March 12, 2014

Religious Belief is Not a Mental Illness

English: An American Lady butterfly against a ...
English: An American Lady butterfly against a cloud-filled sky. (Photo credit: Wikipedia)
I read Chris Stedman's post for Religion News Service, "5 reasons atheists shouldn't call religion a mental illness" and some of the reactions to it with interest. Stedman receives quite a bit of criticism in the atheist community for being overly accomodationist at times; however, this does not mean that much of his work is not still worthwhile.

I think he raised some good points in this post, and I agree with his conclusion that we atheists probably shouldn't call religion a mental illness or label all religious believers as mentally ill. My reasons for doing so overlap with his but are a bit simpler.

After consulting with "two atheist activists," Stedman offers the five reasons listed below:
  1. Even if well-intended, the equation fails
  2. Mental illness is not an insult
  3. Religion is often associated with wellbeing
  4. This parallel distracts us from trying to understand and learn from religion
  5. Atheists and theists share in the challenge of being human
If Stedman writes more on this subject in the future (and I hope he does because I enjoy his work), I'd recommend that he try consulting mental health professionals instead of atheist activists. I imagine that he'd find that more useful if the goal is to understand mental illness, how it is defined, and the process through which mental disorders are diagnosed.

While some of the five reasons Stedman offers are relevant and I certainly welcome efforts to challenge the manner in which mental illness has been stigmatized, the first reason is the only one I find necessary here. Atheists probably should not call religious belief a mental illness because religious belief is not a mental illness.

None of the major diagnostic systems currently in use contain mental disorders for which religious belief is the defining feature. Religious belief is not recognized as a mental illness. Moreover, the primary system used by mental health professionals in the United States, the DSM-5, cautions against labeling something as a mental disorder when it is actually an accepted part of an individual's cultural context.

As explained in DSM-5, a mental disorder not only includes all the disorder-specific criteria but the following general elements:
A mental disorder is a syndrome characterized by clinically significant disturbance in an individual's cognition, emotion regulation, or behavior that reflects a dysfunction in the psychological, biological, or developmental processes underlying mental functioning. Mental disorders are usually associated with significant distress or disability in social, occupational, or other important activities. An expectable or culturally approved response to a common stressor or loss, such as the death of a loved one, is not a mental disorder. Socially deviant behavior (e.g., political, religious, or sexual) and conflicts that are primarily between the individual and society are not mental disorders unless the deviance or conflicts results from a dysfunction in the individual, as described above (American Psychiatric Association, 2013; p. 20).
There is far more to the diagnosis of mental disorders than picking up a DSM-5 and consulting disorder-specific criteria. The manual is not designed to be implemented in such a cookbook approach but as a complex system that requires considerable training and clinical experience. It is not intended as a tool to be applied by lay audiences but as a system for use by mental health professionals.

Nothing I have said here means that it is impossible to conceive of a scenario where religious beliefs might rise to the level of mental illness. It is certainly possible to do so; however, an accurate example would end up being fairly restrictive. It would likely require the beliefs in question to result in clinically meaningful distress and/or disability to the degree where the individual would be recognized as clearly abnormal by those within his or her religious tradition. Such an individual would not simply have strange beliefs; he or she would act on them in ways that resulted in significant problems.  

DSM-5 cautions:
Diagnostic assessment must therefore consider whether an individual's experiences, symptoms, and behaviors differ from sociocultural norms and lead to difficulties in adaptation in the cultures of origin and in specific social or familial contexts (American Psychiatric Association, 2013; p. 14).
It is difficult to imagine that most religious belief gets anywhere close to these thresholds, especially when it is not paired with behavioral abnormalities severe enough to cause problems in someone's daily life.

I have worked with individuals in psychiatric hospitals and outpatient community mental health settings who suffered from schizophrenia and other psychotic disorders and whose symptoms included religiously-themed delusions. It would be difficult to mistake most of them for run-of-the-mill religious believers even though the line between religious delusion and the sort of beliefs held by some religious extremists can be fuzzy at times. Not only were their beliefs far outside what would be accepted by any religious tradition, but their religious beliefs were only one part of much larger syndromes. In most cases, one symptom does not make a mental disorder. Some specific religious beliefs can be held with delusional intensity by persons with psychotic disorders. But this is very different from asserting that anyone who holds any religious beliefs at all is mentally ill.

If some want to argue that our definitions of mental illness should be revised so that certain forms of religious belief (e.g., religious extremism) - or even religious belief itself - becomes diagnosable mental illness, they are free to make such an argument. This is not the argument I am addressing here and not one I would be inclined to make.

Assuming that we atheists wish to be accurate in our communication, we should probably refrain from referring to religious belief as a mental illness for the simple reason that most religious belief is not mental illness, at least not using our current definitions of mental illness.

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