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It's Hard To Get Help

From Marlene Winell on the front lines of advancing knowledge and treatment of RTS :-) ~

HoleImage by Eleder JH via Flickr

Why Religious Trauma Syndrome Is So Invisible

With RTS, the social context is completely different from other trauma recovery situations. Natural disaster experiences, childhood sexual abuse or family violence are all understandable to friends and professionals who are likely to be sympathetic and supportive. In the case of religious abuse, a person is often hounded by family and church members to return, and reminded in many ways that they are condemned otherwise. In essence, they are pressured to return to the perpetrator of their abuse. Their suffering is not seen. In fact, they are made pariahs when they do not return and this social rejection is an added layer of serious injury absent from other varieties of trauma.

Even in the general society, “atheist” connotes an amoral person who lives a meaningless life and is often pitied. In the U.S. there is serious discrimination; one cannot possibly hold public office, for example. Atheists are (or at least were in 2006) the least trusted minority in the U.S. to the extent that 47% of respondents said they would disapprove of their child's wish to marry an atheist.

A survivor of religious trauma is also surrounded by potential triggers, especially in more religious communities. Symbols of sexual abuse are not celebrated, but someone with RTS is expected to enjoy Christmas and Easter, or at least be quiet. Religion holds a place of privilege in society. Churches are everywhere and prayers and hymns are ubiquitous. In many communities, to not believe the prevailing religion makes one a deviant, putting one at risk of social rejection, employment problems, and more.

Anger for other kinds of abuse is considered normal and acceptable, whereas ex-believers are supposed to forgive and “not throw the baby out with the bathwater.” They are called too sensitive or accused of taking religion the wrong way. People understand nightmares about wartime combat but not about Armageddon. Expressing feelings is usually dangerous. Too often, the result is a shaming attack rather than support, i.e., “blaming the victim.”

From an orthodox, conservative point of view, people who have left their religion and are suffering are seen as failures - they simply haven’t done it right. A fundamentalist Christian view is that they have been “rebellious” and brought about their own problems. Depression and anxiety are often considered sins or even demonic attacks. Personal misery is seen as a natural result of rejecting God; being apostate brings God’s punishment.

A religious counselor will redirect a client back to the religion, typically with biblical guidelines to repent and become more devout. The client suffering with RTS is then likely to try harder to meet the impossible demands of the religion, much like returning to a situation of domestic violence. They will do this because of the authoritarian nature of such counseling, but fail again and feel hopeless or evil or crazy. No one concludes that it is the religion itself, which is at fault. (And religious counselors often have very little training in psychology while getting exempted from standard licensing requirements).

In many seemingly secular settings, religious views are still considered “normal” and even advocated in aggressive ways. This is the case in the U.S. military, which is dominated by conservative Christianity, affecting mental health services both during active duty and for veterans. In medicine and in treatment for drugs and alcohol, professionals assume that pushing religion is acceptable. Yet people struggling with RTS-related substance abuse simply cannot stomach the religious tone of Alcoholics Anonymous, for example, and get very little sympathy.

In one case, a client of mine who was in a psychiatric ward because of panic attacks due to RTS told me that a doctor told her she needed to get right with God. Imagine giving parallel advice with some other kind of abuse. I also had a call from a veteran who was searching for an alternative because his counselor at the VA said he preferred working with people who believed in hell because he could get them to behave.

In many ways, a person with RTS can be retraumatized again and again. This can cause regression to an earlier state of fear, as illustrated by this person on an online forum who was emotionally bullied by a religious aunt: Once Free, Now Afraid. Another writer on the same website wrote about the unequal social status of religious abuse:

If I were to say that Christianity took my childhood, filled me with fear, paralyzed me with anxiety, annihilated my Self, robbed my body of feeling, stole my future, gave me an unequal marriage role, and cost me thousands of dollars, Christians would dismiss it with “You were in the wrong church, you take things too seriously, or you made your choices based on your own free will”.

It is no better when I talk to those raised outside of Christianity. They gently suggest that I’m over sensitive or making a big deal out of nothing or that I don’t understand who Jesus really was or that it couldn’t have been all that bad since I turned out to be such a nice person.

Why is it so hard for people to understand that Christianity completely messed up my life?!?!?!

If I had been discriminated against, beaten, sexually abused, traumatized by an act of violence, or raped, I would be heard. I would receive sympathy. I would be given psychological care. I would have legal recourse and protection. However, I am a trauma victim that society does not hear.

RTS victims feel very alone because, except on certain online forums, there is virtually no public discourse in our society about trauma or emotional abuse due to religion. This gap was noticed by a young man who wrote to me about his YouTube deconversion series:

"I've been working on the 4th part, focused on trauma, for better than a month now and having a hard time with it. I've been reading a lot about trauma and finding myself amazed by how closely what we attribute to trauma and PTSD align with my experience of deconversion. No one talks about religion and trauma. Not in the scientific journals, not on trauma resources... I thought maybe I would be the only one to address it.

Child Protective Services will aggressively rescue children who are physically or sexually abused, but the deep wounding and mental damage cause by religion, which can last a lifetime, does not get attention. The institutions of religion in our culture are still given a privileged place in many ways. Criticism is very difficult. Parents are given undue authority to treat their children as they wish, even though the authoritarian and patriarchal attitudes of religion, along with too much respect for the Fourth Commandment to obey parents, has resulted in harsh and violent parenting methods. Even the sexual misdeeds of the Catholic clergy have been amazingly difficult to confront. Children are treated like the property of parents or parish, and too much goes on behind closed doors.

Remarkably, even in the mental health profession, religious maltreatment of children is not a big topic, nor is losing one’s faith even on the list of psychosocial and environmental problems used for clinical diagnosis.1 The Posttraumatic Growth Inventory measures coping after trauma, yet religious abuse or losing faith is not on the list of traumas.2 Two of the items on the test are: “I have a better understanding of spiritual matters,” and “I have a stronger religious faith.” A brochure from the American Psychological Association about recovering from trauma, called The Road to Resilience, names a list of adversities, but leaves out anything religious.3

As far as professional training for therapists working with religious or spiritual issues, it doesn’t really exist and there are no requirements, at least for psychologists. This problem has been noticed by David Lukoff (1988) who has worked to bring attention to the matter.

In a survey of Association of Psychology Internship Centers training directors, 83% reported that discussions of religious and spiritual issues in training occurred rarely or never. One hundred per cent indicated they had received no education or training in religious or spiritual issues during their formal internship. Most of the training directors did not read professional literature addressing religious and spiritual issues in treatment, and they stated that little was being done at their internship sites to address these issues in clinical training (Lannert, 1991). A national study of APA member psychologists found that 85% reported rarely or never having discussed religion and spiritual issues during their own training (Shafranske & Maloney, 1990). Similar findings from other surveys suggest that this lack of training is the norm throughout the mental health professions (Sansone, Khatain & Rodenhauser, 1990) . . .
Ignorance, countertransference, and lack of skill can impede the untrained psychologist's ethical provision of therapeutic services to clients who present with spiritual problems.
RTS victims who do make it into therapy are commonly misdiagnosed and medicated for other disorders because religious trauma is not understood. In addition, therapists often recommend spiritual practices as part of therapy, showing insensitivity to a person with RTS much like insisting on going to AA meetings.

The Diagnostic and Statistical Manual-Fourth Edition (APA, 1994) does have a diagnostic category called religious or Spiritual Problem (Code V62.89), defined as follows:

This category can be used when the focus of clinical attention is a religious or spiritual problem. Examples include distressing experiences that involve loss or questioning of faith, problems associated with conversion to a new faith, or questioning of other spiritual values, which may not necessarily be related to an organized church or religious institution. (American Psychiatric Association, 1994, p. 685)
This was added with the last revision of the DSM, which I consider to be an improvement since it at least recognizes religion to be relevant to mental health. However, it includes many subtopics including joining a new faith and issues with mystical experiences. With regard to leaving religion or “crisis of faith,” it seems to be referring to an event or transition of some kind. I do not think it addresses the severity of trauma that religion can cause. While leaving one’s religion can be a discrete period of adjustment, it can also mean a long-lasting upheaval. Some of the damage that is Religious Trauma Syndrome can be deep, intractable, and life-long. It can have disastrous results similar to severe forms of PTSD. But despite the similarities that include panic attacks and phobias that impair functioning, RTS presents a particular configuration of symptoms that is a direct result of the etiology: dysfunctional religious teachings and practice.

In the social/political context of a society that is unduly deferential to religion and a populace that largely claims to believe in God while at the same time sustaining doubt, it is unlikely that the label of Religious Trauma Syndrome will be easily or rapidly received. Yet, the clarity of such a diagnosis can provide the key to effective treatment. And just as knowledge of etiology provides direction in medicine, we can also understand something about prevention and early detection. This gives us an opportunity to rescue the children of our religious country and give them a fair chance to thrive.

1 In psychological diagnosis, “Axis IV” is used to describe any social or environmental stressors that are likely to impact the primary mental health diagnosis. The categories presently are: Problems with primary support group, Problems related to the social environment, Educational problems, Occupational problems, Housing problems, Economic problems, Problems with access to health care services, Problems related to interaction with the legal system/crime, and Other psychosocial and environmental problems. Each of these categories contains a long list within it and ranges all the way from “parental overprotection” to “exposure to war.” Nowhere is any mention of religion, church, spiritual abuse, loss or faith, ostracism, shunning or anything remotely related to religion or spirituality. This omission is glaring given the relevance of religion in people’s lives and the problems experienced. Despite the lack of consideration in diagnosis, surveys show that religious and spiritual issues are frequently addressed in psychotherapy (Lukoff, 1998).

2 The list of traumas in the Posttraumatic Growth Inventory
Loss of a loved one, Chronic or acute illness, Violent or abusive crime, Accident or injury, Disaster, Job loss, Financial hardship, Career or location change/move, Change in family responsibility, Divorce, Retirement, Combat, Other.
Two of the items on the test are: “I have a better understanding of spiritual matters,” and “I have a stronger religious faith.”

3 The Road to Resilience:
“Resilience is the process of adapting well in the face of adversity, trauma, tragedy, threats, or even significant sources of stress -- such as family and relationship problems, serious health problems, or workplace and financial stressors. It means "bouncing back" from difficult experiences.”

American Psychiatric Association. (1994). Diagnostic and statistical manual, fourth edition. Washington, D.C.: American Psychiatric Association.
Lukoff, D. (1998). From Spiritual Emergency to Spiritual Problem: The Transpersonal Roots of the New DSM-IV Category. Journal of Humanistic Psychology, 38(2), 21-50.
(includes the other references within the Lukoff quote)