Religion and Spirituality: Psychological and Biological Perspectives by xx8VAS


									  Religion, Spirituality and
Historical, Psychological and
   Biological Perspectives
    Janet E. Johnson, MD, MPH
  Tulane University School of Medicine
   Department of Psychiatry and Neurology
The Many Images of Spirituality
   Religion versus Spirituality
Religion:                       Spirituality:
– Latin religare: “to bind       – Latin spiritualitas: “breath”
  together”                      – Broader concept than
– Organizes the collective         religion--dynamic,
  spiritual experiences of         personal, experiential
  group of people into             process
  system of beliefs,             – Quest for meaning and
  practices, and rituals           purpose, transcendence,
– Tradition, oral and written      connectedness, values
                                 – Personal quest for answers
                                   to ultimate questions about
                                   life, meaning
                                 – Gives one a sense of
          Brain versus Mind
Brain                      Mind
– Collection of physical   – Phenomenon of
  structures that gather     thoughts, memories
  and process sensory,       and emotions that
  cognitive and              arise from the
  emotional data             perceptual processes
                             of the brain
      Why is this Important?
Surveys show that 90% of Americans believe in
a higher being
90 % pray or meditate
> 70 % believe in life after death
Majority want their physicians to discuss religion
with them
DSM-IV inclusion of diagnostic category
“religious or spiritual problem”
ACGME made instruction in religious-spiritual
issues a curricular requirement in 1995
 Psychiatrists and Spirituality
Psychiatrists are measurably less religious than:
– The general population
– Their patients
– Other physicians
Generally endorse positive influences on health
More likely than other physicians to note that
religion/spirituality can cause negative emotions
that lead to increased patient suffering
– (82 % versus 44%)
 Psychiatrists and Spirituality
More likely to encounter religion/spirituality
issues in clinical settings
– (92% versus 74%)
More open to addressing religious/spiritual
issues with patients
– (93% versus 53%)
Psychiatrists are more comfortable, and have
more experience, addressing religious/spiritual
concerns in the clinical setting
                             Curlin et al, Am J Psychiatry, 2007
 Studies and Physical Health
Majority of the ~350 studies of physical health
have found that religious involvement and
spirituality are associated with better health
– Cardiovascular, decreased rate of CVA’s
– Lowers blood pressure
– Health-promoting behaviors
“Lack of religious involvement has an effect on
mortality equivalent to 40 years of smoking one
pack of cigarettes/day.
                             Harold Koenig, MD, Duke
  Studies and Mental Health
Religious involvement associated with:
– lower risk of depression.
– less anxiety.
– less substance abuse.
– Improved self-esteem
– Less social isolation
Inverse relationship between religious
involvement and suicide.
 Spirituality and the Chronically
            Mentally Ill
Generally viewed as pathological or
symptoms of mental illness.
Little research done in this area.
Religious delusions and auditory
hallucinations common in psychosis.
Hyper-religiosity common in mania.
 Spirituality and the Chronically
            Mentally Ill
Solution versus symptom
Treatment conflict or collaboration
Socialization or increased isolation
Negative versus positive religiosity
Psychosis or mystical experience or
normal experience
Mystic versus psychotic
– Distinct differences
       Negative Religiosity
“I feel God is punishing me for my sins or
lack of spirituality”
“I wonder why God has abandoned me”
“If I believed more/was a better person this
wouldn’t have happened”
Sees God as judgmental and punitive
       Negative Religiosity
Negative AH from God, Satan, demons
– command AH especially worrisome
Negative/harmful/dangerous delusions
– worthless person, offended God, have to pay
  for their sins, perform acts to appease God or
  atone for their actions
– Andrea Yates
       Positive Religiosity
“I look to God for strength, support and
“God will help me through this”
Sees God as benevolent and caring
Religious beliefs provide positive self
esteem and image
Prayer/meditation as coping mechanism
     Chronically Mentally Ill
Survey, 1995
– 28 CMI patients from rehabilitation center
– 60% reported that spirituality had a “great
  deal” of helpful impact on their illness by
  helping them feel cared for and not alone
– 76% thought daily about spiritual matters
– 38% expressed discomfort with discussing
  spiritual matters with their therapist
        Lindgren and Coursey (1995) Psychosocial Rehab J,18, 93-111.
   Bipolar Affective Disorder
Questionnaire covering religious, spiritual,
philosophical beliefs and religious practice.
Sample of patients with BAD in remission.
78% held strong religious/spiritual beliefs.
81.5% practiced their religion frequently.
Most saw a direct link between beliefs and
management of illness.
Many reported conflict in understanding and
managing their illness between medical and
spiritual advisors.
                     J Affective Disord (2003) 75(3):247-57.
Several routine screening questions about
religion and spirituality should be part of
the psychiatric assessment.
More thorough assessment necessary if
religious-spiritual problem is part of
presentation, if clinical issue involves
morality or guilt, concerns regarding
meaning of life, life cycle issues.
      FICA Spiritual History
Faith: Do you consider yourself spiritual? Do you
have a religious faith?
Importance: How important are your religious
beliefs and how might they influence decisions
related to your health?
Community: Are you part of a religious or
spiritual community? If so, how does this
community support you?
Address: How might I address your spiritual
History of Science and Religion
Evidence of spiritual practices dating back to ancient
cave drawings
Myths: from Greek “mythos” meaning “word”  one
spoken with deep and unquestioned authority
Myths of all world cultures are strikingly, consistently
 – Virgin births, world-cleansing floods, lands of the dead,
   expulsions from paradise, dead and resurrected heroes
All religions are founded on myth
Myths are created by basic, universal aspects of the
brain , particularly the fundamental neurological
processes through which the brain makes sense of the
        Historical Precedent
       Medicine and Religion
Medicine and religion historically linked
Hippocratic writings
– physicians received authority from gods
Middle Ages
– sickness punishment from God
– cure by praying
– doctors were “collaborators with God”
15th to early 18th century
– close relationship continued
          Historical Precedent
         Medicine and Religion
Cotton Mather (1663-
 – Prominent Puritan minister
 – Advised physicians to
   prescribe “admonitions of
   piety” as well as drugs.
 – Smallpox epidemic, Boston
   1721  advocated for
   inoculation despite great
   controversy and risk to
 – Influential in Salem Witch
       Historical Precedent
      Medicine and Religion
19th, early 20th centuries still viewed
religion as important in practice of
Mid 20th century, unacceptable to discuss
religion in a secular health care setting
Past two decades, increased interest in
medicine and spirituality
Sigmund Freud
        Religion was irrelevant if
        not clinically harmful
        “an obsessional neurosis”
        Religious individuals
        were weak
        Needed to create a god in
        their own image rather
        than deal with their frailty
        and helplessness
        “Mystical experiences are
        illusions triggered by a
        neurotic, regressive urge
        to reject an unfulfilling
                       Carl Jung
Broke with Freud in 1912 over
Freud’s insistence that he omit
references to religion in
Psychology of the
Believed that humans are by
nature religious
“I attribute a positive value to
all religions”
Regarded the religious
problems that the patient
brought to therapy as relevant
to the neurosis, and as
possible causes of it
Modern Man in Search of a
Soul, 1933
Carl Jung
      Myths are symbolic
      expression of
      archetypal ideas 
      inherited forms of
      thought that exist, in
      universal form, in the
      depths of every
      human mind
Albert Einstein
         “Religion without science is
         blind; science without religion
         is lame”
         “Quantum mechanics is
         certainly imposing. But an
         inner voice tells me it is not yet
         the real thing. The theory says
         a lot, but does not really bring
         us any closer to the secret of
         the Old One. I, at any rate, am
         convinced that He does not
         throw dice”.
         “There is a central order to the
         universe, an order that can be
         directly apprehended by the
         soul in mystical union”
                 Larry Dossey
"I used to believe that we
must choose between
science and reason on one
hand, and spirituality on the
other, in how we lead our
lives. Now I consider this a
false choice. We can recover
the sense of sacredness, not
just in science, but in
perhaps every area of life."

- Larry Dossey, M.D.
  from Reinventing Medicine
            Trend Today
Many books on
science and
Popular literature
Curriculum in medical
schools and
 Psychology and Spirituality
– Pre-death dreams and ability to help prepare
  for death
– Grief dreams
    Visitation, message, reassurance, trauma
– Prophetic or future dreams
ESP, “visions”, deja-vu, out-of-body
experiences, past-life regressions
  Psychology and Spirituality
Intercessory prayer
– Can individuals mentally help heal distant
  persons who were unaware they were doing
– “Various, broader meta-studies of the literature have arrived at
  conflicting conclusions. For instance, a 2006 meta analysis on
  14 studies concluded that "There is no scientifically discernable
  effect for intercessory prayer as assessed in controlled
  studies".[2] However, a 2007 systemic review of 17 studies on the
  use of intercessory prayer indicated that there are "small, but
  significant, effect sizes for the use of intercessory prayer" in the
  reviewed literature.[3]”
 Psychology and Spirituality
Intercessory Prayer
California (UCLA) study of AIDS patients
– No difference in CD4 counts
– Patients receiving intercessory prayer
    Fewer AIDS related illness
    Fewer hospitalizations
    Fewer hospital days
  Psychology and Spirituality
Near-death experiences
– Accounts remarkably similar
– “Bright light”, music, tunnel or passageway, feeling of
  great peace, someone there to receive them
Death bed visions
– Vast majority of dying individuals, families, and care-
  takers find the experience comforting and/or
  spiritually moving
– 85% of nurses surveyed felt experiences were of a
  spiritual nature
– Only 15 % attributed them to hallucinations
    Biology and Spirituality
Approaches from multiple avenues:
– Anatomy
– Electrophysiology
– Brain Imaging
– Genetics
        Pinpoint which brain
        regions turn on or off
        during experiences that
        seem to exist outside
        time and space.
        Association areas in
        cerebral cortex
        –   Visual
        –   Orientation
        –   Attention
        –   Verbal conceptual
Orientation Association Area
Located posterior
section of parietal
Orients the body in
space; allows for 3D
sense of the body
Monks mediating, nuns praying
SPECT scans before and at peak of experience
– prefrontal cortex (quieting of activity)
– “orientation association area”
     Determines where the body ends and the rest of the world
     Sharp reduction in activity at peak of meditative experience
      brain perceives that the self is endless and intimately
     interwoven with everyone and everything
Verbal descriptions of Experiences
“As the river flowing east and west
Merge in the sea and become one with it
Forgetting that they were ever separate rivers,
So do all creatures lose their separation
When they merge at last into”
                                  Hindu Upanishads

“I possessed God so fully that I was no longer in my
   previous customary state, but was led to find a peace in
   which I was united with God and was content with
                                  Franciscan nun
Epilepsy linked with spirituality throughout history
– “Sacred disease” by Greeks; demon possession in Bible
Close to 5 % of patients with epilepsy report religious
Study from UCLA showed that patients with temporal
lobe epilepsy have a heightened response to religious
language, specifically religious terms and icons
“Temporal lobe transients”
– bursts of electrical activity in the temporal lobes producing
  sensations of out-of-body experiences, sense of the divine,
  finding God
Increased activity in the attention association area (pre-
frontal cortex) during certain types of meditation
– Particularly pronounced among Zen practitioners
“Spirituality is among
the most ubiquitous
and powerful forces in
human life”
Genes can
predispose us to
Don’t tell us WHAT to
               The God Gene
Measuring spirituality
– “Self-transcendence scale”
     Cloninger, U Washington in St. Louis
     Out of system of personality classification called the
     biosocial model
– Self-forgetfulness, transpersonal identification,
– Twin studies show that spirituality is significantly
– Similar to many personality traits and greater than
  some physical traits
– More heritability than religiosity
             The God Gene
Monoamines influence spirituality by altering
– Serotonin, dopamine
– Blurring of the normal distinction of self and others
– Provided clue as to where to search for gene
Identifying a Gene
– Specific individual gene associated with self-
  transcendence scale
– Codes for a monoamine transporter
– VMAT2 gene
     Makes protein that packages different monoamines into
     secretory vehicles
           The God Gene
Selective Advantage
– Important role God gene plays in selective
  advantage is to provide humans with an
  innate sense of optimism
– Psychologically, optimism provides the will to
  live and procreate
– Physically, optimism promotes better health
  and quicker recovery from disease
Religion versus Science?
              Science, especially
              Geometry and
              Astronomy was linked
              directly to the divine
              for medieval scholars.
              The compass in this
              13th C manuscript
              is a symbol of creation

                                        Third panel of “Education”
                                        Tiffany glass, 1890
                                        Science and Religion in harmony
                                        Central personification of

“Touching the Void”
Integrated View
Creativity, Spirituality and Mental
Artists and affective disorders
– Vincent van Gogh
– Edvard Munch
– Jackson Pollack
    Abstract Expressionist Artists of the NY School
The Green Muse

Albert Maignan
 Absinthe (the Green Fairy)
References appear in Bible, Egyptian and
early Syrian texts
Greek word apsinthion (undrinkable)
Wormwood leaves soaked in wine or
Major ingredient is alpha thujone
– convulsant that blocks the type A GABA
  receptor chloride channel
“Cocaine” of the artists of the 19th century
1890’s had outgrown cult status and was
drunk by millions
Production, circulation and sale of
absinthe banned in France in 1915
Vincent Van
        Vincent van Gogh
Born March 30, 1853, Netherlands
– son and grandson of a preacher
Age 20, decides to become a clergyman
1876, England
– assistant preacher
– obsessed with evangelical Christianity
– refused admission in theology school
– briefly entered missionary school
         Vincent van Gogh
Goes to southern Belgium (coal-mining)
Extreme commitment draws disfavor from
Church and he is dismissed
Becomes an artist while in God’s service
“To try to understand the real significance of
what the great artists, the serious masters, tell
us in their masterpieces, that leads to God; one
man wrote or told it in a book; another in a
         Vincent van Gogh
Various diagnoses
– Bipolar affective disorder (I versus II)
– Substance abuse
    absinthe, alcohol
– Temporal lobe epilepsy
– Borderline personality disorder
– Acute intermittent porphyria
– Syphilis
        Vincent van Gogh
Psychotic episode 1888
– threatens Gauguin, cuts own ear
– hospitalized for several months
– “acute mania with hallucinations of sight and
– ingested his paints (? suicide attempt)
– paints Pieta (original Delacroix)
– Starry Night also done during this time
The Pieta
        Vincent van Gogh
May, 1890 leaves hospital and is relatively
stable for two months
Paints nearly a painting per day
July 27, 1890, walks to wheatfield and
shoots himself in the chest
Dies two days later
– “The sadness will last forever”
    words spoken on deathbed
The Raising of Lazarus 1890 (after Rembrandt)
            Edvard Munch
1863-1944, Norway
Pioneer in Expressionist movement
Father deeply religious military doctor
– ? mentally ill
Mother died of TB when Munch 5 y.o.
Older sister died of TB age 15 y.o.
Younger sister diagnosed with mental
illness at an early age
By the Deathbed   1895
          Edvard Munch
“Sickness, insanity and death were the
angels that surrounded my cradle and they
have followed me throughout my life”
1908, admitted to private psychiatric clinic
in Copenhagen
Alcohol abuse and depression
Spent eight months there
The Scream


Most extreme
of Munch’s
“soul paintings”

“Inner Hell”

Anxiety and

in Hell

 Jackson Pollack 1912-1956
American Abstract Expressionist
Had recurrent episodes of depression and
probable hypomanic episodes
Alcohol abuse, hospitalized at least twice
for alcohol tx, once with co-morbid
Died in a single vehicle accident
Treated with psychotropic medications and
     Abstract Expressionists
“The last generation of modern artists who
challenged the secular materialism of society
resulting from industrialization and they were
thus among the last active carriers of spiritual
value in a materialist age”.
Jung wrote of the artist’s role in putting the
viewer back in touch with the spiritual forces
repressed by the culture.
“Abstract art is a form of mysticism”
Circumcision 1946
Religion/spirituality and its relationship to health
and illness is increasingly being discussed and
Much more research in this area needed for the
Chronically Mentally Ill.
Spiritual assessment is recommended as part of
a psychiatric evaluation.
Are artists with affective disorders more likely to
include religious content in their work?
Religion and Science do not have to be in
opposition or incompatible
Evidence suggests that the deepest
origins of religions are based in mystical
– Religions persist because the wiring of the
  human brain continues to provide believers
  with a range of experiences that are
  interpreted as assurances that God exists
Much evidence demonstrates that the
transcendent states from which religions arise
are neurologically real
Are these experiences merely the result of
neurological function?
Or are they genuine experiences which the brain
has evolved the ability to perceive and
experience a higher plane of being that actually
Does our brain wiring CREATE the idea of God,
or did God create our brain wiring?
“There are two ways to live your life. One is
  as though nothing is a miracle; the other is
  as though everything is a miracle”
                          Albert Einstein

“Those who love wisdom must investigate many
“We are not physical
  creatures having a
  spiritual experience.
  We are spiritual
  creatures having a
  physical experience”

     Pierre Teilhard de Chardin
     French philosopher, Jesuit
     priest, palentologist and

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