On Spiritual Illness

In the synaxarion* of the saints of Western Medicine, no name is more luminous than Hippocrates. It was he who came down from Mount Olympus with stone tablets bearing the message that the Gods had changed their minds. In more terrestrial terms, Hippocrates challenged one of the most unassailable beliefs of his age. It had been universally believed in ancient times that when an individual becomes insane, it has been induced by the gods. In other words, mental illness is essentially a spiritual problem. But Hippocrates knew the truth: mental illnesses are diseases of the brain.

The story of Hercules illustrates the contemporary view. We remember him from his heroic exploits, in particular the Twelve Labors: cleaning the Augean stables, Cerberus, the Hydra and so on; these were undertaken to atone for the murder of his wife Megara and his three children. Hercules slew his wife and children after he was made to go mad by his stepmother Hera, a goddess.

That insanity derives from divine will is not unique to the Hellenistic tradition. The story of King Saul from the Old Testament is similar; when Saul becomes paranoid we learn that it is because God has sent an "evil spirit" into him. In the New Testament (Matthew 17:14-21, Mark 9:14-29, and Luke 9:37-42), Jesus heals epilepsy by casting out a demon.

Centuries before the birth of Christ, Hippocrates makes his startling revelation. In his essay "On the Sacred (Spiritual) Disease," he says "It is thus with regard to the disease called Sacred: it appears to me to be nowise more divine nor more sacred than other diseases, but has a natural cause which originates like other affections. Men regard its nature and cause as divine from ignorance and wonder, because it is not at all like to other diseases." He goes on to say that "Men ought to know that from nothing else but the brain come joys, delights, laughter and sports, and sorrows, griefs, despondency, and lamentations. And by this, in an especial manner, we acquire wisdom and knowledge, and see and hear, and know what are foul and what are fair, what are bad and what are good, what are sweet, and what unsavory; some we discriminate by habit, and some we perceive by their utility. By this we distinguish objects of relish and disrelish, according to the seasons; and the same things do not always please us. And by the same organ we become mad and delirious, and fears and terrors assail us, some by night, and some by day, and dreams and untimely wanderings, and cares that are not suitable, and ignorance of present circumstances, desuetude, and unskilfulness. All these things we endure from the brain, when it is not healthy." Hippocrates described six brain diseases: Melancholia, Mania, Phrenitus, Epilepsy, Scythian Disease and Hysteria.

It is not surprising that in ages without medical and scientific knowledge, individuals would attribute mental disturbances to spiritual forces. They had no knowledge of neurons, synapses, action potentials, dopamine, norepinephrine, serotonin and so on. It is far more suprising that Hippocrates was able to detect the truth without the tools we have in the 21st Century, but then, that's what makes him the Father of Western Medicine. We discern in his writings that he must have been one of the greatest observational minds through all the generations of human kind.

What is more suprising still is that in spite of the wisdom of Hippocrates and Avicenna and many others since, and despite the great volume of science in the 20th and 21st centuries, confusion between what is spiritual illness and what is mental illness remains pervasive.

Several years ago I led a Bible study and fellowship group for Orthodox Christians at a college in Charleston SC. There were many such groups for different faiths and denominations and they were all coordinated by the executive chaplain of the college, a military man and evangelical Christian minister. When he learned I am a psychiatrist, he thrust his chest out and professed the belief that "all mental illnesses are basically spiritual." Now when ignorance gushes from the mouth of a man in Klan robes or a clown suit, we wish for a better world. But when the source is an intelligent person we are in a precarious situation. Unfortunately, it is not an uncommon thing.

The chaplain believes, as do many others, that phenomena such as depression are the result of a spiritual defect, and that if the patient accepts Christ as his or her personal savior, the improvement will be superior to the benefit derived from antidepressants or psychotherapy. To be fair, I agree that individuals with a robust spiritual life tend to suffer less frequently from milder psychological disorders and substance use disorders, and I have seen scientific evidence to that effect. After all, one of the major functions of religion is to effect resiliency and transendence. But let us undertake a thought experiment to carry forth some of the assumptions that mental and spiritual disorders are really of one substance, so to speak.

God, according to the chaplain, is a specialist in medical terms. He has the power to halt and reverse psychiatric disorders, but he has much greater difficulty healing general medical conditions, such as diabetes. In my experience people who attribute psychiatric disorders to spiritual defects, or sinfulness, have without exception this same dyssynchronous view that God has an easy time healing mental conditions but he has limited power over "medical" illnesses. These individuals believe that psychiatric disorders are rare or nonexistent among those who share their "true" version of the faith, but they do not view heart disease or cancer among their parishioners as having the same implications.

I disagree with these believers in two ways. First, I believe that God has just as much ability to heal general medical illness as he does psychiatric illness. The modest but unmistakeable impact of religion on psychiatric health can also be seen in some of the scientific data on general medical health. I remember one study in particular that statistically linked longevity to regular church attendance, for example.

Second, mental illnesses do not conform as well as certain general medical illnesses to the notion of having a spiritual dimension. Christian tradition holds that there are "Seven Deadly Sins," and however many serious sins you think there are, most Christians will agree that these seven are important: Lust, Envy, Sloth, Gluttony, Pride, Avarice and Greed. It is rather difficulty to draw a direct line between any of these and anxiety of depression. Adult-onset diabetes, by far the most common type of diabetes, is essentially a product of too little exercise and excessive caloric intake. In other words, it is the result of gluttony and sloth, despite the fact that we tend to view it as a genetic error of some kind. In fact, most of what we treat in the primary care setting is related to various manifestations of gluttony and sloth: obesity, hypertension, hyperlipidemia, heart disease, and many others. Even the most common cancers, such as colon cancer, breast cancer and prostate cancer are related to overweight. Truly, gluttony and sloth are deadly.

But the frontier between mental illness and moral illness cannot be sufficiently clarified by unmasking certain glitches in the cognitive software of Evangelical Christians. For in the ivory tower of academia, an equally perfidious line of code smudges the line between moral illness and mental illness, and it is the mentally ill who are victimized.

Academics are almost all non-believers. They view religion as a waste of time at best, at worst a dangerous delusion and like cigarette smoking, an important cause of preventable suffering. They view Good and Evil as superstitious attributions created to explain complex social and psychological phenomena. There is no Evil in their cosmos, only mental derangement or bad social policy. This view is just about as widespread in public imagination as the Evangelical one I have just refuted.

The notion that mental illness and evil behavior are one phenomenon is wrong, for I have worked with seriously mentally ill individuals for twenty years, and I have not found them more evil or dangerous than people who do not have mental illnesses. An exception is mentally ill patients who abuse alcohol and/or drugs, but interestingly, individuals without mental illnesses who abuse alcohol and/or drugs also have tendencies toward violence and problematic behavior. And yet, mental hospitals are closed and the patients are left to fend for themselves in the streets, and there does not seem to be any compassion for them in our culture. The only way to explain the lack of feeling for the mentally ill is that Americans must have accepted the notion that they are evil and therefore not worthy of our help. Certainly in film and television the mentally ill are almost without exception portrayed as murders and rapists, a misconception that has been imprinted on the American mind.

Take the case of Anthony Capozzi. He was convicted of rapes and murders he did not commit and he spent 22 years in prison. The evidence against him could not have been substantial, for he did not rape or kill anyone. He was, however, guilty of schizophrenia, he is insane, and therefore he is almost certainly capable of violent crimes. The jury and the three victims who wrongly identified him as their assailant were programmed by cinema and television and print media to believe that an individual who is mentally ill is also evil. Like university professors and religious bigots, Scientologists also have called mentally ill individuals "unethical" and "immoral;" with Scientology's influence in Hollywood, what chance does a patient with schizophrenia have in American society? Precious little.

It is ironic that in our hypersensitive era where we police our thoughts and actions to avoid being perceived as without feeling for our fellow man, we have no empathy for the most devastated among us. How revolting the image of politicians struggling to produce tears for the television cameras as they profess their capacity to feel our pain, spending incalculable sums on football stadiums while schizophrenics have nowhere to sleep. The first victims of the Holocaust were not Jews or Gypsies or homosexuals; they were the mentally ill. They have no monument to remember them, for we have not yet decided whether anything of value was lost.

*Synaxarion is Greek for "Book of the Worthy." It is a collection of biographies of the Saints of the Orthodox Church.

Copyright 2009 Robert Albanese