The Humanistic and Transpersonal Origins of the Diagnostic and Statistical Manual’s Religious or Spiritual Problem Category

Abstract

Until recently, mainstream psychiatry has eschewed the clinical consideration of spiritual matters. This article traces key historical influences leading to the inclusion of a ‘Religious or Spiritual Problem’ category (RoSPc) in the American Psychiatric Association’s (APA) Diagnostic and Statistical Manual of Mental Disorders (DSM). First, I discuss psychiatry’s ‘spiritual’ aversion issue and the 1994 RoSPc inclusion in DSM-IV. Second, I examine the humanistic and transpersonal psychology thinking from which the seed-idea for the RoSPc later emerged. This includes a philological exposition on initial uses of the term ‘transpersonal’. Third, I examine the transpersonal notion of ‘spiritual emergency’ and unpack related dynamics leading to the RoSPc creation. Fourth, I describe and critique RoSPc developments from DSM-IV to DSM-5-TR. This provides an unfolding historical depiction of factors preceding and influencing the DSM inclusion of spiritual considerations, and subsequent related issues beyond. Overall, my article demonstrates the apparent need for psychiatry to expand the RoSPc’s diagnostic scope to include the types of spiritual experiences originally intended by its transpersonal instigators. Finally, while this article was under consideration for publication, the RoSPc was suddenly updated to ‘Moral, Religious or Spiritual Problem’, so a subsequent Epilogue has been added to discuss and critique this change.