When Religion Reinforces Stigma: a Call to Bridge the Gap

A young man, contemplating suicide, is told by a pastor to pray. A woman with complex posttraumatic stress disorder, nightmares, and hypersensitivity to suspected abuse is encouraged to think about her symptoms as demonic in origin and to tell negative thoughts to “go back to the pit of hell.”

In one case, a religious authority may explicitly warn against seeking out mental health professionals; in another case, there is a subtle, unspoken message that to do so indicates lack of faith in God.

Each of these cases is representative of a phenomenon believed to be common across the world’s faiths: religiously reinforced mental health stigma.

Mark Moran

In an article in Psychiatric Services, John Peteet, M.D., outgoing chair of APA’s Caucus on Religion, Spirituality, and Psychiatry, wrote that religiously based mental health stigma is a widespread obstacle to treatment and a clinical challenge when patients who have been exposed to such stigma do, reluctantly or tentatively, seek treatment.

It is hard to quantify a negative phenomenon, and Peteet acknowledges there are few data on the effect of religiously based stigma on individuals who might benefit from psychiatric treatment. But he said the phenomenon is familiar to many clinicians.

“I have encountered it clinically in work with patients who come primarily from conservative religious faiths,” Peteet told Psychiatric News. “Colleagues have talked about it with me, and there is little in the psychiatric literature addressing the issue. It’s a problem for delivery of psychiatric services and for clinical care.”

In the Psychiatric Services article, Peteet outlined five features of religious faith that may contribute to stigma:

• Fundamentalist thinking. “Studies have found that religious fundamentalism correlates more with stigma against mental illness than does orthodox Christian belief, and higher levels of religious fundamentalism are associated with greater preference for religious rather than psychological help seeking,” Peteet wrote.

  An example of a fundamentalist approach to mental illness is the Biblical Counseling movement, which contends that truth can be known literally only through revelation in scripture and rejects mainstream psychology and psychiatry as humanistic, secular, and antithetical to Christianity.

• The role of tribalism. Strong social bonds formed through sharing a faith can encourage a sense of security among trusted “kin,” altruistic care for fellow members of the faith group, and “a deep foundation for one’s identity,” Peteet wrote. But this kind of tribalism can also mobilize mistrust, scapegoating, and stigmatization of outsiders. Congregations may sanction or exclude individuals with mental illness or substance use disorders because their appearance or behavior deviates from the group’s norms.

• Misattribution of psychopathology. Behavior or experiences a psychiatrist may label as a psychiatric symptom may be regarded in a religious context as signs or signals from God. “Examples include patients with bipolar disorder believing they are being directed by God, patients with depression believing they have committed an unpardonable sin, or patients with obsessive-compulsive disorder feeling guilty of imagined sexual indiscretions,” he wrote.

• Traditional ways of understanding. Faith communities in certain subcultures may rely on traditional cultural ways of understanding and dealing with depression, psychosis, or addiction. Before or instead of standard mental health treatments, they may employ prayer, exorcism, or pastoral counseling to heal.

• Adverse experiences with secular mental health professionals. Most psychiatrists manage the relationship between religion and psychiatry with little overt conflict, wrote Peteet. However, some mental health professionals (following Freud) may express antipathy to religious belief, and individuals from religious faith traditions may assume that such antipathy is endemic to the mental health professions.

Find Points of Alignment

Peteet said religiously based stigma calls for a professional and organizational response by psychiatry and the mental health professions. “Understanding its principal causes—fundamentalist thinking, communal bonding, misattribution of psychopathology, traditional beliefs and healing practices, and adverse experiences with secular providers—is a prerequisite to effective mitigation,” he wrote. “This requires a sensitive search for common ground, efforts to work within community values, attempts to address both psychiatric and spiritual concerns, and educational interventions tailored to these challenges.”

Some religious leaders and faith communities have begun to recognize the importance of aligning with mental health professionals (see box).

There are resources that can aid in bridging the gap between faith communities and psychiatry, especially APA’s Mental Health and Faith Community Partnership. The partnership is a collaboration between psychiatrists and clergy aimed at fostering a dialogue between faith communities and the mental health professions, reducing stigma, and bringing together medical and spiritual dimensions as people seek care. The convening organizations are APA, the APA Foundation, and the Interfaith Disability Advocacy Coalition, a program of the American Association of People With Disabilities.

Among the resources offered by the partnership is Mental Health: A Guide for Faith Leaders, which seeks to educate clergy about mental health treatment.

In comments to Psychiatric News, Peteet also said dealing with religiously inspired stigma calls for openness and sensitivity on the part of individual clinicians. “You want to understand where the fear is coming from when working with patients from a fundamentalist background who have religiously based resistance to treatment,” he said. “It may be a fear that they are losing their grip on the truth or compromising their core beliefs if they receive mental health treatment. You want to respect their beliefs and find points of alignment with patients that support their religious convictions.”

If the issue is tribalism and a patient’s feeling that he or she may lose connection to the faith community, the psychiatrist may work with the patient to find points of partnership with the community that are supportive of treatment. And if someone has had an adverse experience with a secular professional because of perceived hostility to religious beliefs, it is important to acknowledge that grievance while communicating that not all professionals share that antipathy.

“Just because someone comes to treatment with a religious resistance, it is not true that nothing can be done about it,” Peteet said. “The clinician needs to be willing to form an alliance with the patient informed by an understanding of the fear that a patient brings to therapy.” ■