Transpersonal psychiatry

Transpersonal psychiatry is an area of transpersonal studies that integrates the clinical and theoretical framework of modern psychiatry with the spiritual and philosophical worldview of the transpersonal. It is considered to be one of several transpersonal disciplines.[1][2] The field is associated with the work of Bruce W. Scotton, David Lukoff and Francis Lu.

Definition and context

According to Walsh and Vaughan,[2] who conducted an extensive review of transpersonal definitions, transpersonal psychiatry is the area of psychiatry that focuses on the study of transpersonal experiences and related phenomena. Its focus is similar to transpersonal psychology, but with a particular interest in the clinical and biomedical aspects of transpersonal phenomena. The close relationship between the two disciplines is reflected in the title of the first standard introductory book to the field; the Textbook of Transpersonal Psychiatry and Psychology, which was published by Basic Books in 1996.[3]

In the textbook Scotton provided an "Introduction and definition of Transpersonal psychiatry" and stated that Transpersonal psychiatry is a psychiatry that seeks to foster development, correct developmental arrests, and heal traumas at all levels of development, including transpersonal levels. It extends the standard biopsychosocial model of psychiatry to a biopsychosocial-spiritiual one in which the later stages of human development are concerned with development beyond, or transcendent of, the individual.[4] In the same publication Chinen described the origins of the fields of Transpersonal psychiatry and Transpersonal psychology in a fashion that illustrated how the emergence of the two fields are intertwined with each other.[5]

History

According to Miller[6] there are precursors to clinical work in the transpersonal field. He mentions the work of William James, Sigmund Freud, Carl Jung, Abraham Maslow, and Roberto Assagioli. In his review of the "Emergence of Transpersonal psychiatry" Chinen[5] traced the common origin of the fields of transpersonal psychiatry and psychology to the counterculture of the 1960s, and the Humanistic psychology movement of the same period. The Journal of Transpersonal Psychology was founded in 1969 and became an important forum for the development of transpersonal theory. Clinicians participated in the transpersonal literature from the early rise of the field.[5]

In 1992 the Menninger Clinic organized its first symposium on transpersonal psychiatry. The conference was well attended.[5] A few years later, in 1994, the American Psychiatric Association included a new diagnostic category in its official manual (DSM-IV), following a proposal from clinicians associated with transpersonal psychology and psychiatry.[5][7] The category was called Religious or Spiritual Problem.[8] Note a Among the coauthors of the new category was David Lukoff.[9]

In 1995 John Hiatt founded the transpersonal care program at the Veterans Administration Medical Center in San Francisco. The program was intended to address spiritual issues in the health care of veterans.[10]

In 1996 Basic Books published the Textbook of Transpersonal psychiatry and psychology, marking the first comprehensive textbook introduction to the field.[11][6][3] As noted by Liff,[12] the book does not differentiate clearly between the two areas of transpersonal psychiatry and transpersonal psychology. However, in the August 1999 issue of Psychiatric Annals a distinction was made, and special attention was paid to the area of transpersonal psychiatry.

In 2001 the American Psychiatric Association introduced the topic of transpersonal psychiatry to their Annual Meeting Course Guide.[13]Note b The topic was later featured in successive course guides.[14][15][16] The courses included direction from Bruce W. Scotton and Allan B. Chinen. Course Faculty included John R. Battista, Francis G. Lu, Roger Walsh, William W. Foote, Lewis Mehl-Madrona, John F. Hiatt and Bruce S. Victor.

In 2007 educators at the University of California (Davis) presented a new academic program for its psychiatric residents. The program was designed to improve culturally appropriate diagnosis and treatment in the Sacramento area. It included training in religion and spirituality, as well as insights from transpersonal psychiatry, as part of the PGY-residency.[17] The integration of transpersonal psychiatry in psychiatric residency training programs has earlier been suggested by Francis Lu.[11]

Contribution to academic theory and clinical work

Transpersonal psychiatry's contribution to the field of psychiatry is the actualization of spiritual and transpersonal dimensions in clinical work. Several clinicians have engaged with this issue.

In 1991 psychiatrist John Nelson published the book Healing the Split. In a review of the book Publishers Weekly described it as a "synthesis of transpersonal psychology, medical psychiatry and neuroscience".[18]Note c Nelson interpreted several major psychiatric disorders as altered states of consciousness, involving expansion of the self-concept, and, in some instances, contact with a spiritual dimension. Other clinicians that have engaged with transpersonal approaches include Bruce Scotton, Bruce Victor, David Lukoff, Francis Lu and John Hiatt, who all contributed to Psychiatric Annals, Volume 29.

Bruce Scotton[19][20] presented what he called the "assumption of transpersonal psychiatry"; which is the idea that human development extends to levels beyond the ego, and that this development is recognizable across cultures. Also, since all levels of development are prone to developing pathology, transpersonal psychiatry can, according to theory, provide models for therapeutic intervention at all stages of maturation, including trans-egoic stages.

Bruce Victor[21] discussed the principles of transpersonal psychopharmacology, and transpersonal psychiatry's relationship to mind-altering medication. Other attempts to reconcile psychopharmacology with transpersonal psychiatry has been suggested by Gary Bravo and Charles Grob.[11]

David Lukoff and Francis Lu[22] considered the role of religious and spiritual issues in a clinical setting, and listed the most common types of psychiatric problems that can occur when a person is confronted with these issues. Among the problems associated with the area of religion was: loss or questioning of faith; change in denominational membership or conversion to a new religion; intensification of adherence to the beliefs and practices of one's own faith; joining, participating in, or leaving a new religious movement or cult. Among the problems associated with the area of spirituality was: distress related to a mystical experience; distress related to a near-death experience; distress related to a spiritual emergence or emergency; distress related to meditation.

John Hiatt[23] described his experiences with the transpersonal care program, an outpatient program that aimed to reintegrate spiritual considerations into health care. Moran,[10] who reported on the program in 2000, noted that the treatment included individual psychotherapy, medication clinics, and group therapy.

According to Mick Collins,[24] who addressed the topic of spiritual emergency from a social-political perspective, Transpersonal psychiatry provides a much needed impetus for establishing differential diagnosis and appropriate treatment for those people who need additional support through a spiritual-transformational crisis.

The concept of transpersonal psychiatry is also featured in the construction of psychological instruments. In 2008 Grabovac, Clark and McKenna [25] developed the Course Impact Questionnaire as part of their effort to evaluate the “Interface between Psychiatry, Religion and Spirituality” in an academic curriculum. The instrument (questionnaire) had three items on transpersonal psychiatry.

Reception - recognition and criticism

In his review of the Textbook of Transpersonal psychiatry and psychology Paul Grof[7] notes that the field has been subjected to criticism. He suggests that this criticism is the result of misunderstandings. However, commentators have offered both recognition and skepticism towards the concept of transpersonal psychiatry.

In 1999 the journal Psychiatric Annals dedicated a large portion of its August issue to the topic of transpersonal psychiatry. The Issue was guest edited by Bruce W. Scotton.[26][27] According to the editor at the time of publication, Jan Fawcett, the issue discussed transpersonal psychiatry and encouraged its readers to broaden their "concept of psychiatry to include such issues as cultural norms, religious meanings, and spiritual issues" in their practice of psychiatry.[26] The issue resulted in both positive and negative reactions from readers. Jay Liss (MD) dismissed the theories of transpersonal theory and suggested that it was not "clinically appropriate to consider aberrations of the brain as spiritual or religious". On the other hand, Wells Goodrich (MD) welcomed the inititative from transpersonal psychiatry. He found that a transpersonal approach worked well with a small number of informed patients.[28]

In her review of the book In Case of Spiritual Emergency: Moving Successfully Through Your Awakening, by Catherine G. Lucas, Alison Gray[29] expressed serious reservations about the concept of spiritual emergencies, and the transpersonal dimension in psychiatry.

In her review of The Textbook of Transpersonal Psychiatry and Psychology Marlene Dobkin de Rios describes the field as controversial, but also relevant to the future of psychiatry and psychology.[11]

See also

Notes
a. The Code was listed under "Other Conditions That May Be a Focus of Clinical Attention", Religious or Spiritual Problem, Code V62.89. (American Psychiatric Association, DSM-IV, 1994)
b. In the 2002 and 2003 Course Guides the American Psychiatric Association informed that the course was "a repeat of a course given last year".
c. The book was later (1994) published by the State University of New York Press in the SUNY series in the Philosophy of Psychology.

References and sources
  1. Walsh, Roger. "The Transpersonal Movement: A History and State of the Art". Journal of Transpersonal Psychology, 1993, Vol. 25, No.2
  2. Walsh, R. & Vaughan, F. "On transpersonal definitions". Journal of Transpersonal Psychology, 25 (2) 125-182, 1993.
  3. Scotton, Bruce W., Chinen, Allan B. and Battista, John R., Eds. (1996) Textbook of Transpersonal Psychiatry and Psychology. New York: Basic Books..
  4. Scotton B.W. Introduction and definition of Transpersonal psychiatry", in Scotton, Bruce W., Chinen, Allan B. and Battista, John R., Eds. (1996) Textbook of Transpersonal Psychiatry and Psychology. New York: Basic Books
  5. Chinen, A.B. The emergence of Transpersonal psychiatry, in Scotton, Bruce W., Chinen, Allan B. and Battista, John R., Eds. (1996) Textbook of Transpersonal Psychiatry and Psychology. New York: Basic Books.
  6. Miller, J.J. Book Review: Textbook of Transpersonal Psychiatry and Psychology. Psychiatric Services, April 01, 1998 https://doi.org/10.1176/ps.49.4.541
  7. Grof, P. Book review: Textbook of Transpersonal Psychiatry and Psychology. Canadian Journal of Psychiatry, June 1998, Volume 43, Number 5. https://doi.org/10.1177/070674379804300513
  8. American Psychiatric Association. (1994). Diagnostic and Statistical Manual of Mental Disorders, fourth edition. Washington, D.C.: American Psychiatric Association.
  9. Lukoff, D. (2014). From personal experience to clinical practice to research: A career path leading to public policy changes in integrating spirituality into mental health. Spirituality in Clinical Practice, 1(2), 145- 152, American Psychological Association. https://doi.org/10.1037/scp0000016
  10. Moran, Lisa A. Innovations: Transpersonal Psychiatry at VA Medical Center. Psychiatric Services, April 2000, vol. 51, No. 4.
  11. de Rios, Marlene Dobkin. Book review: Textbook of Transpersonal Psychiatry and Psychology. The Journal of Nervous & Mental Disease, Volume 185(8), August 1997, pp 526,527.
  12. Liff, Zanvel. A. Book review: Adding the Spiritual to the Biopsychosocial Framework. PsycCRITIQUES, 43(2):144–145, Feb. 1998 https://doi.org/10.1037/001527
  13. Philadelphia, May 18–23: The 21st-Century Psychiatrist. APA’s 155th Annual Meeting: Course Guide. Published Online:18 Jan 2002, psychnews.psychiatryonline.org. Retrieved on March 20, 2019. https://doi.org/10.1176/pn.37.2.0023
  14. American Psychiatric Association Annual Meeting Course Guide. Sunday, May 18, 2003. Published Online:17 Jan 2003. psychnews.psychiatryonline.org. Retrieved on March 20, 2019. https://doi.org/10.1176/pn.38.2.0022
  15. Annual meeting: List of Sessions on Issues of Diversity in Psychiatry. Published Online:18 Mar 2005, psychnews.psychiatryonline.org. Retrieved on March 20, 2019. https://doi.org/10.1176/pn.40.6.00400039
  16. 161st Annual Meeting Course Guide. Washington, D.C. Saturday May 3. 2008. Psychiatric News, January 18, 2008.
  17. Bender, Eve. "Cultural Diversity Curriculum Covers All Residency Years." psychnews.psychiatryonline.org, Retrieved on March 20, 2019. https://doi.org/10.1176/pn.42.9.0007
  18. Publishers Weekly Book Review. John L. Nelson - Healing the Split. Reviewed on: 02/04/1991, publishersweekly.com. Retrieved on March 20, 2019.
  19. Scotton, B.W. Transpersonal Psychiatry. Psychiatric Annals, 1999;29(8):449. https://doi.org/10.3928/0048-5713-19990801-05
  20. Scotton, B.W. The Context, Theoretical Basis, and Professional Implications of Transpersonal Psychiatry. Psychiatric Annals. 1999;29(8):455-464. https://doi.org/10.3928/0048-5713-19990801-07
  21. Victor, B.C. Transpersonal Psychiatry and Psychopharmacologic Practice. Psychiatric Annals. 1999;29(8):465-468. https://doi.org/10.3928/0048-5713-19990801-08
  22. Lukoff, D. and Lu, F. Cultural competence includes religious and spiritual issues in clinical practice. Psychiatric Annals; Thorofare Vol. 29, Iss. 8, (Aug 1999): 469-472. https://doi.org/10.3928/0048-5713-19990801-09
  23. Hiatt, J. A transpersonal care program in an institutional setting. Psychiatric Annals; Thorofare Vol. 29, Iss. 8, (Aug 1999): 480-483. https://doi.org/10.3928/0048-5713-19990801-11
  24. Collins, M. Spiritual Emergency: Transpersonal, Personal, and Political Dimensions. Psychother. Politics. Int. 6(1): 3–16 (2008). https://doi.org/10.1002/ppi.147
  25. Grabovac A.; Clark N.; McKenna M. Pilot study and evaluation of postgraduate course on "the interface between spirituality, religion and psychiatry". Academic Psychiatry, 2008, Jul-Aug;32(4):332-7. https://doi.org/10.1176/appi.ap.32.4.332
  26. Fawcett, J. Will a "Real" Psychiatrist Please Step Forward? Psychiatric Annals, 1999;29(8):447 https://doi.org/10.3928/0048-5713-19990801-03
  27. About the Guest Editor - Bruce W. Scotton, MD. Psychiatric Annals, 1999;29(8):448 https://doi.org/10.3928/0048-5713-19990801-04
  28. Liss, Jay L, Scotton, B.W; Goodrich, W. Transpersonal psychiatry/Guest editor responds. Psychiatric Annals; Thorofare Vol. 29, Iss. 11, (Nov 1999): 614-615. https://doi.org/10.3928/0048-5713-19991101-03
  29. Gray, Alison J. "Reviews: In Case of Spiritual Emergency: Moving Successfully Through Your Awakening. The Psychiatrist Online 2012, 36:360 https://doi.org/10.1192/pb.bp.111.038042
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