In a now-closed thread, RfM poster "robertb" suggests examination of a paper that deals with religion and mental health. It is offered as recommended reading in order to counter the premises put forth by professor emeritus of psychiatry at Ontario's McMaster University, Wendell W. Watters, M.D.; namely, that religion--specifically, Christianity--fosters mental disorder and dysfunctionality. (see Watters, "Deadly Doctrine: Health, Illness and Christian God-Talk" [Albany, New York: Prometheus Books, 1992], 198 pp.)
As "robertb" notes about the recommended review:
"In a 2009 study titled 'Research on Religion, Spirituality, and Mental Health: A Review,' Dr. Harold G. Koenig writes:
"'Religious and spiritual factors are increasingly being examined in psychiatric research. Religious beliefs and practices have long been linked to hysteria, neurosis, and psychotic delusions. However, recent studies have identified another side of religion that may serve as a psychological and social resource for coping with stress. After defining the terms religion and spirituality, this paper reviews research on the relation between religion and (or) spirituality, and mental health, focusing on depression, suicide, anxiety, psychosis, and substance abuse. The results of an earlier systematic review are discussed, and more recent studies in the United States, Canada, Europe, and other countries are described. While religious beliefs and practices can represent powerful sources of comfort, hope, and meaning, they are often intricately entangled with neurotic and psychotic disorders, sometimes making it difficult to determine whether they are a resource or a liability." Can J Psychiatry. 2009;54(5):283-291.' . . ."
("Research since Watters' book was written nearly 30 years ago shows a different picture," by "robertb," on "Recovery from Mormonism" discussion board, 28 November 2011)
The reference is appreciated and I've, in fact, read the entire paper.
While interesting in proposing that people utilize religion as a mechanism to “cope with stressful health problems and life circumstances” (p. 11), what is not mentioned in your introduction to the paper is Koenig's own admission about the possible consequences of his review.
He confesses, for instance, that “clinical implications” of his paper include the following potential negative:
“Religious beliefs may contribute to mental pathology in some cases.”
Koenig also admits:
“My review of recent studies is selective, not systematic." (p. 1)
Furthermore, although Koenig states that “religious involvement is an important factor that enables [certain] people [such as ‘medical patients, older adults with serious and disabling medical conditions and their caregivers’] to cope with stressful health problems and life circumstances,” he nonetheless concedes that “this may not be true in all populations . . . ." (p. 11)
Where that isn't always true will be dealt with shortly.
To his credit, Koenig acknowledges evidence of bias in studies regularly produced by pro-religion researchers. He notes that, methodologically speaking, analyses of human spirituality have in recent years frequently been tainted by that bias, with the examined areas ”often [being] assessed either in terms of religion or by positive psychological, social, or character states. . . . For example, standard measures of spirituality today contain questions asking about meaning and purpose in life, connections with others, peacefulness, existential well-being and comfort and joy.
"This is problematic, as it assures that spirituality in such studies will be correlated with good mental health. In other words, spirituality--defined as good mental health and positive psychological or social traits--is found to correlate with good mental health. Such research is meaningless and tautological." (p. 2)
Despite his apparent nod to rigorous sciencitific methodology, Koenig remains a big fan of supernaturalism's benefits.
He writes that while “a handful” of systematic studies have reported “negatives associations [between religious involvement and mental health’], the majority [of] quantitative studies prior to the year 2000, based on a systematic review, reported statistically significant positive associations.”
Koenig’s own admittedly selective review of the literature concludes that in areas of what he classifies as negative human behavior, there is a measurable positive association between religious beliefs/practices and mental health:
"Religious involvement is related to better coping with stress and less depression, suicide, anxiety and substance abuse. While religious delusions may be common among people with psychotic disorders, healthy normative religious beliefs and practices appear to be stabilizing and may reduce the tremendous isolation, fear and loss of control that those with psychosis experience." (p. 3)
_____
Koenig then examines five specific areas for evidence of the positive influence of religious belief and practice on negative mental conditions:
--Depression--
Although Koening asserts that non-psychotic religious practices and beliefs have an overall postive affect on reducing depression, he also notes that at least one Canadian study examining the connection between religion involvement and depression found a negative relationship:
“[The researchers] followed teenaged mothers . . . (87% unmarried) before delivery and four weeks after delivery in southwestern Ontario. They examined the relation between religion and depressive symptoms during the first few weeks after babies were born.
“Catholics and teenagers affiliated with more conservative religious groups scored significantly higher on depression and those who attended religious services more frequently also had higher depression scores. However, the highest depression scores were among girls who cohabitated with someone while continuing to attend religious services.” (ibid.)
That last observation is most likely connected to a sense of guilt induced by religious teaching, as will be seen.
Koenig further acknowledges that even in a different study (one which found religious attendance correlated positively with less depression), “participants [who] indicat[ed] that spiritual values were important or perceived themselves as spiritual or religious had higher levels of psychiatric symptoms.” Significantly, Koenig adds that this study was “conducted in largely healthy community-dwelling adults with relatively low stress levels.” (ibid.)
In other words, in locales not typified by high personal stress levels, religious beliefs and practices created high personal stress levels.
Koenig further admits that while “studies in medical patients, older adults with serious and disabling medical conditions, and their caregivers suggest that religious involvement is an important factor that enables such people to cope with stressful health problems and life circumstances, . . . , this may not be true in all populations, as studies of pregnant unmarried teenagers and non-stressed community populations above suggest.” (p. 4)
Adding another factor that religion can't seem to effectively overcome, Koenig also notes that high rates of religion-related depression may be tied to genetic realities:
“Critics say that most studies reporting positive results are observational and that some unmeasured characteristic may be related both to religion and to depression, confounding the relation.
"In particular, genetic factors have been implicated. In a fascinating study that examined the relation of spirituality to brain 5-HT1A binding using positive emission tomography, investigators found that 5-HT1 A binding was lower in people who were more spiritually accepting.
"Note that lower 5-HT1 A binding--the same pattern seen with spirituality--has been found in patients with anxiety and depressive disorders. Thus, rather than being genetically less prone to depression, RS [Religion/Spirituality]-oriented people may be at increased risk for mood disorders based on their 5-HT receptor binding profile.” (ibid.)
Simply put, religion doesn't fool Mother Nature.
_____
--Suicide--
Koenig writes that his study of the relationship between religion involvement and suicide points largely to a positive result:
“Religious involvement may . . . help to prevent suicide by surrounding the person at risk with a caring, supportive community.”
He does acknowledge, however, that some studies found either no association one way or the other bewtween religious involvement and suicide, or produced mixed results. (ibid.)
_____
--Anxiety--
Koenig reports that religious teachings significantly help reduce anxiety.
However (and somewhat ironically), he also reports that anxiety which is produced by religion itself can bring about reduced anxiety by forcing socially acceptable behavior:
“While religious teachings have the potential to exacerbate guilt and fear that reduce quality of life or otherwise interfere with functioning, the anxiety aroused by religious beliefs can prevent behaviors harmful to others and motivate pro-social behaviors.” In a related vein, Koenig also reports that multiple recent studies indicate that “anxiety and (or) fear is a strong motivator of religious activity.” (ibid.)
So, social pressure combined with religious indoctrination can induce fear-driven anxiety which leads individuals to engage in religious activity the reduces their anxiety. A strange way to achieve the desired result.
On the issue of death-related anxiety, Koenig writes that one study found “no linear relations between religiousness, fear of death and fear of dying.” Interestingly enough, he notes, “[s]ubjects with the lowest anxiety levels were those who were either high or low on religiousness.” Those who believed in an afterlife but did not regularly attend religious services were found to be more death-anxious than those who received religious teachings at church. (p. 5)
Meaning, possibly, that the more one is indoctrinated in church settings to accept the myth of immortality, the less one is concerned about dying. (Put another way, burying one's head in the sand about the reality of death's finality might mean less anxieity about being permanently buried).
Koenig admits, however, that not all types of religious friction produces anxiety reduction:
“While positive forms of religious coping may reduce anxiety in highly stressful circumstances, negative forms of religious conflict may exacerbate it. For example, one recent study of women with gynecological cancer found that women who felt that God was punishing them, had deserted them, or did not have the power to make a difference, or felt deserted by their faith community, had significantly higher anxiety. These results persisted after multiple statistical controls, and are consistent with other studies in medical patients.” (p. 5)
In other words, individuals feeling abandoned by God and/or
by God's people as a result of their personal sinful behavior experienced higher anxiety--which is understandable, given the immense guilt trip on which judgmental religious systems send their followers.
_____
--Psychotic Disorders--
Koenig describes the correlation between weird religious delusions and psychotic states:
“Psychiatric patients with psychotic disorders may report bizarre religious delusions, some of which can be difficult to distinguish from so-called normal religious or cultural beliefs. About 25% to 39% of psychotic patients with schizophrenia and 15% to 22% of those with bipolar disorder have religious delusions.”
Koenig then asks:
“Do religious beliefs play a role in the etiology of psychotic disorders or might they adversely affect the course of these disorders or response to treatment? Alternatively, might non-delusional religious beliefs and practices help these patients to cope with psychological and social stresses, thus serving to prevent exacerbations of illness?”
Answering his own question, he declares:
“Unfortunately, there are relatively few studies--particularly from the United States or Canada--that have examined the relation between religion and psychotic symptoms. In an earlier review [conducted by Koenig] of the literature, . . . . [a] mong . . . 10 cross-sectional studies, four found less psychosis or psychotic tendencies among people more religiously involved, three found no association, and two studies reported mixed results.” (p. 5)
4-3-2. Sounds like a fairly tight horse race.
Koenig reports a higher practice of religion among those suffering from depression and schizophrenia:
“The final study, conducted in London, England, found religious beliefs and practices significantly more common among depressed and schizophrenic psychiatric in-patients, compared with orthopedic control subjects.” (p. 5)
Koenig also found that patients suffering from religious delusions suffered more psychotic disorders and that these mental maladies were more severe than those experienced by non-religiously delusional patients:
“Subjects with religious delusions (24%) had more severe symptoms, especially hallucinations and bizarre delusions, poorer functioning, longer duration of illness and were on higher doses of anti-psychotic medication, compared with patients with other kinds of delusions.”
Koenig also reports that culture-based religious teachings can exacerbate psychotic disorders:
“In the largest study to date, 62 investigators compared the delusions of inpatients with schizophrenia in Japan with patients in Austria and in Germany. . . .
"[R]eligious themes of guilt and (or) sin were more common among patients in Austria and Germany than in Japan; whereas delusions of reference (such as being slandered) were more prevalent because of the role shame plays in Japanese culture.” (ibid.)
No surprise there.
Koenig notes the existence of disagreements over the relationship between religious delusions and the presence of psychotic problems, but adds that patients suffering from such delusions had more severe problems:
“While some studies report that patients with schizophrenia and religious delusions have a worse long-term prognosis, others do not. In one of the most detailed studies to date, [researchers] did not find that patients with religious delusions or patients who described themselves as religious responded less well to four weeks of treatment than other patients.
"However, patients with religious delusions had more severe illness and greater functional disability than other patients.” (p. 6.)
While Koenig writes that most recent studies have pointed to positive affects on schizophrenic patients who attend church, not all of these patients are shown to benefit from religion as a coping mechanism, with some of them reporting that “religion . . . induced spiritual despair.” (ibid.)
Gimme that old-time despair-inducing religion.
_____
--Substance Abuse--
Koenig reports that, based on studies conducted by others (mostly of high school and college students), “90% . . . found significantly less substance use and abuse among the more religious.”
Koenig also cites a subsequent study from Columbia University that found the following negativer results among examined adults who did not place a high value on religion:
“Adults who did not consider religion very important were 50% more likely to use alcohol and cigarettes, three times more likely to binge-drink, four times more likely to use illicit drugs other than marijuana and six times more likely to use marijuana, compared with adults who strongly believed that religion is important. The same pattern was seen for religious attendance and an even more pronounced inverse relation between religion and substance abuse was evident in teenagers.
"In addition, people who both received professional treatment and attended spirituality-based support programs (such as 'Alcoholics Anonymous' or 'Narcotics Anonymous') were far more likely to remain sober than if they received only professional treatment.” (p. 6)
Still, Koenig reports that substance abuse (as well as heart problems) can be heightened by strict religious treatment that induces guilt, shame and isolation:
“While religious influences on substance abuse appear to be generally positive, this is not always the case. When people from religious traditions that promote complete abstinence start using alcohol or drugs, substance use can become severe and recalcitrant. Those people may completely withdraw from religious involvement, resulting in social isolation and worsening mental health owing to feelings of guilt and shame. Further, religious traditions that advocate complete abstinence from alcohol may deprive members of cardiovascular benefits of moderate, controlled drinking.” (p. 7)
_____
--Koenig’s Summary and Conclusions--
Religious practice and belief, Koenig writes, is not necessarily a benefit to the mentally ill, the emotionally troubled or the situationally challenged; to the contrary, he acknowledges that they can actually be harmful:
“Many people suffering from the pain of mental illness, emotional problems or situational difficulties seek refuge in religion for comfort, hope and meaning. While some are helped, not all such people are completely relieved of their mental distress or destructive behavioral tendencies.
"Thus it should not be surprising that psychiatrists will often encounter patients who display unhealthy forms of [religious] involvement. In other instances, especially in the emotionally vulnerable, religious beliefs and doctrines may reinforce neurotic tendencies, enhance fears or guilt and restrict life rather than enhance it. In such cases, religious beliefs may be used in primitive and defensive ways to avoid making necessary life changes.” (p. 7)
Koenig also concludes, on a conditional happer note, that “religious involvement is related to better coping with stress and less depression, suicide, anxiety and substance abuse," while admitting that “religious delusions may be common among people with psychotic disorders.”
Nonetheless, he ultimately argues that “healthy normative religious beliefs and practices appear to be stabilizing and may reduce the tremendous isolation, fear, and loss of control that those with psychosis experience.” (ibid.)
Which begs the question: Are the religious beliefs and practices of Mormonism or Christianity healthy? I’m with Watters on that one: No.
(see: "Mormonism, Mental Illness and Other Similarly-Rooted Religious Manifestiaons of Dysfunction and Disorder," by Steve Benson, on "Recovery from Mormonism" bulletin board, 28 November 2011, at:
http://exmormon.org/phorum/read.php?2,352408,352408#msg-352408)
____
--Revews from His Professional Colleagues: Koenig's “Research” on "Intercessory Prayer" Doesn't Have Much of a Prayer--
While some may enthusiastically embrace Dr. Harold G. Koenig and his penchant for the religiously ridiculous, that faithful fervor is not shared by colleagues in fields of rigorous discipline who value sound science over the silly supernatural.
Indeed, according to some of his peers, Koenig is something of a religious quack.
To be sure, Koenig has detractors in the halls of empirical investigation, as evidenced in the article, “Faith Healing: Can Prayer Do Anything More Than Make You Feel Better?”
Hard-science professionals concluded that Koening's prayers didn't, well, have a prayer:
“Dr. Harold G. Koenig, director of Duke University’s Center for the Study of Religion/Spirituality and Health, has spent his entire professional life looking at how spirituality affects a person’s physical well-being. . . .
“Koenig is the author of ‘The Healing Power of Faith,’ . . . , a compilation of scientific studies that examine the impact of religious belief on physical and mental health. ‘These studies are inexplicable within the realm of science,’ he says. ‘There’s no traditional scientific mechanism in action, and scientists have a problem with that.’
“Dr. Stephen Barrett has a big, big problem with that. ‘This study is a well-designed waste of time,’ says Barrett, board chairman of the health fraud watchdog organization ‘Quackwatch.’ (
http://www.quackwatch.com/ ) ‘You can’t generate magical forces with magical thinking. It’s absurd.’"
The matter at the heart of the contention:
“A massive study published in the October 25 [1999] issue of the ‘Archives of Internal Medicine’ (a journal of the American Medical Association) showed that heart patients who had someone praying for them suffered fewer complications than other patients.
“Researchers at the Mid-America Heart Institute of St. Luke’s Hospital in Kansas City studied 990 patients admitted to the institute’s coronary care unit in a one-year period. The patients were randomly divided into two groups. One group was prayed for daily by community volunteers--intercessors--and the other patients had nobody assigned to pray for them. The intercessors were given the patients’ first names and were asked to pray daily for 'a speedy recovery with no complications.' It was a blind trial: None of the patients knew they were involved in a study.
“The researchers, led by Dr. William Harris, created an itemized score-sheet to measure what happened to both groups of patients and after four weeks there was a striking result: The prayed-for patients had suffered 10 percent fewer complications, ranging from chest pain to full-blown cardiac arrest. The study concludes, ‘This result suggests that prayer may be an effective adjunct to standard medical care.’"
“ . . . Barrett dismisses the entire study as a roll of the dice. Though the 10% difference may seem like divine intervention, he says the study has no clinical significance. ‘What it reflects is a lucky hit,’ he says. ‘A chance phenomenon.’
“The researchers acknowledge an element of chance in their study--as well as an element of distortion, since patients in the control group most likely had friends and family praying for them, too. Harris writes, ‘It is probable that many if not most patients in both groups were already receiving intercessory and/or direct prayer from friends, family and clergy.'
“There’s no telling, in other words, how much ‘supplementary prayer’ went unaccounted for. Which raises another devilish question from Barrett: What if someone out there was praying for one of the sick patients to get worse? Wouldn’t that skew the results?
“’What if you pray against somebody?,’ Barrett says. ‘Can that do harm? Is health determined by who prays harder?’ . . .
“More fuel for Barrett’s fire: ‘I would be appalled if the government or any research foundation funded this. I wouldn’t want my tax dollars going to support it,’ he says. ‘You’re much better off spending research time and money on activities that might yield practical results.’”
(Jon Bowen, “Faith Healing: Can Prayer Do Anything More Than Make You Feel Better?,” under “Health,” in “Salon” magazine, 3 November 1999, at:
http://www.salon.com/1999/11/03/prayer/singleton/)
When confronted with scientific evidence that undermined his belief in the magical, Koenig predictably fell back on an old religionist defense.
Science, he claimed, "is not designed to study the supernatural.”
That’s assuming, of course, that the subject being studied is actually supernatural. (So much for expunging that pro-religious bias Koenig supposedly opposes).
Specifically, a prayer study (for which Koenig played booster but in which he didn't actually participate) was eventually scientifically analyzed.
The result didn't turn out good for God.
From the article, “Power of Prayer Flunks an Unusual Test”:
“In the largest study of its kind, researchers found that having people pray for heart bypass surgery patients had no effect on their recovery. In fact, patients who knew they were being prayed for had a slightly higher rate of complications.
“Researchers emphasized that their work can't address whether God exists or answers prayers made on another's behalf. The study can only look for an effect from prayers offered as part of the research, they said.
“They also said they had no explanation for the higher complication rate in patients who knew they were being prayed for, in comparison to patients who only knew it was possible prayers were being said for them.
“Critics said the question of God's reaction to prayers simply can't be explored by scientific study.
“The work, which followed about 1,800 patients at six medical centers, was financed by the Templeton Foundation, which supports research into science and religion. It will appear in the ‘American Heart Journal.’
“Dr. Herbert Benson [no relation] of Harvard Medical School and other scientists tested the effect of having three Christian groups pray for particular patients, starting the night before surgery and continuing for two weeks. The volunteers prayed for 'a successful surgery with a quick, healthy recovery and no complications' for specific patients, for whom they were given the first name and first initial of the last name.
“The patients, meanwhile, were split into three groups of about 600 apiece: those who knew they were being prayed for, those who were prayed for but only knew it was a possibility and those who weren't prayed for but were told it was a possibility.
“The researchers didn't ask patients or their families and friends to alter any plans they had for prayer, saying such a step would have been unethical and impractical.
“The study looked for any complications within 30 days of the surgery.
"Results showed no effect of prayer on complication-free recovery. But 59% of the patients who knew they were being prayed for developed a complication, versus 52% of those who were told it was just a possibility.”
Enter Koenig to try to explain it away:
“Dr. Harold G. Koenig, director of the Center for Spirituality, Theology and Health at the Duke University Medical Center, who didn't take part in the study, said the results didn't surprise him.
"’There are no scientific grounds to expect a result and there are no real theological grounds to expect a result either,’ he said. "There is no god in either the Christian, Jewish or Moslem scriptures that can be constrained to the point that they can be predicted."
“Within the Christian tradition, God would be expected to be concerned with a person's eternal salvation, he said, and ‘why would God change his plans for a particular person just because they're in a research study?’"
Why would he, indeed? Koenig throws in the towel, while throwing his support behind that religious bias he supposedly bemoans:
“Science, he said, ‘is not designed to study the supernatural.’”
(“Power of Prayer Flunks Unusual Test: Large Study Had Christians Pray for Heart Patients,” by “Associated Press,” 30 March 2006, at:
http://www.msnbc.msn.com/id/12082681/ns/health-heart_health/t/power-prayer-flunks-unusual-test/#.TtR6f0axjqI)
Mind you, this is the same fellow who wants to be taken seriously when touting the supposedly overwhelming mental health benefits of religion but who can't explain why God demonstrably doesn't answer scientifically-scrutinized prayers of the faithful--unless you buy his supernaturalistic spin that God's too busy focusing on eternally saving you and therefore can't be bothered with your measly prayers offered heavenward in some research study.
So much for God paying attention to every sparrow that falls.
_____
--Further Proof that Koenig's Claimed "Scientific" Approach. to Research Fails the Empirical Test--
Keep in mind how Koenig gives lip service to objective research but when scientifically disproven in his attempts to defend the nutty notion that intercessory prayer works, invokes the supernatural:
First, the "balanced" Koening:
Koenig acknowledges evidence of bias in studies regularly produced by pro-religion researchers. He notes that, methodologically speaking, analyses of human spirituality have in recent years frequently been tainted by that bias, with the examined areas ”often [being] assessed either in terms of religion or by positive psychological, social, or character states. . . . For example, standard measures of spirituality today contain questions asking about meaning and purpose in life, connections with others, peacefulness, existential well-being and comfort and joy.
"This is problematic, as it assures that spirituality in such studies will be correlated with good mental health. In other words, spirituality--defined as good mental health and positive psychological or social traits--is found to correlate with good mental health. Such research is meaningless and tautological." (p. 2)
Now the clearly unbalanced Koening:
“Science, he said, ‘is not designed to study the supernatural.’”
“Within the Christian tradition, God would be expected to be concerned with a person's eternal salvation, he said, and ‘why would God change his plans for a particular person just because they're in a research study?’"
Geezus.
Below are specific--and serious--objections raised by the professionally-credentialed class to Koening's tendency toward sloppiness:
**“Dr Nazar Mansour, SPR Old Age Psychiatry. NHS:
“The author [Koenig] highlights many aspects of understanding patients' religious beliefs with which I totally agree. However, it seems he has underestimated the influence of experience in psychiatric management. The statistical findings presented were the result of surveys which can never replace high quality evidence-based research or well designed qualitative studies. Psychiatrists in the UK have been under enormous strain to maintain a fine balance between legal and clinical responsibilities. The results of the author's suggestions are not measurable and could raise a variety of medico-legal issues. For example; how to decide which patients should be involved with their psychiatrists for joint prayer? I believe, this could be dangerous ground upon which to tread. Religion is a personal activity and psychiatrists could explore the interface between religious beliefs and psychopathology. But, they should definitely not cross sensitive boundaries. ... less
“Submit response
Published June 16, 2008”
**”Religion, Psychiatry and Professional Boundaries.
“Rob Poole, Consultant Psychiatrist Robert Higgo, Gill Strong, Gordon Kennedy, Sue Ruben, Richard Barnes, Peter Lepping, Paul Mitchell North East Wales NHS Trust:
“We were alarmed to read the editorial on religion and mental health (Koenig, 2008). Some of the assertions are highly contentious, and we believe some of the recommendations for clinical practice are inappropriate. The invited commentary by the President of the Royal College of Psychiatrists (Hollins, 2008) is cautious, but nonetheless seems to endorse Koenig’s point of view. In doing so, she lends a certain credibility to Koenig’s recommendations. Closer integration of religion and psychiatric practice is a key aspiration of an element within the Spirituality and Psychiatry Special Interest Group of the College. We believe that there is an urgent need for a serious debate on the implications of such attempts to shift the boundaries of psychiatry and the other mental health professions.
“Koenig uses some statistics that are questionable. For example, the World Chrisitian Database may say that 1.4% of the British population are atheist, but the British Humanist Association website cites recent figures from the National Census, a Home Office survey and a MORI poll ranging from 15.5% to 36%. However, it is his fundamental argument that is seriously flawed.
“Koenig uses the rhetorical ploy of suggesting that religion is denigrated and under attack by psychiatrists. He states that psychiatry has traditionally regarded religion and spirituality as intrinsically pathological. We have been involved in mental health care in the UK since 1978, and none of us has ever known this to be suggested by a mental health professional. He states that there is wide spread psychiatric prejudice against religious faith and that psychiatrists commonly do not understand the role of religion in patients’ lives. However, the research that he cites can be interpreted as suggesting that psychiatrists, by and large, believe that religion can be both helpful and problematic to patients and that they enquire about religious matters when these are relevant. As the salience of religious issues will vary between patients, this seems to us to be the appropriate approach.
“Our major concern about Koenig’s paper is his suggestions for practice. No one could seriously challenge some of his assertions, for example that we should always respect people’s religious or spiritual beliefs and that we should some times make referrals to or consult with appropriate priests or religious elders. However, these are well established parts of routine practice. They are within the limits of existing codes of professional behaviour. Some of his other suggestions constitute serious breaches of professional boundaries, for example:
“1. Psychiatrists should routinely take a detailed ‘spiritual history’, even from non-believers. He recommends that when patients resist this, the clinician should return to the task later. This seems to us to be intrusive and excessive. The insistence that even non-believers have a spiritual life shows a lack of respect for those who find meaning within beliefs that reject the transcendent and the supernatural.
“2. Some spiritual or religious beliefs should be supported and others challenged. This involves the application of the clinician’s values, which is incompatible with the maintenance of an appropriate degree of therapeutic neutrality. It is unnecessary and inappropriate for clinicians to take a position on highly sensitive matters of personal conviction, such as the existence and nature of evil, the meaning of unanswered prayer and doctrinal intolerance of homosexuality.
“3. It is sometimes appropriate to pray with patients. Even when patient and psychiatrist share a faith, the introduction of a completely non- clinical activity carries a grave danger of blurring of therapeutic boundaries and creates ambiguity over the nature of the relationship.
“We have personal experience of dealing with the adverse consequences of religious breaches of therapeutic boundaries. For the most part, these have been well intentioned but ill advised; for example, patients who want to pray with psychiatrists at one point in their treatment can become persistently distressed over having done so when their mental state changes. We have encountered more worrying breaches of boundaries where clinicians have proselytised in the consulting room. Occasionally we have encountered frankly narcissistic practice, where clinicians have been emboldened by the certainties of a charismatic faith and take the position that their personal beliefs and practices cannot be challenged because they are supported by a higher authority than secular professional ethics.
“The problem with blurring the boundaries, by inviting an apparently benign spirituality into the consulting room, is that it makes it more difficult to prevent these abuses. Having moved the old boundary it is then very difficult to set a new one.
“Psychiatrists will always have to understand patients who are different to them in gender, class, ethnicity, politics and religious faith. Understanding patient’s lives, the contexts they exist in and the resources that give them strength is a key skill in psychiatric practice (Poole and Higgo, 2006). Religion can be an important source of comfort and healing, though it can also be a source of distress. Of course, it can be intertwined with psychotic symptoms. Spiritual matters, however, exist in a different domain from psychiatric practice. There are others in our communities who have a proper role in helping patients spiritually and who can be an important source of advice to us. Quite apart from the obvious dangers inherent in confusing these roles, it is completely unnecessary to do so.
“Psychiatry has done much to improve the lot of people with mental illness, though it has also been guilty of some major historical errors. Our professional roles and professionalism are under sustained attack from a variety of sources (Poole and Bhugra, 2008). In order to resist these attacks, we need to be clear about our important and distinctive roles in helping people with mental illness. Psychiatrists are essentially applied biopsychosocial scientists, who work within a clear set of humanitarian values and ethical principles, in order to get alongside patients and facilitate their recovery from mental illness. Psychiatry does not hold all the answers, and other professions, agencies and individuals have different distinctive roles. Within psychiatry, we have to struggle with the internal threat of crude biological reductionism. Equally, if we break the boundaries of our legitimate expertise and become generic healers, we will have lost all usefulness and legitimacy.
}Declaration of interest
}The authors have a range of personal convictions, including atheist, Buddhist, Methodist, Roman Catholic and non-denominational faith.
“References
“Hollins S (2008) ‘Understanding religious beliefs is our business. Invited commentary on….Religion and mental health’, Psychiatric Bulletin, 32, 204.
“Koenig HG (2008) ‘Religion and mental health; what should psychiatrists do?’ Psychiatric Bulletin, 32, 201-203.
“Poole R, Bhugra, D (2008) ‘Should psychiatry exist?’ International Journal of Social Psychiatry, 54 (3), 195-196.
Poole R, Higgo, R (2006) ‘Psychiatric interviewing and assessment’, Cambridge: Cambridge University Press.
“Submit response
Published June 26, 2008”
**”Psychiatrists and Role of Religion in Mental Health
“Imran Mushtaq,MRCPCH,MRCPsych, Associate Specialist-Child & Adolescent Psychiatrist Mohammad Adnan Hafeez, MRCPsych, Forensic Psychiatrist Sp-CAHMS, Eaglestone Centre, Standing Way, Milton Keynes MK 6 5AZ
“Koenig’s message (Psychiatric Bulletin, June 2008, 32, 201-203) is very clear for psychiatrists that they should respect patients' religious beliefs and a sensible way to address this is through time investment in taking a spiritual history, respecting and supporting patients' beliefs. Challenging beliefs and referrals to clergy should be welcomed but praying with patients is highly controversial and should be treated with caution.
“There is a fine line between religiosity and religious conviction becoming a part of a complex delusional system. In clinical experience some patients are not religious prior to the onset of their mental illness. For such patients, becoming religious may be indicative of a relapse of their mental illness.
“Religion and psychiatry are usually considered as two totally different ways of healing. A number of UK, USA and Canadian studies confirm that psychiatrists are less likely to be religious in general, and are more likely to consider themselves spiritual but not religious. Religious physicians are less willing than non religious physicians to refer patients to psychiatrists (Curlin et al, 2007a). The Australian experience is not different either (D’Souza et al, 2006).
“References:
“CURLIN, F. A., ODELL, S.V., LAWRENCE, R. E., et al (2007a) The relationship between psychiatry and religion among US physicians. Psychiatric Services, 58, 1193 –1198.
“D'Souza et al (2006) Spirituality, religion and psychiatry: its application to clinical practice. Australasian Psychiatry, Volume 14, Number 4, 408-412(5).
Authors:
“Imran Mushtaq, MRCPCH, MRCPsych, Associate Specialist-Child and Adolescent Psychiatrist, Sp-CAHMS, Eaglestone Centre, Standing Way, Milton Keynes MK 6 5AZ
“Mohammad Adnan Hafeez, MRCPsych, Forensic Psychiatrist Edenfield Centre, Greater Manchester West Mental Health NHS Trust Bury New Road Prestwich M25 3BL
“Declaration of Interests: None declared.
“Submit response
Published June 26, 2008”
**” The Neglect of the Non-Believer
“Peter Lepping, Consultant Psychiatrist/Associate Medical Director/Honorary Senior Lecturer
North East Wales NHS Trust/University of Wales Correspondence in Response to the Recent Article on religion and mental health (Koenig, 2008).
“I was amazed and alarmed to read Koenig’s article on religion and mental health and the president’s lukewarm support of the article as it presents no scientific evidence that any of the suggested working practices improve patient care. The few figures it uses are not supported by other studies. Koenig claims that only 1.4% of the British population are atheists. His source is the World Christian Database, hardly an unbiased source of information. This low level has no face validity to anyone working in this country. A recent study (Huber & Klein, 2008) funded by the conservative Bertelsmann Institute looked at religious beliefs in 18 countries (8 of them European) across the developed and the developing world. It used a very broad definition of religion and spirituality focussing on Pollack’s work on the belief in the transcendence as the core of substantial spirituality (Pollack, 2000). In other words, it looks for the belief in something spiritual that may or may not be related to formal religion. They professionally polled tens of thousands of people in the 18 countries making it by far the largest and most comprehensive study into the subject so far.
“Their findings confirms Britain to be amongst the least spiritual countries amongst the 18 examined across a wide range of factors including prayer, church attendance, personal religious experience, religious reflection, pantheistic influence etc. It finds that across European Christians more than 10% of those who formally belong to a church do not believe in anything spiritual at all. This makes census data potentially quite unreliable when it comes to assessing people’s real religious believes. In Britain 19% of those polled were classed to be highly religious, 43% as religious, 38% as non-religious using a broad definition of spirituality. 55% of Britons consider prayer to be non-significant for their lives and only 33% have personal religious experiences.
“Far from religion being pervasive throughout the majority of society, in Britain at least the opposite seems to be the case. Moreover, there is already a well organised provision of support for people who follow organised religion in all hospitals with easy access to religious elders and prayer rooms. However, no provision exists for non-believers who look at questions of meaning of life and morality in a non-spiritual way. It is that group that is disadvantaged rather than those who follow organised religion. It follows that rather than insisting on getting a “spiritual history” of each patient we should show respect to those who can discuss meaning of life without spirituality and find solution to identify and facilitate their needs in an increasingly secular society.
“Yours sincerely
“Dr P Lepping, MRCPsych, MSc
“References
“HUBER S & KLEIN C (2008):
http://www.bertelsmann- stiftung.de/bst/de/media/xcms_bst_dms_23399_23400_2.pdf
“KOENIG HG (2008), religion and mental health: what should psychiatrists do? Psychiatric Bulletin, 32, 201-203
“POLLACK D (2000), What is religion? In Waltraud Schreiber (ed.), The religious dimension in history lessons in European schools: an interdisciplinary research project, p.55-81, Neuried: ars una (in German)
“Submit response
Published June 26, 2008”
(“Thank you for validating my point." citations posted by "jacob," on "Recovery from Mormonism" bulletin board, 29 November 2011)
*****
--Summing Up Koenig's Fundy-Mental Problem--
As RfM poster “OnceMore” succinctly observes:
“Koenig edged toward conducting real science based on real research, then he stepped back and indulged in confirmation bias instead.
“He is misusing his education and his position of authority.
“In reading his work, you can feel the strain. He wants to include enough objectivity to earn the respect of non-religious peers, but at the same time, he feels obliged to put his thumb on the scale in judging the effects of religion.
“You can see that thumb. You can feel it.
“I feel sorry for him. He can't quite allow himself to be completely ethical and logical. He has to weight the scale. But he does have a working brain, so he lets a few facts past the filter.
“I would not be surprised to find that he is an example of anxiety caused by the strain of constantly working to fit reality into his confirmation bias.
“You are right of course that it is absurd. Here are some responses to the report that you pointed me to.”
(“Re: (cont., Part 2) Koenig the Seminarian: A Barnstorming Believer Who Wants to Be Taken Scientifically Seriously in His Pitch for the Mental Health Benefits of Supernaturalism,” posted by |"OnceMore,” on “Recpveru from Mormonsm,” bulletin board, 28 November 2011)
Date: November 29, 2011 02:34PM
(**related RfM link: Religion Itself is a Form of Mental Illness," at:
http://exmormon.org/phorum/read.php?2,912246)
Edited 7 time(s). Last edit at 06/01/2013 07:00PM by steve benson.