April 27, 2002 RELIGION JOURNAL
Finding the Place of Faith in Psychiatric Treatment http://www.nytimes.com/2002/04/27/national/27RELI.html?tntemail1 By MAREK FUCHS Hasidic boy, 16, was a patient in a psychiatric ward and hearing the voice of God. Dr. Samuel Klagsbrun, his psychiatrist, wrote a medical order for the boy to be sure to put on his tefillin, the black arm wrapping that religious Jews wear when praying, as he normally would. "It raised some eyebrows," said Dr. Klagsbrun, who added that finding relig ion's proper place in psychiatry was "a true art form." In this case, hearing God's voice fell under the category of psychosis and had to be treated, but the boy's identity as a member of the Hasidic community was an organizing force in his life and needed to be retained. Finding the balance between religion and psychiatry has been a chief focus of Dr. Klagsbrun's life. Born in Belgium to an Orthodox Jewish family, Dr. Klagsbrun became a refugee in World War II, landing in Brooklyn in 1941 at the age of 9. Educated in yeshivas, he went on to the Jewish Theological Seminary in Manhattan. "But I never wanted to become a rabbi," he said. Eventually, he left the seminary to go to medical school to follow his passion, psychiatry, which, he soon discovered, all but ignored religion. "Psychiatrists were not paying any attention to religion or the spiritual aspects of life," Dr. Klagsbrun said. "And religion and religious values and backgrounds and spiritual dimensions are extremely important to people's dynamics." In his five decades in the field, Dr. Klagsbrun, who is now executive medical director of Four Winds Hospital in Katonah, N.Y., said that the relationship between religion and psychiatry had evolved considerably. Like Four Winds, many psychiatric hospitals have broadened the scope of religious counseling offered; psychotherapists have become more comfortable handling religious issues; and clergymen, often the first people those with mental illnesses turn to, are seeking out psychological education and experience. Dr. Klagsbrun himself is back at the Jewish Theological Seminary, where he is now a professor of pastoral psychiatry. All of this is quite a change from the historic relationship between religion and psychiatry, one that was fraught with distrust and unease. >From the primitive thought that mental illness was linked to possession by the devil, Freud's more general skepticism of religion took hold in the first half of the last century, creating hesitancy on the part of many in the psychiatric field to even address the subject. Barbara Stimmel, a psychoanalyst and the president of the New York Freudian Society in Manhattan, said that the divide was not entirely Freud's fault. Like many others in the intellectual and scientific fields, Dr. Stimmel said, Freud was personally wary of religion, but "was not such a super rationalist that he denied the mystical, the spiritual and the transcendent." American Freudianism, however, became obedient to an orthodoxy that made no distinction between Freud's personal and professional thoughts. "But," Dr. Stimmel said, "Freud did know that no psychoanalyst worth his salt would ever leave religion out of a psychoanalytic relationship." Dr. Harold G. Koenig, a professor at Duke University Medical Center and the author of "The Healing Power of Faith: Science Explores Medicine's Last Great Frontier" (Simon & Schuster, 1999), says members of the clergy are also becoming better schooled in psychological matters. "They used to feel that depression was something you could snap out of if you read the Bible and went to church enough," Dr. Koenig said. "It's been a struggle to get them to realize that it could be biological, not the product of weak faith." For Dr. Klagsbrun, a defining moment came early in his career when he was doing a rotation at a Veterans' Administration hospital in Connecticut. "There was a profoundly depressed patient who had been there for seven years," he said. Because psychiatrists rotated on six-month stints, Dr. Klagsbrun said: "I was his 14th psychiatrist, poor fellow. He looked at me kind of despairingly, and I didn't blame him." The patient did not want to tell his story yet again, and Dr. Klagsbrun, assuming there would be no new ground to cover, said he thought that "I'd be putting it on autopilot." But Dr. Klagsbrun posed a simple question about religious upbringing, and issues surrounding a strict Roman Catholic childhood came tumbling out. The patient expressed surprise that after all his psychiatrists, Dr. Klagsbrun was the first to ask about his religious background. Then he expressed apprehension that, during the course of therapy, Dr. Klagsbrun could ever comprehend his feelings of guilt. "I had to assure him that an old yeshiva boy knows a thing or two about guilt," Dr. Klagsbrun said. But just as religion must be seen as an organizing force in people's mental health, Dr. Klagsbrun said, it also needs to be looked at for its potential to cause harm. "It's a bit of a no-no," he said, "but we need to examine to what extent a religious upbringing opens the door to problems." The most obvious cause, he said, is repression. In religious families, communities and organizations, he said, "unacceptable thoughts are considered a sin and are pushed away, put in a mental repository where they go unexamined." Because of his background and ability to speak Yiddish, Dr. Klagsbrun sees many Hasidic patients. In all such insular communities, he said, there is a tendency to "hide mental illness as much as they can until they can't hide it anymore." But forgiveness and the sense of new beginning - the most basic tenets of all religions - "also go hand in hand with psychotherapy," Dr. Klagsbrun said Although people like Dr. Klagsbrun's 16-year-old patient who hear God's voice - or think they are God - remain the most noticeable example of religion's intersection with psychiatric illness, the more common problem is those with depression so severe that they lose everything, even the faith that once explained the world to them. "These people," Dr. Klagsbrun said, "are the hidden tragedy." --- You are currently subscribed to tips as: [EMAIL PROTECTED] To unsubscribe send a blank email to [EMAIL PROTECTED]
