very formative for me. I hadn’t really met my peers who had served. I learned a lot from them.

1897893_762289500447958_1645314971_nThe Naval Academy is a different sort of university. It’s uniformed. Everyone is Ma’aming and Sir-ing. They’re trying to figure out what rank you are. They were used to a very hierarchical universe. And a lot of Navy people are engineer-focused. They want bottom lines. Discussions without clear endings, or deliberative questions without easy right and wrongs, shades of grey, all of that was not something they were comfortable with.

But you discovered they have a natural interest in Stoic philosophy.

Yes. The course took them through deliberative models and major ethical theories – Aristotle, emotions, deliberation and habits; Kant and universalizability; Mill and Bentham, and notions of maximizing utility. When we got to Stoicism – Epictetus, Marcus Aurelius – they felt ‘this is the stuff I know: suck it up, truck on, externals mean nothing to me. I can’t get back for my wedding because I’m on a ship, well, it’s beyond my control.’

One of the greatest officers in their midst was Admiral James Bond Stockdale. He’d endured seven years in the Hanoi Hilton [the north Vietnamese prison], two of them in leg-irons. He’d been given a little copy of Epictetus when studying at Stanford. He committed it to memory and it became his salvation. That’s a well-known story in the military.

You met and interviewed Stockdale several times. What was he like?

He had a kind of James Cagney voice. And you couldn’t tell when it was him talking or when he was quoting Epictetus. It was seamless. You sometimes thought you’re in front of an impersonator. He had a noticeable limp in his left leg, from when his plane crashed in Vietnam, and Epictetus also had a limp in his left leg. So there was a physical kinship and perhaps a spiritual kinship too.

Are the Stoics widely read in the US military? I came across quite a few Stoic soldiers when researching my book, particularly in the Green Berets – I didn’t come across any in the British military.

The Roman Stoics are read by officers and commanders, not so much by enlisted men. How they come to it is an interesting question. I think in the Marines and Navy, probably through Stockdale’s influence on the curriculum – he was head of the Naval War College on Rhode Island. Also these are popular writers, easy to read. Everyone understands stoic with a little s.

How useful or appropriate is Stoicism for soldiers?

51h1oiS7REL._SY344_BO1,204,203,200_It has curses and blessings. It fits an idealized model of invincibility, of external goods not mattering. I can expand the perimeter of my agency so that the only thing that matters is what I can control – namely my virtue. It meshes with what we know to be pretty natural responses to constant threat. As Stockdale once put it, you’re ‘as cagey a Stoic as you can be’. He was a cagey sage with his captors – this won’t touch me, this won’t affect me.

With that goes the notion that your emotions can be fully controlled and you can turn them off, essentially. Anything your emotions attach to in sticky and graspy ways is dangerous, because they can destabilize you, they can make you mourn and grieve. So there’s the idea of not missing something – a cigarette, your child, your spouse, or your buddy who gets blown up next to you. It’s useful armour. That’s the blessing.

The curse is it can be a way of not feeling, or as a lot of soldiers tell me, you feel ‘dead to the world’ – they can’t feel anymore. And that’s awful. You come home and you have this gorgeous child, and a family you want to adore, and you can’t even feel joy because you’ve turned off your emotions in certain ways. That is an absolute curse.

The Stoics were giving salvation for tough times. It’s a great philosophy for tough times, I’m not sure it’s a great philosophy for everyday living. It’s always good to feel more in control, but it’s not good to think that luck and the vicissitudes of the world can’t touch you or that you can’t show moral outrage, love, grief, and so on.

Do some soldiers manage to put on and take off that Stoic armour?

No, that’s really hard. This is a question about ‘resilience’ – the million-dollar-word in the military right now. The idea of resilience is you can bounce back. We have 2.4 million soldiers coming home from war. They can’t bounce back on their own. They can’t bounce back just with their families. They need a community that gets it. They need to know that we’re not just saying ‘thank you for your service’. They need enormous amounts of trust, hope, medical attention. Above all they need emotional connection.

There’s an idea in Stoicism that your loyalty to the Logos, to the ‘City of God’, comes before your loyalty to the state. The Stoics were quite individualistic, probably not great team-players. How does that fit in with the very strong collective or conformist ethos of the military? What if you’re asked to do something that doesn’t fit with your virtue?

The best service-member will never check their conscience at the door. It will be with them all the time. That’s not just Stoic. That’s any moral philosophy – you do the right thing. Your virtue is your guide. If you have an officer, a commander, who is giving you unlawful, immoral, bad advice, and it’s even part of a system – of torture for example – the moral individual will question that, whatever philosophy they have.

Major Ian Fishback
Major Ian Fishback

One of my friends is Ian Fishback, he now teaches at Westpoint and is going to do a Phd in philosophy at Michigan. He’s a special forces major. He served eight years or so in Afghanistan and Iraq. He was at Abu Ghraib and didn’t like what he saw there. He wrote at least 50 letters to command about what was going on. He got no answers. He finally wrote to Senator John McCain, who’d been a POW with Jim Stockdale, and said ‘this is what I’m seeing’. He went public. He blew the whistle. And from that came a referendum that was put before congress. To know Ian is to know that he is thoughtful. He is conscientious.

To be in the military is hard for the thinking soldier. All the people I work closely with, all my PhD students from the military – they have to accept some of the absurd of a career in the military, but you can’t accept some of the missions. You pick your battles. And it may be a career-ender. You face the possibility that you’re not going to be a yes-man.

How well is the military coping with PTSD at the moment? How big a problem is it?

the-untold-war-inside-the-hearts-minds-and-souls-of-our-soldiersWe don’t really know the numbers, but some say there’s maybe 30% incidence of PTSD in soldiers coming home. It’s a central issue which the Americans are taking on in various ways. The Pentagon, and in particular General Peter Chiarelli, wants to drop the D from PTSD. They argue it’s not a disorder, it’s an injury with an external cause. They want to destigmatize it.

Secondly, there’s vast efforts to deal with the suicide peak – for the first time in record-keeping, the rate of suicide in the military exceeds the comparable rate for young male civilians. It’s not always after multiple deployments. Often the precipitating factors have to do with coming home, with difficult family relationships at home. It’s very complex. Some would like to find a ‘biomarker’ for suicidal tendencies.

There aren’t enough mental health workers, that’s pretty clear. And there’s still stigma, still a sense that it’s weak not to be able to handle losing your buddy.

Also, traumatic stress has a moral dimension, often. It’s not just a fear symptom. It’s also that you keep going back to the situation and thinking ‘I should have done that, I wasn’t good enough, I let someone down’. It’s complicated what morality is in the complex of war. You’re in a lethality and violence-soaked environment, increasingly in population-centric environments. There’s a lot of grey area – who’s the enemy, are they a voluntary or involuntary human-shield, and so on.

I read the military isn’t doing a great job at keeping track of what treatments for PTSD actually work.

Well, Cognitive Behavioural Therapy seems to be the leader. But you’re talking about populations that are heavily medicated, on sleeping pills, on anxiety pills, on pain-killers. And that affects their ability to change their thinking.

What do you think of Martin Seligman’s Comprehensive Soldier Fitness programme [ a $180 million programme introduced in 2010 to teach resilient-thinking skills to all service-members, to try and prevent PTSD occurrence]?

This was introduced in 2009 / 2010 when the suicide rate was going up. They needed something fast. As one army psychiatrist said to me, they expected broken bodies, they didn’t expect broken minds. I think Seligman’s work has been shown to be effective in populations of children in tough neighbourhoods. He had not done previous work with combat lethality-saturated environments.

Emotional intelligence is a great thing, being able to talk about things soldiers don’t typically talk about is great. You need forums, you need lots of time. My understanding is you get two hours training twice a year when you’re not deployed. That’s not a lot.

Some military psychiatrists worry that the programme could further stigmatize those who still develop PTSD. If you’ve gone through the preventative programme and you still can’t sleep at night, you’re still racked by guilt, you may feel even worse. Prevention is one thing, but you can’t further stigmatize those who are traumatized. Still, I applaud the armed forces for realizing that mental health is critical for soldiers’ health.

You still work with soldiers now?

I have a lot of veterans enrolled in my classes in Georgetown. I’ve been working with soldiers for 20 years now. They’re my buddies. Next year I have a book coming out about soldiers coming home, called Making Peace with War: Healing the Moral Wounds of our Soldiers, which involved a lot of long interviews with soldiers. My heart goes out to folks who are trying to morally process really complicated issues.

To go back to the beginning, you initially started work with the military because of an ethical crisis, which they thought could be solved with an ethics course. Do you think ethics courses really do improve people’s ethical behaviour?

I think these courses have enormous value. Not when they have sets of right or wrong answers, but when you have small enough groups where you can have discussions. Finding time to think, when you’re not on the spot, is really powerful. It goes into the unconscious and is part of your reserves for hard times.

If you’re interested in the application of Stoicism in modern life, including the military, come to the Stoicism Today event on November 29 at Queen Mary, University of London.