When does piety become pathology?

Arthur Caplan

September 15, 1992|By Arthur Caplan

LAST week several hundred people gathered in a smal church in Cold Spring, Ky., to await the appearance of the Virgin Mary.

While no appearance took place, other persons have in recent years reported sightings of Mary, Jesus and various angels in places as disparate as Arizona, Queens, New York, Mexico and Croatia. Many Americans, including a former presidential candidate, say they have received messages directly from God.

There is a fair amount of snickering and derision in some quarters whenever people announce that they have just concluded a chat with God or have seen Mary in the doorway to heaven.

It is hard to believe that if the Supreme Being felt the need to convey a message, it would be transmitted by making a painting on someone's den wall weep or showing a little girl's face on a billboard on a Texas highway.

Religious leaders of all faiths counsel skepticism and caution concerning reports of mystical experiences. But, if skepticism is in order where such claims are concerned, what are we to make of the people who make them? Are those who say they hear messages from God, see the Virgin or communicate with the saints crazy?

Wondering about the sanity of those who have mystical experiences may seem nutty in itself. Do we really want to dismiss the devout and the spiritual as mentally ill?

According to a new article by Stephen Post, a theologian who teaches bioethics at Case Western Reserve University in Cleveland, Ohio, the field of psychiatry gets awfully close to doing just that.

Writing in the journal "Social Science and Medicine," Mr. Post looks closely at the most recent edition of the "bible" of the field of psychiatry, the "Diagnostic and Statistical Manual of Mental Disorders," to see how it deals with religious belief and practices. The manual, published by the American Psychiatric Association, is the standard reference work for practitioners in this country for the diagnosis and treatment of mental illness.

Post finds that the manual contains passages that convey subtly negative views toward certain religious practices or about those who hold and espouse certain kinds of religious beliefs.

For example, Mr. Post notes that among the descriptions of behaviors or traits ". . . associated with several mental disorders" are persons who act as if their thoughts, words or actions might ". . . cause or prevent a specific outcome in some way that defies the normal laws of cause and effect."

One of the examples the manual uses to illustrate this behavior is the case of a man who believes that if he says a specific prayer three times each night, his mother's death might be prevented indefinitely.

Mr. Post thinks that this example, and others like it, show that psychiatry is inclined to assign those who fervently believe in the power of prayer to the realm of delusion, magical thinking, fetish or psychopathology.

He wonders whether the Catholic, Shiite or Buddhist who everyday offers sets of prayers in a systematic or ritualistic manner are in his words "more likely to be labeled mentally ill because of the more ritualistic aspects of their tradition?"

Certain beliefs about God can sometimes raise questions about a person's mental health. Mr. Post cites examples in the diagnostic and statistical manual's glossary in which people's efforts to try to explain their belief in God are used as models of incoherent, disorganized or muddled thinking.

While the manual cautions psychiatrists not to simply equate "political, religious or sexual" behavior with mental disorders, the fact remains that at least a few of the examples given of mental illness involve instances of behavior that in certain contexts would be viewed as simply examples of theistic beliefs.

Mr. Post does not suggest, and I do not believe, that the field of psychiatry or mental health is intolerant of religion or religious belief. He is one of the few people who, as a theologian, has tried to look at how religion is treated by the field of mental health. Even a painstaking look produces only find a few examples in an enormous book where psychiatry arguably is intolerant of fTC religion or religious belief.

Still, the issue of how psychiatry and mental health respond to religious belief is one of central ethical importance. There clearly are persons whose mental illness reveals itself in the form of religious practices or beliefs. It is wrong to presume that simply dressing up a belief in religious language exempts that belief from psychological or psychiatric assessment.

But, given all the tears and pain that have been associated with "deprogramming," "brainwashing" and "cults," the mental health field must approach the issue of religion and religious belief with the utmost sensitivity and caution.

People who beat their children black and blue in the name of God or who believe themselves to be the Virgin Mary, Mohammed or Jesus are often mentally ill. Those who have visions, talk to the dead or think they see the devil may require therapy rather than awe.

To be both effective and fair, the mental health field needs to take a closer look at whether and how it can distinguish devotion from dysfunction and piety from pathology.

Arthur Caplan is director of the Center for Biomedical Ethics at the University of Minnesota Medical School.

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