Christian The
Impact
Marc
Psychiatry:
of Evangelical
Galanter,
M.D.,
David
Belief
Larson,
M.D.,
and
on Clinical Elizabeth
Practice
Rubenstone,
B.A.
Objective: The authors surveyed psychiatrists in the Christian Psychiatry movement to assess the role of religious belief in their practices. Method: The psychiatrists were members of the Christian Medical and Dental Society; questionnaires were sent to 260, and usable responses were received from 1 93. The subjects were asked about demographic and practice variables, “born again” religious experiences, group cohesion, and beliefs about using the Bible and prayer in treatment. Results: The respondents were somewhat more religious than Americans overall, who are themselves more religious than most psychiatrists. Nearly all reported having been “born again, after which they generally experienced a decrease in emotional distress. There was a significant difference in the respondents’ affiliative feelings toward psychiatrists in the Christian Psychiatry movement and other psychiatrists. For acute schizophrenic or manic episodes, the respondents considered psychotropic medication the most effective treatment, but they rated the Bible and prayer more highly for suicidal intent, grief reaction, sociopathy, and alcoholism. Whether or not a patient was “committed to Christian beliefs” made a significant difference in whether the respondents would recommend prayer to the patient as treatment. About one-halfsaid they would discourage strongly religious patients from an abortion, homosexual acts, or premarital sex, and about one-third said they would discourage other patients from these activities. Conclusions: Many studies have suggested a need for more sensitivity to religious issues by psychiatrists, and this study provides systematic findings on one approach. It remains important to evaluate ways in which a religious perspective can be related to clinical practice and what benefits and problems may derive from such a relationship. “
(Am
J
Psychiatry
1991;
148:90-95)
A
recent resurgence in religious commitment in the United States, including fundamentalism (1), may lead psychiatry to reconsider the place of religious issues in clinical practice. This is particularly relevant to the impact of Christian Psychiatry, a broad-based national movement of psychiatrists who are evangelical Christians. Although most of its adherents are not formally affiliated among themselves, the orientation of this movement is expressed in beliefs espoused by the
Received
Nov.
22,
1989;
revision
received
June
12,
1990;
ac-
cepted July 5, 1990. From the Division of Alcoholism and Drug Abuse, Department of Psychiatry, New York University School of Medicine, and the Department of Psychiatry, Duke University School of Medicine, Durham, N.C. Address reprint requests to Dr. Galanter, Department of Psychiatry, New York University School of Medicine,
550
The authors Burns,
and
First
thank
Ave.,
New
Donald
York,
NY
Gent, M.D.,
90
.
.
.
,
,
10016.
Sidney Macaulay,
Denise Cancellare for their assistance of the APA Committee on Psychiatry
Janice
with this project. and Religion con-
Members sulted in the inception of this project: Drs. M. Galanter (chairperson), C. Aist, P.C. Dobbs-Wiggins, K. Flanagan, G.T. Harding, Jr., K. Hoppe, Copyright
Christian Medical and Dental Society, which has 7,500 members, 260 of whom are psychiatrists on physicians in psychiatry residency training. Applicants must sign a statement acknowledging “the final authonity of the Bible as the word of God the presence and power of the Holy Spirit in the work of megeneration . . . [andi the everlasting blessedness of the saved and the everlasting punishment of the lost.” Because of the intensity of religious commitment in the Christian Medical and Dental Society, it seemed useful to make an independent assessment of the mole religious belief plays in the clinical practice of psychiatnists who are members of the society. We also hoped to provide a better understanding of how strong religious belief can affect mental health came.
P. Mohl, H.R. Spiro, R.J. Thurrell, and B. Wenegrat. © 1991 American Psychiatric Association.
METHOD We established an agreement with officers of the psychiatry section of the Christian Medical and Dental Society that we would conduct a study for the purpose
Am
J
Psychiatry
148:1,
January
1991
GALANTER,
of familiarizing the mental health field with Christian Psychiatry by means of objective findings. A representative group of members was initially interviewed, and a mailing was then sent to the 260 potential respondents. It included a letter from the president of the psychiatry section which explained that only summary data would be published and that identifiable infommation on respondents would not be retained or reported. A 121-item codeable questionnaire was included in the mailing, to be returned anonymously. From this and follow-up correspondence, 193 usable questionnaires were returned, representing a 74% response rate. The questionnaire included items on demography and practice, many drawn from the report on a survey of American psychiatrists that was conducted by APA (2). Additional items on religion were drawn from a report from a Gallup poll of a probability sample of 1,S53 Americans (3). Responses to items were given on a S-point scale, from 1, for “not at all,” to 5, for “very much.” The subjects were asked to retrospectively assess their psychological state immediately before having “been born again or having . . . an intense religious experience that changed your outlook on life.” They were then asked to make the same assessment for the month immediately after that experience. They rated eight items, such as, “I felt nervous and tense,” on a S-point scale (maximum possible total=40). This neumotic distress measure has been reported previously (4, p. 33) to have a high level of internal consistency; it correlates significantly with measures of behavior in zealous religious and self-help groups, with contempomary measures of distress in related groups, and inversely with the General Well-Being Schedule of the National Center for Health Statistics (5). Five items assessing group cohesiveness, such as, “They came for me” and “I enjoy being part of their activities,” were also used. A high internal consistency among these items and a significant correlation between the items and behavior in zealous groups have been reported (4, p. 32, and 5). Respondents used the S-point scale for each item to mate their affiliative feelings toward two target groups, the 10 Christian Psychiatmists they know best and the 10 psychiatrists they know best who are not members of the movement. The maximum possible total score was 25. The respondents were asked to give their estimation on the S-point scale of the effectiveness of each of three possible interventions in treating each of seven diagnoses, such as alcoholism. The three interventions were the Bible and prayer, insight psychotherapy, and psychotropic medications. The mole of religion in the respondents’ clinical practice was addressed in two ways. The respondents were first asked to indicate what portion of committed Christian believers with given diagnoses-schizophrenia, depressive neurosis (dysthymia), and alcoholismthey would treat with each of three modalities: a specified conventional treatment, insight psychotherapy, and prayer (by the patient). They were then asked
Am
J
Psychiatry
I 48: 1 January ,
1991
LARSON,
AND
RUBENSTONE
what portion of nonbelievers they would treat with each of the modalities. The mole of religion was further addressed by asking the respondents whether on not they would suggest to a committed Christian patient that he or she act otherwise if he or she were about to act contrary to evangelical Christian creed. Three examples of such acts were given: planning an abortion, engaging in homosexual acts, and engaging in premarital sex. The respondents were then queried as to how they would respond to the same three situations if the patient were not a committed Christian believer. Some respondents did not answer every question, so the total number of subjects used for calculating percentages varies among the questions asked.
RESULTS
Demographic
and
Professional
Background
The respondents’ mean±SD age was 49.1 ± 12.7 years, and 172 (89%) were male. Of the 179 who were not currently in residency training, 175 (98%) had completed psychiatric residency, and 121 (68%) were Board certified. The most common primary work setting was private practice (N= 100, 52%), followed by medical school/university (N23, 12%) and mental health clinic (N20, 10%). These findings are similar to those reported for American psychiatrists overall, according to APA biographical data (2). The mean±SD length of membership in the Christian Medical and Dental Society was 15±12.4 years. Over half of the respondents (N=112, 59%) had faculty appointments at medical schools, and 168 (88%) were APA members. The respondents were geogmaphically dispersed and lived in 35 states; the states with more than 10 respondents each were California, Texas, Pennsylvania, and Michigan.
Religious
Beliefs
Data gathered from the responses to the questions on religious beliefs were compared with figures from Gallup poll data (3). They revealed a moderately strongem religious commitment among the respondents than among Americans overall. For example, 78% of the respondents (N= 145) indicated that they believe in a personal God who “rewards and punishes” them for their actions, as do most (69%) of the general population; 98% (N= 188) stated they believe in the Devil (versus 70% of the general population). The respondents’ religious orientation was further reflected in three items used by Gallup as strict criteria for defining evangelical Christians among the general population: 182 (96%) said they had been “born again” (versus 40% of the general population), 183 (96%) acknowledged having encouraged someone to accept Jesus as a savior (48% in the general population), and 80 (43%) stated that every part of the Bible is the actual word of God,
91
CHRISTIAN
PSYCHIATRY
TABLE 1. Ratings of Effectiveness of Three Treatments
by 193 Psychiatrists Who Were Members of the Christian Medical and Dental
Society Rating
of Effect iveness
Psychotropic Medication Psychiatric
at all
,
S=very
much)
Insight Psychotherapy
ANOVA
Mean
SD
Mean
SD
Mean
SD
4.8
0.6
1.7
0.9
1.5
0.6
1,227
Acute manic episode Suicidal intent
4.9 3.2
0.4 1.1
1.7 3.5
0.9 1.1
1.4 3.2
0.6 1.0
1,614
Grief
2.1
0.8
4.1
0.9
3.4
0.9
1.4 1.9 3.1
0.7 0.8 1.0
2.8 3.6 3.S
1.2 1.1 1.1
2.1 2.7 3.8
0.9 0.9 0.9
Acute
Syndrome
(1=not Bible and Prayer
schizophrenic
reaction
Sociopathy Alcoholism Depressive
neurosis
episode
to be taken literally (37% in the general population). Regarding religious issues that may anise in clinical practice, a large majority felt the following practices are wrong: homosexual relations between consenting adults (N=166, or 88%, versus 62% in the general population), sexual relations before marriage (N= 159, or 86%, versus 50%), and abortion on demand (N= 187, on 99%, versus 87%). The subjects’ ratings of their emotional distress before and after their “born again” experiences were significantly different. Their mean±SD scone on the eightitem measure was 1 1.0±7.0 for immediately before the experience and 8.2±4.4 for the month afterward (t=8.1, df= 178, p
Impact
Marc
Psychiatry:
of Evangelical
Galanter,
M.D.,
David
Belief
Larson,
M.D.,
and
on Clinical Elizabeth
Practice
Rubenstone,
B.A.
Objective: The authors surveyed psychiatrists in the Christian Psychiatry movement to assess the role of religious belief in their practices. Method: The psychiatrists were members of the Christian Medical and Dental Society; questionnaires were sent to 260, and usable responses were received from 1 93. The subjects were asked about demographic and practice variables, “born again” religious experiences, group cohesion, and beliefs about using the Bible and prayer in treatment. Results: The respondents were somewhat more religious than Americans overall, who are themselves more religious than most psychiatrists. Nearly all reported having been “born again, after which they generally experienced a decrease in emotional distress. There was a significant difference in the respondents’ affiliative feelings toward psychiatrists in the Christian Psychiatry movement and other psychiatrists. For acute schizophrenic or manic episodes, the respondents considered psychotropic medication the most effective treatment, but they rated the Bible and prayer more highly for suicidal intent, grief reaction, sociopathy, and alcoholism. Whether or not a patient was “committed to Christian beliefs” made a significant difference in whether the respondents would recommend prayer to the patient as treatment. About one-halfsaid they would discourage strongly religious patients from an abortion, homosexual acts, or premarital sex, and about one-third said they would discourage other patients from these activities. Conclusions: Many studies have suggested a need for more sensitivity to religious issues by psychiatrists, and this study provides systematic findings on one approach. It remains important to evaluate ways in which a religious perspective can be related to clinical practice and what benefits and problems may derive from such a relationship. “
(Am
J
Psychiatry
1991;
148:90-95)
A
recent resurgence in religious commitment in the United States, including fundamentalism (1), may lead psychiatry to reconsider the place of religious issues in clinical practice. This is particularly relevant to the impact of Christian Psychiatry, a broad-based national movement of psychiatrists who are evangelical Christians. Although most of its adherents are not formally affiliated among themselves, the orientation of this movement is expressed in beliefs espoused by the
Received
Nov.
22,
1989;
revision
received
June
12,
1990;
ac-
cepted July 5, 1990. From the Division of Alcoholism and Drug Abuse, Department of Psychiatry, New York University School of Medicine, and the Department of Psychiatry, Duke University School of Medicine, Durham, N.C. Address reprint requests to Dr. Galanter, Department of Psychiatry, New York University School of Medicine,
550
The authors Burns,
and
First
thank
Ave.,
New
Donald
York,
NY
Gent, M.D.,
90
.
.
.
,
,
10016.
Sidney Macaulay,
Denise Cancellare for their assistance of the APA Committee on Psychiatry
Janice
with this project. and Religion con-
Members sulted in the inception of this project: Drs. M. Galanter (chairperson), C. Aist, P.C. Dobbs-Wiggins, K. Flanagan, G.T. Harding, Jr., K. Hoppe, Copyright
Christian Medical and Dental Society, which has 7,500 members, 260 of whom are psychiatrists on physicians in psychiatry residency training. Applicants must sign a statement acknowledging “the final authonity of the Bible as the word of God the presence and power of the Holy Spirit in the work of megeneration . . . [andi the everlasting blessedness of the saved and the everlasting punishment of the lost.” Because of the intensity of religious commitment in the Christian Medical and Dental Society, it seemed useful to make an independent assessment of the mole religious belief plays in the clinical practice of psychiatnists who are members of the society. We also hoped to provide a better understanding of how strong religious belief can affect mental health came.
P. Mohl, H.R. Spiro, R.J. Thurrell, and B. Wenegrat. © 1991 American Psychiatric Association.
METHOD We established an agreement with officers of the psychiatry section of the Christian Medical and Dental Society that we would conduct a study for the purpose
Am
J
Psychiatry
148:1,
January
1991
GALANTER,
of familiarizing the mental health field with Christian Psychiatry by means of objective findings. A representative group of members was initially interviewed, and a mailing was then sent to the 260 potential respondents. It included a letter from the president of the psychiatry section which explained that only summary data would be published and that identifiable infommation on respondents would not be retained or reported. A 121-item codeable questionnaire was included in the mailing, to be returned anonymously. From this and follow-up correspondence, 193 usable questionnaires were returned, representing a 74% response rate. The questionnaire included items on demography and practice, many drawn from the report on a survey of American psychiatrists that was conducted by APA (2). Additional items on religion were drawn from a report from a Gallup poll of a probability sample of 1,S53 Americans (3). Responses to items were given on a S-point scale, from 1, for “not at all,” to 5, for “very much.” The subjects were asked to retrospectively assess their psychological state immediately before having “been born again or having . . . an intense religious experience that changed your outlook on life.” They were then asked to make the same assessment for the month immediately after that experience. They rated eight items, such as, “I felt nervous and tense,” on a S-point scale (maximum possible total=40). This neumotic distress measure has been reported previously (4, p. 33) to have a high level of internal consistency; it correlates significantly with measures of behavior in zealous religious and self-help groups, with contempomary measures of distress in related groups, and inversely with the General Well-Being Schedule of the National Center for Health Statistics (5). Five items assessing group cohesiveness, such as, “They came for me” and “I enjoy being part of their activities,” were also used. A high internal consistency among these items and a significant correlation between the items and behavior in zealous groups have been reported (4, p. 32, and 5). Respondents used the S-point scale for each item to mate their affiliative feelings toward two target groups, the 10 Christian Psychiatmists they know best and the 10 psychiatrists they know best who are not members of the movement. The maximum possible total score was 25. The respondents were asked to give their estimation on the S-point scale of the effectiveness of each of three possible interventions in treating each of seven diagnoses, such as alcoholism. The three interventions were the Bible and prayer, insight psychotherapy, and psychotropic medications. The mole of religion in the respondents’ clinical practice was addressed in two ways. The respondents were first asked to indicate what portion of committed Christian believers with given diagnoses-schizophrenia, depressive neurosis (dysthymia), and alcoholismthey would treat with each of three modalities: a specified conventional treatment, insight psychotherapy, and prayer (by the patient). They were then asked
Am
J
Psychiatry
I 48: 1 January ,
1991
LARSON,
AND
RUBENSTONE
what portion of nonbelievers they would treat with each of the modalities. The mole of religion was further addressed by asking the respondents whether on not they would suggest to a committed Christian patient that he or she act otherwise if he or she were about to act contrary to evangelical Christian creed. Three examples of such acts were given: planning an abortion, engaging in homosexual acts, and engaging in premarital sex. The respondents were then queried as to how they would respond to the same three situations if the patient were not a committed Christian believer. Some respondents did not answer every question, so the total number of subjects used for calculating percentages varies among the questions asked.
RESULTS
Demographic
and
Professional
Background
The respondents’ mean±SD age was 49.1 ± 12.7 years, and 172 (89%) were male. Of the 179 who were not currently in residency training, 175 (98%) had completed psychiatric residency, and 121 (68%) were Board certified. The most common primary work setting was private practice (N= 100, 52%), followed by medical school/university (N23, 12%) and mental health clinic (N20, 10%). These findings are similar to those reported for American psychiatrists overall, according to APA biographical data (2). The mean±SD length of membership in the Christian Medical and Dental Society was 15±12.4 years. Over half of the respondents (N=112, 59%) had faculty appointments at medical schools, and 168 (88%) were APA members. The respondents were geogmaphically dispersed and lived in 35 states; the states with more than 10 respondents each were California, Texas, Pennsylvania, and Michigan.
Religious
Beliefs
Data gathered from the responses to the questions on religious beliefs were compared with figures from Gallup poll data (3). They revealed a moderately strongem religious commitment among the respondents than among Americans overall. For example, 78% of the respondents (N= 145) indicated that they believe in a personal God who “rewards and punishes” them for their actions, as do most (69%) of the general population; 98% (N= 188) stated they believe in the Devil (versus 70% of the general population). The respondents’ religious orientation was further reflected in three items used by Gallup as strict criteria for defining evangelical Christians among the general population: 182 (96%) said they had been “born again” (versus 40% of the general population), 183 (96%) acknowledged having encouraged someone to accept Jesus as a savior (48% in the general population), and 80 (43%) stated that every part of the Bible is the actual word of God,
91
CHRISTIAN
PSYCHIATRY
TABLE 1. Ratings of Effectiveness of Three Treatments
by 193 Psychiatrists Who Were Members of the Christian Medical and Dental
Society Rating
of Effect iveness
Psychotropic Medication Psychiatric
at all
,
S=very
much)
Insight Psychotherapy
ANOVA
Mean
SD
Mean
SD
Mean
SD
4.8
0.6
1.7
0.9
1.5
0.6
1,227
Acute manic episode Suicidal intent
4.9 3.2
0.4 1.1
1.7 3.5
0.9 1.1
1.4 3.2
0.6 1.0
1,614
Grief
2.1
0.8
4.1
0.9
3.4
0.9
1.4 1.9 3.1
0.7 0.8 1.0
2.8 3.6 3.S
1.2 1.1 1.1
2.1 2.7 3.8
0.9 0.9 0.9
Acute
Syndrome
(1=not Bible and Prayer
schizophrenic
reaction
Sociopathy Alcoholism Depressive
neurosis
episode
to be taken literally (37% in the general population). Regarding religious issues that may anise in clinical practice, a large majority felt the following practices are wrong: homosexual relations between consenting adults (N=166, or 88%, versus 62% in the general population), sexual relations before marriage (N= 159, or 86%, versus 50%), and abortion on demand (N= 187, on 99%, versus 87%). The subjects’ ratings of their emotional distress before and after their “born again” experiences were significantly different. Their mean±SD scone on the eightitem measure was 1 1.0±7.0 for immediately before the experience and 8.2±4.4 for the month afterward (t=8.1, df= 178, p
