Psychiatrist vs. Christianity

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I heard that a psychiatrist from Columbia made the statement that Christians are evil. I wish I had more details about what actually was said and in what context. I heard this from a Christian physician who was trying to make the point that Christians are persecuted and that "theirs is the kingdom of heaven," as a result of being persecuted for their faith (as stated in the sermon on the mount).

Does anyone know anything about this? Does the fact that a lot of psych patients believe that they are Jesus affect your view of Christianity? Do you think becoming a psychiatrist had any impact on your faith or lack thereof?

This could potentially be a sensitive topic so I encourage respectful and non-offensive posts.

 

[DropkickMurphy]

As a practicing Christian, I don't find it offensive, because I believe that a LOT of people who claim to be Christian do so only for their own benefit and tend to not follow the teachings. Evil? Probably not in most cases.

Actually I'm more offended by the idiot who thinks he's guaranteed a spot in Heaven for this "persecution". OK....yeah....a minority of people disagreeing with you doesn't make it persecution. When you're being fed to wildlife, nailed to rough hewn lumber or otherwise tortured- that is persecution.

 

[OldPsychDoc]

There is a lot of bad blood between psychiatry and Christianity, some of going back to Freud and interpretations of his "belief system". It sounds like the statements you heard were coming from a person bent on polarizing the issue--just as a radical creationist might quote Richard Dawkins or an equally radical evolutionary scientist to gain sympathy for his cause, rather than exploring the complex beliefs of many scientists who might also be practicing Christians.

Anyway, don't write off the whole profession (or the whole religion, please) because of a sound bite. I have worked with psychiatrists and therapists of many religious bents. It's not a big deal unless you make it so. Even my atheist colleagues treat the belief systems of their believing patients with respect. There are times when a patient desperately wants to know that you believe. I try to maintain professional neutrality and healthy boundaries, but there are times when I wish I could "prescribe" belief. I always encourage my patients to develop a healthy spirituality, and to build supportive relationships in their spiritual community. If they want me to pray, I refer them to the hospital chaplain or to their own clergy, even if I am praying silently that I CAN help them to get better.

Delusions are just that--delusions. Fixed false beliefs not consistent with a cultural norm. If someone believes that Jesus lives in their heart, that's consistent with their subcultural norm, and it might be a "hook" to help them grow a healthier sense of self. If they believe that they ARE Jesus, then it's delusional, and related to the reason they are in my office.

 

[atsai3]

Does anyone know anything about this? Does the fact that a lot of psych patients believe that they are Jesus affect your view of Christianity? Do you think becoming a psychiatrist had any impact on your faith or lack thereof?

I don't know anything about the specific incident to which you are referring.

Here are two books about religion and psychiatry that you may find helpful:

The Question of God: C.S. Lewis and Sigmund Freud Debate God, Love, Sex, and the Meaning of Life, by Armand Nicholi (click here for Harvard Gazette article for more information about the book)

and

Freud vs. God: How Psychiatry Lost Its Soul and Christianity Lost Its Mind, by Dan Blazer (click here for Am J Psych review by Peter Kramer)

Cheers,
-AT.

 

[atsai3]

-

 

[whopper]

So some psychiatrist made some wise-ass crack which smacks of histrionic traits.

Without more info I can't judge. IT could be for whatever reason this comment may have even been justified given the context.

But 1 psychiatrist does not represent the psychiatric community just like Peter Breggin, a psychiatrist, actively criticizes the way modern psychiatry is practiced.

"Does the fact that a lot of psych patients believe that they are Jesus affect your view of Christianity? Do you think becoming a psychiatrist had any impact on your faith or lack thereof?
"
1) I haven't had 1 patient think he was Jesus. I did have one believe he was the Archangel Michael. So? Every faith/culture will have grandiose people who believe they are religiously higher than ohters.
2) did it have an impact? Yes, but not to a major degree. I still question if there is life after death, but most of my questions in that field were not answered by psychiatry but by other fields of science before I studied psychiatry. Psychiatry if anything just fine tuned it a bit.

 

[manwhoisthursdy]

I heard that a psychiatrist from Columbia made the statement that Christians are evil. I wish I had more details about what actually was said and in what context. I heard this from a Christian physician who was trying to make the point that Christians are persecuted and that "theirs is the kingdom of heaven," as a result of being persecuted for their faith (as stated in the sermon on the mount).

Does anyone know anything about this? Does the fact that a lot of psych patients believe that they are Jesus affect your view of Christianity? Do you think becoming a psychiatrist had any impact on your faith or lack thereof?

This could potentially be a sensitive topic so I encourage respectful and non-offensive posts.

Why not resurrect (no pun intended) an old thread?

I remember at the annual APA meeting a couple years ago Dr. Nicholi (author of a book about Freud and CS Lewis) gave a presentation about Freud and Oskar Pfister. Pfister was a good friend of Freud's (always, I believe -- there was no rift between them). He was also a Lutheran clergyman and a lay psychoanalyst who studied under Freud.

In response to one of Freud's works critical of religion, The Future of an Illusion, Pfister wrote a work called The Illusion of a Future. I wish I could find it to read, but no luck.

Anyway, the point of this all being that while psychiatry traditionally has some "anti-Christian" elements, there have been others interested in and practicing forms of psychiatry who from the beginning have not been hostile to, and even defended, traditional religion.

Dr. Nicholi also gave an analysis of the ambiguity of Freud's own views, citing, for example, the vast number of religious phrases Freud used in his own works.

In my own experience I've known psychiatrists who are very hostile to Christianity in a "traditional Freudian" way. But I know of a psychiatrist who was a Christian missionaries before he became a psychiatrist. I know of several psychiatrists who are priests (Catholic and otherwise). Some psychiatrists are very interested in Eastern religions (as Westerners) or continue to practice Eastern religions (as people brought up in those traditions). And of course I know psychiatrists who couldn't care less about religion and just try to respect the beliefs of those who do seem to think it important.

 

[toby jones]

I think that it would be fair to say that in the United States of America athiests are discriminated against more than christians are. Americans are guaranteed freedom OF religion, but not freedom FROM religion, for example.

Some 'bio-psycho-social' models enlarge things still more so that they are 'bio-psycho-social-spiritual' models. One must wonder how much absense of spirituality would be regarded problematic the way that absence of social connections is regarded as problematic currently.

There is an 'exclusion criteria' on delusions such that the belief must be different from that endorsed by the persons culture / sub-culture. This can't be right, however, as we want to say that sometimes people suffer from 'mass delusions' and that it is surely possible for an entire culture / sub-culture to suffer from delusion (such as the delusion that the aliens are going to come tomorrow night and if we all kill ourselves then they will take us directly to heaven).

It is hard to draw the line between delusion and religious beliefs. E.g., 'I'm literally drinking the blood of Jesus' (catholic doctrine of transubstantiation etc). It can be similarly hard to draw the line between delusion and scientific beliefs. E.g., 'I believe the future will be like the past even though I have no evidence for that'. 'I believe that there is an external world that roughly matches the way things appear to me - even though I have no evidence for that'. Try believing the converse (that the world will end tonight, or that there isn't an external world) and you will be considered delusional, however.

Basically... Psychiatry is trying to be sensitive to different cultures. But... There doesn't seem to be a principled way of drawing the line... Seems that we need to trust them... And seems that there is indeed a value to realising how evaluative or normative the judgement of 'delusion' is - such that we can hold those evaluative / normative aspects up to scrutiny rather than being under the false impression that whether someone is delusional or not is determined by 'objective facts' rather than the norms of our society (where of course tolerance of other cultures beliefs is becoming one of those norms)

 

[whopper]

1) I haven't had 1 patient think he was Jesus. I did have one believe he was the Archangel Michael

Since my last post I've now had 4 think they were Jesus.

Religion can be good or bad. I'd hate to think people in our field have split enough to join a "war". There are of course bad things about any religion, but to condemn a religion across the board is not fair.

However, we maybe shouldn't be putting too much stock in the supposed comment from a Columbia psychiatrist. We don't know if it really happened, and if it did, we don't know the context.

 

[manwhoisthursdy]

I think that it would be fair to say that in the United States of America athiests are discriminated against more than christians are. Americans are guaranteed freedom OF religion, but not freedom FROM religion, for example.

This is certainly debatable. I won't try to establish a counter-argument or anything here; I just want to point out that someone who is not religious would find the above statement true, and a traditionally religious Christian/Muslim/Jew is much more likely to disagree and believe that adherents of traditional religion suffer more discrimination. It's hard to measure such a thing! Examples abound on both sides.

It is hard to draw the line between delusion and religious beliefs. E.g., 'I'm literally drinking the blood of Jesus' (catholic doctrine of transubstantiation etc). It can be similarly hard to draw the line between delusion and scientific beliefs. E.g., 'I believe the future will be like the past even though I have no evidence for that'. 'I believe that there is an external world that roughly matches the way things appear to me - even though I have no evidence for that'. Try believing the converse (that the world will end tonight, or that there isn't an external world) and you will be considered delusional, however.

I think you focus too much on the fact that delusions are false (which they are) and without corroborating evidence. There's a lot more to it: delusions are meaningfully psychopathological -- they are symptoms that reflect and point us to illness. Dogmatic is different -- healthy people throughout history have believed in things such as "the future will be like the past" or "the Bible is the inspired Word or God" or "my place in my next life will be determined by my conduct in previous lives."

Sims, in Symptoms of the Mind (I love this book by the way), gives some criteria distinguishing religious belief and delusion. They seem to me to be, beyond interesting, very useful.

Religious belief tends to be

1. Metaphorical/spiritual. I might believe "Christ lives in me," but I don't believe that some dude is actually in my body somewhere. Schizophrenic patients tend to have concrete and over-inclusive thinking, not fine spiritual distinctions.

2. Freeing. A religious person usually sees their belief as making them "more free," "better able to do what one wants to do." This is very different from the first-rank delusions in Schizophrenia which are often delusions of passivity.

3. Religious experience provides and sustains meaningful activity. Religious people, based upon beliefs, go and write books, build synagogues, preach in a coherent way that attracts others. Patients with delusions often have difficulty initiating and maintaining even everyday goal-directed activity.

4. Unlike with delusions, in religious belief there is a preservation of ego integrity. The believer also follows a source of religious authority, not delusional evidence. If I believe the Koran is dictated by God, so I believe stuff in it ... that makes sense. If I believe I am the true heir to the throne of the United Kingdom because my neighbor commented on my tattoos ... that's delusional percept.

5. Religious beliefs are held alongside doubts. Even very devout Muslims/Buddhists/Catholics/etc can (almost always) say to themselves, "I believe these things, but I can imagine things being different." But for a delusional person, you might as well ask them to question the existence of the chair they are sitting on.

Delusional patients, additionally,

1. Often have other symptoms of psychopathology: hallucinations, thought disorder, mood disorder, etc.

2. Show a lifestyle, behavior, etc. that are consistent more with the natural history of mental disorder as opposed to a personally enriching life experience.

Conclusion: there is a difference between delusion and religious belief. And it's NOT about content or culture/subculture ... delusions can be religious, and religious beliefs obviously can be false. It's the about the form of the belief ... the cognitive and perceptive changes that lead to the formation of the belief -- why and how that belief is held.

If we confuse delusion and religious belief based upon a general feeling of suspiciousness towards religion, we are doing a huge disservice to our patients! The religious beliefs of the treater should be irrelevant here ...

 

[strangeglove]

There is an 'exclusion criteria' on delusions such that the belief must be different from that endorsed by the persons culture / sub-culture. This can't be right, however, as we want to say that sometimes people suffer from 'mass delusions' and that it is surely possible for an entire culture / sub-culture to suffer from delusion (such as the delusion that the aliens are going to come tomorrow night and if we all kill ourselves then they will take us directly to heaven).

A mass delusion, if that is what you want to call religion, should not be mistaken for a mental illness. It's not simply about what you can fit into a logical argument about what is and what isn't a mental construct (i.e. a delusion). It's about whether or not someone has some sort of brain dysfunction that disconnects them from their social network. This is revealed not only by delusions, but also by disorganized thought and behavior. That, in my opinion, is the essence of being psychotic and what keeps you from having job or connecting with your family/friends. The delusions are really the icing on the cake.

Also, there is this notion that many people who are having delusions may actually be "prophets" who are having "visions," and that because we view such people as mentally ill, we are missing out on being delivered from all of this bad stuff that we are into these days. To that, I say: Let's allow for a moment that the next Moses/Jesus/Mohammed/Budda is around today and actually was talking to God and teling people about it on a street corner. I'm guessing that when you did your mental staus exam on this prophet in the ER they wouldn't appear disorganized or disheveled; they would have good judgement and insight ("I know that in this society I must appear mad for saying what I's saying, and I understand the need for you to keep me here against my will, but this is my holy mission.") and you would actually be able to have a coherent conversation with them. You might even be drawn in by what they had to say. You have to give prophets the benefit of the doubt that they are not just crazy people who sit in caves and talk to God and then babble what they heard on street corners/mountaintops. They are highly dynamic and intelligent (i.e. organized) people who are deeply connected with other people (at least when they're not sitting under a fig tree and fasting). Indeed, some argue that this is all they are. This would disqualify them from being psychotic, in my opinion. My point is that psychosis is more than just delusions; it's a severe disconnect of one person's mind from the prevailing reality structure.

 

[manwhoisthursdy]

Thank you strangelove ... that's what I was trying to get at, from a different angle, in my post

 

[toby jones]

The reason why I said that in the USA there is more discrimination against athiests was on the basis of the following poll:

http://hotlineblog.nationaljournal.com/archives/2007/02/usa_todaygallup_1.html

The majority of people in the USA identify themselves as being 'Christian' and thus to talk about persecution within the USA against, what is in effect, a majority, seems a little off to me...

Don't get me wrong people can *feel* like they are being persecuted for a variety of reasons. I wasn't talking about *feelings* of being discriminated against, however, I was talking about actual practices of discrimination (as is objectively measured by things like those polls).

> I think you focus too much on the fact that delusions are false (which they are) and without corroborating evidence.

Not all delusions are false. A person who complains persistently that their partner is cheating on them can have a delusion that their partner is cheating on them whether or not their partner is cheating on them as a matter of fact. It is fairly common that the persistent belief 'my partner is cheating on me' actually goes some way toward making it more likely that the persons partner will come to cheat on them. This is the standard example in the literature to illustrate that not all delusions are false.

> I might believe "Christ lives in me," but I don't believe that some dude is actually in my body somewhere.

The Catholic doctrine of transubstantiation is that one is LITERALLY drinking the blood and eating the body of Jesus. As such, Jesus is LITERALLY going into my mouth and making its way down my throat.

> A religious person usually sees their belief as making them "more free," "better able to do what one wants to do." This is very different from the first-rank delusions in Schizophrenia which are often delusions of passivity.

A religious person typically sees themself as 'following what God has revealed to them' E.g., in not committing adultery because the bible tells them so. This seems to me to be similarly passive.

> Religious experience provides and sustains meaningful activity. Religious people, based upon beliefs, go and write books, build synagogues, preach in a coherent way that attracts others. Patients with delusions often have difficulty initiating and maintaining even everyday goal-directed activity.

This fails to distinguish between Religions (non-delusional) and the activities of Cults (where the leaders are often involountarily treated as delusional).

All this is by way of saying... That the criteria is insufficient to distinguish delusion from religious belief. I'm not at all trying to say that there ISN'T a distinction - All I'm saying is that we don't have a good grip on the distinction at present.

There is some evidence that 'Religiousity' is correlated with TLE. Does this make 'religiousity' pathological? Or... Does it depend on whether a society values 'religiousity'? I'm thinking... It is more dependent on the latter than on anything else.

I'm saying that people don't have to worry about people being involountarily treated / locked up for their christian beliefs since the culture in the USA is such that such beliefs are valued by the majority. Minorities are the groups who should be the most concerned.

Science can't tell us the difference between whether someone has a 'malfunction' or a 'dysfunction' or is merely 'differently functioning'. Whether someone is considered 'disordered' compared with 'different' is a function of our values. Sometimes our values are in synch enough such that we don't even appreciate that there is an evaluation there. E.g., 'conditions that lead to likely death are BAD for the person and we SHOULD intervene if possible'. Othertimes there is a clash of values and then we see that actually, this is an evaluative rather than a factual issue.

 

[manwhoisthursdy]

The majority of people in the USA identify themselves as being 'Christian' and thus to talk about persecution within the USA against, what is in effect, a majority, seems a little off to me...

Don't get me wrong people can *feel* like they are being persecuted for a variety of reasons. I wasn't talking about *feelings* of being discriminated against, however, I was talking about actual practices of discrimination (as is objectively measured by things like those polls).

1. I hope you're not being condescending. Many of traditional religions (majority or minority) "feel" they are persecuted in the sense that they "believe it based upon their own experience." 2. A majority can obviously be persecuted when minorities have power. In certain places (universities, public schools) it can be argued that decision makers are rarely of the same mind as traditional believers. Persecution is about power and intolerance, *not* about a numbers game. The upper classes have almost always been smaller in # than those they have oppressed, in various cultures and times.

Not all delusions are false.

Agreed.

The Catholic doctrine of transubstantiation is that one is LITERALLY drinking the blood and eating the body of Jesus. As such, Jesus is LITERALLY going into my mouth and making its way down my throat.

The doctrine of transubstantiation also teaches that it is the substance, not the accidents, which change. It is *literally* true but NOT *physically* or *chemically* so. Catholics fully realize the host tastes like bread, looks like bread, would look like bread under a microscope, etc. So although you could say it's non-falsifiable, you can't say it's a belief held against any contrary evidence. Jesus' presence according to this belief is also SPIRITUAL though LITERAL AND REAL (remember, many people believe spiritual things, like God and angels, are real ... real doesn't mean it has to be physical). Enough about the details of the doctrine ... if you can't see the difference between Christs' true spiritual presence in the Eucharist and the belief that Christ is physically occupying space next to one's gallbladder, I don't know what else to say.

A religious person typically sees themself as 'following what God has revealed to them' E.g., in not committing adultery because the bible tells them so. This seems to me to be similarly passive.

Choosing not to do something because you want to follow God's commandment is hardly a passive delusion! Schizophrenic first-rank passive delusions include ideas such as "I didn't even move my arm, something else made me move it"; "I didn't think that thought, someone inserted that thought into me from without"; "I didn't want to smash that window, but something put that irresistable impulse within me." Still seem similarly passive??

> Religious experience provides and sustains meaningful activity. Religious people, based upon beliefs, go and write books, build synagogues, preach in a coherent way that attracts others. Patients with delusions often have difficulty initiating and maintaining even everyday goal-directed activity.

This fails to distinguish between Religions (non-delusional) and the activities of Cults (where the leaders are often involountarily treated as delusional).

This criteria alone does not make the distinction ... but of course no one criteria is perfect. My point is that seen as a whole, there are a wide variety of differences between religious belief and delusion.

There is some evidence that 'Religiousity' is correlated with TLE. Does this make 'religiousity' pathological? Or... Does it depend on whether a society values 'religiousity'? I'm thinking... It is more dependent on the latter than on anything else.

Not sure why you mentioned the link with TLE ... but the point I'm trying to stress is that while I do admit there may be an overlap, there are vast areas of religious belief that are clearly not delusional, and a vast area of delusional thinking that is clearly pathological and not simply religious belief. As you mentioned above ... if you really can't see the difference between "I don't eat pork because it is forbidden by the Koran" and "I can't eat because some other force is controlling my actions and won't let me pick up the fork even though I try" ... well I find it hard to believe! The major phenomenological difference is that the Muslim could say "I could eat pork, physically, but I won't ... haha, if I couldn't at all, there wouldn't even be a need for the commandment against it."

I'm saying that people don't have to worry about people being involountarily treated / locked up for their christian beliefs since the culture in the USA is such that such beliefs are valued by the majority. Minorities are the groups who should be the most concerned.

This is sort of an aside ... I would argue strongly that we should respect all religious belief. I certainly disagree that those who adhere to majority beliefs are never discriminated against, as I mentioned above. No one is even truly in the majority ... even Christians are not a monlith, and have a variety of different attitudes and practices. Speaking in tongues? A minority. Orthodox Christians? A minority. Traditionalist Catholics? Minority. Episcopalians? A minority. You also seemed to ignore (I'm sure not with any motive) what I wanted to emphasize in my last post ... even if we lump Christians together, which we shouldn't ... what about Orthodox Jews and other religous traditional minorities? What I'm trying to say about belief vs. delusion applies to them also ... we should not conflate true pathology with belief, and there are ways to distinguish the two that do not rely on the arrogance of the psychiatrist ... "that patient believes differently so he must be delusional ... or that patient takes religion more seriously than I do ... so he must be hyperreligious."

Science can't tell us the difference between whether someone has a 'malfunction' or a 'dysfunction' or is merely 'differently functioning'. Whether someone is considered 'disordered' compared with 'different' is a function of our values. Sometimes our values are in synch enough such that we don't even appreciate that there is an evaluation there. E.g., 'conditions that lead to likely death are BAD for the person and we SHOULD intervene if possible'. Othertimes there is a clash of values and then we see that actually, this is an evaluative rather than a factual issue.

No disagreement with this! That's why it's so important to understand the different nature, cognitively and psychopathologically, of religious delusion and religious belief. So we don't fall into the trap of labeling patients based upon our own value judgments.

 

[Chimed]

One thing that is missing in this discussion is that the definition of a delusion includes something that can not be altered by rational argument AND cannot be accounted for by the cultural background of the individual.

Not all delusions are false. A person who complains persistently that their partner is cheating on them can have a delusion that their partner is cheating on them whether or not their partner is cheating on them as a matter of fact. It is fairly common that the persistent belief 'my partner is cheating on me' actually goes some way toward making it more likely that the persons partner will come to cheat on them. This is the standard example in the literature to illustrate that not all delusions are false.

In my opinion, your example is splitting hairs with the definition. A person can have a delusion that is "nonbizzare" and that has some logic to it. As your example suggests, one scenario would be the case of real life event, such as an unfaithful spouse. This would be considered a delusional disorder, erotomanic type. The fact that the partner eventually started cheating on that person does not circumvent the false belief that existed before it happened. Also, we are assuming the first partner had absolutely NO reason to suspect an affair. If there was, then we're dealing with something different.

The Catholic doctrine of transubstantiation is that one is LITERALLY drinking the blood and eating the body of Jesus. As such, Jesus is LITERALLY going into my mouth and making its way down my throat.

I'm not Catholic, so maybe someone else can comment on this. But I seriously doubt too many Catholics that do subscribe to the literal drinking of the blood and body of Christ would agrue that a scientific study of the blood and bread would reveal literal blood and body parts, such as RBC's and DNA. Why is that important? Because as manwhoisthursday suggested, you have to take the belief in context of the person's entire cognitive throught process and content. Also, the definition of delusion includes beliefs that represent one's cultural background, as stated above.

All this is by way of saying... That the criteria is insufficient to distinguish delusion from religious belief. I'm not at all trying to say that there ISN'T a distinction - All I'm saying is that we don't have a good grip on the distinction at present.

Your point is well taken and is valid. However, I respectively disagree that the definition doesn't hold up. If one is going to rigiditly adhere to a definition, then perhaps in some way you are right. But I think that most good clinicians are able to put the peron's beliefs in context of their overall thought process, as others have already elborated on. If not, then I think one could argue that a strict atheist is also having delusions. An atheist assumes that there is abosuletly no possibility of a God, despite the fact that this belief can not be proven. So, in many ways being an atheist is a sort of religious belief, but I don't think too many people would start saying that atheists are delusional.

 

[Chimed]

I know of several psychiatrists who are priests (Catholic and otherwise)

In the spirit of the season, can anyone name this famous Priest/Psychiatrist hero (on your left) and the movie?

 

[PeeWee137]

the exorcist?

 

[whopper]

Paul Fink, M.D. (if you don't know him, he's quite a pillar in the psychiatric community) has an interesting article on doctors who refer to clergy instead of psychiatrists when the psychiatrist should've been the referral. Its in the latest clinical psychiatry news.

 

[manwhoisthursdy]

Paul Fink, M.D. (if you don't know him, he's quite a pillar in the psychiatric community) has an interesting article on doctors who refer to clergy instead of psychiatrists when the psychiatrist should've been the referral. Its in the latest clinical psychiatry news.

I read something about survey (not sure if it was also done by Fink) with that exact finding ... referral to clergy. Factors may be patient attitude (which you can't force, but can educate at least), but also the attitude of the referring physician, which is unfortunate.

I do think there is an appropriate way to work with clergy, not as a substitute for mental health treatment of course, and only on a case by case basis. I do think, however, that part of this is the fault of mental health practitioners -- religious physicians and patients should not fear that by considering psychiatric treatment they are throwing themselves into an atheist strict Freudian anti-religious field where their beliefs will be ignored (or even criticized) and they will be forced to redefine their thinking along a "rational" and "non-deluded" (i.e., irreligious) paradigm if they want help. I'm certainly not saying that psychiatry is like this ... I'm saying that this perception exists.

I'm speaking from the perspective of someone who belongs to a religious community -- when I tell my fellow members about my plans to train in psychiatry, I often hear this concern from them. I also hear, "we need more _________ psychiatrists" ... though I don't know if I specifically agree that we need more psychiatrists with my religious views, what I think is behind that remark is, "we need more psychiatrists who will understand and respect _______ view."

 

[strangeglove]

the exorcist?

Correct. Father Damien Karras, priest, psychiatrist. Also, Father Lancaster Merrin, priest, archaeologist. What a great movie. Very relevant to the present discussion, in fact.

 

[Chimed]

Correct. Father Damien Karras, priest, psychiatrist. Also, Father Lancaster Merrin, priest, archaeologist. What a great movie. Very relevant to the present discussion, in fact.

I'm not a big fan of horror films, but you've got a love a film where one of the main characters is a Priest-Psychiatrist!

I got the quote below off the web. It describe one of the interactions between the a group of psychiatrists and the victim's mother...Can you imagine this conversation taking place at your psych hospital???
-------------------------------------------------------------------
Dr. Barringer, Clinic Director: [looking at Regan on the monitor screen] It looks like a type of disorder that you rarely ever see anymore, except in primitive cultures. We call it a somnambuliform possession.
Dr. Barringer, Clinic Director: [Regan has welts on her face and is screaming] Quite frankly, we don't know much about it except that it's starts with some conflict or guilt that eventually leads to the patient's delusion that his body's been invaded by an alien intellegence; a spirit if you will.
Chris MacNeil: Look, I'm telling you again and you'd better believe it, I'm not about to put her in a goddamn asylum! And I don't care what you call it! I'm not putting her away!
Dr. Barringer, Clinic Director: I'm sorry.
Chris MacNeil: You're sorry. Christ, eighty-eight doctors and all you can tell me is all of your bulls%$t...
Dr. Barringer, Clinic Director: There is one outside chance of a cure. I think of it as shock treatment. As I say, there is an outside chance...
Chris MacNeil: Will you just name it, for God's sake? What is it?
Male Doctor: Do you have any religious beliefs?
Chris MacNeil: No.
Female Doctor: What about your daughter?
Chris MacNeil: No, why?
Dr. Barringer, Clinic Director: Have you ever heard of exorcism?
Dr. Barringer, Clinic Director: [Chris looks at him baffled] It's a stylized ritual in which rabbis or priests try to drive out the so-called invading spirit. It's pretty much discarded these days, except by the Catholics who keep it in the closet as a sort of embarrassment. It has worked, in fact, although not for the reason they think, of course. It was purely the force of suggestion. The victim's belief in possession helped cause it; and just in the same way this belief in the power of exorcism can make it disappear.
Chris MacNeil: You're telling me that, I should take my daughter to a witch doctor? Is that it?

 

[toby jones]

> I hope you're not being condescending.

Not at all.

> Many of traditional religions (majority or minority) "feel" they are persecuted in the sense that they "believe it based upon their own experience."

Sure. But a 'feeling' of persecution doesn't entail that one is in fact persecuted.

> A majority can obviously be persecuted when minorities have power.

Agreed. I hadn't really thought of that, but of course you are right. Even if the majority of people in Russia were political dissentors, I guess what would have happened in that situation would have been that the p-docs would have maintained that there was an epidemic of 'sluggish schizohrenia' in Russia...

> if you can't see the difference between Christs' true spiritual presence in the Eucharist and the belief that Christ is physically occupying space next to one's gallbladder, I don't know what else to say.

The difficulty isn't whether I can see a difference or not - the difficulty is in whether there is an objective and systematic difference or not.

> This criteria alone does not make the distinction ...

That was all I was trying to say. We have this 'intuitive' distinction between non delusional and delusional and I'm asking for the principled distinction. No current criteria seems up to the task. The problem then becomes: Is there a principled difference? What is to determine that Russian psychiatrists were wrong when they diagnosed political dissentors as having sluggish schizophrenia? What is to determine that the guy who suggested drapetomania (desire for slaves to escape their master) was wrong? What is to determine that the decision to remove homosexuality was right? What is to determine whether addiction or sociopathy are moral failings, legal problems, or psychiatric problems? I'm looking for a principled distinction and while you can cite your 'intuitions' your intuitions are a function of your culture. And what determines that your cultural practices are authorative with respect to 'disorder' vs 'difference'? I'm looking for a principled distinction...

> My point is that seen as a whole, there are a wide variety of differences between religious belief and delusion.

And my point is that those distinctions break down.

> Not sure why you mentioned the link with TLE ...

Because of the possibility that religious experiences / religiousity is due to a disorder / dysfunction (temporal lobe epilepsy). but even if religious experiences / religiousity are the result of malfunction it won't constitute a mental disorder unless society disvalues it - which it does not.

> we should not conflate true pathology with belief

Of course we shouldn't. But in order to avoid it... We need an account of the distinction. because... peoples intuitions do differ. and where sameness of intuition depends on sameness of values then shouldn't we be explicit about that?

 

[toby jones]

> the definition of a delusion includes something that can not be altered by rational argument

And yet empirical evidence shows cognitive behaviour therapy to be fairly effective for treating delusional belief. So either... Delusions ARE amenable to rational argument (cognitive restructuring) after all, or psychiatrists are going around WRONGLY DIAGNOSING DELUISON (since the people who are diagnosed as delusionsl ARE amenable to rational argument).

> In my opinion, your example is splitting hairs with the definition.

I'm looking for a principled distinction that can be explained to someone who doesn't share our intuitions. I suspect that where people share intuitions it comes down to sameness of values and where peoples intuitions diverge it comes down to difference in values. If you can provide me an objective (non-evaluative) criteria for differentiating:
1) religious beliefs
2) over-valued ideas
3) delusions
That doesn't rely on values then you will have pursuaded me that I'm wrong and there is an objective distinction to be had after all...

> An atheist assumes that there is abosuletly no possibility of a God, despite the fact that this belief can not be proven.

It can if you can prove that the concept of 'God' is contradictary therefore cannot be instantiated. This does of course depend on how you define 'God' but one take is that the 'omni-god' of christianity, Judaism, and Islam is contractory and hence cannot exist - except as an (inconsistent) idea... (there is a contradiction inherent in 'unlimited power' and a quadralema with 'unlimited power', 'all knowing', 'all benevolent' and - the existence of evil).

 

[manwhoisthursdy]

toby,

The problem you mention, of the difficulty of value-based judgments, is well taken. It's important to avoid saying that the only reason a patient's religious beliefs are not delusional is because they are part of an accepted subculture ... because what happens when the subculture is not accepted? The examples you gave of Russian psychiatry and political dissidents is a good one. We could add to this examples where societal views are rapidly changing (e.g. homosexuality).

The point I'm trying to emphasize is that we don't need to rely alone on the criteria that "if it's part of an accepted cultural belief, it's not a delusion." There are many other things that separate delusion from odd belief (inability to comprehend the delusion being false, reacting with aggression or anxiety when the delusion is challenged, basing it on a perception where the delusion simply does not follow even if the perception is true, the presence of hallucinations or mood disorder or thought disorder, etc etc). Though I can't give you strict criteria to easily distinguish the two, and therefore I have to admit that there will be cases where "belief or delusion?" will be a legitimate question, that is quite a far cry from saying that belief and delusion are usually confused and are basically the same thing objectively. That latter statement is false. Most religious belief does not resemble delusion at all. If it becomes the focus of obsessions and/or compulsions, or an overvalued idea, it will be less clear-cut.

In addition, I'd argue that the reason we don't call a belief a delusion if it's part of an accepted subcultural belief is not because we want those beliefs to be "protected" because we respect those subcultures. Respect is important, but secondary. The thing is, no matter how odd a belief, if the believe derives from a cultural teaching, it doesn't tell us much about a person psychology. It doesn't tell us about their reality testing or their ability to function occupationally/interpersonally etc. It's normal for lots of people to belief stuff deriving from their culture. If someone develops a false belief that cannot be explained culturally, and meets other criteria for delusion, then this tells us something about their thinking, and points to a pathological change in their psyche ... impaired reality testing, maybe delusional atmosphere, possibly impaired functioning ... basically psychosis.

 

[toby jones]

> There are many other things that separate delusion from odd belief

Well, I'm kind of questioning all of that... I'm thinking that each point is probematic. I think the dialectic goes that delusions are different from other kinds of beliefs because of x - then seeing that x is insufficient to capture the distinction (because some delusions don't have x and / or because some non-delusions have x). Then somebody suggests y is the crucial feature... And on and on it goes...

> inability to comprehend the delusion being false

If that really is a feature then it stipulates that cognitive behaviour therapy would not be able to help patients see that their delusions are in fact false (when they are in fact false). Evidence strongly suggests that cognitive behaviour therapy is effective for treating delusions, however, and the best candidate for the mechanism of change is that it teaches patients to question their delusional belief. Now it might be the case that the majority of people who are regarded (by psychiatrists) as being delusional are not delusional as a matter of fact. That would be disturbing, though...

> reacting with aggression or anxiety when the delusion is challenged

People without delusions can similarly react with agression or anxiety when their (non-delusional) belief is challenged - so that isn't going to work as a defining feature either. If I seriously consider the possibility that I am a brain in a vat of nutrients being fed inputs to simulate an external world via electrodes then I surely feel a little anxious...

I could continue with each of the other features...
The features don't seem to be capable of distinguishing delusional belief from religious belief from other beliefs that are accepted on faith (such that the future will be like the past or such that i am not a brain in a vat).

> there will be cases where "belief or delusion?" will be a legitimate question

Agreed. I think that is a more pressing problem than it is commonly taken to be...

> that is quite a far cry from saying that belief and delusion are usually confused and are basically the same thing objectively.

I'm not claiming that they are 'basically the same thing' I'm just saying 'there is supposed to be a difference so... what is the difference?' Until we know what the difference is it would be hard to figure out whether we are confusing them or not...

> Most religious belief does not resemble delusion at all.

I think that religious belief resembles delusion quite a lot...
But I think that scientific assumptions resembles delusion quite a lot too...
I take it that it is uncontroversial that scientific assumptions are not delusional? I'm not claiming anything about religious beliefs either way except...

That I do think that the way people identify delusions is on the basis of matching a particular case to some 'prototypical case' or 'exemplar'. In ones training one is given many many many examples of delusional utterances. One then uses that and assesses similarity fairly intuitively in a way that is difficult to specify. Like... Recognising faces. Hard to describe the features that are relevant to our ability to identify, and yet it is something that we can learn to do.

The problem comes when we want a justification for why those prototypical or exemplary cases get to be hailed as paradigmatic of 'delusion' in the first place. I haven't seen a good justification. So... Should 'I am a brain in a vat' or 'I am not a brain in a vat' make it into the paradigmatic cases that med students are given or not? If so then which one? If not then why not? (Need to pretend that one or the other becomes prevalent such that it is a pressing concern for us to decide) Haven't seen a good answer yet...

> No matter how odd a belief, if the believe derives from a cultural teaching, it doesn't tell us much about a person psychology.

Right. In fact... If someone fails to acquire a belief then we might wonder whether they are impaired in their learning. We do want to keep a place for 'mass delusions' (found in cults) though, where it seems that people are acquiring their delusional beliefs through their sub-culture. I'm not sure whether in mass delusion it is typically thought that only the leader is mentally disordered, or whether the others who come to believe the delusions are similarly regarded as mentally disordered?

 

[cleareyedguy]

This series of posts goes back a year, but to go back to post 1: I would be absolutely stunned if a Columbia psychiatrist actually said "Christians are evil." I can see variations on this :"Christians have done evil things; in the name of Christ, people have done evil things, etc." But no reasonably bright person would summarize hundreds of millions of people as 'evil.'


The Christian physician who said he "heard" this might want to ask for forgiveness.

 

[whopper]

Did a google search on this
Closest thing I could come up with was this
http://www.martinfrost.ws/htmlfiles/evil.html

In the article, Michael Stone, a professor of psychiatry @ Columbia references some Judeo-Christian concepts of evil but never says "Christians are evil".

The comment of course could've been said, but could've been taken out of context.

I would like to see a link to the comment if anyone has one. Columbia is an excellent institution. In their defense unless someone has a link or at least the context, we should not assume it was said by someone from Columbia or the meaning of the comments without the context.

Still, the debate is worthwhile. It might not have been said by a Columbia psychiatrist, but it is said by others.

 

[toby jones]

.

 

[Ephesus]

I would not recommend any psychotic pt to follow any belief system or get involved in any type of religion if they have - even a hint of - religious delusions.

Fortunately, many neuropsychologists agree with me on this one.

There's the concrete/abstract distinction, but I believe that's DEEPLY flawed, so I'll leave it at that.

 

[manwhoisthursdy]

I would not recommend any psychotic pt to follow any belief system or get involved in any type of religion if they have - even a hint of - religious delusions.

Fortunately, many neuropsychologists agree with me on this one.

There's the concrete/abstract distinction, but I believe that's DEEPLY flawed, so I'll leave it at that.

It seems like one could only say this if believing that religion is not really that important. Is it appropriate to counsel a patient from this perspective ... isn't this imposing a religious view (the religious view that religion isn't very important)?

I'm not sure what the evidence is, but I suspect that if a psychotic patient with a religious belief system develops religious delusions, a very useful corrective could be consultation with a trusted religious adviser (imam or pastor or whoever), to help guide the patient as delusions subside with pharmacotherapy. My hunch, though again I'd like to see actual evidence to support it, is that replacing religious delusions with a total void instead of with religious guidance, could be inviting trouble.

Besides, would we tell a psychotic patient with delusions about food to avoid eating? If a patient and his/her community believes that spiritual nourishment is as important or more important than physical nourishment, is it really appropriate for us as clinicians to oppose that?

If anyone has other thoughts about these questions, I'd love to hear them.

 

[Ephesus]

The concrete/abstract distinction: we want to ground pts in concrete thoughts and not let them grow too abstract.

 

[toby jones]

No logic or mathematics or art therapy for them then ;-)

 

[manwhoisthursdy]

The concrete/abstract distinction: we want to ground pts in concrete thoughts and not let them grow too abstract.

Are you trying to say that religion is "too concrete" for such patients? I have trouble believing that a religious person would agree that religion "grounds" one in concrete thoughts without letting them grow too abstract...

 

[cbrons]

A lot of it is enhanced with the emerging science of evolutionary psychology and many of the new ideas about what "natural" behavior is.

 

[zenman]

Since my last post I've now had 4 think they were Jesus.

In the military we had two at the same time. Had to keep them on different units because they would fight over who was the real Jesus. Guess we could have given them some wood and a hammer to see who was the best carpenter, lol!

 

[billypilgrim37]

In the military we had two at the same time. Had to keep them on different units because they would fight over who was the real Jesus. Guess we could have given them some wood and a hammer to see who was the best carpenter, lol!

The Three Christs of Ypsilanti requires mention at this point in the thread😉