Religion, Spirituality and Creativity: Historical, Psychological and Biological Perspectives

1. Religion, Spirituality and Creativity:Historical, Psychological and Biological Perspectives Janet E. Johnson, MD, MPH Tulane University School of Medicine Department of Psychiatry and Neurology

2. The Many Images of Spirituality

3. Religion: Latin religare: “to bind together” Organizes the collective spiritual experiences of group of people into system of beliefs, practices, and rituals Tradition, oral and written Spirituality: Latin spiritualitas: “breath” Broader concept than religion--dynamic, personal, experiential process Quest for meaning and purpose, transcendence, connectedness, values Personal quest for answers to ultimate questions about life, meaning Gives one a sense of peace/joy Religion versus Spirituality

4. Brain Collection of physical structures that gather and process sensory, cognitive and emotional data Mind Phenomenon of thoughts, memories and emotions that arise from the perceptual processes of the brain Brain versus Mind

5. Why is this Important? • Surveys show that 90% of Americans believe in a higher being • 90 % pray or meditate • > 70 % believe in life after death • Majority want their physicians to discuss religion with them • DSM-IV inclusion of diagnostic category “religious or spiritual problem” • ACGME made instruction in religious-spiritual issues a curricular requirement in 1995

6. Psychiatrists and Spirituality • Psychiatrists are measurably less religious than: • The general population • Their patients • Other physicians • Generally endorse positive influences on health • More likely than other physicians to note that religion/spirituality can cause negative emotions that lead to increased patient suffering • (82 % versus 44%)

7. Psychiatrists and Spirituality • More likely to encounter religion/spirituality issues in clinical settings • (92% versus 74%) • More open to addressing religious/spiritual issues with patients • (93% versus 53%) • Psychiatrists are more comfortable, and have more experience, addressing religious/spiritual concerns in the clinical setting Curlin et al, Am J Psychiatry, 2007

8. Studies and Physical Health • Majority of the ~350 studies of physical health have found that religious involvement and spirituality are associated with better health outcomes. • Cardiovascular, decreased rate of CVA’s • Lowers blood pressure • Health-promoting behaviors • “Lack of religious involvement has an effect on mortality equivalent to 40 years of smoking one pack of cigarettes/day. Harold Koenig, MD, Duke

9. Studies and Mental Health • Religious involvement associated with: • lower risk of depression. • less anxiety. • less substance abuse. • Improved self-esteem • Less social isolation • Inverse relationship between religious involvement and suicide.

10. Spirituality and the Chronically Mentally Ill • Generally viewed as pathological or symptoms of mental illness. • Little research done in this area. • Religious delusions and auditory hallucinations common in psychosis. • Hyper-religiosity common in mania.

11. Spirituality and the Chronically Mentally Ill • Solution versus symptom • Treatment conflict or collaboration • Socialization or increased isolation • Negative versus positive religiosity • Psychosis or mystical experience or normal experience • Mystic versus psychotic • Distinct differences

12. Negative Religiosity • “I feel God is punishing me for my sins or lack of spirituality” • “I wonder why God has abandoned me” • “If I believed more/was a better person this wouldn’t have happened” • Sees God as judgmental and punitive

13. Negative Religiosity • Negative AH from God, Satan, demons • command AH especially worrisome • Negative/harmful/dangerous delusions • worthless person, offended God, have to pay for their sins, perform acts to appease God or atone for their actions • Andrea Yates

14. Positive Religiosity • “I look to God for strength, support and guidance” • “God will help me through this” • Sees God as benevolent and caring • Religious beliefs provide positive self esteem and image • Prayer/meditation as coping mechanism

15. Chronically Mentally Ill • Survey, 1995 • 28 CMI patients from rehabilitation center • 60% reported that spirituality had a “great deal” of helpful impact on their illness by helping them feel cared for and not alone • 76% thought daily about spiritual matters • 38% expressed discomfort with discussing spiritual matters with their therapist Lindgren and Coursey (1995) Psychosocial Rehab J,18, 93-111.

16. Bipolar Affective Disorder • Questionnaire covering religious, spiritual, philosophical beliefs and religious practice. • Sample of patients with BAD in remission. • 78% held strong religious/spiritual beliefs. • 81.5% practiced their religion frequently. • Most saw a direct link between beliefs and management of illness. • Many reported conflict in understanding and managing their illness between medical and spiritual advisors. J Affective Disord (2003) 75(3):247-57.

17. Assessment • Several routine screening questions about religion and spirituality should be part of the psychiatric assessment. • More thorough assessment necessary if religious-spiritual problem is part of presentation, if clinical issue involves morality or guilt, concerns regarding meaning of life, life cycle issues.

18. FICA Spiritual History • Faith: Do you consider yourself spiritual? Do you have a religious faith? • Importance: How important are your religious beliefs and how might they influence decisions related to your health? • Community: Are you part of a religious or spiritual community? If so, how does this community support you? • Address: How might I address your spiritual needs?

19. History of Science and Religion • Evidence of spiritual practices dating back to ancient cave drawings • Myths: from Greek “mythos” meaning “word”  one spoken with deep and unquestioned authority • Myths of all world cultures are strikingly, consistently similar • Virgin births, world-cleansing floods, lands of the dead, expulsions from paradise, dead and resurrected heroes • All religions are founded on myth • Myths are created by basic, universal aspects of the brain , particularly the fundamental neurological processes through which the brain makes sense of the world

20. Historical PrecedentMedicine and Religion • Medicine and religion historically linked • Hippocratic writings • physicians received authority from gods • Middle Ages • sickness punishment from God • cure by praying • doctors were “collaborators with God” • 15th to early 18th century • close relationship continued

21. Historical PrecedentMedicine and Religion • Cotton Mather (1663-1728) • Prominent Puritan minister • Advised physicians to prescribe “admonitions of piety” as well as drugs. • Smallpox epidemic, Boston 1721  advocated for inoculation despite great controversy and risk to himself • Influential in Salem Witch Trials

22. Historical PrecedentMedicine and Religion • 19th, early 20th centuries still viewed religion as important in practice of medicine • Mid 20th century, unacceptable to discuss religion in a secular health care setting • Past two decades, increased interest in medicine and spirituality

23. Sigmund Freud • Religion was irrelevant if not clinically harmful • “an obsessional neurosis” • Religious individuals were weak • Needed to create a god in their own image rather than deal with their frailty and helplessness • “Mystical experiences are illusions triggered by a neurotic, regressive urge to reject an unfulfilling reality”

24. Carl Jung • Broke with Freud in 1912 over Freud’s insistence that he omit references to religion in Psychology of the Unconscious • Believed that humans are by nature religious • “I attribute a positive value to all religions” • Regarded the religious problems that the patient brought to therapy as relevant to the neurosis, and as possible causes of it • Modern Man in Search of a Soul, 1933

25. Carl Jung • Myths are symbolic expression of archetypal ideas  inherited forms of thought that exist, in universal form, in the depths of every human mind

26. Albert Einstein • “Religion without science is blind; science without religion is lame” • “Quantum mechanics is certainly imposing. But an inner voice tells me it is not yet the real thing. The theory says a lot, but does not really bring us any closer to the secret of the Old One. I, at any rate, am convinced that He does not throw dice”. • “There is a central order to the universe, an order that can be directly apprehended by the soul in mystical union”

27. Larry Dossey • "I used to believe that we must choose between science and reason on one hand, and spirituality on the other, in how we lead our lives. Now I consider this a false choice. We can recover the sense of sacredness, not just in science, but in perhaps every area of life." - Larry Dossey, M.D.  from Reinventing Medicine

28. Trend Today • Many books on science and spirituality • Popular literature • Templeton Foundation • Curriculum in medical schools and residencies

29. Psychology and Spirituality • Dreams • Pre-death dreams and ability to help prepare for death • Grief dreams • Visitation, message, reassurance, trauma • Prophetic or future dreams • ESP, “visions”, deja-vu, out-of-body experiences, past-life regressions

30. Psychology and Spirituality • Intercessory prayer • Can individuals mentally help heal distant persons who were unaware they were doing so? • “Various, broader meta-studies of the literature have arrived at conflicting conclusions. For instance, a 2006 meta analysis on 14 studies concluded that "There is no scientifically discernable effect for intercessory prayer as assessed in controlled studies".[2] However, a 2007 systemic review of 17 studies on the use of intercessory prayer indicated that there are "small, but significant, effect sizes for the use of intercessory prayer" in the reviewed literature.[3]”

31. Psychology and Spirituality • Intercessory Prayer • California (UCLA) study of AIDS patients • No difference in CD4 counts • Patients receiving intercessory prayer showed: • Fewer AIDS related illness • Fewer hospitalizations • Fewer hospital days

32. Psychology and Spirituality • Near-death experiences • Accounts remarkably similar • “Bright light”, music, tunnel or passageway, feeling of great peace, someone there to receive them • Death bed visions • Vast majority of dying individuals, families, and care-takers find the experience comforting and/or spiritually moving • 85% of nurses surveyed felt experiences were of a spiritual nature • Only 15 % attributed them to hallucinations

33. Biology and Spirituality • Approaches from multiple avenues: • Anatomy • Electrophysiology • Brain Imaging • Genetics

34. Neurotheology • Pinpoint which brain regions turn on or off during experiences that seem to existoutside time and space. • Association areas in cerebral cortex • Visual • Orientation • Attention • Verbal conceptual

35. Orientation Association Area • Located posterior section of parietal lobe • Orients the body in space; allows for 3D sense of the body

36. Research • Monks mediating, nuns praying • SPECT scans before and at peak of experience • prefrontal cortex (quieting of activity) • “orientation association area” • Determines where the body ends and the rest of the world begins. • Sharp reduction in activity at peak of meditative experience  brain perceives that the self is endless and intimately interwoven with everyone and everything

37. Verbal descriptions of Experiences “As the river flowing east and west Merge in the sea and become one with it Forgetting that they were ever separate rivers, So do all creatures lose their separation When they merge at last into” Hindu Upanishads “I possessed God so fully that I was no longer in my previous customary state, but was led to find a peace in which I was united with God and was content with everything” Franciscan nun

38. Electrophysiology • Epilepsy linked with spirituality throughout history • “Sacred disease” by Greeks; demon possession in Bible • Close to 5 % of patients with epilepsy report religious auras • Study from UCLA showed that patients with temporal lobe epilepsy have a heightened response to religious language, specifically religious terms and icons • “Temporal lobe transients” • bursts of electrical activity in the temporal lobes producing sensations of out-of-body experiences, sense of the divine, finding God • Increased activity in the attention association area (pre-frontal cortex) during certain types of meditation • Particularly pronounced among Zen practitioners

39. Genetics • “Spirituality is among the most ubiquitous and powerful forces in human life” • Genes can predispose us to believe. • Don’t tell us WHAT to believe

40. The God Gene • Measuring spirituality • “Self-transcendence scale” • Cloninger, U Washington in St. Louis • Out of system of personality classification called the biosocial model • Self-forgetfulness, transpersonal identification, mysticism • Heritability • Twin studies show that spirituality is significantly heritable • Similar to many personality traits and greater than some physical traits • More heritability than religiosity

41. The God Gene • Monoamines influence spirituality by altering consciousness • Serotonin, dopamine • Blurring of the normal distinction of self and others • Provided clue as to where to search for gene candidate • Identifying a Gene • Specific individual gene associated with self-transcendence scale • Codes for a monoamine transporter • VMAT2 gene • Makes protein that packages different monoamines into secretory vehicles

42. The God Gene • Selective Advantage • Important role God gene plays in selective advantage is to provide humans with an innate sense of optimism • Psychologically, optimism provides the will to live and procreate • Physically, optimism promotes better health and quicker recovery from disease

43. Religion versus Science? Science, especially Geometry and Astronomy was linked directly to the divine for medieval scholars. The compass in this 13th C manuscript is a symbol of creation Third panel of “Education” Tiffany glass, 1890 Science and Religion in harmony Central personification of “Light-Love-Life” “Touching the Void”

44. Integrated View

46. Creativity, Spirituality and Mental Illness • Artists and affective disorders • Vincent van Gogh • Edvard Munch • Jackson Pollack • Abstract Expressionist Artists of the NY School

47. The Green Muse Albert Maignan 1895

48. Absinthe (the Green Fairy) • References appear in Bible, Egyptian and early Syrian texts • Greek word apsinthion (undrinkable) • Wormwood leaves soaked in wine or spirits • Major ingredient is alpha thujone • convulsant that blocks the type A GABA receptor chloride channel

49. Absinthe • “Cocaine” of the artists of the 19th century • 1890’s had outgrown cult status and was drunk by millions • Production, circulation and sale of absinthe banned in France in 1915

50. Vincent Van Gogh Self-Portrait 1889