According to a 2023 Gallup survey, 47% of Americans identify as “religious”, and 33% as “spiritual”. And a 2003 report issued by the National Library of Medicine reported that members of the clergy, across religious and denominational lines, were contacted by persons with mental health issues in higher proportions (23.5%) than were psychiatrists and general medical practitioners (16.7% each).
A 2023 article in the American Psychological Association publication Monitor on Psychology asserts: “Myriad studies show that religious or spiritual involvement improves mental health and can be useful in coping with trauma.” The article also suggests that when clergy don’t know enough about psychology and clinicians not enough about spirituality, they can inadvertently do harm to those who seek their help. Therefore, how religious leaders, who are generally untrained or under-trained in clinical psychology, respond to such persons may require careful discernment to ensure that it helps and does not unintentionally harm. Likewise, it is also incumbent on mental health clinicians to possess a good working knowledge of how spirituality can be embedded into clients’ narratives about self, others, and the world.
On the clinical side, I have sometimes stumbled in this regard. For instance, I used to blanketly impart to my clients the virtues of Maslow’s Hierarchy of Needs, a theory grounded in Western “bootstrap” individualism in which one is supposed to achieve what Maslow called “Self-Actualization”: by devoting their life to ascending the pyramid via achievement and individual growth until, if fortunate, one makes it all the way to the top (a pinnacle that even Maslow admitted few ever reach). Maslow, it turns out, co-opted his model from the Blackfoot Nation term niita ‘pitapi, which means “someone who is completely developed, or who has arrived.” Blackfoot spirituality perceives niita ‘pitapi as a birthright and not something to be gained through individual effort. Blackfoot culture, like that of many other indigenous communities throughout the world, is collectivist rather than individualistic, and grounded in mutual cooperation and sharing of resources. To paraphrase a Blackfoot saying, the wealthiest person in the community is the one with the least material possessions, because they gave most of them away to others who needed them more.
When we don’t properly understand a client’s particular cultural and spiritual background and if it is not like that of Western culture, espousing Maslow’s Pyramid as a self-help tool can be an afront. This is where we as clinicians have the obligation to become spiritually and culturally informed.
Those who serve their religious communities have a similar obligation. As I sat in church one recent Sunday morning, the music director introduced a worship song. “If this song does not grip your heart,” she said, “I don’t know if you’re a Christian.” The song, living up to her promise was indeed gripping and inspirational. Later our pastor, in his sermon, spoke on how, if you can’t push past your guilt, grief, pain and brokenness in order to embrace the idea that God has His hand on your life, then you, as a believer, must change your way of thinking.
Those messages brought me back to a young client I’d seen a few days earlier. Just 24 hours prior, their spouse had died suddenly and unexpectedly. My client was understandably still in shock and disbelief. “I feel numb,” they said. “I don’t know why I can’t cry right now, although sometimes I spontaneously have been. I just don’t know what I feel.”
As Sunday services continued, I thought to myself, what if any emotions would my client (also a Christian) be able to feel were they sitting with me at that moment? What would they be thinking about God and eternal life, and how would they perceive the comments that if they weren’t feeling “gripped” by the song then they might not be a Christian, that if they can’t at that point cast aside their devastation and feel the spirit of God, then they must change their mindset?
To be clear, I do not question the good intentions of the music director and the pastor any more than I question my own good intentions when I preached Maslow. Their mission is to inspire and equip the congregation to get closer to God and spread the Good News of Jesus Christ. The problem, however, is that too often such messages are geared toward people in relatively good mental health. But for persons struggling with depression, grief and loss, trauma, and other issues, such words can cut like a knife and increase distress rather than soothe it.
Let’s take trauma for example. Research shows that traumatic experiences, such as sexual assault, alter the synaptic functions in the brain, particularly what is called fear circuitry to where the victim can experience distressing nightmares, hyper-arousal and hypervigilance, avoidance of certain places, people and activities, and even flashbacks (where they actually relive the event as if it were happening all over again in real time). Trauma is existential: it challenges our erstwhile narratives of self, other people, and the world. This can alter, either temporarily or permanently, our concept of how our God or higher power loves us, protects us, and nurtures us. It may even challenge our belief altogether.
This is not a sign of weak faith. Fr. Francis P. Duffy, the iconic chaplain of the 69th New York Infantry Regiment (165th U.S. Infantry), served valiantly with his men in the trenches of World War I, regularly venturing into No Man’s Land to minister to wounded and dying soldiers and assisting stretcher bearers in bringing the casualties back to aid stations. While he was never known to have suffered what was then called “shell shock” (now PTSD), on at least one occasion he was reported to have sobbed uncontrollably upon finding the body of a soldier he’d mentored.
So how can we bridge the gap between religion and mental health, especially now when so many people need hope, assurance, and healing? I suggest that clinicians and clergy begin to more proactively reach out to one other for better mutual understanding, to exchange clinical and spiritual insights, and to collaborate in serving our clients and congregants. Here’s how we might do this:
1. Establish connections with ministers, priests, rabbis, imams, and other religious leaders, to discuss our common interest in helping those we serve to heal and to live a more balanced and satisfying life.
2. Cross-refer with them, when indicated.
3. Learn as much as we can about our own religion and other religions, particularly those that are most prevalent within our catchment areas. And make ourselves available to educate clergy members on the basic neuropsychology of depression, anxiety, bipolar disorder, trauma, and other mental health conditions.
4. Adopt a faith-based component to our services, and promote it in our social media, websites, and other communication platforms.
Imagine the possibilities that might arise from such a synergy between psychology and spirituality in helping our clients to overcome their challenges.
