Shrink's Views

ramblings of an unknown psychiatrist

Religion,Depression and Suicide:an Observation

Posted by Dheeraj Kattula on July 26, 2009

Kandhamal district of Orissa is stunningly beautiful. In the peak of winter there is a place here where it snows. It is surrounded by mountains and is covered with thick forests. The air is pleasantly cold. The canvas of it’s beauty was marred by violence that struck its heart in August 2008.You may read about what happened here.

It is sad that I have not seen Kandhamal in its best of times. I have been there on two occasions.Once it was as a Medical Officer from Red Cross to look into health issues in Nuagam Relief Camp in November 2008. Recently I went with a team of other doctors and conducted camps in four different sites in the district.

A carpenter looks for nails everywhere. I, a novice carpenter of the mind looked for stress related mental disorders. I expected to see PTSD, Severe Depression, Anxiety disorders, Insomnias, complicated grief and suicidal ideation. What else do we expect in a group of people who have lost all their assets and have no clue what the future had in store for them?

I was wrong.I did not find even one PTSD case in about 1000 consultations that I had in the Relief Camp. Of course people were concerned about their future and were sad about the persecution they faced,but they had enormous faith in their God,who they felt allows suffering but is in control. I found that they had tent prayers everyday.

Situations have changed. The situation now is not at all as bloody as it had been. There may be tensions. There may be animosity, but the situation is now in control.The Governments are trying their best. In this state of peace, I recently went to Kandhamal again.

In this visit I  saw about 250-300 patients. I did find people with depression. I found a couple of them quite severely depressed. When we mental health workers probe about very personal thoughts and behaviors, we usually ask open ended broad questions and slowly zero-into specific areas.

In case of depression,we usually enquire if the patient feels himself to be useless & worthless, then ask if he feels lonely and helpless, then ask if he thinks that things are going to improve in future. If he says yes to these then we tell him,”when life feels so difficult many people feel it is better to die,have you ever felt like that?” If patient says yes, then we ask regarding suicidal intent,which will have a bearing on how we would manage the patient by asking ” Have you ever felt like killing yourself?”

I have seen a many people in Tamil Nadu, easily consider the thought of killing themselves when overwhelmed with stress. In a study in Vellore,the average annual suicide rate was 95 per 100 000 for the years 1994-99. The rates in adolescent males and females and those over 55 years were 148, 58 and 189 per 100 000 respectively.(The British Journal of Psychiatry (2006) 188: 86.)

In Kandhamal I had a shock.I did not find even one person consider suicide despite overwhelming adverse life events and financial distress.Individual cases were depressed clinically, but they were not feeling ‘hopeless’.Many reflected their view to be like,”Yes I feel bad.I have nothing left.I do not know what I will happen tomorrow.I wish to go back to my village to start a new life.I hope they allow me to start again.I feel sad,but I know God is there.He has helped us till now.If it were not him,I would not be here today.He will continue to take care of me and my family.Why would I kill myself and hurt God?Things will improve.We are praying.”

The pattern forced me to think if indeed religion and faith protected people from suicide and mental illness in general. Why is it that I did not find a single case of PTSD in a relief camp after a spate of bloody violence?What makes them stronger than American war veterans from Vietnam!!?

Harold G Koenig’s review in Candian Journal of Psychiatry 2009;54(5): 283–291  concludes stating that “In general, studies of subjects in different settings (such as medical, psychiatric, and the general population), from different ethnic backgrounds (such as Caucasian, African American, Hispanic, and Native American), in different age groups (young, middle-aged, and elderly), and in different locations (such as the United States and Canada, Europe, and countries in the East) find that religious involvement is related to better coping with stress and less depression, suicide, anxiety, and substance abuse.”

Considering suicidality in specific, an article in Journal of Affective Disorders reports that its results suggest that religious attendance is associated with decreased suicide attempts in the general population and in those with a mental illness independent of the effects of social supports.

Indeed, research validates my observation that religion does help in coping stress and prevent mental illness and decrease suicidality.

References:

1.In the name of God.

(http://www.tehelka.comstory_main40.asp?filename=Ne130908CoverStory.asp)

2. Manoranjitham et al.Suicide in India.

(http://bjp.rcpsych.org/cgi/content/full/188/1/86)

3.Harold G.Koenig.Research on Religion, Spirituality, and Mental Health:
A Review

(http://publications.cpa-apc.org/media.php?mid=793&xwm=true)

4.Daniel T.Rasic et al.Spirituality,religion and suicidal behaviour in a nationally representative sample.

(http://www.jad-journal.com/article/S0165-0327(08)00344-3/abstract)

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3 Responses to “Religion,Depression and Suicide:an Observation”

  1. RPR said

    Religious beliefs probably do protect against suicide, both by acting as a deterrent and by promoting hope. In traditional Christian thought (see Chesterton’s “Orthodoxy”), suicide was considered to be one of the worst possible sins… I’ll leave you to read Chesterton on the topic, though, as he explains it better than I could. Hope is diametrically opposed to despair, which is a vice.

    On the other hand, the social networks fostered by strong religious communities and the bonds they build are equally important. A strongly religious person who does not “belong” to a broader community of like-minded people is likely to find it hard to cope with life-changing stressors, especially if he or she finds themselves excluded because of their beliefs.

    Finally, social and cultural responses to stressors also shape behavioural patterns. Though I’m not by any stretch a fan of Richard Dawkins, his ideas on “memes” – cultural elements or ideas that propagate, replicate, mutate, and infect minds – are relevant here. My own theory has been that, in the wake of historical and social upheavals in Europe from the 16th century onwards (the Reformation, migration and colonization, the Industrial Revolution, etc…) a fertile ground for the “meme” of psychological mindedness – in which the individual’s troubles are paramount, and everything can be conveniently blamed on others – arose, and was given expression in the works of Freud and others.

    We are still paying the price for this – people in “psychologically sophisticated” societies develop PTSD after a car accident, while those in simpler, community-based societies remain more resilient. Ignorance of certain “memes” or ideas can actually be bliss.

    How this relates to suicide exactly isn’t clear even to me, but I hope to work it out – someday. 🙂

    @RPR
    Yes, you are absolutely right.The persecution in Kandhamaal was not individual but was targeted against a community.In situations like this social cohesion increases and isolation decreases (within their group).So there is reason to believe suicidality could be lower during times like these.

    It is also worth noting that persecutions like this could increase “heroic suicides”, where one sacrifices his life for the benefit of community’s interests.For example Kamikaze of Japan and many of the contemporary suicide bombers,who do not mind sacrificing their lives for their community’s sake.

    So, it is my theses that restraint from violence be it directed against self ( suicide ) or others (heroic suicide ) comes from a worldview,which could be influenced largely by religious affiliation.Christian worldview,which believes in forgiving seventy times seven (infinitely ),has played its pacific role in the hearts and minds of thousands of affected,who chose to silently suffer for their faith than fight for their religion.We saw that in 18th century Europe,when France was burning in revolution,England was calm, being busy with Whitfield and Wesleyan revivals. The peace of godliness saved the monarchy of England.

  2. Samuel John said

    Dear Dr.Dheeraj,

    I appreciate your findings in Kandhamal district of Orissa. However your conclusion that there is no case of depression cannot be taken at face value. People may be depressed (or else they are not human) – They may not be clinically depressed. From the Bible we know that JOB was depressed. He even cursed the day he was born. There are many other cases of depression in the Bible.

    Many Christian leaders like Charles Spurgeon have suffered depression. We are human. Any one can fall sick. No one is immune to illness whether it be Physical or Mental. As a Doctor you should know the chemistry behind mental illness. Depression is an illness – not a weakness.

    Your article seems to conclude no strong Christian will suffer depression. This is a pentecostal point of view. I am afraid all your years in medical school at CMC, Vellore has not taught you enough about Psychiatry.

    I am a Christian and I suffer from Bipolar Disorder. I know how the struggle with the illness is for me daily. People from your (pentecostal) school of faith even say I am demon possessed . However the spirit of God (Holy Spirit) dwells in me and I am his child. I am sealed by the blood of Christ and though I am ailing on this earth where I am a Sojourner I will be in eternity with Christ before people with such prejudicial views ever get there.

    Samuel John

    @ Samuel John

    Dear Sam,

    Thanks for your detailed comment.I appreciate your concerns.
    You seem to have gotten me wrong,Sam. I have said in the post “I did find people with depression. I found a couple of them quite severely depressed.” So,I did not deny the reality of depression at all.

    I do not deny the reality of mental illness.I agree with you 100% when you say,”Depression is an illness – not a weakness.

    I strongly believe in biological model for mental illness.Therefore I do not refrain from using psychotropic medicines in patients with mental illness.I have not suggested “only pray” model at all.Did I?

    What I actually said was that the people who are religious,have better coping than ones who are not. This is when you compare groups.
    When I see individuals, I believe one would face life stresses better if one were more spiritual. This is definitely not to say if one is spiritual,he is immune to mental illness.

    I am absolutely convinced that you are a strong Christian and also that you suffer from Bipolar Disorder.I think they can co-exist in the same person.Being a Christian does not prevent people from Bipolar illness just as it does not prevent from Diabetes or Hypertension.

    What I believe about you is that your faith in our Lord, helps you overcome a lot of stress that comes up naturally in life. If you did not believe in Him, you might not have the hope in eternity.It is the same hope that carries victims in Kandhamal to live on despite difficulties that are real.

    You being ‘demon-possessed’ is absolutely rubbish. It is true that you are ailing in this world,but you are as precious in the sight of God as anybody else.I am sure we would be in eternity with Christ.

    Yours in His Kingdom,
    Dheeraj

  3. Amazing and thoughtful ideas. I’m very glad that I came to this blog. Thank you! I wouldn’t take confrontational misreadings and demon possession (!!!??) too seriously. I get a lot of this nonsensical crap from trolls on my blog and I’ve learned to press delete more often.

    As an atheist who grew up Christian, I understood what you’re getting at and accept your observations on a whole. I do however think that it’s fairer to say that this is a matter of
    1) hope/faith in general (whatever the world-view, even an atheist world-view, not necessarily one driven by some kind of ‘religion’ per se) and
    2) the presence of a loving community spirit (as was concluded in the later comments above). No community support and a lack of personal purpose is oppressive nihilism for sure and I believe this is the deep problem in “modern” societies that will never be adequately resolved with technology.

    It should also be said that religion can just as easily provide deep despair if its tenets condemn the individual. When you speak of the ‘power of religion’, you’re of course speaking only of those not oppressed by their worldview. However, many Christians or other religious persons unfortunately are oppressed in various ways by their own inflexible faith.

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