In my reading about the “Spirituality in Healthcare” debates, I have started reading books from proponents. I’ve already read a number of articles on both sides of the issue, including more than a handful of articles published in peer reviewed journals covering claims of evidence, and also expert opinion pieces. But now it’s time to dig into the motives, ideas and points that are being made in the more in-depth way that books supply. To me, books are where authors speak in a personal voice about their honest, and to some degree, personal perspectives on these topics.
I have a number of books in my reading queue, but one proponent who comes up repeatedly—a juggernaut of research articles, books, and text books (for spirituality/religious courses now incorporated at the good majority of medical schools in the U.S.)—is Harold G. Koenig, M.D.
Koenig is no hack. He’s got the sheepskin to be able to take on healthcare as a topic. His background and credentials could never be labeled as sub-par. But the reason we offer “blind” studies, is precisely because we have to understand that even well intentioned, well educated people can, without realizing, be biased.
“Faith & Mental Health” is not intended for the lay public. In fact, in the beginning of the book, Koenig lays out precisely who this book is for:
This book is for mental health providers, public health service planners, researchers, university or medical school faculty involved in the training of mental health practitioners, and other health professionals who desire to understand better the role of religion as a resource (or liability) for those with emotional or metal problems.
I was encouraged by the parenthetical, but after reading more, I became less so. So far, liabilities have been mentioned, but not recognized. If they are ever recognized, I’ll share them here on the blog, but so far cataloged religious abuses and liabilities described in the book have been ignored or diminished, while innate human attributes—such as kindness, empathy, compassion and willingness to help others—seem to all be credited to religion (even though they are innate to humans, and seem to be demonstrated in other social species as well).
Just to supply a few examples for clarity, what follows are summaries of two stories Koenig presents, and how he interprets them:
Koenig tells a tale of a community in Gheel, Belgium in the 13th century. In his own words, the community, which took mentally ill people into their homes (he calls this the origin of foster family care) was motivated by “religion”—not by innate human qualities of compassion, humanity or love: “The motivation of the people here was again religious, an act of Christian charity.” He says they believed that “if we take care of these people and treat them as family members, we will be rewarded in the hereafter.”
There are a few issues here:
First of all, Koenig suggests the reason they helped was to gain a reward. But we have no way to know if, without the religious bribe, they would have still helped out of core human attributes, such as love, compassion and concern for community. What if we could go back in time and take the promise of heaven away—and they were still willing to help? I have often helped people who needed it—with no expectation of a reward. If I were a practicing Christian, is there any reason to think I wouldn’t still help because I’m simply a human being endowed with those motivations? Is the fact that the church expresses an offer of heaven, and I believe it’s real, honestly evidence that this is what is motivating me to behave decently? Since many people do behave decently without religion, I am not prepared to agree that it is the religious bribe making Christians decent human beings. I suggest they may actually be decent humans—religious affiliation or not. I see no logical justification for assuming religion as the motive, rather than being a basic, decent human being. In fact, in Koenig’s next story, we see a tale of many, many Christians, with that same promise of reward, refusing to help someone in need. It appears some Christians help others, and some do not. This seems very similar to how people who aren’t religious also behave—some are helpful, some are not. The reward of heaven, then, appears to not make much difference in the end to how people behave, at least in these examples.
Please also notice that Koenig notes the promise of reward—but what is glaringly missing is the threat of punishment and hell that the religion also imposed upon those who did not comply with church dogma. If we are going to use religious doctrine as motive, and list the incentive of heaven, can we then dismiss the threat of being tortured in the never-ending torment of hell?
In Koenig’s telling of this tale, a martyr was said to have been killed nearby, and a shrine to this martyr/saint (Dymphna) was thought to have magical healing powers. As a result, people began taking their mentally ill friends and relatives to the shrine for healing. And he describes this, “The local hospital was soon overflowing with chronic sufferers who were often left there, sometimes chained to trees near the shrine.”
So, here I absolutely see religious motivation at work, but nowhere does Koenig condemn this or call it a religiously inspired “liability.” Mentally ill people, chained to trees, and abandoned by their caregivers in a strange location—because the church spun a yarn that it was a magic place. This is fully upon religion.
But somehow, religion isn’t blamed, but is credited with the reality that people in the town had to figure out what to do with a flood of people being brought to their community and, literally, left to die, and so did the only human thing: They helped them. I very much hope that the majority of humans don’t need to be told to help someone they find tied to a tree and left to die. But I’m sure they do need to be convinced that a particular location has magical properties before they would think to abandon loved ones in such a vulnerable, dangerous, and precarious situation.
The next tale that stunned me was Koenig’s own experience—right out of his own case files. He describes a patient he calls “Sally,” who is mentally ill and very religious. She contacted Koenig to ask if he could find some community/social support options for her, and he asked why she wasn’t using her church connections—which is a logical question when a patient is very religious. It turned out her minister had met with her a few times, but he seemed to not have enough time for her, and she needed to find more available resources. Her congregation was about 1,000 members strong, but she wasn’t able to find anyone willing to meet with her twice a week to just be a friend (although they seemed to have abundant time to devote to the youth, they had less time for the elderly and ill.)
Koenig began making calls to find support that matched her leanings. He says, “I thought it would be a snap to locate someone to help her, someone eager to minister to this poor soul who was a committed Christian.” He describes the months that went by as religious person after religious person either ignored his requests or passed him off to yet another religious person or religious resource that put him off. He even tried outreach to groups outside the state, he was so discouraged. Again, he says “Here I was, a well-known and respected psychiatrist with many, many contacts in the Christian community. If I was having this much trouble, I couldn’t imagine how difficult it would be for Sally to find support on her own.” Finally one older woman, from a local church (remember the outreach was all inside the religious community, so whoever ultimately was found to help was going to be religiously affiliated) offered to befriend and support Sally. The volunteer wasn’t a pastor, religious counselor or leader—just a person who attended one of the churches he’d contacted. She was the person who finally stepped up to show basic, human compassion.
When Koenig asked others about this situation, he found a number of issues that impeded finding help for Sally, including that “some judge the person with emotional or mental problems, blaming them for their condition. Many people are just plain scared of making contact with a person who has severe and persistent mental problems, afraid of the unpredictability of entering into such a relationship.” To be fair, this sort of trepidation to befriend a person you don’t know who has mental health issues, isn’t something limited to churches—although blaming people for their ills is key to Christianity (if not for The Fall, mental illness would not even exist, and this is before we get into the more direct blaming concepts found in the Old Testament and modern prosperity gospel).
This dismal fail to assist Sally is a tale offered in a set of several stories, about which Koenig, in his Summary, says, “these cases illustrate how individual persons and communities of faith can help those with emotional and mental problems bear their burdens, which is a major focus of this book.” [Emphasis mine.]
It makes me wonder if Koenig and I are reading the same stories. What I took away was that people can be easily convinced to abandon their loved ones to die by religion’s spurious claims—and without common human decency from those left to clean up that mess, they’d be perpetrators of negligent homicide, directly inspired by religious miracle claims. And when a person with mental illness needs help, the church leadership is suddenly unavailable, and one has to canvas congregations for miles to finally find the single decent human being willing to extend herself to just meet with someone twice a week. And, remember, this is with a promise of heaven and threat of hell.
According to Koenig, these are among the stories of “help” the faith community can offer.
But most disturbing of all, so far in the reading, was a passage where Koenig considers how mental illness may be god’s way of teaching us how to love. He is careful to not mention “god” directly, but a careful reading reveals he’s not saying simply that we can learn about love and compassion by helping others. He’s saying that is actually why people suffer. To be fair, he’s “asking.” But it’s in a clearly “JAQing Off” mode. They are statements posing as questions. So, for example, when he asks “Many see it as a cruel stroke of fate. Or is it?” He is rather asserting that something like mental illness is not simply something that occurs in the lives of some and not others, but that it is actually orchestrated in some way for a purpose.
The passage from Koenig, below, reminds me of a conversation I had with a woman who told me about her extreme sexual abuse suffered for many years as a child. She has a religious relative who told her that she is such a wonderful person today—and suggested that the abuse was for the best—as it resulted in inputs that have made the woman that wonderful person. It was god’s intent to use the abuse to help her become the person she is today. The woman wrote to me to say she had worked hard to overcome the trauma, and that she is proud of the person she is today—and that who she is, is rooted in all of her past, like everyone else. But she didn’t quite know what to tell this relative in response, because the comment was so horrifying to her, and she didn’t quite know how to express it or how to identify the problem that was nagging at her.
I offered, “Perhaps next time she tells you that your extreme sexual abuse was all for the best, and intended to help you become a wonderful person, you should reply by saying ‘Oh, I agree. I think we should ensure that all children are aggressively sexually abused for that very reason.’” The fact that someone was able to work through pain and trauma, and become a functional, and maybe even happy, human being, is a credit to what that person was able to accomplish, but not to the abuse. What of people who die by suicide after being sexually abused? Or are killed by their abusers? How did it help them improve their lives? But ultimately if sexual abuse helps people become better people, then we should rethink our laws against sexual abuse, and perhaps begin a promotional campaign? Please understand that sexual abuse does not help people. The fact is, she is a wonderful person in spite of that abuse, not because of it. And it’s thoughtless to suggest that a person should view being horribly violated and assaulted as some sort of blessing in disguise or silver lining. And with that, I bring you the passage that I found most shocking:
By emotional problems I mean short- or long-term struggles with depression, anxiety, or other difficulties with mood or happiness. By mental illness I mean schizophrenia, bipolar disorder, and other long-term psychoses or severer personality disorders. Emotional problems and mental illness trap people in prisons of fear, despair, confusion, and loneliness…Those afflicted with these conditions did not choose them…more likely it is their genes, childhood experiences, or severe adult trauma that have thrust them onto these precarious, painful paths. Many see it as a cruel stroke of fate. Or is it?
What if having such a life meant something else, something not completely senseless but rather was evidence for—and I say this a bit cautiously—a type of unique “calling”? Is it possible that those with mental illness provide others with the opportunity to care, to love, to reach out to them, an opportunity that otherwise would not exist? What if their pain caused people of faith to sacrifice their comfort and smug way of life to reach out and minister to them? Who, then, would really be the receiver of ministry and who would be the giver? Could those struggling with mental illness serve as beacon lights illuminating the “narrow” way to real life that few ever find? Could they be pointing the way for people of faith and others to follow, so that the care, love and service provided to the mentally ill by them would demonstrate to the world the best of what it is to be human? Would that be possible without the help of those with mental illness, without their pain? Does this mean that religious congregations need persons with mental illness in their midst in order to be fully functional, caring communities? It’s worth thinking about.
Might such a calling for those in mental distress require the experience of suffering and pain in order to give these “wounded healers” the insight and compassion necessary to truly help others with similar afflictions, a special kind of training that prepares them to really know, to really understand what others are going through? For those who must live day in and day out with the demon of despair, who must bear the heavy burden of mental anguish despite the best treatments that modern medicine can offer, this “calling” is indeed a tough one.
I suggest that if mental illness is such a boon to our society, perhaps we should stop trying to cure it—as that is antithesis to society’s best interests. As Koenig says (by way of “JAQ”), “Could they be pointing the way for people of faith and others to follow, so that the care, love and service provided to the mentally ill by them would demonstrate to the world the best of what it is to be human? Would that be possible without the help of those with mental illness, without their pain?” He literally says that “the best of what it is to be human” may not even be possible without other people suffering with mental illness. Why would we want to lose that? Followed to the logical conclusion, we’d stop trying to cure the mentally ill immediately. In trying to cure these people, we are operating against humanity’s best interests, if we adopt Koenig’s explanation.
Koenig and I agree about one thing—however, we likely have different reasons. When Koening “asks,” “Does this mean that religious congregations need persons with mental illness in their midst in order to be fully functional, caring communities? It’s worth thinking about,” I fully agree this is worth thinking about. I think about it quite a lot, in fact. It’s not uncommon for the church to actually work against family and social interest in order to propagate harm that they then use as evidence of a fallen world—or as Koenig unwittingly notes, justification for their existence. Simply put: They need suffering, and this bias often conflicts with truly robust efforts to end it.
The most obvious example of their inability to see their counterproductive efforts is when they denounce abortion, while simultaneously opposing accurate and thorough sex education, access to birth control, and even arguing against condom use. Not only is the only solution they will accept abstinence, but they fight viciously against any attempts to implement solutions that would allow anyone to operate successfully outside of their religious teachings—teachings which, coincidentally, create suffering by compounding the problem of unplanned pregnancies—a problem they then use as the springboard to justify a need for people to do things god’s way, because if we practiced abstinence, we wouldn’t have this problem they have greatly inflamed. And it doesn’t matter to them that “abstinence” has proven a dismal failure throughout all of human history. All that does matter is that they need people who do not comply with their religion to suffer for it—because they need this suffering, as Koenig notes, “to be fully functional, caring communities.” In fact, it allows them to appear to be caring—while propagating immense social harm. I would add, in fairness, religious people are generally just like everyone else in that they most often desire to do the right thing. But their innate humanity and their biased need to protect, promote, and create justifications for their religion are far too often at cross purposes. Another well documented and overt catalog of this type of pervasive harm coming out of a misguided religious impulse to “help,” can be found in Hitchens’ analysis of the work of Mother Teresa.
I don’t expect the lay Christian to see the contradiction, any more than I expect Koening to understand how he sounds to someone who doesn’t listen with the same religious bias.