Religion and mental illness form a complex relationship

Commands from God, visions of demons, spiritual persecution – at least one national expert estimates that one-third of psychoses involve religious delusions.

Yet others cling to religion in the face of mental illness, seeking comfort in the church, synagogue, mosque or temple.

So what’s the ultimate relationship between religion and mental illness?

“I would describe it as being complex and patient specific,” said Lisa Harding, a resident in the Department of Psychiatry and Behavioral Science at the University of Kansas School of Medicine-Wichita.

“There’s no ‘one shoe fits all’ as to how religion fits mental health.”

Harding has worked on the board of directors of the National Alliance of Mental Illness in Iowa, where she explored what pastors believed about mental illness.

Now in Wichita, she’s working on a project to determine whether faith leaders can lead to increased awareness of mental health issues and services among minorities.

She wonders: Where are religious people who have mental illnesses going if they’re not being treated?

“Are they going for an exorcism?” Harding asked. “Who are they calling? What are they doing?

“The question my project and my paper is trying to answer is can collaboration with faith institutions lead to providing mental health services to minority populations. … Sometimes as people of faith, they’re not going to call the crisis line, they’re not going to call 911; the person they’re going to call is the pastor.”

If religion is something that protects a patient, then it’s a good thing, Harding said.

Researchers at the University of Missouri reported in 2012 that better mental health is “significantly related to increased spirituality,” regardless of religion.

In other instances, a beneficial relationship between religion and mental health isn’t the case.

“For some people, religion is actually persecutory for them and religion is not helpful,” Harding said. “The overall message in medicine is that there’s not a fixed model.”

A study reported in the Journal of Religion and Health in 2014 found that belief in a God who punishes, “a punitive God,” was associated with an increase in four psychiatric symptoms, although general belief in God wasn’t significantly related to any psychiatric symptoms.

When it comes to illnesses such as schizophrenia or bipolar disorder, religion often appears in the form of a delusion, a “fixed, false belief.” That becomes particularly concerning when the delusion is a command compelling a person to hurt themselves or others, Harding said.

Harold Koenig, professor of psychiatry and behavioral science at Duke University Medical Center, estimates that one-third of psychoses involve religious delusions.

“Religion is a very powerful social, cultural factor,” Koenig said. “There’s something about the grandiosity of religious beliefs that leads to these symptoms.”

Yet over the course of years of studying religion and mental illness, Koenig said, his research shows that religion can decrease stress. And stress is something that exacerbates mental illness.

Often the people with religious delusions are people who are not actually religious, Koenig said, and are not supported by a religious community.

The American Psychiatric Association has also paid close attention to the relationship between mental health and religion, issuing a mental health guide for faith leaders.

“Because religion and spirituality often play a vital role in healing, people experiencing mental health concerns often turn first to a faith leader,” the guide reads.

Faith leaders “can help dispel misunderstandings, reduce stigma associated with mental illness and treatment, and facilitate access to treatment for those in need.”

The guide has sections on mental health and spirituality, including how a person with a mental illness might believe they are receiving a message from God, are being punished or are possessed by evil spirits.

The guide says “it is important to distinguish whether these are symptoms of a mental disorder … distressing experiences of a religious or spiritual problem, or both.”