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• Religion - the actual practice of a faith, e.g. going to a temple, mosque, church or synagogue
• Spirituality - the belief that there is some power or force other than themselves that might influence their life.
• Christianity - a particular faith tradition which qualifies as both a religion and as spiritual belief and/or experience ←

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• The potential conflicts between psychiatry and religion, as well as the potential areas for meaningful conversation and cooperation cannot easily be grasped by discussing generic "religion" or "spirituality".
• Christianity (in its various forms) is the most frequently acknowledged faith tradition in the United States.

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• Freud initiates the conversation
  • Was convinced that religious beliefs and experiences derived solely from human needs and desires (Feuerbach)
  • Was convinced that religion had no objective reality
  • Challenged the life story of individual Christians (sin and redemption recast)

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"A personal god is, psychologically, nothing other than an exalted father. Religiousness is to be traced to the small human child’s long-drawn-out helplessness in need of help; and when later in life he perceives how truly forlorn and weak he is when confronted with the great forces of life, the adult feels his condition as he did in childhood."

The Future of an Illusion

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However, Freud:

• Was cared for by a Catholic Nanny
• Carried on a genial correspondence with a protestant minister, Oscar Pfister (perhaps the most congenial ongoing relationship with a colleague during his lifetime)
• Carried on an intriguing correspondence with Romain Rolland (Nobel Prize), a French writer, mystic, about the "oceanic feeling".

 

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"If Freud could have realized how basic a component of human freedom anxiety is... it would have become apparent that all the aberrations with which he deals are not the consequence of the repressions of his ‘super-ego’ but arise out of the very character of human freedom."

Niebuhr (1941)

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• This cooperative attitude gave way in large part during the 1960s to a perception of Christians as unsophisticated, archaic and restrictive in beliefs by psychiatrists.
• Evangelical Christians, in turn, launched a frontal attack upon psychiatry as being atheistic, encouraging unbounded sexual freedom, and extinguishing the feeling of guilt.

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"There are no scientific studies which show that religion is capable of serving mental health."

Sanua, American Journal of Psychiatry, 1969

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"the Christian counselor ... should see no need ... to defer to a self-appointed caste of men called psychiatrists who have pontifically declared that their province necessarily extends beyond his own."

Jay Adams: Competent to Counsel, 1970

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• Psychiatry and Christianity have never experienced better superficial relations. Each has accommodated and, to some degree, assimilated the other.
  • Psychiatry rarely does battle with Christianity but rather has moved to recognize and utilize spiritual strengths, both individual and communal.
  • Christianity, in turn, has assimilated many psychiatric techniques (and the theories behind these techniques), such as cognitive/behavioral therapy.

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The inherent tension between modern psychiatry and Christianity has given way to a comfortable segmentation.

The materialism of psychiatry more often ignores than challenges the spiritual dimension of humankind.

The "spirituality" of Christianity tends to ignore the influence of the body upon the mind and soul.

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"I concentrate on the details of the Burgess Shale because I don't believe that important concepts should be discussed in the abstract ... God dwells in the details, not in the realm of pure generality ... all those pretty pebbles on the shoreline ... the ocean of truth washes over the pebbles with every wave, and they rattle and clink with the most wondrous din." Gould, Wonderful Life

 

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"to really understand a human experience, it must be appreciated from the subjective point of view of the person undergoing it ... the meanings attached to objects, events and situations are not built into them. Instead, they are products of our responses to them ..."

Stephen Karp, Speaking of Sadness

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"the case of depression almost demands reflection on questions of identity and self transformation. Questions about the origins of self, its consequences for behavior, and its changes over time are among the most central ... Because depression is often defined precisely as an illness of the self ... it constitutes ... a case study for considering how individuals arrive at illness definitions and then reconstruct their identities accordingly."

Karp, Speaking of Sadness

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"Be gracious to me, O Lord, for I am in distress; my eye is wasted from grief, my soul and my body also. For my life is spent with sorrow and my years with sighing; my strength fails because of my misery, and my bones waste away ... I have passed out of mind like one who is dead ... But I trust in thee, O Lord."

Psalms 31:9, 10, 14

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"Depression is a disorder of mood, so mysteriously painful and elusive in the way it becomes known to the self - to the mediating intellect - as to verge close to being beyond description. It thus remains nearly incomprehensible to those who have not experienced it in its extreme mood, although the gloom, "the blues" which people go through occasionally and associate with the general hassle of everyday existence are of such prevalence that they do give many individuals a hint of the illness in its catastrophic form."

Yet these deep felt emotions are overlooked or discounted.

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Five or more of the following symptoms have been present during the same two-week period and represent a change from previous functioning - depressed mood or loss of interest or pleasure (must be present), weight loss, insomnia or hypersomnia, psychomotor retardation or agitation, fatigue or loss of energy, etc.

"Does the patient meet criteria?"

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"Now that depression has reached virtually epidemic proportions nationally ... Of one thing I am confident: you do not have to be depressed ... I am convinced that by using the formula in this book, you can avoid ever being depressed again."

LaHaye, How to Win over Depression

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See Blazer, Freud vs God: How Psychiatry Lost Its Soul & Christianity Lost Its Mind, 1998.

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• Decade of the Brain (1990s) and the rise of neuroscience
• Empirical studies of psychopathology
• Psychopharmacology
• Evidence based practice guidelines
• The advent of many new medications
• New psychotherapies (CBT)

however ...

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• The disappearance of Freud
• Brain vs. Mind
• The limits of the medical model
• Looking for rather than listening to emotional distress
• The rise of numbers (score on a scale) and the decline of intuition
• The hegemony of medications
• The loss of narrative

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"I was surprised at the virulence of the animosity expressed toward psychiatrists. Individuals saw psychiatrists as oppressively evangelistic 'true believers' in biochemical causes of depression, a view that they didn’t hold ... The gap between the expectations that patients bring to psychiatric professionals and what their doctors can actually deliver may be so great that disillusionment is inevitable ... Patients want understanding, warmth, even love. Instead they find detached professionals who often do not even inquire about their feelings, only their smptoms ..."

(Karp)

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Background

The fundamentalist reaction to liberal theology

The ascendance of modern evangelicalism

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Detached from the western intellectual tradition

Promotes individualism and self-control

Positive in outlook

Market oriented

Often formula driven - educational approach to problems

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• The church has lost its tradition of life as a pilgrim’s progress
• The church has not struggled with our current understanding of neurosciences
  • The two realms and their relationship (mind/soul/spirit and brain/body)
• Handbooks and manuals have replaced the willingness to meet and deal with complex and ambiguous problems

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• The church often has more the atmosphere of a country club than "God's hospital"
• The church has too readily accepted medications as a "fix" for emotional problems
• The church has too easily been seduced by the authority of science to demonstrate the "value" of faith

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• Patient center care by non-psychiatric physicians
• The new age movement
• The "soul" doctors (Scott Peck, Thomas Moore, etc.)
• Self-help groups (e.g. AA, Weigh down workshop)
• The scientific study of religion

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Can our professional values be maintained without a conscious recognition of their origins in the Judeo-Christian tradition as well as the other great religions? Doesn’t this suggest that at least one reason psychiatry and religion should be in continuing and important dialogue?

Joseph English, former President of APA

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Back to the particulars

Particular patients/parishioners

Particular problems (struggling with the meaning of life in the midst of a depression)

Particular conversationalists (ministers and psychiatrists across faith traditions, educational backgrounds, race/ethnicity, etc.)

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• Psychiatrists and pastors are different (first thing we share is that there is much we don’t share)
• Psychiatrists vary in faith traditions, so do Christians

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• Humankind exists in a state of striving for meaning (witness Edmund Wilson).
• Emotional suffering must be understood from the perspective of the person suffering (depression is perhaps more an illness than a disease)
• Emotional suffering occurs within a person’s life history (including religious/spiritual history)
• Personal histories evolve within the context of relationships

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• The care and the cure of emotional suffering are shared within a society (in the care of the severely depressed Christian, psychiatrists and the church work together whether they know it or not).
• Theory cannot lag far behind practice (otherwise things fall apart).
• Islands of community can be found in the sea of diversity (and this is perhaps one way of viewing the local church).

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