Religion and Spirituality in Psychiatry

202 Harold G. Koenigfrom the early Middle Ages through the seventeenthcentury. Using more than five dozen illustrations,he argued that the Catholic mystics inthese paintings were actually examples of hysteria(St. Catherine of Sienna being the prototype).(27) Paintings of saints in positions of prayer andeven those of the crucifixion were said to illustratehysteria. In some cases, Charcot actually claimedthat these saints were suffering from opisthotonus(a severe hyperextension of the head in which thehead, neck, and spinal column enter into a bridgingor arching position). Charcot believed thatthe ecstatic states of the religious in these greatworks of art were manifestations of psychopathology.A more detailed and fascinating discussionof this topic is provided elsewhere.(28) Charcot’swritings and teachings are particularly relevantbecause Freud would later train under Charcot,and the development of Freud’s negative viewstoward religion could have been due to Charcot’sinfluence.Might religious beliefs contribute to thedevelopment of some kinds of somatoform disordersas Charcot argued and Freud would lateremphasize? Examples of physical manifestationsof psychological conflicts related to religioninclude the phenomenon of stigmata, where aphysical wound (or bleeding) appears spontaneouslyon the body of a religious person in thesame location as the wounds suffered by Jesus.(29, 30) The Italian priest, Padre Pio, is reportedto have had stigmata on his hands, feet, side, andchest.(31) Other more contemporary examplesof physical manifestations of spiritual-psychologicalforces might include the “faint” thatoccurs when someone is “slain in the spirit” ata Pentecostal healing service (where the ministerplaces his hand on the forehead of a memberof the congregation, who then faints and falls tothe ground) or perhaps even the manifestationof “speaking in tongues.” While not examplesof somatoform disorders, they do illustrate howphysical manifestations may occur as a result ofreligious beliefs acting through psychologicalphysiologicalprocesses.There have also been reports of more seriousreligion-related conversion disorders thatinterfere with functioning and cause great distressand suffering. According to DSM-IV , conditionsthat occur in a specific religious or culturalcontext are diagnosed as “culture-bound syndromes,”and are often characterized by dissociationand seizure like manifestations.Please Don’t Kill MeSarah is a 24-year-old married, unemployedPuerto Rican woman, with twochildren ages two and four. She presentedto a neurologist with the complaint of “seizures”that were completely incapacitatingher. Sarah was diagnosed with tonic-clonicgeneralized seizures and treated with carbamazepine.Despite this treatment, shecontinued to have seizures two or threetimes per week. She would typically have aheadache, and then soon afterward wouldbecome unconscious and begin tonic-clonicmovements, which would last for aboutten minutes. After arousing, she wouldnot recognize family members and wantedto leave the home. After the seizures, shewould sometimes hallucinate a threateningfemale figure and was observed by familymembers to be begging, “Please don’t killor harm me.” Further history revealed thattwo years before the seizures began, at theage of 17 years old, Sarah witnessed thesuicide of her grandmother, who burned todeath when she set fire to her home. Sarahfelt guilty over this because she thoughtthat if she had alerted people sooner, theycould have saved the grandmother’s life.When asked to explain her behaviors,Sarah said that she and her family believedin espiritismo (Spiritist religion) and participatedin séances. They believed that disturbedspirits could take possession of theliving, especially spirits of persons who haddied a violent death. Such spirits could lingerindefinitely in space and attack peopleto extract revenge. After twenty-two treatmentsessions in psychotherapy over severalmonths and nearly a year of follow-upwith less frequent sessions, her psychogenic