Spiritual Implications of Psychosis: How a Spiritual Perspective Can Provide Health Benefits to Mind and Body. A blog post by Melissa Ruisz Nazario, based on an interview with Tanya Marie Luhrmann, Ph.D., by Bonnie Bright, Ph.D.
According to the World Health Organization (WHO), schizophrenia is defined as “a severe mental disorder, characterized by profound disruptions in thinking, affecting language, perception, and the sense of self. It often includes psychotic experiences, such as hearing voices or delusions. It can impair functioning through the loss of an acquired capability to earn a livelihood, or the disruption of studies.” The condition affects more than 21 million people worldwide. 
This is an area of mental health that Dr. Tanya Marie Luhrmann, Watkins University Professor in the Stanford Anthropology Department and speaker at Pacifica’s sold out Trauma and Transcendence conference in June 2018, has devoted much of her research. Her work focuses on the edge of experience of voices, visions, the world of the supernatural, and the world of psychosis.
Tanya uses a combination of ethnographic and experimental methods to understand the phenomenology of unusual sensory experiences, the way they are shaped by ideas about the mind and person, and what we can learn from this social shaping that can help us to help those whose voices are distressing. She has done ethnography on the streets of Chicago with homeless and psychotic women and worked with people who hear voices in Chennai, India; Accra, Ghana; and in the San Francisco Bay area. She’s also done fieldwork with Evangelical Christians who seek to hear God speak back, with Zoroastrians who set out to create a more mystical space, and with people who practice magic.
How people interpret these experiences has differed significantly over time and in different cultures, Tanya says. Those who are very sick are often universally recognized as sick or schizophrenic regardless of culture or region, but people who are more on the healthy side of that continuum might have their experience interpreted in many different ways. “It’s quite possible that a clinician would say, well they have something like a story in the body, that looks like what I would call schizophrenia,” she says. “In the interpretive religious wing, another domain, they might be seen as if they were possessed by demons or might be seen as prophets.”
Only recently have mental health researchers and professionals looked at the content of these voices as something that should be studied and listened to, instead of insignificant side effects of the disorder, Tanya observes. “Psychiatric scientists used to think that these voices were just the side effects, the byproducts of the disorder, and you shouldn’t pay any attention to them. You know, they were unreal yet very painful to people, but they were just the byproducts of the disorder.”
These days, however, researchers and mental health professionals are seeing some benefits to paying attention to the content of these voices. Dr. Luhrmann has been studying how one modern faction in Europe has been approaching voices in this way. “There’s now a new movement in Europe called the Hearing Voices Movement (HVM), and what they do is that they teach people to respect their voices,” she says. “They teach people with schizophrenia, paradoxically, to treat their voices as persons, to respect them as persons, and they find that some people are able to, in effect, persuade their voices to become more reasonable persons.”
Tanya likens this approach to the Golden Rule we learned in kindergarten, that if you respect people, they respect you in turn. She has observed that this approach does work for people who dissociate, and it might work for people with schizophrenia as well. “One of the things that’s true of dissociation is that people who go in and out of these funny states, often connected to trauma, have more control through their imagination,” she says. “You know, in some sense, the capacity to go into a daydream is a low-level dissociative state.”
Tanya suggests that there are two different kinds of processes that may occur in the body when one experiences schizophrenia. One is psychosis, that is, the disconnect from reality that seems so radical and different. The other might be loosely termed dissociation, which she describes as a trance-like capacity to get really disconnected from the world, but also includes one’s capacity to return. She posits that for both conditions, the way in which the therapist helps the person to listen may affect whether the person is able to return.
C.G. Jung, Tanya observes, used the imagination to work at the borderlines between dissociation and psychosis. “It was never clear to me exactly where he was in that borderline, and there are lots of debates about what that border consists of,” she says. “But we know that using your imagination to interpret your experience is always helpful for you, but that does not necessarily make the problem go away. Either there are people who clearly have positive interpretations of their voices, and who find that the voices tell them to do terrible things, and then they do them."
Both the manner in which one with schizophrenia observes these voices, as well as how “mean” or “loving” the voices are perceived to be, also have a significant impact on the person experiencing them, according to Tanya. “Now we have learned that the way people respond to their voices probably has an impact on what their voices say and then in fact how costly those voices are for them,” she says.
“One of the things you see is that the Americans who hate their voices the most, who seem to be most articulate about the meanness of their voices, on average, we now know that that caustic quality may be bad for the course and outcome of the disorder. And because there are cultural variations, that implies that the way that you listen to your voices will actually impact the way that you experience them, so that the American experience of feeling assaulted by these voices may actually be very costly for Americans who suffer from this disorder.”
However, Dr. Luhrmann makes the point that listening to the content of one’s voices or trying to reframe one’s perception of them is not a magic bullet for the disorder. “When we talk about teaching people to think about their voices differently, this is a lot of work,” she says.
“There’s something about these experiences, particularly with psychosis, that it just becomes deeply ingrained in people’s experiences of their world, so it’s important not a have a kind of a romantic idea about, gee, if we just didn’t call it schizophrenia, all our problems would go away–that wouldn’t happen.”
To better understand the disorder, it helps to know why it may have occurred in the first place. Tanya notes that there is a strong correlation between reporting childhood trauma and a higher risk of schizophrenia.
“The more that they report that they’ve had, you know, unwelcome and inappropriate sexual contact as kids, the more they were beaten up by other kids or parents physically or emotionally, the more bad things have happened to them, the loss of a parent, the loss of a guardian, the higher their risk goes for schizophrenia,” Tanya remarks.
“And some people think that when people with schizophrenia hear voices, that their voices are carrying the message of their trauma for them. So, some of the Hearing Voices movement will say, that’s why you need to listen to those voices, you need to listen to respect the message and the understanding that your voices give to you.”
Dr. Luhrmann delineates two different ways to understanding post-traumatic stress disorder (PTSD), and the method of transcending that trauma based on that perception of PTSD. The first is the concept of having a vulnerable body, which submits to the traumatic event. She says that PTSD is
“more this kind of domain of trance, dissociation that something bad was going on to people as kids or adults, and as the event was going on, people went into an altered state to kind of protect themselves from the experience, and then the memory remains sort of alive for them. So, there’s one kind of story that says we have vulnerable bodies, we’re beaten up by life, our vulnerable body succumbs.”
The second kind of story, she says, is that when traumatic events happen, at that moment in time, people will try to protect themselves from the event, but the memory lives on for them.
Each story offers a different path for transcending the experience. “So those are very different ideas about what’s going on in the psyche of the person who is in torment,” Tanya says. “And it suggests somewhat different ways of transcending the experience. For the person who has a toxic memory, it suggests that the person transcends the experience by gaining access to the memory that they don’t have, and interpreting that in a way that feeds their life’s meaning.”
With the concept of the vulnerable body transcending the traumatic event, Tanya says that the suggested solution is that
“you’ve got to figure out how to handle what’s happened to your body after the insult. And that also can be a spiritual intervention, but it suggests that what you really need is not so much working with memories, you need a loving community, you need a God who cares for you, you need to feel embraced by the universe, you need to have that sort of social relationship that might have been disconnected.”
Although there is debate about whether religion or spiritual beliefs actually serve people, especially those who may have experienced trauma or have a disorder like schizophrenia, Tanya remarks that the research shows that having a relationship with God who is loving is actually good for your health, but it takes a lot of work to develop and maintain that relationship. “It’s clear that if you are able to be in relationship with a loving god, it’s probably better for your body,” she says.
“So, what I saw in my research was evangelicals who learn to develop an intimate relationship with a loving god, I really saw that this involves a lot of micro attention and careful work, in which people start to reinterpret some thoughts as being thoughts from this invisible other, and they work with the church community to interpret their everyday lives as containing signs that this invisible other is there for them, and the church community, particularly the church community I was spending time in, was just really focused on trying to remind you that this invisible other was deeply loving and caring.”
Tanya also references other researchers’ work in the benefits of religious practices and beliefs but notes that the benefits depend on perceiving God as loving, as well as doing the work necessary to maintain that perspective and loving relationship. “You look at these big data sets, which often have some data points like, ‘Do you go to church?’ and ‘How often do you go to church?’” she says.
“So, now you look at these data sets with thousands of people, the more you go to church, the healthier you are, the longer you live. We know that in some slightly more careful academagogical work, it suggests that, I think this is Chris Ellison’s work,  the more that you pray, if you’re praying to a god that you experience as loving you, the less mental illness you report, but the more you report to a God that you experience as judging you, the more mental illness you report. What I saw is that it really takes attention and effort to hold onto this sense of an invisible being who always cares the best for you, and is there for you, because that’s such a hard thing for humans to do, and to really commit to that perspective, takes a lot of attention.”
Suggesting that patients develop and embrace a relationship with a loving God, Dr. Luhrmann understands, is outside of the medical model, and many would scoff at the idea of encouraging a person to experience voices of people who aren’t there, or of embracing irrational experiences or symptoms. Tanya makes the point that while medication can be helpful, the long-term use of it can take its toll on the body, and that there is a growing trend amongst European clinicians to be open-minded to other ways of dealing with these experiences if patients find them beneficial.
“One of the things that I see happening in Europe, and quite strikingly in a recent publication from the British Psychological Society, is that these European clinicians are willing to say, okay let’s not insist that people accept a medical model,” she recalls. “If people find it more helpful to experience these voices or symptoms in a more spiritual way, and it’s more helpful to them, they should do that.”
Based on her research, this is also the position that Dr. Luhrmann takes on patients developing a spiritual perspective and relationship with a loving God. “I tend to be sympathetic to the view that a spiritual perspective can be helpful for people, that it can help them to come to terms with their experiences, and it might help them to transform their experiences,” she says.
“I don’t think it’s a panacea. I have met people who had spiritual interpretations that are voices, and those spirits told them to do terrible things, and then they did them, but I think to have a more spiritual understanding gives people a possibility of a little more control over the experience, paradoxically enough. I think there’s something very deep about the observation that when you give more reality–how do you give more personal reality to these events, and you respect this invisible person as a person, even as a divine person, then it makes it a little easier for that invisible other to be experienced as a respectful person. And I think also people in some spiritual contexts become less afraid of the events. I mean, again, I think that a wise clinician is always an asset to somebody who’s struggling, but I think a wise clinician negotiates somebody’s interpretation of their experience, and whatever biomedical model that clinician might possess.”
 Ellison, C. G., Bradshaw, M., Kevin J. Flannelly, K.J., Galek, K.C. (2014). Prayer, attachment to God, and symptoms of anxiety-related disorders among U.S. adults. Sociology of Religion, 75(2), 208-233. Retrieved from https://academic.oup.com/socrel/article/75/2/208/1649843
Tanya Marie Luhrmann, Ph.D., is the Watkins University Professor in the Stanford Anthropology Department. Her work focuses on the edge of experience: on voices, visions, the world of the supernatural and the world of psychosis. She has done ethnography on the streets of Chicago with homeless and psychotic women, and worked with people who hear voices in Chennai, Accra and the South Bay. She has also done fieldwork with evangelical Christians who seek to hear God speak back, with Zoroastrians who set out to create a more mystical faith, and with people who practice magic. She uses a combination of ethnographic and experimental methods to understand the phenomenology of unusual sensory experiences, the way they are shaped by ideas about minds and persons, and what we can learn from this social shaping that can help us to help those whose voices are distressing. She was elected to the American Academy of Arts and Sciences in 2003 and received a John Guggenheim Fellowship award in 2007.When God Talks Back was named a NYT Notable Book of the Year and a Kirkus Reviews Best Book of the Year. She has published over thirty OpEds in The New York Times, and her work has been featured in The New Yorker, The New York Review of Books, The Times Literary Supplement, Science News, and many other publications. Her new book, Our Most Troubling Madness: Schizophrenia and Culture, was published by the University of California Press in October 2016.
Melissa Ruisz Nazario is a graphic designer and social media consultant for Pacifica Graduate Institute. She is also the production manager and webmaster for Immanence Journal and creative director for Total Okinawa magazine. In 2006, Melissa earned an M.A. in English and American literature at the University of Texas at El Paso (UTEP). Her thesis, “Parting the Shadowy Veil: Trauma, Testimony, and Shadow in Toni Morrison’s Beloved” received UTEP’s 2006 Honors Convocation Award for Outstanding English Thesis. Melissa has served as a content editor and graphic designer for the U.S. Marine Corps Public Affairs Department in Okinawa, Japan, as well as a technical writer and quality assurance specialist for Advanced Computer Learning Company in North Carolina. As an educator, she has taught college-level literature, composition, and drama; she also taught English as a second language to adults and children in Japan.
Bonnie Bright, Ph.D., earned her doctorate in Depth Psychology at Pacifica Graduate Institute. She is the founder of Depth Psychology Alliance, a free online community for everyone interested in depth psychologies, and of DepthList.com, a free-to-search database of Jungian and depth psychology-oriented practitioners. She is also the creator and executive editor of Depth Insights, a semi-annual scholarly journal, and regularly produces audio and video interviews on depth psychological topics. Bright is especially interested in ecopsychology, dream work, and divination, and has completed 2-year certifications in Archetypal Pattern Analysis via the Assisi Institute and in Indigenous African Spiritual Technologies with West African elder Malidoma Somé. She has also trained extensively in Holotropic Breathwork™ and the Enneagram.