Religion and mental health: a double‐edged sword or a life‐giving medicine?
Authors: David Greenberg
Journal: World Psychiatry (2013)

Pargament and Lomax present religion as a double-edged sword: on the one side, succor, self-regulation, social support, meaning, and spirituality; on the other side, struggles and violence. In this commentary, I would like to discuss the meaning of such a perception for religionists and the implications for mental health services. The attitude of religious codes to the impact of the religious life is expressed clearly in the following quotation from the Babylonian Talmud, a central text of orthodox Judaism: "The Rabbis teach: 'It is written, 'And you shall put the words of my Torah in your hearts' (Deuteronomy 11:18) and the word 'you shall put' can also mean 'a perfect medicine', for the Torah can be compared to a life-giving medicine' ". The effect of religion is perceived to be entirely positive. Is this an absence of insight? Would members of a religion find the observations of Pargament and Lomax offensive? How would they respond to the specific claims of the effects of struggles and the occurrence of religiously motivated violence? During the last three decades of providing mental health services to the ultra-orthodox Jewish community of Jerusalem, there have been many opportunities to consider: is religion a double-edged sword or a life-giving medicine? Evaluating the religious background of new referrals, we found an overrepresentation of newly orthodox Jews, and concluded initially that their religious change had precipitated their disturbance. On reevaluating the data, however, the majority had a history of mental health problems prior to their religious change, the change brought several years of relief, and then the earlier problems reemerged 1. Our attention then focused on obsessive-compulsive disorder (OCD). Is OCD more common in this population, encouraged by the demand and praise accorded the punctilious? Epidemiological studies of OCD in a range of cultures have not measured degree of religiosity, although urban versus rural studies did not suggest OCD was more prevalent in the rural, more traditional societies that were likely to be more religious. Studying ultra-orthodox patients with OCD, we noted that the content of the religious OCD symptoms was similar to nonreligious populations. Further, despite the centrality of religious observance in their lives, most had religious and nonreligious symptoms 2. When asked if they saw a link between their OCD and their religion, their responses covered the whole gamut of possibilities, from blaming their religious practice, blaming their educators, to understanding it was their own problem ("I realize this is my problem, as it says: 'The Torah was not given to angels', the Torah is for fallible humans") and that if they were not religious, it would just appear in a different form. The overall impression is that the religious form of OCD ("scrupulosity") is not caused by religion, but assumes a religious form reflecting the content and values of the religious lives of the sufferers 3. The ideal method for approaching these questions is via large-scale epidemiological studies. Unfortunately, the reticence of the ultra-orthodox community to participate in secular projects and consequent high refusal rate led the organizers of a recent study in Israel to exclude this community ab initio 4. Religion is based on belief, and beliefs, by definition, have no objective proof. Doubts in matters of religious belief are a normal component of adolescence and early adulthood, which is the period in life when people are most likely to undergo religious change, either by abandoning or increasing their religious observance 5. For a religious person, religious doubts create anxiety. As adolescents become adults, their cognitive processes mature, and they are likely to learn to tolerate the ambivalence of doubt. As such, doubt is normative. As with all normative processes, it has a range of expressions and degrees. Similarly, the emotional response to doubt is varied and will be influenced by serious life events, such as severe mental illness, in which the sufferer may either find succor in religion, or ask "why me?" and "why did He create a world with such problems?" that will inevitably lead to doubts 6. It is unclear, however, why the blame for the human capacity for doubt is to be placed at religion's door. Religiously motivated violence is problematic in the present context. The world news brings daily proof that it exists, rarely the act of individuals but of organizations and countries that are motivated by religious beliefs. As the largest scale murders of the last century have shown, however, this is not the prerogative of religion alone. As organized and ideologically based acts, it is an unfortunate truth that there is no role for mental health services for the individual in their prevention.