WHAT’S THE MATTER WITH NED? HE CAN’T SAY WHAT’S BOTHERING him. An MBA student, blond and clean-cut, he tries to explain why he’s come, but I’m still waiting.
What could it be? Students confide in me about all sorts of misbehavior and foul play, and they do it without hesitation. I’ve heard about cheating, plagiarism, shoplifting, forgeries, infidelities, and property destruction. Students report on their DUIs, arrests, dismissal from school. They all manage to spit it out. So what’s Ned’s problem?
“I don’t think you’ll understand,” he says. “I’m Catholic. I’m married, and I love my wife.”
I wait.
“We’re happy together, and we want to start a family soon.”
I wait again.
“There’s something I do that I want to stop…. It may not sound like much to you, but for me it’s awful—and it causes my wife pain.”
He looks at me.
“I have urges to look at pictures of women. Sometimes I give in and go online, or I buy a magazine. Not pornography—maybe the Sports Illustrated bathing suit edition or a Victoria’s Secret catalog. I’ve confessed, I’ve prayed, I’ve even fasted, and nothing has helped. You probably don’t think it’s a big deal. But I want to stop—it’s not Christian, and it hurts my wife…can you understand?”
This is his lucky day, I thought.
“Yes, I understand. I’m religious too. My son would feel the same way.”
His mouth drops, and his eyes open wide. “You are? He would? Wow—that’s great!”
Ned had expected a culture clash. He’d assumed I’d think him overscrupulous, his religiosity extreme. Although wrong in this particular instance, Ned’s instincts were correct: most psychiatrists and psychologists do not share his worldview. 1 Ned’s whole approach to life—like that of three-quarters of Americans—is based on his faith. His relationship with Jesus is central, and he turns to the church for guidance. But a majority of clinical psychologists have left the religion of their upbringing, and they rarely attend religious services. 2 In one survey, a majority characterized their beliefs and practices as an “alternative spiritual path which is not a part of an organized religion.”3 In another, 25 percent of psychologists thought God is “a product of human imagination.”4
How do these numbers compare with the religious identification of other highly educated professionals? In one survey, 5 university faculty were asked about their current religion, and the percentage in each department saying “none” was compared. Fifty percent of psychology faculty had no religion, as compared to 27 percent of physicians and 16 percent of dentists. Compared to the general population, psychologists are almost five times more likely to be agnostic or atheist. 6 When a therapist thinks her client follows an extreme ideology—especially when it is an ideology opposite to hers—it can affect her personal response and clinical judgment in a negative way. 7 She may consider the client more disturbed and less mature; she might not like him as much, and the therapy could be less successful.
Ned was relieved to have me as his doctor. I learned of other compulsive behaviors, and suggested medication. We spoke about the importance of prayer and hope, and agreed that while we both need to do everything we can, ultimately a cure comes from above.
While Ned was surprised to find a religious psychiatrist, I found him unusual as well. Having worked with university students for years, I take in stride the pierced lips and tongues, the tattoos, shaved heads, or dreadlocks. I’m not surprised when students can only estimate the number of sexual partners they’ve had or admit to using hallucinogens, passing out from alcoholic binges, or picking up strangers in bars. I am (fairly) comfortable with a patient who appears to be male, but has breasts and menstruates.
Ned, in contrast, values chastity and self-restraint. He prays, gives to charity, and strives for godliness in his life. After abstaining from sex, he married his high school sweetheart and now wants to be a father. Now that’s strange.
Reading the campus newspaper—or the pamphlets in our waiting room—suggests that for most students, affairs of the spirit are the last thing on their minds. It would appear that students are primarily concerned about their sexual health and identity, drugs and alcohol, academic success, learning how to relax, and getting enough sleep. Not that those issues aren’t important, but the results of a national study of thousands of college students support a different conclusion. 8 Over three-quarters of students said they pray, and nearly as many report they are “searching for meaning and purpose in life.”
Prayer, meaning, purpose—on our college campuses? Who would’ve guessed? And here I thought young people just wanted to get good grades and avoid genital warts!
The study also indicates that students who are highly involved in religion report better mental health: non-church-going students are seven times more likely to feel overwhelmed, nearly three times more likely to rate themselves “below average” in emotional health, and twice as likely to report depression or psychological distress. How do the researchers define “religious involvement”? These are the students who read sacred texts, attend religious services, and join religious organizations on campus. 9
Sarah is one such student. She studies the Book of Mormon daily and is immersed in church activities. She told me the following story.
Sarah called the student health center for an appointment. She and her husband wanted another child, but Sarah needed medication in order to conceive. “This is the right time for us to try,” she explained. “If I don’t take the medication soon, it may be many months until our next opportunity. Could someone please see me in the next day or two?” No, she was told, the next available appointment for that is in two months. “Two months!—but all I need is a prescription, I’ve used it before, and it’s on my record. Are you sure?” Yes, I’m sorry, two months.
She hung up, upset and frustrated. Then she had an idea, and called again. “Hello, I need an appointment to get some birth control.” It was eleven o’clock. Birth control? Sure, when do you want to come? I have 11:30, 12, 12:30…
She took the twelve o’clock. After all, Sarah told me, it was birth control—but of a different sort: she wanted a baby!
You have five children, why would you want to get pregnant? the physician asked. “Because I want another child!” Sarah explained. The doctor didn’t buy it. “You don’t need help ovulating,” she announced, “you need birth control.” And she left the room.
Stunned and hurt, Sarah sang a hymn to herself, and was able to calm down. She reminded herself that the decision to have a child is between a husband, a wife, and the Lord. She didn’t need anyone else’s approval. She focused on the teaching that bearing a child is a great blessing, the noblest calling for a woman. When the doctor returned, Sarah tried a different approach. “I hope to go to law school next year,” she said, “and I want to have one more child before I start.” The doctor weighed this new information. Law school? You’re going to law school? “Yes,” Sarah told her. She got the medicine.
“What a shocking story,” I said to her. “What an ordeal. How did you feel?”
“I’m used to it. I expect those people to give me a hard time. It’s like asking an abused woman how she felt the tenth time she’s beaten.”
Let’s compare Sarah’s experience with the tolerance on campus of another student. Kris, a chemistry major, came to see me for evaluation. He is on his way to becoming a man: his beard is coming in, and his voice is changing. But it’s not what you think—Kris is not a boy becoming a man. Kris—aka Kristina—is a woman becoming a man.
Kris’s appearance is rather odd at the moment: he has the start of a beard and mustache as well as large breasts. I am touched by the story of his journey, and impressed with his intelligence, humor, and courage. Some people might feel awkward and unsure of how to relate to him, but I’m at ease—I attended a program at the university about transgenders. A workshop was held for the counseling center staff, to sensitize us to the unique issues facing this group. There was a guest speaker, a therapist with expertise in counseling “trans folk,” and a female-to-male transgender described his experience and took questions. I heard about childhood struggles, hormone treatments, surgical procedures, hate crimes, and discrimination. I learned about “Patriot Act Hell”—documents like driver’s licenses and school records cannot be changed. One’s birth name and sex are still there, so one is automatically “outed.” I was informed of the proper language to use: to say “chest surgery,” not “mastectomies.” When I’m not clear whether a patient wants to be considered male or female, I was taught, I should ask.
I learned that the “gender binary system” of male/ female isn’t accurate; that the male whose sense of himself is that he is a man, is masculine, and is attracted only to women, and the woman whose sense of self is that she is female, is feminine, and is attracted only to men, are “stereotypes.” My colleagues and I were gently advised to “start with ourselves, and examine how we are programmed into a binary gender system,” and to reject it, because “we all benefit from breaking down the gender binary.”
I’m glad I attended the program. My “cultural competency” got a boost—even if I don’t agree with the ideology. I am now better equipped to care for Kris and the other .08 percent of students on campus to whom these issues are relevant.
“Cultural competency” is very big right now in health promotion, especially campus health. The American College Health Association’s Cultural Competency Statement declares,
We…believe that healthy communities must be guided by the values of inclusion, respect, and equality. Intolerance and subtler forms of insensitivity or exclusion have no place at an institution of higher learning…. We therefore commit to: Foster an inclusive, affirming, and respectful climate…. Promote the cultural competence of individuals and organizations with respect to race/ ethnicity, gender, sexual orientation, disability, religion, and other identities…. Engage in the personal and professional growth required to embrace individual and institutional diversity…. Through these efforts we will enhance our services, foster our own personal and professional development, and advance the health of all students.10
Now, if “cultural competency” is a valid concept in health and psychology (and some question that11), it’s fair to ask: where do Ned and Sarah fit in? Given the tsunami of calls for tolerance, diversity, and multiculturalism, given the policy statements, declarations, ethically mandated culturally sensitive behavior, training programs, professional requirements, and hiring preferences, it’s fair to wonder: when is the workshop sensitizing staff to beliefs and practices of strict Roman Catholics, Mormons, Evangelicals, Baptists, and Orthodox Jews? 12 When will health and counseling center staff be told to examine their own misconceptions and bias, and to recognize the offensive and sometimes hostile experiences a religious student faces on campus?
Ned wants to know: Is there a therapist here who shares his values and lifestyle? He believes abortion and homosexuality are forbidden—do we have a psychologist or social worker who won’t automatically label him a religious extremist and a homophobe? Sarah asks: Is there a counselor whose own life is pious and disciplined, who can identify with her and the lifestyle she’s embraced—patriarchal family and all? And I wonder: What efforts are being made, pursuant to the calls for inclusion and affirmation, to increase the sensitivity and respect for these students and their culture—a culture that believes God created the world, and gave us rules to live by?
I once asked about this, when our center had an open position for a social worker. I suggested to a collegue, who I knew to be a dedicated, compassionate psychiatrist, that perhaps we could recruit a therapist from a community of faith. Students making appointments sometimes ask for a Christian therapist, and in fact, I said, thinking of Ned, I am seeing a student right now who prefers a counselor who shares his religious values. Well, he answered, any of our therapists could work with him, because a good therapist is able to work with clients whose values differ from theirs. He added that he, a biracial man, once counseled a client who was sympathetic to the Klan, and it was difficult, but he was able to do it. That may be so, I said. Still, in the past we’ve recruited applicants who were gay or lesbian, or belonged to racial minorities because our staff is supposed to reflect the diversity of the campus. And there is a subpopulation of students on our campus who are from fundamentalist religious communities. 13 So isn’t it reasonable to recruit a therapist with expertise in working with those clients? “No,” he said, “I don’t believe we are allowed to do that.”
Let’s look at this closely. Ned and Sarah have paid their registration fees and student insurance premiums, just like other students. These monies fund our center. Like everyone else, they are entitled to nonjudgmental, culture-affirming health care. But unlike a Latino, black, or lesbian student, students like Ned and Sarah will not find a therapist at the student counseling center with their conservative social values. And unlike Kris, Sarah—now joyfully pregnant with her sixth child—avoids the health center, because of her painful and offensive encounters there. You see, the doctors, nurses, and ancillary staff there are aware of the medical needs of the transgendered student, and they won’t be thrown off when a male student comes in for his yearly Pap smear. But are they sensitized to the needs of devout women like Sarah? Are they encouraged to embrace and respect her minority, in which the job of “family planning” is given over to God, and every child is welcomed as a gift and a blessing? Yes, even a sixth pregnancy. Because in Sarah’s culture, in her community, there are no “unwanted pregnancies.” The very concept is offensive and distressing.
“If it wasn’t for Jesus, I wouldn’t be here anymore. I’m sure of it.” That’s how Melodie answered when I asked what kept her going. She’s a twenty-year-old Asian American woman, an accomplished tennis player who can’t play due to a series of injuries. She also has financial and academic stressors. But when Melodie felt like jumping off a building, her beliefs stood in the way.
Like many people with strong religious faith, Melodie is less likely to end her life. 14 Believing the body sacred, and suicide a sin, restrains her from self-destructive behavior. But it’s not only fear of punishment that has saved Melodie. It’s also hope, and meaning.
When it comes to preventing suicide, hope is a very big deal. All things being equal—the depth of a depression, the severity of life events—the presence or lack of hope can mean the difference between life and death. 15 Melodie draws hope from the Gospel of Luke and Psalms. She carries a Bible in her backpack. Sometimes she prays between classes. Paxil and cognitive therapy notwithstanding, Melodie credits her survival to her church: it has had the most profound influence on her struggle. I agree.
Sincere devotion and frequent participation in a religious community benefits mental health. 16 A place of worship provides structure, a community, and meaningful relationships. Religious commitment encourages healthy behaviors, such as avoidance of smoking, alcohol, drug use, and sex outside of marriage. By lowering disease risk, it increases well-being. Prayer and other rituals are associated with positive emotions like empowerment, contentment, self-esteem, and love. Most important, regardless of faith and denomination, sincere religious devotion infuses life with depth, meaning, and hope—the polar opposites of the emptiness and despair associated with suicide. Indeed, the intolerable mental pain of meaninglessness has been called “the essence of the suicidal mind.”17
Large numbers of studies, performed at secular medical schools and schools of public health, indicate that practicing a mainstream faith confers significant health benefits. People who use “religious coping”—prayer, confession, seeking strength and comfort from God—adjust better to stressful life events such as kidney transplant, cancer, the Oklahoma City bombing, the death of a close friend, and the loss of a child through sudden infant death. 18 Devotion and participation in a religious community significantly decrease the likelihood of depression in at-risk adolescent girls. 19 In a survey of nearly 35,000 adolescents, religiousness was inversely associated with dangerous behaviors: binge drinking, marijuana use, cigarette smoking, and premarital sex. 20 A study of children whose parents had severe mental illness showed some were strengthened by “the sense of incorporating something larger than oneself.” To the researchers’ astonishment, some of these children climbed to success and health through intense affiliations with religious groups. 21 Frequency of prayer is associated with long survival in persons with HIV/AIDS. 22 Religiosity and spirituality is associated with lower blood pressure in older adults. 23 Attending religious services once a week may be a more cost-effective way of living longer than taking cholesterol-lowering medication. 24 After studying the relationship between attending religious services and mortality, a professor of preventive medicine concluded: “I think I’ll go to church.”25 Yes, people who go to church live longer. 26
Attitudes fostered by religious or spiritual paths have been examined, and Ph.D.s confirm what common sense already tells us: forgiveness promotes personal and marital happiness; gratitude contributes to well-being; and optimism is associated with better outcomes. 27
Now don’t get me wrong. I’ve written plenty of prescriptions for devout patients who struggle with debilitating sadness, obsessions, violent outbursts, or psychotic episodes. Members of religious communities, like everyone else, suffer from every symptom in the book—I refer here to psychiatry’s bible, Diagnostic and Statistical Manual of Mental Disorders, or DSM-IV. Some ministers beat their wives, some rabbis abuse children, some Catholics commit suicide. But these facts do not justify the omission by therapists of faith as a potential source of meaning and comfort for their distressed clients.
One NIH researcher wrote, “Results…have been consistent in indicating a salutary relationship between religious involvement and health status…. This finding has been observed in studies of old, middle-aged, and young respondents; in men and women; in subjects from the United States, Europe, Africa; in research conducted in the 1930’s and into the 1990’s; in case-control, prospective cohort, cross-sectional, and panel studies; in Protestants, Catholics, Jews, Muslims, Buddhists, Parsis, and Zulus.”28
Memo to the American Psychological and Psychiatric associations: Believing in God is good for you. A sense of meaning and purpose benefits mental health. It toughens the skin, and softens the blows of life. To know there is a larger plan, to believe that events are not random, and that you and your behavior matter—this can soothe and heal. To have gratitude and hope, to forgive oneself and others, and to connect with something greater than oneself though prayer and ritual—this is great medicine, maybe even better than Zoloft. And mind you—I love Zoloft; I’ve prescribed tons of it.
Given the very strong evidence that religious faith is associated with health benefits, especially mental health, one would expect doctors, nurses, and therapists to be reminding their patients about it 24/7. But think back: has your internist ever mentioned that optimists have stronger immune systems, or that churchgoers live longer? Has your family therapist told you that religion protects against adolescent drug and alcohol use, early sexual activity, and suicide?
Probably not. Medical providers typically ignore the role of faith in health maintenance. Psychotherapists do too. It’s fair to say, in fact, that in mainstream clinical psychology, religion is taboo.
A book could be written on this alone, but a few examples will have to do. Consider that psychology is the study of the mind—thought, emotion, and behavior. Polls consistently show that about 95 percent of Americans believe in God, almost 90 percent pray to God at least occasionally, and about 60 percent attend a place of worship monthly. 29 Eighty-five percent consider religion “very important or fairly important” in their lives, and 80 percent believe religion strengthens family life. 30 Religious beliefs predict behavior more than race, education, or economic status. Religious beliefs are protective against suicide, 31 substance abuse, and risky sexual behavior. Now consider:
There is a name for the irrational antagonism that psychology has for religion: theophobia. I suggest that most psychologists, 41 who themselves have made a conscious decision to leave the faith of their upbringing and whose circle of professional and personal associates consists mostly of secular, humanistic persons like themselves, experience discomfort discussing God and other ultimate issues, and therefore avoid them. Such topics, they mistakenly believe, are important only to a small fringe group. These highly trained professionals hold stereotyped views of religious people as uneducated and primitive. Why would a self-realized, fully mature person turn to the pope for guidance? How can an intelligent adult believe that the world was created in six days? Why would a woman living in this century have ten children? The notion that God hears and responds to prayers is childish. Fundamentalists must be disturbed. These prejudices and misconceptions are rooted in psychologists’ own ignorance, guilt, fears, and insecurities.
Theophobia is endemic to campus health and counseling; issues of faith are absent in the evaluation and treatment of distressed college students. 42 For example, the initial interview with a student includes many questions, some of them deeply personal: Do you drink too much? Have you ever been suicidal or homicidal? What method of birth control do you use? Are you questioning your sexual orientation? Was there verbal, physical, or sexual abuse in your family? And some of them not: Do you smoke? How much coffee, tea, and soda do you drink? But these are absent: What gives your life meaning? Do you believe in God? For what do you pray?
These questions are vital. They are just as important as the routine questions about alcohol, drugs, cigarettes, caffeine, sleep, exercise, and abuse. When first meeting a patient, therapists are urged not to assume heterosexuality. This would be evidence of “heterosexism,” says the APA. It’s essential for a therapist to ask about sexual orientation; the patient may not offer the information on his own. But the neglect of a patient’s religious beliefs also makes an assumption: the patient has none. By omitting faith and existential issues from her work, a therapist deems them irrelevant, putting her dangerously out of sync with some students, and losing a potentially powerful component of treatment. With Prozac the number-one prescribed medication on college campuses, 43 and with about 1,100 student suicides each year, this is alarming indeed.
Acknowledgment of the role of religion in students’ lives is also strangely absent from a recent book, College of the Overwhelmed. 44 The authors, one of whom is chief of the Mental Health Service at Harvard University Health Services and a national expert in the field of campus mental health, write in their introduction, “This is a book about the extraordinary increase in serious mental illness on college campuses today and what we can do about it.” College students are stressed to their limits, they explain. They face many challenges: leaving home, competing for grades, getting along with roommates, dealing with relationships, sexuality. There are parental pressures and cultural expectations. The job market is shrinking, and there is a post-9/11 culture of fear. For some students, it’s simply more than they can handle. Therefore the dramatic increase in depression, eating disorders, self-mutilation, substance abuse, and suicide. What to do? In the sixty-page section of the book titled “The Solution,” the authors advise: Universities must strengthen student counseling services. Parents must improve communication, know warning signals, and be proactive. Students have to take better care of themselves (exercise, drink enough water, choose healthy snacks, sleep well…), stay connected with family, learn to manage their time, and know when to ask for help.
The authors seem oblivious to affairs of the spirit, at least in this book. Do they not recognize this deeper dimension of their patients, the drive to find meaning and purpose and to connect with something greater than themselves? Is it not relevant to their topic that spirituality in college students tempers the impact of stressful events? 45 That young adults returning from two years of missionary work had higher self-esteem, and greater purpose in life? 46 What about the evidence supporting the protective quality of personal devotion in the mental health of adolescents? And what about the essential role of hope, meaning, and purpose in deterring post-traumatic stress disorder47 and suicide? Is not part of the solution for the “College of the Overwhelmed” to include faith as a possible resource, an ally for counselors?
Likewise, pamphlets and Web sites of campus health and counseling centers omit the health benefits of mainstream religious beliefs and worship. Students are fed the usual mantras about health promotion through diet, exercise, sleep, calcium, breast exams, condoms, smoking cessation, seat belts…The counseling centers emphasize healthy relationships, self-assertion, time management, making time for fun. These are all valid, but well-being goes beyond cholesterol levels and hours of sleep. Many young people ache to have ultimate issues asked and answered. Many actually believe they have a soul, and that to reach well-being on the deepest level, it too demands proper nourishment and protection.
As much as mental health professionals and organizations may shun issues of faith due to theophobia, 75 percent48 of college students are on a spiritual search and seek answers to existential questions. Sounds like a large population, but it shouldn’t come as a surprise; it’s consistent with research indicating that neurologically, we may be designed to search for meaning.
You probably haven’t heard about it. Two neuroscientists at the University of Pennsylvania used radioactive imaging to study the brain’s capacity for spiritual experience. 49 They scanned the heads of skilled Tibetan meditators and Franciscan nuns following a period of intense religious contemplation, and discovered an unusual pattern of brain activity. As peak moments approached, the circuits responsible for orientation in time and space fell quiet. The area of the brain that informs us where we end, and the rest of the world starts, was turned off. These moments, according to the subjects, were accompanied by a rush of positive emotion. They were moments of “being connected to all of creation,” of “a sense of timelessness and infinity” and “a tangible sense of the closeness of God and a mingling with Him.” The researchers suggest that the brain is equipped from birth with a capacity—even an urge—for religious experience, and they call the study of this capacity “neurotheology.” They even admit,
our research has left us no choice but to conclude that the mystics may be on to something, that the mind’s machinery of transcendence may in fact be a window through which we can glimpse the ultimate realness of something that is truly divine. This conclusion is based on deductive reason, not on religious faith—it is a terrifically unscientific idea that is ironically consistent with careful, conventional science.
It seems to me that psychology had better get its act together. The irrational avoidance of religion in therapeutic work is not only unethical, it’s old. It has no place in this century, where single-photon emission computed tomography identifies “neuronal spirituality circuits” and produces color photos of a brain connecting with God.
I am not suggesting that psychotherapists get training in pastoral counseling. Rather, they might at least inquire about a client’s beliefs and, if appropriate, inform the client about the health-promoting effects of regular practice and facilitate his growth in this area. Otherwise, a powerful inner resource is untapped, and the therapeutic work is handicapped. For those who are searching, there are books such as Man’s Search for Meaning (2 million sold), The Road Less Traveled (7 million sold), and The Purpose-Driven Life (20 million sold). 50 Yes, some students need to be reminded to take care of themselves. But many would benefit from being less self-absorbed, not more. Along with a prescription for medication, counselors should more often consider a referral to a priest or rabbi with expertise in working with young adults. One does not replace the other. They need to both be on the radar screen. When mental health professionals overlook such an integral dimension of people, they make a dangerous blunder.
But we don’t know if God even exists, some may argue. To that I answer: no matter. Call it what you like, “a higher consciousness,” “universal wisdom,” “the transcendent,” whatever. The point is, the yearning to know it exists, our neural machinery can mediate it, and the experience is a positive one. We don’t know all the details yet, but these moments of a different reality can be health-promoting, and should be encouraged in a willing patient. We don’t really know how aspirin works either, but we still consider it a wonder drug.
When survivors of catastrophic events, like war or the death of a child, are asked how they survived, some credit their faith in God. In the midst of calamity and suffering, they say, life still had meaning. Even in the worst of circumstances there were moments of hope. This kept them going. If belief in life’s meaning and purpose helped concentration camp prisoners endure, it seems reasonable to assume these may be of some utility to college students unable to cope with finals and roommates. With a vast majority of college freshmen believing in God, it’s time campus psychologists move beyond their own issues, and make room for Him in their work.