Psychiatry and Religion

Context, Consensus and Controversies

Dinesh Bhugra

• Publisher: Routledge
• Year: 2018
• ISBN:
  9780429955303
• Edition: 1
• Topic: Medicine
• Subtopic: Internal Medicine & Diagnosis

Psychiatry and Religion: Context, Consensus and Controversies works to eradicate the distinction between spiritual and psychological welfare and promote greater understanding of the relationship between the two.

This book brings together chapters from fifteen mental health practitioners and pastoral workers to explore what their different philosophies have to offer the individuals in their care. As well as all the major world religions, the text also provides detailed information about newer religions and the significance of their belief systems for mental health management. The book examines the positive and negative effects that strict moral codes and religious rituals can produce and shows how awareness of these effects is crucial to the treatment of these patients.

This classic edition of Psychiatry and Religion, with a new introduction from Dinesh Bhugra, will continue to provide an important resource to practicing and training psychiatrists.

Part I
Introduction and history

Chapter 1
Religion and mental health

Dinesh Bhugra

Man’s faith in religion is as old as humankind itself. The need for a greater force that could be seen as immortal developed as man struggled to survive physiologically and then psychologically and started to make sense of traumatic and not so traumatic experiences. As a result, all illness in the beginning was seen as a responsibility of priests and shamans. They would not only provide descriptions and enable the individual to make sense of this experience but also help the individual and his family to manage the illness in different ways. Priests and physicians were often the same individuals in different civilisations across the world. Physicians did not appear to have any confusion about their dual functioning.

In different medical systems, whether Graeco-Roman or Hindu, psychiatric illnesses were often seen to be due to different types of possession. Management involved dietary restrictions, the use of herbs and prayers (see Bhugra, 1992, for a discussion of Hindu systems). In classical Greece and Rome, with the development of more secular states, a split appeared to have occurred between the profession of priest and physician (Ball, 1985). However, the overlap did continue for a time and physicians continued to work in temples within a single religious framework. Furthermore, a change developed with limited use of religious factors, and outstanding, secular physicians emerged.

The fall of the Roman Empire and the growth of the Catholic Church led to the dual role of priest–physician, with the church becoming a repository for all knowledge. The Galenic principles held a monopoly on medical ideas for a considerable length of time, which meant that the development of medicine as a separate individual system was sluggish. Ball (1985) argues that the chaotic political situation and problems of the Church also contributed to this sense of a lack of innovation or exploration.

The secularisation of medicine has been linked with the parallel development of other professions. Ideas of contagion and possession continued to plague aetiological discourses of psychiatric illness. Ball (1985) blames the resurgence of possession of phobic attitudes towards women along with sexual anxieties and morbid hostility. The persecution of witches was a kind of mass psychosis where charity and compassion vanished and social class, intelligence and education counted for nothing. Until the fifteenth century, medicine and the priesthood could work together but several reasons, chiefly secularisation, led to the two professions going their separate ways. The development of pathology and the discovery of bacterium led to the ‘scientification’ of medicine and left psychiatry in the realm of philosophy. The growth of psychiatric asylums and the isolation of the mentally ill from society were a sign of the quarantine where a possibly ‘contagious’ individual was shunted away and a new class of ‘carers/warders’ emerged. This has led some authors, notably Szasz, to argue that psychiatrists emerged as the new priests, dealing with confessions and giving absolutions. Taking the imagery further, one could argue that the development of pills added to the communion scenario where the patient is asked to put the pills on their tongue and a small tumbler with perhaps about 20 mls of water is used as ‘communion wine’.

Increasingly, mental health practitioners are assuming the three functions traditionally recognised as being in the domain of religion. First, an explanation of the unknown. Second, ritual and social function, and, third, the definition of values (Nelson and Fuller Torrey, 1973). When priests interpreted earthquakes, epidemics and droughts, they were focusing on the explanations of the unknown, and this explanation was responsible for reassuring the masses that things were under control. With the advent of scientific inventions and theories, these mysteries of nature have largely been explained. Whereas formerly, the mentally ill were seen by the priests as possessed by spirits, demons and devils, their odd behaviour was subsequently explained away by psychiatry as ‘illness of the mind’.

The competition between the priest and the psychiatrist for the mind and the soul of the individual continued. Psychiatrists were the father figures who gave sage advice and occasionally controlled the patient without appearing to do so. The strength of psychiatry is not as unlimited as that of religions, or rituals. As Crenshaw (1963) comments, there are enough similarities between medicine and religion partly because both serve moral and humanitarian purposes. Science without religion can be destructive, and religion without science can become superstition according to Feibleman (1963). He then goes on to argue that, since the problems of today do not draw a sharp demarcation between what is medical and social or religious, the treatment should cover cooperation of all these disciplines. Although the training, expertise and views of physicians and priests may be different, their sensitivity to various factors affecting the individual in psychic or spiritual pain brings them together on the same level. Neither of the two is, nor should be, morally or scientifically superior. Cooperation between doctor and clergyman is essential in ministering to the total needs of the person (Sholin, 1962). There is, of course, an ongoing debate to ascertain whether mental health is a state leading towards the goal of religious growth, or whether religion is only one part of a mentally healthy person whose goal may be biological or social adaptation (see Sutherland, 1964). The raison d’être of the psychiatrist is to alleviate suffering of the mentally ill and support, treat and manage such an individual along with managing members of the family and the community that such an individual affects. The Church and the priest, on the other hand, also have to provide a therapeutic environment, intercede for the sick, administer the sacrament, help man prepare for death, and in general inculcate the somewhat personal faith that upholds one in difficult times (Feilding, 1964). Thus, it would appear that, as the psychiatrist prepares the individual with an array of coping strategies, the priest can do exactly the same. The process of psychic immunisation can thus be approached in two ways, which do not have to be in competition with each other for the individual’s soul.

The interaction between religion and psychiatry can be at several levels. Psychiatric patients may have religious beliefs that may need to be taken into consideration when planning any management. They may also seek help from religion and religious healers, using different models of distress. The interaction of the therapist’s religious views and the patient’s religious views may cause conflict. The patient’s religious values may affect acceptance of psychotherapy and other treatments. Furthermore, symptoms of one kind may be understood completely differently by someone else. Possession states are a classic example of this. In a recently completed study, Campion and Bhugra (1994) found that 75 per cent of their psychiatric patients had consulted religious healers about possession and similar findings have been reported from other parts of India. On the other hand, while looking at possession syndromes, Teja et al. (1970) and Varma et al. (1970) reported that these conditions were seen in women, and were largely hysterical in origin. Spirit possession remains a ‘culturally sanctioned, heavily institutionalized and symbolically invested means of expression in action for various egodys-tonic impulses and thoughts’ (Kiev, 1961). Life events have been linked to the onset of these states. Their management has to include clear understanding of the cultural background and the explanations of the experience.

Morris (1987) argues that, with the growth of materialistic interpretations of social reality, the general interest in comparative religions emerged. The phenomenological approach of religion made its appearance. Phenomenology is (its) instrument of hearing, recollection, restoration, and of meaning, as are the underlying meanings of religion. Jung (1938) went so far as to suggest that religion is not only a sociological or historical phenomenon but that it also has a profound psychological significance. He defines religion as a numinous experience that seizes and controls the human subject (Morris, 1987). The Jungian approach too is phenomenological. Although Jung (1938) argues that the phenomena are true thoughts – these can be understood by relating these to ‘collective unconscious’ – a psychic reality shared by all humans.

Religion, its psychological aspects, and its practice all affect mental health. Beliefs about mental illness and its treatment may be closely tied to beliefs about sin and suffering and views that mental illnesses may result from some kind of separation from the divine, or even possession, by evil (Loewenthal, 1995). Psychiatry may be mistrusted and religious healers may use modified versions of cognitive–behavioural approaches.

Loewenthal (1995) suggests that good mental health may go with religiously encouraged social support, religious ideas, feelings, experiences and orientation. The continuing collaboration and consensus between religion and psychiatry are essential for the well-being of patients, but it is also important to be aware of the conflict between two disciplines.

References

Ball, J. R. (1985) ‘Psychiatry/medicine/religion – union, association – symbiosis?’, paper presented at Psychiatry and Religion Conference, Melbourne, Australia, 27–28 June 1985.

Bhugra, D. (1992) ‘Psychiatry in ancient Indian texts: a review’, History of Psychiatry 3: 167 – 86.

Campion, J. and Bhugra, D. (1994) ‘Religions healing in south India’, paper presented at World Association of Social Psychiatry Meeting (June), Hamburg.

Crenshaw, C. P. (1963) ‘Medicine and religion’, Journal of the Mississippi State Medical Association 4: 383 – 5.

Feibleman, J. B. (1963) ‘Men of God and Science’, Journal of the Mississippi State Medical Association 15: 29 – 39.

Feilding, C. R. (1964) ‘Some misunderstandings in spiritual healing’, Pastoral Psychology 15 (143): 29–39.

Jung, C. (1938) Psychology and Religion, New Haven: Yale University Press.

Kiev, A. (1961) ‘Spirit possession in Haiti’, American Journal of Psychiatry 118: 133.

Loewenthal, K. (1995) Mental Health and Religion, London: Chapman & Hall.

Morris, B. (1987) Anthropological Studies of Religion, Cambridge: Cambridge University Press.

Nelson, S. H. and Torrey, E. F. (1973) ‘The religious functions of psychiatry’, American Journal of Orthopsychiatry 43: 362–7.

Sholin, P. D. (1962) ‘Medical–religious liaison’, Arizona Medicine 19: 31 A–34A. Sutherland, R. L. (1964) ‘Therapeutic goals and ideals of health’, Journal of Religion and Health 3: 119–35.

Teja, J. S., Khanna, B. C. and Subrahmanyam, T. S. (1970) ‘“Possession states” in Indian patients’, Indian Journal of Psychiatry 12: 71–87.

Varma, L. P., Srivasrva, D. K. and Sahay, R. N. (1970) ‘Possession syndrome’, Indian Journal of Psychiatry 12: 58–70.

Chapter 2
Religion and psychiatry

Extending the limits of tolerance

K. W. M. Fulford

Introduction

Religion and psychiatry occupy the same country, a landscape of meaning, significance, guilt, belief, values, visions, suffering and healing. This indeed is the world of the psyche, itself interchangeably soul or mind (Bettelheim, 1982). Yet the relationship between the two disciplines, which in the past has ranged from mutual suspicion to open hostility (Lipsedge, this volume), is even in today’s more liberal times hardly more than one of tolerant indifference. Pastoral counselling has brought the two sides closer (Sutherland, this volume), but the ‘religiosity gap’, in Lukoff et al.’s (1992) apt phrase, remains: psychiatric history taking, as John Cox (this volume) notes, although covering many of the most intimate details of a patient’s life, normally does not include enquiries about religious beliefs, notwithstanding the fact that these are likely to be important for up to three-quarters of patients. Conversely, while priests may nowadays be willing to engage the help of psychiatrists, there is little in the way of formal guidance on where spiritual or psychological interventions are appropriate, with even those closest to psychiatry acknowledging significant tensions (Foskett, this volume).

So far as psychiatry is concerned, there are a number of prejudices standing in the way of a closer relationship with religion. Many of these are dealt with in this book. It is said that religions attract the mentally unstable–but the mental health of the followers even of new religious sects is if anything above rather than below average (Barker, this volume). It is said that religions may have their origins in madness (Littlewood, this volume)–but madness can also be a source of creativity in art and science (Storr, 1972). It is said that religious experience is phenomenologically similar to psychopathology (visions are like hallucinations, for example)–but this is to confuse form and content: normal and pathological varieties of religious experience stand to be differentiated by essentially the same criteria as normal and pathological varieties of non-religious experience (Jackson and Fulford, forthcoming). It is said that paranormal experiences are a product of definable patterns of brain functioning–but as Fenwick (this volume) points out, paranormal experiences are no less invalidated by their grounding in neuro-physiology than are normal experiences. It is said that religions are harmful, that they induce guilt, for example (Nayani and Bhugra, this volume)–but religion, no more than psychiatry, is not harmful as such. It is also said, conversely, that religious belief is ineffective–but there is empirical evidence that it is not, improved ‘coping’, for instance, being correlated with religious faith in a variety of adverse situations (Griffith and Bility, this volume; Koenig et al., 1992). The effectiveness of religion in this respect is no proof of its metaphysical claims (a delusion could be just as effective). Also, it is unclear from published work whether it is specifically religious faith which is required (there have been no double blind faith trials). But this work none the less does dispose of the question of efficacy as such.

There are, though, deeper reasons for the separation between psychiatry and religion. These have to do with the identification of psychiatry with what is sometimes called the ‘medical’ model (Macklin, 1973). According to this model, medicine is, essentially, a science. Psychiatry, therefore, in identifying with the medical model, has come to think of itself as a branch of science, and hence, by common implication, as separate from religion both epistemologically and ethically. T...

Table of contents

• Cover
• Title
• Copyright
• Dedication
• Contents
• List of contributors
• Preface for the Classic Edition: Psychiatry and Religion
• PART I Introduction and history
• PART II Religions: East and West
• PART III Psychopathology, psychiatry and religion
• Index