Faith & mental health.

Koenig, Harold G., M.D. (2005).

Faith & mental health: Religious resources for healing. West Conshohocken, PA: Templeton Foundation Press. Paper. 343 pp. $29.95 ISBN.1-932031-91-X.

In Faith & Mental Health, Dr. Harold G. Koenig, the leading authority on spirituality and health, examines what religion has done for and against people who struggle with emotional problems and mental disorders. He then looks at what people of faith are doing now to meet the needs of the mentally ill, and what more they could be doing. Dr. Koenig is professor of psychiatry and behavioral sciences and associate professor of medicine at Duke University Medical Center. He is director and founder of Duke's Center for the Study of Religion/Spirituality and Health. He has published and edits for numerous publications extensively.

While I have been a Christian a long time, I must admit, it takes tenacity to hold to faith in the unseen when such priority in this world and in this profession is placed on that which can be proven. In addition, it takes courage to believe in Jesus as the way and the truth when the world says He is but one way and one truth. Frequently I encounter clients with similar struggles. Faith, especially the kind that really impacts one's thinking and behavior, and makes a dent in one's adverse symptoms or negative relationships, seems to be increasingly rare. Take the example of a client I will call Tomas. Like the apostle, he was looking for some hard and fast evidence to convince him of the reality of God. Depressed and down trodden, Tomas cried in the initial intake as he described a sense of void and meaninglessness in his life. In assessing his spiritual beliefs, I found he had made a commitment to Christ as a teenager, but abandoned this faith early on, when life as an adult proved more complicated and painful than he had anticipated. Now in his late 20's he was wrestling with a lack of spiritual belief. Though full of doubts, he had not quite abandoned his search. Something (or someone) compelled him to seek answers, and I, as a witness to his profound spiritual struggle, pondered how to offer meaningful council.

Dr. Harold G. Koenig, one of the nation's foremost researchers in the area of faith and mental health explores this intersection in his recent book by the same name. Although he does so in a very politically correct way embracing all branches of spirituality from Islam to Buddhism, Native American spirit worship to Judaism, still, Christian clinicians can be grateful. He stands as a reputable, outspoken voice in a field where a cognitive, neutral stance is required if one is to gain any kind of meaningful secular respect. Such is the way of the unbelieving world in which we live. Faith requires a constant and heady defense. As co-director of the Center for Spirituality, Theology, and Health at Duke University Medical Center, Koenig seems a most likely candidate for making one. He is thorough in his coverage and fairly balanced in his conclusions. However, the Christian clinician looking for a practical handbook on the integration of faith and practice will need to look elsewhere for inspiration.

Divided into four main sections, Koenig begins the book with a historical account of how people of faith have influenced the field of social services and psychiatry. Next he offers a very thorough review of recent scientific studies linking religion and mental health outcomes, as well as an examination of "whether religious beliefs are associated with fewer (or more) symptoms and whether religious involvement predicts faster (or slower) resolution of psychiatric symptoms (pp.82)." There are also descriptions of numerous existing faith-based organizations offering everything from advocacy to addiction recovery, counseling to professional networking. He also provides a list of state resources, (however completely ignores certain states such as Washington, much to the disappointment of this Pacific Northwest therapist).

The book concludes with Koenig's views on what he terms barriers to research implementation and possible ideas for solutions. In this section he identifies the main problem with science in general and psychiatry in particular: they are not representative of the public and therefore, do not adequately reflect nor honor the beliefs of a more faith oriented society. For example, he points out that "among the most prestigious scientists in the National Academy of Science, only 4% said they believed in God, (compared with) 96% of the American population who say they believe.... Furthermore, psychologists and psychiatrists are the least likely (of all health professionals) to believe in God or be involved in religious activities (pp. 247)." Hence the lack of interest in either researching or funding studies examining connections between faith and mental health. In the solutions section, he poses a number of thought-provoking questions to ponder regarding future research to prove which type and which delivery of faith actually "works" best.

The book is undeniably a useful resource. His consolidated review of current research provides the kind of material Christian therapists or pastoral counselors will find helpful when mounting their own defense to skeptics questioning faith-based clinical practice. By suggesting "the growing consensus that religious factors in one way or another influence the mental health and well-being of persons with mental illness (pp.133)," Koenig clearly alludes to faith becoming an increasingly respected component in mental health care. Chapter six in particular outlines ten specific ways in which research is finding religion to have a positive impact on mental health. This kind of information makes a compelling argument for clinicians to address the spiritual needs of their clients. In the past, the trend has been to separate the spiritual from the clinical. Clinicians were encouraged to remain silent about their personal faith beliefs, and spiritual conversations were generally to be either avoided or referred to clergy. However, according to the research presented by Koenig, people seem to welcome spiritual conversations when they are in pain and attempting to make sense of their suffering.

With research revealing a positive connection between mental health and belief, it seems only ethical for the clinician to both assess and address a person's spiritual condition as part of therapy. Koenig would partially agree. On the one hand, he supports "religious" interventions with "religious" clients in therapy. However, he does not endorse using such interventions with "non-religious" patients or encouraging "non-religious" patients to become "religious" (pp. 145)." He states "the responsibility of the therapist lies primarily in helping patients understand how their religious beliefs either help or hinder their way of coping with problems (pp.154)." Thus he advocates spiritual assessment as important, but cautions against the misuse of religion in therapy. The reader will find a highly analytical text which provides a fairly strong argument based upon research, for the inclusion of faith in social services. However the Christian will quickly realize the kind of faith endorsed by the studies is a generic, whatever-works-for-you kind of faith rather than one based on truth. In this sense, I found the text to be like the spiritual experience of most of my clients: aloof and theoretical rather than vibrant and life changing.

I admire courageous advocates such as Koenig who at the academic levels of society are working to convince unbelieving intellectuals of the importance of the mind, body, spirit connection. Books like Faith and Mental Health offer credibility to the profession of Christian counseling and provide a foundation for the integration of faith into therapy. If as clinicians we can use the research to inform clients of the link between spirituality and well-being, we stand a chance of engaging them in faith conversation. But talking about generic spirituality is different than sharing the life-changing good news of Jesus. When working with clients like Tomas, the faith endorsed by the research feels anemic and powerless. Though Tomas initially admitted to an inner spiritual struggle, he did not list it as a major concern to be addressed in therapy. Thus, out of respect for his "non-religious" presentation, I focused on the topics he brought to the room: a recent relational break up, how alcoholism in his family of origin had influenced his sense of well-being, and career frustrations. Though it felt as if little progress was really being made, I waited. He remained extremely tearful, and amid clinical vigilance of his symptoms and the possible need for medication, I continued to silently intercede praying specifically for an opportunity to address what I perceived was the underlying problem. Then it came. A session began with his sharing about a friend who was also wrestling with depression, but had found comfort in the daily reading of tarot cards. My client found this to be an interesting idea and said he too might give it a try. I commented it appeared he had realized a possible connection between the depression and his lack of spirituality. He agreed. I asked about his belief in the supernatural and he agreed it was an area of curiosity. The conversation segued into a theoretical discourse on the differences between good and evil, Christ and the devil, Christianity and spirituality. Attempting to make it more personal I asked,

"If Jesus came and sat beside you, what would you like to ask Him?"

He did not ponder long before replying,

"I would ask 'who is your favorite person'?"

"What if He said ... you?" I returned.

"I would say, 'where have you been all my life'?" he laughed, then more seriously confessed it would be hard to believe. "I mean, out of all the people who have done good things in the world why would he ever choose me?"

I continued "What if He said it wasn't about your being good, but rather about His goodness ... that He loved you because He created you."

His eyes filled with tears as he admitted it would be wonderful.

I cannot say if or how the type of spiritual conversation I had with Tomas will begin to fill the voids in his life or alleviate his sadness. Clearly, his responses revealed a deep hunger for love and favor from God. Would being convinced of such love help his depression? Koenig implies that the research is saying it could, but so too, apparently could the daily reading of tarot cards. Until a study actually reveals the Christian faith as superior to any other faith, it will remain in the eyes of the unbelieving world, simply another form of religious intervention. Until then, I guess as Christian therapists we continue to tenaciously and courageously walk by faith and not by sight.

REVIEWERS FOR THIS ISSUE

ANDERSON, TAMARA L., Ph.D. is Associate Dean of Graduate Students and Associate Professor of Psychology at Rosemead School of Psychology, Biola University. Dr. Anderson teaches in the areas of psychopathology, ethics and law for psychologists, and clinical supervision. She also maintains a private practice in Fullerton, California as a Clinical Psychologist.

TIMMINS, CAROLINE, M., M.S. is a private marriage and family therapist at The Shepherd's Center for Psychological Services in Gig Harbor, Washington. She received her undergraduate degree from Biola University and her graduate degree from Seattle Pacific University.

Reviewed by CAROLINE M. TIMMINS, MS