Journal of Religion and Health, Vol. 13, No. 4, 1974

Some Contributions of Religion to Mental and Physical Health IRVING M. ROSEN My purpose in presenting this material is t o assist dialogue a b o u t health among practitioners in two great fields o f endeavor, one of which we k n o w to be concerned with health; we think the o t h e r should be so concerned. T o anticipate my conclusions, let me say at once t hat I believe the clergy have mu ch to c o n t r i b u t e and ought t o be an integral, n o t peripheral, part o f the health team. Since in many areas even psychiatrists at this late date are held suspect b y o t h e r physicians as s om e w hat mystical, the n o t i o n of ministers as i m p o r t a n t health workers remains truly avant-garde in m a n y places. This despite the outstanding w or k of Westberg ~ and Young and Meiburg, 2 and the efforts o f all those in the Institutes of Religion and Health. It has proved surprisingly difficult to bring even a small n u m b e r of physicians to a symposium on health with clergymen despite the prolonged and extensive effort. Life seems complex enough for doct ors and nurses, apparently, w i t h o u t their taking into a c c o u n t religion, which t h e y have safely, and even amiably, relegated to the chapel on Sunday mornings and to an occasional pastoral visit. Th o u g h a psychiatrist, I do have one advantage over the clergy in discussing this topic. I am n o t particularly religious and do n o t u n d e r s t a n d mu ch o f wh a t the clergy are talking a b o u t when t hey bring up prayer, God, faith-healing, salvation, spirit, heaven and hell. (I asked a priest recently w h a t he m e a n t by spirit; he answered " n o n m a t e r i a l s u b s t a n c e " ! ) Yet I still believe, from what I can grasp of strictly secular practical matters, t h a t religion has a vital stake in health. And this after reading the recent b o o k by Chesen entitled Religion May be Hazardous to Your Health. 3 Religion has fost ered u n h e a l t h y taboos against b o d y and sex, p r e m a t u r e altruism, provincialism and prejudice, legalisms and superstitions, excessive p r o m o t i o n of sin, excessive use of nonrational authority, and confusions among children and adolescents. This is all very one-sided, o f course, y e t examples can easily be f o u n d among our patients. Nonetheless, anything strong enough to do harm usually has p o wer for good. Before dialogue becomes popular, one m ust c o n f r o n t the great differences th at exist within each field. There is a sharp difference, particularly in Irving M. Rosen, M.D., is Director of Education at the Cleveland Psychiatric Institute and a member of the Institutes of Religion and Health. This paper was adapted from a talk sponsored by the Lorain County Board of Mental Health and Retardation, Elyria, Ohio, February 20, 1974. 289

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psychiatry, between those who have organic bias, who want to confine the field to organic medicine and to the general hospital, and those with wholistic bias who would pursue the field into religion, education, and c o m m u n i t y affairs. The clergy, too, are divided, m a n y feeling t h a t health is n o t a primary concern of religion, but rather a by-product of good religious, especially ritualistic, practice and belief. First, I wish to focus on the current situation in medicine. America is far indeed from being a healthy society. Recent studies of whole populations have shown the astonishing prevalence of various mental disorders, to cite just one category of illness. These conditions are usually painful, stubborn, afflicting the old and young, rich and poor, city, suburban, and rural dweller. For these conditions medicine has no specific cures, no "magic bullets," as it does for the infectious conditions and specific organic deficiencies. Psychiatric drugs and surgical procedures are often late and always palliative, directed at relief or cutting a vicious circle and, we hope, prolonging life. It is becoming increasingly difficult to find something to die of besides complications of some psychosomatic ailment involving the circulation or gastrointestinal tract, or a condition brought about by addiction, over eating, smoking, suicide, or accident-proneness. Since the powerful new drugs and electroshock therapies are n o t cures b u t adjunctive agents, patients tend to relapse again and again. The period of greatest medical progress in the late nineteenth century coincided with a low point in psychiatry and the growth of vast human warehouses t h a t few, once admitted to, could leave. Search for organic causes led to a dehumanization process, a lack of interest in whole persons. It is easy to demonstrate, especially in hospital practice, that excessive and sole use of organic approaches in the psychiatric field often creates eventual dependency and loss of coping ability. It appears to me that an important r o o t of the current prevalence of depression is indeed a sense of dependency and helplessness in the face of strong stress and even at times of minor stress. The question has to be faced head on: Is medicine now confronted with spiritual diseases that its successes have not prepared it to cope with and have these very technological successes increased spiritual decay? I am using the word "spiritual" in a limited sense to refer to the whole person and "spiritual disorder" to mean disorder of the process of humanization and to loss of the person. Curiously, psychiatry had a period when results were good in the early nineteenth century, a period of so-called "moral t h e r a p y " under the influence of the period of enlightenment before the development of a great deal of technology. 4 Turning to the religious field, I believe that health should be a direct as well as indirect concern of the clergy. They should suffer no identity conflict by taking a major interest in health. To defend this belief, I have to explain my conception of the relation of religion to the h u m a n organism. I do not agree with Marx or Freud that religion is just an opiate or an illusion. The instinct psychologists, it is true, have not found a single religious instinct to account for the astonishing pervasiveness of religion in human history. Man's

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instincts are vague and plastic. Some philosophers and theologians, like Kant and John Baillie, s have located the place of religion in the valuing process, the conduct of life, and the relation of value to reality. Religion appears to enter at the point of choice-making, valuing. Instead of the instinctual map seen in m a n y organisms that seem to know how to mate, build nests, and raise families rather quickly, man has religion. This idea is reinforced by study of primitive religions that seem to consist largely of taboo, tradition, and manna--in other words, of what n o t to do, what to do, and the power to decide and implement choice. There are certain implications in this line of thought. Religion is inescapable, n o t optional. Those who have thrown out their religious heritage seem to have some religion coming in the back door. Communists end up worshiping the state; Freud ends up worshiping man and reason, which are frail reeds. Others worship pleasure, m o n e y , status, power. If Marx said that religion is the opiate of the people, we have lived to see opium become the religion of too m a n y people. If Freud said t h a t religion is an illusion, further t h o u g h t teaches us the exact opposite--that religion is man acting as the inclusive scientist searching for what is most real. Great religious figures and saints of history all avoided the easy path; all acted in a manner that is the opposite of the statements of some of our influential secular thinkers. Moses, Jesus, and St. A n t h o n y were n o t weak people seeking opiates. To make good choices and implement them, two important ingredients are necessary. Knowledge--the best possible from all sources--is needed. It is n o t surprising that practically all subjects have emanated from the mother-lode of religion, whether the subject be metaphysics, nutrition, astronomy, medicine, or law. There would thus seem to be no theoretical conflict between science as the best possible knowledge and religion. Religion must, of course, go beyond laboratory science, which can abstract, can wait for answers, and can postpone decisions but cannot deal with most vital h u m a n problems. Religion, on the other hand, must decide now with any and all tools available. It must use inductive, deductive, traditional, and intuitive sources. It is the science of the whole with history serving as the ultimate laboratory. The second requirement for religion to carry on its mission is health. Indeed health--especially that of the choosing organ, the ego--comprises an impressive a m o u n t of the writings in a theological library. Health as one fundamental pillar of religion, though of course not the only one, has been an integral part of the religious enterprise from the beginning. In the Bible and other religious literature there is to be found a wealth of insights of value to medicine, particularly psychological medicine. I will have to leave out much of it, but will focus on five of the more easily understandable aspects of this rather neglected field. 1) There is a striking similarity in traditional parish work to modern c o m m u n i t y mental health activities and concepts. Ruth Caplan in her recent book H e l p i n g the Hel;)ers to H e l p 6 has written of the assets of the minister as mental health worker. The church somehow seems to have anticipated most of our best recent thinking. The minister serves a catchment area and is

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family- and neighborhood-oriented. He provides early and easy access to disturbed people; he maintains a fairly flexible schedule and can even visit homes w i t h o u t being called. He is familiar to people in the neighborhood, wh o are n o t stigmatized by going to see him; he is able to provide for co n tin u ity of care. His salary remains the same w h e t h e r his parishioners are hospitalized or not. Beyond the resources of the mental health worker, the minister has an available small c o m m u n i t y and a group of volunteers of all ages. He also has built-in techniques for relieving strong e m o t i o n and has access to a system of meaning. 2) The needs m e t by religion are similar to those m e t in the concepts of identity d e v e l o p m e n t promulgated in m o d e r n ego psychology. It is now becoming fashionable in psychology to talk about c o m m i t m e n t , involvement, belief, will, the laying on of hands, and even grace as the equivalent of unearned acceptance leading to basic trust. 3) There is m uc h a t t e nt i on in religious literature devoted to the resolution of painful and real emotional reactions to real events. I refer primarily to the resolution of anger, anxiety, guilt, and grief. In medicine there appears to be a habitual a t t e m p t to relieve emotion, which m ay indeed be a mistake m uch of the time. Even psychiatry is strangely naive in dealing with emotions, regarding th em as symptoms of neuroses while paying small a t t e n t i o n to real an x iety and guilt and justified anger about which something could constructively be done b y t h e client. Such alternatives in the resolution of emotions as faith, endurance, and mind control (through meditation) for anxiety; forgiveness and reconciliation for anger; and confession, at onem ent , and repentance for guilt are left to the field of religion and then forgotten. The client's inability to deal definitively and realistically with em ot i on, particularly negative emotion, is in my opinion the single greatest issue in depression and masked depression. 7 The answers do n o t appear to lie in the psychiatric or medical literature. 4) We are beginning to realize the health value in meditation since various laboratories have been demonstrating t ha t mind-control techniques relax the nervous system and bring down the various indexes of tension. Through the use o i devices to feed back i nf or m a t i on a bout the state of the neuromuscular system and circulation, it is now possible to teach people rapidly some control of their aut onom i c nervous systems w i t h o u t requiring t hem to study with a teacher in India for m a n y years, s This field of biofeedback appears to constitute quite a breakthrough in medicine. It may be in the process of being oversold as a r e m e d y for insomnia, migraine, asthma, hypertension, and o t h e r conditions; some of the news reports are som ew hat sensationalistic. Yet it appears that we have here a major new frontier. The patient can n o w take an active role in learning not to have certain illnesses. 5) There is the fascinating subject of the whole person, or a systems approach to the person, t ha t would constitute a study o f the over-all tendencies o f the human organism over the course of life. Perhaps the major c o n t r i b u t o r to this field is Charlotte Bilhler. 9 Others include Maslow and Frankl. Whole-person study includes the process of h u m a n i z a t i o n - - t h a t is,

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how man learns to become secure, to defend his unity and integrity, to overcome powerlessness, and to develop motivation. It also includes the implications of the study of man as a developing organism and how he changes, grows, and stagnates. Such study considers ways in which a person's centrality becomes lost behind rules, ideologies, money, expediency, cleanliness, politics, and what not. Important also are studies of goals and values and value conflicts, as well as integrative and disintegrative factors, such as hope, despair, and commitment. There are certain balances needed to maintain the hygiene of the whole person, such as those between selfishness and altruism, pleasure and pain, play and work. I would include also a study of the significance of the "whole-person" emotions such as loneliness, boredom, meaninglessness, and alienation. This wholistic view has interesting implications. For example, a very good case can be made that schizophrenia, on the psychosocial level, is a disease of the h~manization process itself, and that involutional melancholia is a kind of emotional stagnation. There are several possible health-related functions of the clergyman in the c o m m u n i t y and hospital. 1) He can be consultant on the theological and whole-person aspects of disorder. He ponders the influence of religious beliefs and practices on health, the meaning of sickness to the patient, patient's attitudes toward the body and sex, toward emotional outlets like crying, and toward self-pampering behaviors like resting and recreating. He should be able to separate o u t religious phenomena like conversion from symptoms of mental illness. 2) He can be consultant on ethical aspects of new medical and surgical technology. This is a large field t h a t I do not need to go into here. 3) An ombudsman role is useful to counteract the impersonality of the hospital or of treatment. The minister can visit the transient, the lonely, the presurgical, and all those who are extremely anxious for any reason. 4) He can function in prevention. For primary prevention he provides various kinds of education for family living. He intervenes in life's stages and crises. Also, he is in a position to provide a base of security or c o m m u n i t y root, as well as a chance for a person to function in a role in a small cohesive c o m m u n i t y that gives him status. For secondary prevention, he certainly is strategically placed for the early detection of individual and family disorder and counseling, since m a n y people go to a minister before consulting any other c o m m u n i t y helper. For tertiary prevention, he can function in social rehabilitation, giving people h u m a n contacts in the church c o m m u n i t y , and he can counsel handicapped people to transcend those difficulties t h a t cannot be corrected. 5) He can help patients to accept treatment. For example, many schizophrenics will not admit that they are ill; they do n o t wish to co-operate in t r e a t m e n t and do n o t trust people or doctors. Ulcer patients do n o t like to be told what and when to eat and when to sleep. (They d o n ' t even like to listen to Mother Nature!) Cardiac patients feel they should n o t be resting b u t rather should be doing something to achieve, since they may feel t h a t no one will love them if they slow down. They feel they can only give, not take. The

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result is th at a large percentage of these patients do n o t follow medical orders and prescriptions. 6) The minister can and should function as consumer advocate for the whole person. He should even m o n i t o r the medical system from his value perspective. He should be asking what is the long-term effect of the physician's short-term, crisis-oriented, of t e n simply organic treatment. He should be asking what is the effect of p r e m a t u r e hospital release on the children in the family. 7) The minister should function as spiritual helper to physicians. After all, physicians cannot be getting m uc h help; otherwise t hey would not rank so high in suicide and addiction. There are m a ny possible ways in which dialogue between medical and religious fields might be continued. I have poi nt ed to a good m a n y topics th at could profitably be pursued and amplified. One can visualize a wide variety of multidisciplinary care conferences, rounds, and research discussions with ministers as full partners. A t t e m pt s should continue to be made to integrate churches with c o m m u n i t y mental and physical health projects. Finally, with co-operation among practicing professionals it is possible that mo r e interdisciplinary i nf or m a t i on in the overlapping fields of religion and health will find its way into college curricula. Summary

A strong case can be developed for the inclusion of the clergyman as an i n t e g r a l rather than peripheral part of the health team, a role he is far from fulfilling at this time. With the prevailing enormous a m o u n t of psychiatric and psychosomatic disorder for which we have no specific medical cures, we should turn for help to specialists in the "whole p e r s o n . " The clergy should face the fact that health is and always has been one fundamental pillar of religion. Many potential contributions from the field of religion and m any roles for the clergy are described. References

1. Westberg, G. W., Minister and Doctor Meet. New York, Harper and Bros., 1961. 2. Young, R. K., and Meiberg, A. L., Spiritual Therapy. New York, Harper and Bros., 1960. 3. Chesen, E., Religion May Be Hazardous to Your Health. New York, Collier, 1972. 4. Caplan, R., Psychiatry and Community in Nineteenth Century America. New York, Basic Books, 1969. 5. Baillie, J., The Roots o f Religion in. the Human Soul. New York, George H. Doran Co., 1926. 6. Caplan, R., Helping the Helpers to Help. New York, The Seabury Press, 1972. 7. Rosen, I. M., "Ego Psychology of Depression with Implications for Treatment," J. Religion and Health, 1970, 9, 250-257. 8. Lawrence, J., Alpha Brain Waves. New York, Avon, 1972. 9. Biihler, C., and Massarik, F., eds., The Course o f Human Life. New York, Springer Publishing Co., 1968.

Some contributions of religion to mental and physical health.

A strong case can be developed for the inclusion of the clergyman as anintegral rather than peripheral part of the health team, a role he is far from ...
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