Ascent of the Transpersonal Model?

Approaches to PTSD using the DSM and Transpersonal Models: Analysis of Excerpts from the Case History and Self Assessment of Judy Schavrien

Mallikarjun Posanipalli

California Institute of Integral Studies

Community Mental Health

Cohort 11

Abstract: Using accounts from a case history provided by Judy Schavrien entitled On Being Shot Awake and The Dreams That Foresaw it: A Transpersonal Self Psychology View of PTSD Recovery I will assess her incident of PTSD using frameworks from a few diagnostic perspectives which include the DSM biological model and Transpersonal perspectives as envisioned through Stanislav grofs model and the Spiritual Emergency Network. In addition I will consider the issue From a Somatic point of view. I will further elucidate on any linkages between the varying perspectives while deliberating possibilities for their integration.

In Judy Schavriens (2005) account of her PTSD inducing incident, she views it as an invocation or spiritual emergency that progresses towards spiritual gnosis and transformation. From this perspective PTSD can be ascribed to the etiology of an another underlying process. This blurs the boundaries between what can be considered psychopathology vs. a potentially healthy process of differentiation and individuation. She charts her account through the events leading up to it, amidst it and a reconstitution process she charts over the 7 years following it.  Her timeline for writing this occurred from the time of the event up until the 7th year where after the major symptoms of her PTSD eventually cleared up upon her continued journaling of the experience, by psychotherapy, by a healing journey through tropical countries that lasted 18 months and then starting a new life in a new region of the United States. This brief period after the 7th year interim could be considered her consolidation of an individuation process whose outer reflection was represented by a new life unplagued by PTSD. Schavriens PTSD precipitating incident involves a mugging followed by a shooting which she recounts as “being shot awake and the dreams that foresaw it” (Shavrien, 2005). What is peculiar from a biological reductionist lens is her precognitive capacities to foresee the incident and make sense of what’s happening her to her within that context. Schavrien (2005) Opens her essay as follows:

“Near midnight, on the brink of April Fool’s Day in 1986, I was mugged and shot in the face. A series of dreams led up to this mugging. I had been working with a spiritual guide and paying close attention to dreams; the goal was to make my 40th birthday, which would arrive on April 4th, a watershed birthday. The dreams, as it turned out, not only led up to this mugging but foresaw both the shooting and my recovery from it. The recovery entailed a fulfilling of the goals I had set for my 40th—but these were accomplished by way of challenges, choices and events that would have seemed, before the fact, hideous, wondrous and, on the whole, bizarre (pg.1).”

The insight derived from this foresight, along with her psychotherapy background, helped her navigate and make meaning out of a process she was undergoing. Without the good fortune of her circumstances she could have easily descended into the psychopathological aspects of PTSD and even regress substantially past her still immature state prior to the incident. As a parallel to this Ann Leach states her thesis titled “To be able to frame the experience as something many have gone through before with positive results is of tremendous significance to the sufferer, who may feel this s/he is the only person ever to feel this way. (Ann D, 2006)” Fortununtely her presaging the experience through her dreams allowed her to recall a positive context to the occurrence that enabled positive results to come to the fore. This passage could have also been enabled by a support system that reinforced this recall, features that weren’t too present for Judy.

Looking through the lens of a DSM biological model does not allow us to entertain this perspective as it necessitates causal logic. What cant be measured cant be counted or seamlessly integrated into its parameters. Judy (2005) states within her self assessment that, “In this essay, the experiential account of these matters is at the core. In other words, this is a case history that sets the clients voice (my own from back then and also recently, in a retrospective view) above theoretical filters and inferences (pg.99)”. She further elucidates that “the theory may, in turn, profit from the experiential account, which forces a broadening and seeping to fully accommodate that account (pg. 99). The DSM parameters can only account for Judys transpersonal self psychology view of PTSD recovery if it, like Judy,  broadens its lens to accommodate for it. According to the diagnostic standards of the DSM III here is how Judy (2005) accounts for her diagnosis in an exquisite self assessment.

“With bravura, I launch, reading from my pocket edition of the DSM III: ‘‘It says you have sleep disturbance. I do have sleep disturbance, you might say that. It says you get recurrences. Well we could consider I suppose the nightmares recurrences . . . And there are the flashbacks. Circumstances that reproduce the event: well like loud noises with me, or even just the night itself, I’m jumpy all night; sometimes I’m more than jumpy, terrified the whole night. (I do not mention that most nights I wake up screaming). Oh yes, it can be a climate that reminds you of the event, they explain, so I suppose it can be a period of the day. You feel disconnected from normal goals and pursuits and have lost your taste for accomplishment . . .’’ Dave, to my surprise and relief, accepts my proposed diagnosis, shows no qualms. ‘‘Another symptom would clinch the diagnosis,’’ he says. ‘‘What do you say to ‘suppressed affect’?’’ Suppressed affect? I am surprised. Surely I am expressive enough about this incident, too expressive for some people’s taste. We proceed to have an excellent session, one that heralds a new era in my healing. At the end of it, Dave gives me a book I might read, about a woman shattered, literally, into the pieces of a multiple personality: Andrea’s Prism (pg.110).”

After reading a segment of Andreas Prism she clinches the diagnosis of PTSD by declaring her final symptom to be suppressed rage. Looking at it from a current DSM perspective Judy meets all the preconditions for PTSD w/ the exception that she made her self diagnosis only a week and a half after the incident while the DSM asks that most of these symptoms have continued for at least a month, something we can overlook given the full extent of her experience. During Judy’s time, the DSM III barely if at all accounted for the Psycho Spiritual or cultural dimensions she alludes to in her essay. This was due to the advent of the biological model as it was coming to dominance and asserting its footing. Prusak (2016)  contends that starting with the DSM IV however and with its introduction of V-code 62.89 its lens have expanded to increase the possibility of differential diagnosis between religion/spirituality and health/psychopathology. Lukoff (1992) traces the roots of this change to the influence of transpersonal clinicians whose original focus was on spiritual emergencies, similar to the one exemplified by Judy, or forms of distress associated with spiritual practices and experiences. The proposal (From spiritual emergency to spiritual problem 1992) sprung from the work of the Spiritual Emergence Network that was addressing the “religiosity gap” or cultural insensitively of the DSM in accounting for people with religious or spiritual experiences. Spiritual emergency is a term coined by Grof and Grof (1991) to describe “critical and experientially difficult stages of a profound psychological transformation that involves one entire being” (p. 31). This change would have improved Judys diagnosis assessment and enabled a more nuanced and differential diagnosis. Fortunately as Judy had a precognitive understanding of this difference and tools to navigate her process it enabled her to do the self repair necessary that allowed her to cross over. Further the New DSM accounts for some of her protective factors, particularly environmental, that could explain the nature of her positive prognosis such as coping strategies, socioeconomic status, education, race and social support prior to event exposure. Her social support prior to the experience is particularly noteworthy as her spiritual guide and dreams played a crucial role in sense making through her experience of PTSD.

One would expect the lens to broaden further with the advent of DSM V to incorporate a fuller extent of transpersonal perspectives and their range of criteria but this isn’t necessarily the case. Jacek Prusak( Prusak), in explaining the possibilities and limitations of incorporating religious or spiritual problem, shows how DSM V emphasis on cultural diversity has enabled non reductive and non pathologizing insight into problems of a spiritual nature. However he also depicts the increase in pathologizing these states through the medicalisation and psychiatrization of various problems therefore asking us to go beyond these limitations.

The closest the DSM could have been to the expansion of these limitations was when Meek proposed a new addition to the DSM termed ‘creative flooding’. Meek (Viggiano et al, 2010) aptly describes this phenonomen as:

“A spiritual emergence/emergency also can lead to increased creativity, though the effect may become creative flooding. In these circumstances, too much of spirit or too much creativity for the individual to manage is trying to come through, and for this reason it seems appropriate to consider creative flooding a spiritual emergency. (p.121)”

Unfortunately this proposal never came to pass asking us to infact stretch ourselves beyond the limitations imposed by the DSM as Prusak has suggested.

Examples of Transpersonal models that go beyond these limits include Stanislav Grof’s Model of Spiritual Emergencies and Michael Washburn’s Dynamic-Dialectical model. They address the growing need cited by the recent incisions from the Mayo Clinic Proceeding (Mueller et al.,2019) for closing the gap between spiritual and religious needs of clients and lack of provisions that are available for their care. This is also further corroborated by the clinics findings suggesting positive health outcomes associated with Religious involvement and spirituality. Grofs model of spiritual emergencies Enlists ten kind of spiritual emergence/emergency experiences. These main types of spiritual emergencies include shamanic crisis, psychic opening, possession states, kundalini awakening, unitive experiences, near death experiences, channeling, UFO encounters, past life reports and renewal through return to the center (Viggiano, 2010) which all further contain their own particular characteristics. Judy’s experience can be seen as a spiritual emergency containing more than a few of these emergencies which are also noted to have considerable overlap. Notable emergencies as relating to Judys experience include some of the traits associated with peak experiences, Near-Death Experiences, psychological renewal through return to the center, the shamanic journey, psychic opening and spirit guides and channeling. Peak experiences that the grofs enlisted according to Walter Pahnkes include:

1/sense of unity

2/positive emotional associations

3/ transcendence of space and time

4/sense of the sacred

5/ paradoxical quality

6/ a sense of the experience being real

7/ ineffability and

8/ positive aftereffects.

Amongst these the transcendence of space and time is one of the most apparent in Judys case as her precognition allowed her to view and contextualize the event from a standpoint removed from time she was broken open from the incident as she contextualize the entirety of the episode through the pledges she had made for her 40th birthday.

Sense of the sacred is also prominent as her self objects transferences are mirrored in the wider world context and that of divinity in the aftermath of the incident. The positive aftereffects are also consolidated as she clears up most of her PTSD symptoms. The positive effects are also ascribable to Grofs basis in grounding his model in the holotropic model that emphasizes the human tendency to move towards wholeness as abetted by inner healing (Viggiano, 2010).

Through her precognitive dreams and proposed wishes for transition she was subconsciously incubating and attracting an incident that would transport her towards this wholeness. The paradoxical quality of her experience is exposed in her moment of “losing face” in terms of all her claims to success within the previous order collapsing but she is able to later recontextualize these experiences of losing as optimal frustrations towards a greater level of wholeness. This is captured in her language when she says, “with this caveat in mind—-not to solidify winner and loser into opposite terms because, in the paradoxical language of the minds depths, they can be kissing cousins—let me boast on behalf of this “client,” myself (Schavrien, pg 101, 2005).” Psychological renewal to center is also present through the death of her old self as represented by adherence to activities based in gaining acknowledgment through family, friends and society is destroyed and fragmented only to be reconstituted through a renewal through return to the center or whole self as represented by her new dedication to ‘the all’. This is further consolidated by her eventual relocation to a new state with a new life.

Aspects of a shamanic journey are apparent as she contends with a grueling initiatory process that is followed by themes of resurrection and ascent while psychic openings are evident in her precognitive dreams.

It’s also interesting to note her 40th birthday as a transitional marker that precipitates a mid life crisis. Erick Erickson marks this period by a need for generativity which involves “making your mark” on the world and a sense of being a part of the bigger picture (McLeod, 2018). Brandon attributes this phase with, “a desire for expansion into new areas and a yearning to align with ones ‘true self,’ despite social conventions or old habits (bragdon, 23).” Washburn characterizes this period with the statements, “for those who are destined to proceed along this path, this dark night awaits them as the energies of the spiritual ground erupt, bringing up repressed material from the unconscious and the ground itself. The person experiences this as terrifying (pg27, repository). Washburn also describes this period as Regression in service to transcendance (RIST) as the forces of the ground pour into the conscious mind which may turn into a spiritual emergency. All of these models of the transpersonal diagnosis fit to capture expansive experiences such as Judys.

The two perspectives of diagnosis presented to determine the nature of Judy Schaviers both offer valid explanations for her incidence of PTSD. The question remains whether both models can operate in an integrated fashion. Can the DSM expand to fit in circumstances that require an expansion of their lens to account for experiences like Judys? Though it seems like an uphill battle for the DSM to change it is promising notion when Vaughn, Wittine, and Walsh (Ann,2006) state:

“A transpersonal orientation does not invalidate other approaches, any of which may be relevant to an integrative therapy. It does, however, call for a more expanded context than is usually assumed by other approaches and allows for a vision of the human potential that explicitly includes spiritual experiences(pg 22).”

According to their statement It sounds like the transpersonal orientation is already integrative and does not need to fit into the DSM model of diagnosis but rather the DSM needs to transform to accommodate these bigger truths. A further determinant for determining whether to use the medical model or spiritual emergence model has been devised by The Grofs through a guidance offering table. This table in particular focuses on differentiating psychosis from spiritual emergencies while not including the full spectrum of emergence phenomenon. It is important to note the distinction between emergence vs. emergencies. Emergence can be attributed to the full spectrum but the nature of spiritual emergencies are a subset that can be confused with other psychopathology while still needing the proper support to help the client in sense making. “For the vast majority of people, opening to spiritual experience is a welcome and easily integrated process. However, for a small minority, spiritual experience occurs so rapidly or forcefully that it becomes destabilizing, producing a psycho-spiritual crisis. This is where spiritual emergence becomes spiritual emergency (an integral approach to spiritual emergency (author unknown,pg.1)”.

In concluding, I think its safe to plea for a more expansive lens to our diagnosis given the growing need to address spiritual emergencies in a society that is bereft of a global spiritual perspective.

References

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http://www.centerforspiritualemergence.com/uploads/7/4/5/5/74555131/an_integral_approach_to_spiritual_emergency.pdf