Religion and Spirituality in Psychiatry

12 Samuel B. ThielmanIf I walked in the Garden , (as there sometimesI took many distracted turns) Iwould fancy all about me Places of Burning ,and Torments , and Devils .… Thus I discoveredthe Confusion and Distraction of myMind where ever I went [Italics added].(pp. 98–99) (23)He was taken by friends to the house of a physicianwho specialized in the treatment of madpeople.But at length, thro’ the Goodness of God , andby His Blessing upon Physick , a low Diet ,and hard keeping , I began to be orderedand civil in my Carriage and Converse , andgradually to regain the use of my Reason[Italics added]. (p. 101) (23)Trosse read the Scriptures, memorized portionsof Scripture, began to “favor somewhatmatters of Religion ,” and prayed with a Christianwoman who was one of the employees of themad-house (p. 181).(23) He began to improve.Trosse suffered two relapses shortly afterward,but he recovered, attended university, and had anactive career as a Presbyterian minister until hisdeath at age 81.5 . DEVELOPMENT OF A MORESECULAR MEDICAL APPROACHTO MADNESS DURING THEENLIGHTENMENTDuring the seventeenth and eighteenth centuries,philosophers and physicians began to thinkof the soul less in religious terms and more inphilosophical or scientific terms. Likewise,those dealing with the mad began separatingreligious causes from other causes and religion/spirituality became a category of madness.This way of thinking about madness is mostclearly laid out in Robert Burton’s Anatomy ofMelancholy (1621), in which Burton coined theterm “religious melancholy” and wrote at lengthdescribing the condition and offering recommendationsfor cure.In the eighteenth century, Enlightenmentthought permeated the philosophical aspects ofmedicine, and the Reformation had created religiouschange all over Europe. A reform was alsotaking place within madhouses and asylums inEurope where the asylum began to be viewed ashaving a therapeutic as well as a custodial purpose.Although management and medicine hadbeen part of the regimen of madhouses for sometime (p. 8), (24) several physicians for the madbegan outlining the need for a particular regimenof management in the asylum and began to presentthe asylum as a therapeutic institution.(25)Several individuals instituted extensive reformsfor institutions for the mad. Sometimesthese reforms were driven by a religious motive,as in England at the York Retreat. Sometimesit was driven by a rationalist/secular reformmotive, as in the case of Philippe Pinel and hisreforms in France at the Salpetrière and otherhospitals. Sometimes the motives for humanereforms were a mixture of these things, as theywere at the South Carolina Lunatic Asylum inColumbia, South Carolina and at the EasternLunatic Asylum in Williamsburg, Virginia.(26)But whether reform motives were secular or religious,patients and their religious views had to beconsidered.In France, Philippe Pinel (1745–1826) institutedreforms at Biĉetre and Salpetrière, andthese reforms sprang from an Enlightenment/rationalistic motive (pp. 9, 47, 53, 78–81).(27)In fact, like his revolutionary contemporariesin France, Pinel did not have much use forreligion. Pinel was very much motivated by thepursuit of knowledge and by the need to treatmad patients humanely and with a degree ofrespect. He criticized physicians’ reliance oncontemporary theories of inflammation tounderstand the brain, advocating instead thatthey focus on the “management of the mind,”that is, moral therapy (pp. 4–5).(27) Pinel’sapproach to “religious enthusiasm” was to separatethe religiously delusional patient fromothers; encourage physical activity; removefrom view every book, painting, or other objectthat could remind them of religion; order them