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Spiritual interpretation of natural desires and unadjusted behavior. Spiritual ... Objects and Protection against Evil: Pictures of Saints, Amulets, Holy Cross, ...

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Slide 1:“THE SICK SOUL” AND BEYOND – Religious interpretations of mental distress Samuel Pfeifer Clinic Sonnenhalde, Riehen Switzerland

Slide 2:Psychiatric Clinic Sonnenhalde, Basel

Founded in 1900 by a protestant order (Diakonissenhaus Riehen) Open doors – no restraint Professional clinical psychiatry combined with Christian values Teaching hospital of the University of Basel

Slide 3:„The sick soul“ (William James)

Those persons who cannot so swiftly throw off the burden of the consciousness of evil, but are congenitally fated to suffer from its presence. …for whom evil is no mere relation of the subject to particular outer things but something more radical and general, a wrongness or vice in his essential nature, which no alteration of the environment, or any superficial rearrangement of the inner self, can cure, and which requires a supernatural remedy.”

Slide 4:Three conditions

Melancholy – depression Obsessive-scrupulous doubt Panic fear No reference to psychotic disorders and delusional states No reference to dissociative states

Slide 5:Descriptive approach

“Please observe that I am not pretending to judge any of these attitudes. I am only describing their variety.” William James, p. 144

Heinrich Füssli (1741 - 1825) Nightmare Overview A) Definitions B) Causal attributions C) Psychodynamics and Spiritual Interpretations D) Clinical Implications Spirituality An attitude directed towards the intangibly transcendental (God). For the spiritual person this is the source and the goal of his or her life, fundamentally influencing his or her way of living, responsibility and ethics. (modified after Scharfetter 1999)

Slide 9: Spiritualization

incidents and experiences are interpreted in a religious context The interpretation relates to causality and change (therapy) of problems. Subjective experience is perceived in a comprehensive spiritual context

WHY?

Slide 10:Causal attribution

Tolstoy, Confessions “The questions of ‘Why’ and ‘What for?’ beset him more frequently – These questions of ‘Why’ and ‘Wherefore’ and ‘What for’ found no response.” William James

WHY?

Slide 11:Causal attribution

Locus of Control Internal (spiritual life, personal effort) External (affliction, oppression, curse) Stability Stable (personal discipline, effective protection) Variable (actual condition, reliability of others)

Effects (Weiner) Coping or Hopelessness Cooperation and Empathy or Blame and Rejection STUDY: Causal Attributions in Schizophrenia (Angermeyer & Klusmann, 1988) Five areas: Psychosocial burden family Personal problems Biological factors „Esoteric“ factors Eur Arch Psychiatr Neurol Sci 238:47-54 (1988) Family Broken home lack of parental love father was too strict parents had too high expectations overprotective mother hostile-rejective attitude of parents evading daily problems lack of will power alcohol and drugs too intelligent too ambitious general failure Personal Problems Eur Arch Psychiatr Neurol Sci 238:47-54 (1988) «Esoteric Problems» Lack of vitamins Environmental pollution Possession by evil spirits Detrimental radiation Divine punishment Unfavorable Horoscope Open Question 1,0 % Possible Cause 54,9 % (Very) Probable Cause 22,3 % Evil spirits: Possible Cause 10,9 % (Very) Probable Cause 3,1 % Angermeyer & Klusmann (1988) Eur Arch Psychiatr Neurol Sci 238:47-54 “Occult Bondage” 343 Patients (114 m, 229 f) all were religious mainline church (cath, ref.) 139 Trad. free churches (TFC) 164 Char. free churches (CFC) 40 Schizophrenia 60 Depression 87 Anxiety Disorders 56 Personality Disorder 65 Adjustment Disorder 75 Pfeifer S. (1994) Belief in demons and exorcism. An empirical study of 343 psychiatric patients in Switzerland. British Journal of Medical Psychology 67:247–258 “Occult Bondage” Occult Bondage 37,6 % as possible cause Ritual of deliverance 30,3 % performed Significant correlation with Diagnosis (p < 0.01) Religious affiliation (p < 0.005) Pfeifer S. (1994) Belief in demons and exorcism. An empirical study of 343 psychiatric patients in Switzerland. British Journal of Medical Psychology 67:247–258 Belief in demonic causality (in percent) Bio-psycho-social Model Mosaic of Causal Attributions Conflicts from Individual Experience Cultural Traditions Alternative Body Theories and Diets Religious Convictions Spiritual and Magical Beliefs Pfister, S. & Thiel, S. (1999). Religiosität und subjektive Krankheitstheorie. Eine empirische Untersuchung bei 53 psychiatrischen PatienInnen. Dissertation Medizinische Fakultät der Universität Bern. The Bio-Psycho-Social Model and Spiritualization Forms of Spiritualization Spiritual forms of intrapsychic communication: „I talk to God; God talks to me.“ Spiritual interpretation of natural desires and unadjusted behavior Spiritual interpretation of distress (mentally and somatic); i.e. causal attribution without delusional aspects Religious delusions Functions of Spiritualization Interpretation (Causal attribution) e.g. „oppression“ as a reason for sleep disorders Defense mechanisms e.g. prayer meeting instead of behavioral change --- e.g. spiritual justification of wishful thinking Coping e.g. prophetic words of encouragement / subjective relief through “rebuking spirits” A continuum of intensity Empathy possible failure to attain a religious ideal: e.g. „I am not praying enough!“ e.g. „I feel abandoned by God“ e.g. „I am damaging my Karma!“ Extreme demon of pride, lust etc. (unacceptable drives and behaviors are attributed to demons) Demons as cause of sleep disorders, nightmares, obsessional thoughts etc. 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 Contamination Mixture of spiritual support with popular superstition (especially in catholic and orthodox context) with Psychoanalytic Popular Psychology (e.g. in the charismatic literature) Dealing with Spiritualization 1. Assessment “Approaching the unfamiliar with respect helps us to gain understanding” Explanatory Model or secondary phenomenon? Delusion or Subculture? Psychodynamics: Positive Coping or Dysfunctional Defense Mechanism? Which therapeutic consequences result from the religious interpretation of the problem? (traditionally Christian, magical, dramatic) Dealing with Spiritualization - 2 2. Evaluation In cooperation with the client / patient Different forms of “religious style” Personal integrity of the therapist Theological evaluation is not primary concern of therapy IMPORTANT QUESTION: What is the influence of religious interpretations on symptom relief, coping with life events and psychosocial development of the patient / client? Symptom Relief Personal freedom -- Interpersonal Relations -- Coping Results of Spiritualization 3. Therapeutic strategies Develop a supportive therapeutic setting in collaboration with the patient Spirituality 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 (e.g. depression) Image: out-of-tune piano Determine functional and dysfunctional aspects of spiritual interpretation „Agree to disagree“ 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.

Slide 31:Conclusions

The construction of meaning on the background of sub-cultural values is a universal phenomenon. Help-seeking behavior Physicians, healers and counselors are unwitting partners in health care Cultural sensitivity Utilizing functional aspects of religion in a patient‘s coping process

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