Continuity and discontinuity in psychiatry and the study of religion (original) (raw)
1. Continuity and Discontinuity in Psychiatry and the study of Religion EASR 2019 @madpassim Richard Saville-Smith r.saville-smith@sms.ed.ac.uk
2. ا إال جبتي في ماهلل There is nothing in my cloak but God Mansur Al-Hallaj 858-952
3. Pivot Continuity and Discontinuity at the intersection of Psychiatry and the study of Religion Deconstructing Part I
4. “Religious experience is brain-based. This should be taken as an unexceptional claim. …The external reality of religious precepts is neither confirmed nor disconfirmed by establishing brain correlates of religious experience Jeffrey Saver, The Neural Substrates of Religious Experience 2005
5. While all people are governed by their own minds, there are a few who are judged worthy of direct divine communications Gregory of Nyssa 335-394 PG44.172B miller p47
6. Anomalous Experiences Pechey R & Halligan P, 2012, Prevalence and correlates of anomalous experiences in a large non-clinical sample, Psychology And Psychotherapy, 85, 2: 150-162, Visual Hallucinations 14% Hearing voices 15% 75% had some kind of anomalous experience Pechey & Halligan In a sample of 1,000
7. van Os J, Linscott R, Myin-Germeys I, et al, 2009, A systematic review and meta-analysis of the psychosis continuum, Psychological Medicine, 39(2), 179-195. Psychotic Experience 8% Psychotic Symptoms 4% Psychotic Disorder 3% The Psychosis Continuum
8. “Disruption” Disruption, evidenced by discontinuities of self, may or may not be a Disorder (mental illness) Depending on whether it is or is not a normal part of a broadly accepted cultural or religious practice. American Psychiatric Association, 2013, Diagnostic and Statistical Manual of Mental Disorders Fifth edition (DSM-5), Arlington, APA. DSM-5 – Dissociative Identity Disorder
9. Stace W.T, 1960, Mysticism And Philosophy, London: Macmillan If X has an alleged mystical experience P1 and Y has an alleged mystical experience P2 and if the phenomenological characteristics of P1 entirely resemble P2…then the two experiences cannot be regarded as being of two different kinds. (Stace 1960: 29) The principle of causal indifference
10. Entirely Resemble? There are 3,000 varieties of pear but three species account for the vast majority of edible fruit – The European pear, the Chinese white pear and the Asian pear.
11. If Disruption is accepted as a normal part of a religious practice, it is not necessarily a mental disorder. The Psychiatrist’s instinct is to reduce experience to mental disorder The Scholar of Religion’s instinct is to defend tradition by recourse to a sui generis conceit.
12. William James – The Seraph and the Snake Another false dichotomy 12
15. Normal Experience 15 AcuteBlunt Disruption Possession Dissociative Identity Disorder Mystical States Hyperreligious Peak Experiences Shamanic flight Agency Over-detection Trance Excess Theory of Mind Psychotic Schizophrenia Bipolar Schizoaffective Ecstasy Numinous
16. Disruption Mystical States Hyperreligious Depersonalisation Peak Experiences Shamanic flight Agency Over-detection Excess Theory of Mind Revelation Hallucination Delusions of Grandeur Psychosis Schizophrenia Schizoaffective Ecstasy Numinous Samādhi Schizoaffective Transfiguration Hierophany Possession Schizotypal DID Visions Voices Fana Rapture Bliss Moksha Awe Bipolar Satori Trance
17. Prayer Meditation Drumming Chanting Singing Repetition/Dhikr Stress Pain Trauma Entheogens Fasting Sleep deprivation Light deprivation Temperature Extremes Sex Flagellation Dancing Illness – fevers, etc. Life! Passivity can use a helping hand
20. Here the prophets of all the different religions come with their visions, voices, raptures, and other openings, supposed by each to authenticate his own peculiar faith William James [1902] 1985: 513 The More
21. Lifestyle choice or lifestyle necessity?
22. Genetic Predisposition? Or Accessible to all?
23. Disruption is a very old story: told by evolutionary psychologists
24. o is ancient and prevalent o results from gene variation o is socialised and significant o is not necessarily pathological o need not necessarily require fixing Disruption
25. Pivot The rise of the Psychiatric Epistemology Bibliographies bear witness Part II Words have Power
26. Hoerikwaggo is not Table MountainDenali is not Mount McKinley Sagarmāthā or Chomolungma is not Mount EverestUluru is not Ayers Rock
27. Modernity as a Cultural Milieu – Here’s few you might know They weren’t facebook friends but they read across the line The New Scientists of the Mind The New Scientists of Religion Jean-MartinCharcot French 1825-1893 Max Müller German/English 1823-1900 Wilhelm Wundt German 1832-1920 Cornelius Tiele Dutch 1830-1902 Wilhelm Dilthy German 1833-1911 Edward Tylor English 1832-1917 Henry Maudsley English 1835-1918 Andrew Lang Scottish 1844-1912 William James, USA 1842-1910 Chantepie de la SaussayeDutch 1848-1920 Emil Kraepelin German 1856-1926 James Fraser Scottish 1854-1941 Sigmund Freud Austrian 1856-1939 Émile Durkheim French 1858-1917 Eugen Bleuler Swiss 1857-1939 Max Weber German 1864-1920 Pierre Janet French 1859-1947 W. Brede Kristensen Norwegian 1867-1953 Adolf Meyers Swiss/USA 1866-1950 Rudolf Otto German 1869-1937 Carl Jung Swiss 1875-1961 Arnold van Gennep Dutch/German 1873-1957 Karl Jaspers German/Swiss 1883-1969 Joachim Wach German 1898-1955
28. George de Loosten (1905) Jesus Christ from the point of view of a psychiatrist Emil Rasmussen (1905) Jesus a Compartitive study in Psychopathology William Hirsch (1912) Religion and Civilisation from the Standpoint of a Psychiatrist Charles Binet-Sanglé (1908-1915) La Folie de Jésus Albert Schweitzer (1913) The Psychiatric Study of Jesus 1,861 pages Size isn’t everything But… 78 pages
29. Modernity as a Cultural Milieu – ‘Jesus’ as object in the new sciences of the mind After Freud’s “The future of an illusion” (1927) there was a psycho-silence Rational godliness: after the mind of Christ 1855 R. Williams The mind of the master 1896 I. Maclaren Studies in the mind of Christ 1898 T. Adamson Laws of life after the mind of Christ 1901 J.H. Thom. Jesus and the gospel: Christianity justified in the mind of Christ 1908 J. Denney. The Psychiatric Study of Jesus : Exposition and Criticism 1913 A. Schweitzer. The mind science of Christ Jesus 1913 C.W. McCrossan. Christian Experience and Psychological Processes 1917 R. Rouse & H.C. Miller Jesus the Christ in the light of Psychology 1917 G.S. Hall. Christ’s view of the Kingdom of God 1918 W. Manson. Some Aspects of the Life of Jesus from the Psychological and 1923 G. Berguer. Psycho-analytic Point of View A study of the mind of Christ 1926 D. Jenks. According to the mind of Christ 1934 G.D. Henderson.
30. I I II III IIIR IV IVTR 5 Diagnostic & Statistical Manuals The Historiography of Psychiatry and Mental Illness English Language Source: Ngram Viewer 30 The data shows that Psychiatry and Mental Illness co-constitute each other.
31. In 1899 Emil Kraepelin simplifies a rich tradition of nosology by introducing a division • Dementia Præcox – on the one hand • Manic Depression – on the other
32. In a 1908 lecture Eugen Bleuler overwrites Kraepelin’s Dementia Praecox with ‘Schizophrenia’. Bleuler theorises ‘Schizophrenia’ in his 1911 Dementia Praecox: Or, The Group of Schizophrenias (Written in German it isn’t published in English until 1950 = 39 years later)
33. The Reification of Psychotic Diagnoses 1 2 4 3 5 6 Perälä Psychotic Pubmed Proportionate Prevalence Ratio Research Quantity As a % Nonaffective psychotic disorders - of which: 1.94 63% 57,181 49,833 7,348 15% Schizophrenia 0.87 28% 55,267 22,348 32,919 147% Schizoaffective disorder 0.32 10% 1,127 8,220 -7,093 -86% Schizophreniform disorder 0.07 2% 220 1,798 -1,578 -88% Delusional disorder 0.18 6% 191 4,624 -4,433 -96% Brief psychotic disorder 0.05 2% 19 1,284 -1,265 -99% Psychotic disorder Not otherwise specified 0.45 15% 357 11,559 -11,202 -97% Affective psychoses: of which 0.59 19% 21,407 15,155 6,252 41% Bipolar 0.24 8% 21,317 6,165 15,152 246% Major Depression with psychotic features 0.35 11% 90 8,991 -8,901 -99% Substance-induced psychotic disorder 0.42 14% 13 10,789 -10,776 -100% Psychotic disorder due to a Medical Condition 0.21 7% 2 5,394 -5,392 -100% Total psychotic disorders 3.06 100% 78,603 78,603 0 0% Excess/Deficit of Publications Data extracted from PubMed 8/3/2017 Hyman S.E, 2010, The Diagnosis of Mental Disorders: The Problem of Reification, Annual Review of Clinical Psychology 6:155-79. van Os J, 2016, “Schizophrenia” Does Not Exist, BMJ 352: 2 February 2016, Vol.352. Perälä J, Suvisaari J, Saarni S.I. et al. (10 others), 2007, Lifetime Prevalence of Psychotic and Bipolar I Disorders in a General Population, Archives of General Psychiatry 64, no. 1: 19-28.
34. Data Visualisation The Kraepelinian Dichotomy Schizophrenia & Bipolar Only 36% Prevalence But 97% of Research The Twin Towers of Psychosis Research
35. In the Middle Ages and until the Renaissance, man’s dispute with madness was a dramatic debate in which he confronted the secret powers of the world; Foucault M. & Khalfa J, [1961] 2006: xxxiv, History Of Madness, New York: Routledge. the experience of madness was clouded by images of the Fall and the Will of God, of the Beat and the Metamorphosis, and of all the marvellous secrets of Knowledge.
36. 25% of those occupying the secure psychiatric units of the West articulate their experiences in religious terms Foucault was right about the dominant narrative But wrong about the Mad reality (Brewerton 1997, Koenig 2009, Siddle 2012), (and, interestingly, Pinel 1806 who found 25 out of 113 cases due to religious fanaticism #42)
37. The Psychiatrist asks: Is the Shaman mad? But rarely asks if (some of) the Mad are Shaman?
38. van Os J, Linscott R, Myin-Germeys I, et al, 2009, A systematic review and meta-analysis of the psychosis continuum, Psychological Medicine, 39(2), 179-195. Psychotic Experience 8% Psychotic Symptoms 4% Psychotic Disorder 3% The Psychosis Continuum
39. Crazy Religious Stuff 1 2 Crazy Stuff No need to rehabilitate all the Mad: it’s a matter of nuance Psychotic Experience 8% Psychotic Symptoms 4% Psychotic Disorder 3% 25%
40. 1. Gearing et al. (2011) Association of religion with delusions and hallucinations in the context of schizophrenia found 70 relevant publications from 1980-2010 2. Bonelli and Koenig (2013) Mental Disorders, Religion and Spirituality 1990-2010 found 43 relevant publications from 1990-2010 3. Cook (2015) Religious psychopathology: The prevalence of religious content of delusions and hallucinations in mental disorder found 55 relevant publications from 1960-2014
41. Disappointing results: Driven by instrumental questions of how psychiatric outcomes might benefit from religious beliefs and practices Protective factors Risk factors Medication adherence Psychiatrists are oblivious to Religious studies scholarship
42. Pivot Ancient Acute Religious Experiences Post-Psychiatry Part III The Case Study…
43. I could just as easily do this analysis with Moses
44. I could just as easily do this analysis with Mansur Al-Hallaj
45. But I could just as easily do this analysis with Saver and Rabin’s reductionist selection in The neural substrates of religious experience P.B.U.H. St Paul Mohammed Margery Kempe Joan of Arc St. Catherine St Theresa Swedenborg Ann Lee Joseph Smith Dr Z Van Gogh St Therese of Lisieux
46. Episode 1 Episode 2 |------------------around three years----------| I’m going to re-read Jesus who had two episodes of visions and voices
47. Just as Jesus was coming up out of the water, he saw heaven being torn open and the Spirit descending on him like a dove. 11 And a voice came from heaven: “You are my Son, whom I love; with you I am well pleased.” Mark 1:10-11 Visions and Voices 1a
48. At once the Spirit sent him out into the wilderness, and he was in the wilderness forty days, being tempted by Satan. He was with the wild animals, and angels attended him. (Mark 1:12-13) Visions and Voices 1b
49. Visions and Voices 2 …led them up a high mountain, where they were all alone. There he was transfigured before them. His clothes became dazzling white, whiter than anyone in the world could bleach them. And there appeared before them Elijah and Moses, who were talking with Jesus. (Mark 9:2-4)
50. My argument: After the Disruption at the Transfiguration, Jesus pivoted towards Jerusalem intent on arriving during the magico- religious time of the Passover Festival, so he could die, like the prophets before him. Why? Because he had to. Driving the Destiny of Death
51. Provocation 1 – Becoming a Target Jesus entered Jerusalem and went into the temple courts. He looked around at everything, but since it was already late… (Mark 11:11)
52. Provocation 2 – Disturbing the Peace Jesus entered the temple courts and began driving out those who were buying and selling there. He overturned the tables… (Mark 11:15)
53. “Do you see all these great buildings?” replied Jesus. “Not one stone here will be left on another; every one will be thrown down.” (Mark 13:2) Provocation 3 – Blaspheming the Temple
54. And what of Judas? the chief priests and the teachers of the law were scheming to arrest Jesus secretly and kill him. 2 “But not during the festival,” they said, “or the people may riot.” (Mark 14 1-2)
55. Willing collusion not passive resistance But Jesus still made no reply, and Pilate was amazed (Mark 15:5)
56. Conclusion For the purposes of the EASR, where the limits of Psychiatry have been exposed, there is no need to protect ‘authentic’ religious experience from psychiatric reductionism, by recourse to a sui generis conceit. I suggest that scholars of religion can relax about the role of anomalous experiences, psychotic symptoms and the ambiguous status of Acute Religious Experiences in the study of religion. Because the visions, the voices, the delusions are not dangerous secrets but defining qualifications and characteristics of the experience of The More. The Seraph and the Snake lie down together.
57. The Mad were here first, before Psychiatry and before Religion And we’re not going anywhere