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Religious Content of Hallucinations in Paranoid Schizophrenia

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Religious Content of Hallucinations in Paranoid Schizophrenia Psychiatria Danubina, 2012; Vol. 24, Suppl. 1, pp 65–69 Conference paper © Medicinska naklada - Zagreb, Croatia RELIGIOUS CONTENT OF HALLUCINATIONS IN PARANOID SCHIZOPHRENIA Marek Krzystanek1, Krzysztof Krysta1, Adam Klasik2 & Irena Krupka-Matuszczyk1 1Department of Psychiatry and Psychotherapy, Medical Universityof Silesia, Katowice, Poland 2Institute of Psychology, University of Opole, Poland SUMMARY Background: Different environmental factors are thought to be responsible for 15-20% of schizophrenia pathogenesis. Religion has long been considered a major force in human life, regardless of economic, social or political affiliation. How the perception of religion has changed over time, especially in the context of mental illness, was the focal point of this long-term comparative study. Subjects and methods: A random selection of 100 case histories from the years 1932, 1952, 1972 and 1992 was selected. By reviewing the subject history and medical notes, information on the presence of religious hallucinations and/or delusions were collected and grouped. Results: Religious topics were demonstrated in 46.8% of the test population. Whereas there was a clear diversity of religious- themed delusions, “God”, “Christ”, “Mary”, “Satan/devil” and “hell” all figured prominently across all reviewed years. There is a progressive decrease in the number of religious topics in paranoid schizophrenia. The transfer of holiness from historical saints onto a subject was observed. Evil dominates over good in productive symptoms in paranoid schizophrenia. The phenomenon of apocalyptic subjects in paranoid hallucinations and delusions increased after the Second World War. Conclusion: Religious topics of hallucinations and delusions change over time and relate to objective historical events and reflect changes in religiosity in society. Key words: schizophrenia - auditory hallucinations – delusions - religious topics * * * * * INTRODUCTION schizophrenia may be associated with increased severity of psychosis, poorer prognosis and auto-aggression Religion and spirituality belong to the most (Siddle et al. 2002). Patients with religious delusions important and common topics of human life and culture. appear to be more seriously ill (Siddle et al. 2002). The role religiousity plays in psychotic disorders is A religious viewpoint seems to be crucial to obscure. Spiritual subjects of positive symptoms (i.e., understand the special meaning of the psychotic delusions and hallucinations) appear to be a deformation symptoms of the individual patient (Okada et al. 1994). of mystical experiences of healthy humans and are Moreover, spirituality is hypothesized to be beneficial in influenced by contemporary events, socio-demographic recovery from mental illness (Sullivan 1998). Mental factors and the particular culture of every nation (al-Issa diseases are sometimes difficult to discriminate from 1990, Azhar et al. 1995, Maslowski et al. 1995, Tate- normal mental life processes (Peters et al. 1999). yama et al. 1993). Especially, regarding human inner life, the borderline Religion plays a significant role in the psycho- between mysticism and psychosis is sometimes faint. pathology of schizophrenia (Tomczak 2006). This role Spiritual experiences are thought to be a potential may be protective, a finding particularly important for precipitating factor for the development of paranoid patients with psychosis who are known to be at high risk disorders (Greenberg et al. 1992). A psychotic process of serioue suicide attempts (Huguelet et al. 2007). may be also be induced by different sects or by a Religion may induce spiritual despair, decrease or psychotic cult leader (Maier 1986, Spencer 1975). Some increase of psychotic and general symptoms of forms of religion (e.g. shamanism) are hypothesised to schizophrenia, increased social integration or social have an origin similar to schizophrenia (Polimeni & isolation, reduction or increase of the risk of suicide Reiss 2002). To discriminate religiousity in mental attempts, reduction or increase of substance use, and normality and in disease, the religious aspect of fostering adherence to or opposition to psychiatric psychosis must be explored. treatment. Spirituality should be integrated into the Because of the lack of long-term phenomenological psychosocial dimension of care (Mohr et al. 2006). studies on the religious content of delusions and Religiosity of schizophrenic patients may play a role hallucinations in paranoid schizophrenia the authors in the genesis and maintenance of delusions. Religious decided to explore that domain. The stream of positive delusions seem to play an important role in the symptoms from the 1930s to 1990s was investigated to symptomatology of paranoid schizophrenia (Bhavsar & ascertain the method in which religiousity in paranoid Bhugra 2008). Religious delusions in patients with schizophrenia does change in time. S65 Marek Krzystanek, Krzysztof Krysta, Adam Klasik & Irena Krupka-Matuszczyk: RELIGIOUS CONTENT OF HALLUCINATIONS IN PARANOID SCHIZOPHRENIA Psychiatria Danubina, 2012; Vol. 24, Suppl. 1, pp 65–69 SUBJECTS AND METHODS RESULTS The method was a random selection of case histories From Table 2, a significant number of patients of paranoid schizophrenia diagnosed in in-patients. The presented religious topics of delusions and hallu- case histories were obtained from the archives of the cinations, but gradually the trend decreased. Each State Neuropsychiatric Hospital in Lubliniec (Poland). patient covered over one topic and there appears to be The archives of the hospital contain files from the an even distribution of topics over time. beginning of the 20th century. Well organized and Results in Tables 3 and 4 show a clear dominance of complete files were found starting from 1932. A total of Catholic over non-Catholic topics. This is not surprising 400 case histories divided into four equal groups from given that the data collection was from a country that is the years 1932, 1952, 1972 and 1992 were explored. overwhelmingly Catholic (95.8%) and that three of the The characteristics of the examined groups are provided four subject-years were a time of religious isolation. in Table 1. From Table 4, subjects are shown to be more prone Sex-division of the subjects was found to be fairly to visions of a religious figure than communication or even, comparing to the incidence of schizophrenia in a personal identification. There is a marked shift from normal population. No separation of delusions by sex visions of religious figures to interactive forms, with a was completed, but each subject’s delusions were downward trend of visions and a rise over time of the divided and considered individually. Therefore, one subjects’ interactions with religious figures. It is of note subject could contribute multiple religious topics. that the same percentage of patients experienced contact Both delusions and hallucinations were treated as with God and Mary, which is possibly explained by the equivalent sources of positive symptoms from each co-dominance of the two figures in Catholic prayers. subject. The symptoms with religious content were After World War II, there is also a connection in abstracted and the following thematic groups were delusions of contact and delusions of incidence distinguished: the Holy Trinity, the Virgin Mary, the regarding God and Christ. From Table 2, we can also Bible, saints, religious imagery, church and names of state that two delusions could coexist in the positive deities. The coexistence of particular topics in positive symptoms of patients. Perhaps the most astounding symptoms of one patient was also considered. A trend is the sharp drop in the belief of God in delusions percentage comparative analysis was performed to and hallucinations post- World War II. It is not until determine changes between particular time periods. 1992 that the topic of God appear at levels similar to Table 1. Composition of examined group Personal data year 1932 year 1952 year 1972 year 1992 number of patients 100 100 100 100 mean age (+ SD) 33.8 + 13.9 33.1 + 11.4 44.0 + 10.2 41.6 + 12.9 gender: women 44 49 52 51 men 56 51 48 49 Table 2. Numerical analysis of religious topics distinguished in all subject-years. Results are expressed as patient percentage in every analyzed period Average number of Maximal incidence of Number of patients Year religious topics in a patient one religious topic (%) with religious topics (%) 1932 1.46 19 50 1952 1.02 12 46 1972 1.47 15 49 1992 1.04 15 42 Mean (+ SD) 1.25 + 0.25 15.3 + 2.9 46.8 + 3.6 Table 3. Incidence of positive symptoms involving non-Catholic representative entities. Results are expressed as patient percentage in every analyzed period 1932 1952 1972 1992 Total Positive symptoms subject (%) (%) (%) (%) (%) Jehovah 0 0 0 2 0.5 Isis 0 0 1 0 0.3 Zeus 0 0 1 0 0.3 Total (cumulative) 0 0 2 2 S66 Marek Krzystanek, Krzysztof Krysta, Adam Klasik & Irena Krupka-Matuszczyk: RELIGIOUS CONTENT OF HALLUCINATIONS IN PARANOID SCHIZOPHRENIA Psychiatria Danubina, 2012; Vol. 24, Suppl. 1, pp 65–69 those before the war. The Holy Spirit is not a common appearing of ‘pope’ in positive symptoms in 1992 was figure in any subject-years, but its appearance often interesting, considering the appointment of a Polish coincided with contact. Though saintly contact remains Pope in 1978. Other topics appeared sparsely: at an even level until 1992, identification with saints Czestochowa (the most famous Polish monastery) and disappears entirely after 1952. ‘pope’ were present
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