RELIGIOUS INTERPRETATIONS OF MENTAL DISTRESS empirical findings and clinical implications

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RELIGIOUS INTERPRETATIONS OF MENTAL DISTRESS
empirical findings and clinical implications
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Heinrich Füssli(1741 - 1825)
Nightmare
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Overview
A) Definitions B) Causal attributions C)
Psychodynamics and Spiritual Interpretations D)
Clinical Implications
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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)
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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

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Causal attribution
Locus of Control

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

WHY?
Stability

• Stable (personal discipline, effective
  protection)
• Variable (actual condition, reliability of others)

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Effects (Weiner)

• Coping or
• Hopelessness
• Cooperation and Empathy or
• Blame and Rejection

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STUDY Causal Attributions in Schizophrenia
(Angermeyer Klusmann, 1988)

• Five areas
• Psychosocial burden
• family
• Personal problems
• Biological factors
• Esoteric factors

Eur Arch Psychiatr Neurol Sci 23847-54 (1988)
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Family

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

Personal Problems

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

Eur Arch Psychiatr Neurol Sci 23847-54 (1988)
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Esoteric Problems
Angermeyer Klusmann (1988) Eur Arch Psychiatr
Neurol Sci 23847-54

• 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

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Occult Bondage
Pfeifer S. (1994) Belief in demons and exorcism.
An empirical study of 343 psychiatric patients in
Switzerland. British Journal of Medical
Psychology 67247258

• 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

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Occult Bondage
Pfeifer S. (1994) Belief in demons and exorcism.
An empirical study of 343 psychiatric patients in
Switzerland. British Journal of Medical
Psychology 67247258

• Occult Bondage 37,6 as possible cause
• Ritual of deliverance 30,3 performed
• Significant correlation with
• Diagnosis (p lt 0.01)
• Religious affiliation (p lt 0.005)

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Belief in demonic causality(in percent)
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• Pfister, S. Thiel, S. (1999). Religiosität
  und subjektive Krankheitstheorie. Eine empirische
  Untersuchung bei 53 psychiatrischen PatienInnen.
  Dissertation Medizinische Fakultät der
  Universität Bern.

Mosaic of Causal Attributions
Bio-psycho-socialModel
Conflicts fromIndividualExperience
Cultural Traditions
Alternative Body Theoriesand Diets
ReligiousConvictions
Spiritual and Magical Beliefs
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The Bio-Psycho-Social modeland Spiritualization
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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

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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

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A continuum of intensity
Empathy possible

• failure to attain a religious ideale.g. I am
  not praying enough!e.g. I feel abandoned by
  Gode.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.

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Forms of Spiritual Therapy(in the Christian
context )
) wide variations in other religious cultures

• 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.

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Contamination

• Mixture of spiritual support
• with popular superstition (especially in
  catholic and orthodox context)
• with Psychoanalytic Popular Psychology (e.g. in
  the charismatic literature)

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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)

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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?

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Results of Spiritualization
Symptom Relief
Personal freedom -- Interpersonal Relations --
Coping
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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

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Indicators of functional spirituality

• Improves self-confidence (based on confidence in
  God)
• Enables mature patterns of relating to others
• Enhances coping with lifes demands
• Preserves the awareness and the awe of the
  ultimate spiritual reality, God.

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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)