RELIGIOUS INTERPRETATIONS OF MENTAL DISTRESS empirical findings and clinical implications
Jan 03, 2016
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“)