Is there a specific religious factor in psychopathology?

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Is there a specific religious factor in
psychopathology?
Dr. Samuel Pfeifer

• Aarhus 2003

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Four models
Psychiatry
Religion
Psychiatry
Religion
Psychiatry
Religion
Psychiatry
Religion
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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!"

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Example of religious conflict - 2

• 28-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!"

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Example of religious conflict - 3

• 36-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!"

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Discussion

• What were the factors leading to the conclusion
• Faith is making me sick!

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Labels

• suggesting faith-induced pathology
• Toxic Faith
• Adult Children of Evangelicals
• Spiritual Abuse
• Ecclesiogenic Neurosis

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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.

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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.

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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?

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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

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"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.

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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.

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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?

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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.

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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.

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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.

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Current life conditions
childhood stressful life events
Causes of depression
Thinking Belief systems Basic assumptions
STRESS
BRAIN heredity
Body functions vegetative symptoms
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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?

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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 1128)

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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

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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.

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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.

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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)

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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.

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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 235-45.
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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.

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Areas of tension
I D E A L S
External or internalized, general, familial or
religious ideals
InnerExperience
Needs Drives Emotions
(Sub)culturalrules und limitations
R E A L I T Y
General life situation Social network Physical/emo
tional constitution
ExternalFramework
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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

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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 55281298.
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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.

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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.

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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.

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