Dr. Samuel Pfeifer
Is there a specific religious
factor in psychopathology?
Aarhus 2003
Four models
Psychiatry
Religion
Psychiatry
Religion
Psychiatry
Religion
Psychiatry
Religion
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 - 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!"
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!"
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 individual’s 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 multicausal 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 ICD10 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.
childhood
stressful life events
Causes of
depression
Thinking
Belief systems
Basic assumptions
Body functions
vegetative symptoms
STRESS
Current life conditions
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)
b)
c)
d)
Psychopathology and severity of disorder
Life events and coping abilities; stress and strain in general
Personal religious life of the client (extrinsic and intrinsic factors)
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
Inner
Experience
IDEALS
External or internalized,
general, familial or religious
ideals
Needs
Drives
Emotions
(Sub)cultural
rules und
limitations
REALITY
General life situation
Social network
Physical/emotional
constitution
External
Framework
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.
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