Magazine article Clinical Psychiatry News


Magazine article Clinical Psychiatry News


Article excerpt

Assessing Religious Claims

In his recent guest editorial, Dr. Ansar Haroun discussed the case of a defendant who said that God told him to cut the throat of a 10-year-old boy ("Delusions of Psychiatrists," April 2003, p. 14).

Examining psychiatrists diagnosed the defendant as psychotic, but Dr. Haroun objected to this characterization. He said that the phenomenon was labeled a delusion only because the psychiatrists did not like or agree with it, and went on to state that psychiatrists have no justification in making assessments of a phenomenon that has religious implications or overtones.

I respectfully disagree. There are steps that examiners can take to make reasonable and science-based assessments of such symptoms that are well within the standards required for clinical and forensic work.

First, the clinical examination of the defendant should reveal the presence or absence of a pattern of symptoms of mental illness. Although the experience of hearing the voice of God might be difficult to evaluate in an otherwise ordinary person, the presence of other symptoms (affective, psychomotor, cognitive, behavioral, etc.) would be most useful in pointing toward the correct diagnosis.

Theoretically, God is just as likely to speak to a person in an acute manic psychosis as to anyone else. Given the clinical context, however, how likely would that explanation, as opposed to a hallucination, be? Further examination might clarify the delusional content: Perhaps this defendant thought he was Abraham and the child was Isaac.

Second, the defendant's subculture and/or religious belief system of origin can be determined and compared with his reported experience. I will use Lutherans as an example, because I am one and because Garrison Keillor can back me up.

In the Lutheran religious experience, God would not command that the throat of a 10-year-old child be cut. (Remember, the biblical Abraham's hand was stayed at the last moment.) This would be inconsistent with everything Lutherans understand and experience about God. if a Lutheran were to report having heard the voice of God telling him or her to commit such an act, the most likely explanation, by far, would be that it was a psychotic symptom. …

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