Indian Journal of Clinical Psychiatry

An Official Journal of Association of Clinical Psychiatry (Indian Psychiatric Society- Uttar Pradesh State Branch (IPS-UPSB))

Religion and Mental Health

Anil K. Agarwal

Practicing Psychiatrist (Ex-Professor & Head, Department of Psychiatry, KGMC), Lucknow, Uttar Pradesh, India.

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ARTICLE INFO

*Correspondence:

Anil K. Agarwal mradulanil@gmail.com

Practicing Psychiatrist (Ex-Professor & Head, Department of Psychiatry, KGMC), Lucknow, Uttar Pradesh, India.

Dates:

Received: 16-05-2023 Accepted: 03-06-2023 Published: 30-06-2023

How to Cite:

Agarwal AK. Religion and Mental Health. Indian Journal of Clinical Psychiatry. 2023;3(1): 36-42.

Introduction

“If god did not exist, it would be necessary to invent him”. Voltaire1

“…I may live without air and water but not without him… blast my beliefs in

God and I am dead.” Gandhi2

I am grateful to the U. P. Chapter of the Indian Psychiatric Society for inviting

me to deliver the first oration. I have chosen the topic of religion and mental health for this oration. The definition of mental health (WHO) includes the concept of spiritual health, but the profession has not given it much emphasis because we wish to remain scientific and reject religion and spirituality as areas beyond the realm of science. We need to understand that drugs may treat the body and brain but may not be effective for discontent, negativity, etc. Spiritu- ality is needed for total treatment. This presentation will focus on exploring the application of these precepts in day-to-day clinical practice.

I will start this oration by reciting a story many of you might have read or heard. A middle-aged lady went to church every day and used to cry. One day the priest asked her what made her so unhappy. She informed him that her husband is extremely sick, and she is praying to God to make him better. The priest asked her whether she believed in God. The lady replied, “Yes”. The priest told her, that she should leave the decision about her husband to God and should request God to do what is best for her husband. This advice reduced the anxiety and she felt better. This story is important for us for two reasons.

Faith- This lady had faith in God but wanted him to do what she desired. This also meant that her faith was partial, as she could not trust God to do the needful. Selfishness- This lady wanted that her husband should get well as it would

make her life easier but did not consider what is better for her husband.

Faith is always associated with doubts. I will illustrate it with another story. One person was stuck in the mountains at night. He decided to go down using a rope. It was freezing cold, and he started praying to God to help him. Some- times later God told him not to worry and leave the rope. He felt that if he let go of the rope he will fall and die, so he kept holding the rope. The next morning people saw that the man died holding the rope and he was just a few feet from

the ground. This again reflects the doubt /faith conflict.

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What is religion?

Religion has been defined in multiple ways.

The belief in and worship of a superhuman con- trolling power, especially a personal god or gods.

Oxford dictionary

To Gandhi, God is truth, love, and morality; he is

the source of Light and Life. He is in us and yet above and beyond us… Gandhiji has repeatedly insisted that “There is no Religion higher than Truth.” There should be truth in thought, speech, and action2.

“All sects are different because they come from men. Morality is everywhere the same because it comes from god”. Voltaire

Religion has, unfortunately been used for polit- ical purposes. Each religion wants to rule supreme and tries to convert others by fair or foul means. This politicization of religion created so many distortions that instead of a tool to help one to untangle his problems, it became a tool to suppress others. Reli- gion in its current form is responsible for too much misery, wars, and destruction.

Swami Vivekananda3 stated in World’s Parlia- ment of Religions in Chicago on 11th September 1893. “All the different streams having their sources in different places all mingle their water in the sea, so, O Lord, the different paths which men take through different tendencies, various though they appear, crooked or straight, all lead to Thee.”

My Religious Practices

I must also state my perception of religion. I am a Hindu by birth. I do not go to temples, keep fast, or perform ‘puja’ regularly. I do believe in a power beyond us that is watching all our activities. Our actions decide our future well-being. I believe God resides in each one of us and serving humanity is true worship of God. One should not do anything that may harm others. Being a doctor, I believe every patient is God himself, and serving them to the best of one’s ability is the true service to God.

Review of literature

Religion and mental health have been extensively discussed in Indian psychiatry. Many presidential addresses4-7 of the Indian Psychiatric Society were totally devoted to this subject. Many other research-

ers8,9 have provided extensive coverage of this. A task force report of the Indian psychiatric society provides a comprehensive review.10

Two of the giants of psychiatry one from India other from abroad made some important obser- vations about eulogizing religion for mental health.

“India is an ancient and great cultural, spiritual, and anthropological laboratory. She has been the nursery of saints and sages, scientists and founders of the world’s major religions, and promulgators of profound philosophy. Nevertheless, to be satisfied with the glory of the past is to turn into a fossil; but to interpret the old from a new point of view is to revitalize the past and bring in a current of fresh air into the monotonous present.” Venkobarao11 “One must admit that there is little firm evidence that either meditation or religious observance sig- nificantly modifies, tens of thousands of Indians, young and old, have become disciples of teachers who support them in their twofold ambition to practice right conduct in accordance with Hindu dharma and to enhance their personalities by fol- lowing a particular technique of meditation. If it could be established, with appropriate control, that changes in symptoms and in personality traits do come about, and in the desired direction, then the possibility of collaborating between psychiatrists and Gurus could be worth exploring”. Carstairs12

We should become more scientific and conduct experiments to demonstrate that various religious practices are in fact beneficial for health. The last few decades have seen remarkable progress in this area. Vahia13-14 studied the role of yoga in psychiatric disorders. Gangadhar15 and his group are actively studying different aspects of Yoga especially Sudar- shan yoga with positive results. Patients with psy- chotic illness tend to do better with add-on Yoga.16 Many other workers described the effect of Islam on mental health.17-18.

A study on belief systems in Delhi19 found that God’s punishment for their past sins (39.6% rural, 20.7% urban, 5.2% professionals) was responsible for mental illness. Many persons in all three groups believed that daily worshipping and keeping fasts can reduce the bad effects. 39.4% of people in rural areas, 34.4% in urban areas, and 4% of professionals believed in the bad effects of ghosts/devils/witches.

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25% of the rural respondents even claimed to have come across a person getting cured this way, but only 14% of the urban respondents did.26.1% of Rural,31.6% of urban and 11.5% of professionals believed that these diseases can be treated by faith healers or Tantriks. We have focused on this research in detail as it shows a large part of our population still believes in the role of God, bad deeds, and faith healers in mental illnesses. A few professionals also share this belief.

Many researchers20-23 demonstrated that children with religious backgrounds did better in avoiding drug abuse, delinquency, and other psychiatric problems. Neeleman and King 24 surveyed the psychiatric practices of 231 psychiatrists in London. 73% had no religious affiliation, 28% had a belief in God, 61% believed that religion can protect against mental illness, and 48% asked patients about their religious practices. Baetz et al. 25 surveyed 1204 psychiatrists and 157 psychiatric patients in Canada. 54% of psychiatrists believed in God, 47% asked patients regarding their religious beliefs, and 55% consulted clergy for the management of patients. Among the patients, 71% believed in God, and 24% preferred psychiatrists who were religious. In an Australian survey, a large majority of patients with psychiatric illnesses wanted their therapists to be aware of their spiritual beliefs and needs and believed that their spiritual practices helped them to cope better.26 In a 12-year follow-up of all articles appearing in the American Journal of Psychiatry and Archives of General Psychiatry, 72% of the religious commitment variables were beneficial to mental health; participation in religious services, social support, prayer, and relationship with God was beneficial in 92% of citations.27 Similar findings were reported in a review of the Journal of Family Practice. 28 This review is cited from Verghese.8

Religious practices affecting mental health

The current presentation is focused on the role of religion in mental health on a practical basis. We are not interested in highly philosophical discussions about religion or its differences with spirituality. We are focused on how religion is affecting mental health at a concrete level in this part of the world.

Religion and caste are often emphasized during elections, but they are also an integral part of day-to- day living.

Religious practices that are currently prevalent in our country.

Religious Gurus

Every city and many villages have so-called demigods who run ashrams where people flock. These living gods are an important source of comfort and guidance to people who visit them. The people visiting them can be divided into the following cat- egories.

Seeking relief from illness

Seeking relief for personal problems,

Trying to obtain power by becoming part of an influ- ential congregation,

Purely to pray and for enlightenment

These Gurus claim that they can solve all prob- lems. The advantage of this situation is, that there is a living person who listens to you in your language and assures you of divine intervention. They provide structure to the believer’s life. Though many of these so-called gurus have been found to be cheaters and have even physically exploited the disciples, yet the diehard followers continue to worship them. I per- sonally believe that they are important safety valves. They require proper supervision and control, so that negative features are removed, and the healthy potential is strengthened. I had occasion to treat a couple of such gurus for psychiatric problems, which clearly indicates that they cannot treat mental illnesses. They help people with unhappiness, inter- personal problems, and intrapsychic conflicts. These Gurus impress their followers by grandiose lifestyle, and by circulating stories of miracles delivered by them.

‘Satsang’ is another common practice prevalent in most cities and even in larger villages, especially among women. These women meet once a week or more at the appointed place and sing bhajans and have religious discourse. Most people find these groups extremely helpful and do not want to miss them. These women find an outlet for emotional expression and get empowered by religious talks. The women often feel suffocated in families where they cannot express themselves freely.

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Pilgrimage

This is another religious activity that helps troubled minds. This acts in multiple ways. A person leaves a normal environment and goes to a new place, which nullifies the stresses of home. Exposure to new places changes the interaction even with family members. The shared belief in the good outcome of a religious journey further pacifies the soul.

Chanting mantras is another accepted way by different religions. The Ramayana emphasizes that the name of Rama is much more powerful than the lord himself. If one chants Rama even by mistake that takes away all one’s sins. Chanting mantras is the simplest way of worship and reduces ‘anxieties.’ There is physiological evidence that chanting pro- duces an effect on neural circuits.

Bathing in pious rivers, giving alms to the needy, good deeds can produce mental peace. These concrete activities are available to ordinary human beings to achieve solace.

Conceptual issues in Hindu religion

I will focus mainly on the Hindu view of life as a large population of this state belongs to that religion. Secondly for me to comment on other religions that I know little about may not be correct. The Hindu religion emphasizes the following.

Geeta29 one of the most important religious text of Hindus emphasizes the following. There are three ways to reach God or salvation, do your duty and leave the results on God, by praying to God, and by developing knowledge about the supreme so that you are detached from worldly things, and you are fully devoted to the lord. One should be able to control Moha (Kama), greed, anger, and pride. One needs to control negative emotions and should learn to live a contented life. These are laudable objectives but not achievable by most of us. Arjun asks lord Krishna if the mind is uncontrollable, and it is diffi- cult to control it, then what one should one do (14 chapter 6). Krishna tells him that those who are not able to control but try to do so will get rebirth in fam- ilies who are of religious inclination and may succeed in the next life. These ideals cannot be achieved by many of us. The aim should be to reach as near the ideal as possible. To convince Arjun Krishna needed

to show his Virat image. This instance shows that belief is strengthened by miracles.

Goswami Tulsidas30 describes the difference between good (sant) and bad(asant) persons in (shloka 37 and 38 of Uttarkand)

Saints are detached, full of good deeds and cool temperaments. They feel sad if others are in trouble and feel happy if others are happy. They treat every- one else similarly. They have no enemies. They have no pride and are detached. They have given up greed, anger, happiness, and fear. They are devoted to God. They are peaceful, polite, happy, and friendly.

On the other hand, the bad are described as dis- satisfied. They feel jealous of others’ property and feel happy on hearing ill of others. (ninda) They are involved in lust, anger, and greed. They are deceitful and cruel. They have animosity with everyone, even with those who are good to them.

He describes the mental illness and its treatment. The root of all illness is in emotions’ MOHA’. This is translated as ‘agyan’ or lack of knowledge. It leads to the development of different problems. Lust is ‘vat, and greed is ‘kaph’ which produces burning in the chest. Other mental states that effects are attach- ment, jealousy, happiness/sadness, and not being able to accept the happiness of others. All these negative emotions are the root of these illnesses.

People try to treat these illnesses by following rules, good deeds, tapa, yagya, knowledge, charity, etc. But these illnesses are not totally relieved. Bless- ing of Ram and belief in him can only relieve these illnesses. One should feel free of illness when he has developed detachment and distances himself from desires.

The Hindu religion has a multitier religious system. There is a Head god (Vishnu) who is omni- present. Shiva, and Brahma are responsible for birth and death. There are ‘Devatas’ for each specific purpose. There are branches that worship various demons. There is also ‘Nirguna’ branch where God becomes an abstraction and is sought by persons with higher wisdom. All religious texts undermine the controversy between idol worship from worship of abstract god as different stages of worship. Hindu religion has been modified by Jains, Buddhists, Aryasamaj, and Ramakrishna Mission. This religion is not rigid, but it provides different levels of wor- shipping for person with different needs.

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Every religion of the world like Christianity, Islam have undergone many changes. All religions must change with change in time. What was important hundreds of years back cannot be applicable now. Secondly most religions were initiated by men therefore interests of women have not been pro- tected. This is a common negative consequence of all religions.

A stalwart of Indian Psychiatry and my esteemed teacher Prof. N.C. Surya31 offered a simple three- point definition of mental health based on the Indian cultural tradition: “Each culture provides positive and negative cues and modes of reaction leading to an integrative and creative behaviour in the culture. It also provides how positively and negatively to meet threatening changes. But, in all cultures most of the people can only represent the negative or lower levels of behaviour – so to say, a vast majority become reflex victims of their own culture. Only a minority are the reflective, conscious representatives of the best in their culture, so to say the leadership. The codes are provided by religion, philosophy, and such other structures. Moreover, some cultures are statistically oriented.”. ……. The Indian culture pays attention to the ideal norm of its culture and striving toward that ideal is considered, by even the average person, as an important component of sound mental health. The signs of good mental health; (is) the degree to which you have an inner sense of comfort in as many situations as possible is the measure of your mental health; (ii) the faces of your intimate associ- ates are an index of your level of mental health. The more unhappy and tense they look, or the happier and more relaxed they look in your presence is the minus and plus of your store of mental health; (iii) your account may be very poor in the above two, but the degree and duration of your aspiration and effort to change for the better is the most posi- tive index of the state of your mental health.” The multi-layered concept of mental health is the only practical solution in our culture. This is an especially important paradigm and should be the cornerstone of our efforts in developing positive mental health.

Practical Application

We must accept that all persons in any society are not similar, either in their knowledge and intelli-

gence, nor they are similar in their belief systems. There cannot be one single prescription for all. I would like to share with you my experience in using religious concepts in treatment of mental illness. These are not necessarily right, nor perfect but are steps towards effective treatment.

Qualifications of the clinician

Psychiatric postgraduation is not enough. The person needs to be practicing what he is trying to preach. He must respect individuals for what they are. Their religious beliefs could be entirely opposite of the clinician, but he should be able to appreciate them. His actions and behaviour should be on the same wavelength that he wishes to convey to the patients.

Who is suitable for these methods?

Does he have a religious bent of mind? Does he consider this illness to be caused by supernatural causes?

Does he believe in God at a concrete level?

Does he believe in spirituality?

Does not believe in God or superpowers at all. Has he tried religious healing before?

Nature of the illness

These methods are more effective if the problem is caused by psychological factors.

Effective for unhappiness, feelings of being deprived, negativity, and hopelessness. These methods have not been found effective in major mental illnesses, schizophrenia, bipolar disorders, depression, severe anxiety, or panic. But may help reduce the distress caused by disease.

The common effective condition is unhappiness and negativity by any reason. Even in severe mental and physical illnesses associated negative thoughts and gloom can be reduced by these methods.

How it is to be used?

Common conflicts are seen in our patients.

He has been so good to others, but they have

not responded.

People have cheated me.

I have worked hard but the results are not according to my efforts.

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I am being discriminated against. No one loves me.

God has also been against me. Legal and marital problems

Keeping all the above in mind one must decide on methods. The aims of the treatment should be clearly specified.

Patients with little psychological orientation need concrete approaches according to their belief systems. They may be asked to chant certain bhajans or shloka, visit temples regularly, or go on a pilgrimage. They must be clearly told that all these measures are to increase peace of mind and bolster their courage to face adverse situations properly.

People with more psychological awareness could be advised on the principles of controlling one desire to the extent they feel comfortable. They can be advised of the principle of detachment. They should not feel upset by failures or overjoyed with success. All these are relative terms and should be done to a level that is acceptable to patients. The common conflict that people have, not given my due can be resolved by making them understand you did what you felt should do and that gave happiness to you. A mother gives her child food even if she was hungry and that gave her satisfaction. If the son does not care for her but cares for his wife, why should she feel jealous? The Hindu religion says that a son fulfils his obligation to his parents by looking after his children. Many people complain that they have been cheated by their relatives in not giving them a proper share of the property. They get involved in prolonged litigation causing severe anxiety and monetary loss. Most of the time the problem is due to ego issues. I usually advise them to calculate the cost of litigation in terms of money and mental peace. Most people do understand it and resolve issues through negotiations.

These methods and strategies require proof and must be validated scientifically. Recently Andrade and Radhakrishnan32 concluded that religious treat- ments have been found to be ineffective. Verghese33 commented, that the religious methods cannot be quantified and thus cannot be scientifically verified. The dilemma persists.

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