Religion and Spirituality in Psychiatry

The Bible: Relevant Issues for Clinicians 35Case ExampleA 39-year-old single man took out hisright eye with his fingernail in obedience toMatthew’s biblical injunction. He claimedthat voices of devils, angels, and personshe had formerly known commented on hisbehavior in an accusatory tone and commandedhim to injure his remaining eye.He believed that he had stolen the soul ofa nurse seven years previously and that sheexerted great control over him. He alsobelieved that he possessed both male andfemale sexual organs and that he producednumerous babies daily.(7)In another passage, Jesus told his disciples thatdivorce was permissible only in cases of adultery.They commented that if a man’s wife committedadultery, “It is better not to marry.” Jesus replied,“All cannot accept this saying, but only those towhom it has been given. For there are eunuchswho were born thus from their mother’s womb,and there are eunuchs who were made eunuchsby men, and there are eunuchs who have madethemselves eunuchs for the kingdom of heaven’ssake. He who is able to accept it, let him acceptit” (Matt. 19:11–12). What exactly is meant bythis passage has been debated for two millennia.A small number of Christian groups have used ithistorically to justify the castration of its members(within the Eastern Orthodox tradition,for example, the sect known as the Skoptsi, oreunuch, was widespread in eighteenth and nineteenthcentury Russia, and the Catholic Church’spractice of castrating young boys to preservetheir high-pitched voices for the Vatican choirendured until 1880), and some psychotic patientshave used it to justify their self-castration.Case ExampleA shy, withdrawn man with an excellentwork record was constantly afraid thatpeople would consider him a homosexualbecause of his gentleness. At the age of 35years, he suddenly developed deep religiousfeelings. His work deteriorated ashis religious preoccupations increased. Hewas hospitalized and received electroshocktreatment. He dwelled on the Bible andon outer space. He then decided that hemust renounce “the sex life of the world.”After reading passage 19 in the Gospel ofMatthew, he castrated himself with a razorin the belief that this act of purificationwould qualify him to serve as the pilot whowould carry the godly to outer space.(8)Although it is difficult to anticipate acts ofmajor self-injury, ominous signs in a psychoticor pre-psychotic person include intense religiosity,a focused interest in the Bible, and a markedchange in physical appearance such as cutting offall of one’s hair or dressing bizarrely. It should benoted clinically that one act of major self-injuryputs a patient at very high risk for a second act.2.2. Sin and GuiltIn both Judaism and Christianity, sin refers to anybehavior that violates the moral codes of conductestablished by God primarily in the Bible but alsoin theological works by esteemed rabbis, priests,and church councils. The O.T. Book of Leviticuscontains 613 laws revealed by God to Moses concerningofferings, the priesthood, purification,the Day of Atonement, feasts, the tabernacle,blasphemy, the Sabbath years, and blessings forobedience and curses for disobedience. Althoughthe laws refer mainly to priestly legislation, allJews were expected to know and obey them. Amajor theme in Leviticus is atonement throughanimal sacrifice. “For the life of the flesh is in theblood, and I have given it to you upon the altar tomake atonement for your souls; for it is the bloodthat makes atonement for the soul (17:11). Thosepersons who atoned for their sins achieved holiness.“You shall be holy; for I am holy” (11:44).The O.T. also contains the Ten Commandments.Punishment for not keeping the laws and commandmentsinclude death, humiliation, loss ofpossessions, and all sorts of bodily ills such asinsanity, scabs, boils, and famine.Animal sacrifice has long been abandoned byJews who note that the O.T. prophets said that