Religion and Spirituality in Psychiatry

Theological Perspectives 23beliefs, and the experiencing of inner attitudes,feelings, and sentiments.” Moreover, insofaras languages emerge from and are made intelligibleby their association with the ways of lifeof particular communities, theological languagecannot be dissociated from the practice of a commonlife. A religious tradition’s “doctrines, cosmicstories or myths, and ethical directives areintegrally related to the rituals it practices, thesentiments or experiences it evokes, the actionsit recommends, and the institutional forms itdevelops. All this is involved in comparing areligion to a cultural-linguistic system.” (16) Justso, a clinician can often assess the relationshipof her patient’s illness to that patient’s religiousfaith only by taking into account not simply thefact that her patient believes, but also the entirecultural-linguistic framework within which thatbelief is acquired and exercised. In accounting forthe cultural and linguistic history of her patient’sfaith, the clinician may be surprised to discoverthat her patient is part of a tradition that historicallyhas afforded a generous space to those wetoday call the mentally ill and that also possessesabundant resources for wrestling with the particulartheological and existential questions raisedby mental illness.3. PSYCHIATRY AND THEOLOGYIN TENSION AND IN CONVERSATIONThe kinds of theological challenges mentalhealth professionals are likely to face withrespect to their patients’ religious commitmentsdepend to a significant extent on the particularreligious tradition with which the patient isaffiliated. Mental illness and its treatment willpresent different kinds of theological challengesto different religious traditions. In what follows Iwant to discuss what I take to be two ultimatelyinseparable challenges that mental illness and itscontemporary treatment present to my own tradition,Christianity. Although adherents of othertraditions, Judaism in particular, may recognizeanalogies with my account, I do not presume tospeak here on behalf of any tradition other thanmy own.A first type of theological challenge the clinicianis likely to encounter at the intersection ofpsychiatry and religion is with the connotationelicited by the very category “mental” illness.Psychiatry’s traditional suspicion of religionis often greeted with a corresponding antagonismby religious believers. Psychiatrists andother mental health professionals may have tocontend with religious patients who are suspiciousof and even hostile toward the very ideaof modern psychiatry. Although this suspicionis clearly in part a defensive reaction, it is morecomplex than that. Judaism and Christianityhave for centuries recognized and wrestled withthe existence of melancholia, anxiety, and otherconditions that bear undeniable resemblances towhat modern psychiatry identifies as disorders ofmood, affect, and personality. In the world of theBible, such conditions are generally and for themost part understood as “spiritual” challenges,or perhaps as “sicknesses of the soul,” the appropriateresponses to which are similarly “spiritual,”which is to say, religious. The psalms andprophetic writings in particular are replete withboth communal and individual laments madeby women and men confronted by the apparentabsence of God from their lives and those oftheir communities. The “absences” lamented inthese texts range from existential despair overthe apparent meaningless of life, to expressionsof the real or imagined fear of imminent death,to expressions of remorse over the commission ofsins, to protests against God’s failure to meet hiscovenant obligations to the psalmist’s or prophet’scommunity. In many cases, these laments includenothing less than pointed demands that God givean account of godself. And yet in spite of theirintroductory tone, these texts linger neither inanger nor despair, but transition without fail toexpressions of praise and gratitude in response toanticipated liberation by the very God who at thetime seems totally absent. Given the undeniablyliturgical character of much of this literature (thatis, the fact that it appears to have been written tobe performed in the gathered public worship ofthe community), these transitions appear to correspondto declarations of forthcoming salvation