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Mental Health, Religion & Culture
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Finding common ground: the boundaries and interconnections between faith-based organisations and mental health services
Gerard Leavey , Gloria Dura-Vila & Michael King
a a b c
Northern Ireland Association for Mental Health, 80 University Street, Belfast BT7 1HE
Imperial College, London, UK
Department of Mental Health Sciences, University College, London, UK Available online: 07 Jul 2011
To cite this article: Gerard Leavey, Gloria Dura-Vila & Michael King (2012): Finding common ground: the boundaries and interconnections between faith-based organisations and mental health services, Mental Health, Religion & Culture, 15:4, 349-362 To link to this article: http://dx.doi.org/10.1080/13674676.2011.575755
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*Corresponding author. meditation and prayer. at times the boundaries are so tightly drawn that it is hard to see where they might share values and concerns.doi. mental illness. Gloria Dura-Vilab and Michael Kingc a Northern Ireland Association for Mental Health.tandfonline. 1988. acceptance. London. individually or collectively. In Christianity and other religions. London. religion-oriented behaviour. 1986). No. Additionally. is a central function of most religions (Csordas & Lewton. Briefly. Levin. help-seeking.575755 http://www. These worlds are often depicted as oppositional and antagonistic. First. Numbers & Amundsen.com . 2000. Keywords: clergy. These findings have been reviewed comprehensively elsewhere and the various possible mechanisms of the association between health and religion well aired (Koenig. privately or publicly is often directed to the removal. suggests that religion and spirituality promote health. UK.1080/13674676. Belfast BT7 1HE. b Imperial College.2011. a large body of literature. 80 University Street. these can be understood in sociological or social-psychological terms whereby the individual benefits from community acceptance. Religion & Culture Vol. 15. organisations psychiatry. cDepartment of Mental Health Sciences. and the editors apologise to authors and readers for its delayed appearance. attenuation or endurance of suffering (Church Review Group. religious communities may sometimes provide a moral framework for positively oriented health behaviour (for example. UK (Received 10 February 2011. This paper examines the interface areas of religion and mental health care in order to consider where consensus and from where collaboration might emerge. We suggest that while certainly there is a need for dialogue and mutual understanding. April 2012. 4. religious values and practices are also thought to energise healthy coping styles through forgiveness. 1994). the avoidance of sexual promiscuity and substance misuse). Email: Gerard. ISSN 1367–4676 print/ISSN 1469–9737 online ß 2012 Taylor & Francis http://dx.Mental Health. Moreover. 1998. University College. 1897/1997). healing.org/10. Religion.org y This paper is a contribution to the Special Issue on Psychiatrists’ views on the place of religion in psychiatry. mostly from the USA. final version received 24 March 2011) A perennial theme in the literature of religion and mental health is the need for dialogue between psychiatry and faith-based organisations in the care of people with mental health problems. there is also a need for psychiatry and faith groups to explore the nature and boundaries of proposed relationships. 349–362 Finding common ground: the boundaries and interconnections between faith-based organisations and mental health servicesy Gerard Leaveya*. Durkheim.leavey@compasswellbeing. and from sociological and anthropological theoretical perspectives. belonging and participation. faith-based Downloaded by [Universiteit Leiden / LUMC ] at 06:42 20 March 2012 Introduction The importance of religion and spirituality in the context of mental illness can be considered in various ways. in theological terms.
there is also a need for psychiatry and faith groups to explore the nature and boundaries of proposed relationships. public and nonstatutory agencies have warmed to the inclusion of FBOs as partners in health and welfare services. it is religious in origin and that faith communities continue to be an important resource. Correspondingly. Baum & Ziersch. sometimes coterminous with minority ethnic communities. Kawachi. & Lochner. Latterly. indeed many healthcare systems and hospitals in Western societies have a religious provenance (Koenig. the conflict between moral perspectives and discriminatory behaviour related to homosexuality. in part ideological but also driven by pragmatic economics. the prospect of unbridled materialism. for example. we consider the role of religion in psychiatric care and why it has relevance in the care of psychiatric service users.350 G. religion and spirituality have re-emerged as part of the discourse around public service provision. In the second section. there has been increased demand for partnerships with faith-based organisations (FBOs) in the care of people with mental health problems. We have structured the paper in three sections: in the first section. in the context of healthcare provision. activism and voluntarism – which solidify the community and benefit the individual. However. and the valued deep-rooted social connections of many faith communities in fostering social cohesion agenda (Putnam. Kennedy. Thus. we review the role of religion and clergy in helpseeking which we suggest is a vital linkage between FBOs and mental health care. welfare and health has been largely enveloped by the state system. for the time being at least. 2000). stand as fairly useful exemplars of social capital ideals – reciprocity. in recent years. albeit for often negative reasons. we examine the role of FBOs in mental health care. 2000. from the latter end of the twentieth century there has been a tendency towards partnership with non-governmental agencies in the provision of welfare services. These emerge in the health literature as the potential public health value attached to notions of social capital (Baum et al. 2005. have slowed up the seemingly inexorable progression to secularism within the United Kingdom and other European societies. 2003. Downloaded by [Universiteit Leiden / LUMC ] at 06:42 20 March 2012 Additionally. In the final section. 1986). Religion-based communities. Arising from this counter-anomic vision of religion the incorporation of FBOs as a significant adjunct to statutory sector health and welfare appears as a rational move. perhaps. cultural sensitivity and other concepts such as consumer involvement and choice. . The rationale for this partnership is generally predicated on the latter’s declared commitment to entwined spiritual and social values. Although in Western social economies the provision of education.. Numbers & Amundsen. Despite such tensions. government departments. holistic care and the expert patient challenge the growth of medical scientific objectivism. socialisation. In consequence. in the United Kingdom there has been no attempt to examine or test the processes and frameworks in which this relationship might flourish. individualism and the corollary of weakened communities has prompted government attraction to the communitarian ideas of commentators such as Putnam (2000) and Etzioni (1993). health care has been accommodated within secular professional institutions. ethnic and religious pluralism. The role of FBOs in mental health care Social capital and FBOs Among larger religious groups. integration. In the discussion. Leavey et al. 1997). we tie up these themes and suggest that while certainly there is a need for dialogue and mutual understanding. we suggest that while current mental health is dominated by state provision.
In the USA during the Bush years. 1971). It is obvious to any policy-maker that the widespread and embedded presence of FBOs across a diversity of communities. the transfer of welfare dollars to church-based groups may be viewed in more ideological terms. individual clergy and their institutions have been at the forefront of many social and political causes across Western Europe. For others the concerns relate simply to the destruction and displacement of long-established non-religious voluntary sector bodies as they lose out to the FBOs. such changes may have negative consequences in public health and personal life-chances. youth offender initiatives. 1992). 1990). operating within predominantly migrant and inner-city communities throughout Europe and South America. 2008). liberation theology. where socio-economic deprivation and ethnicity coincide. 2002). often overlooked is the vast but seldom quantified amount of community building and cohesion in which clergy and FBOs quietly engage. 1994. meeting the gaps that the welfare state leave behind or are unable to fill (Davis.1 Other critical perspectives on religion emphasise its service to conservatism and the domination or hegemony of establishment values through false consciousness (Bourdieu. the spread of materialism and capitalist forces have been regularly challenged by clergy from various faith traditions. For instance. 2002). embrace a counter-anomic approach to their mission. There is. 2002) have documented the huge moral and financial commitment to social aid and reform by the Protestant mainstream churches (Olson. liberation theology which emerged in the late 1960s in Latin America produced a revision of the Gospel as a call to end poverty and deliver people from oppressive political systems (Casanova. 1969. in addition to spiritual healing they offer work programmes. 1994. While the media in the USA has focused on the sex and financial scandals of the religious right. marginal and otherwise. This ‘‘branch’’ of Christianity offers support that is not solely compensatory. However. Wuthnow and colleagues (Wuthnow & Evans. been attacked as hypocritical. Downloaded by [Universiteit Leiden / LUMC ] at 06:42 20 March 2012 . Also. Elsewhere. Not simply sour grapes. working amidst marginalised peoples and urban blight (D’Epinay.Mental Health. but provides a vehicle for material change on earth (Droogers. 1985. Thus. drug rehabilitation. For instance. of course. Paulhus. Gramsci. Religion & Culture 351 In our post-enlightenment universe. Sexual and financial scandals add to the weight of evidence against clergy. the long-standing health and welfare patchwork provided as part of ministry. & Bradstock. offers readymade structures for the dispersal of welfare goods and services. infantilising. On the other side of the fence. faith organisations often occupy a key community leadership role for both spiritual and material reasons. socially and individually. in any case it would be difficult to argue that state welfare provision is always free of ulterior motives or supplementary outcomes. parasitical and exploitative. deep-seated ideological opposition to an erosion of state secularism. 2002). Government motivation for church involvement is largely a matter of pragmatic economics. clergy have. black Pentecostal churches. 2003). As the frontline embodiment of religion. black civil rights issues. South Africa and Latin America. Martin. anti-apartheid and various social justice campaigns in the United Kingdom. the Black churches in the USA have occupied a central position in the African-American communities from the nineteenth century onwards and have been at the heart of social activism and reform (Chaves & Higgins. Mart|n-Baro. the USA. Studies elsewhere reveal that certain religious groups may adopt quite assertive religious approaches to the care of mental health sufferers (Redko. religion has often been pilloried for being. It has been argued that this type of engagement is motivated by proselytisation rather than altruistic concern but the evidence suggests otherwise. However. However. Martin. the promotion of a wider neo-conservative strategic alliance with evangelical (or simply religious) populations. a spiritual redemption in the afterlife. Thus. of course. divisive and destructive.
at least) that communitybased religious leaders have significant contact with people from their congregations who suffer from emotional and mental health problems. However. without additional contact from professionals. There is also concern that so many people obtain ‘‘help’’ from clergy.. many others have poor understanding of mental health problems and lack confidence in referral to professional services (Wang et al. Thus. 2000). is an essential part of Pentecostal life. 2003).352 G. & Kessler. Pentecostal welfare provision appears to draw little attention in countries such as Brazil or Chile where health inequalities are severe and state welfare is weak. Downloaded by [Universiteit Leiden / LUMC ] at 06:42 20 March 2012 The role of clergy in mental health care As noted in the previous section. it is argued within a Christian context that pastoral care cannot be simply ‘‘applied theology’’. psychology and anthropology (among others). Regardless of how we might interpret their motivations.2 Pentecostals believe in the inerrancy of the bible and the omnipresent threat of satanic power (Cox. Various studies suggest that although many clergy see mental health pastoral care as a large part of their work. 2003). while the scope of pastoral care is considerable. Leavey et al. the potential for conflict is likely to be greater. strictly speaking. Significantly. Weaver. Moreover. Thus. Other ethnographic research in urban Brazil has examined Pentecostal involvement with patients with schizophrenia (Redko. community advisers and mediators between government and people. clergy in order to have contemporary relevance must engage with and learn from an increasing range of modern disciplines and methods including secularist disciplines of psychiatry. Kirmayer. in essence it attempts to deal with the problems. Berglund. Wylie. Wang and colleagues found that suicidal thoughts and behaviours increased contact with clergy and suicidal individuals were as likely to contact the clergy as other providers. political or otherwise. While not. including deliverance from possession. 2005) play a pivotal role as gatekeepers for services. there is a considerable evidence (in the USA. Weinfeld. indeed many people experiencing what appears to be psychiatric illness look to clergy rather than psychiatric professionals (Wang. 1996). clergy in many communities. the core ingredients of pastoral activity described by church historians are those of guidance. 1995. a term which suggests that clergy rely on biblical text to guide their relationships with troubled congregants (Hiltner. reconciliation and sustenance of the community. fundamentalists. the sociologist Martin (2002) points to the work of Pentecostals in Latin America in transforming the lives of women. Samford. 1997). However. some obtaining specialist training in counselling and psychotherapy. 1995). 1986). healing. particularly among recently arrived and minority ethnic (Jarvis. 1990. providing them with secular aspirations (in tandem with spiritual change) and the practical and emotional supports to realise these. & Lasry. in the absence of evidence as to the efficacy of whatever it is they provide. Studies in the USA consistently reveal that across all major religious groupings between 50% and 80% of clergy considered their seminary training in pastoral counselling to be deficient and reported being inadequately prepared to deal with the severe mental problems and marriage counselling issues to which they were asked to respond (Weaver. Previous research indicates that . 1984). Where they compete head to head with more developed health and welfare systems. Ritual healing. 2003. concerns and suffering of people within a theological or religious framework (Mollica & Streets. & Kline. Weaver. In concurrence with this view other studies suggest that clergy may be unable to discern between various disorders and have poor training to assess needs and offer appropriate pastoral care (Domino.
Secular professionals were regarded as providing fairly safe but limited. impersonal and theoretical’’ and rejecting of the spiritual dimension. secular therapy is considered amoral in that it is thought to take a neutral. professional help conflicted with religious beliefs and were a last resort for help. 2008). Leavey. At worst. compliance with treatment and outcomes. a need for . & McBride. the research pointed to a desire among the informants for the ‘‘definitive directiveness’’ offered by religious guidance and not by secular professionals. The openness to holding in tension both religious and medical beliefs about aetiology and treatment may be crucial in the care of patients who are uncertain about the origins of their suffering (Dura-Vila. 1960. The role of religion in psychiatry Individual narratives and recovery Since the 1960s. value-free stance to what are clearly. Of course. Secular professionals were generally trusted in terms of their professional standards and confidentiality but were nevertheless regarded as ‘‘cold. the emergence of ‘‘customer primacy’’ and the notion of the patients’ voice has permitted a challenge to the biomedical model. problems of sinful behaviour and thought. more strongly. To a degree. morality and conscience they are generally limited in their resolution of such problems and unable to engage with the ‘‘guilty’’ person in acts of atonement.Mental Health. Rondon. psychiatric problems identified as spiritual or supernatural in origin by clergy may lead to delays in reaching professional psychiatric help and/or difficulties in the patient’s relationship with mental health workers. 2011). acculturation by clergy of secularist beliefs is likely to be influential. This point is also made by religious leaders who suggest that while psychotherapists can explore issues of guilt. from the religious viewpoint. Importantly too. What then do religious people value about their religious leaders? One study examined the help-seeking beliefs and attitudes of committed UK Christians (Mitchell & Baker. the likelihood of maintaining more complex explanatory models. However. Leavey. 2008). & King. the willingness to accommodate biomedical and naturalist explanations of disease may in some part be conditioned on exposure to psychiatry and psychiatric knowledge and some clergy will have had some training. Liberalising reforms in the mental health system have attempted to reframe the patient as an active consumer of. 2008). short-term and possibly superficial help. Moreover. 2007) but this should not be considered as a rejection of supernatural connections with health and illness but rather. & Leavey. in Western healthcare systems. Thus. They will also affect their subsequent relationships with their respective religious communities (Leavey. 1980. Loewenthal. 1960. Thus. 2011). Dein. Szasz. confession or ‘‘offer dispensations’’ (Bar-Ilan & Hoffman. these presumed positions are much more likely to be on a continuum than polarised. Others will have had a medical. or collaborator in. health care. 1990. or at least exposure to this discipline. Holmes & Howard. since the 1960s social science perspectives of medicine have promoted the salience of the patient’s biography and context. Religion & Culture 353 Downloaded by [Universiteit Leiden / LUMC ] at 06:42 20 March 2012 clergy have been relatively unprepared to assess suicidality or indeed manage the needs of people bereaved by suicide (Domino. nursing or psychotherapy training (Leavey. Hagger. 2000). as part of their work as hospital chaplains. a fake or pseudo discipline (Laing. psychiatry came to be variously regarded as misguided or repressive and. The recognition and interpretation of disorder by religious leaders are likely to have important implications for patient pathways to appropriate care and their relationship with psychiatric services. In the midst of wider social discourses about the nature of mental illness and the role of the state. 2003.
the rites and diets of this or that ethnic group are the focus of attention in hospital settings. Such aspirations are reflected in the literature on recovery approaches in mental illness whose advocates argue that the lives of people with mental illness have significance beyond illness. & Johnstone-Sabine. however laudable. much neglected. However. Vallianatou. Coker. discrimination and misdiagnosis increasingly demanded examination as evidence emerged that black and minority ethnic (BME) patients experienced differential access and poorer outcomes than their white majority counterparts3 (Coid. 1966. & . the cultural competency approach. 2000. 1989). Thus. Leavey et al. & McDavis. religious patients regardless of ethnocultural background. provide structures for meaning. Thus. argue that their beliefs and values are either disregarded or seen as further evidence of pathology among atheistic mental health professionals and as a result. perhaps collaborative. However. 2004). Downloaded by [Universiteit Leiden / LUMC ] at 06:42 20 March 2012 patient-clinician engagement with meaning (Bury. religion and cultural competence The presence of ethnic and cultural diversity within Western societies became increasingly evident within health care and other public services (Parekh. Consequently. the need for cultural competency (Sue. generally. 1982. While much of the evidence is anecdotal there remains a widespread perception of services as religio-phobic among patients and carers (Mayers. research continued to show elevated rates of depression and schizophrenia among migrant and minority ethnic patients (King. Littlewood & Lipsedge. Arredondo. Leavey. This type of self-censorship is experienced by some as distressing and harmful (Leavey. In the United Kingdom and other Western healthcare systems. 2003). Leavey. patients could not be viewed merely as a bundle of symptoms neatly sealed with a diagnosis. spirituality. such patients and their carers suppress cherished beliefs. community groups and mental health professionals. Boardman. Religion and spirituality. could hardly be surprised when the religiously oriented patient shunned services which they found demeaning. From this subjectivist or phenomenological perspective. 1992). Thus. 2005). 1996). suggesting that any discordance between providers and users arises through ignorance and stereotyping. Ethnicity. 1988). 1994). promoted in various recent policy documents (National Institute for Mental Health in England. & Mackenzie. Religious belief and practice often appear to be the sensitive interface of poor services to people from minority ethnic backgrounds rather than of intrinsic value to the general population as a whole. A secular-oriented professionalism that paid little attention to the religious beliefs of the individual. contact with services is poor. Kahtan. the NHS and local providers slowly began to incorporate within their service frameworks. & Slade. 1991. Supported by an informal coalition of service users. Good. Thus. somewhat crudely expressed here. religion and increasingly. 2008). it was hoped that eventually a mechanistic view of the irrevocably damaged patient would give way to a more holistic. Gault. & Jarman. Pargament.354 G. Husband. they have social identities and personal resources which can be supported and directed towards a fulfilling and meaningful existence (Shepherd. ineffective and offensive due to the provision of culturally inappropriate services (Gerrish. or in some circumstances challenged and insulted such beliefs. usually implicitly. implicitly offers a fairly benign view of mental health services. for many. Hoar. reconstruction of self. 2000). Littlewood & Lipsedge. 1997). action and coping with suffering (Berger & Luckman. The issues of racism. are foundational aspects of identity and central resources. an alien cultural expression of distress may be misinterpreted by Western-trained professionals and the person misdiagnosed (Fernando.
it is. However. Moreover. while psychiatrists tend to be less religious than the general population (Neeleman & King. While the articulation of spiritual or religious views may indicate the existence of genuine pathology. the cognitive and behavioural dimensions of religion may be relevant to the issue of misdiagnosis among BME patients. Similarly. Forty-four per cent of the patient . 1996. 1991). the same study suggested that psychiatrists with religious beliefs also self-censor because they fear being seen as ignorant. 2007). Moreover. & Hoar. in charismatic groups. For instance. We asked the participants about their religious and other beliefs related to the supernatural. among mental health professionals. greater knowledge of background. 2007).. there is little evidence that religious patients are penalised or discriminated against because of their beliefs or that they experience relatively worse outcomes than non-religious patients (Mayers et al. Other commentators in psychiatry consider religion to be communally and individually problematic and divisive (Ellis. 2003. acute psychotic episodes with a rich religious flavour may reflect culturally determined expressions of distress (Littlewood & Lipsedge. although relatively harmless and perhaps. some of the reluctance of religious people to consult psychiatry. religion and help-seeking During our research on ethnicity and psychotic illness we attempted to explore the association between pathways into care and causal attributions of patients and carers (Cole. the experiential and exuberantly expressive behaviour among Pentecostal groups and other charismatic Christians. 1986). 1902). 1961). the case that religious beliefs may impact in other ways on such patients’ experiences of mental health services. 1984). However. 1995). And. For example. to be avoided at all costs (Dura-Vila et al. have tended to provoke anxieties among outsiders. among African and African-Caribbean communities where religious and spiritual beliefs appear more prevalent and readily expressed. for example. Downloaded by [Universiteit Leiden / LUMC ] at 06:42 20 March 2012 Explanatory models. a recent qualitative study of UK psychiatrists and their views on religion suggests that engaging with the religious beliefs of patients is to open a Pandora’s box. For instance. it is plausible that religiously devout patients may be viewed by secular mental health professionals in a negatively stereotypical way as ignorant. For example. Leavey. Sabine. Thus. some descriptions of religious belief. 1993). neurotic and superstitious or have concerns about clergy interference in treatment. 2011). James. Fearing that secular therapists might try to challenge or attempt to alter their beliefs and values they preferred to consult clergy or religious counsellors (McLatchie & Draguns.Mental Health. Some of the anticipated antagonism of psychiatry towards religion may be traced to Freud’s views of religion as delusional (Freud. among some religious people. beliefs and context is vital. 1988). nevertheless. psychotherapy or counselling services may be explained by what Shafranske and Gorsuch (1984) and others have termed the ‘‘religiosity gap’’ between the religious patient and mental health. Religion & Culture 355 Barker. Hathaway. a UK study of evangelical Christians and help-seeking indicated deep-seated anxieties about the beliefs and values of mental health services. King. religious beliefs and experiences tend to be negatively interpreted by mental health professionals. Nevertheless. although misdiagnosis is largely discounted as an explanation for the high rates of schizophrenia among African Caribbeans in the United Kingdom. Indeed. expression or spiritual experience bear a resemblance to psychotic symptoms or those of compulsive obsessive disorders (Jackson. even beneficial to adherents.. profound religious or ecstatic mystical experience may be considered desirable and beneficial (Cox.
while 18% believed in Witchcraft. such as possession or deliverance. in some circumstances. Does it increase their standing within their own congregation or likely to bring them into disrepute with the wider religious Downloaded by [Universiteit Leiden / LUMC ] at 06:42 20 March 2012 . to a spiritually conceptualised. Twenty-three per cent stated a belief in spirit possession. 2008). and by association. Leavey et al. 1997. it may also confer upon the individual. 2004). However. More strikingly. and the extent to which clergy encourage religious or spiritual explanations and healing is likely to be predicated on several interrelated factors such as cultural background and degree of acculturation. may be too dire for the family to accept. they have sinned or have weak faith. & Struening. 18% of patients claimed to have personally experienced the effects of spirit possession. 1994). Many of these patients and their relatives ascribed the occurrence of mental illness to these ‘‘spiritual’’ phenomena (unpublished data). Leavey. A religious solution. for some people. ‘‘problem’’ may represent the possibility of a dramatic and immediate fix. Of the Black group (N ¼ 101) 40% claimed to believe in Witchcraft. moral transgression and guilt. the family) seeks assessment and legitimacy from the priest and in return. some reluctance to relinquish an intervention of healing through faith and the close involvement of the local church or temple. 1951). A similar proportion of Asians believed in spirit possession. & Majcher-Angermeyer. in a community-based study in Haringey (N ¼ 428) more than a quarter of participants reported a belief in supernatural forces (Cole. consenting to treatment. Thus. Behaviour that is conceptualised as spiritual in origin may be accorded greater social latitude. 1997). This study indicated that more than 10% of patients and their carers during a first episode of psychotic illness contacted religious and spiritual leaders prior to psychiatric contact.4 It is probably safe to suggest that within most communities the stigma of mental illness remains potent (Angermeyer. there are considerable differences between and within religions. Thus. the collateral damage of the psychiatric label. Some of the reasons for the valued position of religion in help-seeking are associated with religious or spiritual conceptualisation of illness and suffering and the perceived need for religious resolution. other people rely on their faith as a means of coping with suffering (Pargament. in ways that parallel the relationship between the patient and doctor as theorised in Talcott Parson’s ‘‘sick role’’ (Parsons. It is therefore important to consider clergy utility in promoting spiritual healing. When these occur clergy may be sought for expiation. the family. a spiritual conceptualisation of the problem may deflect suspicion or blame away from the individual and the wider family. Whereas. help-seeking behaviour may be considered as culturally derived in a number of intersecting ways. exceptional qualities or ‘‘gifts’’. if not derived. symptoms of anxiety and depression may arise from a spiritual conflict. Additionally. Redko. the individual (or more usually. Alternatively. Stigma related to mental illness in closed communities has both widespread and profound consequences for the individual’s (and his or her family’s) marital. spiritual guidance and healing. reversing the negative into a special degree of spiritual connection.356 G. education and training for mission. Link. Cullen. Therefore. Mirotznik. Indeed. group believed in witchcraft and also spirit possession. 1989. 2003). Where there is some acceptance of psychiatric diagnosis by families there often remains. Link. 1992) and the attribution of psychiatric symptoms to a religious causation may be of ‘‘help’’ to the individual and/or her family (Galanter. social and economic ties and prospects. a damning spiritual selfevaluation. & King. in terms of blighted job and marital prospects. These findings are supported by other studies on explanatory models and pathways into care for patients (McCabe & Priebe. ‘‘church’’ theology and adherence to doctrinal orthodoxy and an acceptance of bio-medical illness models (Leavey.
Religion & Culture 357 Downloaded by [Universiteit Leiden / LUMC ] at 06:42 20 March 2012 community? For example. Although observed by some as sharing similar concerns. Mohamad. may be improvident (Culliford. tend to be ignored by Western mental health services as potential partners in healing (Larson et al. 2001). 1988. the issue of demonic possession is treated with great caution in the established. Casper. mostly American. 1997) and despite their long historical involvement in healing and health care. while often sounding reasonable the adopted positions tend to polarise along established fault lines that may be less concerned with the beliefs and values of patients but rather to be located within a broader culture war on the position of religion in society generally. In Pentecostal and some African faith traditions. 1988). Some recent studies in the United Kingdom point to a preference among Muslims and African-Caribbeans for spiritual care rather than psychiatric services. 1988.. public health education and offer advice to community members consonant with the formal healthcare strategies. This leads many commentators and researchers. Rahim. 1999. 1995). conservative branches of the mainstream (Catholic and Anglican) churches which remain fearful of bad publicity. Sorensen. Conclusions Professional boundaries and competencies In the USA various studies indicate that clergy currently play an important role in the provision of mental health services and their involvement may not be limited to common or minor mental health disorders (Gurin. advocating spiritual or secular intervention. Mindful of the strategic and symbolic importance of clergy in many minority ethnic communities. Reiger.. & Kessler. Greenberg and Witzum provide insightful views on providing mental health services to Hasidic Jews in Israel (Greenberg & Witzum.Mental Health. 2001). Veroff. Dein’s ethnographic study among the Hasidic Jews of north London highlighted the central and adjudicatory role of the rabbi on matters of health and suffering (Littlewood & Dein. Sandanger. some commentators argue that the neglect of spirituality. Ingebrigtsen. Lynn. 1960. 1996). strengthening or challenging religious health beliefs and in effect. there is continued demand. 2008) revealed the residual sensitivities around any engagement of the spiritual in psychiatric services. 2005). However. 2010). the concept of demonic possession is integral to the belief system and promoted among adherents (Ensink & Robertson. Hohmann. 2003). 1980. that psychiatry should develop partnerships with FBOs which one assumes would then facilitate the provision of culturally sensitive community-based services. Knox. while evangelical or charismatic Christian churches perceive supernatural forces as seminal in much human suffering and willingly work towards demonic eradication. clergy.. & Narrow. 1996. in patient care and in research. & Feld. the relationship between psychiatry and religion is often regarded as oppositional and quarrelsome (Bhugra. 2002. . & Tanweer. based on multicultural and equal opportunities perspectives. Wang et al. While psychiatry in the United Kingdom appears more reluctant to co-opt a religious dimension into mental health care. a preference influenced by their health beliefs (Hatfield. Clergy in highly boundaried communities such as the Orthodox Jewish or Muslim communities may be pivotal in the problem definition period of patients’ help-seeking. 1993. Poole et al. Larson. & Schlosser. William. & Dalgard. Recent publications and correspondence in a British psychiatric journal (Koenig. our knowledge on the role of clergy in mental health help-seeking is limited. to argue for greater collaboration between psychiatry and clergy (Koenig. Sorgaard. Meyer. 2008) and greater spiritual competency among mental health professionals (Bergin. More generally.
Additionally. it appears that the churches put no resources in either training or pastoral support to clergy in order to manage such problems (Leavey et al. and nature about clergy involvement in mental health care these areas are seldom explored. Downloaded by [Universiteit Leiden / LUMC ] at 06:42 20 March 2012 Notes 1. Second. avoid dealing with mental illness among their communities. the promotion of religious/moral values (such as the silver ring thing) may be at the cost of genuinely effective programmes aimed at reducing sexualtransmitted diseases and teenage pregnancies. clergy begin to focus more narrowly on religious and spiritual role functions. . . More perplexingly. let alone assessment and evaluation. interests and vocational training in counselling or mental health professionals with strong religious convictions (Sims. 1995). It may be the case that many clergy would. 2003).. Religion spans a vast spectrum of beliefs and practices. 1986). through processes of professional differentiation. with overlapping religious and professional interests. confidence and willingness of faith groups and clergy to engage in this care is unavailable. while the demand for collaboration is well placed it may be that the barriers between the two sides have been minimised. Moreover. while there is possible cause for suspicion or anxiety on both sides. may be stepping further towards secularisation. in the case of sex education. there is scant information on the referral patterns of clergy to psychiatric services or to what extent clergy are instrumental in assisting or directing patients and families to professional medical or psychiatric help. there is a clear need to articulate what this means for mental health professionals. In the United Kingdom. Nevertheless. this is not the case. clergy shift towards ‘‘professionalist’’ and personalised stance. placing emphasis upon an individual clientprofessional relationship. most are simply ill-equipped. about the extent. 1993). as some see it. welfare and education. some clergy regard this as a blurring of role boundaries. not unreasonably. 2008. clergy with a background. tend to be presented by individuals. Leavey et al. It has been noted before that clergy are de facto mental health workers in the community and that this aspect of their role is challenging to the point of stress and burnout (Louden & Francis. While there appears an obvious need for knowledge. Two divergent changes occur. most ministers of religion do not see themselves as rivals or enemies with any branch of medicine (Numbers & Amundsen. However. these generalisations have seldom been empirically explored.358 G. like their psychiatrist counterparts. However. while the discussion of clergy involvement in mental health care is generally presented as one of voluntary engagement. particularly. forsaking more general aspects of their work which have been appropriated by medicine. if they could. While the former is unsatisfactory. This approach lends itself to the increasingly adopted concept that religion is an essentially personal and private matter. The ideal model of mental health partnerships between FBOs and psychiatry. Pattison suggests that the adoption of professional role has had a profound influence on pastoral care in the twentieth century. For example. While some denominations or sects such as the Scientologists remain antipathetic. p. 85). spiritually and individually orientated’’ (Pattison. the latter. 2000. however. First. For example. while some psychiatrists advocate an engagement with religion and spirituality. the evidence as to the capacity. ‘‘an important predisposing factor towards pastoral care which is psychologically. it should be pointed out that most of the debate takes place within psychiatry rather than between religion and psychiatry. In part. Weaver. However. many of which will not be easily accommodated. .
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