How to Distinguish Between a Religious Experience and a Psychotic Episode

There are possibly many ways in which we can define a religious experience. We need to ask ourselves: What features should such an experience exemplify? There is also the issue of trying to ascertain whether a certain experience is pathological in nature. For reasons which will become clear, I will be using the term religious in a way that is broadly synonymous with the terms mystical and spiritual. It is important to use the term religious to stand for a wide variety of experiences, otherwise, the term might only apply to an experience that pertains to a particular religion. Religious experiences cannot be narrowly defined in this way since many people report having religious experiences that do not include specific deities or mythological characters. In order to compare religious experiences with psychosis, the nature of these experiences will be discussed in more detail.

The term pathological usually means something involving, or being caused by, a mental illness or disease. But of course, this definition begs the question: Which experiences should count as a manifestation of a mental illness? This contentious question should, therefore, be addressed in more detail. The aim of this discussion is to concede that religious experiences and psychotic episodes are phenomenologically similar, but that they can be distinguished in a way that implies that religious experiences are non-pathological. This conclusion can be reached by taking into account the cultural and social context of the religious experience, as well as the attitudes and values of the individual.

What is a Religious Experience? 

In order to examine whether religious experiences are pathological, it is first of all necessary to establish what exactly a religious experience is, or what it involves. Religious experiences are altered states of consciousness and like mystical or spiritual experiences, they share some very common features. They can involve contact (in the form of auditory or visual hallucinations) with religious figures, such as Jesus in the case of Christian individuals, and goddesses like Kali in those individuals who subscribe to a Tantric or Hindu philosophy. Even if the individual does not encounter a specific religious figure in a religious experience, contact or communication with some sort of separate entity is still a common feature of these experiences.

David Lukoff, following the opinion of William James that religious experiences share some basic features, argues that the main characteristic of religious experiences is their ineffability. If this is true, then the content of the religious experience is something completely alien; something that cannot be described by the individual, nor understood by anyone else who has not had the experience. It becomes clear that these types of experiences are ineffable, given their other peculiar characteristics. The most common of these characteristics include a loss of boundary between the self and the world, a feeling of psychological death and rebirth, a feeling of intense ecstasy, being united with the cosmos, feelings of time distortion or even timelessness, and the sense of gaining important insights and knowledge.

Religious experiences can have a number of causes. In Eastern mystical traditions, experiences such as loss of subject and object boundaries can be attained through different methods of meditation, such as those found in Zen Buddhism. This loss of boundaries can result in feelings of connectedness and oneness with all things. In Hindu and Tantric philosophy we are told that an encounter with the goddess Kali involves an apprehension of absolute time, of perceptual changeless duration – often described as timelessness. Similar altered states of consciousness can be achieved by practices such as fasting and sleep deprivation.

Another common way of intentionally having a religious experience is through the use of hallucinogenic drugs. In his book DMT: The Spirit Molecule, Dr Rick Strassman recognises the similarities between mystical experiences and experiences with the compound DMT (di-methyl-tryptamine). The DMT experience can involve “encounters with the demonic and angelic entities, ecstatic emotions, timelessness, feelings of having died and being reborn [and] contacting a powerful and living presence underlying all of reality”.

The DMT experience also seems to bear similarities to reports of near-death experiences (NDEs), which, in contrast, are unintentionally achieved. However, writers realise that religious experiences can also be a result of stress and trauma, and this may lead one to conclude that religious experiences can share the same underlying cause as a pathological mental disorder. This has prompted some authors to find out what brain structures and processes correlate with religious experiences in order to see if religious experiences and mental disorders are similar in this way.

The field of neurotheology has sparked a great deal of controversy. In this field, neuroscientists have tried to discover the neural correlates of religious experiences. Michael Persinger, in his paper ‘The Neuropsychiatry of Paranormal Experiences’, observed people reporting the presence of God when a magnetic field was manipulated over the temporal lobe. Similarly, the radiologist Andrew Newberg scanned the brains of Tibetan monks whilst meditating and claimed that in prolonged meditation the posterior superior parietal lobe (which is associated with spatial orientation) is starved of input, resulting in a breakdown of spatial boundaries and a sense of oneness.

These results are controversial for a number of reasons. First of all, as Matthew Ratcliffe points out, this kind of approach assumes that if we discover the neural correlates of a religious experience, we can, therefore, understand what the experience consists of. On the contrary, by claiming that a religious experience is correlated to changes in the posterior superior parietal lobe, for example, we are no closer to understanding whether religious experiences are phenomenologically similar to psychotic episodes, nor whether religious experiences are pathological.

A second issue with the findings of Persinger, Newberg, and others, is that they ignore how diverse religious experiences can be. Religious experiences can have manifold causes – they can be caused by trauma, hallucinogenic drugs, meditation, fasting etc. – and they can also largely differ in their phenomenological content. If religious experiences are so varied, then it is futile to search for a neural correlate that could only correspond to a single, standard religious experience. So, while the field of neurotheology has produced some interesting and promising results, especially to do with the psychological benefits of meditation, these findings generally do not help to describe or define what a religious experience is. The subjective nature of religious experiences needs to be described in as much detail as possible in order to distinguish them from psychosis.

In trying to define what a religious experience is, it is also unhelpful to define such experiences in too broad a fashion. Marek Marzanski and Mark Bratton, for example, maintain that a religious or mystical experience can simply involve “loving one’s neighbour” or leading a “Christian life”. In their case studies, they cite examples of people, such as ‘Carol’, who expressed faith, love, and kindness to her husband as characteristic of a religious experience. Yet we can recognise that Marzanski and Bratton’s Christian-influenced definition of a religious experience discounts the fact that people of different religions can foster faith, love, hope, and kindness, as can agnostics and atheists. Furthermore, this broader definition of a religious experience is useless because it avoids the problem of why religious experiences (with the features I have previously described) bear so many similarities to features of psychotic episodes. It will be more useful then to analyse these similarities.

Similarities Between Religious Experiences and Psychotic Episodes

It is quite common for those suffering from a mental illness to have religious content in their psychotic episodes. Psychosis is defined as an impaired relationship with reality and is a symptom of severe mental disorders, such as schizophrenia. It’s common for people who suffer from psychosis to experience hallucinations or delusions.

Peter, a case study participant that Marzanski and Bratton examined, was diagnosed with manic-depressive psychosis, having experienced delusions, such as thinking he was the reincarnation of the Holy Ghost, and having experienced Thought Insertion, such as feeling that Christ was talking to him from within. There are also cases of religious experiences where the individuals demonstrate symptoms of a psychotic episode. In Mike Jackson and K.W.M Fulford’s paper, ‘Spiritual Experience and Psychopathology’, a participant called Simon reported being the “living son of David” (signs of Delusions of Grandiose Ability) and claimed he could see sacred words and letters on ordinary objects (evidence of Primary Delusions).

The definitions of delusions and hallucinations, as found in the DSM-III, apply to religious experiences and psychotic episodes equally. However, although the phenomenological content of religious experiences can appear similar to episodes of schizophrenia, there are generally differences in content as well. In the case of schizophrenia, there seems to be a predominance of auditory over visual hallucinations, whereas, in a mystical experience, we find the complete opposite.

The mystical experience does not appear to cause a disruption in thought patterns either, as schizophrenia does on the other hand. But even if religious experiences were phenomenologically indistinguishable from psychotic episodes, this would not necessarily imply that religious experiences are pathological. The DSM-III uses the term psychotic in two ways: first, as meaning a temporary state, and second, as meaning a mental disorder. A religious experience could – depending on its content – satisfy the first definition and not the second, meaning that the experience is not pathological. So, although there can be similarities between religious experiences and psychotic phenomena, the case can still be made that religious experiences are non-pathological.

Differences Between Religious Experiences and Psychotic Episodes

First of all, the fact that hallucinations are so common amongst the general population suggests that these kinds of experiences are not indicative of a mental disorder. In one study, researchers contacted 13,057 people from Britain, Germany, and Italy by telephone, 38.7% said they had experienced hallucinations in the past. Out-of-body experiences, as well as the experience of some sort of separate sentience, are not uncommon either.

This evidence implies that we need to look beyond the content of an experience in order to establish whether it is indicative of a religious experience or psychosis. Some writers have suggested that it is the benign and life-enhancing aspect of religious experiences which makes them non-pathological, and that, conversely, it is the malign and life-damaging nature of psychotic episodes which makes them pathological. One such writer, the mythologist Joseph Campbell, expressed this point when he said, “The psychotic drowns in the same waters in which the mystic swims with delight.” The famous psychologist Carl Jung also believed that a mystical experience was a psychologically healthy experience. And in a study conducted by Dale Caird, it was found that individuals who had a mystical experience scored higher in terms of psychological well-being scales and lower on psychopathological scales compared to a control group.

However, these results do not conclusively show that religious experiences in and of themselves are benign or life-enhancing. It is entirely possible for religious experiences to be negative, or to at least have negative aspects. Spiritual experiences can include a feeling of dread since they can be beyond the grasp of common sense and reason. It is also questionable whether psychotic episodes are pathological simply because they have life-damaging consequences. J.W. Perry, in his book The Far Side of Madness, maintains that we should not view psychotic episodes in such a narrow fashion; rather, it is possible that psychotic episodes can have good outcomes.

Perry coined terms like problem-solving schizophrenia in order to take into account these types of experiences. From these considerations, we can say that religious experiences generally are benign and possibly life-enhancing, but that it is not this feature that makes these experiences non-pathological. The value-laden nature of the terms, benign and life-enhancing, also makes it difficult to use them in a way that can objectively distinguish religious experiences from pathological disorders.

The form of the experience, as opposed to the content, is useful in distinguishing religious experiences from disorders such as schizophrenia and, in turn, psychosis. In The Varieties of Religious Experience, William James noted that a key feature of a mystical experience is its transiency – the fact that the experience is short in duration. Pathological disorders, on the other hand, including depression and schizophrenia, are persistent and long-lasting. The fact that these disorders are long-lasting explains why psychotic episodes are more likely to cause suffering to the individual, than would a short, religious experience that involved psychotic phenomena. This difference in duration, therefore, suggests that religious experiences are non-pathological.

The intensity of the experience also helps to distinguish religious experiences from psychotic episodes. In accounts of religious experiences, we find that the hallucinations appear to be integrated into the non-hallucinatory world, whereas in psychosis, the hallucinations are engulfing and can become too overwhelming. As Michael McGhee puts it, “the psychotic person enters a delusional world and the spiritual practitioner falls out of delusion” and this, at least partially, explains why the former person has a pathological condition and the latter does not. The reason why psychotic episodes tend to be more intense is also due to the fact that such episodes are beyond one’s control.

This explains how mystical experiences can develop into a psychotic episode, typified by David Greenberg’s account of four Jewish mystics who turned psychotic. The four men lost the ability to control entry into the mystical state and it was this that led to their paranoid delusions, social withdrawal, and deterioration of habits. In contrast, most religious experiences (excluding those induced by stress, trauma, or near-death events) are deliberated. Taking hallucinogenic drugs, fasting, and meditating are voluntary actions and so the experiences which result are, in some sense, under the individual’s control.

More central to the explanation of why religious experiences are non-pathological is the way in which the social context and attitudes of the individual interact with the experience itself. It is a common observation with schizophrenic, depressive, and delusional individuals that they have difficulty in establishing a shared inter-subjective reality with others. Living in this inter-subjective reality involves recognising the perspective of others and realising that we all live in a common world. Pathological disorders involve a radical change in the individual’s experience of the world, often making it difficult to immediately understand the lives of others. Individuals who have religious experiences, on the other hand, are usually able to integrate these experiences into their inter-subjective reality, and often in positive ways.

Bruce Greyson uses this distinction in order to differentiate between NDEs from post-traumatic stress disorder (PTSD); emphasising that individuals who suffer from PTSD normally feel estranged from others. This distinction also explains why those suffering from mental disorders often struggle to socially interact with others, be it through maintaining a relationship, family, or career.

Some argue that the attitudes of the individual, as well as the clinician, should also be taken into account when trying to define religious experiences as non-pathological. For example, if an individual is able to doubt the objective reality of a religious experience, then the experience has not become engulfing and it has not become an enduring problem. Whereas, perhaps a mental disorder arises when the individual is certain about the reality of their psychotic episodes and their phenomenological content.

This analysis is supported by research carried out by P.D. Slade which found that individuals who were not diagnosed with any disorder were less troubled by auditory hallucinations, whereas schizophrenic patients found similar hallucinations to cause them a great deal of stress and trauma. These different responses to similar experiences can be attributed to the non-critical attitude that the schizophrenic takes towards the engulfing nature of their hallucinations. This would also explain why the manic-depressive cannot take pleasure or interest in activities in the physical world, because they are too preoccupied with the ‘reality’ of their psychotic states. In addition, we should not forget (as Lukoff reminds us) that the attitudes of the clinician “can significantly influence whether the experience is integrated and used as a stimulus for personal growth, or repressed as a sign of a mental disorder”.

A diagnosis of a series of religious experiences as psychotic may, therefore, cause the individual in question to develop a mental disorder. Moreover, if we view religious experiences and mental disorders within a cultural context, it becomes clear how the former can develop into the latter, even if the former is essentially non-pathological.

The anthropologist Erika Bourguignon found that out of 448 societies in her study, 52% of them would often engage in some sort of ‘religious trance’ involving “possession by spiritual beings”. Indeed, countless writers have noticed that when shamans of the Amazon basin ingest the hallucinogenic brew ayahuasca, they claim to be in direct contact with spirits. This kind of phenomenon is, therefore, the norm for these societies and is only considered pathological when the possession by spirits occurs in an uncontrolled way, without the proper guidance of a spiritual teacher, or a grounding in spiritual practices.

This would conveniently explain why Sara’s religious experiences, described in Jackson and Fulford’s case study, did not develop into a pathological condition, because she had the spiritual instruction of a priest to help make sense of her experiences. In fact, the DSM-IV appropriately recognises this aspect of religious experiences in its category, Religious or Spiritual Problem, which emphasises that distressing religious and spiritual experiences occur as non-pathological problems, but may still require clinical attention. Likewise, if you are bereaved and fulfil the criteria for Major Depressive Episode, this does not mean that the experience of bereavement is pathological; rather, the experience is a normal reaction given the context. The way to treat distressing religious experiences could perhaps involve assistance from support groups, family, peers, and religious figures.

Interestingly, Stanislav Grof proposes that distressing spiritual experiences, what he calls spiritual emergencies, should be treated with transpersonal therapy because this approach focuses on the spiritual aspects of human experience, making the approach more relevant and, thus, more likely to contribute to the individual’s well being. All the evidence so far implies that religious experiences are not, in and of themselves, pathological, and this is supported by current psychiatric practice, which does not treat such experiences with neuroleptic drugs.

In conclusion, given the way in which religious experiences have been defined, as well as the criteria for a pathological condition, religious experiences can be clearly distinguished from psychosis. It is not necessarily a neural correlate or difference in phenomenological content that determines this. It is the distinct form of the experience, how the experience leaves one’s inter-subjectivity unaffected, and the way in which the experience interacts with the attitudes and cultural background of the individual which makes religious experiences non-pathological.