Running head: SPIRITUALITY, RELIGION, AND PSYCHOPATHOLOGY

The interplay between religion and psychology is complex and has a rich history. There appears to be, even now, a degree of ambiguity in the field of psychology as to how religious beliefs fit into our perspectives on mental illness. There is uncertainty around the delineation of pathological religious ideation and religious beliefs. Likewise, certain experiences of mental illness, delusions for instance, have been regarded by different religious groups as spiritual experiences and important cultural practices. The relationship between these different views can be either beneficial or damaging in a therapeutic setting, and are influenced by the worldview commitments of both therapist and client. The following articles provide information and examples of the many ways that religious and spiritual beliefs influence views of psychopathology, how the field of psychology views spiritual and religious experience, and the various ethical issues which arise as a result.

Bartocci, G. (2004). Transcendence techniques and psychobiological mechanisms underlying religious experience. Mental Health, Religion & Culture, 7(2), 171-181. In this article, the author explores various cultural transcendence techniques, which he likens to denial defense mechanisms, using examples to illustrate how altered states of consciousness can be triggered by means of external devices (the Sybils dromos) or by an internal output (Janets crystal ball). The author claims that once a practice facilitating psychic detachment from the world is reinforced by social consensus it becomes an inherited cultural practice. The author explains that, for this reason, it is clear that clinicians need some degree of expertise in assessing varying forms of supernatural beliefs as a means of distinguishing between culturally appropriate transcendence techniques and pathological delusions or hallucinations.

SPIRITUALITY, RELIGION, AND PSYCHOPATHOLOGY

Dura-Vila, G., & Dein, S. (2009). The dark night of the soul: spiritual distress and its psychiatric implications. Mental Health, Religion & Culture, 12(6), 543-559. This article compares the Dark Night of the Soul (an expression describing a phase of life characterized by a spiritual crisis and concerns about relationship with God) and the features of a depressive episode. The author is particularly concerned with the way in which individuals going through the Dark Night of the Soul do not view it as pathological, but instead see it as an opportunity for reflection and beneficial change. The author uses five cases of important religious figures who experienced the Dark Night of the Soul, and outlines five similarities and six key differences which differentiate salutary religious depression and pathological religious depression. It is suggested that salutary religious depression (Dark Night of the Soul) is distinct from clinical depression in that it involves healthy feelings of guilt, a clear wish to recover, maintained social interaction, improved attitude of service towards others, a conscious search of the love object (God), and a persistent sense of hope. This article provides an alternative lens for viewing a clients experience of depression, and can be used to guide exploration of spiritual issues in relation to depression.

Holstein, A. A. (2011). Tough Grace: Mental Illness as a Spiritual Path. Communities, (150), 26-29. This article is an account of one womans experience with debilitating manic depression. The author explains how developing a spiritual view of her mental illness provided a route to healing. The author came to view her depression as a spiritual experience of suffering which taught her humility, surrender, endurance, compassion. She likens her

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journey to the heros journey described by Joseph Campbells studies of world myths. This article illustrates how intentionally reframing a mental illness in a way that provides spiritual meaning can be a powerful route to healing. Meissner, W. W. (1991). The phenomenology of religious psychopathology. Bulletin of the Menninger Clinic, 55(3), 281-298. The author of this article uses clinical examples from his psychoanalytic experience to illustrate how religious belief systems can be used as an expression of neurotic tendencies and needs. The author discusses typical patterns of neurotic religious involvement as they are expressed clinically in hysterical, obsessional, depressivemasochistic, narcissistic, and paranoid modes and styles. The article provides interesting examples of the interaction of religion and psychopathology, but neglects to comment on ethical implications or how the clinicians own belief systems might impact his or her observations of this interaction. Meyerstein, I. (2004). A Jewish Spiritual Perspective on Psychopathology and Psychotherapy: A Clinician's View. Journal of Religion & Health, 43(4), 329-341. The author of this article presents her own version of a Jewish Spiritual Perspective of clinical work. She does this by describing the origins of Jewish values, including the relationship between body and emotions, the human being as an integrated whole, the repair of the world, free will, peace in the household, and emphasis on community and multigenerational continuity. She goes on to discuss some of Judaisms views of mental illness as depicted in the Bible and the Talmud. The author also describes common Jewish symptom presentations including psychosis, neurosis and depression. Finally, the article explores the use of spiritual resources such as prayers, rituals and

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music in treatment, acknowledging the importance of awareness of the religious level and practices of clients and families. This article is valuable for the insight it provides into the Jewish faith and how this affects views and treatment of psychopathology. O'Connor, S., & Vandenberg, B. (2005). Psychosis or Faith? Clinicians' Assessment of Religious Beliefs. Journal of Consulting and Clinical Psychology, 73(4), 610-616. This article investigated whether or not clinicians alter their judgments about the pathogenic significance of beliefs if the beliefs are identified as belonging to an established religion. The authors state that the impetus for this study stemmed from what they perceived to be ambiguity in the DSM-IVs definition of delusions, which states that beliefs cannot be considered delusions if they are ordinarily accepted by other members of the individuals religion or culture. The results showed that beliefs associated with Catholicism were rated significantly less pathological than the beliefs of Mormonism and Nation of Islam, and Mormon beliefs were rated as less pathological than Nation of Islam. Nation of Islam beliefs had higher ratings of pathology than the other two religions, even when the religion was not explicitly identified. This article is valuable in that it highlights a conflict in the DSM-IVs view of religion and culture, and provides valuable information about what factors impact a clinicians likelihood of viewing religious beliefs as pathological. Vardy, M. M., & Kaplan, B. M. (2008). Christ/Messiah delusions revisited: Toward an anthropological definition of religious delusions. Psychoanalytic Review, 95(3), 473-487. This article is concerned with the Christ/Messiah themes which occur in the delusions of psychotics and the need to delineate these from the delusion-like experiences of prophets, artists, and others like individuals. The authors question who should be

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responsible for making this judgment. Several case studies are used to illustrate occurrences of delusions or hallucinations which resulted in beneficial change for the individual. The authors concluded that only social-psychological criteria for psychopathology are sufficient to differentiate delusional ideas from their equivalents in religion or politics. The ideas presented in this article highlight the difficulties faced by clinicians in diagnosing pathological delusions or hallucinations, and the importance of exploring the social and spiritual context of the individual in order to determine the legitimate presence of psychopathology. Yarhouse, M. A. (2003). Ethical issues in considering 'religious impairment' in diagnosis. Mental Health, Religion & Culture, 6(2), 131-147. The author of this article draws on the American Psychological Associations Ethical Principles of Psychologists and Code of Conduct to explore ethical issues of including religious functioning and impairment in assessment of psychopathology. This article is very useful in that it describes a continuum of responses or models representing the relationship between psychology and religion. These are (1) religion as harmful, (2) benign neglect of religion, (3) formal inclusion of religion when it contributes to presenting problems, (4) formal inclusion of religion as a domain of functioning, (5) viewing religion as a paradigmatic alternative to psychology. The author systematically applies these models to three clinical case studies, outlining the ethical difficulties that arise from each. This article demonstrates clearly how a clinicians view of the relationship between religion and psychopathology can significantly impact the diagnostic and treatment process which can impact the degree to which he or she practices ethically.