The DSM Opened the Door:

What kind of provider do we need to become for the door to be opened more fully?

Imagine awakening one morning after a profound spiritual experience.

Perhaps you feel overwhelmed by an unexpected sense of unity with all life. Perhaps powerful currents of energy seem to move through your body without explanation. Perhaps you have returned from a near-death experience convinced that consciousness survives physical death. Or perhaps your perception has expanded so dramatically that the world no longer feels the way it did only yesterday.

You are not intoxicated. You are not trying to attract attention. You are frightened, confused, and searching for someone who can help you understand what is happening.

Who do you call?

A family physician?

A psychiatrist?

A psychologist?

A clergy member?

A spiritual director?

A psychedelic integration specialist?

The uncomfortable truth is that there is no obvious answer.

It is not because these experiences are rare. Increasing numbers of people from every culture, every major religion, and no religion at all report profound experiences that transform their understanding of themselves and the world. Rather, the problem is that our systems of care have not kept pace with what many people are experiencing.

This article answers the question: If these experiences are real—and increasing—what kind of professionals should we prepare to accompany them?

Personal Story

In the summer of 1967, I was 20 years old. I decided to attend a 3-month retreat at a Zen Buddhist Center in the mountains behind Big Sur, California. I had to sit for 5 days of intensive meditation to demonstrate my dedication. During those 5 days I experienced physical pain sitting cross legged on the floor for hours on end. I also ran the gamut of emotional experiences: extreme impatience, self-recrimination, boredom, excitement, joy. At one point I attained a pervasive ecstasy in which I was convinced I was having an enlightenment experience, a Satori. I got up and ran to Suzuki Roshi, the abbot of the center, who was our guide. He received me with warmth and interest, listening to my story. His advice? “Return to the meditation hall and continue meditating.” Was he saying I was wrong? Was I deluded? I was confused. I thought: “Why return to hours of sitting when I had reached the pinnacle?” But, with his advice, I returned and went deeper into equanimity—accepting the highs and lows and everything in between with peace. A goal of Buddhist meditation. I stayed close to the community for 5 years until Suzuki passed away.

My mother who lived in Vermont had asked me to teach her how to meditate and she practiced daily. In 1971, after almost 4 years of her practice, she was found dead with Suzuki Roshi’s book in her hands, now soaked with her blood. The conclusion her friend made was she had become deluded in her spiritual understanding thinking that death would quicken her way to enlightenment.

My mother hadn’t had the supports I had: a Self-realized guide close by, a spiritual community to meditate with, close companions who shared the path of meditation and the values attached to it. She was alone with no one to talk to about her experiences, and not one to give her counsel. She likely felt she didn’t fit into the conventional community around her.

It was her passing that set me on the road to try to understand how she came to her death. She clearly had had profound inner experiences—but with no support, these experiences had taken her into confusion and self-destruction. This motivated me to do intense psychotherapy, introspection, and continued meditation with excellent supports. It led me to a life of being a psychotherapist bridging the worlds of spirituality and psychotherapy to optimize mental health. In 1971 that role was extremely rare. It is still uncommon, partly because professional psychiatry has been slow to delve into what experiences people have which impact their mental health.

A BIG Change

Thirty-three years ago, an important door began to open.

In 1993, the editors of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV)[i] introduced a new diagnostic category: Religious or Spiritual Problem (V62.89). It was a landmark achievement. For the first time, psychiatry officially acknowledged that distress related to religion or spirituality did not necessarily indicate mental illness but needed to be recognized and responsibly attended to by clinicians.

That change did not happen by accident. It reflected years of thoughtful advocacy by psychiatrist, Stanislav Grof and his wife Christina Grof, as well as psychologists. Francis G. Lu, MD, David Lukoff, PhD, and Robert Turner, MD shared a powerful essay[ii] in 1992 with the DSM editorial board which argued that profound spiritual experiences deserved careful clinical consideration rather than automatic pathologizing.

The DSM door had opened.

But only a crack.

The original description of Religious or Spiritual Problem focused largely on distress arising from religious conflict, i.e. facing crises of faith, or changes in one’s spiritual beliefs. DSM-5, published in 2013, later broadened the discussion by recognizing that spiritual and religious experiences reflect a person’s cultural background and therefore deserve respectful consideration.

Both changes represented genuine progress.

What Was Left Out

Yet they left a larger question largely unexplored.

What about profound spiritual experiences that arise independently of any particular religion or culture? For example: near death experience, or mystical experience.

Researchers have since documented a wide range of transformative experiences that appear across cultures and belief systems. These include near-death experiences, mystical states of consciousness, spontaneous kundalini awakenings, powerful experiences during meditation, and other forms of spiritual transformation that often leave individuals profoundly changed. Changes include more self-acceptance, more compassion for others, more empathy and an increased desire to be in service.

Whether these experiences are ultimately understood through neuroscience, psychology, spirituality, or some combination of all three, one fact is difficult to dispute:

They are happening. This amplifies the article published in 1995[iii] which is a response to the limitations of the 1993 code.

Research by Bruce Greyson, MD, and colleagues at the University of Virginia has helped establish near-death experiences[iv] as a legitimate subject of scientific inquiry. Studies at Johns Hopkins University[v] led by Roland Griffiths, MD, demonstrated that carefully induced mystical experiences can produce lasting psychological benefits and enduring positive changes in people’s lives. Meditation researchers such as Richard Davidson, PhD[vi], Judson Brewer, MD[vii], PhD, Lisa Miller, PhD[viii], and Mathew Sacchet, PhD[ix], continue to demonstrate measurable changes in the brain associated with sustained contemplative practice which result in less depression and anxiety.

Meanwhile, some national surveys by organizations suggest that profound spiritual experiences are far from uncommon. Pew Research Center’s 2025 Religious Landscape Study[x] found that 74% of Americans report experiencing a deep sense of spiritual peace and well-being several times a year or more, while 61% report sensing the presence of something beyond this world with similar frequency.

Important Clinical Questions

These developments raise an important clinical question.

Who is prepared to help people understand these experiences when they become confusing, disruptive, or overwhelming?

At present, most physicians, psychiatrists, psychologists, counselors, nurses, and social workers receive little formal education about spiritual emergence or spiritual emergency. Faced with experiences they have rarely encountered during training, clinicians naturally interpret them using the diagnostic frameworks they know best.

Sometimes those diagnoses are exactly right.

Sometimes they are not.

Similarly, the growing number of people identifying as “spiritual but not religious” has created demand for spiritual directors, coaches, psychedelic integration specialists, and other guides who offer valuable forms of support. Many are thoughtful, compassionate, and deeply committed to serving others.

Yet here, too, important gaps exist.

Some have received little education in trauma, psychopathology, suicide assessment, neurological disorders, medication effects, or the many medical conditions that can resemble spiritual experiences.

Neither extreme serves the public well.

Not every unusual spiritual experience is evidence of mental illness.

Not every unusual spiritual experience is evidence of spiritual awakening.

Sometimes the answer is one.

Sometimes it is the other.

And sometimes both processes are occurring simultaneously.

Discerning the difference is among the most challenging tasks in contemporary mental healthcare.

The Question of Competency

Perhaps, then, we have been asking the wrong question.

The question is not whether licensed clinicians are qualified.

Nor is it whether spiritual counselors are qualified.

The better question is:

What competencies are required to support someone experiencing profound transformation?

Competence matters more than professional title.

Those who work with individuals undergoing transformative spiritual experiences need to understand psychopathology, trauma, crisis intervention, contemplative traditions, ethics, altered states of consciousness, human development, and the medical conditions that can mimic psychiatric or spiritual phenomena. Equally important, they must recognize the limits of their own expertise and know when consultation or referral is essential.

In other words, they must become bilingual—fluent in both the language of mental health and the language of spiritual transformation.

That kind of interdisciplinary preparation remains surprisingly uncommon.

A New Field of Practice

Yet I believe we are witnessing the emergence of a new field of practice.

It will likely include psychiatrists, psychologists, physicians, nurses, chaplains, clergy, social workers, psychedelic integration specialists, and spiritual emergence coaches working collaboratively rather than competitively. Each profession brings essential knowledge. None possesses all the expertise required to navigate these complex human experiences alone.

Recognizing this educational gap, several organizations have begun developing specialized training in supporting spiritual “emergence”, i.e. awakening to higher states of consciousness. At Integrative Mental Health University (IMHU), for example, we focus on preparing Spiritual Emergence Coaches®—not as replacements for licensed mental health professionals, but as members of an emerging interdisciplinary community of care. The emphasis is not on promoting one worldview or profession. It is on developing competencies: learning to recognize spiritually-transformative experiences, understanding trauma and psychopathology, practicing within ethical boundaries, collaborating across disciplines, and knowing when referral is essential.

Human Qualities Needed

We also need to ask: What kind of people do we need to become to wisely walk through the door opened by the DSM editorial board? That shifts the emphasis from credentials to character.

The qualities that are most needed to effectively care for individuals having spiritually-transformative experiences cannot be measured by a diploma alone. The ideal qualities of the provider include:

• humility

• discernment

• emotional maturity

• self-awareness

• ethical integrity

• respect for science

• respect for the noetic qualities of the experience

• willingness to work together, respecting the client’s perspectives

• knowing the limits of one’s competence

Those qualities are every bit as important as knowledge. In fact, they may be what distinguishes an excellent Spiritual Emergence Coach®—or psychiatrist, psychologist, chaplain, or spiritual director—from an average one.

In Sum

For more than three decades, advocates have worked patiently to help psychiatry acknowledge that spiritual experiences belong within conversations about mental health.

Thanks to their efforts, the door has begun to open.

The real question is no longer whether spiritual experiences deserve a place in mental healthcare.

The more pressing question is whether we are willing to prepare a new generation of professionals—clinicians, chaplains, spiritual directors, coaches, and guides—who possess the humility, discernment, and interdisciplinary training needed to serve people wisely.

The DSM editorial board opened the door.

Now it is up to us to decide who walks through it—what capacities do they need to have to work with the DSM board to bring more knowledge of spiritual awakening into the next DSM.

Education—not ideology—will determine whether that doorway becomes a source of misunderstanding or of healing.

That is the work now before us.

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NOTES

[i] American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders (4th ed.), APA.

[ii] Lukoff, D; Lu, FG, Turner, RP. (1992) Toward a more culturally sensitive DSM-IV. Journal of nervous and mental disease 180(11):673-82 DOI: 10.1097/00005053-199211000-00001

[iii] Turner, R. P., Lukoff, D., Barnhouse, R. T., & Lu, F. G. (1995). Religious or Spiritual Problem: A Culturally Sensitive Diagnostic Category in the DSM-IV.
Journal of Nervous and Mental Disease, 183(7), 435–444.

[iv] Greyson, B. (2021). After: A doctor explores what near-death experiences reveal about life and beyond. St. Martin’s Press.

[v] Griffiths R, Richards W, Johnson M, McCann U, Jesse R. (2008 Aug) Mystical-type experiences occasioned by psilocybin mediate the attribution of personal meaning and spiritual significance 14 months later. J Psychopharmacol.;22(6):621-32. doi: 10.1177/0269881108094300. Epub 2008 Jul 1. PMID: 18593735; PMCID: PMC3050654.

[vi] Goleman, D., & Davidson, R. J. (2017). Altered traits: Science reveals how meditation changes your mind, brain, and body. Avery.

[vii] Brewer, J.(2022) Unwinding Anxiety: New Science Shows How to Break the Cycles of Worry and Fear to Heal Your Mind

[viii] Miller, L. (2021). The awakened brain: The new science of spirituality and our quest for an inspired life. Random House.

[ix] Sacchet, M. (2026, Jan.) Your Brain on Advanced Meditation. Harvard Gazette.

[x] Pew Research Center. 2025. “2023-24 U.S. Religious Landscape Study Interactive Database.” doi: 10.58094/3zs9-jc14.

Author

Emma Bragdon, PhD. is Founder and Executive Director of Integrative Mental Health University, IMHU.org