Presentation on theme: "Is there a specific religious factor in psychopathology? Aarhus 2003 Dr. Samuel Pfeifer."— Presentation transcript:
Is there a specific religious factor in psychopathology? Aarhus 2003 Dr. Samuel Pfeifer
Four models PsychiatryReligion PsychiatryReligion PsychiatryReligion PsychiatryReligion
Three examples of religious conflict 19-year old secretary, mother died when she was 15. A few weeks before our interview she had been raped. "Maybe others do feel God's presence. I don't. I have believed in him; I have read my Bible; I have prayed. I thought that he loved me and watched over me. But why didn't he hear my prayers at the bedside of my mom? Why didn't he see the anguish of my father? If there is a God, he must have been sleeping! I don't want to hear anything about God anymore. Faith is making me sick!"
Example of religious conflict year old teacher suffering from a severe anxiety disorder and a pervasive lack of energy was forced to give up his job. Hard father, caring mother (both non-religious). He was perceived as "a failure". In a time of intense crisis and anxiety during his college years he found Christ. But despite his hopes, the anxiety did not abate, rather it now expanded into the area of religion. "I see God as a huge menacing being, constantly observing all my activities and thoughts. There is no way I can hide from him. He demands devotion, holiness and being a testimony for him, but I feel like a bundle, all corded up, without arms and legs. Faith is making me sick!"
Example of religious conflict year old nurse, parents both alcoholics; with 12 she was placed with a catholic farmer's family in the country. She was a difficult and stubborn girl, and she did not receive much love either. When she was 13, her foster-father started to abuse her sexually. Plagued by feelings of guilt after each incident, he pleaded with her to forgive him. Finally, after 2 years, the foster-mother found out, and under terrible cursing, chased her from the farm. She eventually made her life, but she told me: "I don't want to hear anything about religion anymore. These pious hypocrites have destroyed my life! Religion has made me sick!"
Discussion What were the factors leading to the conclusion: Faith is making me sick!
Labels suggesting faith-induced pathology: Toxic Faith Adult Children of Evangelicals Spiritual Abuse Ecclesiogenic Neurosis
Possibly problematic aspects church doctrine ("Churches That Abuse, Enroth): legalism, authoritarian leadership, manipulation, excessive discipline and spiritual intimidation faith-related parental behavior: stifling aspects of "holiness, threatening religious consequences for wrong (sinful) behavior, denial of cultural activities (dancing, cinema), Separation from the world. dysfunctional forms of personal faith -- cognitive distortions of obedience to God, holiness, guilt and grace, obligations toward others.
Critique Tendency of (mono-)causal models of psychopathology in the religious patient Over-generalisation of the effects of faith on an individuals personality Neglecting the fact that the same dysfunctional processes can also occur in those who are not committed to religion. Often theological teachings and personality problems are not clearly kept apart. The desire to blend distorted religious content, dysfunctional religious behavior and depression and anxiety into a singular typology of "religious addiction" seems problematic.
Causality trap Sloan, Adult Children of Evangelicals describes problem situations, behaviors and verbal exchanges without any religious content as evidence for the ACE syndrome, just because they occurred in a Christian family. It may well be that a "Christian father" develops a brain tumor and exhibits difficult and even violent behavior (notably without religious overtones) due to a frontal lobe syndrome. But does this allow the conclusion of faith-induced pathology in an adult daughter?
Causality trap It is questionable to link a family's dysfunctional style to their faith alone. Some are dysfunctional despite their Christian creed; Some have become Christians because they suffered from the consequences of their dysfunctionality A third group may use their Christian beliefs and values in a dysfunctional way
"Ecclesiogenic Neurosis" (1955) Dr. Eberhard Schaetzing, gynecologist in Berlin As a professing Christian he often encountered patients who had a Christian background and who struggled with their sexual problems (masturbation, impotence, frigidity, homosexuality and sexual deviations) within the context of their Christian faith. His conclusion: restrictive Christian sexual ethics caused the problems e.g. premarital sex: You are not allowed to do it before marriage, and you are required to do it, when you are married.
Selective focus? Christian therapists who are exclusively working with Christian clients seem to be especially prone to infer specific faith-related causes for their problems, neglecting the fact that the same dysfunctional processes can also occur in those who are not committed to religion. Their models of causality are often created out of a selective group of patients combined with a selective focus in problem definition.
Diagnosis: A closer look - How is psychopathology in religious patients assessed? - What is the nature and the definition of "Neurosis"? - What is known about the causes and the development of neurotic disorders in the general population, outside the religious community? - How are negative effects of religion in neurotic patients explained? - In what way and in which personalities do religious issues cause tension? - How can religion be understood as an element in a multi- causal model of the etiology of neurotic disorders?
Value Bias hard variables are value-neutral or reflect consensually held values (e.g. descriptive diagnosis following the ICD- 10 or the DSM-IV) soft or "intrapsychic" variables sometimes reflect an implicit value bias as to what constitutes mental health. Example: A young woman who wants to wait till marriage before having sex -- is she unhealthily inhibited or guided by Biblical ethics, of strong character and therefore healthy? Or is this topic relevant to her depressive condition at all? Assessment should follow the general guidelines of applied psychopathology without prematurely implicating underlying causes, religious or otherwise.
What is neurosis? applied to a wide range of psychological problems, from short-time adjustment disorders to severe chronic depressive and anxiety disorders. With the introduction of the DSM-III the term "neurosis" has been taken out of the diagnostic vocabulary of the American clinician (Bayer & Spitzer, 1985), although it has retained its importance in a psychodynamic approach towards mental health. The development of a more operationalized and descriptive system has many advantages, but there is still a value in using the term "neurosis", albeit without its implicit causal meaning in the framework of orthodox psychoanalysis.
Causes of depression and anxiety Heredity (genetics) childhood adversity and life events (stressors) during the development of a person from childhood to adult life. Vulnerability to depression and anxiety first episode is usually following a stressful life event.
Current life conditions Causes of depression childhood stressful life events Thinking Belief systems Basic assumptions Body functions vegetative symptoms STRESS BRAIN heredity
Depression When I feel down, I have the impression that God has abandoned me. I do not feel his presence and cannot believe he is loving me any more. But I long for him and for his intervention in my difficult situation. (a 45 year old woman with severe depression) What are the parallels in non-religious individuals?
Is depression more common in religous individuals? The available data and clinical experience do not allow for the assumption that neurotic disorders (depression, anxiety, OCD etc.) are more common in any subcultural group, including religious subgroups. However, it might be that more melancholic and highly sensitive individuals tend more towards religion as it answers basic questions of life Jesus has called the weary and the burdened: Come unto me, all ye that labour and are heavy laden, and I will give you rest (Matthew 11:28)
Depression and religious life Depression overshadows not only life in general, but also religious life, which is of special significance to the religious person. Depression is experienced as –Loss of faith and rejection by God. –Punishment for perceived sins / misdeeds –Darkening of spiritual life For the religious patient, this subjective experience of abandonment by God weighs heavier than all other depression-related deficits and losses. Recovery from depression includes religious life
Anxiety Disorders / Neurotic Disorders Anxiety leads to conflict-prone functioning Conflicts between EGO, ID, and SUPER-EGO Super-Ego (Ideal Ego) can be formed in a negative way by religion. Anxiety is the driving force. Anxious conflicts with persons of authority (parents, teachers, priest, rabbi etc.) Moral conflict enhanced through religion. Compulsions and rituals can be superimposed by religious content and motivation.
Explaining negative findings Neurotic patients tend to be more anxious, conflict-prone, and scrupulous, and less able to tolerate ambiguity more struggles with issues of meaning. Limiting aspects of religion (moral directions and prohibitions) as well as difficult passages of the Bible are experienced as a factor increasing inner conflict in the search of meaning. Patients suffering from minor neurotic symptoms (personality problems) seem to struggle more with religious faith, some of them indicating a negative impact on their well-being.
Social support through religion Patients with severe neurotic syndromes such as chronic anxiety syndromes or long-standing depression seem to find support and understanding through their faith. although they are often handicapped in their desire to actively take part in religious activities. "Our study confirmed the observation made in individual counseling and psychotherapy, that neurosis disturbs religious life, whereas positive religiosity contributes towards healing. (Hark 1984)
Assessment a)Psychopathology and severity of disorder b)Life events and coping abilities; stress and strain in general c)Personal religious life of the client (extrinsic and intrinsic factors) d)Social support associated with religious factors (e.g. church attendance, counseling opportunities) e)Problematic aspects of the patient's Christian subculture (e.g. special teachings of the church, high social control) f)Interpersonal relations with religious people (often patients do not make a clear distinction between the personal religiosity of a person and his or her behavior that is not necessarily linked with religion) g)Intrapsychic attributional style and belief systems.
Results of our own study 1) No significant correlation between religiosity and neuroticism, neither in the patient nor in the control group. 2) General life satisfaction is negatively correlated with neuroticism but positively with religiosity in the patient group. Religion as important factor in coping with depression and anxiety. 3) Anxiety concerning sexuality, super-ego conflicts (conscience) and childhood religious teaching is primarily associated with neuroticism and not with religiosity. 4) Religious individuals (control group) showed a very critical stance against psychotherapy. However, in the patient group this critical view was reduced, probably as patients had positive experiences with the supportive aspects of therapy. Pfeifer S. & Waelty U. (1999): Anxiety, depression and religiosity – a controlled study. Mental Health, Religion & Culture 2:35-45.
Differences between groups Individuals who are not struggling with the existential suffering of depression and anxiety, tend to experience religion in a different and potentially more conflictuous way. Mentally healthy younger subjects (mostly students) experience the conflict between religious values and cultural limitations in opposition to their personal wishes, needs and drives, and they often tend to blame their inner conflicts on those limitations that might be represented by religious parents or authorities. Patients with mental and physical illness derive comfort, meaning and hope from religion, helping them to cope with their limitations.
Areas of tension Needs Drives Emotions External or internalized, general, familial or religious ideals I D E A L S General life situation Social network Physical/emotional constitution R E A L I T Y External Framework Inner Experience (Sub)cultural rules und limitations
Seven sources of conflict 1. General tendency towards conflictuous functioning 2. Conflicts involving family loyalty vs. perceived trauma or injustice 3. Conflicts between ideals and reality 4. A basic tendency toward increased anxiety 5. Feelings of guilt as part of the human condition 6. Dependence on God vs. taking personal responsibility 7. Human legalism vs. Christian freedom
Conclusions Studies do not support a correlation of neuroticism and faith. Religious belief systems can serve as vehicle for the expression of neurotic tendencies and needs. (Meissner, 1991). It is not faith or the church in general that causes psychopathology but the way in which a person deals with the teachings of his or her church or religion. Not all psychopathology observed in a religious individual, even if presented in religious vocabulary or ritual, is faith-induced or "ecclesiogenic". Feelings of guilt, for example, seem to be a ubiquitous phenomenon in religious and non-religious individuals suffering from major depression. Meissner W.W. (1991). The phenomenology of religious psychopathology. Bulletin of the Menninger Clinic 55:281– 298.
Conclusions Even churches that would be regarded as narrow or dysfunctional by average standards, do not necessarily produce psychopathology in their followers. Rather, a tight belief system and forms of communitarian control can have a stabilizing effect as long as they are not challenged by conflicting drives, needs or experiences of the individual. It is at this point that the emotional stability of a person is subjected to the test of his or her conflict resolution potential. Individual freedom may cause a person to rebel against church teaching and to leave a group.
Ecclesiomorphous Neurosis Psychopathology may be forming, deforming and inhibiting a healthy development of religiosity. It would, therefore seem more justified to call religious psychopathology "ecclesiomorphous" than "ecclesiogenic". Faith or church teachings may shape the problems of an individual, but not as the only factor. Narrow religiosity may be detrimental for the highly sensitive, causing distorted images of God and conflictuous interpersonal relationships. Strong personalities will either adjust to the system or break up, looking for a different style of religion that fits them better.
Implications for counseling Interpretative disentanglement: "to separate the intrapsychic conflict from its 'religious' defense system." (Moshe H. Spero) As religious patients often suspect the therapist to devalue or even attack their faith, this will strengthen the therapeutic alliance. Differentiate: functional and dysfunctional attributions within the religious framework of the client (Spilka, 1989). Religion is assumed to be functional, if it meets the client's needs of meaning, control, and esteem.