Does Religion Harm or Help Recovery from Schizophrenia?
Religiousness may have a positive impact on the quality of life of older adults with schizophrenia, according to new research looking at a large multiracial group of people with schizophrenia living in the community. The research appears in the September issue of Psychiatric Services, a journal of the American Psychiatric Association.
Previous research has identified the potential benefit of religion in the recovery of persons with schizophrenia, but has not specifically looked at older adults. With an anticipated doubling of the older population with schizophrenia over the next 20 years, the focus of this research was specifically on the potential role of religiousness among older adults.
The study participants included 198 people 55 and older living in the community who developed schizophrenia before age 45 and a randomly selected community comparison group of 113 older adults. Researchers used a seven-item religiousness scale consisting of three dimensions: salience (the importance of religion in the person’s life), use of religion as a way of coping, and attendance at religious activities.
The researchers found that persons with schizophrenia attended religious activities less frequently than their peers, four times a year compared with once a month, but were equally likely to report that religion was important in their lives and that they used religion as a coping strategy.
The study found that religiousness had independent and positive effects on the participants’ quality of life—that is, it did not simply act as a buffer that prevented psychotic symptoms from eroding a person’s quality of life. In addition, participants who had psychotic symptoms were no more likely to be religious than those without such symptoms.
The authors concluded that religiousness “must be considered along with other therapeutically important agents.” The authors also note that “mental health professionals have been found to be much less religious than their patients, and often they are not aware of their patients’ religious involvement….clinicians may overlook a therapeutically important agent.”
The study authors included Carl I. Cohen, M.D, Carolina Jimenez, MD, and Sukriti Mittal, MD—all affiliated with SUNY Downstate Medical Center in Brooklyn, N.Y., and the study was supported by grants from the National Institute of General Medical Sciences.
I’ve blogged in the past in regard to schizophrenia, faith and suicide:
September 5th, 2010 at 2:26 am
This is an interesting article. In the mid-90s I was a volunteer at a mental health ‘drop-in’ for Jewish people. I’m not Jewish, but did a social work placement at a Jewish Social Work agency. Through this placement I came into contact with the drop-in and liked its ethos. It was begun by Jewish people with mental health problems, it wasn’t begun or organised by therapeutic or statutory mental health services. It was just a bunch of people with mental health problems who met a few times a week in a ‘safe’ environment. Volunteers were vetted by the group and only participated as facilitators and helpers. I liked it because the power dynamics were so different from much ‘medicalised’ mental health provision.
Faith and belief were important to many of the people who attended, though being a Jewish venture, culture was probably of greater importance. I noted how belief could be really helpful to people. It did provide some focus for hope and meaning to what can seem wholly daunting. Yet there were also down sides to this, in that some people’s illness and its symptoms were augmented by religious ideas and the symbolic vocabulary religion affords its adherents.
As a community social worker I know on occasion I was rather wary if on a visit a new client’s home had lots of religious statues – and in particular pictures of Padre Pio. Obviously many people have such things in their house, but there seemed to be a disproportionate of people who went in for such overt religiosity who also suffered from mental health problems.
At the monastery where I was once a novice there have been a considerable number of people attempting to join the community who had/have mental health problems. I was thinking this over in my head earlier this evening and of the eight people who joined the community since I left (in 1992) five either had serious psychotic illnesses they kept quiet about and then had some major episode while living in community or had some in-patient treatment post monastery. Again, the access to a symbolic and cultural universe populated with ideas of spiritual conflict appeared helpful to some, but in the main often resulted in these would-be monks transposing their problems into spiritual ideas that usually meant they became passive victims. One serious issue arose when some within the community believed one of these brothers was suffering from demonic attack. I noted at the time (I was asked for advice) that if this was so, why was it the brother himself was so sure of this ‘diagnosis’ and used it to excuse abusive and sometimes violent behaviour? For this particular brother the state of affairs continued for the best part of five or so years before eventually he left and got proper help.
So I can see the pros and cons in making use of a person’s religious beliefs in treating mental illness. But I would caution great care is needed. A fundamental part of a good deal of mental illness is an unhealthy view of the ‘self’ – either the belief that one is more important than one is in reality – often demonstrated by paranoia and grandiose ideas. Or that one is worth less than one really is – self hatred and self harm. Given aspects of religious belief mirror these traits it is obvious that the combination of the two can have disastrous consequences. Hence care is needed. Some of the biggest errors I have seen in the care of the mentally ill has come from well meaning religious types who think mental illness is the result of the demonic or spiritual conflict or that they know better than professionals (I got the knife scar I have on my right hand from working with a schizophrenic in my early 20s when I held similar beliefs – the man needed professional care and we at the Evangelical nightshelter decided prayer was the answer – we were lucky none of us were seriously injured or killed as the man had a 9” carving knife in his hand and we thought prayer would get him to give it to us!).
An interesting post.
Thanks:
S.
September 5th, 2010 at 2:14 pm
@Steven. Fascinating, thanks so much for sharing this, you have had some marvelous experiences.
I had occassion to be in a psychiatric ward not so long ago and there was a seating area for patients. I would say that there were 10-12 patients and roughly 7-8 of them were reading bibles. Now, I don’t mean the standard Gideon bibles that were in their rooms, but their own personal Bibles.
It transpired that 3/4 of the patients on that ward, at that time, were Christian.
I have asked many folk their opinion and have never received a satisfactory answer as to why the proportion of mental health patients on this unit were Christian.
It is either that Christinity is the religion of the mad, which I’m happy with, or Christians are for some reason more prone to mental problems.
A real strange one….which still perplexes me….
September 5th, 2010 at 3:07 pm
@ webmaster: I was going to post along the same lines as Steven. In my experience both in social settings and as a patient (I’m a sober alcoholic) as well as in my work as a medical writer, religiosity is often a manifestation of serious psychiatric illness.
When you consider that thinking invisible others are speaking to you or that unknown powers track your every move are common psychotic experiences, it makes perfect sense that these manifest themselves in religion.
I fondly remember an art therapy session in a psychiatric ward. We were all doing rainbow gradients except for one huge bloke who was painting Calvary. Very simple: large navy crosses on a magenta hill. The therapist was gently encouraging him to try something new (this patient always painted the same Calvary)
No, he insisted. He was doing God’s work. Someone started giggling. Then, out of nowhere, a crack of thunder and rain started pouring down the windows.
“It’s a judgement! He has spoken!” he cried in triumph, and the whole class collapsed in laughter.
September 5th, 2010 at 9:08 pm
September 6th, 2010 at 11:07 am
@ webmaster: Luckily the huge schizophrenic bloke thought it was funny too. He was very kind and affable. People think psychiatric patients are scary, but most of them present a danger only to themselves.
Schizophrenia is a horrible, horrible illness. I made friends with a woman in hospital who explained how the voices tortured her. At her worst she would curl up on the floor, hands pressed over her ears, crying and crying. The voices told her she was useless, evil, ugly – she could feel them driving her to suicide. When she was well she knew the voices were delusional but she told me it was impossible to remember that they weren’t real when they returned. Then they seemed entirely real.
During my 20s I worked with a woman with schizophrenia. She was on a long-acting injection that kept her functioning but she hated the side-effects. They made her leaden, sexless, dreary. She desperately didn’t want to lose her job, but she also wanted to take as little of this nasty drug as possible.She would put off having the next injection for as long as possible, only giving in when she became obviously bonkers.*
We become so close that she asked me to monitor her so she could strike a balance. It worked well – she would be a little bit odd, but pass as normal, for weeks then suddenly reach a point where I could tell she needed her injection. I was touched she trusted me to tell her truthfully, especially when suspicion and paranoia are part of the disease.
I think the fact that I’m not entirely sane myself helped.
*Bonkers being the term used by all the best doctors.
September 6th, 2010 at 12:45 pm
In the life of St John of the Cross there is an incident where a couple bring their son to the saint and ask that he drive out the demon which they think is possessing him and causing his madness. John+ examines the boy and then says to the parents that boy is merely mad and that they should care for him. This story is one we can learn from, because there are those in certain expressions of Christianity (mainly Charismatic Evangelicals) who are apt to see demons at every turn. Whatever our purpose in this world – and like many who read this blog I think religion offers only a partial explanation – it is clear we have a duty to care for those with mental ill health.
This week is the second anniversary of my nephew’s suicide and such issues are to the front of my mind at present – especially as it coincides with the 20th anniversary of the week’s holiday I had with my nephew. Why that happy-go-lucky, cheerful 11 year old boy became the tortured and haunted creature he became – and was ultimately found by his father hanging from a homemade noose in the stairwell of his flat – is a question I ask myself almost daily, even now… I remember thinking, as I took my seat in the crematorium after helping carry my nephew’s coffin into the chapel, that it should have been the other way around. He should have shouldered my corpse – as I was the elder by 14 years – and had at least a portion of the happiness I have had in life. A sad day.
Some may find this assessment rather peculiar, even dangerous and reactionary, but I am convinced a major factor in the death of my nephew was the British welfare system. As his mental health became worse, he became entitled to more benefits. At his death he received more in ‘real’ income (if calculated to include free housing and payment of local tax (Council Tax in England & Wales)) than I earned as a part time senior social worker or my partner earned as the full time manager of a bookshop (i.e. £25,000 p/a). In the main much of his income was spent on fripperies, cannabis and amphetamines. Yet it is not these drugs I am complaining about (though they didn’t help); it is the fact there was no incentive to get well. As a social work student and newly qualified social worker I used to ‘moonlight’ at a half-way hostel for young people who were in the process of discharge into the community after their first psychotic episode and many of these were content to remain ‘ill’ because once within that cycle of dependence there was no point, for many of them (as unskilled, and poorly educated adults) to move on. This may seem harsh and removed from my usual left of centre worldview. But I am basing my thoughts on my observations – I have spent many years as a social worker working with the mentally ill, besides voluntary work in the same field.
In the 18th century, William Tuke, a Quaker, founded ‘The Retreat’ a diversion away from the ‘Mad House’, where people with mental illness were no longer incarcerated and punished, but supported and educated in family norms. In addition to this, ‘in-mates’ were given meaningful occupation (see pp 65-6 Turner, B.S. (1987) Medical Power and Social Knowledge London: Sage; and pp 223-4 Foucault, M. (1967) Madness and Civilisation London: Routledge – both excellent reads on the subject).
It is interesting to note that many of the innovations in social care in the 18th & 19th centuries were heavily influenced by both humanism and religious non-conformity! Perhaps it is here that religion can play its most useful role. Just paying out money kept my nephew in the destructive cycle of hospital admissions and rehabilitations, whereas some means of providing dignity, meaning and occupation could (and I stress the ‘could’ because my nephew was not an easy person to deal with in his adult years!) have made a difference.
September 6th, 2010 at 3:36 pm
@ Steven Underwood: I feel for you in your loss, but I entirely disagree with your analysis. My perspective is also informed by my work and lots of personal experience.
If seriously mentally ill people stop getting benefits they don’t pick themselves up. They don’t move on. They despair. They find it impossible to sort out the paperwork or find work. They neglect themselves, they become emaciated. They end up in squats or living rough. They die young.
Suicide among schizophrenics is two or three times that of the normal population, with the greatest risk being young men soon after diagnosis – which fits your poor nephew to a tee.
Your premise that while benefits were provided your nephew had no incentive to get well couldn’t be more wrong. What you’re saying is the equivalent of the common, exasperated response to someone suffering from profound depression “Why can’t he just pull himself together?” To which the answer, of course, is that if the person could pull themselves together they wouldn’t be ill. No one chooses to be depressed or schizophrenic.
Your feelings of frustration – that if only he had been forced to support himself, pull himself together – that he might still be with us – is the natural, almost universal, reaction of anyone who has not experienced serious mental illness themselves.
Far from being disadvantaged, your nephew was very lucky to be included in a continual cycle of admissions and rehabilitation. Far too many mentally people simply don’t have enough intervention. My own opinion is that we failed people like your nephew when we shut the asylums. He needed not to have to be independent. He needed safety and oversight.
Incidentally, when you say rehabilitations, do you mean for chemical dependency? Because of course this carries its own high risk of suicide. Very few people realise how many addicts/alkies kill themselves. When you put the two together – schizophrenia + chemical dependency – the suicide risk must go off the clock.
September 6th, 2010 at 3:51 pm
I agree with you Sophie…
September 6th, 2010 at 3:55 pm
The use of illegal drugs is a chicken and egg.
Some “self-medicate” as a result of their symptoms of mental anguish. For a few the drugs trigger the mental problems, however, I would still maintain that they had a pre-disposition toward mental problems.
Either way, there is an underlying mental condition waiting to expose itself.
Drugs may provide short term relief, but ultimately exacerbates the problem.
If you are in enough mental angusih you will choose the short term option regardless of the consequences.
The very charismatic churches can also exacerbate mental health problems, as I have known them advise folk to stay off medication for “faith” reasons and attribute all strange behaviour to demonic influence. All very very dangerous and I have been told first hand of type of these experiences….sad…
September 6th, 2010 at 4:38 pm
Sophie
Thanks for the thoughtful comments.
It is difficult to put my complete thinking on benefits etc. into one post. I am certainly not saying benefits etc. don’t have their purpose, nor that people with mental health problems should be denied them; but in the case of my nephew they were of little help to his overall situation. Similarly, my own experience in social work was that many people are happy to toddle along maintaining their identity as a person with mental health problems rather than move on, once their condition is stabilised. Now this is contentious because there is also a good deal of stigma in our society attached to people with mental health problems – particularly schizophrenia and hence it is a two way process as society itself has to change its attitude.
Yes there are people who have problems with forms etc. but there is an amazing number of people who claim to be debilitated by their condition and yet display considerable acumen when it comes to what benefits they are entitled to and how is the best means of claiming them. Personally I think the problems lie in how benefits are calculated and their usefulness. To my nephew they were useless, because the bulk went on cannabis and to be frank his real problems couldn’t be solved with money. He quickly latched on the idea of victimhood in his teens and was a manipulative little shit a good deal of the time. He was told again and again not to use cannabis and offered professional help in this matter (I will add that my thinking was that it was a family problem – his mother (my sister) and her husband, who all needed to work together – family counselling was offered but refused, my sister’s retort being ‘His problems have nothing to do with our behaviour!’ (I thought the reverse!!)). He would agree to help this and then tell the psychiatrist or counsellors to fuck off. In the end his death had a sort of inevitability – and although I was grief stricken at the time, I mourn more for the little boy I knew than the manipulative and irresponsible adult. Perhaps I just find it difficult to empathise, particularly those who claim handicaps in their past as the reason for their problems as an adult. I grew up surrounded by alcohol fuelled domestic violence on a dog-rough council estate, I was fostered as a child, and spent a good deal of my childhood in the remedials’ class, labelled as ‘stupid’, for the first five years of my working life I wiped backsides in old people’s homes. But I did something about this by sheer determination and hard work. I come from what Americans would call a ‘white trash’ background and still have close family members who are happy to live off benefits and covet ‘diagnoses’ as a means of getting more money (tho’ my parents and my brother have always been hardworking people).
So what, you may say. ‘Good for you’… But there are other people in the world who are not so lucky and not as resourceful or self-reliant. This is true and therefore we need a benefit system, but we also need a means of moving people on from benefits once they no longer need them or if the benefits themselves don’t provide support or the person doesn’t use them for their intended purpose. Here I don’t mean the person loses the benefits, just that the money is spent in another way – if my nephew had had the money spent on additional support, he might be alive today. All I am really saying is that cash benefits have their place, but that they are not a cure all and there needs to be some careful thought about how benefits are awarded and used.
Regards and thanks again for your thoughtful insight.
S.
September 6th, 2010 at 5:22 pm
p.s.
Don’t like this ‘ But there are other people in the world who are not so lucky and not as resourceful or self-reliant…’ since mental illness can sap both attributes…
S.
September 7th, 2010 at 9:44 am
@ webmaster: A year before I got sober my darling parents paid for me to see a consultant psychiatrist at a London teaching hospital. She assumed that, because I was young, well-educated and well-spoken, alcohol wasn’t my primary problem. She urged me to tell her my woes, encouraging self-pity and solipsism. At one point she put forward a theory that I’d been molested by my dad, which was why my parents were paying for help. Told her that wasn’t the issue, but she only wanted to follow her own preoccupations. She’d decided what the problem was.
Didn’t matter how clearly I explained my booze dependence, she kept putting it down as a symptom. She called it a “problem” when even I knew having to drink vodka first thing was way more than a problem.
Roll forward 12 months and I entered rehab. Six weeks in the country, facing my worst fears. It was amazing. One of the best experiences of my life. Certainly the most important. Without it I would be dead by now.
When I stopped drinking most of my pressing problems simply vanished. Since then I’ve become aware that I’m a recurrent depressive, which is grim, but that if I don’t drink it lifts in time. Medication and therapy help, but neither is a complete solution.
I’m sure my depression is biochemical. When I’m depressed I lose my sense of smell, which is a neurological symptom from deep in the brain. I’m also confident a medical cure will be found, maybe in my lifetime. I hope so.