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Psychiatry in scripture: sacred texts and psychopathology

  • Christopher C. H. Cook (a1)
Summary

The engagement of psychiatry with religion is increasingly important for better understanding of the ways in which religious people find resources to cope with mental disorder. An example of how a more critical and constructive engagement might be achieved is found in the psychiatric literature on sacred texts. Articles which engage with the alleged psychopathology of the 6th-century BC Hebrew prophet Ezekiel are examined as an example of this and proposals are made for a more critical yet sensitive and constructive future debate.

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Copyright
This is an Open Access article, distributed under the terms of the Creative Commons Attribution (CC-BY) license (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.
Corresponding author
Christopher C. H. Cook (c.c.h.cook@durham.ac.uk)
Footnotes
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a

Quoted English translations of Ezekiel are all from the Holy Bible, New Revised Standard Version Bible, 1989.

Declaration of interest

C.C.H.C. is Chair of the Spirituality and Psychiatry Special Interest Group (SPSIG) at the Royal College of Psychiatrists. The views expressed in this article are his own. The SPSIG does not adopt any particular position in relation to the matters debated in this article, but welcomes open debate about this and other matters related to spirituality and psychiatry, both in publication and at its meetings. C.C.H.C. is an Anglican priest, and is Director of the Project for Spirituality, Theology and Health at Durham University.

Footnotes
References
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1 Cook, CCH, Powell, A, Sims, A, Eagger, S. Spirituality and secularity: professional boundaries in psychiatry. Ment Health Relig Cult 2011; 14: 3542.
2 Cook, C, Powell, A, Sims, A (eds). Spirituality and Psychiatry. RCPsych Publications, 2009.
3 Stein, G. Morbid jealousy may have been recognised in the Old Testament. Br J Psychiatry 2011; 198: 142.
4 Stein, G. Early child psychiatry. Br J Psychiatry 2010; 197: 105.
5 Stein, G. Hannah: a case of infertility and depression. Br J Psychiatry 2010; 197: 492.
6 Stein, G. The case of King Saul: did he have recurrent unipolar depression or bipolar affective disorder? Br J Psychiatry 2011; 198: 212.
7 Stein, G. Alcoholism in ancient Israel. Br J Psychiatry 2008; 193: 113.
8 Stein, G. Was the scoundrel (belial) of the Book of Proverbs a psychopath? Br J Psychiatry 2009; 194: 33.
9 Stein, G. The essa zarah, the strange women of the Book of Proverbs. Br J Psychiatry 2009; 195: 293.
10 Stein, G. Lost in translation: the biblical classification of personality disorder. Br J Psychiatry 2008; 193: 337.
11 Stein, G. Psalm 38: A man with major depression. Br J Psychiatry 2010; 196: 309.
12 Stein, G. Did the author of Psalm 30 have cyclothymia or bipolar disorder? Br J Psychiatry 2009; 195: 550.
13 Stein, G. Paranoia in the Psalms. Br J Psychiatry 2010; 197: 284.
14 Stein, G. Did Ezekiel have catatonia? Br J Psychiatry 2008; 193: 253.
15 Stein, G. Did Ezekiel have first-rank symptoms? Br J Psychiatry 2009; 194: 551.
16 Stein, G. The voices that Ezekiel hears. Br J Psychiatry 2010; 196: 101.
17 Foote-Smith, E, Bayne, L. Joan of Arc. Epilepsia 1991; 32: 810–5.
18 Schweitzer, A. The Psychiatric Study of Jesus: Exposition and Criticism. Beacon, 1948.
19 Fales, E. Scientific explanations of mystical experiences. Part I: The case of St Teresa. Relig Studies 1996; 32: 143–63.
20 Landsborough, D. St Paul and temporal lobe epilepsy. J Neurol Neurosurg Psychiatry 1987; 50: 659–64.
21 Cook, CCH. Psychiatry and mysticism. Ment Health Relig Cult 2003; 7: 149–63.
22 Lindblom, J. Prophecy in Ancient Israel. Blackwell, 1967.
23 Altschuler, EL. Did Ezekiel have temporal lobe epilepsy? Arch Gen Psychiatry 2002; 59: 561–2.
24 Kohn, RL. Ezekiel at the turn of the century. Currents Biblical Res 2003; 2: 931.
25 Joyce, PM. Ezekiel: A Commentary. Continuum, 2009.
26 Allen, LC (eds Hubbard, DA, Barker, GW, Watts, JDW). Ezekiel 20–48. Word Books, 1990.
27 Zimmerli, W (eds Cross, FM, Baltzer, K, Greenspoon, LJ). Ezekiel. Fortress Press, 1979.
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32 Davis, EF (ed Gunn, DM). Swallowing the scroll: textuality and the dynamics of discourse in Ezekiel's Prophecy. Almond Press, 1989.
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Psychiatry in scripture: sacred texts and psychopathology

  • Christopher C. H. Cook (a1)
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eLetters

Lessons from sacred texts

John S. Price, Retired
26 June 2012

Dr Cook (1) has written a stimulating article on "an important opportunity to engage psychiatry in a critical and constructive way with religious texts..." He concentrates on evidence for schizophrenia, but possibly the contribution of sacred texts may be even more helpful in the case of depression. In addition to the unfortunate King Saul (2), there are probably many accounts of depressed mood, but two examples stand out because the mechanism of the relief of the depression is apparent in the texts.

Job in the Old Testament and Arjuna in the Bhagavad Gita, which is a part of the Mahabharata (the Hindu equivalent of the Bible) suffered from depression (3,4). Job was depressed because the Lord had allowed Satan to have his children killed, his livestock driven off and his body to be covered with boils. He felt this was unjustified according to the current philosophy of retributive justice, so he was angry with God. Arjuna was depressed (and had a typical panic attack) because Krishna (the ninth avatar of the god Vishnu) told him to slaughter many of his relatives and mentors, and he was reluctant to take Krishna's advice. Both Job and Arjuna have lengthy dialogues with their gods, who express their majesty and omnipotence in marvellous poetry. These displays of dominance have some effect, but final and complete submission is not achieved in either case until the god shows himself in person. Submission is then unqualified in both cases, and both then recover from their depressions and lead successful lives. We concluded from these examples that whereas belief in god may relieve anxiety about the meaning of life and what happens after death, it requires submission to god to relieve depression (4). Those who believe but do not submit are liable to spiritual struggles, as pointed out by C.S.Lewis (5) in The of Problem of Pain.

The Book of Job is of particular interest to psychiatry because the story can be read in two ways. The usual interpretation is that Job suffers from a reactive depression, understandable considering the degree of his misfortune. The other is that he has a psychotic depression and his misfortunes are delusional. Favouring the latter is the fact that histhree comforters do not offer condolences on the deaths of his children, and that finally his children are restored to him in the original proportions (seven sons and three daughters) which is more likely to be due to the loss of a delusion than to further childbearing effort on the part of Job and his wife. If the latter is the case, it shows how a delusion may appear real not only to the patient, but to generations of biblical scholars who have read of Job's situation.

The lessons from these extracts from scripture are: 1) those treating depressed believers should ensure that the patient has made a total submission to the will of God; 2) those studying the relation of mental health to religion should construct a scale which measures the degree of submission versus rebellion, or "My will" versus "Thy will"; 3)those treating depressed agnostics should look for a secular equivalent tojoyous total surrender to God.

References 1. Cook CCH. Psychiatry in scripture: sacred texts and psychopathology.The Psychiatrist 2012, 36 225-229. 2. van Praag H M. The downfall of King Saul: the neurobiological consequences of losing hope. Judaism 1986, 35: 414-428. 3. Kahn J. Job's Illness: Loss, Grief and Integration; A Psychological Interpretation. London: Gaskell, 1986. 4. Price JS, Gardner R. Jr. (2009) Does submission to a deity relieve depression? Illustrations from the Book of Job and the Bhagavad Gita. Philosophical Papers and Reviews 2009; 1: 17-31.http://www.academicjournals.org/PPR/PDF/Pdf2009/July/Price%20and%20Gardner.pdf 5. Lewis CS . The Problem of Pain. New York, Collier Books; 1940.

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Conflict of interest: None declared

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