Psychosis and Religious Conversion

By: Tony Stern, M.D.

Psychosis and conversion are closely related, as the following abbreviated case study illustrates. A seventeen-year-old youth loses all interest in doing his schoolwork. He is unable to concentrate. For the last two or three months he becomes withdrawn, indifferent to family and friends. Family members grow worried and angry. Teachers give extra homework assignments to discipline him. One Sunday afternoon he is trying to do a lesson, but his mind wanders. His older brother walks in, sees his inattentiveness, and scolds him. The next morning the boy runs away from home. Immediately, previous habits of sleeping and eating go by the wayside. He sleeps rarely and erratically. He eats only if fed by concerned strangers. He stops speaking. In fact, he talks to no one for the next four years. He becomes disheveled, oblivious. He never bathes. Insects bite him, leaving pus-filled sores on his back and legs. He hardly notices. This process in its most acute form continues for about a year.
What has happened here? Perhaps it would help to know that the boy’s father died when he was twelve years old, and that one day around the time his schoolwork began slipping he suddenly felt gripped by a fear of death and a sense of certainty that he himself would die imminently. Even with only this information, there can be little doubt that we are dealing here with a severe psychotic break. What kind of treatment would be indicated? Supportive psychotherapy? Antipsychotic medication, perhaps mood stabilizers? Adjunctive family therapy, perhaps?

This boy never received professional help. He never returned home. When an uncle and then his mother and brother first found him years later, he all but entirely ignored them. In his subsequent long life he never worked at a job, never married, never developed normal relationships. Instead, this young man, born Venkaturamana Iyer, grew older, settled down considerably, and came to be known as Sri Ramana Maharshi, one of the most deeply and universally admired saints in the history of India. For almost anyone looking to the East for inspiration, Maharshi represents a phenomenal pinnacle of spirituality and wisdom. While he lived all his life, from 1879 to 1950, in or around two small villages in southern India, he attracted an international following. Among Western visitors to his cave were the author W. Somerset Maugham, who later wrote The Razor’s Edge. The psychiatrist C.G. Jung, wrote of the sage: “In India he is the whitest spot in a white space. What we find in the life and teachings of Sri Ramana is the purest of India” (Forward, in The Spiritual Teaching of Ramana Maharshi, Shambhala: Boston, 1972).

Without the case’s unexpected end—“the rest of the story”—it is simply a sad glimpse at the life of a teenager with a major mental illness. With its conclusion, however, it is a challenge to basic assumptions about psychosis and conversion. Are they separate entities? Is it possible to distinguish between a profound mystical conversion experience and a psychotic episode? Sri Ramana’s transformation is one type of conversion, in which a person “converts” to a deeper form of his or her own tradition rather than turning to another sect or religion. In any conversion experience, as in a psychotic episode, the world is suddenly seen with different eyes—through a rearranged belief system.

Henri Ellenberger’s idea of creative illness may be useful here, which is one way of talking about “regression in the service of the ego.” Stanislav Grof provided a recent version of this concept with his diagnostic category of “spiritual emergency.” Yet both thinkers run the risk of over-romanticizing and prematurely clarifying a gray area. This same risk applies to Ken Wilber’s important work. At the core of his efforts (in books like The Spectrum of Consciousness and The Atman Project) is his simple yet brilliant explication of the distinction between regression and transcendence—between pre-egoic psychopathology and trans-egoic spirituality. Wilber has indicated that true spiritual practice transcends the ego; it is a mistake to dismiss it as narcissistic withdrawal or oceanic regression. Genuine spirituality lies above and beyond and builds upon a healthy ego; don’t reduce it to regression or equate it with emotional disturbance. (See Walsh, R., and Vaughan, F, Eds., Paths Beyond Ego, Jeremy P. Tarcher: Putnam, NY, 1993, and Wilber, K., Engler, J., and Brown, D.P., Transformations of Consciousness, Shambhala: Boston, 1986)

In this light, how shall we understand Ramana Maharshi? Was he disturbed or inspired? Was he pulled into his flight from home by regressive tendencies? Or was he pushed from home by a divine process? My own answer to these questions is “yes” and “yes;” both are true. One can discern a mixture of pre-egoic and trans-egoic elements in the unfolding of his early life, but more importantly either interpretation becomes compelling depending on how one views the story. Seen from a psychiatric standpoint, Maharshi was clearly regressed and obviously ill, at least in his late teen-age and early adult years. Seen from a spiritual orientation, he was undergoing a salutary transformation—extreme in its manifestations yet tremendously positive in its end result.

However one might clarify and understand Maharshi’s transitional period, it poses a challenge to any vision of spirituality as supreme or higher psychologic health and of development as proceeding from the stage of childhood conflicts to normal mature functioning and then ascending into spiritual realization and mastery. It is helpful to re-consider the situation without the benefit of historical hindsight. Forget “the rest of the story” and all the spiritual definitions and categories (samadhi, kundalini, or the like) that go with it. If you saw a patient with the behaviors described above, what would you think? What should your way of looking at it and responding to it be? Despite the possibility of distortion, imaginative reconstruction with oneself in the picture is necessary. To explore the interface between spiritual realization and madness and shed light on both, highlighting the hidden story of madness in the saint is a vital task, and it carries with it the requirement to intentionally forget and then remember again that the person under consideration was a religious pioneer and a spiritual giant. Equally important, though beyond the focus of this article, is uncovering the urge toward transcendence in madness. Of course, in the sketch of the saint’s adolescent years above, I have purposely been selective. I have given a thumbnail history close to what would probably be culled at the average mental health clinic or psychiatric hospital. Most of the recorded details we have left unmentioned would be summarily characterized as “hyper-religiosity” and therefore further evidence of a psychotic illness at any conventional treatment facility. Our protagonist had religious longings beginning rather suddenly at age sixteen. A year or so before his departure from home he read a devotional book that stirred him to his depths. Thereafter he visited the local temple every day for hours at a time, tears in his eyes, fervently praying to be made a true devotee of God. Upon fleeing home he left a note that read, “I have started from this place in search of my Father in accordance with His command….”

A further issue should be touched upon, though it is beyond the scope of the present discussion. In describing the young Maharshi, I mentioned in passing that he had an experience of abruptly feeling certain of his own imminent death. This occurred about two months before he left home. I neglected to add that he then lay down for a half hour and calmly and rather spontaneously inquired into the matter of who was dying. According to the spiritually oriented biographical sources about the sage, at the end of that half hour he had fully awakened to That which is deathless, That which can never die. The Absolute. From that time on he was, they say, completely liberated. All this occurred some weeks before the saint’s rapid downslide into months and years of a shockingly deteriorated level of functioning!

Sri Ramana’s story is one of those instances where life eludes our best efforts at categorization. More specifically, he exemplifies the reality that psychosis and conversion cannot always be cleanly separated, nor can psychopathology and transcendence. Differentiation between regression (pre-egoic experience) and spirituality (trans-egoic existence) remains a preliminary and useful theoretical construct, but it does not seem to hold up terribly well in many real life situations. It is tempting to resolve the problem of explaining Maharshi’s behavior by saying that the human struggle and perhaps the spiritual journey in particular contains a mixture of regressive and transcendent elements. After all, even spiritual teachers have their human side. While this may shed some light, it does not come to grips with the important finding that in this story and similar ones the times that are most worrisome psychologically are the very transitions of deepest spiritual unfolding. It is no accident that Maharshi recalled the period of apparent psychosis as the transformative turning point of his life. Such paradoxical logic applies to the specific behaviors under scrutiny as well. For instance, is a person’s sudden and dramatic drop of interest in his customary routine a sign of illness or of health? In terms of current psychiatric diagnosis, it can only be appreciated as an expression of illness. From the spiritual perspective, however, it sometimes implies an upsurge of profound health.

Ramana Maharshi may be an exception in some important ways, but the difficulty his story presents is encountered to one degree or another in the histories of most individuals of significant spiritual realization about whom there is adequate personal data. The people in this category whose biographical or autobiographical writings I know include Ramakrishna, who along with Sri Ramana has been generally considered one of the brightest spiritual lights of modern Hinduism; the great Zen Buddhist teacher Hakuin; the well-known philosopher J. Krishnamurti; the 19th-century Hasidic rabbis Nahman of Bratzlav and Mendel of Kotzk; many of the Catholic saints, including St. Anthony, the third-century Christian recluse known as “the father of monks,” and St. Francis of Assisi; and George Fox, the founder of Quakerism, who was scrutinized by William James in The Varieties of Religious Experience. This list is incomplete, but perhaps it gives some sense of the range of individuals under view. The figures who have led to major religious traditions might also be mentioned in this connection, even though much less is clearly known about their lives. For instance, according to Christian scripture, in the early days of Jesus’s mission his own family thought he was “out of his mind” (Mark 3:21).

Let us return to Ramana Maharshi and the central unresolved question we have been asking about him. How are his flight from home and subsequent disruption of previous functioning to be best understood? Psychosis or conversion? Regression or transcendence? Was it an expression of sickness or a part of a process of realization? The conventional psychologic view would see Maharshi as an example of unhealthy regression, whereas an Eastern vantage point would essentially claim that his apparent psychosis was a pseudo-psychosis involving the adjustment of his physical body to the profound spiritual energies released by awakening. Fortunately, spiritual heroes like Ramana Maharshi save us by defying the categories we have decided are real. Was he regressed or not? The idea of regression (or for that matter suppression or repression) does not make quite so much sense in this case, however, as something we might call compression. The magnitude of Sri Ramana’s spiritual life compressed other aspects of his life to the periphery for a period of years. Our psychiatric and spiritual categories soften in the face of a phenomenon like this. Any good solution to the dilemma posed by this saint will be found not through maintaining our old logic but through seeing how it has misled us. The dilemma remains, and as we walk a fine line into the ambiguity here, as reductionism and romanticism both fall away, the dilemma heightens.

One of the issues here is the never-ceasing challenge of selectivity in constructing a “history of present illness.” Inevitably a multitude of suggestive data presents itself, each bit clamoring for recognition as “significant” or “central.” For example, was Maharshi’s brother’s scolding him important? What if that two-minute incident had been bypassed in the narrative? Suddenly the seeker leaving home now seems a little less like an average teenager or a troubled youth, and therefore a touch more like a newly converted religious man off to meet his destiny. Psychoanalysis today offers a meaningful starting point for moving more fully into the dilemma. As a fundamental psychoanalytic view, all human experience and behavior is adaptation. Psychosis and conversion are both adaptations to the realities of loss, separation, change, and death—and these realities surely affected the young Ramana deeply. This is only a starting point. It leaves much unresolved, but it is a good place to begin. It is also where Buddha’s First Noble Truth (the central fact of suffering) and the living symbol of Christ on the cross join modern psychotherapeutic thought.

(I am indebted to Jeffrey Rubin, Ph.D., who co-authored an earlier version of this paper.)


Tony Stern, M.D. is in private practice and on the faculty of New York Medical College. He is also an attending psychiatriston the Westchester Medical Center’s mobile crisis team and at Abbott House,a foster care agency.

Correspondence to: Dr. Tony Stern, 7 Ravine Drive, Hastings-on-Hudson, NY 10706

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