Religion and mental health: the contribution of anthropology
Authors: Simon L. Dein
Journal: World Psychiatry (2013)

Pargament and Lomax provide a comprehensive overview of the rapidly growing literature on religion and mental health. Their account is balanced, describing the positive and negative impacts of religion and spirituality on wellbeing. In this commentary, I focus on some areas where my approach, which derives from social anthropology, may differ from Pargament and Lomax, with the intention of furthering discussion about future research on religion and mental health. Several of the areas mentioned in the review (e.g., meaning, violence, and conflict) have attracted considerable anthropological attention. As an anthropologist, I agree that the findings cited need to be extended to other religious groups, cultures, and countries. Religious factors always operate in cultural frameworks. For example, the lived experience of Islam may differ in communities with different cultures. Gender hierarchy and political organization may differ in two Islamic societies, contributing to the experience of stressors. This has both theoretical and clinical implications. Anthropology has much to contribute to this debate, with its emphasis on in-depth descriptions of individual experiences, and its key methodology — participant observation — which allows for long-term engagement with a cultural group and facilitates understanding of how religion and mental health impact on each other over time 1. Furthermore, it permits emic understanding of the ways that concepts such as religion, spirituality, coping, belief, and mental illness are culturally constructed. Future work on religion and mental health needs to take stock of lay meanings of terms such as religion, spirituality, and health rather than imposing professional definitions. Data from anthropological fieldwork can be deployed in rendering existing measurement scales culturally sensitive. The extant literature on religion and mental health has predominantly focused on belief rather than experience. Anthropologists have generally taken issue with the notion of belief, especially when discussing religious convictions 2. It is debatable whether the notion of belief used in Protestant Christianity can easily be applied to other faith groups. And the relations between belief, knowledge, and faith are often vaguely defined in the current literature. Experience comprises both cognitive and affective elements. The cognitive emphasis to date has ignored the important role of emotional factors in maintaining belief. R. Firth 3 conceptualized religious belief as a set of ideas more or less integrated by reason but held with conviction that they are true — that they are meaningful in relation to reality. He points out that we can distinguish elements of knowledge, emotion, and volitional activity acting on belief. It is the element of emotion in whatever kind of experience that gives a basis to belief and provides it with a strong flavour of reality. While I would accord with Pargament and Lomax's (who themselves quote the anthropologist C. Geertz) assertion that religion provides a source of meaning for believers, social anthropology moves beyond individual beliefs and provides a broader perspective through looking at the ways in which power structures and religious hierarchies engender specific convictions and the ways that these convictions are contested by different factions in communities. Anthropologists have long recognized the importance of specific religious experiences in maintaining wellbeing in communities and the role of rituals in engendering such experiences. There is wealth of anthropological data examining the role of rituals in engendering mental health. Yet the existing scholarly work has not examined the mental health implications of specific rituals. For instance, despite the fact that much of the contemporary literature has focused on Christianity, there is a dearth of work examining Christian rituals such as Baptism, the Eucharist, and laying on of hands in terms of facilitating wellbeing. Religious experience and rituals and their impact on wellbeing should be a future target of research in this area 4. Furthermore, long-term immersion in a religious community facilitates the collection of detailed phenomenological descriptions of religious experiences, such as hearing God's voice, and allows an understanding of how they are interpreted in diverse cultural contexts 5. It allows to better understand the similarities and differences between normative religious experience and psychopathologic states. One area that Pargament and Lomax discuss — religious hallucinations — has attracted some anthropological discussion. Anthropologist T. Luhrmann 6 points out that hallucinations are a vivid illustration of the way culture affects our most fundamental mental experience and the way that mind is shaped by both cultural invitation and biologic constraint. The anthropological literature has indicated that conceptualizations of wellbeing include physical, emotional and spiritual dimensions, and similarly healing often reflects the reestablishment of a harmonious relationship with whatever communities label as the transcendent through diverse rituals. As the social anthropologist V. Turner points out in his work among the Ndembu 7, healing does as much to repair the social fabric as it does to repair the body, mind, and soul of sufferers. Thus, the impact of religion/spirituality on mental health should encompass measures of social harmony and social integration. Finally, in terms of treatment, there is by now a growing literature on cross-cultural psychotherapy and the benefits of matching patient and therapist 8. This literature demonstrates that, while sometimes cultural matching enhances psychotherapeutic efficacy, other factors such as gender and social class are equally important in determining outcomes. These findings could be extended to research on spiritually integrated therapy, looking at the ways in which religious matching may enhance or diminish outcomes.