Thick Patients, Thin Therapy, and a Prozac God

It is a very dangerous inversion to advocate Christianity, not because it is true, but because it might be beneficial.
– T. S. Eliot1

Apart from William James, who thought religion was a proper subject of psychological study, most of the past century followed the lead of Sigmund Freud, for whom religion was an illusion, a compensation for instinctual sacrifices, and a residual incarnation of pre-Enlightenment thought.2 The warfare between religion and the science of psychology continued unabated with psychology reducing religious practices to local conditioning, ecstatic visions interpreted as temporal lobe seizures, and the love of God seen merely as an emotional attachment to a transitional object.

By the end of the past century a thaw appeared in the relationship: psychological conferences included talks on spirituality; psychology journals published editions on the role of spirituality in different specialties; the American Psychological Association (APA) published texts addressing the role of religion in therapy and made DVDs available that illustrate spiritual and theistic models of counseling.3 A well-known rational behaviorist4 was converted from regarding religious beliefs as irrational and emotionally harmful, to an acknowledgement that religion might actually be useful in coping with stress.

Current studies suggest that religious believers live longer, are less depressed, have lower suicide rates, and fewer alcohol addictions.5 There is persuasive evidence that religion protects against death, and being prayed for improves physical recovery from acute illness.6 After a careful review of the methodology of these studies, Thoresen and Miller conclude: “Substantial empirical evidence points to links between spiritual/religious factors and health in U.S. populations, although the processes by which these relationships occur are poorly understood, and evidence is sometimes exaggerated.”7

While much of this research indicates that the relationship between religious practices and health is correlational, the general population and practitioners tend to assume a causal relationship. Rebecca Propst and her colleagues report that patients receiving religious cognitive therapy scored lower on measures of depression, a difference that persisted when measured again after three months and after two years.8 While researchers are cautious, many practitioners assume religiously oriented therapy to be effective.9

One might respond with relief and gratitude. Finally, in a culture of unbelief, spirituality and religion are finding their place in the sun, affirmed as beneficial and life-enhancing. Some health maintenance organizations have already included spiritual therapy as a specialty available to their members, even as one division of the APA (36)10 is still developing guidelines for addressing spiritual issues in therapy. Research findings are encouraging in that persons in crisis pray, meditate, or find support from their religious communities. It is long past time for therapists to recognize that, in a highly religious culture, clients come to therapy with religious language to describe their pain. If this newfound recognition of religiosity means therapists will respond more holistically to clients in terms of the clients’ religious convictions, practices, and communities, I would be elated. Hence, in my own empirical research, I am exploring the use of religious language by clients and the response of therapists.

But there are nagging questions. Exactly what religion or spirituality is being referred to in the research and therapeutic literature? Is this religion “thick,” as in the culturally rich, ethically maximalist faith of Abraham, Rachel, Mary, or John the Baptist? Or is the religion “thin,” as in a spirituality that tends to be utilitarian, consumerist, and private? I suggest that when the implicit definition of “religion” is that which simply enhances health, such a narrow view may even be harmful to one’s spiritual health.

Religion as a Utilitarian Concern

First, in the application of the religion/health research, a utilitarian view of religion emerges. It is useful. While the religion/health research is of value in that it provides a more detailed picture of the relationship, authors repeatedly speak of the benefits of being religious.11 If one engages in particular kinds of devotional behaviors such as regular church attendance, meditation, or prayer, the effort will be rewarded with increased health. Just as medication alters moods, so a “Prozac god” becomes the dispenser of health when we engage in personal acts of piety. It is one thing to affirm that persons with shared religious beliefs and practices live longer or spend less on healthcare, but it is quite another matter to argue that for those reasons one should be religious or spiritual. To value religion for its usefulness is a form of idolatry.

Unfortunate for this instrumental view of religion, not all religious convictions and practices have positive effects. A violation of a deeply held belief may (appropriately, if I may say so) occasion depression.12 A prophet may pay with his or her life for taking a specific stance. For some contemporary Christians, practicing radical faith in public—taking up the cross of Jesus—does not pay off with good mental health.

More important than whether religion is effective in reducing health risks is whether a Christian client is being faithful to the charter of his or her culturally thick religious tradition. Historic religions have been concerned less with teaching their adherents to live long and more with how to live faithfully. Shuman and Meader point out that the Christian can “live hopefully, with the certainty that the ultimate meaning of history—including each individual’s personal history of sickness and of health—is determined not by scientific or religious cause and effect but by the cross and the resurrection of Christ.”13

Religion as a Consumerist Concern

Second, “religion” in the formula for health may well be consumerist. Since capitalist cultures tend to take on the character of an exchange of merchandise, religion becomes simply a commodity one can select, purchase, and exchange without all the institutional religious baggage.14 If religious interventions work, then religion is a cost-effective way of addressing rising health costs. Effective religious coping strategies that have been scientifically proven fill the bill. In consumerism, religion and health are commodities, medical and psychological practitioners are purveyors, and health insurers are brokers. But is not health a gift rather than the result of a contract in which a Prozac god is bound to fulfill an obligation to reward devotion with health? The question not asked is: What does God require of me? Doesn’t it have something to do with living justly, loving mercy, and walking humbly before God? (Micah 6:8).

Religion as a Private Concern

Third, the “religion” associated with health is private. In a recent video distributed by the APA, the therapist reports that she practices spiritual therapy. Though researchers may be more cautious, she justifies her approach because she believes there to be considerable research which indicates that spirituality can protect one from acute forms of pathology. When asked to define her approach, she states:

Spiritual therapy is a process whereby we become more attuned to the universe, a process through which we listen, hear, and interact with the universe in a way that helps us to evolve in our spiritual path. . . . We are walking in a living universe which has love and intention for us and for us as a collective. . . . The client has within them their own spiritual trajectory and my job is to create an environment for them to journey.15

This spirituality reflects the individualism of our Western cultures—the self as autonomous, self-interested, and unencumbered by responsibilities for others. Healing is not assumed to occur in the context of a community, and hence an individualistic culture constructs a religion that helps me achieve my mental health. However, as Wendell Berry suggests, “The community . . . is the smallest unit of health and . . . to speak of the health of an isolated individual is a contradiction in terms.”16

Finally, the implicit “religion” is substantively thin in that it is generic, abstract, and departicularized. As is apparent in the comments of the therapist above, the content of the religion is irrelevant. Says Herbert Benson, a guru in the movement:

I describe “God” with a capital “G” in this book but nevertheless hope readers will understand I am referring to all the deities of the Judeo-Christian, Buddhist, Muslim, and Hindu traditions, to gods and goddesses, as well as to all the spirits worshipped and beloved by humans all over the world and throughout history. In my scientific observations, I have observed that no matter what name you give the Infinite Absolute you worship, no matter what theology you ascribe to, the results of believing in God are the same.17

This health-producing “religion” is traditionless, and can be used by anyone. Ken Pargament and his associates propose a spiritually integrated psychotherapy which is “based on a theory of spirituality, empirically-oriented, ecumenical, and capable of integration into virtually any form of psychotherapy.”18 When spirituality is construed as an intervention that is universally applicable, moral content is thinned.

Religions don’t function “in general.”19 I prefer a thick, particularist view of a faith community since it has memory, rituals, and symbols that differ from other faith communities. Similarly, I prefer to thicken the process of healing by counseling from within the client’s religious tradition rather than to thinly universalize spirituality as an intervention.20 I encourage psychologists and marriage and family therapists to elucidate the communal memories and religious traditions the client brings to therapy—to validate and nourish what is good of a client’s ethnoreligious particularity. This is faithful to my calling as a Christian to respond to the whole person God has created. Hereby I assist clients in assessing emotional pain, psychological gifts, or marital conflict from within their religious tradition so they can live consistently within the narrative charter of their faith community.

Some clients have a vague spirituality, no religious tradition, or one very different from my own. This therapy builds on thinner commonalities and on the relationship that emerges in sessions over time. I adapt to my client even as I encourage greater relational and spiritual depth.

A Christian therapist counseling a Christian client would seek to provide psychological assistance from within that client’s worldview. Psychological issues, supports, community, and vision of the Christian community become salient. A Christian client seeking to be shaped into the ideals of his or her Christian community is not being imposed upon when the therapist draws on the tradition and gently holds the client accountable to his or her professed convictions.

Problems emerge when a client with a rich faith tradition has a therapist who functions with a “religions-in-general” perspective. It is possible that his or her particularity will not be affirmed and perhaps even eroded. For clients with thick religious construals, instrumental religiosity may undermine belief in the truth of their faith apart from its usefulness.
In contrast to a religion that promises to be useful and effective, we might wish to consider how to be faithful to our clients as Christians. Rather than a consumerist religion of health, Christian therapists would lean toward a view of health as a gift of God. Not only is religion personal, it is also communal: as a psychologist, my Christian tradition shapes definitions of health, wholeness, illness, and healing.

Finally, rather than presuming religion is general, we would do well to acknowledge the counselee’s particularity and function as Christian therapists who witness to God’s healing presence, to the joy of being Christ followers, and to the gracious wisdom of the Holy Spirit.

1. T.  S. Eliot, Christianity and Culture: The Idea of a Christian Society and Notes Towards the Definition of Culture (New York: Harcourt Brace, 1940/1968), 46.
2. Sigmund Freud, The Future of an Illusion (New York: Norton, 1932/1989).
3. The most recent publication by APA is Len Sperry and Edward P. Shafranske, eds., Spiritually Oriented Psychotherapy (Washington, DC: American Psychological Association, 2005).
4. Albert Ellis, “Can Rational Emotive Behavior Therapy (REBT) Be Effectively Used with People Who Have Devout Beliefs in God and Religion?” Professional Psychology: Research and Practice 31 (2000): 29–33.
5. Harold Koenig, ed., Handbook of Religion and Mental Health (San Diego, CA: Academic Press, 1998); Everett Harold Koenig, Michael E. McCullough, and David B. Larson, Handbook of Religion and Health (London: Oxford University Press, 2001).
6. Lynda H. Powell, Leila Shahabi, and Carl E. Thoresen, “Religion and Spirituality: Linkages to Physical Health,” American Psychologist 58 (2003): 36–52
7. William Miller and Carl Thoresen, “Spirituality, Religion, and Health: An Emerging Research Field,” American Psychologist 58, no. 1 (2003): 33.
8. Rebecca Propst, R. Ostrom, P. Watkins, and T. Dean, “Comparative Efficacy of Religious and Nonreligious Cognitive-Behavioral Therapy for the Treatment of Clinical Depression in Religious Individuals,” Journal of Consulting and Clinical Psychology 60 (1992): 94–103.
9. E. P. Shafranske and L. Sperry, “Addressing the Spiritual Dimension in Psychotherapy: Introduction and Overview,” in Spiritually Oriented Psychotherapy, ed. L. Sperry and E. P. Shafranske, 11–30 (Washington, DC: American Psychological Association, 2005).
10. William Hathaway, “Preliminary Practice Guidelines for Religious-Spiritual Issues,” paper presented at the annual convention of the APA held in Washington, DC, August 20, 2005.
11. Christopher Ellison and Jeffery Levin, “The Religion-Health Connection: Evidence, Theory, and Future Directions,” Health Education and Behavior 25 (1998): 700–720.
12. See Merle Jordan, Taking on the Gods: The Task of the Pastoral Counselor (Nashville: Parthenon Press, 1986). Jordan suggests that depression can result when the false gods we worship let us down.
13. Joel James Shuman and Keith G. Meador, Heal Thyself: Spirituality, Medicine, and the Distortion of Christianity (New York: Oxford University Press, 2003), 17. I am deeply indebted to this insightful book in the writing of this essay.
14. Vincent Jude Miller, Consuming Religion: Christian Faith and Practice in a Consumer Culture (New York: Continuum, 2004).
15. Lisa Miller, Spirituality in Therapy (DVD produced by APA, 2003).
16. Wendell Berry, “Healing as Membership,” in The Art of the Common-Place: The Agrarian Essays of Wendell Berry, ed. Wendell Berry and Norman Wirzba (Washington, DC: Counterpoint, 2002), 146.
17. Herbert Benson, Timeless Healing (New York: Scribner, 1996), 200.
18. Ken Pargament, Nicole Murray-Swank, and N. Tarakeshwar, “An Empirically-Based Rationale for a Spiritually Integrated Psycho-therapy,” Mental Health, Religion and Culture 83 (2005): 155–65.
19. Al Dueck and Kevin Reimer, “Retrieving the Virtues in Psychotherapy: Thick and Thin Discourse,” American Behavioral Scientist 47 (2003): 427–44; Al Dueck and Kevin Reimer, “Religious Discourse in Psychotherapy: Thick and Thin,” International Journal of Existential Psychology and Psychotherapy 1 (2004): 3–15.
20. Michael Walzer, Thick and Thin: Moral Argument at Home and Abroad (Notre Dame: University of Notre Dame Press, 1994).

This article was published in Theology, News & Notes, Winter 2006, “Psychology and Spirituality.”