Distinguishing denial from authentic faith in miracles: a clinical-pastoral approach.

Is it possible to distinguish between authentic religious faith in a miraculous cure and the psychiatric syndrome of denial in the face of serious illness? There are, of course, atheists who consider all religious beliefs delusional, and, therefore, would not accept the meaningfulness of the distinction. Many others, however, including some persons of faith, might still demur before undertaking such a task. They might, at first pass, think that the attempt to distinguish between genuine faith and psychological denial is either disrespectful toward the patient, intolerant, or an impossible task, given what is taken to be the inherently private nature of religious matters. For these critics, the notion that anyone other than the individual could make a judgment about the authenticity of the faith of another is itself morally offensive. What seems at first the morally correct response might seem to be, “How could one dare to question the authenticity of the religious views of another person?” Yet, such a view, upon careful analysis, is no less dismissive of the religious person than the view of the “hard-nosed” atheist. The assertion that it is impossible to distinguish authentic faith from a disordered psychiatric state could only be true if faith were taken to be at least functionally equivalent to a disordered psychiatric state. Such an assumption could hardly be construed as reflecting an attitude of respect for religious persons, or evidence of the kind of tolerance that ought to characterize a liberal polity. Therefore, contrary to many people’s initial impressions, it is deeply insulting to religious persons to suggest that expressions of belief in miracles cannot be questioned. Important clinical observations support this view. It is a well-known fact that mentally ill persons not infrequently use religious language. Except in unusual cases, such as malingering, this is usually not a conscious manipulation of religion but one among many possible clinical manifestations of the psychiatric disease. All clinicians are aware of this. If the patient in the emergency room shouts, “I am Jesus Christ, and I condemn all of you to hell,” most physicians and nurses know that they should call the psychiatrist, not the chaplain or the ethicist. The view that an individual’s belief in miracles ought to be susceptible to challenge is also supported by a careful philosophy of religion. As I argue in another paper in this issue of the Southern Medical Journal, the rhetoric of privacy and religion can lead to logical inconsistencies. Properly understood, respect for the privacy of religious belief ought to imply tolerance, not a purely subjective epistemology of religion. Tolerance means that there should be no imposition of religious beliefs upon individuals by the state (or by physicians) in a pluralistic and tolerant society. Unfortunately, the notion of respect for the privacy of religious belief is often amplified beyond this moral notion of tolerance to imply a subjective epistemology of religion, ie, the notion that all religious beliefs are inherently subjective and that individual religious beliefs are not susceptible to challenge. As I have argued, however, private religion is just as incoherent as the notion of private language. If one believes that there are religious truths, as the religious person must, one must also accept the existence of a criterion by which to judge the truth of any given religious claim. If one’s standard for judging the truth of one’s private religious claim were itself private and subjective, that subjective standard would, in turn, need its own objective truth criterion, and so on, in an infinite regress of subjectivity. A believing person must hold that his or her religion expresses at least some truths; otherwise, it would not be worth believing. But the criterion for judging the truth of a religious claim must be something other than that person’s own subjectivity. Where could such a truth criterion be found? That criterion must be the deposit of faith of that person’s religion. This will at least be an intersubjective criterion of truth. Religions are believing communities. Whether any particular religion would go further than intersubjectivity and claim an objective criterion (such as revelation or scripture) will depend upon the creed of that religion. But the criterion for assessing an individual’s beliefs must be outside that individual. Claims about miracles may therefore be subjected to scrutiny according to the criteria of the patient’s faith. Faith is, in this sense, public and not private. Judging the authenticity of patients’ or families’ claims about miracles therefore involves examining such claims in light of the deposit of faith of the person’s own religious tradition. From The John J. Conley Department of Ethics, Saint Vincent’s Hospital— Manhattan, New York, NY.