Gauguin: „Vision in der Predigt“

Phenomenology and psychodynamics of religious delusions

Samuel Pfeifer and Regula Gasser

An emprirical study of 43 patients

Psy. Clinic Sonnenhalde, Basel / Switzerland

Gauguin: „Vision during a sermon“

Mystical experience or psychosis?

The Bishop and the Buddhist

Example 1: A young priest has a mystical experience in the St. Peter’s Dome in Rome. A sun ray gleaming through a gem in the crown of Mother Mary hit him like a holy lightening. He falls to the earth feeling an intense presence of God. To him this is a calling into his future ministry. He later serves as a bishop in the catholic church.

Example 2: A highly intelligent student neglects his studies, cuts off all social contacts, and is finally brought to the psychiatric clinic by his parents. He claims to have converted to Buddhism and asks permission for a pilgrimage to Tibet. He leaves without preparations. Three days later he calls from Munich: He had slept in a park, and was stung by a mosquito. Now he did not want to pursue his journey but rather come home.

Case vignette

A 30-year old man was arrested by the police when found lingering around an atomic power plant, being obviously disturbed. The man was not religious before the incident, but he reported that when visiting a church, he experienced an encounter with God in the shape of a light that shone through the stained-glass windows. He felt compelled to burn banknotes in the church. When he drove away, the oncoming cars and trucks gave him messages with their headlights. Finally he left his car with the ignition key on, and continued his pilgrimage on foot, spending two nights in the woods. He claimed to have received a mission from God to protect the people around the nuclear plant from harmful radiations. He therefore approached the fence around the power plant, carefully pacing up and down. Finally, he urinated into a bottle, deposing his urine in drops along the fence to create a protective wall.

Faith vs. Delusion

Faith Delusion

Group experienceSingularity – pathological restriction to the Ego.

FellowshipLoneliness. Lack of communication

Doubt accepted incorrigible

Trust Mistrust

Content often transcendent Content often threatening

No clinical psychopathology

Additional psychopathological sympoms.

Nach Haenel 1983

Factors of influence

Religious belief is not the only determinant of a religious delusion

In Manchester (Siddle et al. 2002): 68 % of the schizophrenic patients said they were religious, but only 23 % had a religious delusion (45 of 193 patients).

In Saudi-Arabia 43 % of the patients are using religious coping strategies against hallucinations (Wahass & Kent 1997).

Frequency of religious content in delusions

Seoul 47.1 % Austria 21.4 %

Shanghai 7.9 % Pakistan (?) 4.6 %

Taipeh 41.0 % Italy 20.1 %

Manchester 23.0 %

Kim et al. 2001

Stompe et al. 1999

Siddle et al. 2002

Raja et al. 2000

Criteria of Delusions

a) Incorrigibility of an objectively strange conviction

b) Not amenable to reason - failure to look for proofs

c) Pathological egocentrism.

Conviction, Preoccupation, Distress

Multidimensional phenomenon Gradual differences between norma faith

convicitons and clear delusions. Hallucinations (especially voice hearing)

do not only occur in schizophrenic patients (Romme & Escher).

Three Dimensions Conviction Preoccupation DistressPeters E, Day S, McKenna J, Orbach G. (1999) Delusional ideation in religious and psychotic populations. Br J Clin Psychol. 38 ( Pt 1):83-96.

Delusional experiences (nonreligious)

Delusion of Meaning („All had tears in their eyes as if they knew about my troubles....")

Delusion of Reference („They are painting the house in orange to harass me – or to give me a message.")

Delusion of being annoyed („I am being mobbed„ - however in a bizarre way)

Delusion of persecution („Conspiracy against me")

Love (erotic) delusion Delusion of grandeur Etc.

Diagnostischer Algorithmus (Siddle 2002)

Does the patient have a belief (include the attribution of hallucination) which has the characteristics of a delusional idea, e. g. an idea which is firmly

held, it may be bizarre, is not amenable to reason?

I

other delusions, hallucinations, thought disorder, anxiety etc.?

I

religious content

I

Would non-psychotic churchgoing religious people also find these ideas unacceptable?

I

Are the patients’ lifestyle / goals etc. more suggestive of a psychotic episode than an enriching life event? Was this a religious experience or

was it a psychotic episode?

Our own study

43 patients (30 w, 13 m) Age at index episode: 22 – 68 Jahre Educational level

– University degree 2

– A level degree 5

– Advanced school 7

– Apprenticeship 22

– unqualified 7

Diagnoses– Schizophrenias 29 (68 %)

– Affective Disorders 14 (32 %)• (Mania, psychotic depression)

Salience of Religion

Salience of personal religiosity Total

Konfession none little moderate strong Very strong

none 1 1 0 0 0 2catholic 0 2 1 3 3 9protestant 1 0 2 2 1 6TFC 0 0 1 2 8 11CFC 0 0 0 1 10 11others 1 2 0 1 0 4total 3 5 4 9 22 43Salience of personal religiosity is described as strong, when the patient is an active member of a religious group, is regularly visiting servicesor when his religion is visible in is outer appearance or behaviour (e.g. special clothes, oiving in a monastery).

Two patients lived in a religious order, three attended a bilbe college, three lived in a non-formal religious community.

TFC = traditional free church, CFC = Charismatic free church

72 %

Degree of religiousness

Religious education – not significant– 12 patients (28 %) – no religious upbringing– 14 patients (33 %) – regular attendance of religious

meetings during childhood– 13 patients (30 %) – moderate religious influence– 4 patients : no information– 13 of 31 patients (41 %), who gave religion a high

importance in their lives, had also had a religious education during childhood.

Ego-syntonic religiosity:– 23 patients (53.5%) showed besides their delusions an ego-

syntonic religiosity which was shared by the rurrounding sub-culture,

Self-destructive actions (n = 10)

Examples

Suicide attempt in the hope to be near God.

Cutting as an offering to God.

Demonic voices order a patient to chop off his hand.

A woman jumps out of the window to meet God-Jehova.

Suicide attempt because of failure to fulfil god‘s commission

Rituals detrimental to health in order to counteract satanic curse.

Fast up to 30 days.

No autocastration or self-blinding in this sample – but in literature.

Peculiar behavior (n = 13)

Giving lectures at the work place on the coming doomsday

Falling to the ground in an evangelistic meeting, trembling, shouting.

Hallucinations are passed on as prophetic messae in a church service.

A woman takes off her clothes and confesses her sins in public space.

A patient showed around her ring, which she had received from her „bridegroom“ Jesus.

Preaching to passing cars on a busy road.

Barricades in front of the house to ward off satanic attacks.

examples

Help-seeking behavior und compliance

Search for a religious form of therapy (healing prayers, exorcism)– 15 patients (34.9%) expressed a demonic

causality of their illness– 7 patients (16.3%) underwent „deliverance

ministry“ or exorcism.

Compliance and religious delusions:– In 15 patients (34.9%) religious delusions had an

influence. Often they insisted that their problem was spiritual and did not require medication.

Archetypes of religious delusions

General Religious

Enlightenment Apparitions of God

Dichotomy Good / Evil God – Satan

Persecution (Mobbing) “Spiritual Battle”

Warding off Evil Divine Protection

Passing on a Message Mission

Symbolic Hints Divine signs

Sexual topics Love / Temptation

Themes of Religious delusions

POSITIVE NEGATIVE

Prophecy Condemnation

Mission Bondage

Offering Curse

Visions Spirits of the Dead

Pregnancy Demons

Psychodynamics:Four functions of religious delusions

1. Interpretation (cognitive reframing) of threatening experiences („Why me?“).

2. Context in a larger framework of reference.

3. Exculpation or Dis-Egoification – relief from perceived guilt.

4. Wish fulfilment and significance though delusional experience.

a) Interpretation

What is vaguely perceived as an evil, life threatening and overwhelming threat to a person’s existence, gets a new significance if it is labeled “demonic”.

“Why me?” is one of the most tormenting questions of the delusional person. Whereas normal life would give no explanation for singling out an individual in such a destructive way, the events receive significance in the light of religious writings, where the just is threatened and attacked, even in the absence of personal wrong-doing.

But the study also describes positive connotations, such as identifying a comforting voice as the voice of Jesus or an angel in the midst of puzzling and threatening events.

b) Context

Cosmic dimension of personal suffering

Battle of spiritual powers

Fulfillment of ancient revelations

c) Externalization of ego-dystonic impulses

Psychodynamic mechanism of guilt reduction.

Sexual desires and erotic sensations as the experience of Jesus coming to them in their sultry dreams.

Aggressive acts are “ordered by demons”.

Wall painting Rila monastery / Bulgaria

d) Wish fulfillment / Significance

Love, sexual fulfillment, harmony with others, pregnancy (like Holy Mother Mary).

Significance: important role, being a prophetesse, having a mission, giving one’s life as an offering to save the world.

Therapeutic approach

RESPECT: The patient is first of all, a suffering individual. Religion may be part of his or her life, but it is embedded in his or her existence which is now overshadowed by the disorder.

CULTURAL SENSITIVITY: His or her religious ideas are part of the cultural background and require further clarification– Are they expressing fears or unfulfilled desires in an

archetypical way?– Are they part of his or her subculture?– Are they functional or dysfunctional?– Is it possible to ask relatives or colleages to clarify

religious aspects of the delusions?

Clinical Treatment

Manual-based Diagnosis of the psychiatric disorder (DSM-IV or ICD-10).

Medication (Neuroleptics). Regular clinical treatment. Inclusion of Family for support and

understanding. Religious Ideas:

– Do not give overdue attention.

– They will pass in most of the cases without specific treatment.

Culture and interpretation of delusion

PAT*

Subculture

Shared culture

Psychotic experiences

Life events

ObserverPsychiatrist

SubculturePrivateProfessional

InterpretationDiagnosisCultural Sensitivity

* PAT = The psychotic person shows both functional and dysfunctional aspects of behavior and ideas, some of which could be called “religious”.

Literature

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Gasser R. Religiöser Wahn. Eine katamnestische Untersuchung zu Verbindungen zwischen religiösem Wahnerleben, belastenden Lebensereignissenund Überzeugungen religiöser Gemeinschaften. Lizentiatsarbeit an der Philosophischen Fakultät, Psychologisches Institut II der Universität Zürich 2007.

Erichsen F. (1974). Bemerkungen über das so genannte „religiöse“ Erleben des Schizophrenen. Nervenarzt 45:191-199.

Henning C. & Belzen J., Hrsg. (2007): Verrückt nach Gott. Zum Umgang mit aussergewöhnlichen Phänomenen in Psychologie, Psychotherapie und Theologie. Schöningh, Paderborn.

Siddle R, Haddock G, Tarrier N, Faragher EB. (2002). Religious delusions in patients admitted to hospital with schizophrenia. Soc Psychiatry Psychiatr Epidemiol. 37:130-138.

Lenz H. (1973). Glaube und Wahn. Fortschritte der Neurologie und der Psychiatrie 41:341-359 Mohr S, Brandt PY, Borras L, Gillieron C, Huguelet P. (2006). Toward an integration of

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Kimhy, D., Goetz, R., Yale, S., Corcoran, C., & Malaspina D. (2005). Delusions in individuals with schizophrenia: Factor structure, clinical correlates, and putative neurobiology. Psychopathology, 38:338-344.

Stanghellini G. (2005). Schizophrenic consciousness, spiritual experience, and the borders between things, images and words. Transcult Psychiatry 42(4):610-629.