Gauguin: „Vision in der Predigt“
Samuel Pfeifer and Regula Gasser
Phenomenology and
psychodynamics of
religious delusions
An emprirical study of 43 patients
Psy. Clinic Sonnenhalde, Basel / Switzerland
Gauguin: „Vision during a sermon“
Mystical experience or psychosis?
The Bishop and the Buddhist
 Example 1: A young priest has a mystical experience in
the St. Peter’s Dome in Rome. A sun ray gleaming
through a gem in the crown of Mother Mary hit him like a
holy lightening. He falls to the earth feeling an intense
presence of God. To him this is a calling into his future
ministry. He later serves as a bishop in the catholic
church.
 Example 2: A highly intelligent student neglects his
studies, cuts off all social contacts, and is finally brought
to the psychiatric clinic by his parents. He claims to have
converted to Buddhism and asks permission for a
pilgrimage to Tibet. He leaves without preparations.
Three days later he calls from Munich: He had slept in a
park, and was stung by a mosquito. Now he did not want
to pursue his journey but rather come home.
Case vignette
 A 30-year old man was arrested by the police when
found lingering around an atomic power plant, being
obviously disturbed. The man was not religious before
the incident, but he reported that when visiting a church,
he experienced an encounter with God in the shape of a
light that shone through the stained-glass windows. He
felt compelled to burn banknotes in the church. When he
drove away, the oncoming cars and trucks gave him
messages with their headlights. Finally he left his car with
the ignition key on, and continued his pilgrimage on foot,
spending two nights in the woods. He claimed to have
received a mission from God to protect the people
around the nuclear plant from harmful radiations. He
therefore approached the fence around the power plant,
carefully pacing up and down. Finally, he urinated into a
bottle, deposing his urine in drops along the fence to
create a protective wall.
Faith vs. Delusion
Faith
Delusion
Group experience
Singularity – pathological
restriction to the Ego.
Fellowship
Loneliness. Lack of
communication
Doubt accepted
incorrigible
Trust
Mistrust
Content often transcendent Content often threatening
No clinical
psychopathology
Nach Haenel 1983
Additional psychopathological
sympoms.
Factors of influence
 Religious belief is not the only
determinant of a religious delusion
 In Manchester (Siddle et al. 2002): 68 %
of the schizophrenic patients said they
were religious, but only 23 % had a
religious delusion (45 of 193 patients).
 In Saudi-Arabia 43 % of the patients are
using religious coping strategies against
hallucinations (Wahass & Kent 1997).
Frequency of religious content in delusions
Seoul
Shanghai
47.1 %
7.9 %
Taipeh
41.0 %
Manchester
23.0 %
Kim et al. 2001
Stompe et al. 1999
Siddle et al. 2002
Raja et al. 2000
Austria
Pakistan (?)
Italy
21.4 %
4.6 %
20.1 %
Criteria of Delusions
a) Incorrigibility of an objectively strange
conviction
b) Not amenable to reason - failure to look
for proofs
c) Pathological egocentrism.
Conviction, Preoccupation, Distress
 Multidimensional phenomenon
 Gradual differences between norma faith
convicitons and clear delusions.
 Hallucinations (especially voice hearing)
do not only occur in schizophrenic
patients (Romme & Escher).
Three Dimensions
 Conviction
 Preoccupation
 Distress
Peters E, Day S, McKenna J, Orbach G. (1999) Delusional ideation in religious and psychotic populations. Br J Clin
Psychol. 38 ( Pt 1):83-96.
Delusional experiences (nonreligious)
 Delusion of Meaning („All had tears in their
eyes as if they knew about my troubles....")
 Delusion of Reference („They are painting the
house in orange to harass me – or to give me a
message.")
 Delusion of being annoyed („I am being
mobbed„ - however in a bizarre way)
 Delusion of persecution („Conspiracy against
me")
 Love (erotic) delusion
 Delusion of grandeur
 Etc.
Diagnostischer Algorithmus (Siddle 2002)
Does the patient have a belief (include the attribution of hallucination) which
has the characteristics of a delusional idea, e. g. an idea which is firmly
held, it may be bizarre, is not amenable to reason?
I
other delusions, hallucinations, thought disorder, anxiety etc.?
I
religious content
I
Would non-psychotic churchgoing religious people also find these ideas
unacceptable?
I
Are the patients’ lifestyle / goals etc. more suggestive of a psychotic
episode than an enriching life event? Was this a religious experience or
was it a psychotic episode?
Our own study
 43 patients (30 w, 13 m)
 Age at index episode: 22 – 68 Jahre
 Educational level
–
–
–
–
–
University degree
A level degree
Advanced school
Apprenticeship
unqualified
2
5
7
22
7
 Diagnoses
– Schizophrenias
– Affective Disorders
• (Mania, psychotic depression)
29 (68 %)
14 (32 %)
Salience of Religion
Salience of personal religiosity
Total
Konfession
none
little
moderate
strong
Very
strong
none
1
1
0
0
0
2
catholic
0
2
1
3
3
9
protestant
1
0
2
2
1
6
TFC
0
0
1
2
8
11
CFC
0
0
0
1
10
11
others
1
2
0
1
072
total
3
5
4
9
22
%
4
43
Salience of personal religiosity is described as strong, when the patient is an active
member of a religious group, is regularly visiting servicesor when his religion is
visible in is outer appearance or behaviour (e.g. special clothes, oiving in a
monastery).
Two patients lived in a religious order, three attended a bilbe college, three lived in a
non-formal religious community.
TFC = traditional free church, CFC = Charismatic free church
Degree of religiousness
 Religious education – not significant
– 12 patients (28 %) – no religious upbringing
– 14 patients (33 %) – regular attendance of religious
meetings during childhood
– 13 patients (30 %) – moderate religious influence
– 4 patients : no information
– 13 of 31 patients (41 %), who gave religion a high
importance in their lives, had also had a religious education
during childhood.
 Ego-syntonic religiosity:
– 23 patients (53.5%) showed besides their delusions an egosyntonic religiosity which was shared by the rurrounding
sub-culture,
Self-destructive actions (n = 10)
Examples
Suicide attempt in the hope to be near God.
Cutting as an offering to God.
Demonic voices order a patient to chop off his hand.
A woman jumps out of the window to meet God-Jehova.
Suicide attempt because of failure to fulfil god‘s commission
Rituals detrimental to health in order to counteract satanic curse.
Fast up to 30 days.
No autocastration or self-blinding in this sample – but in literature.
Peculiar behavior (n = 13)
examples
Giving lectures at the work place on the coming doomsday
Falling to the ground in an evangelistic meeting, trembling,
shouting.
Hallucinations are passed on as prophetic messae in a church
service.
A woman takes off her clothes and confesses her sins in public
space.
A patient showed around her ring, which she had received from her
„bridegroom“ Jesus.
Preaching to passing cars on a busy road.
Barricades in front of the house to ward off satanic attacks.
Help-seeking behavior und compliance
 Search for a religious form of therapy
(healing prayers, exorcism)
– 15 patients (34.9%) expressed a demonic
causality of their illness
– 7 patients (16.3%) underwent „deliverance
ministry“ or exorcism.
 Compliance and religious delusions:
– In 15 patients (34.9%) religious delusions had an
influence. Often they insisted that their problem
was spiritual and did not require medication.
Archetypes of religious delusions
General
Religious
Enlightenment
Apparitions of God
Dichotomy Good / Evil
God – Satan
Persecution (Mobbing)
“Spiritual Battle”
Warding off Evil
Divine Protection
Passing on a Message
Mission
Symbolic Hints
Divine signs
Sexual topics
Love / Temptation
Themes of Religious delusions
POSITIVE
NEGATIVE
Prophecy
Condemnation
Mission
Bondage
Offering
Curse
Visions
Spirits of the Dead
Pregnancy
Demons
Psychodynamics:
Four functions of religious delusions
1. Interpretation (cognitive reframing) of
threatening experiences („Why me?“).
2. Context in a larger framework of
reference.
3. Exculpation or Dis-Egoification – relief
from perceived guilt.
4. Wish fulfilment and significance though
delusional experience.
a) Interpretation
 What is vaguely perceived as an evil, life threatening and
overwhelming threat to a person’s existence, gets a new
significance if it is labeled “demonic”.
 “Why me?” is one of the most tormenting questions of the
delusional person. Whereas normal life would give no
explanation for singling out an individual in such a
destructive way, the events receive significance in the
light of religious writings, where the just is threatened and
attacked, even in the absence of personal wrong-doing.
 But the study also describes positive connotations, such
as identifying a comforting voice as the voice of Jesus or
an angel in the midst of puzzling and threatening events.
b) Context
 Cosmic dimension of
personal suffering
 Battle of spiritual
powers
 Fulfillment of ancient
revelations
c) Externalization of ego-dystonic impulses
Wall painting Rila monastery / Bulgaria
 Psychodynamic
mechanism of guilt
reduction.
 Sexual desires and
erotic sensations as
the experience of
Jesus coming to them
in their sultry dreams.
 Aggressive acts are
“ordered by demons”.
d) Wish fulfillment / Significance
 Love, sexual
fulfillment, harmony
with others,
pregnancy (like Holy
Mother Mary).
 Significance:
important role, being
a prophetesse,
having a mission,
giving one’s life as
an offering to save
the world.
Therapeutic approach
 RESPECT: The patient is first of all, a
suffering individual. Religion may be part of his
or her life, but it is embedded in his or her
existence which is now overshadowed by the
disorder.
 CULTURAL SENSITIVITY:
His or her religious ideas are part of the cultural
background and require further clarification
– Are they expressing fears or unfulfilled desires in an
archetypical way?
– Are they part of his or her subculture?
– Are they functional or dysfunctional?
– Is it possible to ask relatives or colleages to clarify
religious aspects of the delusions?
Clinical Treatment
 Manual-based Diagnosis of the
psychiatric disorder (DSM-IV or ICD-10).
 Medication (Neuroleptics).
 Regular clinical treatment.
 Inclusion of Family for support and
understanding.
 Religious Ideas:
– Do not give overdue attention.
– They will pass in most of the cases without
specific treatment.
Culture and interpretation of delusion
Psychotic
experiences
Shared culture
PAT*
Subculture
Observer
Psychiatrist
Interpretation
Diagnosis
Cultural Sensitivity
Subculture
Private
Professional
Life events
* PAT = The psychotic person shows both functional and dysfunctional aspects of
behavior and ideas, some of which could be called “religious”.
Literature
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Peters E, Day S, McKenna J, Orbach G. Delusional ideation in religious and psychotic
populations. Br J Clin Psychol. 1999 Mar;38 ( Pt 1):83-96.
Gasser R. Religiöser Wahn. Eine katamnestische Untersuchung zu Verbindungen zwischen
religiösem Wahnerleben, belastenden Lebensereignissen
und Überzeugungen religiöser Gemeinschaften. Lizentiatsarbeit an der Philosophischen
Fakultät, Psychologisches Institut II der Universität Zürich 2007.
Erichsen F. (1974). Bemerkungen über das so genannte „religiöse“ Erleben des Schizophrenen.
Nervenarzt 45:191-199.
Henning C. & Belzen J., Hrsg. (2007): Verrückt nach Gott. Zum Umgang mit
aussergewöhnlichen Phänomenen in Psychologie, Psychotherapie und Theologie. Schöningh,
Paderborn.
Siddle R, Haddock G, Tarrier N, Faragher EB. (2002). Religious delusions in patients admitted
to hospital with schizophrenia. Soc Psychiatry Psychiatr Epidemiol. 37:130-138.
Lenz H. (1973). Glaube und Wahn. Fortschritte der Neurologie und der Psychiatrie 41:341-359
Mohr S, Brandt PY, Borras L, Gillieron C, Huguelet P. (2006). Toward an integration of
spirituality and religiousness into the psychosocial dimension of schizophrenia. Am J Psychiatry
163(11):1952-1959.
Kimhy, D., Goetz, R., Yale, S., Corcoran, C., & Malaspina D. (2005). Delusions in individuals
with schizophrenia: Factor structure, clinical correlates, and putative neurobiology.
Psychopathology, 38:338-344.
Stanghellini G. (2005). Schizophrenic consciousness, spiritual experience, and the borders
between things, images and words. Transcult Psychiatry 42(4):610-629.