It is time for another entry into the mailbag series where I answer feedback email from readers and others. If you want to send me a question, comment or any other kind of feedback, please do so using the contact form on the about page.
In a previous post, I explored the pseudoscientific belief that schizophrenia is the result of demonic possession. In reality, schizophrenia is a psychiatric condition that results from a complex interaction of biological, psychological and social factors. The Journal of Religion and Health (impact factor 0.8) had published a paper by M. Kemal Irmak falsely claiming that hallucinations are just misinterpretations of real sensory information caused by demons. What evidence did Irmak present for this astonishing view? None whatsoever.
In response to that post, Michael wrote me the following email (additional personal information has been redacted):
I came across your blog while researching the use of folk healing methods for believed possession states in light of the new DSM diagnosis for Dissociative Identity Disorder. Specifically I saw your response to Irmak’s paper attributing hallucinations by persons with schizophrenia as caused by demonic activity. I certainly understand your argument against the etiology Mr. Irmak is advancing. My question is more on the treatment side […]. If a Turkish patient with schizophrenia believes that their symptoms are caused by djinn/demons, sees a faith healer and experiences a treatment consistent with social-cultural-religious understandings, could it be argued that this is a good treatment if the person has a reduction in their symptoms? It seems that there is evidence these approaches have better “recovery” rates for chronic psychosis than the medication-heavy methods in the West. (I am not saying no one should take anti-psychotics. […])
In other words, can faith healing be a valid part of a culture competent treatment program for schizophrenia if it was associated with a reduction in symptoms?
I am not a psychiatrists, psychologist, psychotherapist or any other kind of mental health professional, so I cannot give any medical advice in regards to treatments for individuals with schizophrenia above the mainstream standard of care, which is not limited to antipsychotics, but include cognitive behavioral therapy, rehabilitation and other treatments.
Cultural competence is crucial for psychotherapists who work with culturally and ethnically diverse clients. Otherwise, there is a risk of miscommunication, collapse of the therapeutic alliance and treatment failure. This means taking into account how culture and ethnicity can influence affect and behavior, individual versus collective goals, culture-specific beliefs about mental health and psychiatric conditions, value systems, relationship between treatment provider and client and so on. At the same time, psychotherapists should not fall for simplistic stereotypes of clients from different cultures or of different ethnic backgrounds.
What role does traditional cultural treatments play in culturally competent psychiatric treatment? Can faith healing be a valid part of a culture competent treatment program for schizophrenia if it was associated with a reduction in symptoms? The following arguments are from the standpoint of scientific skepticism and should not be considered medical advice.
First, we need to examine precisely what is meant by “symptom reduction”. To put it simply, symptom reduction can be due to a treatment effect, a placebo effect or a mix of the two. This means that symptom reduction is not sufficient to establish the clinical validity of a treatment since the treatment in question might not be better than placebo. To answer this, we need methodologically rigorous scientific research. Second, traditional cultural treatments can have substantial risks, such as transmission of HIV or hepatitis B from acupuncture or heavy metal poisoning from Ayurveda. Third, there might be a conflict between the science-based treatments and the cultural beliefs that are reinforced by the traditional cultural treatments, such as the etiology of psychiatric conditions or the relative merits of rationality and spiritual thinking. Fourth, there is the ethical issue with giving clients placebo treatments that do not have any clinically significant effect.
In other words, the perceived benefit of traditional cultural treatments has to be demonstrated to be better than placebo (both in terms of the treatment effect and the cultural benefit), the risks have to be adequately assessed and compared with the benefits and the effects of combining science-based and superstition-based treatments have to be understood. This might seem needlessly harsh and a lot of people make knee-jerk responses along the lines of “what’s the harm?”. The general skeptical response is that we should not peddle to cultural superstitions if they do more harm than good, especially since there are plenty of other ways to ensure culturally competent treatment. If the cultural traditions had a clear medical benefit, it would be just called “medicine” and not “cultural traditions”.
As for the alleged better recovery rates of faith healing over mainstream standard of care for individuals with schizophrenia, a quick pub med search for “faith healing schizophrenia” gave six results, neither or which were related to the topic.