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LEARNING OBJECTIVES
After reading this article you will be able to:
better understand how the majority of psychiatrists during the 20th century viewed patients’ religious beliefs and practices
know how to take a spiritual history and other sensible ways to integrate religion/spirituality into clinical practice
recognise when religion is a problem and how to approach patients in that case.
The evidence base documenting the effects of religious involvement on mental health is growing rapidly, and much of it shows that religion has beneficial effects on mental health and well-being (Koenig 2020). The view during the 20th century that religion is primarily neurotic was driven by the perspectives of influential individuals such as Francis Galton, Jean-Martin Charcot, Sigmund Freud and Albert Ellis (Koenig 2012, pp. 58–63). Even today, religious manifestations of mental illness are common, which certainly affected the opinions of early mental health professionals without access to the systematic research available today.
These negative views of religion had a significant impact on the care provided by mental health professionals, and at that time, the existing research did not help matters. In a review published in the American Journal of Psychiatry, Sanua (1969) concluded that ‘The contention that religion as an institution has been instrumental in fostering general well-being, creativity, honesty, liberalism, and other qualities is not supported by empirical data. Both Scott […] and Godin […] point out that there are no scientific studies which show that religion is capable of serving mental health’. A later examination of 45 case examples in the DSM-III-R glossary of technical terms found that 22.2% (n = 10) had substantial religious content, including references to illogical thinking, incoherence, poverty of affect, catatonic posturing, delusions of being controlled, hallucinations, magical thinking and other types of delusion (Larson 1993). Around the same time a survey of 231 British psychiatrists at general and psychiatric hospitals in London found that almost three-quarters (73%) reported no religious affiliation and 78% attended religious services less than once a month (Neeleman 1993). Only 19% of male psychiatrists believed in God. A survey of American psychiatrists around that time found that 60% were atheist or agnostic and more than 60% rarely or never attended religious services (Franzblau 1975).
Even in one of the most religious...