For Kathleen Figueroa, getting dressed each morning was a battle between the evil in her and the goodness of God.
"I'd think God wanted me to wear certain clothes," said Mrs. Figueroa, a day-treatment patient of the Milwaukee County mental health system. If she didn't wear God's choice, she felt like a bad person all day. If she did, she felt blessed. But the blessing had a price. It set her up to stumble over every decision. Each misstep flooded her with guilt and recrimination.
"Even when I was doing good, I'd think about the things I was not doing," said the 28-year-old. Traditional Freudian psychiatric treatment would have tried to quash Figueroa's religious impulses. She would have had three choices: Hide her spiritual revelations, fight her therapists, or forsake her quest for God.
Luckily for Figueroa, a devout Catholic, the Milwaukee system offers a fourth choice. Her doctor referred her to a voluntary therapy group, called Spiritual Beliefs and Values, led by Chaplain Gloria Krasno and Dr. John E. Prestby, who studied at a seminary for two years before training as a psychologist. The group is part of a new development in psychotherapy that is tearing apart Sigmund Freud's ideas about religion and mental health.Called the "psyche-spirit" movement or spiritually attuned therapy by author Russell Shorto, this new thinking is causing psychiatrists and psychologists to redefine the line between delusion brought on by mental illness and religious revelation. No one in the group told Ms. Figueroa that God didn't have a pressing interest in her wardrobe. Instead, they listened and probed as Ms. Figueroa talked through whether she truly believed God was choosing clothes for her, and what the results of that belief were.
"Who are we to say that God doesn't speak through mental illness?" asks Dr. Prestby, clinical program director of day treatment for Milwaukee County. "What we try to help people realize is that a spiritual experience does sometimes move into a manic phase," he said. And that can have an unpleasant outcome.
Figueroa and others in the group talk of struggling to know the difference between God's voice and impulses brought on by illness. They talk of anger at God and, conversely, the sense of oneness and elation that came from spiritual experiences. After eight months in the group, Figueroa sometimes still struggles over what to wear in the morning. "But when I find myself asking, 'Would God want me to wear this?' I know that I'm...God is going to love me no matter what I do," she said.
Therapists who once might have agreed with Freud that religion is "regression to primary narcissism" are casting back to ideas such as those of the psychiatrist Carl G. Jung and psychologist William James, who were much more open to humans' spiritual side. Spiritually attuned therapists don't deny that chemical imbalances bring on mental illness, and they generally support using anti-psychotic medications. But they also cast mental illness in a broader context.
Shorto's book, "Saints and Madmen," begins with the story of Joshua Beil, a young Californian whose ecstatic religious visions led him to believe that gangs of evil angels were spying on him through electronic appliances. He stopped bathing and sleeping. His ravings became so bizarre that he was arrested for his own protection. Mr. Beil believes anti-psychotic drugs saved his life. Even so, his early visions were so profound and blissful that he was not willing to totally repudiate them.
He is among a group that Shorto calls "the new psychotics," people who believe mental illness pushed them into a new state of spiritual awareness. "There was something so wonderful about it," wrote Mr. Shorto of Mr. Beil's experience, "it seemed to crack through his ordinary way of knowing himself and the world and deliver him into a new awareness of the world as whole and true, and of himself as an integral part of it. It was so wonderful that the memory of it still glinted through all the horror and muck that had surrounded it."
Mr. Beil's psychologist, David Lukoff, is one of the leaders of the spiritually attuned therapy movement. In the 1970s, Lukoff had a six-month psychotic break during which he came to think of himself as the reincarnation of the Buddha and Christ. He recovered, but he didn't forget that along with his illness came a sense of spiritual richness.
When Mr. Beil came to him, Lukoff affirmed the 21-year-old's sense that something wonderful as well as something terrible had happened to him. Lukoff told Mr. Beil that he had been through an experience akin to American Indian vision quests. Then the psychologist directed Mr. Beil to do exactly what. Figueroa did: Separate the good from the bad in this experience and use the good to reorient his life.
The Milwaukee program refers patients to local congregations if they want to move toward organized religion. That's a good idea, said Dan Blazer, the Gibbons Professor of Psychiatry and Behavior Sciences at Duke University. Secular therapists can't interpret whether visions and voices really are from God in the way that religious authorities can and have for centuries, he said. Today's individualistic approach to spirituality encourages an "anything goes" attitude, said Blazer, author of "Freud Versus God." "If it's up to you to decide whether the experience is real or not, up to you to decide if the experience is positive or not without any guidance from spiritual tradition, that can potentially be damaging," he said.
According to Shorto, fate turns the mentally ill into "natural theologians." As the rest of the world rushes about gaily or grimly pursuing the thousand tasks of normal life, people with mental illness sit apart asking questions they cannot evade.
"When you have a mental illness, you have to look at who you are and ask, 'Why is this happening to me?'" said Sara Yelich-Koth, a client of the Milwaukee mental health system and member of the spiritual beliefs group. "It goes beyond a chemical imbalance. You have to look to your roots and what is behind everything."
"You experience emptiness in a more extreme way," said Figueroa. "You need some structure that assures you that--"
"That there's more to this life," said Yelich-Koth, finishing her friend's sentence, "than just this struggle, just this pain we're experiencing."