1 Biblical themes in psychiatric practice: Implications for psychopathology and psychotherapy Samuel Pfeifer, M.D., Riehen, Switzerland presented at the first international conference of the Dutch Foundation for Psychiatry and Religion, Amsterdam, March 4th - 6th, 2002

2 1. The phenomenology of biblical themes in psychiatric practice. 2. Biblical aspects of causality in Psychiatry. 3. Biblical aspects of the bio-psycho- social model. 4. Therapeutic implications.

3 1. The phenomenology of biblical themes in psychiatric practice.  Human suffering and mental distress are mirrored in the plight of God-fearing individuals and their prayers (e.g. the psalms) – Affective Disorders, Depression and Stress.  Explaining the inexplicable in the turmoil of psychosis – Schizophrenia.  The psychodynamics of personality functioning, defense mechanisms or coping style – Anxiety and Personality disorders.

4 Depression 1. Sad affect -- loss of joyful emotion in regard to God and his creation. 2. Ruminating and doubting, inner restlessness and endless brooding -- loss of the conviction of salvation or predestination. 3. Self reproach and ideation of guilt. 4. Lack of energy and inability to make decisions obstruct participation in religious activities. Even Scripture readings and prayer become a burden. 5. Fear, regression, or inadequate clinging to others – impairment of the religious social network of support.

5 Depression II 6. Worries and a lack of perspective take away the confidence which the person had through faith. Bible quotations telling them not to worry, can increase the sense of disobedience and inadequacy. 7. Irritability can result in dysfunctional behavior not compatible with the Biblical ideals. 8. A lack of hope and the wish to die are sometimes supported by Bible quotations out of context, which seem to encourage suicide. 9. Interpretion of complaints as demonic (thus adding a dimension of terror to the depressive experience).

6 Schizophrenia  Hearing Voices  Mystical illusions and constructions of autistic meanings  Prophecy and future doom  Mission / Messiah / Redemption  Sacrifice (Identification with the suffering Christ)  Somatic Sensations (e.g. pregnancy from God, demonic attacks)

7 Anxiety and personality disorders "Consideration should be given to how patients use their religious belief systems as a vehicle for the expression of neurotic needs and conflicts, in particular to identify patterns of symptomatic and characterological expression with their particular religious phenomenology.“ "The phenomenology of religious psychopathology", W.W.Meissner (1991)

8 2. Biblical aspects of CAUSALITY in Psychiatry  Sin (individual, family / generations, people) - John 9:1-4.  Curse  Demonic affliction

9 Demonic causality and exorcism Pfeifer S. (1999), Psychopathology 32:252–259 Non-delusional disorders

10 Demonic causality and exorcism II  Causal attributions of mental illness to demonic forces are frequent  They occur in many religious cultures (e.g. the “djinn” in the Arabic world, the “zar” in Ethiopia / Israel)  Demonic causality has its roots in popular mythology and existential suffering  there is no systematic Biblical teaching on the subject.

11 3. Biblical aspects of the Bio-psycho- social Model of Psychiatry  Biblical texts support the bio-psycho-social model of psychiatry  The question of an additional “spiritual” dimension is largely unexplored for its clinical relevance. Research on religion and mental health seems to reflect social and psychological implications of the spiritual factor.  Clinicians are called to serve as interpreters between “Biblical models” and scientific psychiatry -- (and vice versa!)

12 Emotions - Thinking Volition – Behavior Coping - Defense PSYCHOLOGICAL Factors contributing to Mental Illness Childhood, Family Life Trauma, Life events „Stress“ SOCIAL ASPECTS Genetics, Personality Neurobiology Physical Constitution BIOLOGICAL Mental Problems Burden Hardships Trials Temptation Gal 6,2 2. Cor 6,4 1. Peter 1,6 1. Cor 10,13 Weakness 2. Cor 12,9 Way of Life (Eph 4,22) Mind (Rom 8,6; 12,2)

13 Disentanglement of religion and neurosis "The orientation of such therapy should not be directed at the destruction of religion nor is the philosophical background one that denies the usefulness of religion. Rather, the general goal is to separate the intrapsychic conflict from its "religious" defense system. Such a goal appears to be in the service of both psychotherapy and religion." Moshe H. Spero 1976

14 4. Therapeutic Implications  Develop a supportive therapeutic setting in collaboration with the patient.  Biblical aspects 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 and distress (e.g. depression) -- Image: out-of-tune piano.  Determine functional and dysfunctional aspects of religious interpretation.  "Agree to disagree" - but focus on the areas which help a patient regain his balance.  Value-sensitive therapy: Using references to the Bible without losing sight of the bio-psycho-social aspects of psychopathology.

15 Indicators of functional spirituality  Improves self-confidence (based on confidence in God)  Enables mature patterns of relating to others  Enhances coping with life’s demands  Preserves the awareness and the awe of the ultimate spiritual reality, God.

16 Forms of Spiritual Therapy (in the Christian context *)  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. *) wide variations in other religious cultures

17 Symptom Relief Personal freedom -- Interpersonal Relations -- Coping Outcome negative Outcome positive Results of “spiritual therapy”

18 The End