Religion and psychopathology Presentation Transcript
Religion and Psychopathology Dr Lokesh Prabhu and Dr Ramkumar G.S Chairperson : Dr S.K Chaturvedi 1/12/10,ARTS THEATRE, NIMHANS
Outline of presentation
Influence of religion on various disorders
Studies have operationalized religion as church attendance, personal devotion, religious beliefs.
At times, several dimensions of religiosity are measured and analyzed separately.
In addition, this heterogeneity of measurement approaches makes it difficult to isolate which precise religious variable (i.e., service attendance, prayer, devotion) is most associated with positive health findings.
Among the general adult population, psychiatric inpatients have been reported as being as religious as control subjects, although they did not practice their faith as frequently (Kroll and Sheehan, 1989).
The beneficial effects of religiousness on mental health and health in general may be explained by the use of religious beliefs or behaviors to facilitate problem-solving to prevent or alleviate the negative emotional consequences of stressful life events. (Kroll and Sheehan, 1989).
Religions offer groups of like-minded people who share the same faith and beliefs.
Religion is considered to offer direction, spirituality, and faith, people sometimes might not fully understand religion and end up misinterpreting it.
Certain demographic variables are known to influence religious coping; these include older adults, females, blacks, those less educated, economically deprived and those affiliated with conservative religious denominations (Koenig et al., 1992).
Certain events and experiences might be considered sinful and unpardonable, leading people to be overwhelmed with guilt.
These thoughts and guilty feelings might lead to people slipping into depression.
Young children, teens, and adults often jump to conclusions based on limited knowledge of religion and get caught in mental distress.
Therefore, without knowing how to deal with the situation and their feelings, they begin to get depressed.
These feelings will create a lot of inner turmoil leading to hopelessness, self loathing, and worthlessness. These negative thoughts will accumulate and one will start contemplating suicide.
Religion, on the other hand, also has a positive influence on depression. It offers a lot of comfort and spiritual support.
It enables them to be aware of their inner strengths, religions help people to face difficult situations without breaking down.
It also helps people to learn to accept failure and negative experiences as part of life and make peace with them.
Religious people form a strong social core which helps provide emotional and other kinds of support. This not only helps to prevent depression, but also helps in the recovery of depressed persons.
Therefore, people should learn to draw comfort from religion rather than become guilty and pessimistic.
In a study to test the associations between religious variables and psychological distress involving 200 college students.
Participants reported more comfort than strain associated with religion. Religious strain was associated with greater depression and suicidality, regardless of religiosity levels or the degree of comfort found in religion. (Exline JJ et al 2000)
In the Indian context it was found that Muslims, those who are divorced or widowed, those residing in nuclear families and urban areas were more likely to be depressed. (Sundeep Grover et al 2010)
Rachel Elizabeth Dew and colleagues examined the relationship between religion and mental health. They found that about 75% of the studies found that greater religiosity was associated with less depression.
However longitudinal data suggests that the relationship between public religious activities and depression may be bidirectional i.e. attendance may be affect and be affected by depression. (Harker et al 2001)
From the dawn of history, anxiety has been associated with religion.
People suffered from anxiety, when rules and rituals that were meant to calm deities and ancestral spirits were disobeyed.
Religion can cause both positive and negative emotion. Some find it to be the solution to every problem, others find religion to be the source of anxiety and distress.
Many religious traditions attributed illness and disease to the work of demons and other spiritual entities.
Having some type of religious affiliation appears to be related to lower anxiety levels in the general population.
Intrinsic religiosity is associated with less worry and anxiety, whereas contemplative prayer is correlated with increased security and less distress.
Intrinsic religiosity refers to a lifestyle in which religion is personally appropriated and "lived" from within.
Extrinsic religiosity, refers to a lifestyle in which religion is related to social circumstance.
Clinical trials show that religious therapies from a variety of religious traditions appear to improve anxiety symptoms.
In a review done by Koenig found that more religious people showed lower levels of anxiety. (Koenig HG et al 2001)
In an epidemiological study done by Koenig and colleagues it was found that religion and anxiety are only related in young people.
Church attendees, showed less evidence of anxiety disorders, whereas persons with no religious affiliation, have more anxiety disorders. (Koenig HG et al 1993)
Religiosity factors could be associated with internalizing disorder and externalizing disorders.
An attitude of personal retaliation rather than forgiveness was associated with internalizing disorders, and two factors (social religiosity and thankfulness) were related to both internalizing and externalizing disorder.
Anxiety and panic attacks sufferers worry about the things which are most important to them, like the loss of loved ones, their health etc. For deeply religious people, faith is most important thing, so they worry about it!
Post traumatic stress disorder have mixed findings. (Shaw A et al 2005)
Religion may positively affect one's ability to cope with trauma and may deepen one's religious experience. (Maercker A et al 2003)
Connor and colleagues, however, found that religion has little or negative impact on post trauma symptoms. (Connor KM et al 2003)
The direction of causality is uncertain in these studies. Religion may, not be a protective factor against developing PTSD, but offers some help as a way of coping with high levels of distress and/or poor health.
Death anxiety seems to be related to both high and low religiosity. (Kendler KS et al 2003)
Religion involves intangible matters of faith that cannot be seen, touched, or discussed from a scientific or logical point of view.
Contamination obsessions were the most frequent in all studies.
However, the similarities of the contents of obsessions between Muslims and Jews, as compared with Hindus and Christians.
Obsessions of religious, contamination and dirt were more common among Muslims and Jews.
Hindus had more commonly contamination, pathological doubts, orderliness and aggressive obsessions. (Akhtar et al., 1975; Greenberg, 1984; Khanna and Channabasavanna, 1988; Pollitt, 1957).
Christians had more commonly religious obsessions which was associated with mental compulsions resulting in priests, having to come into regular contact with hyper-confessors as a part of their mental ritual.
Even where a religious leader is sympathetic, consistent compulsive questioning and phone calling for reassurance by a sufferer can wear them down to the point where they become angry or impatient.
If they are fortunate, patients might find somebody understanding their problem. If not their symptoms are criticized or passed of as ‘nothing to worry’.
In the worst cases, individuals are treated harshly, and told that they really are sinful and that their religious practice needs to be improved.
Many patients have mentioned that "OCD seems to know how to pick on whatever will bother me the most.’’
One particular area that is of great importance and sensitivity to many people is their religion and patients with OCD seems to have religious obsessions which affects them most producing extreme distress.
Types of religious obsession
Person has sinned or broken a religious ritual.
Prayers have been omitted or recited incorrectly
Repetitive blasphemous thoughts.
Person has lost touch with God or their beliefs in some way.
Thoughts of being "unworthy" of salvation in some way.
Intrusive "bad" thoughts or images that occur during prayer, meditation.
Believing that one's religious practice must be 100% perfect, or else it is worthless.
Thoughts of being possessed.
Types of religious compulsions
Saying prayers, or carrying out religious acts repetitively until they are done perfectly.
Constantly asking for God's forgiveness, or telling God that you didn't mean what you said or did.
Rereading passages from holy books over and over to make sure nothing was misunderstood or missed
Double checking different religious acts or observances to be sure they were done correctly.
Protecting religious symbols, ornaments, books, or pictures from "contamination’’.
Trying to imagine special "good" religious images or thoughts to cancel out "bad" and irreligious images or thoughts.
When any activity was performed with a blasphemous thought in mind, having to redo it with a "good" thought.
Having to carry out religious dietary, dress, or appearance codes perfectly.
Religious obsessions really have nothing to do with true religion as it is understood.
Religion is not the source of OCD; rather, it is a medium for the disorder’s effects. One can easily remain a believer in God and learn to deal with thoughts against God.
Jewish views on suicide
Suicide is forbidden by Jewish law. Judaism has traditionally viewed suicide as a serious sin. It is not seen as an acceptable alternative even if one is being forced to commit certain cardinal sins.
Assisting in suicide and requesting such assistance is also forbidden.
Christian views on suicide
According to the theology of the Catholic Church, death by suicide is considered a grave or serious sin. The chief Catholic Christian argue that one's life is the property of God and a gift to the world, and to destroy is a tragic loss of hope.
Conservative Protestants (Evangelicals, Charismatic and Pentecostals) have often argued that because suicide involves self-murder, then anyone who commits it is sinning and is the same as if the person murdered another human being.
An additional view is that asking for salvation and accepting Jesus Christ as personal savior has to be done prior to death. The unpardonable sin then becomes, not the suicide itself, but rather the refusal of the gift of salvation.
Islam views on suicide
Islam views suicide as one of the greatest sins and utterly detrimental to one's spiritual journey. Most Muslim scholars and clerics consider suicide forbidden, including suicide bombings.
Hinduism views on suicide
Generally, committing suicide is considered a violation of the code of ahimsa and therefore equally sinful as murdering another.
Some scriptures state that death by suicide (and any type of violent death) results in becoming a ghost, wandering earth until the time one would have otherwise died.
Hinduism accepts a man's right to end one's life through the non-violent practice of fasting to death, but this is strictly restricted to people who have no desire or ambition left, and no responsibilities remaining in this life.
Jainism views on suicide
Jainism is one of few religions that does permit suicide.
Jainism allows non-violent fasting to death termed Santhara.
Buddhism views on suicide
Buddhism, individuals' past acts has an influence on what they experience in the present; what they experience in the future (the doctrine of karma).
Buddhists, consider destruction of life, suicide as a negative form of action which would have a negative influence on the present and the future.
Descriptions of cases show the variety of relationships between religion and dissociative disorders: identity disorder with religious content but without possession, divine possession, and demonic possession.
The concept of spiritual possession exists in many religions, including Islam, Christianity, Buddhism, Southeast Asian and African traditions.
In possession, the person enters an altered state of conscious and feels taken over by a spirit, power, or other person who assumes control over his or her mind and body.
Possession also appears in early Christianity. Many contemporary forms of evangelical Christianity consider it desirable to be possessed by the Holy Spirit, with physical manifestations that include shaking and speaking like the Holy Spirit.
Possession may be voluntary or involuntary and may be considered to have beneficial or detrimental effects.
Such experiences have a long human history and many religions offer rituals and healings to protect participants from unwanted possession.
One of the signs of Christ's divinity was his ability to cast out demons from people who were possessed.
Spirit possession cults have continued to proliferate, even in the secular West, and many spirits and their mediums are part of local as well as global cultures. (Behrend and Luig, 2000).
However, the deliberate induction of possession states is part of valued religious rituals in many cultures, and is probably the most popular form of union with the divine power.
Many dissociative states occur in Southeast Asia, for example, in a culturally conditioned and controlled setting.
These episodes of possessions are dysfunctional when there is impairment in social or occupational functioning or marked distress.
Religious Delusions: Finding Meanings in Psychosis: Vishal Bhavsar Dinesh Bhugra,2008 Psychopathology 2008;41:165–172
Religious delusions - common in Catholic societies, less with Islamic and Protestant societies .
Those with religious delusions had waited longer before establishing service contact, received more medication, had higher symptom scores and had poorer functioning
Poor outcome, violence, poor adherence, self harm
Religious content generally decreasing.
Religious Delusions: Finding Meanings in Psychosis: Vishal Bhavsar Dinesh Bhugra:Psychopathology 2008;41:165–172
Higher levels of ritual behavior within a society higher prevalence of religious delusions.
A recourse to ritual as a response to the chaotic experiences of early psychosis in India.
Ritual frameworks also have an important role in the delineating abnormal behavior – for example, in India, the function of caste and jati distinctions can define social interaction.
Increased religious activity among Christians increased severity of religious delusions.
Religious Delusions: Finding Meanings in Psychosis: Vishal Bhavsar Dinesh Bhugra:Psychopathology 2008;41:165–172
Hindu societies have relatively few religious delusions, despite religious narratives being heavily prominent in social life in India.
It is argued that family units could have a role in shaping the phenomenology, as well as the clinical parameters of psychosis
Religious Explanatory Models in Patients with Psychosis: Three-Year Follow-Up Study, P. Huguelet Psychopathology 2010;43:230–239
Potential clinical consequences-
(1) as a meaning-making form of coping e.g. by distressing or soothing, with an impact on wellbeing,
(2) as a factor in treatment adhesion, e.g. when explanatory
models of patients entail alternative ways of healing, and
(3) impact on outcome
Clinicians should address this issue on a regular basis, by asking patients about their explanatory model before trying to build a bridge with a medically based model
The limited evidence indicates that persons suﬀering from mania are much more likely than normals to profess a belief in major religious tenets.
Religious delusions and hallucinations were reported by 90% of bipolar manic patients in the survey of Brewerton (1994),
In terms of delusions of grandiosity with religious content persons suffering from mania scored higher than any clinical population, including schizophrenics (Brewerton, 1994; Kroll & Sheehan, 1989).
Manic patients also reportedly experience a 2.5-fold increase in religious conversions (Gallemore, Wilson, & Rhoads, 1969).
Schizophrenics to have stronger religious beliefs and more religious experiences than normals. Brewerton (1994) and Kroll and Sheehan (1989).
The playwright August Strindberg (Brugger, 2001) and the Nobel laureate and mathematician John Nash (Nasar, 1998) are two of the more famous schizophrenics reputed to have suﬀered religious delusions.
Schizophrenic religious delusions range from the ‘‘messiah complex’’ ( Goldwert, 1993 ) to the ‘‘passivity’’(alien-control) delusion, in which the schizophrenic feels his actions and thoughts to be controlled by God or some other powerful entity ( Frith et al., 2000 ).
Religious and paranormal beliefs in normals have been occasionally studied in connection with ‘‘soft’’ neurological signs and tendencies, and there have been suggestions of a relation-ship between religiosity and certain personality traits (e.g., schizotypy, magical ideation, and obsessiveness)that may have an underlying fronto-temporal source.
Somatic Neurosis in Muslim Women in India N. Janakiramaiah and D. K. Subbakrishna Social Psychiatry 15, 203-206 (1980 )
Gautam (1976) mentioned that at NIMHANS, it was " felt by most of the consultants that most of the Muslim patients (particularly females) presented with a peculiar group of somatic complaints such as Headache, Burning of eyes, pain in back, chest pain, pain in all the extremities, palpitation and weakness . . . . most of these symptoms were essentially present in most of them .“
“ Hence, an intensive socio cultural study of this condition in Muslims is advised”
Attitude to religion
Cultural insensitivity can be traced to roots of psychoanalysis, behaviorism , cognitive therapy
Religion was portrayed akin to psychopathology especially DSM III-R
Religiosity gap between mental health professionals and general public.
70% of world population use non allopathic systems of medicine and these systems gives credence to spiritual aspects.
DSM- V 62.89
Other conditions that may be a focus of clinical attention- Includes 3 categories
Normal religious and spiritual experiences;
Religious and spiritual problems leading to mental disturbances;
and mental disturbances with a religious and spiritual context.
Cultural formulation-- Role of religion and kin networks I providing emotional, instrumental, and informational support
ICD chapter XXI(Z00-Z99)
Factors influencing health status and contact with health services.
No mention of religion associated problems.
Distinguish normative religious experience from psychotic experience
DSM --- certain religious practices or beliefs (eg. hearing or seeing a deceased relative during bereavement) are excluded.
Psychotic episodes are more intense, often terrifying, pre occupying, associated with deterioration in social skills and personal hygiene and often involve special message from religious figures.
Another criteria suggest using good prognostic indicators to distinguish the two.
SIMS’s symptoms in the mind
Concrete thinking is useful to distinguish between psychosis and strong religious belief.
“ if thy right hand offend thee cut it off ”
Ecstatic and religious experience.
Religious delusion and experience of an unusual religious practice.
Authentic religious belief vs religious themed psychopathology
A genuine religious experience is an abnormal interpretation of a normal event.
Psychotic religious experience is an abnormal perceptual experience.
The challenge would lie in understanding the difference religious culture and pathology without jumping to conclusions regarding unfamiliar religious beliefs.
Physio-Kundalini Syndrome with neurocognitive deficits, Paradkara A and Chaturvedi SK 2010 International Journal of Culture and Mental Health
Types of religious problems
Loss or questioning of faith.
Change in denominational membership or conversion to a new religion.
Intensification of adherence to beliefs and practises. Voluntary and also as coping mechanism.
New religious movements and cults.– “spiritual group pathology”- distinguish “between false prophets and genuine spiritual masters,
between misguided cults and Wholesome spitiual communities”
Types of spiritual problems
Near death experience.
Spiritual emergence/ emergency.
DSM says voluntary induced experiences of depersonalization or derealization form part of meditative and trance practices that are prevalent in many religions and cultures and should not be confused with depersonalization disorder.
Religious/ spiritual problems coexisting with mental disorder
Alcohol and drug dependence and abuse. –also how psychopathology helps religion– fundamental Christianity holds sway in Latin American and am Indian communities– through insistence on abstinence.
Substance perhaps most widely used around the world for ceremonial purposes is alcohol.
Ode-ori (Nigeria) associated with paranoid fears of malevolent attack by witch craft. Fear of malign magic, bewitchment, or spirit attack may be misdiagnosed as symptoms of psychosis by the uninformed clinician.