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Is there a specific religious factor in psychopathology?


Title: Is there s specific factor of religious psychopathology? Author: pfeifers Last modified by: Pfeifer Created Date: 12/11/2002 6:54:42 AM Document presentation ... – PowerPoint PPT presentation

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Title: Is there a specific religious factor in psychopathology?

Is there a specific religious factor in
Dr. Samuel Pfeifer
  • Aarhus 2003

Four models
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

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!"

  • What were the factors leading to the conclusion
  • Faith is making me sick!

  • 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

  • Tendency of (mono-)causal models of
    psychopathology in the religious patient
  • Over-generalisation of the effects of faith on an
    individuals 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
  • 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
  • - What is the nature and the definition of
  • - 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 multi-causal model of the etiology of neurotic

Value Bias
  • hard variables are value-neutral or reflect
    consensually held values (e.g. descriptive
    diagnosis following the ICD-10 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

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.

Current life conditions
childhood stressful life events
Causes of depression
Thinking Belief systems Basic assumptions
BRAIN heredity
Body functions vegetative symptoms
  • 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

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
  • 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 1128)

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
  • 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
  • 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
  • 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
  • "Our study confirmed the observation made in
    individual counseling and psychotherapy, that
    neurosis disturbs religious life, whereas
    positive religiosity contributes towards
    healing. (Hark 1984)

  • a) Psychopathology and severity of disorder
  • b) Life events and coping abilities stress and
    strain in general
  • c) Personal religious life of the client
    (extrinsic and intrinsic factors)
  • d) Social support associated with religious
    factors (e.g. church attendance, counseling
  • 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

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
  • 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

Pfeifer S. Waelty U. (1999) Anxiety,
depression and religiosity a controlled study.
Mental Health, Religion Culture 235-45.
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
External or internalized, general, familial or
religious ideals
Needs Drives Emotions
(Sub)culturalrules und limitations
General life situation Social network Physical/emo
tional constitution
Seven sources of conflict
  • 1. General tendency towards conflictuous
  • 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
  • 6. Dependence on God vs. taking personal
  • 7. Human legalism vs. Christian freedom

  • 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 55281298.
  • Even churches that would be regarded as narrow or
    dysfunctional by average standards, do not
    necessarily produce psychopathology in their
  • 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
  • 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
  • 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

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