# Crisis bring people into a pivotal mental state #crisis #stress_vulnerability_model #prodome #Mental_Illness #schizophrenia #brain **A person enter into a Pivotal Mental States PiMS during crisis/stressful period Outcome of it determine if person experience personal spiritual growth or psychotic disorder.** [[What a spiritual high shares with a mental breakdown Aeon Essays]] British psychologist and neuroscientist Robin Carhart-Harris and I recently introduced the construct of ‘pivotal mental states’ (or PiMSs), which we see as an evolved human capability for sudden and radical psychic change. In our [paper](https://journals.sagepub.com/doi/full/10.1177/0269881120959637) in the _Journal of Psychopharmacology_ in 2020, we defined PiMSs as ‘hyper-plastic state\[s\] aiding rapid and deep learning that can mediate psychological transformation’. We believe that the spiritual or incipient psychotic experiences that can lead to religious conversion or psychotic disorder, respectively, are both examples of PiMSs, as are the acute traumatic experiences that can lead to post-traumatic stress disorder, post-traumatic growth, or some combination thereof. Crucially, we believe that shared neurobiological processes underlie all these intense transformative experiences, whether they culminate negatively or positively. Specifically, we propose that chronic stress primes and acute stress triggers PiMSs by increasing the expression, sensitivity and activity of a specific neurochemical receptor in the brain – the serotonin 2A receptor (also known as 5-HT2AR). Past [work](https://www.sciencedirect.com/science/article/pii/S2211124718307551) has shown that activation of the 5-HT2AR increases neuroplasticity, thereby facilitating certain forms of learning that might help an individual overcome challenges. Critical to our proposal is that pivotal mental states can function to promote radical transformation, but that they can also function as a key step toward maladaptation, and that this could help explain the commonalities in stories of dramatic personal transformation, whether revelatory or pathological. We believe that the divergent outcomes of pivotal mental states are context dependent, and we mean context in the broadest possible sense of the word, including genetic susceptibility, prenatal development, early life experience, adolescence, young adulthood, and then of course the immediate context surrounding a specific pivotal experience. To appreciate the importance of the immediate context, consider the following two hypothetical cases. First, a monk embarks alone on a spiritual retreat in the woods with blessings from his community. He takes no food or shelter, exposing himself to the elements, and sleeps very little. The monk stays like this for 30 days with the intention of deepening his connection to God. Second, imagine a political prisoner is forced into solitary confinement and deprived of food, water and adequate clothing. The lights in his cell are kept bright and the prisoner cannot sleep well. He is humiliated and interrogated by his captors. He does not know how much time has or will pass in this state. The prisoner is forced to endure at the mercy of his captors. Both scenarios are acutely stressful and likely to trigger PiMSs. The difference lies in the social contexts in which the physiological stressors (fasting, sleep deprivation, exposure) are embedded. The monk consents to his experience, welcomes the presence of benevolent agency (eg, God), and prepares for positive change. Our prisoner does not consent, and prepares to resist the influences of what he perceives to be malevolent agents (his captors). It is more likely that our monk will have a spiritual experience, and our prisoner a transient psychotic or dissociative reaction, due to differing immediate circumstances. However, there is clearly more to these experiences than the immediate context. What if our monk embarks on his retreat with suspicious, bizarre and disorganised thoughts, exhibiting odd behaviour and a dishevelled appearance? Does the likelihood of emerging psychotic symptoms seem more likely? What if the monk has a history of psychotic experiences? Certainly, the personal history of our monk is an important element of context. We would say the same for our prisoner. If he is amenable to the worldviews of his captors, perhaps the psychological outcome for him would be different. The capability of humans to undergo radical psychological change in response to intense stress helps to make sense of cultural practices going back thousands of years – why peoples all over the world, some very isolated, use similar practices of food, sleep and sex restriction, isolation, bodily pain, intense endurance activities and temperature manipulation to induce spiritual experiences.