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DSM-IV Religious and Spiritual Problems

Lesson 2.2 Loss or questioning of faith

DescriptionAssociated Clinical problemsTreatmentCase ExamplesWWW Library

Loss of faith is specifically mentioned in the DSM-IV definition as a religious problem. There are several forms that loss of faith can take. Shafranske [1] described a man of professional accomplishment whose life was founded upon the conservative bedrock of Roman Catholic Christianity. He came to doubt the tenets of his religion and, in so doing, declared he had lost the vitality to live.

Some crises of faith are recognized as part of spiritual development James Fowler,hD, building on the work of Piaget, Kohlberg, and other developmental theorists, has proposed that there is an invariant order of faith development in six recognizable stages. Problems may arise in the transition from one stage to another, often experienced as a crisis of faith. (James Fowler, Stages of Faith).

A similar problem can occur when a person is ostracized by their religious community. One such crisis was created when a Jehovah's Witness elected to have a medically necessary heart transplant despite his family's and religious community's objections on religious grounds:

His family and church community subsequently refused any contact with him. Ultimately, the patient became suicidal and required psychiatric hospitalization. (p. 476)
Waldfogel S, Wolpe PR. Using awareness of religious factors to enhance interventions in consultation-liaison psychiatry. Hosp Community Psychiatry. 1993 May;44(5):473-7.

Associated Clinical Problems
For some individuals, loss of faith involves questioning their whole way of life, purpose for living, and source of meaning.. In addition, their social world can be affected since religion is for many an important part of their social network. Barra, Carlson and Maize [2] conducted a survey study and also reviewed the anthropological, historical, and contemporary perspectives on loss as a grief-engendering phenomenon. They found that loss of religious connectedness,

whether in relation to traditional religious affiliation or to a more personal search for spiritual identity, frequently resulted in individuals experiencing many of the feelings associated with more "normal" loss situations. Thus, feelings of anger and resentment, emptiness and despair, sadness and isolation, and even relief could be seen in individuals struggling with the loss of previously comforting religious tenets and community identification. (p. 292)

In summary, these are the clinical sequalae that can result from a sudden loss of faith.


Since this type of loss is typically not acknowledged by others, the authors described this phenomenon as "disenfranchised grief." They cite one case of a graduate student who stopped believing in her religion of origin. She reported feeling alienated, fear, anxiety, anger, hopelessness, and even suicidal ideation, the common sequallae of a grief reaction.

The American Psychiatric Association's "Guidelines Regarding Possible Conflict Between Psychiatrists' Religious Commitments and Psychiatric Practice" mentions a case where a psychiatrist provided interpretations to a devoutly religious man. "In doing this, however, she denigrated his long-standing religious commitments as foolishly neurotic. Because of the intensity of the therapeutic relationship, the interpretations caused great distress and appeared related to a subsequent suicide attempt" [3] This is an iatrogenic effect of culturally insensitive treatment.

Studies have found that struggling with religious beliefs during an illness diminishes the chances of recovering. Persons whose faith is shaken when they fall ill are at greater risk of dying, thus documenting the consequences of a loss of faith. Kenneth Pargament,PhD of Duke University and colleagues studied 596 patients from 1996 to 1997 Participants were 596 patients aged 55 years or older on the medical inpatient services of Duke University Medical Center or the Durham Veterans Affairs Medical Center, Durham, NC. Patients who reported that they felt alienated from or unloved by God and attributed their illness to the devil or said they felt abandoned by their church community had a 19 percent to 28 percent increase in the risk of dying within the next two years, compared with those who had no such religious doubts, even after controlling for the patients' health, mental health and demographic status. Those who indicated that they "Wondered whether God had abandoned me" and "Questioned God's love for me" had a higher mortality rate. Dr. Pargemant indicated that these results highlight the need for spiritual assessment and pastoral interventions for patients whose faith is shaken by illness.

Pargament KI, Koenig HG, Tarakeshwar N, Hahn J. Religious struggle as a predictor of mortality among medically ill elderly patients: a 2-year longitudinal study. Arch Intern Med. 2001 Aug 13-27;161(15):1881-5.

Pargament Study


83 year old Beth has been diagnosed with breast cancer, and has expressed the belief that the illness is a punishment from God for her sins. Based on the study Religious struggle as a predictor of mortality among medically ill elderly patients: a 2-year longitudinal study, she could be at increased risk of death.


Record your answer for later insertion into the Quiz.

Michael Washburn, PhD has noted a possible focus for therapy by focusing on the change as a turning point in faith which offers the potential for personal exploration and discovery:

If, later in life, we suffer a profound disillusionment in our experience of the world, we may find ourselves turning back towards psychic resources that previously we had repressed. This is the beginning of what I have called "regression in the service of transcendence", which I think most people would know better using the term of St. John of the Cross, "the dark night of the soul". It can be a very long, difficult, and trying period.

For people who find themselves in this passage -- as I did 20 years ago -- it is helpful to know that it is a passage. It's helpful to know that perseverance and patience are important, and that it is a time to grow in faith. Frequently it may not look like faith, because the old idols have disappeared, and the old god-ideas have fallen by the wayside. It therefore can look like a loss of faith, and a loss in one's life-direction generally. But this can really be a turning point in faith, the beginning of a mystery, a movement towards an "I know not what" that, though distressing, can also be the real stuff of spiritual experience and of a spiritual relationship.

The therapist can view loss of faith as an opportunity for the patient to grow into a new relationship to the mystery of life. For some who are experiencing loss of faith, work with a religious professional might help them to reconnect with their faith.

Others may not want to get involved with an organized religion. The creation of a new personal mythology as described in Lesson 6.2 is a psychotherapeutic priority in working with clients who have experienced a loss of faith.

Case Examples
S. is a 58-year-old European-American single client who has had progressive liver disease for 2 years. Before her illness, she attended church regularly and volunteered her free time to church-related charity organizations. When given the diagnosis, she ceased her involvement with the charities and attending church services because she says she "has no need to worship a fantasy." During her fourth hospitalization, she was informed that the disease process was not responding to treatment and that her death could occur in the next few weeks. Upon discharge, she became clinically depressed, refused to take any medications, ceased eating, spent her time gazing out of her room or reading books, and complaining that "God had abandoned her." A relative notified a mental health professional. At the intake, she ignored most questions and complained that life seemed so meaningless.

Emma Bragdon has described a similar crisis of faith around her spiritual path of Buddhism.

WWW Library of Religion and Spirituality
The WWW Library contains a directory of sites on losses of all kinds and articles by James Fowler and Michael Washburn.

1 Shafranske, E. (1991). Beyond countertransference: On being struck by faith, doubt and emptiness. American Psycholgical Association, New Orleans, LA.

2 Barra, D., Carlson, E., & Maize, M. (1993). The dark night of the spirit: Grief following a loss in religious identity. In K. Doka & J. Morgan (Eds.), Death and spirituality. Amityville, NY: Baywood.

3 APA Committee on Religion and Psychiatry (1990). "Guidelines regarding possible conflict between psychiatrists' religious commitments and psychiatric practice." American Journal of Psychiatry 147: 542.



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