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According to Webster’s New World Dictionary, psychiatry is deﬁned as ‘the branch of medicine concerned with the study, treatment, and prevention of disorders of the mind, including psychoses and neuroses, emotional maladjustments, etc.’ (p. 1147). In contrast, psychology is deﬁned as ‘the science dealing with the mind and emotional processes’ and ‘the sum of the actions, traits, attitudes, thoughts, mental states, etc. of a person or group’ (p. 1147). From these deﬁnitions, it is clear that the realms of both these ﬁelds have considerable overlap in the questions they address about human behavior, and in many cases, knowledge that is garnered in one ﬁeld is frequently shared and absorbed into the ensuing theoretical development of the other discipline. Hence, for the purposes of this research paper, which addresses the theoretical underpinnings rather than the actual practices of each profession, the ideas from psychology and psychiatry will be used interchangeably, except where otherwise denoted as speciﬁc to their ﬁeld.
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2. The Question
The question about the need for relationship between psychiatry and religion has emerged as a predominantly twentieth-century concern. The movement to inter-relate the two disciplines evolved as participants who believed strongly in the importance of religion in people’s lives were concerned by the lack of religious involvement in modern medicine’s approach to healing. Many adherents to this movement to intertwine the two ﬁelds reject the dualism of body and soul, believing instead that mind and body are inter-related and true healing is best realized when a holistic biopsycho-social-spiritual approach is utilized.
As such, in recent years a growing number of psychiatrists and other physicians, psychologists, clergy, theologians, and religious philosophers who have not been satisﬁed with mainstream traditional and institutionalized eﬀorts at healing have sought to combine the best of modern psychiatric medicine with religion/spirituality to develop an alternate method of healing to relieve mental and emotional distress. These practitioners are joined by religiously committed persons who are seeking treatment. At the same time, a number of traditionalists, both psychiatrists and clergy, are critical of incorporating religion and psychiatry into a single treatment mode. They raise the question whether religion and psychiatry should both be considered in aiding individuals, advocating rather that the two remain separate in their approaches to problem solving and actual practice.
3. Deﬁning The Problem
In his book The Structure of Scientiﬁc Revolutions (1970), Thomas Kuhn deﬁnes a paradigm as a nascent model for looking at the universe in a speciﬁc manner, and answering questions from within that particular framework’s perspective. Furthermore, according to Kuhn, for growth to occur in science and/or ideology, rather than working toward consensus between paradigms, the premise for philosophical development should be that growth comes from complementary coexistence between paradigms, as each domain converses with the other within its speciﬁc applications.
It is arguable that religion and science are two diﬀerent paradigms for understanding the universe, and humanity’s role within it. The diﬃcult and sometimes troublesome relationship between these two ﬁelds emerges in part as a result of the two diﬀerent paradigmatic approaches to answering the same basic questions about humankind. Such questions include, but are not limited to these: what are the fundamental components of human beings? What causes illness? What helps keep individuals healthy?
Furthermore, the more recent developments of specialized disciplines such as psychiatry and psychology in the nineteenth and twentieth centuries also raised alternate perspectives on answering the questions to humanity’s interpersonal troubles— answers diﬀerent from those raised in their antecedent jurisdictions of religion and philosophy (Rechberger 1998).
The question raised is: do these alternate paradigms have communal merit in helping individuals lead happier and healthier lives, or should the division between the two ﬁelds of mental health and religion remain distinctly separate?
Since the 1700s, the period known as the Enlightenment, religion and science have experienced increasing diﬀerentiation and tension. Prior to this point in history, religion and science were interchangeable ideologies. In fact, as Murphy (1997) states, ‘In the Middle Ages, theology was not only a science but also the queen of the sciences’ (p. 155, italics in the original). Indeed, under the church’s rule, when sixteenth and seventeenth century scientists such as Giordano Bruno, Tycho Brahe, and Galileo Gallilei oﬀered data for understanding the universe diﬀerent from the understood Biblical theology of the day, they were declared heretics, punished, and a few were even executed. However, the mathematical evidence presented by scientists such as Copernicus and Galileo was repeatedly validated and supported despite dispute from the church. Hence, for many, science became the primary source of information about the universe and its inhabitants. Furthermore, due to the infamy surrounding the church’s declaration of heresy upon scientists such as Bruno and Galileo, religion was at least somewhat discredited as a viable source of answers to humanity’s problems (Rechberger 1998).
Nevertheless, it is impossible to discount the eﬀect religion has had on humanity throughout history. From the earliest times, religious beliefs and rituals have been a central component of the lives of humankind, frequently providing the structural framework from which societal, cultural, and moral norms developed. In the Western hemisphere, the primary religions of Judaism, Christianity, and Islam have as a core belief a universal God who acts as creator, sustainer, and protector. In the Eastern hemisphere, the predominant religions of Buddhism and Hinduism depict God as less actively involved in the day-to-day workings of humanity; nevertheless, almost all world religions have similar beliefs and practices in a supreme being or group of beings that are in some way interested in humanity’s development. Furthermore, throughout most of known history, it was the religious leaders—whether priest or shaman—who were considered healers (a tradition which continues today in less Westernized cultures). Indeed, prior to the 1800s, what scant treatment there was for mental illness was provided by the church. Unfortunately, one of the negative outcomes of the overlapping domains of religion and medicine was evidenced in the development of concepts such as demon possession and illness as a result of, if not punishment for, an individual’s misdeeds. These explanations were broadly accepted as disease etiology in most Western nations well into the nineteenth century.
In contrast, however, one of the potential beneﬁts of having the same person exercising both religious and healing functions allows for the possibility of positive coordination and integration between the two domains. Reformers such as Philippe Pinel (1745– 1826) in France began to see the mentally ill as sick rather than sinful or wicked. Another reformer, William Tuke (1732–1822), opened the York Retreat in England in 1792, and other pious Quakers were early leaders in the care and treatment of the mentally ill.
Beginning in the latter part of the eighteenth century medicine was developing as an independent science dealing with the maintenance of health and the prevention, alleviation, and cure of disease. This was a clear departure from the intertwining of religious practice and medical intervention that had existed from earliest human history. Until this time it was the church that regulated medical practice by the very fact that doctors needed license from the bishop to practice medicine (Foskett, 1996).
Despite this emerging demarcation between religion and medicine as separate disciplines, some religious leaders continued an interest in maintaining the overlapping interests of religion and medical practice. This was particularly notable in the United States during the mid-nineteenth century, during a zeitgeist that advanced an increasing emphasis on the mind– body relationship. A strong—albeit minority—view of the positive beneﬁts of intermingling religious belief and medicine began to develop. Many wrote about it, including Mary Baker Eddy (1821–1910), the founder of Christian Science, and Ellen G. White (1827–1915), one of the founders of the Seventh-day Adventist church.
Eddy wrote, ‘If we understood the control of mind over body, we should put no faith in material means. Science not only reveals the origin of all disease as mental, but it also declares that all disease is cured by divine mind’ (1875, p. 169). Nearly 100 years prior to psychiatry’s recognition of the inﬂuence of brain chemistry on disease, Ellen G. White wrote that ‘the mind aﬀects health to a far greater degree than many realize and many diseases from which men suﬀer are the result of anxiety, remorse, guilt and mental depression’ (1905, p. 241). These religious writers preceded Herbert Benson and Bernie S. Siegel’s twentieth century emphasis on the mind–body connection.
5. The Emergence Of Mental Health Disciplines
While the trend of separating science and religion was evidencing itself by the growing separation between medical practice and religious ideology, the emergence of psychology and psychiatry as new scientiﬁc disciplines also demonstrated a distinct separation from their religious and philosophical roots. Examining the writings of the earliest primogenitors within these newly emerging disciplines clearly reveals the tension between science and religion as they developed diﬀering paradigms to resolve questions about what the components of ‘good’ mental health comprise.
In the United States, it was pre-Freudian William James (1842–1910) who was at the forefront development of the profession of psychology, along with his Harvard colleague Hugo Munsterberg. Interestingly, James refused to treat physiology, psychology, and philosophy as distinct and separate disciplines. Furthermore, his endeavor to maintain a balanced position between these domains is clearly reﬂected in his 1902 book, The Varieties of Religious Experience, which addresses the questions related to religion as it interacts with mental health. As James wrote:
—–The problem I have set myself is a hard one: ﬁrst, to defend … ‘experience’ against ‘philosophy’ as being the real backbone of the world’s religious life … and second, to make the hearer or reader believe what I myself invincibly do believe, that although all the special manifestations of religion may have been absurd (I mean its creeds and theories) yet the life of it as a whole is mankind’s most important function’ (1902, p. xix, italics in the original).
Although James acknowledged religion as a social and cultural phenomenon, he was interested primarily in the individual response of a person to religious experience. More speciﬁcally, he expressed fascination with the conversion process, the moral and mystical elements of the religious life, and the interaction between religious belief and illness—particularly healthy vs. pathological mental health responses to religion. James espoused a favorable view of religion, based on his perception that ‘healthy-minded’ individuals respond positively to religious beliefs and are the happier for it. Yet this positive view of religion in the scientiﬁc community would shortly be denounced by the writings of psychiatrist Sigmund Freud (1856–1939).
The ﬁeld of psychiatry, although historically a part of medicine, was marginalized as a profession until the appearance of Freud’s writings (Alexander and Selesnick 1966). His ideas about the dynamic structure of personality and the beneﬁts of psychoanalysis Revolutionized the ﬁeld of psychiatry. In his radical new perspectives about the inner processes of individuals, Freud assessed humanity’s desire for God and the function of religion in everyday life as evidence of psychopathology.
In his book The Future of an Illusion, Freud opined that faith is based on the illusion that an idealized father (God) can replace the lost, real father who has proven fallible to the child and is no longer a comfort and source of security. Freud’s solution to his depiction of this ‘infantile’ response on the part of individuals to create a ‘mythological’ God was for them to develop a realistic view of the reality that there is no God: ‘Man cannot remain a child forever; he must venture at last into the hostile world. This may be called ‘education to reality’ (1934, p. 86, italics in the original).
Although the idea that God is a projected illusion did not originate with Freud, his declaration that religious belief is an infantile projective fantasy cast a long shadow over subsequent practitioners’ theories about the relationship between religious belief and mental health. This perspective contributed to many decades in which psychiatry generally viewed religious belief with skepticism and antipathy. What little credit Freud gave to religion for ‘restraining the asocial instincts’ of humankind (p. 65), he reiterated that it had not done so successfully. Instead, Freud advocated that humans should place their trust in the rigors of the scientiﬁc method, out of which discoveries of the truth about the nature of individuals and humanity’s relationship to the world around it would emerge.
This review of the origins of psychology and psychiatry illuminates the tension between the positivist assumption—that the scientiﬁc method and rigors of research would eventually answer all of humanity’s questions about physical and emotional well being—and the alternate view that religious belief is a constructive addition to solving mental health concerns. Although some theorists continued to typify any religious belief as evidence of naivete or pathology, others dissented from Freud’s strict atheism and instead posited a more favorable view of religious beliefs in their psychological theories.
Examples of some of the psychologists and psychiatrists who integrated religion with their psychological theories would include such notables as Carl Jung (1875–1961), Erich Fromm (1900–80), and Viktor Frankl (1905–97). The broadest incorporation of the spiritual with the psychiatric is found in Jung, a Swiss psychiatrist and contemporary of Freud. His worldwide travels, interest in the occult, tribal religion, and other non-mainstream mystical beliefs heavily inﬂuenced his subsequent psychological theory. In stark contrast to Freud, Jung’s liberal premise that all psychic products—including visions, dreams, and hallucinations—are ‘facts’ and should be considered as having the same basis in reality as other physical facts, opened wide the door to religious belief and behavior in psychic functioning that Freud had ﬁrmly attempted to close. Furthermore, according to Jung, it is not the business of psychology or psychiatry to prove or disprove the existence of God: it can only address the psychic eﬀects of the God image and its mythic antecedents on human behavior.
Psychoanalyst Erich Fromm recognized the value of religion in providing healthy feelings of stability and security for individuals. In his book Psychoanalysis and Religion, Fromm stated, ‘Man is not free to choose between having or not having ideals but he is free to choose between diﬀerent kinds of ideals, between being devoted to the worship of power and destruction and being devoted to reason and love’ (1950, p. 25). Fromm further advocated a surrendering of one’s individual goals and identity in favor of living selﬂessly in community with others, a not uncommon ideal of both Judaic and Christian rhetoric.
Finally, Viktor Frankl, the Holocaust survivor and psychiatrist who wrote Man’s Search for Meaning, articulated in his book the premise that all humans are on an unmitigated quest for meaning—even in the midst of horror and despair. Frankl clearly credited his spiritual belief as sustaining his mental health throughout his imprisonment, and contrasted his experience to other prisoners who lost their faith and subsequently their will to live, succumbed to illness, and died. Of the three highlighted theorists who have acknowledged the positive merits of religious belief on mental health, Frankl’s testimony is the most graphic and recent representation of the positive outcome of melding the two.
It is not only within the realm of science that the questions about the potential beneﬁts of intertwining psychiatry and religious belief have been addressed. A number of theologians, religious philosophers, and clergy have also debated the merits of incorporating religious beliefs into the best scientiﬁc practices in mental health.
One of the earliest proponents of such an idea was Anton Boisen (1876–1965), a Protestant clergyman who had once experienced a psychotic illness and subsequently had been institutionalized in a mental hospital. He reported that the hospitalization was a religious renewal experience for him, and he believed that it could be that way for some other patients if the psychiatric community were suﬃciently sensitive to the meaning of these experiences.
Another theologian, Paul Tillich (1886–1965), proﬀered a broader anthropological and philosophical context within which psychiatry could exist and still address its own, more speciﬁc concerns. Similar to Jung’s placing limits on psychiatry’s role in evaluating religious belief, Tillich opined that statements of ultimate concern belong to a domain beyond which psychoanalysis and the scientiﬁc method can neither disprove nor verify. Furthermore, Tillich reiterated that when psychiatry makes either negative or positive judgments about the reality of religious ideas and symbols, it has moved out of the realm of science and into the realm of metaphysics.
Current philosopher of religion Paul Ricoeur (1913– ) has countered the reductive view of religion espoused by Freud, and the inﬂuence Freud’s views have had over much of psychiatry and the wider culture shaped by these theories. In contrast to Freud’s view that religion is basically a public expression of obsessive compulsive neurosis, Ricouer espouses belief that humans grow when confronted by sacred ﬁgures who challenge them to become more than they are.
Other contemporary writers include Karl Menninger (1893–1990), who has written Whatever Became of Sin?, addressing the atheistic stance of psychiatry and the cultural disregard for personal responsibility. Another, Paul Pruyser (1916–87), writes about the need for psychiatry, with its empirically-based ﬁndings, and religion with its faith basis, to be utilized separately rather than attempt their integration in understanding and treating mental illness.
7. Practices Which Ha E Attempted To Merge Religion And Psychology
The concern by some psychiatrists and theologians to interweave the religious with the psychological led to the development of new strains of practice in both disciplines. The most broadly deﬁned psychiatric and religious blend emerged as ‘transpersonal psychiatry,’ the outgrowth of Jungian mysticism combined with tenets of Eastern religion (such as Buddhism, Hinduism, and Taoism). Proponents of transpersonal psychiatry use drug-free methods familiar in spiritual practices, i.e., meditation, as part of the ritual for maintaining optimal mental health.
A distinctly diﬀerent approach to the integration of religion and mental health has been seen in the emergence of ‘Christian Psychiatry’ in the 1970s and 1980s. Led by theologically conservative psychiatrists, this approach was speciﬁcally tailored for Christian patients whose treatment mode, psychiatrists believed, could be enhanced by incorporating elements of their Christian faith in their treatment. ‘Christian psychiatrists’ based their treatment on Biblical principles, including Bible study and prayer.
Also within the theological realm, the development of Clinical Pastoral Education (CPE) emerged as clergy became educated about the nature of psychological problems. Originally developing with the work of Anton Boisen in 1925, CPE emphasizes ministering to the patient by utilizing both theological tenets and psychodynamic theory. CPE subsequently has become an important part of seminary training: a requirement of some, and an elective in even more, to best meet the needs of pastors and chaplains in hospitals and other settings.
8. Psychiatry Addresses The Issue Of Religion
More than 50 years of writing on the positive interaction between religion and psychological health passed before the ﬁeld of psychiatry oﬃcially reexamined its Freudian views on religious belief. In 1956, R. Finley Gale, Jr., the incoming president of the American Psychiatric Association, devoted his entire presidential address to the ‘Conﬂict and Cooperation between Psychiatry and Religion.’ In that speech, Gale called for the development of a committee on psychiatry and religion within the organization, and further suggested that mental health chaplains be invited to join and participate in that venture.
Although the next several decades indicated some gains in psychiatric acceptance of religion as nonpathological, diagnoses as late as those found in the 1987 Diagnostic and Statistical Manual, Third Edition, Revised indicated religious belief as a factor indicated in poorer mental health (Larson and Greenwold 1997). However, the 1990 adoption of the Guidelines Regarding Possible Conﬂict between a Psychiatrist’s Religious Commitments and Psychiatric Practice indicated that ‘patient religious beliefs were being professionally recognized as not only acceptable, but important treatment factors’ (Larson and Greenwold 1997, p. 22).
These guidelines highlighted the usefulness of obtaining information about a patient’s religious or ideological orientation and beliefs, as well as of ad- dressing the procedure for handling any conﬂicts between the patient’s and the psychiatrist’s belief systems. Psychiatrists were reminded that they should not impose their own religious, anti-religious, or other ideological systems or beliefs on vulnerable patients. Furthermore, these guidelines indicated that interpretations concerning a patient’s beliefs should be made in a context of empathetic respect for their value and meaning to the patient.
9. Reﬂections On The Popular View
Despite the defamation of religion by the scientiﬁc community, demographic studies indicate that those who deﬁne themselves as religious spiritual in the population at large have remained relatively consistent over the past several decades. The ﬁrst Gallup poll, conducted in 1937, indicated that 73 percent of Americans were members of a church or synagogue. A 1997 Gallup poll (March 24–26, 1997) reported that 96 percent of Americans believe in God or a universal spirit, with 67 percent indicating membership in a church or synagogue. Further, 61 percent indicate religion is ‘very important’ in their own life (with an additional 27 percent stating it is ‘fairly important’), with 43 percent attending religious services weekly or nearly every week.
In addition, one cannot overlook the host of religiosecular self-help support groups in mainstream culture today, particularly Alcoholics Anonymous (AA), the most therapeutically successful of them all. Alcoholics Anonymous (along with its subsequent oﬀspring such as Narcotics Anonymous, etc.) is considered the most useful organization in the United States to assist persons suﬀering from alcohol abuse and chemical dependence. AA operates much like a religious community, complete with doctrine. The 12 steps proposed as necessary to overcome alcoholism reﬂect a creed that shapes AA, and has strong religious overtones. A similar group, the Samaritans, operates primarily in the United Kingdom. Its 23,500 volunteers make themselves available by telephone 24 hours a day, by personal visits, and by letters.
10. Recent Academic Research Supports The Beneﬁts Of Religion
Finally, recent research studies on the interaction between religion and mental health indicate more positive outcomes for believers receiving mental health treatment than for agnostics or atheists. Supporting the anecdotal success stories from Alcoholics Anonymous, a study by Desmond and Maddux (1981) demonstrated that 45 percent of participants in a religious treatment program for opioid dependence were still sober a year later, in stark contrast to the mere 5 percent who had participated in a nonreligious treatment program.
More recently, Koenig and Larson (1998) indicated that in the last 15 years, over 50 epidemiological studies have been published which demonstrate that ‘religious persons experience not only greater well- being and higher life satisfaction, but less anxiety and depression, lower rates of suicide, less alcoholism, less loneliness, and better adaptation to stress than do persons without spiritual resources’ (p. 385). Furthermore, a substantive body of research on the acts of religious belief, such as prayer, has demonstrated positive impact on both physical and mental health.
In the preface to his 1993 book Healing Words, Larry Dossey, M.D., originally a skeptic, writes about ﬁnding ‘over one hundred experiments exhibiting the criteria of ‘‘good science,’’ many conducted under stringent laboratory conditions, over half of which showed that prayer brings about signiﬁcant changes in a variety of living beings’ (p. xv). Research indicated that patients who became prayer targets experienced altered blood pressure, slowed growth rates of cancerous cells, dissipation of tumors, an increased rate of healing for wounds, and even altered probability for heart attacks.
Finally, in terms of practical and economic outcomes, research indicates that the spiritually committed are less likely to develop serious illness, spend less time in the hospital, and do better upon discharge than those patients who are nonbelievers or aspiritual (Koenig and Larson 1998).
11. Implications For Psychiatry Today
When research indicates that participation in religious activities correlates with a patient’s strengthened immune system, a reduced risk (by 60 percent) of arteriosclerotic heart disease and pulmonary emphysema, an increased (between seven and fourteen years) life span (Koenig and Sloan 2000), as well as a decreased likelihood of depression, anxiety, and persistent mental illness, the link between religious belief and improved health both physically and mentally becomes noteworthy. However, some concern remains about the potential negatives of physicians and mental health practitioners encouraging religious belief in their patients.
Richard P. Sloan, Ph.D., director of the Behavioral Medicine program at Columbia Presbyterian Medical Center in New York, opines that when ‘physicians depart from their medical expertise and enter the religious realm, there’s an element of coercion because patients don’t want to oﬀend or disappoint their doctors’ (Koenig and Sloan 2000, p. 159). Sloan believes that melding the two realms puts a physician ‘in a terrible bind. If he believes that there is strong evidence associating religion with better health outcomes … he would be derelict in his duty as a physician if he didn’t advocate religion’ (p. 156). He further associates this advocating of religion to prescribing antibiotics: a physician doesn’t ask whether the patient is in favor of taking them, but merely prescribes them as being the best course of treatment.
Sloan’s concerns about the potential dangers from intertwining religious ideology and mental health are worth taking into account. History has clearly demonstrated problematic responses to the mingling of religion and science, and an uncritical absorption of religious ideology into psychiatric theory would be foolhardy. However, given the recent research that indicates the positive beneﬁts of religious belief in better mental health outcomes, ignoring those data would be very poor science. It would seem that the best approach would acknowledge the inherent tension between the two paradigms of science and religion, with growth in both ﬁelds occurring as the result of conversant dialogue between the two, much as Kuhn (1970) advocated in his treatise on scientiﬁc Revolution.
12. Future Considerations
Given the recent scientiﬁc evidence for positive outcomes for religious belief, combined with the statistics about religious believers in the population at large, a move toward educating psychiatrists about the interaction between religious belief and mental health practice appeared necessary. Hence, in 1995 the Accreditation Council for Graduate Medical Education (ACGME) responded with a requirement to include religion and spiritual factors in the human development curriculum. To assist program directors in meeting this requirement, a Model Curriculum for Psychiatric Residency Training Programs was developed by David B. Larson, Francis G. Lu, J. Swyers, and Elizabeth Bowman, among others. This model curriculum provided deﬁnitions, Bibliography:, and teaching options to ﬁt individual programs.
Practical considerations aside, the intermingling of religion and science can remind psychiatry that it does not practice in a vacuum or without social, ethical, and public philosophical inﬂuences. Religion confronts psychiatry with decisions regarding the proper stance of a secular, therapeutic discipline on determining components of mental health. Because it serves a wide spectrum of humanity, psychiatry should not wed itself to a speciﬁc religious or cosmological creed. It should, however, consider a public philosophy that provides ‘a broad, intellectual understanding of both its proper focus as well as how it should relate to the wider aspects of social and cultural action’ (Browning et al. 1990, p. 20). Such an academic stance allows psychiatrists to take their patients’ experiences and beliefs seriously and in a respectful manner.
Psychiatry is on its most solid ground when it is investigating the psychological meaning and motivation of the religious beliefs of any patient. To reiterate the concerns of James and Jung, what psychiatrists must not comment upon is whether there is an ultimate truth justiﬁcation for religious faith, for ‘God’ is, logically speaking, an axiom and not an empirically testable scientiﬁc hypothesis. Rather, acknowledging the commensurate questions of the two paradigms (What are the fundamental components of human beings? What causes illness? What helps keep individuals healthy?) and allowing each ﬁeld to share knowledge with the other as a means of improving practice in both disciplines, appears to be the most prudent course. Complementary coexistence, while maintaining studied attention to the polarizing tendencies of both religion and science, is the most likely path to providing optimal care for patients.
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