Commentary on David Lukoff's
"The Diagnosis of Mystical Experience With Psychotic Features"
~Sandra Stahlman
In the article "The Diagnosis of Mystical Experience with Psychotic Features," (1985) David Lukoff criticizes the DSM-III-R, a diagnostic system used nationwide by psychiatrists. Specifically, he proposes a change in the classification of psychotic episodes; he has designed - within the system's guidelines - a new diagnostic category. MEPF for short, a Mystical Experience With Psychotic Features would be a distinct category within the DSM-III-R. Lukoff argues that the current version of the DSM does not distinguish psychotic episodes which have a positive outcome. Lukoff explains that these episodes are brief, come on quickly, and often result in "improvements in the individual's functioning" (p.157); Lukoff believes they should be categorized and treated differently from psychotic episodes which "indicate a mental disorder" (p.157).
Lukoff proceeds under the assumption that there are mystical experiences, psychotic episodes, mystical experiences with psychotic features and psychotic disorders with mystical features. He briefly defines all his terms, noting that what will be necessary is the ability to discriminate the two. Lukoff explains that the MEPF would describe "the presence of the psychotic state during an essentially religious experience" (p.166). Three criteria for the MEPF are: overlap with mystical experience, positive outcome likely, and low-risk - an "exclusionary criterion" to be implemented "only if the danger seems immediate and severe" (p.171). Five categories define the overlap with mystical experience: ecstatic mood, sense of newly-gained knowledge, perceptual alterations, delusions (if present) have themes related to mythology, and finally, no conceptual disorganization is apparent. In addition, two of the following must be present to fulfill the positive outcome likely criteria: good pre-episode functioning, acute onset of symptoms during 3 months or less, stressful precipitants to the episode, and a positive attitude towards the experience. If these criteria are met, MEPF would be the diagnostic category to use. It would be assumed that the experience will be relatively brief, and beneficial (assist growth). The treatment would differ from the other psychoses, where persistent conceptual disorganization and successful reintegration into society is unlikely.
Lukoff presents an example case study. In addition, he supplies references to scales and tests which may be used to make a diagnosis of MEPF. For example, he suggests a scale and interview created by N. Andreasen (1979) which can help determine if conceptual disorganization is present; because, Lukoff notes, that bizarre speech does not always indicate disorganization. Also included is an excellent bibliography on the topic at hand.
bibliography
Andreasen, N. (1979) The clinical assessment of thought, language, and conceptual disorders. Archives of General Psychiatry, 36, 1325-1330.
Lukoff, David (1985) The Diagnosis of Mystical Experience With Psychotic Features. Journal of Transpersonal Psychology, 17, 155-181.
