Religion and Spirituality in Psychiatry

Delusions and Hallucinations 83church. When he drove away, the oncomingcars and trucks gave him messages withtheir headlights. Finally, he left his car withthe ignition key on and continued his pilgrimageon foot, spending two nights inthe woods. He claimed to have received amission from God to protect the peoplearound the nuclear plant from harmfulradiations. He therefore approached thefence around the power plant, carefullypacing up and down. Finally, he urinatedinto a bottle, deposing his urine in dropsalong the fence to create a protective wall.In major depressive disorders with psychoticfeatures the content is “mood congruent,” underliningthe basic feelings of worthlessness, guilt,and rejection.Case ExampleSister Mary (not her real name), a memberof a Catholic women’s order, had a historyof bipolar illness. When she lapsedinto a depressive state, she was directed toa psychoanalyst and received antidepressantmedication. After two serious suicideattempts, she was admitted to a clinic. “Ideveloped feelings for my therapist whichwere not acceptable. It was infidelity againstJesus. I have fallen from grace. Bad thingshappen around me, and it is my fault. I havethe terrible feeling of the evil using me. I amlike a nuclear bomb, destroying and burningeverything around me. I have no moreright to live. It would be better to destroymy life than that of the community.”1.3. Religious Delusions Associatedwith a Poorer PrognosisReligious delusions may lead to violent behavior.Aggression and homicide have been perpetratedby religiously deluded people.(17–19)Some religiously deluded people have literallytaken statements from the Bible to justify pluckingout offending eyes or cutting off offendingbody parts. This may lead to autocastration.(17)Approximately half the cases of self-inflicted eyeinjury occur with psychotic preoccupations aboutsinfulness and higher deities.(18) Potentiallylethal self-injuries could be perpetrated underreligious delusion, as the following 30-year-oldman with paranoid schizophrenia reported.Case ExampleOne night, I was persecuted by voices.I drove a knife into my belly to kill thedemons.” Another example is a 23-yearoldman with paranoid schizophrenia, whoreported, “Once, during a crisis of anxiety, Iwas controlled by others, I believed myselfto be in a relationship with God, I had tokill myself to save the children (playing infront of his house). It was an obligation. Itook a leash to hang myself, the leash broke,I fell down, the children were still alive, andanxiety went away.Religious delusions have been associated withpoorer outcome more generally. In India for example,sexual, religious, and grandiose delusions andflat affect on admission predicted a poorer clinicaloutcome over a ten-year period.(19) In the UnitedKingdom, patients with religious delusions in onestudy appearred to be more severely ill.(20) In theUnited States, among hospitalized patients withschizophrenia, people with religious delusions werealso more severely ill; they had more hallucinationsfor a longer period of time.(16) In a German study,the intensity of religious faith was associated withpoorer outcome; however, religious delusions werenot differentiated from normal religious faith.(21)Thus, the association between religious delusionsand poorer outcome seems at least controversial.Is this relationship an artifact? Is it due to delusionor to religion? Or is religious delusion in itself amarker of the severity of the pathology?2. MODELS OF DELUSION2.1. What is Religious Delusion?To answer the question, we have to consider bothconcepts: the concept of religion and the concept