NAT
H. SANDLER
Attitudes of Ministers toward Psychiatry OFTEN the first person to be consulted about a mental disturbance or psychological problem is the minister? People troubled most often turn to their minister as the logical source of help. Excessive religiosity frequently accompanies emotional disturbances. 2 According to the Gallup poll, about 46 per cent of the adult population went to church in a typical week in i9627 It is this group that usually turns to the minister for counsel? A study by the National Institute of Mental Health showed that 40 per cent of the people first sought out their pastor for help with a personal problem? How, then, do the ministers feel about psychiatry? H o w do they handle problems that come to them? What is their training in this field? H o w do their attitudes toward psychiatry vary from one denomination to another or from the older ministers to the more recently ordained ones? Many articles have been written concerning the similarity or difference between psychiatry and religion? Studies have been conducted to determine how ministers can better counsel the members of their congregations in psychological matters/Little has been done, however, to assess the ministers' attitudes toward and training in such counseling? This is the area we studied in seeking answers to the questions above. Our locale was the city of Memphis, Tenn.
This paper, presented at a meeting of the Michigan Association of Neuropsychiatric Hospital and Clinic Physicians, Pontiac, Mich., October 3o, i964, reports Dr. Sandler's study conducted at and under the auspices of the Brain Research Institute, Department of Psychiatry, University of Tennessee Medical Units, and the Tennessee State Department of Mental Health. The study was supported in part by a Public Health Grant from the National Institute of Mental Health.
Attitudes o~Ministers to'wardPsychiatry
47
FIGURE I THE UNIVERSITY OF TENNESSEE DEPARTMENT OF PSYCHIATRY MINISTER'S SURVEY
Denomination Year Ordained I. A member of your congregation comes to you and says she feels her husband is in need of help. He recently changed jobs. She feels he is starting to drink to excess. The wife later brings the husband in to see you. You talk to this man but he denies that he has a problem. I. I feel this is primarily a: 2. I would probably: a. religious problem a. counsel them myself b. psychological problem b. refer to a psychiatrist c. social c. refer to Family Service d. legal d. refer to Alcoholics Anonymous e. do nothing in view of the huse. band's denial of need for any help f. refer to Calvary Colony, Harbor House or similar center g.
II.
M y knowledge of counseling came from training received in: a. undergraduate school b. seminary c. postgraduate courses d. read on own time (self-study) because of interest e. special seminars set up by mental health groups, universl W, church f. no special training g.
III. Number in the order in which you see the following problems: a. drinking f. childhood b. marital problems difficulties in school e. failure to keep job juvenile delinquency d. sexual m a l a d j u s t m e n t _ _ g. mental retardation e. lack of faith h. obvious mental disease i.
IV. W h a t problems do you feel you can handle yourself? V.
W h a t type of problems do you feel you need to refer to a psychiatrist?
VI. W h a t do you consider the desirable relationship between psychiatry and the ministry?
Method Our study was conducted by means of the questionnaire shown as Figure i. It had been compiled after interviews with ministers, psychiatrists, psychologists, and social workers. It was mailed to 604 ministers whose names came from the telephone directory, city directory, and lists 48
Journal of Religion and Health
made up by the church bodies. Over 95 per cent of the ministers of Memphis were addressed. N o follow-up was made on any questionnaire sent out. A letter explaining the purpose of the study and an addressed stamped envelope for return of the questionnaire were enclosed. Recipients were asked to mark as many answers as they considered applicable. No identification was required on the returned questionnaire. The only identity asked for was denomination and year of ordination. In the letter, we offered to send those interested a copy of the results on request.
FIGURE 2 RESULTS N u m b e r of questionnaires distributed .................................... N u m b e r of questionnaires returned ...................................... Total per cent returned ................................................
Denomination
Number sent out
Jewish A.M.E. Presbyterian Lutheran Episcopal Church of Christ Christian C.M.E. Catholic Methodist Baptist Assembly of God Greek Orthodox Church of God of Prophecy Unitarian Unity Church of God Seventh Day Adventist Nazarene Church of God in Christ Congregational Christian Missionary Alliance Pentecostal Pentecostal Holiness Reorganized Latter Day Saints Non-denominational Spiritualist Independent
232 38 .6
Per cent returned
9 7 37 13 18 24 II 8 3o 98
77 71 7o 61 6I 58 54 50 46 37
292
3I
6 2 2 2 2 2 3 4 4 2 2 5 3 3 5 3 3
600
17 I00 I00 Ioo IOO 50 33 25 o o o o o o o o o
Attitudes o~ Ministers tovmrd Psychiatry
49
Results The greatest number of responses from groups to which more than five questionnaires were sent came from the Jewish clergy (77 per cent). Presbyterian ministers also furnished a high response (7 ~ per cent), as did the A.M.E., with 71 per cent. No group to which we sent more than five questionnaires failed to respond. The zero responses seem to have come from the more fundamentalist sects, such as the Pentecostal. Very few returned questionnaires were hostile. Only one respondent thought that psychiatry was useless. Two questioned the validity of our study. Interestingly, the group that showed the best response to our questionnaire had also shown most interest when we conducted our personal interviews in setting up the study. The clergymen were asked to mark what they felt was the nature of the problem outlined in the first question. FIGURE 3 COMPARISON BY PERCENTAGE OF HOW" MINISTERS OF DIFFERENT DENOMINATIONS LOOKED AT PROBLEM
Psychological Total % Jewish
A.M.E. Presbyterian Lutheran Episcopal Church of Christ Christian C.M.E. Catholic Methodist Baptist Assembly of God
67.3 (7) 60 (3) 60 (20) 72 (6) 72 (8) 78 (IO) IOO (6) 75 (3) 78 (II) 56 (32) 49 (45) IOO (I) IOO
Religious
Social
44.6 14
(I)
40 (2) 33 (II) 60 (5) 54 (6) 42 (6) 33 (2) 50 (2) 50 (7) 42 (2o) 55 (50) o
I2.5 O
20 27 (9) 24 (2) 9 (I) 14 (2) o :25 (I) o 16 (4) 16 (15) o
Legal I. o O
20 (1) o o o o o O o o o o
(Number in parentheses is actual number that gave response) Most marked more than one.
As shown by Figure 3, "psychological" was given as the kind of problem by the largest number of ministers (67. 3 per cent). In the Baptist group, however, "religious" was the most frequent response (55 per cent). Only 49 per cent of the Baptist ministers marked "psychological." In the Catholic group, there was a variation in the response of the younger (ordained after i945) and the older priests (ordained So
Journalof Religion and Health
before I945). Six of the seven ordained before I945 marked this problem as having a religious origin, whereas only one of the seven ordained after 1945 so marked it. In the Church of Christ group, a similar picture was seen. All of the pre-i945 group considered the problem religious, but only two of the eight in the post-i945 group so regarded it. As to psychological basis, i oo per cent of the post-i945 group marked this response, whereas only 5~ per cent of the pre-I945 group marked "psychological." In the Lutheran group, a similar situation was noted. All post-i945 ministers marked "psychological," but only 50 per cent of pre-i945 marked it. MI groups, with the exception of the Baptist, followed the total group pattern. With the exceptions noted, there were no other marked variations between younger and older groups. FIGURE 4 HOW MINISTERS WOULD HANDLE PROBLEM BY PERCENTAGE
Counsel themselves Total Jewish A.M.E. Presbyterian Lutheran Episcopal Church of Christ Christian Catholic Methodist Baptist Assembly of God C.M.E.
73.6 o 80 (4) 60 (20) IOO (8) 72 (8) 78 50 78 58 87
(II) (3) (II) (29) (78)
IOO (I) 75 (3)
Refer to a psychiatrist
Do nothing
Alcoholics Anonymous
Church Mission Farm
Family Service
26.4 56 (4) 40 (2) 18 (6) o 36 (4)
14.7 14 (I) o 6 (2) o o
I1.2 14 (I) o 12 (4) o 36 (4)
5.5 o o 3 (I) o o
4.6 28 (2) o 9 (3) o 18 (2)
28 33 42 16 21
79 33 7 IO 6
7 (I) o 28 (4) IO (5) 7 (7)
o o O o 2 (I)
o 16 (I) O 6 (3) 12 ( I I )
(3) (2) (6) (7) (20)
o 25 (I)
o o
(I) (2)
(I) (5) (6)
o o
o o
o o
(Number in parentheses is actual number that gave response)
The next question concerned the handling of this problem. Most would attempt to do the counseling themselves (73.6 per cent). Many also indicated that they would refer to a psychiatrist (26. 4 per cent). Even those who did not mark this often commented that they would refer to a psychiatrist, if, after two or three sessions, they were making no progress. But by far the majority would just try to handle the problem themselves.
Attitudes of Ministers tov2ard Psychiatry
51
Among the Baptists, 16 per cent ordained before I945 would utilize Family Service, a social agency, as one of their primary approaches. Only 7.3 per cent of those ordained later would consider this a primary approach. In the Episcopal group, there were slight variations from the total group response. As many as 36 per cent would use Alcoholics Anonymous as a referral. The same number would use a psychiatrist. Sixty-six per cent of the older group considered a psychiatrist in the referral, yet only 25 per cent of the younger group would consider a psychiatrist as the first approach. Among Jews, 28 per cent marked Family Service as their first approach. This is much higher than the response of the total group (4.6 per cent). It was the second most frequent response among the Jewish group. The most frequent response of this group was "refer to a psychiatrist" (56 per cent). This was the only group that listed this as their most frequent choice. All other groups followed the pattern of the total group With little significant difference as to response of the earlier-ordained and later-ordained ministers.
FIGURE 5 TRAINING IN COUNSELING BY MINISTERS OF DIFFERENT DENOMINATIONS BY PERCENTAGE
Selfstudy
UnderPostSeminary Seminars graduate graduate
Total 57.4 56.0 40.8 25.7 Jewish 28 (2) 28 (2) 42 (3) 28 (2) A.M.E. IOO (5) 6o (3) 40 (2) o Presbyterian 54 (18) 60 (20) 51 (17) 24 (8) Lutheran 48 (4) 84 (7) 36 (3) 12 (I) Episcopal 54 (6) 63 (7) 63 (7) 9 (I) Church of Christ 42 (6) 50 (7) 28 (4) 5~ (7) Christian 83 (5) IOO (6) 16 (I) 66 (4) Catholic 92 (13) 92 (13) 42 (6) 7 (I) Methodist 58 (29) 47 (21) 24 (12) 24 (12) Baptist 50 (46) 53 (49) 38 (35) 27 (25) Assembly of God o o IOO (I) o C.M.E. 50 (2) o 75 (3) o (Number in parentheses is actual number that gave response)
52
Journal of Religion and Health
21. I
28 (2) o 36 (I2) 12 (I) 27 (3) 46 33 21 18 8 o o
(6) (2) (3) (9) (8)
Experience (added)
lO.8 o o 3 (i) 12
(1)
9 (I) o o 21 (3) 6 (3) 16 (15) o o
No
training 3.3 14 20
(i) (1)
3 (1) i2
(i)
o o o o 4 (2) 6 (6)
o o
FIGURE 6 COMPARISON OF TRAINING OF PRE-I945 AND POST-I945 MINISTERS BY PERCENTAGE -Pre-I945
Self-study 66.2 Seminary 49.I Seminars 37.7 Postgraduate 2o.2 Undergraduate I6.7 Experience 23.7 No Training 7.9 (Number in parentheses is actual number)
(75) (56) (43) (23) (I9) (27) (9)
-Post-~945
57.o 73.7 43.9 2I 1 36.8 7.0 2.6
(65) (84) (5 o) (25) (42) (8) (3)
The next part of the study concerned the training in counseling the ministers had received. "Self-study" was the most frequent response (57.4 per cent). "Seminary" was marked on 56 per cent of the questionnaires. There did not appear to be any marked differences as to denominations. The differences seemed to be between the pre-i945 group and the post-i945 group within a denomination. Among the Baptist group, 7 z per cent of the pre-i945 group put "self-study," but only 4 z per cent of the post-1945 group listed this choice. W h e n responses were compared as to pre-i945 and post-I945 groups, 66.2 per cent of the prei945 group listed "self-study" and 57.o per cent of the post-i945 group listed it. On "special seminars," among Baptist ministers, 27. 9 per cent of the pre-i945 group listed this response, but 65.7 per cent of the post1945 listed it. This same difference was seen in total comparisons, where 37.7 per cent of the pre-i945 group listed "seminars" and 43.9 per cent of the post-i945 group listed them. A choice added by many was "experience." Twenty-three per cent of the older Baptist group added this, but only i4.2 per cent of the newer groups did. On the total comparison, 23.7 per cent of the older group had added it, but only 7.o per cent of the younger group had. "Undergraduate training" was listed as a source of training by 36.8 per cent of the younger ministers, but by 16.7 per cent of the older ones. The difference was even greater among the Baptists. "Undergraduate school" was marked by I3.9 per cent of the pre-i945 group, but 54.2 per cent of the post-1945 group marked this choice. Six per cent of the pre-i945 group among the Baptists marked "no training." None of the post-1945 Baptist group had this choice. In comparing the total pre-
Attitudes of Ministers to'ward Psychiatry
53
x945 group and post-i945 group, 7-9 per cent of the pre-i945 group listed "no training," but only z.6 per cent of the post-i 945 group did. The highest discrepancy between age groups was seen in the Methodist response to "seminary" as a source of training. The pre-i945 group marked "seminary" on 28. 5 per cent of their returns, but 93.7 per cent of younger ministers marked this choice. In the Methodist group, a variation from most other groups was seen in the "seminar" response, 50 per cent of the younger group marked "seminar" as source of learning, but 78.5 per cent of the older group marked it. The Jewish group listed "seminars" as their most frequent source of training (4 z per cent). "Seminary" and "self-study" were listed on z8 per cent of their questionnaires. This was the most frequent choice of all groups. In the next part of the questionnaire, the ministers were asked to number the order in which they saw the various problems. It was interesting to see how many ministers left this question blank. Approximately io per cent did not list a maior problem, and 35 per cent did not list a rare problem. This problem called for more than just circling an answer, and the response was somewhat smaller. The minister had to write in a number, ranking the various problems on the basis of the frequency with which he encounters them in the counseling situation. FIGURE 7 RANKING OF PROBLEMS IN ORDER SEEN BY MINISTERS
I. 2. 3. 4. 5.
Marital problems Drinking Lack of faith Sexual maladjustment Failure to keep job
6. Juvenile delinquency 7- Childhood problems 8. Obvious mental disease 9. Difficulties in school IO. Mental retardation
The most common problems brought to ministers were "marital." "Drinking" and "lack of faith" were also common. "Mental retardation" was the least common problem. "Obvious mental disease" and "difficulties in school" were also rarely dealt with. The Catholic group saw "drinking" the most often (4 z per cent). The Episcopal ministers noted "marital problems" and "lack of faith" with equal incidence (27 per cent). The Christian group listed "marital" on 66 per cent of their returns as the number one problem. A low-ranked problem that was
54
Journalof Religion and Health
very high in Jewish returns was "obvious mental disease." It was ranked number one on 4 z per cent of the Jewish returns. Among the Baptists, it was interesting to note that 36 per cent of the pre-I945 group hsted "drinking" as number one. Only i7.2 per cent of the post-x 945 group listed "drinking" this high. "Lack of faith" was ranked higher by the newer ministers of the Baptist faith than by the older ordained ones. In the Church of Christ group, "drinking" was rated number one by 5~ per cent of the earlier ordained ministers, but only 25 per cent of the post-i945 group put it this high. Most denominations followed the total picture except for the differences noted. The next response asked the ministers to write in the problems that need to be referred to a psychiatrist. There were no choices. The person responding to the survey had to fill in his own response. FIGURE 8 PERCENTAGE OF REPLIES THAT LISTED PROBLEMS TO BE REFERRED TO A PSYCHIATRIST Total
Pre-I 945
Post-I 945
Obvious mental disease
50.9%
34.2%
(39)
69.3%
Sexual problems
I2.9%
22.4%
(26)
I2.3%
(I4)
I5.3% I6.2% 18.o% 13.2% 11.2% 4.4% 5.4% -9%
(I7) (I8) (20) (15) (13) (5) (6) (I)
II.7% 9.9% 5.4% 6.1% 2.7% .90-/o .9% 1.8%
(I3) (II) (6) (7) (3) (I) (I) (2)
Drinking I2.9% Mental retardation I2.5% Marital problems 11.2% Childhood problems 9-5% Job failure 7.3% Juvenile delinquency 2.6% School problems 3.0% All 1.3% (Number in parentheses is actual number)
(79)
The most commonly referred problem by a large percentage was "obvious mental disease" (5o.9 per cent). It was listed on 34.z per cent of the pre-~945 returns and 69. 3 per cent of the post-I945 returns. Except for the response of "all problems," it was the only response marked by more post-I945 ministers than by pre-i945 ones as a problem to refer to a psychiatrist. In the next part of the questionnaire, the ministers were asked: "What type of problems do you feel you can handle yourself?" Here again the respondent had to write out his answers. There were no choices to mark.
Attitudes of Ministers toward Psychiatry
55
FIGURE 9 P E R C E N T A G E OF REPLIES THAT LISTED PROBLEMS TO BE H A N D L E D BY MINISTERS
Problems
or faith Total
59.9
Denomination Jewish A.M.E.
Presbyterian Lutheran Episcopal Church of Christ Christian C.M.E.
Catholic Methodist Baptist Assembly of God
Marital problems Drinking
School
di~culties
12.4
I I .4
IO.O
9.7
8.6
o 4o (2) 18 (6) I2 (I) o
o 2o (I) 9 (3) 12 (I) o
o o 3 (I) I2 (I) 9 (I)
14 (I) o 9 (3) I2 (I) o
o o 3 (I) O o
O o o 21 (3) 6 (3) IO (IO)
O 16 (I) 25 (I) o o 3 (3)
O o o 21 (3) o 4 (4)
O o 50 (2) o o I (I)
(3) (4) (6) (4)
56 (4) 6o (3) 2I (7) 60 (5) 27 (3)
7 33 5o 64 46 61
(I) (2) (2) (9) (23) (56)
7 33 5o 42 26 29
o
Sexual problems
33.3
42 8o 33 72 36
(II)
Job Failure
Childhood diffzculties
o
(I) (2) (2) (6) (13) (27)
o
o
7 o o 7 6 7 o
(I)
(I) (3) (7)
o
o
(Number in parentheses is actual number that gave response)
In Figure 9, we listed percentage of respondents who wrote in the various responses. T w o said that ministers could handle all problems, and two said that ministers could not handle any. "Lack of faith" was the most frequent response. It was listed on 59.9 per cent of the questionnaires returned as being a problem that most ministers could handle. In contrast, "school difficulties" were listed on only 8.6 per cent of the returns. This question seemed to be responded to better by the younger ministers. With the exception of the Catholic group, it was answered by more of the post-I945 ordained ministers. Most groups followed the same response as the total group. Our final question asked the ministers to state what they felt was the desirable relationship between psychiatry and the ministry. Here are some of the comments: "One complements the other" from a Baptist minister. A Catholic priest wrote: "Psychiatry is as confusing to a minister as religion is to a psychiatrist." "Religion must mature with psychiatry. Mental illness must be left to the psychiatrist" (Jewish). "Psychiatrists should inform the ministers of their progress" (Presbyterian).
56
Journalof Religion and Health
"Let the minister quit practicing psychiatry and concern himself with religious matters" (Unitarian). These comments were typical of those received. Most ministers thought that mutual understanding was the key to a desirable relationship. Each profession, however, should stick to its own field. A minister knows the members of his congregation and can aid a psychiatrist on background. Many felt that psychiatrists needed to be more tolerant of ministers. Mutual understanding can come about only "if ministers and psychiatrists get to know each other professionally and personally" was a recurring statement.
Discussion We believe that our study gives the attitudes of a cross section of ministers in an average city. The questionnaire was very general and nonspecifie in parts. We deliberately made it this way, thinking it would stimulate comments. Many of the ministers receiving the questionnaire were only part-time ministers; their principal means of living was in some other field. It is impossible to guess accurately the number that fall into the part-time category, but in some denominations it was over 5o per cent. It was noted that in the first mailing, which included only ministers having their own churches, the response was much greater. Our total response of 38.6 per cent is extremely good for a mail questionnaire of this type. World War II brought psychiatry to the forefront. Religion and medicine began to combine forces to help people in distress. Since that time, the movement has continued to bring psychiatry and religion closer together. In x954, the Academy of Religion and Mental Health was founded. In ~96o, the Group for the Advancement of Psychiatry, through its Committee on Psychiatry and Religion, released a report entitled "Psychiatry and Religion: Some Steps Toward Mutual Understanding and Usefulness." In x96I, a Department of Medicine and Religion within the American Medical Association was organized. Such periodicals as the Journal of Religion and Health, Pastoral Counseling, and the Journal of Pastoral Care are now widely read. Groups in the pastoral field such as the Council for Clinical Training, Inc., and the Institute of Pastoral Care, Inc., have sprung up. Our study shows an increased awareness of psychiatry by ministers in recent years. Most ministers felt that the drinking problem presented
Attitudes of Ministers tov:ard Psychiatry
57
to them was "psychological." It is interesting, however, to see that a larger percentage of the post-I945 group gave this response, whereas many of the pre-i945 ordained group listed "religious" as its basis. An overwhelming majority of the ministers would counsel this problem themselves. Even though most admit the problem is "psychological," they feel capable of handling it. It is interesting to note that in a study conducted by Knight and Kramer, the medical staff of the Cleveland Clinic rated counseling with patients as less important in a chaplain's role than his other duties? That seminary training has improved in psychological counseling is indicated by the fact that the post-i 945 group ranked "seminary" much higher as a source of training in psychological matters. Our undergraduate schools have gone along with this interest in psychology. "Undergraduate schools" were ranked higher as a source of training by the newer ordained group than by the older group. The older group ranked "self-study," "no training," and "experience" higher. "Marital problems," "drinking," and "lack of faith" were all problems commonly seen by ministers. "Obvious mental disease" and "mental retardation" were rarely brought to them. Ministers are evidently dealing with personal problems, but obvious medical problems are being taken elsewhere, no doubt to medical personnel. It is interesting that "drinking" was ranked higher in frequency by some of the older ministers. This is the same group that considered the nature of the problem more religious than psychological. Perhaps the older ministers are more aware of its incidence. The better relationship and communication between ministers and psychiatrists can be shown in the response as to what problems they would refer to a psychiatrist. More younger ministers would refer "obvious mental disease" to a psychiatrist. However, they must be utilizing their improved training. They feel more comfortable in the counseling situation and seem more willing to counsel other problems themselves. T h e i r training is better, and they use it. As shown by our comments, today's minister is aware of psychiatry. He reads periodicals, goes to seminars, and seems to counsel or refer to other sources as needed. He realizes that not all problems can be solved by simple faith and prayer alone. Many problems need professional guidance. There seems to be a desire to learn about psychological counseling and to be of aid to the psychiatrists. The ministers' comment that 58
Journal of Religion and Health
there is a need for better communication between ministers and psychiatrists is similar to the comment that appeared in Garber's questionnaire sent to a group of general practitioners asking them how psychiatrists could be of more help to family physicians. Most of the general practitioners also indicated that there was a need for better communication between themselves and psychiatrists. 1~W e believe that ministers can be of help. They can give support to persons with problems and refer those who need help to proper sources. There does not seem to be any wide difference in attitude among denominations. Even the older and younger groups of ministers are generally in agreement about their method of approach. Along with the general upsurge of interest in psychiatry since i945, training of ministers in the field has increased. With better training has come a willingness to become involved in counseling. Evidently the current training of ministers emphasizes the psychological aspects of problems, but even older ministers desire to cooperate and be of help. Most ministers seem to know their limits, and very few overstep them.
Conclusions i. Two hundred thirty-two ministers (38.6 per cent) replied to a mailed questionnaire. 2. Training in counseling comes from self-study, seminary, seminars, and postgraduate courses. 3. Self-study was the major means of training in counseling by the prei945 group, but the post-i945 group considered the seminary as their major source of training in counseling. 4. The problems most commonly brought to ministers for counseling are: a . Marital problems b. Drinking C. Lack of faith d. Sexual maladjustment 5. The problem that is most commonly referred to a psychiatrist is obvious mental disease. 6. With the improved training in psychiatry since I945, communication between psychiatrists and ministers has improved. The post-i945 group will more frequently refer an obvious mental disease to a psy-
Attitudes of Ministers toward Psychiatry
59
chiatrist, yet they feel so m u c h more at ease that t h e y attempt much more counseling than the pre-1945 group. REFERENCES ,. Campbell, John D., "Psychiatry and Religion," Journal of the Medical Association of Georgia, i949, 38, 317. 2. Ibid., p. 317. Molner, Joseph G., "To Your Health," Syndicated Column, July, 1963. 3. Gallup, George, "Gallup Poll," Syndicated Column, Dec. 29, I962. 4. Lipman, Hyman, and others, "Pastoral Psychiatric Workshops: The St. John's Mental Health Institute," American Journal of Psychiatry, I958, /zy, 529-534. 5. Bruder, Ernest, "Some Basic Concerns in Pastoral Counseling." In Pastoral Problems and Clinical Understanding--Workshop Manual May 4-7, 1959, Gearhart, Oregon, p. 96. McCleane, Paul, "Medicine, Religion and the Patient," The New Physician, 1963, 12, A-9-io. Novey, Samuel, "Considerations on Religion in Relation to Psychoanalysis and Psychotherapy," Journal of Nervous and Mental Disease, x96o, z3o, 315-324. Lipton, Harry R., "Psychiatry and Religion," Journal of the Medical Association o~ Georgia, 1957, 46, I7. 7. Foster, Arthur, "Current Trends in Clinical Pastoral Education," Mind over Matter, ~96", 7, I6-24. Dodson, Sam, "The Church's Responsibility to Community Institutions," ibid., 24-28. Franzblau, Abraham, "Distinctive Functions of Psychotherapy and Pastoral Counseling," Archives of General Psychiatry, I96O, 3, 583-589. 8. Klink, Thomas; Personal Communication, April, I96z. 9. Knight, Ward, and Kramer, David, "Chaplaincy Role Functions as Seen by Mental Patients and Staff," Journal o~ Pastoral Care, i964, 18, i54-i6o. io. Garber, Robert; Family Physicians Look at Psychiatry and Psychiatrists. Smith, Kline and French Laboratories, Philadelphia, I962.
60
Journal of Religion and Health
H. SANDLER
Attitudes of Ministers toward Psychiatry OFTEN the first person to be consulted about a mental disturbance or psychological problem is the minister? People troubled most often turn to their minister as the logical source of help. Excessive religiosity frequently accompanies emotional disturbances. 2 According to the Gallup poll, about 46 per cent of the adult population went to church in a typical week in i9627 It is this group that usually turns to the minister for counsel? A study by the National Institute of Mental Health showed that 40 per cent of the people first sought out their pastor for help with a personal problem? How, then, do the ministers feel about psychiatry? H o w do they handle problems that come to them? What is their training in this field? H o w do their attitudes toward psychiatry vary from one denomination to another or from the older ministers to the more recently ordained ones? Many articles have been written concerning the similarity or difference between psychiatry and religion? Studies have been conducted to determine how ministers can better counsel the members of their congregations in psychological matters/Little has been done, however, to assess the ministers' attitudes toward and training in such counseling? This is the area we studied in seeking answers to the questions above. Our locale was the city of Memphis, Tenn.
This paper, presented at a meeting of the Michigan Association of Neuropsychiatric Hospital and Clinic Physicians, Pontiac, Mich., October 3o, i964, reports Dr. Sandler's study conducted at and under the auspices of the Brain Research Institute, Department of Psychiatry, University of Tennessee Medical Units, and the Tennessee State Department of Mental Health. The study was supported in part by a Public Health Grant from the National Institute of Mental Health.
Attitudes o~Ministers to'wardPsychiatry
47
FIGURE I THE UNIVERSITY OF TENNESSEE DEPARTMENT OF PSYCHIATRY MINISTER'S SURVEY
Denomination Year Ordained I. A member of your congregation comes to you and says she feels her husband is in need of help. He recently changed jobs. She feels he is starting to drink to excess. The wife later brings the husband in to see you. You talk to this man but he denies that he has a problem. I. I feel this is primarily a: 2. I would probably: a. religious problem a. counsel them myself b. psychological problem b. refer to a psychiatrist c. social c. refer to Family Service d. legal d. refer to Alcoholics Anonymous e. do nothing in view of the huse. band's denial of need for any help f. refer to Calvary Colony, Harbor House or similar center g.
II.
M y knowledge of counseling came from training received in: a. undergraduate school b. seminary c. postgraduate courses d. read on own time (self-study) because of interest e. special seminars set up by mental health groups, universl W, church f. no special training g.
III. Number in the order in which you see the following problems: a. drinking f. childhood b. marital problems difficulties in school e. failure to keep job juvenile delinquency d. sexual m a l a d j u s t m e n t _ _ g. mental retardation e. lack of faith h. obvious mental disease i.
IV. W h a t problems do you feel you can handle yourself? V.
W h a t type of problems do you feel you need to refer to a psychiatrist?
VI. W h a t do you consider the desirable relationship between psychiatry and the ministry?
Method Our study was conducted by means of the questionnaire shown as Figure i. It had been compiled after interviews with ministers, psychiatrists, psychologists, and social workers. It was mailed to 604 ministers whose names came from the telephone directory, city directory, and lists 48
Journal of Religion and Health
made up by the church bodies. Over 95 per cent of the ministers of Memphis were addressed. N o follow-up was made on any questionnaire sent out. A letter explaining the purpose of the study and an addressed stamped envelope for return of the questionnaire were enclosed. Recipients were asked to mark as many answers as they considered applicable. No identification was required on the returned questionnaire. The only identity asked for was denomination and year of ordination. In the letter, we offered to send those interested a copy of the results on request.
FIGURE 2 RESULTS N u m b e r of questionnaires distributed .................................... N u m b e r of questionnaires returned ...................................... Total per cent returned ................................................
Denomination
Number sent out
Jewish A.M.E. Presbyterian Lutheran Episcopal Church of Christ Christian C.M.E. Catholic Methodist Baptist Assembly of God Greek Orthodox Church of God of Prophecy Unitarian Unity Church of God Seventh Day Adventist Nazarene Church of God in Christ Congregational Christian Missionary Alliance Pentecostal Pentecostal Holiness Reorganized Latter Day Saints Non-denominational Spiritualist Independent
232 38 .6
Per cent returned
9 7 37 13 18 24 II 8 3o 98
77 71 7o 61 6I 58 54 50 46 37
292
3I
6 2 2 2 2 2 3 4 4 2 2 5 3 3 5 3 3
600
17 I00 I00 Ioo IOO 50 33 25 o o o o o o o o o
Attitudes o~ Ministers tovmrd Psychiatry
49
Results The greatest number of responses from groups to which more than five questionnaires were sent came from the Jewish clergy (77 per cent). Presbyterian ministers also furnished a high response (7 ~ per cent), as did the A.M.E., with 71 per cent. No group to which we sent more than five questionnaires failed to respond. The zero responses seem to have come from the more fundamentalist sects, such as the Pentecostal. Very few returned questionnaires were hostile. Only one respondent thought that psychiatry was useless. Two questioned the validity of our study. Interestingly, the group that showed the best response to our questionnaire had also shown most interest when we conducted our personal interviews in setting up the study. The clergymen were asked to mark what they felt was the nature of the problem outlined in the first question. FIGURE 3 COMPARISON BY PERCENTAGE OF HOW" MINISTERS OF DIFFERENT DENOMINATIONS LOOKED AT PROBLEM
Psychological Total % Jewish
A.M.E. Presbyterian Lutheran Episcopal Church of Christ Christian C.M.E. Catholic Methodist Baptist Assembly of God
67.3 (7) 60 (3) 60 (20) 72 (6) 72 (8) 78 (IO) IOO (6) 75 (3) 78 (II) 56 (32) 49 (45) IOO (I) IOO
Religious
Social
44.6 14
(I)
40 (2) 33 (II) 60 (5) 54 (6) 42 (6) 33 (2) 50 (2) 50 (7) 42 (2o) 55 (50) o
I2.5 O
20 27 (9) 24 (2) 9 (I) 14 (2) o :25 (I) o 16 (4) 16 (15) o
Legal I. o O
20 (1) o o o o o O o o o o
(Number in parentheses is actual number that gave response) Most marked more than one.
As shown by Figure 3, "psychological" was given as the kind of problem by the largest number of ministers (67. 3 per cent). In the Baptist group, however, "religious" was the most frequent response (55 per cent). Only 49 per cent of the Baptist ministers marked "psychological." In the Catholic group, there was a variation in the response of the younger (ordained after i945) and the older priests (ordained So
Journalof Religion and Health
before I945). Six of the seven ordained before I945 marked this problem as having a religious origin, whereas only one of the seven ordained after 1945 so marked it. In the Church of Christ group, a similar picture was seen. All of the pre-i945 group considered the problem religious, but only two of the eight in the post-i945 group so regarded it. As to psychological basis, i oo per cent of the post-i945 group marked this response, whereas only 5~ per cent of the pre-I945 group marked "psychological." In the Lutheran group, a similar situation was noted. All post-i945 ministers marked "psychological," but only 50 per cent of pre-i945 marked it. MI groups, with the exception of the Baptist, followed the total group pattern. With the exceptions noted, there were no other marked variations between younger and older groups. FIGURE 4 HOW MINISTERS WOULD HANDLE PROBLEM BY PERCENTAGE
Counsel themselves Total Jewish A.M.E. Presbyterian Lutheran Episcopal Church of Christ Christian Catholic Methodist Baptist Assembly of God C.M.E.
73.6 o 80 (4) 60 (20) IOO (8) 72 (8) 78 50 78 58 87
(II) (3) (II) (29) (78)
IOO (I) 75 (3)
Refer to a psychiatrist
Do nothing
Alcoholics Anonymous
Church Mission Farm
Family Service
26.4 56 (4) 40 (2) 18 (6) o 36 (4)
14.7 14 (I) o 6 (2) o o
I1.2 14 (I) o 12 (4) o 36 (4)
5.5 o o 3 (I) o o
4.6 28 (2) o 9 (3) o 18 (2)
28 33 42 16 21
79 33 7 IO 6
7 (I) o 28 (4) IO (5) 7 (7)
o o O o 2 (I)
o 16 (I) O 6 (3) 12 ( I I )
(3) (2) (6) (7) (20)
o 25 (I)
o o
(I) (2)
(I) (5) (6)
o o
o o
o o
(Number in parentheses is actual number that gave response)
The next question concerned the handling of this problem. Most would attempt to do the counseling themselves (73.6 per cent). Many also indicated that they would refer to a psychiatrist (26. 4 per cent). Even those who did not mark this often commented that they would refer to a psychiatrist, if, after two or three sessions, they were making no progress. But by far the majority would just try to handle the problem themselves.
Attitudes of Ministers tov2ard Psychiatry
51
Among the Baptists, 16 per cent ordained before I945 would utilize Family Service, a social agency, as one of their primary approaches. Only 7.3 per cent of those ordained later would consider this a primary approach. In the Episcopal group, there were slight variations from the total group response. As many as 36 per cent would use Alcoholics Anonymous as a referral. The same number would use a psychiatrist. Sixty-six per cent of the older group considered a psychiatrist in the referral, yet only 25 per cent of the younger group would consider a psychiatrist as the first approach. Among Jews, 28 per cent marked Family Service as their first approach. This is much higher than the response of the total group (4.6 per cent). It was the second most frequent response among the Jewish group. The most frequent response of this group was "refer to a psychiatrist" (56 per cent). This was the only group that listed this as their most frequent choice. All other groups followed the pattern of the total group With little significant difference as to response of the earlier-ordained and later-ordained ministers.
FIGURE 5 TRAINING IN COUNSELING BY MINISTERS OF DIFFERENT DENOMINATIONS BY PERCENTAGE
Selfstudy
UnderPostSeminary Seminars graduate graduate
Total 57.4 56.0 40.8 25.7 Jewish 28 (2) 28 (2) 42 (3) 28 (2) A.M.E. IOO (5) 6o (3) 40 (2) o Presbyterian 54 (18) 60 (20) 51 (17) 24 (8) Lutheran 48 (4) 84 (7) 36 (3) 12 (I) Episcopal 54 (6) 63 (7) 63 (7) 9 (I) Church of Christ 42 (6) 50 (7) 28 (4) 5~ (7) Christian 83 (5) IOO (6) 16 (I) 66 (4) Catholic 92 (13) 92 (13) 42 (6) 7 (I) Methodist 58 (29) 47 (21) 24 (12) 24 (12) Baptist 50 (46) 53 (49) 38 (35) 27 (25) Assembly of God o o IOO (I) o C.M.E. 50 (2) o 75 (3) o (Number in parentheses is actual number that gave response)
52
Journal of Religion and Health
21. I
28 (2) o 36 (I2) 12 (I) 27 (3) 46 33 21 18 8 o o
(6) (2) (3) (9) (8)
Experience (added)
lO.8 o o 3 (i) 12
(1)
9 (I) o o 21 (3) 6 (3) 16 (15) o o
No
training 3.3 14 20
(i) (1)
3 (1) i2
(i)
o o o o 4 (2) 6 (6)
o o
FIGURE 6 COMPARISON OF TRAINING OF PRE-I945 AND POST-I945 MINISTERS BY PERCENTAGE -Pre-I945
Self-study 66.2 Seminary 49.I Seminars 37.7 Postgraduate 2o.2 Undergraduate I6.7 Experience 23.7 No Training 7.9 (Number in parentheses is actual number)
(75) (56) (43) (23) (I9) (27) (9)
-Post-~945
57.o 73.7 43.9 2I 1 36.8 7.0 2.6
(65) (84) (5 o) (25) (42) (8) (3)
The next part of the study concerned the training in counseling the ministers had received. "Self-study" was the most frequent response (57.4 per cent). "Seminary" was marked on 56 per cent of the questionnaires. There did not appear to be any marked differences as to denominations. The differences seemed to be between the pre-i945 group and the post-i945 group within a denomination. Among the Baptist group, 7 z per cent of the pre-i945 group put "self-study," but only 4 z per cent of the post-1945 group listed this choice. W h e n responses were compared as to pre-i945 and post-I945 groups, 66.2 per cent of the prei945 group listed "self-study" and 57.o per cent of the post-i945 group listed it. On "special seminars," among Baptist ministers, 27. 9 per cent of the pre-i945 group listed this response, but 65.7 per cent of the post1945 listed it. This same difference was seen in total comparisons, where 37.7 per cent of the pre-i945 group listed "seminars" and 43.9 per cent of the post-i945 group listed them. A choice added by many was "experience." Twenty-three per cent of the older Baptist group added this, but only i4.2 per cent of the newer groups did. On the total comparison, 23.7 per cent of the older group had added it, but only 7.o per cent of the younger group had. "Undergraduate training" was listed as a source of training by 36.8 per cent of the younger ministers, but by 16.7 per cent of the older ones. The difference was even greater among the Baptists. "Undergraduate school" was marked by I3.9 per cent of the pre-i945 group, but 54.2 per cent of the post-1945 group marked this choice. Six per cent of the pre-i945 group among the Baptists marked "no training." None of the post-1945 Baptist group had this choice. In comparing the total pre-
Attitudes of Ministers to'ward Psychiatry
53
x945 group and post-i945 group, 7-9 per cent of the pre-i945 group listed "no training," but only z.6 per cent of the post-i 945 group did. The highest discrepancy between age groups was seen in the Methodist response to "seminary" as a source of training. The pre-i945 group marked "seminary" on 28. 5 per cent of their returns, but 93.7 per cent of younger ministers marked this choice. In the Methodist group, a variation from most other groups was seen in the "seminar" response, 50 per cent of the younger group marked "seminar" as source of learning, but 78.5 per cent of the older group marked it. The Jewish group listed "seminars" as their most frequent source of training (4 z per cent). "Seminary" and "self-study" were listed on z8 per cent of their questionnaires. This was the most frequent choice of all groups. In the next part of the questionnaire, the ministers were asked to number the order in which they saw the various problems. It was interesting to see how many ministers left this question blank. Approximately io per cent did not list a maior problem, and 35 per cent did not list a rare problem. This problem called for more than just circling an answer, and the response was somewhat smaller. The minister had to write in a number, ranking the various problems on the basis of the frequency with which he encounters them in the counseling situation. FIGURE 7 RANKING OF PROBLEMS IN ORDER SEEN BY MINISTERS
I. 2. 3. 4. 5.
Marital problems Drinking Lack of faith Sexual maladjustment Failure to keep job
6. Juvenile delinquency 7- Childhood problems 8. Obvious mental disease 9. Difficulties in school IO. Mental retardation
The most common problems brought to ministers were "marital." "Drinking" and "lack of faith" were also common. "Mental retardation" was the least common problem. "Obvious mental disease" and "difficulties in school" were also rarely dealt with. The Catholic group saw "drinking" the most often (4 z per cent). The Episcopal ministers noted "marital problems" and "lack of faith" with equal incidence (27 per cent). The Christian group listed "marital" on 66 per cent of their returns as the number one problem. A low-ranked problem that was
54
Journalof Religion and Health
very high in Jewish returns was "obvious mental disease." It was ranked number one on 4 z per cent of the Jewish returns. Among the Baptists, it was interesting to note that 36 per cent of the pre-I945 group hsted "drinking" as number one. Only i7.2 per cent of the post-x 945 group listed "drinking" this high. "Lack of faith" was ranked higher by the newer ministers of the Baptist faith than by the older ordained ones. In the Church of Christ group, "drinking" was rated number one by 5~ per cent of the earlier ordained ministers, but only 25 per cent of the post-i945 group put it this high. Most denominations followed the total picture except for the differences noted. The next response asked the ministers to write in the problems that need to be referred to a psychiatrist. There were no choices. The person responding to the survey had to fill in his own response. FIGURE 8 PERCENTAGE OF REPLIES THAT LISTED PROBLEMS TO BE REFERRED TO A PSYCHIATRIST Total
Pre-I 945
Post-I 945
Obvious mental disease
50.9%
34.2%
(39)
69.3%
Sexual problems
I2.9%
22.4%
(26)
I2.3%
(I4)
I5.3% I6.2% 18.o% 13.2% 11.2% 4.4% 5.4% -9%
(I7) (I8) (20) (15) (13) (5) (6) (I)
II.7% 9.9% 5.4% 6.1% 2.7% .90-/o .9% 1.8%
(I3) (II) (6) (7) (3) (I) (I) (2)
Drinking I2.9% Mental retardation I2.5% Marital problems 11.2% Childhood problems 9-5% Job failure 7.3% Juvenile delinquency 2.6% School problems 3.0% All 1.3% (Number in parentheses is actual number)
(79)
The most commonly referred problem by a large percentage was "obvious mental disease" (5o.9 per cent). It was listed on 34.z per cent of the pre-~945 returns and 69. 3 per cent of the post-I945 returns. Except for the response of "all problems," it was the only response marked by more post-I945 ministers than by pre-i945 ones as a problem to refer to a psychiatrist. In the next part of the questionnaire, the ministers were asked: "What type of problems do you feel you can handle yourself?" Here again the respondent had to write out his answers. There were no choices to mark.
Attitudes of Ministers toward Psychiatry
55
FIGURE 9 P E R C E N T A G E OF REPLIES THAT LISTED PROBLEMS TO BE H A N D L E D BY MINISTERS
Problems
or faith Total
59.9
Denomination Jewish A.M.E.
Presbyterian Lutheran Episcopal Church of Christ Christian C.M.E.
Catholic Methodist Baptist Assembly of God
Marital problems Drinking
School
di~culties
12.4
I I .4
IO.O
9.7
8.6
o 4o (2) 18 (6) I2 (I) o
o 2o (I) 9 (3) 12 (I) o
o o 3 (I) I2 (I) 9 (I)
14 (I) o 9 (3) I2 (I) o
o o 3 (I) O o
O o o 21 (3) 6 (3) IO (IO)
O 16 (I) 25 (I) o o 3 (3)
O o o 21 (3) o 4 (4)
O o 50 (2) o o I (I)
(3) (4) (6) (4)
56 (4) 6o (3) 2I (7) 60 (5) 27 (3)
7 33 5o 64 46 61
(I) (2) (2) (9) (23) (56)
7 33 5o 42 26 29
o
Sexual problems
33.3
42 8o 33 72 36
(II)
Job Failure
Childhood diffzculties
o
(I) (2) (2) (6) (13) (27)
o
o
7 o o 7 6 7 o
(I)
(I) (3) (7)
o
o
(Number in parentheses is actual number that gave response)
In Figure 9, we listed percentage of respondents who wrote in the various responses. T w o said that ministers could handle all problems, and two said that ministers could not handle any. "Lack of faith" was the most frequent response. It was listed on 59.9 per cent of the questionnaires returned as being a problem that most ministers could handle. In contrast, "school difficulties" were listed on only 8.6 per cent of the returns. This question seemed to be responded to better by the younger ministers. With the exception of the Catholic group, it was answered by more of the post-I945 ordained ministers. Most groups followed the same response as the total group. Our final question asked the ministers to state what they felt was the desirable relationship between psychiatry and the ministry. Here are some of the comments: "One complements the other" from a Baptist minister. A Catholic priest wrote: "Psychiatry is as confusing to a minister as religion is to a psychiatrist." "Religion must mature with psychiatry. Mental illness must be left to the psychiatrist" (Jewish). "Psychiatrists should inform the ministers of their progress" (Presbyterian).
56
Journalof Religion and Health
"Let the minister quit practicing psychiatry and concern himself with religious matters" (Unitarian). These comments were typical of those received. Most ministers thought that mutual understanding was the key to a desirable relationship. Each profession, however, should stick to its own field. A minister knows the members of his congregation and can aid a psychiatrist on background. Many felt that psychiatrists needed to be more tolerant of ministers. Mutual understanding can come about only "if ministers and psychiatrists get to know each other professionally and personally" was a recurring statement.
Discussion We believe that our study gives the attitudes of a cross section of ministers in an average city. The questionnaire was very general and nonspecifie in parts. We deliberately made it this way, thinking it would stimulate comments. Many of the ministers receiving the questionnaire were only part-time ministers; their principal means of living was in some other field. It is impossible to guess accurately the number that fall into the part-time category, but in some denominations it was over 5o per cent. It was noted that in the first mailing, which included only ministers having their own churches, the response was much greater. Our total response of 38.6 per cent is extremely good for a mail questionnaire of this type. World War II brought psychiatry to the forefront. Religion and medicine began to combine forces to help people in distress. Since that time, the movement has continued to bring psychiatry and religion closer together. In x954, the Academy of Religion and Mental Health was founded. In ~96o, the Group for the Advancement of Psychiatry, through its Committee on Psychiatry and Religion, released a report entitled "Psychiatry and Religion: Some Steps Toward Mutual Understanding and Usefulness." In x96I, a Department of Medicine and Religion within the American Medical Association was organized. Such periodicals as the Journal of Religion and Health, Pastoral Counseling, and the Journal of Pastoral Care are now widely read. Groups in the pastoral field such as the Council for Clinical Training, Inc., and the Institute of Pastoral Care, Inc., have sprung up. Our study shows an increased awareness of psychiatry by ministers in recent years. Most ministers felt that the drinking problem presented
Attitudes of Ministers tov:ard Psychiatry
57
to them was "psychological." It is interesting, however, to see that a larger percentage of the post-I945 group gave this response, whereas many of the pre-i945 ordained group listed "religious" as its basis. An overwhelming majority of the ministers would counsel this problem themselves. Even though most admit the problem is "psychological," they feel capable of handling it. It is interesting to note that in a study conducted by Knight and Kramer, the medical staff of the Cleveland Clinic rated counseling with patients as less important in a chaplain's role than his other duties? That seminary training has improved in psychological counseling is indicated by the fact that the post-i 945 group ranked "seminary" much higher as a source of training in psychological matters. Our undergraduate schools have gone along with this interest in psychology. "Undergraduate schools" were ranked higher as a source of training by the newer ordained group than by the older group. The older group ranked "self-study," "no training," and "experience" higher. "Marital problems," "drinking," and "lack of faith" were all problems commonly seen by ministers. "Obvious mental disease" and "mental retardation" were rarely brought to them. Ministers are evidently dealing with personal problems, but obvious medical problems are being taken elsewhere, no doubt to medical personnel. It is interesting that "drinking" was ranked higher in frequency by some of the older ministers. This is the same group that considered the nature of the problem more religious than psychological. Perhaps the older ministers are more aware of its incidence. The better relationship and communication between ministers and psychiatrists can be shown in the response as to what problems they would refer to a psychiatrist. More younger ministers would refer "obvious mental disease" to a psychiatrist. However, they must be utilizing their improved training. They feel more comfortable in the counseling situation and seem more willing to counsel other problems themselves. T h e i r training is better, and they use it. As shown by our comments, today's minister is aware of psychiatry. He reads periodicals, goes to seminars, and seems to counsel or refer to other sources as needed. He realizes that not all problems can be solved by simple faith and prayer alone. Many problems need professional guidance. There seems to be a desire to learn about psychological counseling and to be of aid to the psychiatrists. The ministers' comment that 58
Journal of Religion and Health
there is a need for better communication between ministers and psychiatrists is similar to the comment that appeared in Garber's questionnaire sent to a group of general practitioners asking them how psychiatrists could be of more help to family physicians. Most of the general practitioners also indicated that there was a need for better communication between themselves and psychiatrists. 1~W e believe that ministers can be of help. They can give support to persons with problems and refer those who need help to proper sources. There does not seem to be any wide difference in attitude among denominations. Even the older and younger groups of ministers are generally in agreement about their method of approach. Along with the general upsurge of interest in psychiatry since i945, training of ministers in the field has increased. With better training has come a willingness to become involved in counseling. Evidently the current training of ministers emphasizes the psychological aspects of problems, but even older ministers desire to cooperate and be of help. Most ministers seem to know their limits, and very few overstep them.
Conclusions i. Two hundred thirty-two ministers (38.6 per cent) replied to a mailed questionnaire. 2. Training in counseling comes from self-study, seminary, seminars, and postgraduate courses. 3. Self-study was the major means of training in counseling by the prei945 group, but the post-i945 group considered the seminary as their major source of training in counseling. 4. The problems most commonly brought to ministers for counseling are: a . Marital problems b. Drinking C. Lack of faith d. Sexual maladjustment 5. The problem that is most commonly referred to a psychiatrist is obvious mental disease. 6. With the improved training in psychiatry since I945, communication between psychiatrists and ministers has improved. The post-i945 group will more frequently refer an obvious mental disease to a psy-
Attitudes of Ministers toward Psychiatry
59
chiatrist, yet they feel so m u c h more at ease that t h e y attempt much more counseling than the pre-1945 group. REFERENCES ,. Campbell, John D., "Psychiatry and Religion," Journal of the Medical Association of Georgia, i949, 38, 317. 2. Ibid., p. 317. Molner, Joseph G., "To Your Health," Syndicated Column, July, 1963. 3. Gallup, George, "Gallup Poll," Syndicated Column, Dec. 29, I962. 4. Lipman, Hyman, and others, "Pastoral Psychiatric Workshops: The St. John's Mental Health Institute," American Journal of Psychiatry, I958, /zy, 529-534. 5. Bruder, Ernest, "Some Basic Concerns in Pastoral Counseling." In Pastoral Problems and Clinical Understanding--Workshop Manual May 4-7, 1959, Gearhart, Oregon, p. 96. McCleane, Paul, "Medicine, Religion and the Patient," The New Physician, 1963, 12, A-9-io. Novey, Samuel, "Considerations on Religion in Relation to Psychoanalysis and Psychotherapy," Journal of Nervous and Mental Disease, x96o, z3o, 315-324. Lipton, Harry R., "Psychiatry and Religion," Journal of the Medical Association o~ Georgia, 1957, 46, I7. 7. Foster, Arthur, "Current Trends in Clinical Pastoral Education," Mind over Matter, ~96", 7, I6-24. Dodson, Sam, "The Church's Responsibility to Community Institutions," ibid., 24-28. Franzblau, Abraham, "Distinctive Functions of Psychotherapy and Pastoral Counseling," Archives of General Psychiatry, I96O, 3, 583-589. 8. Klink, Thomas; Personal Communication, April, I96z. 9. Knight, Ward, and Kramer, David, "Chaplaincy Role Functions as Seen by Mental Patients and Staff," Journal o~ Pastoral Care, i964, 18, i54-i6o. io. Garber, Robert; Family Physicians Look at Psychiatry and Psychiatrists. Smith, Kline and French Laboratories, Philadelphia, I962.
60
Journal of Religion and Health
