Manic Depression and Religiousness

Wilson (1998) explains that while the origin of major affective disorders is biological, religion can play a prominent role in the illness:

Religious experiences may precipitate an attack of mania or may end a major depressive episode. Religious conflicts are a stress and, as such, can play a role in the precipitation of a major depression. Religious beliefs, however, are not etiologic in either mania or depression, (p. 168)

Religious themes and mystical experiences pervade the language of manic-depressive illness, "conveying an extraordinary degree and type of experience, one beyond adequate control, comprehension, or adequate description" (Goodwin and Jamison, 1990, p. 16). Religious feelings are commonly reported during manic and hypomanic episodes; these can range from receiving messages from God, having the sense that one is God, being given a divine mission, to ecstatic experiences often described as mystical. The sense of moral imperative and certainty of moral beliefs is closely related to and dependent on mood (Goodwin and Jamison, 1990).

The defining characteristics of the mood-congruent psychotic features of mania, according to DSM-IV, are as follows: "delusions or hallucinations whose content is entirely consistent with the typical manic themes of inflated worth, power, knowledge, identity or special relationship to a deity or famous person" (p. 415). Indeed, William James (1902/1961) outlined many features of mystical

Issues of Mood and Anxiety 85

and conversion experiences that a psychiatrist likely would label as bipolar affective illness: hyperacusis, ecstasy, hallucinatory phenomena, knowledge "perceived as full of importance and significance," a loss of worry, a "passion of willingness," a sense of well-being, altered perceptions, and a "sense of perceiving truths not known before" (cited in Goodwin and Jamison, p. 361). James believed that the ability to experience religious or any other kind of ecstasy was an aspect of temperament.

The elevated mood in mania includes a general sense of well-being; often, as it progresses the sense of well-being is accompanied by a sense of benevolence and communion with nature. In a study undertaken by Winokur and associates, the most common cognitive theme reported during mania was religion, expressed by 32% of patients (Winokur et al., 1969; cited in Goodwin and Jamison, 1990). Possible reasons, suggest Goodwin and Jamison (1990), are reflection of unconscious or learned material; alternatively, the theme may reflect the inability of ordinary language and perceptual frameworks to express transcendent experiences in any other than the language of religion.

Experiencing and drawing upon religious ecstasy have been integral to the work of many poets as well as religious leaders, leading Goodwin and Jamison to speculate that many have suffered from manic-depressive illness, e.g., Martin Luther, George Fox, Sabbatai Sevi, and Emanuel Swedenborg. When I taught a course on Religion and Madness some years ago, students presented case studies on controversial religious leaders, diagnosing almost all of them as either manic-depressive or suffering from schizophrenia. It would seem that religion and religious movements can become a vehicle for expression of the mood swings characteristic of manic-depressive illness.

Koenig (2005) follows an important trajectory in querying the cause and effect sequence of illness and religious inclination. It has been shown, he explains, that religious coping is common in those diagnosed with a severe mental illness in religious areas of the world. Yet is religion more common in persons with severe mental illness because religion somehow causes or contributes to the development of severe mental disorder? Or is it more common because it is used to cope with symptoms? While Koenig cites one study (Yorston, 2001) suggesting that bipolar manic episodes can be induced by religious practices - specifically certain types of meditation - he argues that the notion that religious beliefs can predispose one to develop a serious mental illness is not supported by systematic research.

A logical follow-up question is, Do religious beliefs aid or harm in coping with a severe mental illness, particularly manic depression? This question frames Koenig and colleagues' (1998) definition of religious coping, i.e., "the use of religious beliefs or behaviours to facilitate problem-solving to prevent or alleviate the negative emotional consequences of stressful life circumstances" (p. 513). Religious affiliation was found to be the most important determinant of whether someone used religious coping (Koenig et al., 1992). Pargament and colleagues (Pargament et al., 1990, 1998; Hathaway and Pargament, 1990) found that religious coping is multi-dimensional, with both negative and positive coping

86 Creativity, Spirituality, and Mental Health

methods used. Positive methods were more commonly used and were related to better religious and psychological outcome after stressful events (Pargament et al., 1998). This research suggests the importance of further examining the role of spiritual strategies in the treatment of both mood and anxiety disorders.