Response to the Commentaries

We are grateful to our commentators for so effectively drawing out the issues in this difficult area. Just how difficult an area it is, is reflected in the fact that all four commentators draw in different, and in the case of Roland Littlewood and Andrew Sims opposite, directions. Littlewood argues that we are seeking too sharp a distinction between spiritual experience and psychopathology. Drawing on a depth of anthropological experience, he asks “why any single instance must either be pathological or spiritual?” The distinction, he suggests, acknowledging a point of contact with our position, is “conventional”: why, therefore, feel obliged to force this or that particular case into the mutually exclusive realist categories of a narrowly Western ontology? By “conventional” Littlewood means “experienced through cultural meanings.” Translating this into the terms of our paper, cultural meanings include, though they are not limited to, the values and beliefs of those concerned. On this crucial point, then—that the distinction between spiritual experience and psychopathology turns on values as well as facts—we are in full agreement. However we take this crucial point differently from Littlewood in two respects. First, as one of us has argued in detail elsewhere (Fulford 1989), the distinction between spiritual experience and psychopathology is not alone in being conventional, in this sense. All judgments of health and pathology turn on values as well as facts. It is especially important to recognize that there is an evaluative, as well as factual, element in judgments of psychopathology. This is because people’s values are far more divergent, and hence problematic, here than in respect of judgments of physical pathology (ecstatic states, for example, are judged good by some, bad by others; but appendicitis is a bad condition in anyone’s book [though of course good may come of it]—see Fulford 1989, ch. 5). But just in being value-laden, and to this extent conventional, the distinction between spiritual experience and psychopathology is no different in principle, no less real one is tempted to say, than any other distinction between health and pathology. No less real, and, therefore, to come to our second point of divergence from Littlewood, no less important that it be correctly drawn. That a distinction is conventional, turning on values (as well as facts), makes it indeed more important that it be correctly drawn, not less. As the philosopher Mary Hesse, writing of post-empiricist philosophy of science, noted, values are, in a sense, literally all that matter (Hesse 1980). And in the case of spiritual experience and psychopathology they matter crucially. We noted in our paper, and one of us has reported in detail elsewhere (Jackson, forthcoming), the importance to the people concerned of how others evaluated their experiences, especially significant others like doctors and priests. (This could even have a significant effect on outcome.) Littlewood’s table of possibilities thus risks compounding the problem from the patient’s perspective—would Simon, for example, have found “insane-spiritual” any more acceptable than just “insane”? Such tables, moreover, and the various mechanisms Littlewood goes on to describe, by which pathology may be “normalized” through social events, although contingently important, actually rely on, and incorporate, the very distinction—between spiritual experience and psychopathology—that he urges us to avoid.

That the distinction between spiritual experience and psychopathology is important, is shown, if in no other ways, by the vigorous tone of Sims’s commentary. Like Littlewood, Sims thinks that we are too fussed about the distinction. Where Littlewood accuses us of making it too sharp, however, Sims accuses us of not making it sharp enough. The reason, he says, is simply that the instrument we use, the Present State Examination (PSE), is too blunt for our purpose. This is how his argument runs: 1) it is “not really very surprising” that the PSE is unable to distinguish spiritual experience from psychopathology, since 2) it was designed to differentiate one kind of pathology from another, and in epidemiological, rather than individual case history, research. 3...