Various studies in Western societies have examined lay beliefs about causes and risk factors for mental illness (Jorm et al.
1997), and the findings from the current study suggest that clergy have a similar degree of comprehension as the rest of the lay public (Jorm
2000). It is believed that biomedical or disease models or illness are more common in Western societies while situational models of distress explanation are more prevalent among traditional and minority ethnic communities (Keyes
1985; Patel
1995). However, in a major survey in Australia, social environmental factors were seen as likely causes of depression, consistent with the epidemiological evidence while genetic factors were considered by only half the population. Perhaps more surprisingly, social environmental causes were also given for schizophrenia (Jorm et al.
1997). In UK and Irish studies, stress in the form of family, unemployment and work pressures was the most commonly noted cause of depression followed by bereavement, heredity and childhood adversity (McKeon and Carrick
1991; Sims
1993; Priest et al.
1996). Additionally, a survey among Germans revealed that psychosocial stress was considered to be the biggest risk factor for schizophrenia followed by biological factors, intrapsychic factors, socialisation and the state of society (Angermeyer and Matschinger
1994). In this study, we detected the possibility that some clergy are not prone to the dualistic mind(soul)/body view of humanity. The biomedical model often merges with a world view in which spiritual influences pervade.
Situational Explanations
In a study of cultural conceptions of depression, Karasz (
2004) suggested that causal attributions of mental illness are generally observed as
situational, that is distress is generally understood within the context of events and circumstances of the sufferer’s life, such as those construed by the imam working in the Turkish–Kurdish community of north-east London (Leavey et al.
2007). In relation to the clergy’s causal beliefs about mental illness, the notion of situationality, a ‘commonsense epidemiology’ is important and useful. Thus, the findings suggest that clergy, generally, favour a social stress model of illness but which does not preclude other natural and supernatural explanations. Conversely, the African Pentecostal leaders tend not to advance direct social–political explanations. This may be explained in a number of ways. Predominantly, events and occurrences in the world have a spiritual basis and meaning in which events are determined by forces, good or bad, outside of the natural, empirical view. Ill health, bad luck and lack of social success are ultimately determined by spiritual forces and belief in the Holy Spirit links the believer to a power transcending all human barriers, conquering social, personal and bodily ailments (Martin
2002; van Dijk
2002).
What do the findings from the current study say about the position of the clergy in society and their beliefs about the origins of human suffering in the form of mental distress? Certainly, no unitary and definitive clergy explanatory model of mental illness emerged from these interview data. A common thread that may be detected across clergy beliefs is that mental illness, whatever the genetic origins and biological manifestations, is a symptom of wider social and moral malaise. As such, mental illness may be seen as a distinctly clergy interest within specific local contexts. Taking classical ethnological enquiries as a theoretical backdrop, Kleinman defined experience ‘as the felt flow of interpersonal communication and engagements. Those lived engagements take place in a local world and experience is thoroughly intersubjective. It involves practices, negotiations, contestations among others with whom we are connected. It is a medium in which collective and subjective processes interfuse’ (Kleinman
1988: 3). Moreover, experience is moral, because ‘it is the medium of engagement in everyday life in which things are at stake and people are deeply engaged stakeholders who have important things to lose, to gain and to preserve’ (Kleinman
1988: 5). Moreover, Kleinman emphasises both the variation and the intensity of ‘things that matter’ across and within local worlds.
Importantly however, and echoing Kleinman’s understanding of experience, lay conceptualisations of mental illness are typically perceived to be generated much more visibly, by social forces rather than biological determinants, even though the genetic connection is generally acknowledged. Thus, also such models appear to be viewed through each clergy’s spiritual or theological lens, they reflect their respective environments, social fabric and behaviour of community members, communal and personal anxieties and the economies and politics of their respective communities. The focus is seldom on the individual but rather, it encompasses a vision and a diagnosis for societal ills. Thus, beyond the tangible reactions to existential problems of loss and injury, mental illness is a symptom of social turbulence.
The clergy are patently stakeholders, and the vision they provide of Western society and its values is generally a pessimistic one. The problems associated with mental illness are closely related to the destruction of traditional values, individualism and the erosion of the family and community, materialism, lifestyle and the loss of authority; in clergy terms, a breakdown of structures that are imbued with and informed by religious values. For instance, the emphasis given by the imams and rabbis on the problems generated by materialism and the various ills associated with modernity which are posed as threats to the mental well-being of younger people suggests a number of things. First, the moral threat and the mental health threat associated with modernism are presented as co-morbidity. More, importantly perhaps, the concern for the mental health of young people opens a window to a more generalised concern about the undermining of a minority culture through assimilation; a seduction away from religious adherence and community. However, it is noteworthy that this concern about contamination was seldom associated with the older generation. It may be that the older generation is perceived to be somehow more protected from these dangers or perhaps, less exposed.
Explanatory models, however, are not just diagnostic in nature, but rather also, cognitive systems, organising and orientating the help-seeker and helper towards a resolution or relief. It may also simply provide an acceptance, fatalistic or stoical. Although often fragmentary and inchoate, explanatory models suggest a strategy or at least some resolution possibilities. We can view the explanatory models of clergy as moral manifestoes in which individual behaviour is important, but deeper structural change is regarded as essential to any amelioration of human misery. It is here that clergy conceive of the religious involvement, articulating the need for change and return to tradition, albeit somewhat rosily depicted. In clergy terms, the secular mindset has removed a spiritual dimension from social activity—the consequences of this deletion have both social and spiritual consequences.
Several questions emerging from the diverse local clergy perspectives seem pertinent. Primarily, how might these models of illness impact on the way that pastoral care is provided? At an individual level, we would suggest that generally clergy approaches to help-seeking will not be very much affected by the world views that they espouse. Thus, other data from this study suggests that clergy, irrespective of faith grouping, will still contact or refer to mental health services. That is not to say that clergy uniformly hold psychiatry in high esteem but rather, clergy tend to recognise their inability to help and they tend to react pragmatically to these encounters. However, the findings suggest that clergy may be somewhat sceptical of the biomedical model of illness and will develop pastoral care approaches and potential collaboration with mental health services, distinctly influenced by collective and systemic, non-medical and moral/religious assumptions. This may not lead to disastrous confrontation with psychiatry; after all, social psychiatry continues to grow in influence and logically, the ramifications for community problems and community rates of mental health problems tend to be expressed more fully and appropriately at the political level.
It may be that, given the depth of structural community problems that clergy indicate as problematic to mental health, they may be amenable to involvement in community development and public health promotion. Nevertheless, as argued by various black clergy, misdiagnosis and perceived mistreatment of black and minority ethnic people is likely to be a corrosive issue which will certainly need to be disentangled and discussed if collaboration and partnerships are to advance. Similarly, for some clergy, the notion of a non-moral approach to guidance and counselling as is perceived by clergy to be the case in secular forms of therapy is considered distinctly unhealthy and remains a block to referral.
Should we expect clergy views to differ very much from those of their congregation or even the general public? Taking this question in a circular fashion, our expectations of clergy knowledge on mental health somewhat rests upon whether or not clergy and their organisations formally acknowledge or perceive this to be an important part of the pastoral role. Currently, this is not formally acknowledged, nor does mental health appear to form an important (or even superficial) element of training for ministry in most, if not all, faith groups in the UK and elsewhere (Weaver
1995; Leavey et al.
2012). Among individual clergy, the extent to which they involve themselves with mental health depends as much upon matters of utility as it does upon resources. In other words, in what ways might dealing with mental health problems further the aims of the church or elevate the standing of the pastor?
In a limited way, this paper is an attempt to highlight and explore issues that are of importance to clergy in their understanding of mental illness and which may potentially be of use in attempting to improve relations between psychiatry and clergy. However, some caution is urged here. It should be acknowledged that the perspectives explored here are somewhat partial and particular; and while this study highlights various key thematic issues, these certainly should not be considered as exhaustive.