Psychiatrists Search for Links Between Religion, Illness

The role of religion and spirituality in depression is likewise in question. One study, Dell pointed out, suggested that religious involvement might shield adolescents against depression. In contrast, Dan Blazer II, M.D., Ph.D., a professor of psychiatry at Duke University, and his colleagues found, in a community-based study, that subjects who identified their religious affiliation as Pentecostal had a higher rate of major depression than did the overall population. However, the Pentecostal subjects came from a lower socioeconomic background. So other factors related to psychological stress may have contributed to their depression more than their religious beliefs did, Blazer explained.

Also unclear is whether religious belief can help people cope with trauma, said Samuel Thielman, M.D., Ph.D., director of the Office of Mental Health Services at the U.S. Department of State. Studies have produced both positive and negative results in this domain. For example, one investigation found that trauma made people more religious; another found that it did not.

Even with the paucity of research on religion, spirituality, and mental well-being, and in the face of conflicting research results, one symposium speaker—Marc Galanter, M.D., a professor of psychiatry at New york University—tapped research he has conducted on the subject to make a provocative suggestion.

He and his group have found that substance-abuse patients tend to score high in spiritual needs—that is, in a thirst or reaching out for a God, the arts, humanism, nature, or something that is transcendent for them. He and his team have also learned that physicians recovering from alcoholism rated Alcoholics Anonymous, which is spiritually oriented, very highly. So substance abuse and its treatment might be viewed, at least in certain circumstances, as a spiritual quest, he maintained.

Another speaker, C. Robert Cloninger, M.D., a professor of psychiatry and genetics at Washington University and director of the university's Sansone Center for Well-Being, made an even more audacious hypothesis—that a spiritual vacuum underlies personality disorders. Harm avoidance, novelty seeking, and the search for social approval are some of the emotional needs that people have, Cloninger explained, and they activate more primitive parts of the human brain such as the amygdala.

Yet these emotional needs have to be regulated by certain character traits that activate the rational part of the brain, the prefrontal cortex. These traits include being self-directed (responsible), cooperative (flexible, helpful), and self-transcendent (compassionate).

Furthermore, people with personality disorders tend to lack self-regulation of these character traits and thus can be irritating and unlikable. This lack of self-regulation, Cloninger asserted, can be characterized as “a deficit in their spiritual perspective, which leads to patterns of thought, feeling, and behavior that can be described as vices like pride, lust, and greed.”

Some 19th-century psychiatrists also held the same view, he pointed out. At the beginning of the 19th century, the antisocial personality was referred to as “moral insanity” or “loss of self-government.” Benjamin Rush said that people with personality disorders are“ insensitive to the suffering of others.”

Cloninger, in fact, proposes that if psychiatrists helped individuals with personality disorders develop a fuller spiritual perspective, it might“ expand their awareness of the intangible connections among people....” Such an expanded awareness may not only lead to improvement in their character and behavior, but also “make their lives more meaningful and satisfying.”

“This is fascinating, a totally different approach,” audience member Carl Bell, M.D., commented. Bell is president and C.E.O. of the Community Mental Health Council in Chicago.

And in a sense, spirituality might be viewed as a complementary or alternative treatment, William Narrow, M.D., the symposium discussant, pointed out. Narrow is associate director of APA's Division of Research and director of research for DSM-V.

Yet there is no doubt, Narrow added, that much more research needs to be conducted to determine the roles that religion an information might eventually bolster psychiatrists' efforts to diagnose, treat, and even prevent various mental illnesses. ▪