And vice versa; how do you prevent not picking up on someone’s psychosis, because you are worried about denying their experiences?

The truth is. Psychiatry shouldn’t decide whether something is real or not. Psychiatry is about safety, suffering, and functioning. So the question is not: ‘is this true’, but ‘what does this do to your life’.

Why the distinction between psychosis and spirituality matters

In the DSM (Diagnostic and Statistical Manual of Mental Disorders), and also in practice, a long-standing warning is: don’t class something as a symptom, when it’s a shared, culturally accepted response. This also included psychotic images.

But that little sentence isn’t enough. During the conversation you have to really investigate what an experience means within someone’s context. And that is why the Cultural Formulation Interview exists. A list of short questions that take culture, groups, purpose, and resources into consideration.

Five practical differences that can help in everyday life

1. Can you switch on and off?

A psychosis is something that happens to you. It forces itself on you. It’s relentless, even if you want to sleep, work, or just rest. With most spiritual practices there is a setting and a choice. You can stop, pause, or control it.

The question you need to ask is: Do you control it or does it control you?

2. purpose stays fluid, or becomes rigid

Spiritual meaning can feel really big, but it often remains flexible. People can doubt, adjust, and talk about it without everything falling apart. During psychosis purpose often becomes compulsory. Everything needs to fit within a tight system. Contradiction feels like an attack. This is not a disagreement, but a loss of mental leeway.

Question you need to ask: can you let doubts, nuances, and multiple explanations exist alongside each other?

3. Adjustment to daily life

Someone can believe the strangest things, but still function normally. Work, studies, appointments, money, relationships, and basic self-care. During a psychosis all these things become fundamentally disrupted. Insomnia will start, and pace of life becomes faster. Suspicion grows, and someone loses what other people take for granted.

Question you need to ask: what has gone fundamentally wrong during the past few weeks? Biological rhythm, social life, school, or work?

4. Suffering and hurt become greater

A spiritual experience can be intense, and scary, but shouldn’t have to completely disrupt someone’s life. During a psychosis, you often see increasing suffering, or damage. Sometimes, it starts out euphorically, but then the big blow follows. Relationships end, conflicts escalate, people get exhausted or make dangerous decisions.

Question you need to ask: what’s the cost, and what are the benefits of the experiences; today, not in theory.

5. Social embedding and correction

Many religious and spiritual traditions have rituals, rules, and feedback. There are people who can intervene when you take things too far. A psychosis is a solo experience. Or, if you are in a group, you might be convinced that everyone who tries to correct you is part of a conspiracy.

Question you need to ask yourself: which person from your social circle can be honest with you about your behaviour, and are you still able to accept their advice?

An extra nuance that can prevent a lot of fuss

Hearing voices and having visions can also occur outside of the psychiatric field. People give a certain meaning to that, like spiritual or religious ones. This doesn’t have to collide with the medical view. They can exist alongside each other, as long as you keep looking at direction, suffering, whilst functioning.

In the care sector it often goes wrong when a professional focuses too much on the content. Because then, a discussion arises about tarot, energy, angels, conspiracies, or aliens, even though that’s rarely the point. It can also go wrong when people fail to look at context, like culture, religion, social situation, trauma, drug use, or sleep deprivation. The situation derails completely when the conversation stays vague and no conclusion is reached about concrete behaviour and day-to-day functioning.

As a professional, you can start by paying attention to stability, safety, and everyday functioning. Start with sleep, drugs, food, stimuli, stress, and escalations, because a psychosis thrives on disruption. Explore the cultural and personal significance of the experience by asking them a list of set questions that helps you take their views seriously. Make their day to day functioning measurable and concrete by looking what goes well, but also what they are struggling with, in their studies, work, relationships, finances, and self care.

Psychosis vs spirituality: the key question

If you’re reading this because you’ve experienced something yourself, you can help healthcare professionals by not just telling them what you believe in or experience, but also what it does to you in your day to day life. Are you able to sleep, choose, switch back, and listen to others? These are signals you can build a plan of action with, without someone having to take your experiences away from you.

This topic needs to be talked about, because it’s al about mutual understanding. People don’t want to be labelled, and healthcare professionals don’t want to overlook any potential risks. The distinction lies in shifting the question from ‘is it true?’ to ‘can I live with this?’.