When To Counsel, When To Refer

Misunderstanding of Religion

1. People may develop delusions (a firmly held false belief) of being special agents of God with a divinely inspired mission. They may believe that they are a biblical prophet or saint, the Virgin Mary, the Messiah or even God. While the more conspicuous delusions are easy to recognize, the more subtle delusions may be more difficult. For example, it is not always easy to differentiate between a true call to divine ministry and a manic delusion. One thing that can help a pastor is to assess the person's ability to accurately evaluate his/her gifts and limitations for the intended role. The more accurate or realistic the evaluation, the less likely the thinking is delusional.

2. People with a preoccupation with apocalyptic, end of the world teaching and practices may attempt to warn others of impending doom. They may feel that they are personally responsible for leading or preventing the messianic age or the second coming of Christ. The way to evaluate this situation is to take into account the accepted theological position of that person's religious upbringing and current faith connection. It is essential that a person's concern be viewed within the context of his/her faith traditions, cultural heritage and religious history.

3. Some people have a need for repeating religious rituals. In this instance a person's behavior should be compared to the practice of his/her faith tradition. Attending confession only once in several years is not necessarily unusual for some Roman Catholics. Attending confession ten times in one day, however, may indeed be an indication of a serious problem. Another example would be answering several altar calls over several months. It may be usual in some denominations, but if the calls are in five different churches within two weeks this behavior may be symptomatic of a mental illness.

4. Some people believe they have exceptional spiritual gifts. If they are from a charismatic or Pentecostal background, they may claim to speak in tongues or to have the "gift of tongues." In the context of these faith traditions this may not be out of the ordinary. However, individuals with a mental illness may also believe they have the "gift of tongues" or feel God has given them prophetic words to speak. Both situations can seem bizarre. Again, an understanding of the persons' faith history and current status is essential in assessing the situation.

5. It can be very difficult to evaluate someone when he/she has a belief in angels, demons and other supernatural forces and events. When someone claims to have seen a vision or to have heard the voice of God, a pastor cannot assume that this is evidence of mental illness. And, neither can he/she assume such things are instances of supernatural reality. Compassionate care with an appropriate understanding of the person's thinking and behavior in spiritual, personal, social and cultural contexts can provide clues to assessing if there is a need for a referral to a mental health professional (Weisinger, 1991, 36-38).

Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, DSM-IV, (1994) American Psychiatric Association, Washington, D.C.

Dombeck, M. and Karl, J. (1987) "Spiritual Issues in Mental Health Care," Journal of Religion and Health, Vol. 26, No.3, Fall, 183-197

Eimer, K. W. (1985) "The Assessment and Treatment of the Religiously Concerned Psychiatric Patient," The Journal of Pastoral Care, Vol. XLIII, No. 3, 231-241

Lukoff, D., Lu, F., Turner, R. (1992) "Toward a More Culturally Sensitive DSM-IV," The Journal of Nervous and Mental Disease, 180 (11), 673-682

Shfranske, E. (1991) "Beyond countertransference: On being struck by faith, doubt and emptiness," paper presented at the annual conference of the American Psychological Association, New Orleans, LA

Spero, M. H. (1987) "Identity and Individuality in the Nouveau-Religious Patients: Theoretical and Clinical Aspects," Psychiatry, 50, 55-71.

Uken, R. (1986) "Living with Schizophrenia: A Pastoral Perspective" Pine Rest Today, 8-9

Wagner, W. (1985) "Pastoral Care of the Psychiatric Patient," in Toward a Creative Chaplaincy, Holst, L. E., Kurtz, H. P., (Eds.) Charles C. Thomas, Springfield, Illinois, 78-86

Weisinger, K. R. (Ed.) (1991) Manual for the Clergy: Resources for Helping and Healing, Mental Health Association of Houston & Harris County, Houston, TX