/random/ - random

It is often said that a person experiencing the first stages of serious schizophrenia is more likely to go to see a priest than a psychiatrist1. This is because the delusions suffered by people with schizophrenia often have a religious content. Sufferers may believe that they are a saint, a prophet or God himself, (which is more common in men), or (in women) that they are a saint or are pregnant with the Messiah.

Sometimes the person may believe that they are being punished for some unforgivable sin that they have committed earlier in their life or that they are damned to everlasting hell. This can lead to feelings of intense despondency. In other cases the sufferer may believe that others around them are devils or witches and may attack them or that they themselves are possessed by devils.

There is an amusing story from the 1980s of two patients meeting for the first time on a psychiatric ward who, after telling each other their story immediately fell into an altercation with one patient accusing the other of being an imposter: “how can you be Jesus Christ?” he said,"I am Christ."

How common are religious delusions in schizophrenia?

Various studies have found that the prevalence of religious delusions in schizophrenia is very high. Torrey in the US, for instance, has suggested that around half of sufferers there experience religious delusions. Other studies in other parts of the world have found differently. Mohr and Huguelet in Switzerland found the prevalence to be around 21% (this was probably representative of the overall prevalence in Western Europe) and Rudaleviciene and his colleagues in Lithuania found it to be as high as 64% there.

Whatever the figures may be for an individual country it is clearly a trait that is very common in schizophrenia and psychiatrists encounter it so frequently that they have come up with a name for it: religiosity or religious preoccupation. Religiosity is definitely not new. The early psychiatrists in the 19th century observed the phenomenon although it was not thought to be quite as common then as now.

Religiosity and psychiatry: How is religiosity diagnosed?

Psychiatry and religion have traditionally been ill at ease with each other and in today’s increasingly secular society which the UK has undoubtedly become many mental health professionals feel uncomfortable when dealing with the issue of religiosity and have difficulty in understanding it in the context of the whole person.

These factors have made it difficult for doctors to properly diagnose religiosity. There is an example of a ward nurse in a Westcountry hospital listing a woman’s crucifix on her list of belongings as a “lucky charm”. This may be a good example of how incomplete an understanding medical professionals often have today on religious issues or it may be an example of an individual member of staff allowing her own personal secular agenda to overcome the necessity for professionalism in the practice of her vocation. Whichever, it is I believe a good example of the difficulty that many health professionals have in the UK of understanding religious practice and without such an understanding, diagnosing religiosity properly becomes very difficult.

Coverage, or to be more precise lack of it, in the medical literature has not really helped this problem. Despite religiosity being such a common experience for people with schizophrenia it is not particularly well covered by the medical literature. A review of four major psychiatric journals carried out in the US in 1982 found that only 2.5% of the articles even mentioned religiosity and that in most cases the mention was just cursory.

Religious delusions may be difficult to distinguish and diagnosis often depends on a complete knowledge of the person’s previous religious history. For instance if the sufferer has never had a religious background but has suddenly started visiting churches three times a day this would be significant whereas if previously they had attended church regularly then weekly church going would not be out of place and bear in mind that in some faiths religious observance can be quite significant and involve praying several times a day or abstaining from food at certain times.

This is a good example of how the cultural context of religiosity is vital to understanding it. In days of old and many societies in the developing world today, mental health and spirituality are seen to be closely related. Indeed the Greek word “psyche” from which we derive our terms psychologist and psychotherapy originally meant the soul or spirit.

Excessive religious observance is often the first sign that relatives see that something is amiss. Visiting churches too frequently, praying continuously and fasting (sufferers may often loose excessive amounts of weight) when there has been no previous interest in religious activities are often a sign that something is seriously wrong. it is vital that doctors listen to relatives and take into account any recent changes in the person’s behaviour or lifestyle.

However the major part of the evidence of religious delusions will come from the diagnostic interview with the patient and any further contact that the doctor has with them. As we have seen above holding extreme religious views does not of itself indicate mental illness however doctors should look for any signs of anomalous religious behaviours or beliefs that appear to have started without any prompting and may occur in conjunction with other symptoms such as paranoia or hallucinations. Today’s guidance to psychiatrists in both the UK and US is sound and very explicit in that they must familiarise themselves with the patient’s cultural background before interpreting religious practice as delusional.

Why is religiosity significant?

Some studies have found that sufferers who experience religious delusions tend to experience a more severe course of their illness with a poorer prognosis. In addition religious delusions and hallucinations can give rise to disturbed behaviour that can sometimes be dangerous to both the sufferer and to those around them.

Religious delusions may also be accompanied by hallucinations of a religious nature. The most common here is the phenomenon of hearing voices which the sufferer may interpret as messages from God or saints. The person may also experience visual hallucinations which they interpret as visions.

Religious delusions and hallucinations often link together and can be very powerful in the way they influence the person’s behaviour. After all if you believe that the voices that you are hearing in your head and which are giving you commands are coming from God or some other higher power then there is a powerful reason to listen to them and obey them. When we talk of hearing voices here we are not describing the normal self talk that every individual experiences. The voices that a person with schizophrenia hears are qualitatively different to that. They are true auditory hallucinations: hearing things that the hearer cannot distinguish from reality. For more about this please see our Information Sheets on Voices.

Religious delusions may also lead to dangerous behaviour. Both homicide and violence have been committed by people with schizophrenia at the behest of their religious delusions and some have taken statements from the bible to pluck out offending eyes or cut off offending body parts literally and have done themselves great harm.