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THE SICK SOUL AND BEYOND Religious
interpretations of mental distress Samuel
PfeiferClinic Sonnenhalde, RiehenSwitzerland
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Psychiatric Clinic Sonnenhalde, Basel
Founded in 1900 by a protestant order
(Diakonissenhaus Riehen) Open doors no
restraint Professional clinical psychiatry
combined with Christian values Teaching hospital
of the University of Basel
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The sick soul (William James)

• Those persons who cannot so swiftly throw off the
  burden of the consciousness of evil, but are
  congenitally fated to suffer from its presence.
• for whom evil is no mere relation of the subject
  to particular outer things but something more
  radical and general, a wrongness or vice in his
  essential nature, which no alteration of the
  environment, or any superficial rearrangement of
  the inner self, can cure, and which requires a
  supernatural remedy.

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Three conditions

• Melancholy depression
• Obsessive-scrupulous doubt
• Panic fear
• No reference to psychotic disorders and
  delusional states
• No reference to dissociative states

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Descriptive approach

• Please observe that I am not pretending to judge
  any of these attitudes. I am only describing
  their variety.
• William James, p. 144

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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
Tolstoy, Confessions

• The questions of Why and What for? beset him
  more frequently These questions of Why and
  Wherefore and What for found no response.
• William James

WHY?
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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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Mosaic of Causal Attributions
Bio-psycho-socialModel
Conflicts fromIndividualExperience
Cultural Traditions
Alternative Body Theoriesand Diets
ReligiousConvictions

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

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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Conclusions

• The construction of meaning on the background of
  sub-cultural values is a universal phenomenon.
• Help-seeking behavior
• Physicians, healers and counselors are unwitting
  partners in health care
• Cultural sensitivity
• Utilizing functional aspects of religion in a
  patients coping process

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