Religion and Spirituality in Psychiatry

2 Spirituality and the Care of Madness: Historical ConsiderationsSAMUEL B. THIELMANSUMMARYSpiritual and religious issues are sometimes neglectedor misrepresented in histories of psychiatry.This chapter outlines a historical approach tounderstanding how spiritual and religious ideasare expressed in medical and religious writingsdealing with madness. Sacred writings, inscriptions,ancient architecture, commentaries, pastoralletters, medical texts, and religious andspiritual publications all reflect a range of ideasabout the role of spirituality and the supernaturalin the etiology and treatment of mental disorders.Beginning with ancient pagan and Jewishwritings, and continuing with the writings of theearly church fathers, medieval physicians andPuritan divines, the chapter describes ways inwhich spirituality influenced the care of emotionallydistressed patients. The chapter discusses theways in which both naturalistic and supernaturalisticviews of madness are reflected in practice inthe roots of modern medicine in the eighteenthcentury and how psychiatrists and others dealtwith religious issues during the more secularnineteenth and twentieth centuries. The chapterargues against the position that there has beensteady progression from a supernatural to a naturalisticunderstanding of madness and shows howreligious and spiritual ideas continue to affect thepsychiatric approach to mental disorders.INTRODUCTIONThe history of psychiatry has often been writtenas though the emergence of psychiatry involveda transition from superstition to reason, fromreligion to science, and that only in the modernera have we come to understand that madness isnot the result of the influence of spirits, demons,and curses. In fact, the relationship among ideasof madness and religion, medicine and theology,treatment and ritual is complex and varied.Although natural explanations seem to competewith religious explanations, in fact, peopleactually caring for the mad often (although notalways) held these explanations in mind concurrently,and doctors, clergy, and families used thisunderstanding as a basis for managing those forwhom they cared.Different religious traditions, of course, havehad different approaches to the mad. This chapterfocuses primarily on care given in the Christiantradition in Europe and North America because itis this tradition that has shaped modern psychiatry’sway of dealing with religious and spiritualissues. Historical accounts of the Islamic approachto the mad indicate a variety of ways of dealingwith madness – from the traditional Islamic methodsthat involved casting out the devil, to Koranbasedmethods, to an approach that involves anaturalistic understanding.(1, 2) Hinduism andBuddhism have their own approaches to madnessas well.(3–5)1 . THE BIBLE AND MADNESSFor a variety of reasons, including missionaryactivity, European colonialism, and the adaptablenature of Christian belief, Christians are presentin significant numbers in most parts of the modernworld.(6) The Bible is, arguably, the mostglobally influential of ancient religious texts, and6