Berkley Center

As I was opening the fast on the twenty-seventh of Ramadan, the phone rings. I initially decided to ignore and focus on my prayers. But I instinctively reached out for the phone and was immediately grateful I did. It was one of the community liaisons from the Islamic center requesting advice on a case. A young male, 27 years old and from a very religious family, came to the imam, asking to pray on him because he feels a jinn (spirit) might possess him. He has spiritual and religious experiences where God is taking him to higher realms; he can see hell and heaven. This experience incites extreme fear in him as he worries about his sins that will end him in hell. This local imam is certified in mental health first aid. He prayed ruqyah (a particular verse of the Quran recited when jinn possession or the evil eye is suspected). During the prayers, the imam realized that this also could be a psychotic break down, and hence the young man was referred for further evaluation.

This case brings into sharp contrast the fact that there is a thin line between religiosity and mental illnesses. How hard it might be and yet how crucial it is to discern religious beliefs from religious delusions. It is essential to define whether religion is part of their healing or a source of their distress.

Religion and spirituality often play a vital role in healing for people belonging to or practicing a religion. In these communities, people experiencing mental health concerns often tend first to seek care from a faith leader. They depend on God for healing and may regard receiving psychiatric services as a weakness of their faith. They may also interpret their symptoms as a curse, as being punished for their sins, or as being forsaken by God. Religious delusions may be more prevalent and severe in these patient populations.

Those who have bipolar disorder when manic may feel grandiose and think "I am God." In schizophrenia or psychosis, they may deem auditory hallucinations as hearing God or feeling they are being given commands. They might perceive visual hallucinations as spiritual experiences.

Freud and some present-day psychologists like Albert Ellis deemed all religious beliefs as delusional. Today more psychiatrists are now open to studying the science of religion and its role in the resilience of an individual. The DSM-IV definition of delusion exempts religious doctrine from pathology altogether. In the DSM V, a new diagnosis is added, which can be applied when the focus of clinical attention is a religious or spiritual problem. Examples include distressing experiences that involve loss or questioning of faith, problems associated with conversion to a new religion, and when one is questioning their spiritual values that may not necessarily be related to an organized church or religious institution.

These efforts still fall short of fully encompassing the impact of religion and spirituality in one's mental well-being or illnesses.

Faith leaders and mental health providers can be natural allies, as both propagate the same wellness and well-being goals. Sometimes, ethical concerns are the most significant breach that is hard to navigate. Many religious institutions still take a hard stand on sexual orientation and same-sex marriage. This exclusion is seen as rejection and can exacerbate the mental health of the LGBTQ population, leading to high rates of substance abuse and suicide. Suicide and substance abuse can be seen as moral failures if underlying pathology is not understood or taken into account. We need to train more trauma-informed congregations, where the cognitive shift can happen from what is wrong with you to what wrong happened to you.

We are standing on the verge of the biggest mental health crisis in the aftermath of the COVID-19 pandemic. We are already facing a crumbling mental health infrastructure. Shortages of psychiatrists, hospitals, and limited treatment options leave many falling through the cracks. Religion and faith can fill those gaps and play a significant role in enhancing healing and resilience.

Faith leaders and mental health professionals must continue to collaborate closely. The roles have to be clearly delineated and fully respected. Mental health providers should be more open to faith-based mental health practices and integrate them into mental health care. The faith leaders need to be encouraged to train in mental health first aid training. They have to be mindful of mental illnesses and willing to refer to a mental health provider when needed.