A Defense of the Spiritual Emergency Scale: Emergency Vs

A DEFENSE OF THE SPIRITUAL EMERGENCY SCALE: EMERGENCY VS. EMERGENCE

Lance Storm, Ph.D. Monika Goretzki, Ph.D. Adelaide, South Australia

ABSTRACT: In this article, we propose that the Spiritual Emergency Scale (SES) was not designed to measure a state of spiritual emergence, but measures exactly what the title suggests; namely spiritual emergency. On the one hand, SES scores indicate states of spiritual emergency as is most clearly indicated by the references to emergency in the form of keywords, terms, and phrases embedded in SES items. On the other hand, to infer that ‘emergence’ is ongoing, or is a fait accompli, simply on the basis of SES item responses, would be misleading. The authors also contrast the single-factor solution of spiritual emergency with two different four-factor solutions.

KEYWORDS: Spiritual emergency, spiritual emergency scale, spirituality, psychosis

It has been argued that conventional approaches to psychosis treatment have overlooked the spiritual experiences prevalent during psychosis (Goretzki, Thalbourne, & Storm, 2009; Grof & Grof, 1985, 1991; Phillips, Lukoff, & Stone, 2009). However, clinicians and researchers are starting to recognise the spiritual aspects of psychosis with some referring to psychotic-like crisis (and even psychosis) as a so-called spiritual emergency. Based on the work of Grof and Grof (1985, 1991), Goretzki et al. (2009) constructed ten spiritual emergency subscales which characterize the various aspects of spiritual emergency: (a) Dark Night of the Soul; (b) Awakening of Kundalini; (c) Shamanic Crisis; (d) Peak Experiences; (e) Psychic Opening; (f) Past-Life Experience; (g) Near-Death Experience; (h) Possession States; (i) Activation of the Central Archetype; and (j) Experiences of Close Encounters with UFOs. These are deﬁned in Goretzki et al. (2009). To facilitate the diagnostic process, Goretzki, Thalbourne, and Storm (2013) used factor analytic techniques to devise a 30-item Spiritual Emergency Scale (SES) that correlated highly with measures of psychotic episode and medication use. The SES was subsequently improved (Goretzki, Storm, & Thalbourne, 2014). This 30-item SES contains items from eight of the ten subscales (items about ‘Near-Death Experience’ and ‘Experiences of Close Encounters with UFOs’ were excluded).

Cooper, Rock, Harris, and Clark (2015), and Harris, Rock, and Clark (2015), have recently conducted some in-depth psychometric work on the SES and its related measures. They are to be commended for this work in a pivotal area of research that aims to draw out the differences and similarities between spiritual emergency and psychosis. Both teams of authors differentiate emergency and emergence and suggest that the SES probably does not measure spiritual emergency (SE), but may be a measure of spiritual emergence.1 In agreement with the authors’ deﬁnitions, we take emergence to mean a ‘‘gradual and subtle unfolding of spirituality that

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190 The Journal of Transpersonal Psychology, 2016, Vol. 48, No. 2 leads to a profound shift in values and/or a more fulfilling way of life’’ (Cooper et al., p. 243; after Grof & Grof, 1991), while emergency may be defined as ‘‘a sudden crisis representing a precarious position of danger or opportunity’’ (Cooper et al., p. 243). Cooper et al., and Harris et al., both argue that the SES does not elicit responses that indicate that the respondent is or has been in crisis—to quote: ‘‘the SES appears to neglect the crisis aspect of SE’’ (Cooper et al., p. 242); ‘‘the scale is devoid of items that capture the crisis aspect of SE’’ (Cooper et al., p. 256), and the SES ‘‘may not be sufficiently capturing the crisis aspect of SE’’ (Harris et al., p. 263). In this paper, we will argue that the ‘‘neglect’’ is (as Cooper et al. suggest) only apparent, and that the crisis aspects are ‘sufficiently captured.’ We point out that there is a big difference between failing to capture crisis aspects sufficiently (Harris et al.) and outright ‘neglect’ (Cooper et al.) of crisis aspects, but we aim to address both claims simultaneously.

By making their claims, Cooper et al. (2015), and Harris et al. (2015), both suggest that crisis is synonymous with emergency; i.e., crisis ¼ emergency (or likewise, to experience an emergency means a crisis must be present, or to have gone through an emergency means a crisis was experienced).2 Given the above equation (i.e., crisis¼ emergency), and since Cooper et al., and Harris et al., both argue from their findings that crisis per se is probably not measured on the SES, they conclude that the SES is, by default, a measure of something else—namely, emergence. Effectively, Cooper et al., and Harris et al., argue that SES scores indicate levels or states of emergence, but we would more reservedly say emergence might be taking place, or might have taken place (as is evident in the prefix ‘‘Have you ever . . .’’ before each item). Accordingly, the assumption of emergence as ongoing or a fait accompli, purely on the basis of an SES score, whether that assumption is made by a clinician or a test administrator, would be a mere inference until otherwise confirmed in the expected clinical manner (NB: the assumption of emergency, however, carries different connotations and evokes different implications). Indeed, usage of the term ‘spiritual emergence’ in that way would be premature and may unethically mislead the testee and rightfully evoke accusations of professional misconduct. We make this statement because emergence has to lead to ‘‘a greater awareness of one’s environment, values, and life strategies, prompting changes in perceptions, behaviors, and relationships’’ (Bronn & McIlwain, 2015, p. 349; see also, Watson, 1994) or, as Cooper et al. say above, a ‘‘shift in values and/or a more fulfilling way of life’’ (p. 243). Cooper et al. (2015), and Harris et al., seem to suggest that it might be misleading to call the SES the ‘Spiritual Emergency Scale’, in spite of the fact that the SES is derived from eight of the ten emergency subscales listed above. However, calling it the Spiritual Emergence Scale would be to mislabel and mislead—put simply, the SES cannot indicate emergence, but it can indicate emergency. For the rest of this article, we will expand on these points, and examine the analyses of the two studies in question, in order to show that the SES is an emergency measure.

SES Items Indicate Emergency

Semantically, the implied relationship and similarities between emergency and crisis are not entirely disputed by us, although we may question the sense in which both terms are used—for example, to be conservative, a crisis situation might be

A Defense of the Spiritual Emergency Scale 191 best read as a state of emergency, but a mental health professional might argue that a ‘mild’ crisis is not an emergency, and does not require immediate action. Likewise, not every emergency is a crisis, and emergence might or might not have taken place, or be taking place, whether crisis or emergency is present or not.

It should be noted that Harris et al. (2015) deﬁne SE as a ‘‘non-ordinary state of consciousness’’ (p. 263) that must include, at crisis level, any of the following: ‘‘extrasensory perceptions, disorganised behaviour, physical manifestations (e.g., spasms and jerking, feelings of vibration, digestive problems, burning and heat sensations, crawling sensations on the skin, roaring sounds in the head), and unusual or illogical thoughts and beliefs with strong spiritual content’’ (p. 263)—we suggest positive, negative, and cognitive psychosis symptoms may also describe the crisis in question. Stanislav Grof (Grof & Grof, 1985, 1991) spent many years working with people in these non-ordinary states of consciousness, including those states that would be diagnosed as psychotic disorders. He argued that a number of these states, which he termed spiritual emergencies, were not pathological, but rather, when supported and allowed to run their natural course, were healing and transformative. His research indicated that phenomena tended to fall into various themes that loosely make up the spiritual emergency subtypes. All of the items in the SES are derived from Grof’s many years of research on phenomena arising during spiritual emergencies. We can see that the very wording of the SES items indicates a level of crisis rather than emergence. For example, if we consider the average person answering ‘Yes’ to a number of SES items, with no prior understanding of the phenomena, they would most likely experience, at least, a brief crisis given that the phenomena are distinctly different to the everyday understanding of consensus reality.

Thus, when Harris et al. (2015) state that ‘‘the vast majority of [SES] items do not appear to capture the crisis aspect of SE’’ (p. 277), and Cooper et al. (2015) state that ‘‘the SES . . . does not measure whether a particular experience is associated with personal crisis and psychological distress’’ (p. 256), we are at a loss in determining whether they are arguing that: (a) some (or all) of the items themselves are not worded in such a fashion as to capture crisis indicating SE; or (b) even though some (or all) the items are appropriately worded, crisis cannot be captured because the SES does not measure severity of SE. And in both cases (a) and (b), it is not clear, whether both teams of authors wish to go further and claim that the SES can only be a measure of emergence by default, given that Harris et al. only suggest throughout their paper that ‘‘the SES is, in fact, quantifying spiritual emergence rather than SE’’ (p. 277), whereas Cooper et al. claim ‘‘the 30-item SES is a promising measure of experiences that would otherwise be labelled as ‘pathological’ or ‘psychotic,’ but at this stage may be best regarded as a reliable measure of spiritual emergence rather than emergency’’ (p. 258). Whatever both teams mean, we need only show that there are items in the SES that indicate symptoms that manifest at crisis levels.

Regarding argument (a), we draw attention to the fact that neither team of authors gave examples of how items should be worded so as to capture crisis, and they do not clarify whether they thought the ten emergency subscales listed above measure only emergency, or only emergence, or both, or something other. For argument’s

192 The Journal of Transpersonal Psychology, 2016, Vol. 48, No. 2 sake, if the SES is ‘‘devoid’’ of items that ‘‘capture the crisis aspect,’’ we fail to see how it is in the item wording that capture fails. In fact, emergency/crisis symptoms are quite readily identiﬁed in the 30-item SES (Goretzki et al., 2014, pp. 243-244). We list 12 (40%) of the more overt items from the 30 items:

‘‘lost . . . sense of reference as . . . outer and inner worlds dissolved’’ (extracted from item #1); ‘‘spontaneous production of complex visual geometrical images or chants inside the head’’ (extracted from item #2); hearing ‘‘voices [and] music,’’ etc. (extracted from item #3); ‘‘intense sensations of energy and/or heat along the spine’’ (extracted from item #4); ‘‘spontaneous desire to create rituals’’ (extracted from item #5); ‘‘powerful inner experience that involved a journey into another world’’ (extracted from item #6); ‘‘the presence of spiritual entities’’ (extracted from item #16; extracted from item #17 in Goretzki et al., 2013, p. 116); ‘‘lost . . . sense of identity’’ (extracted from item #19; extracted from item #20 in Goretzki et al., 2013, p. 116); ‘‘overwhelmed by powerful emotions and physical sensations’’ (extracted from item #22; extracted from item #23 in Goretzki et al., 2013, p. 116); ‘‘need to ﬁght off or try to control the actions of a negative being or entity’’ (extracted from item #25; extracted from item #26 in Goretzki et al., 2013, p. 116); awareness ‘‘of a cosmic battle being played out between the forces of good and evil or light and darkness’’ (extracted from item #29); ‘‘destruction of an old sense of identity followed by rebirth and a renewed purpose for living’’ (extracted from item #30).

(These items are presented in full in the APPENDIX.) Of particular note, the keywords, terms, and phrases used in the SES— ‘‘dissolved,’’ ‘‘intense sensations of energy,’’ ‘‘overwhelmed,’’ the ‘‘need to ﬁght,’’ ‘‘cosmic battle ... the forces of good and evil ...,’’ ‘‘destruction’’—are salient and cogent; they unequivocally refer to emergency/crisis aspects, and we suggest that emergence may come before, during, and/or after the crisis/emergency. So, when Harris et al. say: ‘‘Spiritual emergency (SE) is a process of spiritual emergence that becomes a psychological crisis . . .’’ (p. 263), we agree in part, but would reserve judgement over SES scores indicating emergence in any absolute sense.

Regarding argument (b), we may need to concern ourselves with the degree to which afﬁrmative responses to the relevant SES items indicate emergency. Perhaps Harris et al. (2015) only feel these items do not give a sense of degree or intensity of the crisis when they advocate and recommend the use of Visual Analogue Scales (VASs) to measure ‘‘subjective distress and crisis’’ (p. 279), for they do not actually criticize the SES item wording. In fact, they use 40 items from Goretzki et al. (2009) in their own scale. As it happens, two versions of the 30-item SES have been recently correlated: (a) the forced-choice (‘Yes’/‘No’) version, and (b) a ﬁve-point Likert-scale version (‘Never’to‘Very Often’), r(341) ¼ .76, p , .001 (Storm, Drinkwater, & Jinks, 2016). Thus, the relationship between the two scales is strong,

A Defense of the Spiritual Emergency Scale 193 but the Likert-scale version arguably indicates degree of crisis. We note that Likert scales and VASs are found to be generally similar devices (Hasson & Arnetz, 2005), though the latter may sometimes be superior (Grant et al., 1990). While further research in this area of measurement may prove useful, we nevertheless say that crises are not only qualitatively implied by dichotomous (‘yea’ or ‘nay’) responses, but may also be quantiﬁable in the Likert-scale version of the SES, the latter of which are not all that dissimilar to the scale versions used by Harris et al., and Cooper et al.3

Psychosis and Emergency

The SES correlates with psychosis as measured on the Experience of Psychotic Symptoms Scale (EPSS), and therefore SES scores predict symptoms or emergencies that are associated with both psychosis and spiritual emergency. As Goretzki et al. (2013) state, ‘‘The SES appears to function in a way similar to that of the EPSS (with which it correlates very highly), inasmuch as persons who score high on the former tend also to report experience of psychosis . . .’’ (p. 109). The SES also ‘‘predicts prescription and usage of medication’’ (p. 111).

These findings are supported by other researchers. Harris (2010) found the SES and EPSS scales were positively and significantly correlated. Of those 17 participants who scored high on the SES (scores . 100), seven participants (41%) reported mental illness diagnoses. Rooijakkers (2013) found that SES scores predicted psychosis, and Bronn and McIlwain (2015) also reported significant positive correlations between the SES and symptoms of psychosis:

Importantly, the ﬁndings suggest that SE is a distinct construct, overlaps considerably with the positive aspects of psychosis, and can be differentiated from psychosis by its divergent relationship with alogia. The difference between SE and psychosis is further highlighted given the divergent relationship between SE and depression, anxiety, and stress. (Bronn & McIlwain, 2015, p. 367)

Recently, Storm et al. (2016) found that neither SES scale (forced-choice and Likert scale versions) correlated signiﬁcantly with depression as measured on Beck’s (Beck, Steer, & Brown, 1996) Depression Inventory II. Although depressive psychosis is not psychosis per se, these differences distinguish psychosis from SE, but they do not distinguish SE from emergence.

To summarize, results tend to indicate that SES scores predict the emergency condition of psychosis, and high scorers on the SES also tend to report psychosis significantly more often than low-scorers, and the former take medication to treat psychosis significantly more often than the latter (Goretzki et al., 2013). Given all these findings, we argue that strong parallels are indicated between emergency and psychosis, notwithstanding the apparent divergences, but, as we will show, there is no research on emergence and its possible correlates and predictors that allows us to conclude that the SES is a measure of emergence.

194 The Journal of Transpersonal Psychology, 2016, Vol. 48, No. 2 Emergency vs. Emergence

Although Cooper et al. (2015), and Harris et al. (2015), question the SES as an emergency measure, and advocate the argument from emergence, Cooper et al. (2015) provide very little ostensible evidence, and Harris et al. actually confirm significant correlations of the 84-item ‘SES’, the 30-item SES, and their own 40- item version,4 with psychosis or ‘‘psychosis indicators’’ as measured on the EPSS (Harris et al., 2015, p. 277). As mentioned, Harris (2010) also found that the SES and EPSS scales were positively and significantly correlated. To reconcile themselves with such findings, Harris et al. argue: ‘‘. . . if we consider that the SES is measuring spiritual emergence and that the EPSS is measuring the positive symptoms of psychosis, a positive relationship between the scales might be expected, and it does not necessarily follow that the SES is a valid measure of SE’’ (p. 277). Harris et al. are effectively saying that it is because the EPSS contains positive symptoms of psychosis, or ‘‘typical phenomena experienced by someone undergoing psychosis’’ (Bronn & McIlwain, 2015, p. 355), that emergence must be (or probably is) measured by the SES, but not necessarily emergency. This argument cannot hold— one simply cannot prognosticate emergence from psychosis symptoms alone (even if they are positive), though these symptoms may be clear indicators of emergency, as was shown in the previous section. While it is fine to speculate, there must be grounds to do so—regardless, the argument from emergence does no damage to the claim and findings that the SES and the EPSS both predict emergency and psychosis symptoms.

Harris et al. (2015, pp. 274-279) repeat the emergence argument in regard to the hypothesized predictor variables, transliminality, dissociation, emotional stability, abstractedness, sensitivity, openness to change, and tension, which they entered into two multiple regression analyses (MRAs), with the dependent variables being (a) the 84-item ‘SES’ scale, and (b) their own 40-item SES. With the exception of Transliminality, no variable signiﬁcantly predicted SE (though some zero-order correlations were signiﬁcant). Not only did the authors ‘accept’ the null hypothesis as if it had been proven each time (i.e., they repeatedly drew the false conclusion that the SES is not a measure of emergency), they also deferred to the emergence argument as if it was the best alternative (for discussions about the null hypothesis, see Cohen, 1994; Verdam, Oort, & Sprangers, 2014).

Clearly, re-testing the hypothesized emergency predictors is warranted, and that would be a step in the direction of settling these open-ended issues once and for all. Harris et al. (2015) might argue that they got that ball rolling in their MRAs, but there may be problems with these analyses, given that Transliminality made such a profound contribution to both models (see Harris et al., pp. 274-275), whereas the other hypothesized predictors failed to make signiﬁcant contributions (on this sort of problem, see Krasikova, Le Breton, & Tonidandel, 2011). It might have been wise to remove Transliminality from both models so as to gauge whether the regression coefﬁcients changed dramatically. Equally, hierarchical modelling might be attempted—certainly, inspection of a correlation matrix prior to running the MRAs would be helpful to theory and practice (see Girden & Kabakoff, 2011, and Krasikova et al., for other approaches). Unfortunately, we cannot comment further because the method used (Standard? Statistical? Sequential?) was not described, and results of

A Defense of the Spiritual Emergency Scale 195 important preliminary tests on the MRAs, including tests on multicollinearity and heteroscedasticity, were not given for readers to draw their own conclusions about the findings. However, one way of explaining the non-significance of these predictors is that when there is a major contributing variable (such as Transliminality) in a model, and many other (especially lesser contributing) variables, the true significance of the other predictors can be suppressed. Indication of that comes in the form of a significant overall F statistic accompanied by nonsignificant t-test results for a majority of individual b coefficients, which is how the statistics look in Tables 4 and 5 (Harris et al., p. 275). The upshot is that inferences made about the predictors with the nonsignificant b values would not be valid.

Harris (2010) found that seven of 17 participants (41%) who scored high on the SES (scores . 100), also reported mental illness diagnoses, but eight participants (47%) reported spiritual emergence/awakening. Having found this difference, albeit minor, sufﬁciently high SES scores may serve as a cue to clinicians to investigate emergence, notwithstanding our above-mentioned caveat, so it might have proved worthwhile if Cooper et al., and Harris et al. (2015), had focused their attentions on emergence/awakening from a range of perspectives rather than dismiss the emergency aspect of the SES on an indirect premise. Furthermore, Harris’s own ﬁnding, that a good 41% of high-SES scorers reported ‘‘mental illness diagnoses,’’ supports our main point.

Cooper et al. (2015) do make an empirical argument for emergence based on their finding that Ego-Grasping Orientation (EGO; Knoblauch & Falconer, 1986) was not a predictor of SES scores. They reasoned that ‘‘the very definition of an SE encapsulates a state of wrestling with the integration of the experience into everyday life’’ (p. 256), which is meant to be an ego-concern, so that ego-grasping implies emergency. But it could be argued that people in crisis have bigger concerns than their egos so that we cannot expect EGO to predict SES insofar as the SES measures emergency. The very fact that the non-random sample consists mainly of ‘‘spiritual’’ participants (74.70%) with a considerable proportion (13%) being ‘‘members of a yoga, meditation or spiritual group’’ (p. 248) supports this assumption, given that these disciplines mindfully aim at ego-dissolution or suspending the demands of the ego, especially in emergency situations (Rindfleish, 2007; Taylor, 2015; Walach, 2015). We contrast these findings with that of Rooijakkers (2013) who found that the SES and ego resilience (ability to modify level of ego-control in arousing situations) were significantly and positively correlated, r(58) ¼ .45, p , .001. Rooijakkers expands on our point: ‘‘those who experience an extraordinary experience, have a more dynamic ego-complex and are naturally more gifted to keep a level of control, display more characteristics of a spiritual emergency’’ (p. 34). Accordingly, we would expect the SES/EGO correlation to be negative, exactly as shown in Table 3 (Cooper et al., p. 254), and we could expect it to be moderate in strength, and significant, if data were from a truly random sample.

Interpreting Spiritual Emergency by Category and Factor

To aid diagnosis, and speaking in terms of the ten subscales mentioned above, Goretzki et al. (2009) recommended that ‘‘persons who score more than one and

196 The Journal of Transpersonal Psychology, 2016, Vol. 48, No. 2 one half standard deviations above the mean of the given subscale be tentatively classified as having definitely experienced the relevant spiritual emergency’’ (p. 83). Quoting Goretzki et al. out of context as if they were speaking of the SES, Cooper et al. (2015) state that this ‘‘arbitrary cut-off may only identify individuals who have experienced multiple SEs and scored highly on overall SES scores’’ (p. 255, italics added), which of course is quite true, but the SES did not exist at that stage. Only later, and by the same criterion (i.e., 1.5 SDs above the mean), did Goretzki et al. (2013) say ‘‘scores [on the SES] 27 suggest spiritual emergency’’ (p. 109), and they acknowledged the SES ‘‘does not in itself tell us which spiritual emergency has taken place in the respondent’’ (2013, p. 111). But Goretzki et al. also said: ‘‘the problem of identifying a specific spiritual emergency can be rectified on a case-by-case basis through the investigation of a given participant’s item responses’’ (p. 111), which does not at all require a lengthy ‘‘item-by-item analysis’’ (Cooper et al., p. 255). Goretzki et al. (2013) meant that the clinician need only identify ‘yes’ (or high-scoring) items by category, since eight over-arching categories underpin the SES. It is yet to be seen whether the wordy, indeed unwieldy and conflated factors ‘‘Interconnectedness/Spiritual Opening, Experience of Another Time/Place/World, Experiences of Spiritual Entities/Energies, and Loss of Identity/Reality and Altered States of Consciousness’’ (p. 251) can do the same job.5 We think not. Indeed, this issue about factors needs to be addressed further.

Although we recognise the broader purpose of conducting exploratory factor analysis (EFA) to revise and refine scales (Reise, Waller, & Comrey, 2000), we would argue that the use of EFA by Cooper et al. (2015) on SES response data to create four factors was not entirely justified in that instance because it is hard to interpret the factors. In truth, we should be looking for the clearest solution possible purely because the process is exploratory (Osborne, 2014). Thereby this component of the study proves a different point, given that the categories from which the items were drawn already speak to refinement.6 To be blunt, all the EFA did was repeatedly draw items out from virtually the same categories each time and load them onto different factors. Thus, Table 1 in Cooper et al. (pp. 252-253) shows that the first main factor (Interconnectedness/Spiritual Opening) mirrors the SES in substance since its items are drawn from the four major SE categories, Psychic Opening, Peak Experience, Shamanic Crisis, and Central Archetype, exactly as was shown by Goretzki et al. (2013, p. 108). Table 1 also shows that Factors 2, 3, and 4 are primarily conflations of some Factor 1 categories, being comprised mainly of items that again indicate Shamanic Crisis, Psychic Opening, and/or Central Archetype. In other words, the continual cross-over of categories shows that all four factors are roughly defined in the same categorical way, thus rendering the factors tenuous.

Our critics might say that all four categories are roughly deﬁned in the same factorial way, but that would be putting the cart before the horse. At best, it is a moot point whether the EFA was superior in providing a statistical (quantitative) proof of factors when weighed up against the eight established categories represented in the 30-item SES—recall the methodological point we made about Grof’s research. These items were largely derived using qualitative techniques in the ﬁrst place so that the items owe their origins to those eight categories; they were not created outside that categorical criterion. EFA is probably better suited to data comprised of

A Defense of the Spiritual Emergency Scale 197 a heterogeneous set of items that do not owe their origins to categories. In truth, any further arguments over this issue must again be offset against the clinician’s needs.

Still on this same issue of factors (and perhaps this paragraph should precede the previous two), Cooper et al. (2015) did not evaluate the relative importance of the four Eigenvalues from which they constructed their four factors. Instead, they name and speak of all four as if they all carry the same degree of importance, even though three are only just over 1.00, following the standard procedure inherent in many default settings of statistical packages. This rule has been heavily criticized because ‘‘it consistently leads to the retention of too many factors’’ (Reise et al., 2000, p. 291). The kinds of problems that can occur when relying on the ‘Eigenvalue . 1.00’ rule have been illustrated elsewhere (Comrey, 1988; Courtney, 2013; Hattie, 1984; Lee & Comrey, 1979; Norman & Streiner, 2008). In the case of Cooper et al., the ﬁrst factor is the most important (14.37), whereas the other three are minor (1.97, 1.45, and 1.05) and it is easily argued that they are of little importance: ‘‘The factor with the largest Eigenvalue has the most variance and so on, down to factors with small or negative Eigenvalues that are usually omitted from solutions’’ (Tabachnick & Fidell, 1996, p. 646). In other words, the Eigenvalue(s) for the true factor(s) tend to form one effectively straight line when illustrated graphically on a scree plot, while error factor(s) tend to form another more-or-less straight line, and the number of common factors is taken to be the number of Eigenvalues encompassed by the line with the higher slope, terminated by a transition to the scree—SES examples are illustrated in Figure 1, with reservations for Figure 1(e) since N is small.

Taking our analyses a step further, since Cooper et al. (2015) raise the issue of ‘‘unidimensionality’’ (pp. 244, 245, 254-255), Robins, Fraley, and Krueger (2007) note that ‘‘adequate’’ unidimensionality can be determined by calculating the ratio of the first two Eigenvalues—ideally ‘‘a ratio of 3 or more’’ (p. 413). This ratio is quite discriminatory when the first Eigenvalue is very large as in the case of Cooper et al. (14.37), and (as will be seen) Harris et al. (18.22), which yield ratios of 7.29 and 4.86, respectively—both well above 3.00. Applying the ratio rule to the Storm et al. (2016) data, the first Eigenvalue is very large for the forced-choice data (11.25), with a second factor (1.42), which yields a ratio of 7.92. The first Eigenvalue is also very large for the Likert-scale data (16.45), with a second factor (1.66), which yields a ratio of 9.91. It is easy to see from the above Eigenvalues, and the ratios above 3.00, and Figure 1, that a one-factor solution should be preferred, and the scree plot that Cooper et al. might have presented (and, we suggest, would have seen for themselves) must have illustrated this fact. Consequently, Cooper et al.’s (2015) claim that the SES is not unidimensional is unwarranted, and their suggested improvements to the SES (see especially p. 257) are premature so early in this kind of research.

Apart from the commendable approach taken by Harris et al. (2015) in their many analyses, their four-factor solution, with one very important factor (‘‘Physical and Verbal Experiences’’), three lesser factors (‘‘Insight and Interconnectedness,’’ ‘‘Experience of Other Life Forms and Worlds,’’ and ‘‘Extrasensory Perception’’), and respective Eigenvalues of 18.22, 3.75, 3.23, and 2.63 (p. 271), is comparable to the solution reported by Cooper et al. (2015), though the latter used the smaller set

198 The Journal of Transpersonal Psychology, 2016, Vol. 48, No. 2 Figure 1. The usual interpretation of a scree plot is to take the number of factors before the plotted line turns sharply right at the elbow. Five scree plots suggesting a single-factor solution—data from: (a) Goretzki et al.’s (2009) forced-choice [‘Yes’/ ’No’] version of the 30-item SES (N ¼ 109); (b) Storm et al.’s (2016) ﬁve-point Likert scale version of the 30-item SES (N ¼ 343); (c) Storm et al.’s (2016) forced- choice [‘Yes’/’No’] version of the 30-item SES (N ¼ 343); (d) Bronn and McIlwain’s (2015) ﬁve-point Likert scale version of the 30-item SES (N ¼ 243); and (e) Rooijakkers’ (2013) forced-choice [‘Yes’/?/’No’] version of the 30-item SES (N ¼ 61).

A Defense of the Spiritual Emergency Scale 199 of 30 SES items. Harris et al. mention that they used the Oblimin method of rotation, but if rotation is supposed to spread ‘importance’ relatively equally across some ideal number of factors, it has not been demonstrated here. Also, upon inspection, we see that:

Factor 1 (Physical and Verbal Experiences) is mainly Kundalini (seven out of 12 items) and Possession (four items); Factor 2 (Insight and Interconnectedness) is mainly Peak Experience (five out of 13 items) and Psychic Opening (four items) so that it blurs into Factor 4 (i.e., Extrasensory Perception); Factor 3 is mainly UFO Experience (five out of eight items); and Factor 4 (Extrasensory Perception) is mainly Psychic Opening (comprised of five out of seven items that hail from that category).

Thus again, factors are largely deﬁned by categories from which the relevant items originate. While Cooper et al. attempt a case for ‘‘factors’’ representing ‘‘themes’’ with ‘‘substantial overlap across subtypes [of SE]’’ (p. 254), we maintain that a single-factor solution (‘Spiritual Emergency’) is preferred, and the addition of three minor factors does little to shift our judgement—if a researcher or clinician so wishes, SES score evaluation (i.e., the degree and quality of the crisis) is easily accomplished by indentifying the categories from which the afﬁrmative items hail. This ‘analytical’ approach to SE does have ‘‘practical utility’’ (cf. Cooper et al., p. 255), regardless of the fact that the SE is shown to be unidimensional. We will now demonstrate these points in quite different ways.

Harris et al. (2015) say Cooper at al.’s (2015) four factors ‘‘captured themes similar to those highlighted in their [own] study’’ (p. 276). Going by factor names only, we see that:

Cooper et al.’s ‘‘Interconnectedness/Spiritual Opening’’ appears similar to Harris et al.’s ‘‘Insight and Interconnectedness,’’ if we allow the dubious parallel of Spiritual Opening with Insight; Harris et al.’s ‘‘Experience of Other Life Forms and Worlds’’ does not warrant comparison with Cooper et al.’s ‘‘Experiences of Another Time/Place/World’’ since the 30-item SES used by Cooper et al. does not contain UFO items, whereas ‘‘Experience of Other Life Forms and Worlds’’ is mainly UFO items (5 out 8, or 63%); Cooper et al.’s ‘‘Experiences of Spiritual Entities/Energies’’ appears similar to Harris et al.’s ‘‘Experience of Other Life Forms and Worlds’’ but that judgement is premature (as will be seen); and Cooper et al.’s ‘‘Loss of Identity/Reality and Altered States of Conscious- ness’’ may correspond with either ‘‘Physical and Verbal Experiences’’ or ‘‘Extrasensory Perception,’’ but it is difﬁcult to make a ruling.

So, nomenclature is mostly confusing. We may be on more stable ground if we consider actual items within factors:

Cooper et al.’s (2015) ‘‘Interconnectedness/Spiritual Opening’’ and Harris et al.’s ‘‘Insight and Interconnectedness’’ show about 50% of items matching;

200 The Journal of Transpersonal Psychology, 2016, Vol. 48, No. 2 Figure 2. Two scree plots suggesting a single-factor solution—data from: (a) ten subscales correlation matrix in Harris et al. (2015, p. 271, Table 2); and (b) Goretzki et al.’s (2009) ten subscales’ scores.

Cooper et al.’s ‘‘Experience of Another Time/Place/World’’ and Harris et al.’s ‘‘Experience of Other Life Forms and Worlds’’ and have only one item matching (8%); Cooper et al.’s ‘‘Experiences of Spiritual Entities/Energies’’ and Harris et al.’s ‘‘Extrasensory Perception’’ show about 30% of items matching; and Cooper et al.’s ‘‘Loss of Identity/Reality and Altered States of Conscious- ness’’ and Harris et al.’s ‘‘Physical and Verbal Experiences’’ show about 16% of items matching.

Of course, these ﬁgures are not adjusted for the fact that we are comparing the 30- item set against the 40-item set. Nevertheless, it is difﬁcult to argue for overwhelmingly ‘similar themes’ or a capturing of themes across corresponding pairs of factors. We leave it to the reader to make what they will of Harris et al.’s remark when they say that their results are ‘‘inconsistent with the results of Goretzki et al. (2009) and Bronn and McIlwain’’ (p. 276), insofar as Goretzki et al., and Bronn and McIlwain (2015), both agree on a ‘‘unidimensional’’ (single) factor.

Still, on the issue of unidimensionality, Harris et al. (2015) conducted ten factor analyses (Principle Axis Factoring; PAF)—one PAF for each of the ten subscales— and subsequently stated that: ‘‘Only the Peak Experience subscale returned a single factor solution, indicating that the subscales are not unidimensional’’ (p. 271). They deemed subscale scores unsuitable as variables in PAF. Unidimensionality refers to the interrelatedness of items or variables that tap into the same construct. We note that the literature is inconclusive about how to measure it ideally, and defensible cases have been made for both ‘essential’ and ‘strict’ unidimensionality, where the former taps secondary minor dimensions and the latter does not (Hattie, 1984; Slocum-Gori & Zumbo, 2011). A key rule of thumb, as already suggested above, is to assume unidimensionality if, in the scree plot, ‘‘a clear knee point emerges after the ﬁrst factor’’ (Robins et al., 2007, p. 413). Following the same method as Harris et al. (2015) we conducted a PAF on each of the ten subscales using the Goretzki et

A Defense of the Spiritual Emergency Scale 201 al. (2009) data. One factor was extracted for Peak Experience, with tests on all other subscales yielding two or three factors (mostly two in the case of six subscales, and three in the case of three subscales), but we stress for all subscales, Eigenvalues for the second and third factors were in the vicinity of 1.00 (ranging from 1.01 to 1.39). Again, we maintain our argument against the ‘Eigenvalue . 1.00’ rule, and, as the scree plots suggest a single factor each time, all ten subscales have essential unidimensionality. We point out that as far as factor structures were concerned, items tended to overlap across factors rendering multiple-factor solutions uninterpretable.

We now proceed to our ﬁnal demonstration: Using their correlation matrix in Table 2 (Harris et al., p. 271), and entering them into an SPSS syntax, we found a single factor, as illustrated in the scree plot in Figure 2(a). Revisiting the dataset of Goretzki et al. (2009), we present a similar scree plot as shown in Figure 2(b). In both cases, rotations failed as only one factor could be extracted, and in both cases, we call this factor ‘Spiritual Emergency.’ Preliminary tests yielded the following results, indicating that the two models are comparable:

Harris et al. (2015): The Kaiser-Meyer-Olkin (KMO) Measure of Sampling Adequacy was 0.93, which Kaiser (1974) characterizes as ‘‘marvelous.’’ Bartlett’s test of sphericity gave a value that was large and signiﬁcant: 1315.34, df ¼ 45, p , .001, so it appears unlikely that the correlation matrix is an identity matrix. The data were thus appropriate for FA. The single factor has an Extraction Sum of 5.39, with 53.85% of the variance explained. Factor loadings ranged from .51 (UFO) to .88 (Shamanic Crisis), and communalities ranged from .26 (UFO) to .78 (Shamanic Crisis). Goretzki et al. (2009): The KMO statistic was 0.92 (i.e., ‘marvelous,’ Kaiser, 1974). Bartlett’s test of sphericity gives a large and signiﬁcant value: 767.76, df ¼ 45, p , .001, so again, it appears unlikely that the correlation matrix is an identity matrix. The data were thus appropriate for FA. The single factor has an Extraction Sum of 5.72, with 57.22% of the variance explained. Factor loadings ranged from .46 (UFO) to .93 (Shamanic Crisis), and communalities ranged from .21 (UFO) to .86 (Shamanic Crisis).

While some analyses by Cooper et al. (2015) and Harris et al. (2015), have largely supported the validity of the SES in its various guises (e.g., Harris et al.’s 40-item SES), we remind readers that psychometric analyses, particularly factor analytic techniques (and MRA for that matter), are known to be fraught with (oftentimes contradictory) assumptions and subjective evaluations,7 so that they can easily lead to spurious results, even when followed to the letter. Once again, the earlier claim is defended that the 30-item SES ‘‘will signiﬁcantly shorten procedures’’ both in the laboratory and in the clinic (Goretzki et al., 2013, p. 111), given that the SES is ‘‘a generalized pointer to the occurrence of up to eight spiritual emergencies in a person’s history’’ (p. 111). Proper and commendable use of statistical techniques can still yield questionable outcomes that ultimately defeat the aim of shortening laboratory and clinical procedures. Likewise, we may add that longer versions of the SES (see Harris et al., 2015, pp. 272-273) help defeat that aim.

202 The Journal of Transpersonal Psychology, 2016, Vol. 48, No. 2 Conclusion

Scores on the 30-item SES may indicate, to varying degrees, spiritual crises and spiritual emergency, but only hint at spiritual emergence. We ﬁnd no case to class the Spiritual Emergency Scale as a scale that measures spiritual emergence. In point of fact, it would mislead test-users and clinicians into thinking that high SES scores indicate that emergence can be taken as a foregone conclusion (a false assumption), whereas the case has been made, from high SES scores, that emergency is more likely indicated and deﬁnitive, especially as emergency symptoms bear close associations with psychosis symptoms. Indeed, if the SES acronym did stand for Spiritual Emergence Scale, or indeed if it were advised that the SES is useful as a measure of spiritual emergence, SES administrators would be given the green-light to assume that high test scores invariably indicate some kind of spiritual state of mind has emerged, when closer analysis of the client may indicate no such transformation.

On the one hand, to really know if emergence has taken place, other devices would be needed in the SES aimed at getting various forms of confirmation from the respondent that a state of emergence is underway, or has transpired. On the other hand, in the case of emergency, we have already argued that the association between crisis and emergency is proved by definition, by theory, and by statistical findings. Required now, and on this point we agree with Harris et al. (2015), may be more precision, and response devices such as Likert scales and/or VASs may help in this regard, but the emergence construct needs considerable attention in its own right.

In closing, a key issue addressed in this paper is whether we have genuine multi- dimensionality in the SES, as Cooper et al. (2015) and Harris et al. (2015) would claim largely on the basis of insubstantial loadings, or whether we can claim unidimensionality as a more cautious, conservative, and parsimonious option, under the assumption (as parsimony dictates) that there is no need to multiply our entities beyond necessity. At this juncture, all authors should concur that the SES has at least ‘‘essential unidimensionality’’ (Slocum-Gori & Zumbo, 2011), in spite of the arguments for and against minor factors. However, in the ﬁnal analysis, as any good clinician knows, staking a reputation on a single score, on the assumption of unidimensionality, would be no better than misdiagnosing symptoms that are mere statistical phantoms conjured out of multi-dimensional factor space. We nevertheless caution against too strict an adherence to hard-and-fast rules such as the ‘Eigenvalue . 1.00’ rule that ‘‘continuously performs poorly’’ (Slocum-Gori & Zumbo, 2011, p. 456).

With these points in mind, the SES may help researchers reach a theoretical understanding about the nature of spiritual emergency and psychosis so that, for example, the relationship between the two can better inform clinical practice and indeed modify taken-for-granted assumptions about psychotic disorders and issues such as spiritual emergency. Either the current forced-choice (‘Yes’/‘No’) version of the SES (see Goretzki et al., 2014), or the ﬁve-point Likert scale version (see the APPENDIX), are recommended to clinicians, mental health workers, counsellors, etc., as instruments that inform the therapeutic process, but such scales should be regarded as ‘screeners’ at best. They are advised not to assume that a high score

A Defense of the Spiritual Emergency Scale 203 means spiritual emergence is or has been effected, unless therapeutic outcomes and narrative content from the client clearly suggest it. In all cases, high SES scores should be interpreted with caution, even if a spiritual emergency is indicated, and only clinical expertise should be the ﬁnal arbiter in any decision about spiritual emergency, or indeed, spiritual emergence.

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Notes

1 Whenever we use the terms ‘‘emergency’’ and ‘‘emergence’’ from here on, we mean ‘‘spiritual emergency’’ and ‘‘spiritual emergence,’’ respectively. 2 Cooper et al. (2015) state: ‘‘An experience that may warrant the V Code is spiritual crisis, or spiritual emergency (p. 243). Harris et al. (2015) describe spiritual emergency as a ‘‘process of spiritual emergence or awakening that sends an individual into a state of psychological crisis’’ (p. 263).

A Defense of the Spiritual Emergency Scale 205 3 We note that Cooper et al. (2015) used a Likert-type scale form with possible responses ranging from ‘‘definitely not’’ to ‘‘definitely yes’’ (p. 248). We point out that ‘‘definitely not’’ and ‘‘definitely yes’’ are not grammatically or empirically antithetical (‘‘definitely yes’’ should simply be ‘definitely’). 4 We note that 50% of items from the 30-item SES are present in the new 40-item SES, so it is not clear why the 30-item SES was not tested by Harris et al. (2015) to the same degree as the 40-item version when there may be some differences between the two scales. We must ask, Is the correlation between the 40-item SES and the 30-item SES significant, and how strong is the relationship? And if both scales prove to be similar in many ways, what justification is there for a longer SES? 5 The same conclusion may apply to the other four factors: ‘‘Loss of Identity/Reality; Interconnectedness/Spiritual Opening; Experiences of Another Time/Place/World; and Experi- ences of Spiritual Entities/Energies’’ (Harris et al., 2015, p. 276). 6 To answer Harris et al.’s (2015) question: Why did Goretzki et al. (2013) perform ‘‘PAF [Principle Axis Factoring] on the ten subscale scores and not on the total 84 items?’’ (p. 271), we point out that data reduction is already established in the ten categories, whereas Goretzki et al. sought to confirm whether spiritual emergency was the under-riding factor. 7 For example, Harris et al. (2015) claimed that ‘‘the results of the factor analysis by Goretzki et al. (2009) are questionable due to their small sample size (N ¼ 109)’’ (p. 265), and they cite literature that recommend samples upwards of 150 participants. In fact, number of variables/items must also be taken into account. Goretzki et al. could have opted for a subject-to-variable (STV) ratio as low as 2:1, as suggested by Kline (1979), provided there was a minimum of 100 participants, and the lower limit of variables-to-factors ratio was 3 to 6. However, a more conservative rule was followed whereby the STV ratio should be at least 3:1 (Arrindell & van der Ende, 1985), giving Goretzki et al. a limit of up to 33 variables that could have been confidently entered into their FA. They entered a mere 10 variables. By the same conservative 3:1 ratio, Harris et al. would have needed 252 participants (84 3 3) to enter 84 items into their FA (they had only 224 participants).

Appendix

THE SPIRITUAL EMERGENCY SCALE

Introduction: This research is seeking information about extraordinary experiences that occur in the natural, un-intoxicated state, so it is important that you do not include those instances when you may have been under the inﬂuence of drugs.

Instructions: Circle one answer only for each item: ‘Never’, or ‘Not Often’, or ‘Sometimes’, or ‘Often’, or ‘Very Often’

[Scoring: 5-point Likert scale, Never ¼ 1, Not Often ¼ 2, Sometimes ¼ 3, Often ¼ 4, Very Often ¼ 5]

1. Have you ever lost your sense of reference as your outer and inner worlds dissolved? Never Not Often Sometimes Often Very Often 2. Have you ever experienced the spontaneous production of complex visual geometrical images or chants inside your head? Never Not Often Sometimes Often Very Often

206 The Journal of Transpersonal Psychology, 2016, Vol. 48, No. 2 3. Have you ever heard voices, music or the repetition of mantras, without knowing where they’re coming from? Never Not Often Sometimes Often Very Often 4. Have you ever experienced intense sensations of energy and/or heat streaming along your spine? Never Not Often Sometimes Often Very Often 5. Have you ever experienced the spontaneous desire to create rituals? Never Not Often Sometimes Often Very Often 6. Have you ever undertaken a powerful inner experience that involved a journey into another world? Never Not Often Sometimes Often Very Often 7. Have you ever had the ability to move into and out of non-ordinary states of consciousness at will? Never Not Often Sometimes Often Very Often 8. Have you ever developed a deep change in consciousness during which you lost contact with everyday reality? Never Not Often Sometimes Often Very Often 9. Have you ever experienced insights and/or visions, in which you received secret or sacred teachings and healing powers to take back to the ‘‘ordinary’’ world? Never Not Often Sometimes Often Very Often 10. Have you ever experienced an increased connection with animals and plants and the elemental forces of nature? Never Not Often Sometimes Often Very Often 11. Have you ever had the experience of dealing with something that has a divine nature and is radically different from your ordinary perception of the everyday world? Never Not Often Sometimes Often Very Often 12. Have you ever experienced the sense of becoming one with humanity, nature, the creative energy of the universe and/or God? Never Not Often Sometimes Often Very Often 13. Have you ever spontaneously attained profound insights into the nature of reality? Never Not Often Sometimes Often Very Often 14. Have you ever felt a sense of overcoming the usual divisions of the body and mind and reaching a state of complete inner unity and wholeness? Never Not Often Sometimes Often Very Often

A Defense of the Spiritual Emergency Scale 207 15. Have you ever experienced going beyond your normal understanding of time and space and entered a timeless realm where these categories no longer apply? Never Not Often Sometimes Often Very Often 16. Have you ever been aware of the presence of spiritual entities? Never Not Often Sometimes Often Very Often 17. Have you ever spontaneously received accurate information about things in the past, present or future, by extra-sensory means? Never Not Often Sometimes Often Very Often 18. Have you ever spontaneously gained a greater understanding of the cosmos? Never Not Often Sometimes Often Very Often 19. Have you ever spontaneously lost your sense of identity? Never Not Often Sometimes Often Very Often 20. Have you ever been able to see auras around people, animals, plants or other living things? Never Not Often Sometimes Often Very Often 21. Have you ever experienced a greater awareness of the interconnectedness of all things? Never Not Often Sometimes Often Very Often 22. Have you ever been overwhelmed by powerful emotions and physical sensations, concerning yourself and others in various circumstances and historical settings? Never Not Often Sometimes Often Very Often 23. Have you ever experienced living what seemed to be another life, in another time and place, in great detail? Never Not Often Sometimes Often Very Often 24. Have you ever felt like you have personally witnessed detailed sequences of events taking place in other historical periods and/or cultures that you have had no previous exposure to? Never Not Often Sometimes Often Very Often 25. Have you ever had the need to ﬁght off or try to control the actions of a negative being or entity? Never Not Often Sometimes Often Very Often 26. Have you ever experienced rich connections with mythological symbols from ancient history? Never Not Often Sometimes Often Very Often

208 The Journal of Transpersonal Psychology, 2016, Vol. 48, No. 2 27. Have you ever felt that you were in the centre of huge events that had cosmic relevance and were important for the future of the world? Never Not Often Sometimes Often Very Often 28. Have you ever experienced a visionary state taking you back through your own history and that of mankind to creation? Never Not Often Sometimes Often Very Often 29. Have you ever been aware of a cosmic battle being played out between the forces of good and evil or light and darkness? Never Not Often Sometimes Often Very Often 30. Have you ever experienced the destruction of an old sense of identity followed by rebirth and a renewed purpose for living? Never Not Often Sometimes Often Very Often

The Authors

Lance Storm, Ph.D., is a Research Fellow at the School of Psychology, University of Adelaide, where he also completed his post-graduate studies in 2002. He has published in many journals including Psychological Bulletin, Journal of Parapsychology, and Journal of Scientiﬁc Exploration, and the Jungian journals International Journal of Jungian Studies and Quadrant. He has edited or co-edited three books including Synchronicity (2008), and he is author of the Jungian- inﬂuenced book The Enigma of Numbers (2008). His interest in spiritual emergency stems from over 25 years studying Jung’s Analytical Psychology in order to understand the nature of the self, human development, and the differences and similarities between the manifestations of our spiritual nature and the strivings and sufferings of the human soul, both of which are very often mistaken for psychopathology. He can be reached at [email protected]

Monika Goretzki, Ph.D., is a registered psychologist currently working as a counselor at the University of South Australia. She has worked with adults in a psychiatric clinic, children and families in a community health center and youth in a community organization, using client-centered, mindfulness based therapy. She gained a B.Sci. (Hons) in Psychophysiology and Psychology from Swinburne University, Melbourne and a Ph.D. in Psychology from the School of Psychology, University of Adelaide, where she is a Research Fellow. Her long-standing interest in alternative states of consciousness, and work with people experiencing psychosis, led her to pursue a Ph.D. investigating the differentiation of psychosis and spiritual emergency. She can be reached at [email protected]

A Defense of the Spiritual Emergency Scale 209