What is Mental Illness?What is Mental Illness?

The Relationship between The Relationship between Religion and PsychiatryReligion and Psychiatry

Shari Y. ThompsonShari Y. Thompsonthompsons@mail.nih.govthompsons@mail.nih.gov

June 20, 2005June 20, 2005

OverviewOverview

Historical Review of the Relationship with 5 Major ReligionsHistorical Review of the Relationship with 5 Major Religions

Impact of Religion on 20Impact of Religion on 20thth Century Psychiatric Practices Century Psychiatric Practices

Acquiring Scientific KnowledgeAcquiring Scientific Knowledge

HinduismHinduism

1500 B.C.- One supreme deity but recognizes other gods as 1500 B.C.- One supreme deity but recognizes other gods as facets of the supreme deityfacets of the supreme deity

All illnesses are caused by animistic beliefs, demons and evil All illnesses are caused by animistic beliefs, demons and evil spirits and certain human excessesspirits and certain human excesses

100-200 A.D. recorded the first description of insanity with no 100-200 A.D. recorded the first description of insanity with no mention of provisions for caring for the sufferermention of provisions for caring for the sufferer

Segregation of people with mental illness first occurred in the 19Segregation of people with mental illness first occurred in the 19 thth centurycentury

In 1922, the “lunatic asylums” were called mental hospitalsIn 1922, the “lunatic asylums” were called mental hospitals

BuddhismBuddhism

563 B.C.- 2 forms Mahayana (Buddha is the Savior) and Theravada 563 B.C.- 2 forms Mahayana (Buddha is the Savior) and Theravada (individual responsibility)(individual responsibility)

Goal of enlightenment is wisdom and the monastic order is the heart Goal of enlightenment is wisdom and the monastic order is the heart of the spiritual questof the spiritual quest

A vast spiritual world influences diseases and illnessesA vast spiritual world influences diseases and illnesses

Individuals are not responsible for their mental illnesses so they are Individuals are not responsible for their mental illnesses so they are not persecutednot persecuted

Formal Buddhist writings contain very few comments about psychosisFormal Buddhist writings contain very few comments about psychosis

JudaismJudaism

2000 B.C.- Belief that God is good and righteous, and His creations, 2000 B.C.- Belief that God is good and righteous, and His creations, the world and its people are goodthe world and its people are good

Emphasis on social services and humanitarian activitiesEmphasis on social services and humanitarian activities

Late 12Late 12thth Century Maimonides described the anatomy of the brain Century Maimonides described the anatomy of the brain and psychiatric disorders and psychiatric disorders

Early 13Early 13thth Century Maimonides first wrote, “Mental health is as Century Maimonides first wrote, “Mental health is as important as physical health.” important as physical health.”

Stresses prevention not treatment – “The ill cannot serve the Lord Stresses prevention not treatment – “The ill cannot serve the Lord properly.”properly.”

IslamIslam

570 A.D.- Mohammed taught respect for the world order allowing 570 A.D.- Mohammed taught respect for the world order allowing Muslims to approach science sooner than ChristiansMuslims to approach science sooner than Christians

Absence of demonic theory of disease advanced medical knowledge Absence of demonic theory of disease advanced medical knowledge

872 A.D. Cairo - First hospital for those suffering mental illness was 872 A.D. Cairo - First hospital for those suffering mental illness was fashioned after Christian hospitalsfashioned after Christian hospitals

1212thth Century -Sufism ideology of health and illness depended on God Century -Sufism ideology of health and illness depended on God alone causing tension with the medical profession during the Middle alone causing tension with the medical profession during the Middle AgesAges

1313thth Century record listed 1400 drugs produced by Arab scientists Century record listed 1400 drugs produced by Arab scientists

ChristianityChristianity

4 B.C.- Christian church came from a faith in Jesus’ resurrection and 4 B.C.- Christian church came from a faith in Jesus’ resurrection and that he continues to livethat he continues to live

Gospel writers recorded that healing and exorcism played a role in Gospel writers recorded that healing and exorcism played a role in Jesus’ ministryJesus’ ministry

44thth Century healing through the laying of hands, prayer, fasting, Century healing through the laying of hands, prayer, fasting, invocation of Christ’s name, sign of the cross, and exorcisminvocation of Christ’s name, sign of the cross, and exorcism

Care of those suffering was led by the church leading to extended, Care of those suffering was led by the church leading to extended, organized community careorganized community care

1414thth Century pre-scientific demonology gave rise to the Inquisition Century pre-scientific demonology gave rise to the Inquisition

Middle Ages (14th – 17th Century)

2000 BC

1000 BC

563BC

4BC

570AD

1300 AD

1600 AD

2000 AD

Judaism

Hinduism

Buddhism

Christia

nity

Islam

MIDDLE AGES

ScriptureScripture

- MATTHEW 4:24MATTHEW 4:24Tormented with illness and painTormented with illness and pain

““And his fame went throughout all Syria: and And his fame went throughout all Syria: and they brought unto him all sick people that were taken with they brought unto him all sick people that were taken with diverse diseases and torments, and those which were possessed diverse diseases and torments, and those which were possessed with devils, and those which were lunatick, and those that had with devils, and those which were lunatick, and those that had the palsy; and he healed them. the palsy; and he healed them. ””

- MARK 9:17MARK 9:17Possessed by devils Possessed by devils

““And one of the multitude answered and said, And one of the multitude answered and said, Master, I have brought unto thee my son, which hath a dumb Master, I have brought unto thee my son, which hath a dumb spirit; spirit; ””

- LUKE 9:39LUKE 9:39EpilepticsEpileptics

““And, lo, a spirit taketh him, and he suddenly And, lo, a spirit taketh him, and he suddenly crieth out; and it teareth him that he foameth again, and crieth out; and it teareth him that he foameth again, and bruising him hardly departeth from him”bruising him hardly departeth from him”

The Impact of Religion on 20The Impact of Religion on 20thth Century Psychiatric PracticesCentury Psychiatric Practices

Hinduism – yoga and relaxation techniques based on Hinduism – yoga and relaxation techniques based on psychophysiological methods that were used to achieve controlpsychophysiological methods that were used to achieve control

Buddhism – Direct meditation may enhance psychotherapy and Buddhism – Direct meditation may enhance psychotherapy and Zen-derived Morita suggested as a form of treatment for social Zen-derived Morita suggested as a form of treatment for social phobias and specific obsessionsphobias and specific obsessions

Judaism – 52% of psychotherapists in American cities are Judaism – 52% of psychotherapists in American cities are Jewish-Sigmund Freud and his followers made a profound Jewish-Sigmund Freud and his followers made a profound impact on psychiatry from the perspective of clinicians, impact on psychiatry from the perspective of clinicians, researchers, and patientsresearchers, and patients

Impact of Religion on 20Impact of Religion on 20thth Century Practices Contin’dCentury Practices Contin’d

Islam – employ elements of Islamic worship in group Islam – employ elements of Islamic worship in group psychotherapy success in relieving psychiatric symptoms and psychotherapy success in relieving psychiatric symptoms and re-grounding spiritual faithre-grounding spiritual faith

Christianity – reform mental hospitals to improve conditions Christianity – reform mental hospitals to improve conditions of care and mainstreamed the language for psychoanalysisof care and mainstreamed the language for psychoanalysis

Is there a Role for Clergy in Is there a Role for Clergy in Mental Health Care?Mental Health Care?

Points to consider:Points to consider:– Religious life of AmericansReligious life of Americans– Religious practices, beliefs, and values Religious practices, beliefs, and values

may help prevent illnessmay help prevent illness– Religious commitment may influence Religious commitment may influence

decisions about mental health care decisions about mental health care

******Clergy may support and complement Clergy may support and complement traditional medical caretraditional medical care******

SummarySummary

The study and treatment of mental illnesses have The study and treatment of mental illnesses have been influenced by societies’ views of the spiritual been influenced by societies’ views of the spiritual worldworld

Belief in an evil or supernatural causation is not Belief in an evil or supernatural causation is not problematic per se, the issue is how that view problematic per se, the issue is how that view influences the care of individuals with mental illnessesinfluences the care of individuals with mental illnesses

Are we a society that persecutes suffering individuals Are we a society that persecutes suffering individuals or do we provide the best care and treatment that or do we provide the best care and treatment that technology will allowtechnology will allow

Summary Contin’dSummary Contin’d

Medical practices are guided by the true inspiration of Medical practices are guided by the true inspiration of religions - compassion, fairness, sense of justice, and religions - compassion, fairness, sense of justice, and lovelove

The continuing challenge is to be truly worthy of our The continuing challenge is to be truly worthy of our moral responsibilities and intellectual inheritance.moral responsibilities and intellectual inheritance.

22NDND BIGGEST BIGGEST BREAKTHROUGH IN 2003BREAKTHROUGH IN 2003

Decoding Mental Decoding Mental IllnessIllness

– www.sciencemag.org/cwww.sciencemag.org/cgi/content/full/302/5653gi/content/full/302/5653/2039/2039

What is Risk?What is Risk?

Genetics – the genes you inherit Genetics – the genes you inherit from your parentsfrom your parents

Environment – stress, smoking, Environment – stress, smoking, drugs…drugs…

The Human Genome Sequence is Done (ca.2003)

Genes: 25,000Proteins: 600,000

SNPs: 6 million

Nucleotides: 3 billion

What is Risk?What is Risk?

Genetics – the genes you inherit Genetics – the genes you inherit from your parentsfrom your parents

Environment – stress, smoking, Environment – stress, smoking, drugs…drugs…

Genetic Loci Linked to Schizophrenia

1 2 3 4 5

1211109876

13 14 15 16 17 18

19 20 21 22 X Y = genome-wide significance

DISC1

DTNBP1GRM3

NRG1

G72

COMT

GAD1

MRDS1

Genes:

multiple susceptibility

alleles each of small effect

Cells:

subtle molecular

abnormalities

Systems:

abnormal information processing

schizophrenia

Behavior:

complex functional interactions and

emergent phenomena

The path from here to there…The path from here to there…

The Wisconsin Card Sorting Task

temperament

cognition

Functional genomics in human brainFunctional genomics in human brain

gene and protein expressionneuroimagingcognition

Risk allele/haplotype

The Wisconsin Card Sorting Task

how does it do it?

The “N-back” working memory taskThe “N-back” working memory task

GOAL

• To use postmortem human brains to discover the cellular and molecular mechanisms that lead to schizophrenia

NeuropathologyNeuropathology

Neuropathology Brain CollectionNeuropathology Brain Collection Total number of brains = Total number of brains = 861861.. Number collected since last year = Number collected since last year = 359359..

Clinical history ( phone screening, medical Clinical history ( phone screening, medical records, interviews with next of kin), records, interviews with next of kin), neuropathology and toxicology screening neuropathology and toxicology screening yields:yields:

normal controls = normal controls = 100100; schizophrenics = ; schizophrenics = 5555..

Molecular biology screening (pH, in situ Molecular biology screening (pH, in situ histochemistry hybridization, 28s/18s ratios and histochemistry hybridization, 28s/18s ratios and capillary electrophoretic analysis (Agilent) capillary electrophoretic analysis (Agilent) yields:yields:

normal controls = normal controls = 8686; schizophrenics = ; schizophrenics = 3939..

What causes schizophrenia??What causes schizophrenia??

Poor cognitiveperformanc

e

Poor cognitive

performance

Socialwithdrawal

Social withdrawal

Perinatal complicatio

ns

Perinatal complicatio

ns

Geneticpredispositi

on

Genetic predispositi

on

Older fatherOlder father

Other psychiatric

disorder

Other psychiatric

disorderSchizophren

iaSchizophren

ia

Low SES Low SES

Immigration

Immigrati

on

Urbanicit

y

Urbanicit

y

Substance abuseSubstance abuse

Acknowledgements

Special Thanks:Dr. Daniel Weinberger

Dr. Joel KleinmanDr. Karen Berman

All the Principle Investigators and Support Staff at the National Institute of Mental Health/NIH

Genes, Cognition, and Psychosis Program (GCAP)

Clinical Brain Disorders Branch (CBDB) CONSUMERS,

FAMILIES, AND SUPPORTERS