What is Mental Illness? The Relationship between Religion and Psychiatry

1. What is Mental Illness?The Relationship between Religion and Psychiatry Shari Y. Thompson thompsons@mail.nih.gov June 20, 2005

2. Overview • Historical Review of the Relationship with 5 Major Religions • Impact of Religion on 20th Century Psychiatric Practices • Acquiring Scientific Knowledge

3. Hinduism • 1500 B.C.- One supreme deity but recognizes other gods as facets of the supreme deity • All illnesses are caused by animistic beliefs, demons and evil spirits and certain human excesses • 100-200 A.D. recorded the first description of insanity with no mention of provisions for caring for the sufferer • Segregation of people with mental illness first occurred in the 19th century • In 1922, the “lunatic asylums” were called mental hospitals

4. Buddhism • 563 B.C.- 2 forms Mahayana (Buddha is the Savior) and Theravada (individual responsibility) • Goal of enlightenment is wisdom and the monastic order is the heart of the spiritual quest • A vast spiritual world influences diseases and illnesses • Individuals are not responsible for their mental illnesses so they are not persecuted • Formal Buddhist writings contain very few comments about psychosis

5. Judaism • 2000 B.C.- Belief that God is good and righteous, and His creations, the world and its people are good • Emphasis on social services and humanitarian activities • Late 12th Century Maimonides described the anatomy of the brain and psychiatric disorders • Early 13th Century Maimonides first wrote, “Mental health is as important as physical health.” • Stresses prevention not treatment – “The ill cannot serve the Lord properly.”

6. Islam • 570 A.D.- Mohammed taught respect for the world order allowing Muslims to approach science sooner than Christians • Absence of demonic theory of disease advanced medical knowledge • 872 A.D. Cairo - First hospital for those suffering mental illness was fashioned after Christian hospitals • 12th Century -Sufism ideology of health and illness depended on God alone causing tension with the medical profession during the Middle Ages • 13th Century record listed 1400 drugs produced by Arab scientists

7. Christianity • 4 B.C.- Christian church came from a faith in Jesus’ resurrection and that he continues to live • Gospel writers recorded that healing and exorcism played a role in Jesus’ ministry • 4th Century healing through the laying of hands, prayer, fasting, invocation of Christ’s name, sign of the cross, and exorcism • Care of those suffering was led by the church leading to extended, organized community care • 14th Century pre-scientific demonology gave rise to the Inquisition

8. Middle Ages (14th – 17th Century) MIDDLE AGES Christianity Buddhism Hinduism Judaism Islam 2000 BC 1000 BC 563 BC 4 BC 570 AD 1300 AD 1600 AD 2000 AD

9. Scripture • MATTHEW 4:24 Tormented with illness and pain “And his fame went throughout all Syria: and they brought unto him all sick people that were taken with diverse diseases and torments, and those which were possessed with devils, and those which were lunatick, and those that had the palsy; and he healed them. ” • MARK 9:17 Possessed by devils “And one of the multitude answered and said, Master, I have brought unto thee my son, which hath a dumb spirit; ” • LUKE 9:39 Epileptics “And, lo, a spirit taketh him, and he suddenly crieth out; and it teareth him that he foameth again, and bruising him hardly departeth from him”

10. The Impact of Religion on 20thCentury Psychiatric Practices • Hinduism – yoga and relaxation techniques based on psychophysiological methods that were used to achieve control • Buddhism – Direct meditation may enhance psychotherapy and Zen-derived Morita suggested as a form of treatment for social phobias and specific obsessions • Judaism – 52% of psychotherapists in American cities are Jewish-Sigmund Freud and his followers made a profound impact on psychiatry from the perspective of clinicians, researchers, and patients

11. Impact of Religion on 20thCentury Practices Contin’d • Islam – employ elements of Islamic worship in group psychotherapy success in relieving psychiatric symptoms and re-grounding spiritual faith • Christianity – reform mental hospitals to improve conditions of care and mainstreamed the language for psychoanalysis

12. Is there a Role for Clergy in Mental Health Care? • Points to consider: • Religious life of Americans • Religious practices, beliefs, and values may help prevent illness • Religious commitment may influence decisions about mental health care ***Clergy may support and complement traditional medical care***

13. Summary • The study and treatment of mental illnesses have been influenced by societies’ views of the spiritual world • Belief in an evil or supernatural causation is not problematic per se, the issue is how that view influences the care of individuals with mental illnesses • Are we a society that persecutes suffering individuals or do we provide the best care and treatment that technology will allow

14. Summary Contin’d • Medical practices are guided by the true inspiration of religions - compassion, fairness, sense of justice, and love • The continuing challenge is to be truly worthy of our moral responsibilities and intellectual inheritance.

16. 2ND BIGGEST BREAKTHROUGH IN 2003 • Decoding Mental Illness • www.sciencemag.org/cgi/content/full/302/5653/2039

17. What is Risk? Genetics – the genes you inherit from your parents Environment – stress, smoking, drugs…

18. The Human Genome Sequence is Done (ca.2003) Nucleotides: 3 billion Genes: 25,000 Proteins: 600,000 SNPs: 6 million

19. What is Risk? Genetics – the genes you inherit from your parents Environment – stress, smoking, drugs…

20. Genetic Loci Linked to Schizophrenia GAD1 DISC1 1 2 3 4 5 NRG1 DTNBP1 GRM3 MRDS1 6 7 8 9 10 11 12 G72 13 14 15 16 17 18 COMT 19 20 21 22 X Y = genome-wide significance

21. The path from here to there… cognition schizophrenia temperament Cells: subtle molecular abnormalities Genes: multiple susceptibility alleles each of small effect Systems: abnormal information processing Behavior: complex functional interactions and emergent phenomena

22. Functional genomics in human brain Risk allele/haplotype how does it do it? cognition gene and protein expression neuroimaging

23. The “N-back” working memory task

24. Neuropathology • GOAL • To use postmortem human brains to discover the cellular and molecular mechanisms that lead to schizophrenia

25. Neuropathology Brain Collection • Total number of brains = 861. • Number collected since last year = 359. • Clinical history ( phone screening, medical records, interviews with next of kin), neuropathology and toxicology screening yields: normal controls = 100; schizophrenics = 55. • Molecular biology screening (pH, in situ histochemistry hybridization, 28s/18s ratios and capillary electrophoretic analysis (Agilent) yields: normal controls = 86; schizophrenics = 39.

26. What causes schizophrenia??

27. Low SES Immigration Urbanicity Substance abuse Poor cognitive performance Other psychiatric disorder Schizophrenia Social withdrawal Older father Perinatal complications Genetic predisposition

28. Acknowledgements Special Thanks: Dr. Daniel Weinberger Dr. Joel Kleinman Dr. Karen Berman All the Principle Investigators and Support Staff at the National Institute of Mental Health/NIH Genes, Cognition, and Psychosis Program (GCAP) Clinical Brain Disorders Branch (CBDB) CONSUMERS, FAMILIES, AND SUPPORTERS