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DSM-IV Religious and Spiritual Problems

LESSON 2.3 Changes in membership, practices and beliefs

DescriptionAssociated Clinical problemsTreatmentCase ExamplesWWW Library

Changes in Membership
Due to intermarriage, mobility and the breakdown of geographic limitations to church membership, many people convert to new religions or change their denominational membership. In some cases the change may be experienced as forced rather than voluntary. When a person moves to a community which does not have a branch of the original religious group, he or she may experience a sense of loss associated with separation from a previously valued religious community. Conversion experiences in particular can lead to adoption of a new religion or change in denominational membership.

Intensification of Belief
Another type of religious problem can occur when a person intensifies their adherence to religious practices and orthodoxy. Voluntary intensification of religious practice may be the result of a religious experience. This can lead to problems when the person either does not feel free, or does not know how, to talk about the religious aspects of the change. But such intensification may also occur as an attempt to deal with feelings of guilt. Intensification may also be one of the coping mechanisms used to deal with trauma, and is associated with the need to find meaning in the distressing event in order to avoid a breakdown of identity [1].

Conversion Experiences
According to William James, a conversion experience involves

sense of a higher control or power behind reality
feeling of oneness with the world and nature
sensing profound "truths" about reality
everything looking new, alive, and beautiful
being overwhelmed with happiness and ecstasy
inability to express this experience in words
absolute certainty about the importance of this experience

Cultural and social factors play an important role in the conversion process, and different religions and disciplines view conversion differently, from welcoming to questioning such direct experiences.

Associated Clinical Problems
Changes in beliefs and practices
    quite often do in fact disrupt peoples' lives. It does disrupt families. Even though we may give a theology of conversion that can soft pedal all those issues, the truth is, the issue is controversial because it is disruptive...a disorientation, and something that has caused a lot of complications in many peoples' lives.
    The Psychology of Religious Conversion
    , Lewis Rambo

Intensification of religious practice can also be misdiagnosed as mental disorders. Greenberg and Witzum[2] are Israeli psychiatrists who work with orthodox Jewish patients. They have proposed diagnostic criteria for distinguishing normative strict orthodox religious beliefs from psychopathological experiences that present with religious content.

    Symptoms of Mental Disorder:
    1) are more intense than normative religious experiences in their religious community
    2) are often terrifying
    3) are often preoccupying
    4) are associated with deterioration of social skills and personal hygiene
    5) often involve special messages from religious figures

At times devout religious practices can be viewed as extreme and result in conflict with the law as with mutilation, a practice associated with several religions.

Abu-Sahlieh SA, To mutilate in the name of Jehovah or Allah: Legitimization of male and female circumcision. Med Law 1994;13(7-8):575-622

If the patient is newly religious, the therapist needs to help identify and work on conflicts between the patient's former and current lifestyle, beliefs, and attitudes. Spero (1987)[3] described the case of a 16-year-old adolescent from a reform Jewish family who underwent a sudden religious transformation to orthodoxy. The dramatic changes in her life, including long hours studying Jewish texts, avoidance of friends, and sulleness at meals, led to her referral to a psychoanalyst. A mental status examination determined that neither schizophrenia nor any other Axis I or II disorders were present. The analysis then dealt with the impact of religious transformation on her identity and object relations. The process of religious change challenges important areas of stability, and

to some degree the sense of historical dislocation represents a crisis for all nouveau-religionists. ( p 69)

As in the case example below, religious experiences can impact treatment, both of medical and mental problems.

Case Examples
Case Report: Decision-Making Capacity and Religious Conversion-- A Case of Dialysis Refusal
Dinesh Mittal, MD, Samuel F. Sears Jr., PhD, Phillip R. Godding, PhD, and Marti D. Reynolds, MDiv (1999) Annals of Long-Term Care, 7(8),320-322

Dialysis refusal

In Case Report: Decision-Making Capacity and Religious Conversion-- A Case of Dialysis Refusal, the authors describe their approach to working with dialysis refusal by: a) getting a legal mandate to enforce treatment b) working within the patient's belief system c) using rational disputation techniques d) none of the above

Record your answer for later insertion into the Quiz.

Woman's first person account of conversion to Catholicism

WWW LIBRARY of Religion and Spirituality
The WWW LIBRARY of Religion and Spirituality contains articles on the psychology of religious conversion.

Types of Changes


Religious problems can be related to a) changes in membership b) intensification of beliefs c) conversion d) all of the above

Record your answer for later insertion into the Quiz.

1 Van der Lons, J. (1991). What is psychology of religion about? Psychology of religion. H. Malony. Grand Rapids, MI, Baker.

2 Greenberg, D., & Witztum, E. (1991). Problems in the treatment of religious patients. American Journal of Psychotherapy, 45(4), 554-565.

3 Spero, MH (1987). Identity and individuality in the nouveau-religiouis patient: Theoretical and clinical aspects. Psychiatry. 50, 55-71.



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