RELIGIOUS INTERPRETATIONS

OF MENTAL DISTRESS

empirical findings and clinical implications

Heinrich Füssli(1741 - 1825)

Nightmare

Overview

A) DefinitionsB) Causal attributionsC) Psychodynamics and Spiritual

InterpretationsD) Clinical Implications

Spirituality

an attitude directed towards the intangibly transcendental (God). For the spiritual person this is the source and the goal of his or her life, fundamentally influencing his or her way of living, responsibility and ethics.

(modified after Scharfetter 1999)

Spiritualization

incidents and experiences are interpreted in a religious context

The interpretation relates to causality and change (therapy) of problems.

Subjective experience is perceived in a comprehensive spiritual context

WH

Y?W

HY

?Causal attribution

Locus of Control

• Internal (spiritual life, personal effort)• External (affliction, oppression, curse)

Stability• Stable (personal discipline, effective

protection)• Variable (actual condition, reliability of

others)

Effects (Weiner)

• Coping or

• Hopelessness

• Cooperation and Empathy or

• Blame and Rejection

STUDY: Causal Attributions in Schizophrenia (Angermeyer & Klusmann, 1988)

Five areas:

• Psychosocial burden

• family

• Personal problems

• Biological factors

• „Esoteric“ factors

Eur Arch Psychiatr Neurol Sci 238:47-54 (1988)

Family Broken home lack of parental love father was too strict parents had too high expectations overprotective mother hostile-rejective attitude of parents

evading daily problems lack of will power alcohol and drugs too intelligent too ambitious general failure

Personal Problems

Eur Arch Psychiatr Neurol Sci 238:47-54 (1988)

«Esoteric Problems» Lack of vitamins Environmental pollution Possession by evil spirits Detrimental radiation Divine punishment Unfavorable Horoscope

Open Question 1,0 % Possible Cause 54,9 % (Very) Probable Cause 22,3 %

Evil spirits: Possible Cause 10,9 % (Very) Probable Cause 3,1 %

Angermeyer & Klusmann (1988)

Eur Arch Psychiatr Neurol Sci 238:47-54

“Occult Bondage”

343 Patients (114 m, 229 f) all were religious mainline church (cath, ref.) 139 Trad. free churches (TFC) 164 Char. free churches (CFC) 40

Schizophrenia 60 Depression 87 Anxiety Disorders 56 Personality Disorder 65 Adjustment Disorder 75

Pfeifer S. (1994)

Belief in demons and exorcism. An empirical study of 343 psychiatric patients in Switzerland. British Journal of Medical Psychology 67:247–258

“Occult Bondage”

Occult Bondage 37,6 %

as possible cause

Ritual of deliverance 30,3 %

performed

Significant correlation with Diagnosis (p < 0.01) Religious affiliation (p < 0.005)

Pfeifer S. (1994)

Belief in demons and exorcism. An empirical study of 343 psychiatric patients in Switzerland. British Journal of Medical Psychology 67:247–258

Belief in demonic causality

(in percent)

0

10

20

30

40

50

60

%

PSY

MO

OD

AN

X

PE

RS

AD

J

DemonicCausality

Rituals ofDeliverance

Nondelusional Disorders

Bio-psycho-socialModel

Mosaic of Causal Attributions

Conflicts fromIndividual

Experience Cultural Traditions

Alternative Body Theories

and DietsReligious

Convictions

Spiritual and Magical Beliefs

Pfister, S. & Thiel, S. (1999). Religiosität und subjektive Krankheitstheorie. Eine empirische Untersuchung bei 53 psychiatrischen PatienInnen. Dissertation Medizinische Fakultät der Universität Bern.

Spiritualinterpretation

Spiritualinterpretation

The Bio-Psycho-Social modeland Spiritualization

Forms of Spiritualization

Spiritual forms of intrapsychic communication: „I talk to God; God talks to me.“

Spiritual interpretation of natural desires and unadjusted behavior

Spiritual interpretation of distress (mentally and somatic); i.e. causal attribution without delusional aspects

Religious delusions

Functions of Spiritualization

Interpretation (Causal attribution)e.g. „oppression“ as a reason for sleep disorders

Defense mechanismse.g. prayer meeting instead of behavioral change --- e.g. spiritual justification of wishful thinking

Copinge.g. prophetic words of encouragement / subjective relief through “rebuking spirits”

A continuum of intensity

Empathy possible failure to attain a religious ideal:

e.g. „I am not praying enough!“e.g. „I feel abandoned by God“e.g. „I am damaging my Karma!“

Extreme demon of pride, lust etc. (unacceptable drives and

behaviors are attributed to demons) Demons as cause of sleep disorders, nightmares,

obsessional thoughts etc.

Forms of Spiritual Therapy(in the Christian context *)

Traditional and common: Prayer, Confession, Communion / Eucharist, Blessing through the Laying of Hands.

Transitional Objects and Protection against Evil: Pictures of Saints, Amulets, Holy Cross, protecting objects etc.

Religious Activities: Pilgrimage, participation in religious festivals, religious exercises, visiting special healers.

Forms of Counseling: „Imagery“, Prophecy, Deliverance, „Rebuking evil forces“ (self or others), Exorcism.

*) wide variations

in other religious cultures

Contamination

Mixture of spiritual support

with popular superstition (especially in catholic and orthodox context)

with Psychoanalytic Popular Psychology (e.g. in the charismatic literature)

Dealing with Spiritualization

1. Assessment “Approaching the unfamiliar with respect

helps us to gain understanding”

Explanatory Model or secondary phenomenon? Delusion or Subculture? Psychodynamics: Positive Coping or

Dysfunctional Defense Mechanism? Which therapeutic consequences result from the

religious interpretation of the problem? (traditionally Christian, magical, dramatic)

Dealing with Spiritualization - 2

2. Evaluation

In cooperation with the client / patient Different forms of “religious style” Personal integrity of the therapist Theological evaluation is not

primary concern of therapy

IMPORTANT QUESTION: What is the influence of religious interpretations

on symptom relief, coping with life events and psychosocial development of the patient / client?

Sym

pto

m R

elie

f

Personal freedom -- Interpersonal Relations -- Coping

Outcomenegative

Outcomepositive

Results of Spiritualization

3. Therapeutic strategies

Develop a supportive therapeutic setting in collaboration with the patient

Spirituality as part of a comprehensive model of illness and coping.

Cooperation with counselor / pastor (if possible) Psycho-education: Religious life can be affected

by mental illness (e.g. depression) Image: out-of-tune piano Determine functional and dysfunctional aspects

of spiritual interpretation „Agree to disagree“

Indicators of functional spirituality

Improves self-confidence (based on confidence in God)

Enables mature patterns of relating to others

Enhances coping with life’s demands

Preserves the awareness and the awe of the ultimate spiritual reality, God.

Emic / Etic Conceptin Transcultural Psychiatry

derived from linguistic concepts

"emic" describes specific intra-cultural perspectives of social behavior and individual distress (e.g. "kufungisisa" = thinking too much, Zimbabwe)

"Etic" describes universal, transcultural concepts (e.g. „Depression“)