Inaccurately Pathologizing Ego Dissolution (Part 5)
In entry 5 in our series on ego dissolution (pulled from my graduate research on the phenomenon) we continue exploring why counselors and mental health professionals should care about ego dissolution, focusing on how ego dissolution and spiritual experience are often inaccurately pathologized.
According to Lukoff, Lu, and Turner (1996), clients whose religious, spiritual, or transcendental experiences are misunderstood and misdiagnosed are more likely to have poor outcomes in counseling. This fact alone should motivate counselors to dig more deeply into the various nonordinary experiences that clients may have, but this can be a complex undertaking, even though such experiences are relatively normal for humans (Johnson & Hayes, 2003).
A variety of solutions to this problem have been recommended. One is to include an extensive religious history of a client in order to understand the relationship between their presenting problems and their religious structures (Barnhouse, 1986). Building on this, Greenburg and Witztum (1991) suggest that counselors have strong understanding of the tenets of their clients’ religions to distinguish expected from unexpected experiences, and thus avoid unnecessary pathologizing. Unfortunately, this leaves out the fact that unusual religious, spiritual, or transpersonal experiences may differ greatly from those expected in an individual’s cultural context. An American Christian may experience a sense of “emptiness” that would make more sense in a Buddhist practitioner, and a Japanese Buddhist monk may experience the felt presence of a loving god that would make more sense in a Christian context. Similarly, an atheist may have a transcendent experience that is usually described in spiritual language. In cases such as these, a counselor may be challenged if their only guiding schema says that culturally inappropriate spiritual experiences are pathological. It seems that more is needed to help counselors distinguish unusual experiences from pathology.
Perhaps the most promising research in this domain comes from Bronn and McIlwain, who validated and compared the Spiritual Emergency Scale (SES) and the Experiences of Psychotic Symptoms Scale (EPSS). The SES measured spiritual emergency, a construct popularized by Grof and Grof (1989) which entails the type of crises one may endure after or during times of spiritual experience. The EPSS measures both the positive and negative symptoms of psychosis. In comparing these assessments on relevant samples, they found that the constructs of spiritual emergency and psychosis were meaningfully distinct, as divergent validity was observed (Bronn & McIlwain, 2015). Specifically, the presence of spiritual emergency on the SES correlated positively with the positive symptoms of psychosis on the EPSS, but negatively with the negative symptoms (Bronn & McIlwain, 2015). Thus, there is empirically derived evidence that should motivate counselors to understand the distinction between nonordinary spiritual/mystical experiences (including ego death) and psychosis.
Those familiar with dissociative identity disorder may have also picked up on the similarities between concepts of ego death and pathological dissociation or depersonalization. The DSM-V criteria for dissociative identity disorder says that a primary feature of the disorder is a disruption of identity which may include an altered sense of self, though this often involves feeling that one’s self has changed, not disappeared (American Psychiatric Association, 2013, p 292). This also applies to depersonalization, as it is described in the diagnostic criteria for depersonalization disorder (American Psychiatric Association, 2013, p 302).
It’s worth noting that individuals who have had mystical experiences do score higher on dissociative measures, but not on trauma-related measures (Nobakht & Dale, 2018). This implies there is some overlap between ego death and dissociation or depersonalization, but it is not necessarily the case that the two are the same. The DSM-V outlines that a diagnosis of dissociative or depersonalization disorder requires clinically significant distress in addition to the dissociative symptom. In the case of those who experience the dissociative symptom without any distress, it may be inaccurate to apply the diagnostic label to them or to pathologize the experience at all. Furthermore, the nature of the distress entailed in ego death may differ significantly from the distress entailed in pathological dissociation. Though the constructs of ego death and dissociation seem linked, there is no peer reviewed research that investigates the relationship between them.
If we are committed to being culturally and spiritually sensitive counselors, then we need more knowledge to help understand clients who are struggling with ego death. Without attending to this carefully, we run the risk of pathologizing an unusual experience simply because it isn’t common or explainable in a client’s cultural context.
In the next entry, we will examine why counselors need to be aware of the unique types of distress that can follow ego dissolution experiences.
