July 31, 2012

Diseases of the Spirit

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Paul King, MD

Parkwood Behavioral Health System, Olive Branch, Mississippi


Spirituality seemingly has no place in modern medicine, but some groups, like Alcoholics Anonymous (AA), describe chemical addiction and alcoholism as diseases of the Spirit. Diseases of the flesh (eg, cardiovascular disease, diabetes, cancer) are physical in nature and are treated using the traditional medical model: a history is taken, a physical exam and laboratory or other tests are conducted, and treatment is discussed with the patient. Physicians also discuss prevention ideas such as diet and exercise.

Diseases of the Spirit, on the other hand, may result from the misuse of short-term anxiety-relieving techniques and may not be adequately addressed by the medical model. For example, drinking to relieve stress may lead to alcoholism, opiates and benzodiazepines can lead to abuse problems and chemical dependency, sexual promiscuity may become sex addiction, excessive gambling and shopping may lead to financial ruin, and pornography can lead to sex offender behavior. Does psychiatry adequately address these illnesses?

Obesity and video game addiction, especially among our children, are other diseases of the Spirit. In treating obesity, the new catchphrase is “portion control,” but we have more and more buffets and oversize portions at restaurants. The combination of food and video games turns adults into couch potatoes and makes children obese, since they sit in front of the game and eat instead of exercising or going outside to play. Unfortunately, the combination of open access to food and video games is sometimes used by parents to keep children from bothering them, with devastating consequences on the child’s physical health and self-control. This seems to be an American phenomenon. In France, children are allowed only one snack per day. The French child is “educated” by his or her parents to behave with the word “no.” The experiments of Walter Mischel called the “marshmallow test” showed the importance of self-control in children and how this later translates into success as an adult (see Marshmallows, Willpower, and Success).

The Spirit or soul requires sustenance and care, and neglect of the Spirit can lead to disorders, just as neglect of the body leads to disease. Feeding the soul a spiritual program or religious training teaches one to follow a path that puts G-d first. Spiritual strength, purpose, and meaning help one to tolerate frustration and cope with stress. Addicts and alcoholics have either gotten off the path or were never on the path to begin with. An emphasis on spiritual teaching, such as that provided by groups like AA, can help addicts and those who suffer from diseases of the Spirit to move away from self-centeredness and toward a G-dly path that nurtures the Spirit. Feeding the self and ignoring the soul creates all the spiritual disorders that I have pointed out. Once the self-centered individual becomes hooked on whatever he or she craves to feed the self, he or she becomes addicted to it. Relationships and marriages are destroyed because the selfish and self-centered individual only uses the spouse and family to help maintain the addiction. Addiction kills the soul; the disease is therefore spiritual.

Inpatient units of psychiatric hospitals tend to fill up with these types of patients. A number of them have been diagnosed with bipolar I or II disorder. Goldberg et al found that only about a third of patients with substance use disorders who were admitted to a dual-diagnosis unit actually met criteria for bipolar I or II disorders. Clinicians were using the history of high-risk behavior and the evidence of mood instability to make the diagnosis. Cocaine abusers, especially, did not qualify for a bipolar diagnosis (P<.001). The consequences have an effect on our entire health care system because a number of these patients go on to file for Social Security/disability benefits. An attorney is often hired and uses the diagnosis as evidence for the claim. Judges who rule on disability cases are looking for guidance from our profession. We need to do a better job.

Financial disclosure:Dr King had no relevant personal financial relationships to report.​

Category: Substance Use Disorder
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29 thoughts on “Diseases of the Spirit

  1. Clinically diagnosed bipolar II for fifty years.
    AA for 18 years, one day at a time,.
    Age 76, male, London UK

    Thank you, Dr King, for a very interesting article.
    What you say has been my life experience.
    Kind regards

  2. While I agree that many of these disorders do not either fit the “medical model” well for either diagnosis or treatment, I think our patients benefit from a multimodal approach in which the spirit and flesh are viewed as dimensions of an individual which co-exist and both need to be addressed for the individual to heal. I have been impressed by the evidence that the brains of individuals with addictions are wired differently before any of the behaviors are manifest and that those differences are likely coded by one or more genes. Family doc for 32 years.
  3. My experience with dual diagnosis is the dx the clinician is most comfortable is the only dx that is focused on. Dovetailing with that is a lot of clients I see that would prefer to focus on their psychiatric problem and put the etoh/drug issue on the backburner.
  4. Charles: I very much agree with you. Genetic research points to gene differences present in alcoholics. For these individuals one drink sets up the craving to just continue drinking until drunk. This is not true in the rest of us who can consume alcohol without getting into problem drinking. The alcoholic is definitely wired differently. Thus far though there are no medical treatments that have any real degree of success. Pills do not cut craving. Spiritual programs by promoting complete abstinence are the only effective treatment at the present time. AA is the most well known but throughout history there have been religious groups who practice forms of asceticism in which the consumption of alcohol is forbidden.
  5. Michael: You are correct but it usually the alcohol or drugs that lead to the behavioral deterioration that precipitated the inpatient admission. Addressing the mood, depression, or anxiety alone, will do little for the patient unless the substance abuse is treated. This is where many psychiatric programs seem to fail. The program must recognize the spiritual nature of this disease and address it.
    Programs of excellence do recognize the duality of the psychiatric and the spiritual, giving treatment to both.
  6. AA is so important that I do not believe an alcoholic can stay sober if AA is not attended regularly. That applies to those who mix alcohol and drugs.
  7. Bert, you are correct. A spiritual disease is only effectively treated with a spiritual treatment such as AA. The reason that psychiatry seems to not hear this appears to be a lack of understanding about the 12-Step program. If we can properly educate psychiatrists, possibly the situation will change and the patients will receive the type of help needed.
  8. I hear and comprehend everyone but no one has mentioned self worth that is lost when a mental DX is not correctly treated due to the substance abuse issues. Some patientshave resorted to self medicating with drugs, etoh and loose “spirituality” and then self worth and so on, so on. Lets review “Maslow’s Hierarchy”, the variables of loss between the patients are many. So, which came first?, we will never know and the question will linger on for many years to come. I have heard from many patients that they were not worthy to worship or believe that “something” or “someone” would even listen and love them.

    I believe the disease should be “Loss of Maslow’s Hierarchy Disease” (LMHD) or loss of positive affirmation. Dr. Jean Kirkpatrick addressed this issue quite well. AA is NOT the only recovery program for recovering individuals there are other options. Those other options should be introduced to the patients and let them decide which of the many programs fit “their” needs. Spiritality will return.

  9. I am glad that psychiatrists are thinking about this topic. A subject to be addressed in psychiatry residency training. I have been in practice for over 40 years (child adolescent and adult psychiatry).
    In my experience dual diagnosis or any diagnosis, mostly every one get some benefit from psychopharmacology and traditional and other innovative psychotherapies. However they don’t address this area of soul/spirit. My origin from India
    gave me a lot of self control, self discipline, delaying gratification, and frustration tolerance.
    These qualities I attribute to deep roots in nature and nurture. Initially with reluctance I used to suggest to my patients practicing their religious believes and how they help or interfere with their growth and maturing. I also suggest Meditation and Yoga to help them develop some self control and discipline. Now after reading your article it tells me I am in the right track or it gave me validation in what i have been doing for so long. Enjoyed reading this article and others’ response. Looking forward to more discussion.
  10. Christina, can you please throw some light on options to AA and LMHD. Your question of “which came first” is an everlasting unanswerable one.
  11. Padmini: Thank you for your thoughtful comments. You might want to look up my blog: Marshmallows, Willpower and Success. I believe you will enjoy it.
  12. Many have deep religious conviction, but many do not. If we mix religion with our patient care we are in danger of lacking scientific rigor, evidence based medicine and mix up wishful thinking with fact.
  13. I can hear many opinions in this article and I believe this topic ensues great intensity, especially when those commenting have had an addiction.
    I like to remember a few things:
    Statistics show that the majority of people who stop drinking and may be labeled “alcoholics” do it on their own. They just stop.
    There have been a few comments on brain wiring. In considering neuroplasticity, it would seem to me that associations, lifestyle and belief systems that emphasize a healthy life without alcohol would help strengthen new neuropeptides for a non-addictive brain. Attending meetings constantly, in which the brain hears over and over again, “I am an alcoholic…You are an alcoholic,” all gets stored in the entorhinal cortex of the hippocampus. To me this just reinforces to the brain that the person is an alcoholic. Are we not multi-faceted people with qualities of strength, weakness and nuetrals? Also, look at the behaviors that ensue the “alcoholic” once they stop? How many of your patients have gained weight? Incured blood sugar issues, becoming pre-diabetic, developing bulimia, smoking cigarettes? I have observed at AA/NA meetings people drinking coffee, eating high-fat and high-sugar cupcakes while smoking a cigarette. All these substances hit the VTA; same area as alcohol would.
    And calling this a disease of spirit? If a brain has severly low GABA it could be normal for the person to look to alcohol. Afterall, it does temporarily help the neurotransmitter.
    A brain’s choice of thoughts is in our control. Studies have shown that those that work on correcting irrational beliefs and dysfunctional thinking are quite successful in ending an addiction.
    In answer to someone’s comment on other self-help programs, there is SMART Recovery that has meetings in person and online, along with education tools and therapy worksheets. Meetings do not focus on people having character defects or needing God to save them, but on the powerfullness we have as humans and to use the brain to our advantage.
    I appreciate that those who have been helped by AA feel attached to it and want to support that. I respect that, however, in consideration of neuroscience, body mechanics, and statistics, I feel we need better treatments and therapies to offer our patients.
  14. On a personal level I could agree with Howard. On the flipside, in contemplating the religious education of my past, I can see that history, science, and the bible do have areas where they agree and meet each other. I would like to respect my patient’s religious beliefs, and where it is helpful to them, use them to train the brain for effective thinking.
    Also, medicine has evidence that changes drastically over even just a few years. Relying completing on it would seem unwise and illogical to me. Evidence just comes from man alone, who makes mistakes constantly. Many people have a lot more confidence and fortitude with a supreme being and the evidence of him over thousands of years.
  15. I tried to emphasize the concept of spirituality. This common denominator for most if not all religions and A.A. enables the sufferer to get away from self centered behavior and discover a new way of life. This can assist the psychiatrist or therapist who is working with these types of patients. Psychopharmacology had thus far been a woeful failure in treating addictions. Every new treatment for opiate addiction is merely giving another opiate. The problem is rampant and we who treat addictions need all the help we can get from religion, A.A. and other spiritual programs.
  16. As Derek, clinically diagnosed bipolar II, in a blessed sobriety through prayer and AA — a daily reprieve based upon my spiritual condition. My psychiatrist told me he was grateful to share in what he called my “miracle”, from the depths of despair and a very lethal suicide attempt last October, to this consciousness of great peace and joy. He said, “I believe psychiatry is the most spiritual part of medicine.” I agree. Thank you for your compassion and humility as a healer.
  17. Spirituality is not the same as religiosity, I think. All humans have a spiritual dimension. I bellieve the big mistake of the “medical model” is not just to unrecognize the spiritual nature of any mental disorder but to forget the spiritual nature of all medical praxis. We treat people, not diseases or brains. Science inform medicine, but also social sciences and philosophy and, in general, a profound knowledge of human nature trough observation and not only meta-analysis and randomized control trials. Chilean addiction psychiatrist.
  18. Practicing medicine without including the wholeness of life was not rewarding or sustainable for me. Embracing the biopsychosocial dimensions together in an integrated model was better. Including the spirit in the equation seems to be the next best thing. AA has been a great help to me over 19 years and the principles apply to all areas of my life. The comment that continuous exposure to AA may reinforce the problems by filling the hippocampus with negative patterns may be true. This would fit with observations that many AA meetings alone may help one avoid drink but does not nurture real recovery in many aspects of life. Medical science, psychology and social work can truly work together for better outcomes. I find that spirituality is the glue that holds it all together and leads many to become gratefully recovered.
    Thank you for addressing this in a thoughtful and considerate manner.
  19. I am one of the people who spends a fair amount of time advising the judges on questions of disability and mental disorder diagnoses. As you may know Social Security Disability is not given for substance abuse/dependence disorders but can be given for disorders like Bipolar disorder.
    Accurate diagnosis of mental disorders is extremely difficult in the context of ongoing substance abuse and casually made diagnoses become part of a record that is used as evidence in determining disability.
    While I agree that the medical model may not fit substance use disorders well, I personally find calling them diseases of the spirit less than helpful. I think we could all move toward a functional understanding of behavior we could develop workable treatments.
  20. I commend you for being a professional involved in this most difficult area. Especially if the patient meets criteria for the diagnosis of bipolar and has a substance abuse problem, your work becomes so crucial. I have found it helpful to use scales such as the Y-MARS (Young Mania Rating Scale) because these patients tend to be difficult. I am interested in your thoughts on this matter.
  21. After many years of being recovered from this disease through the spiritual program of AA, I can honestly say that no one style of treatment even comes close to solving the problems of addiction. What I adhere to are the recovery principles of AA, but believe that medicine’s role in recovery is helpful especially in the beginning when the physical symptoms are still paramount. I have also found through personal experience that the prognosis is much healthier with regard to morbidity/mortality in those of us who apply the spiritual priciples in the maintenance of this disease.
  22. I agree that the disease is multifaceted. Let’s take it a step further and bring up the old problem, and suppose that we have a cocain addicted newborn baby. The question of behavior becomes one with regard to instinct for the baby. On the other hand if the mother had found years of recovery from cocain through AA or CA, would this recovery be spiritual or medical? Further, although we realize scientifically that the baby could have a genetic predisposition toward addiction inherited from the mother it is now much better off not having been born physically and emotionally addicted. My point is that the baby has no choice in the matter, but that the mother has at some point made the conscientious choice to stop using drugs. If she made the decision after considering the principles of recovery through a 12 step program, then one could say a “spiritual recovery” has played a role. If she made the conscious choice after she listened to a very good counselor’s suggestions then one could say a psychological change has taken place. If she were treated for psychosis associated with withdrawl allowing her brain’s thought process to clear prior to her choice to stop using the drug then there is the psychiatric component as well. I would be willing to bet my next Merc that the woman who makes the choice and successfully recovers prior to her pregnancy has been introduced to her recovery through all of these modalities. The healthy baby is a bonus that many would consider a gift from G-d.
  23. as a psychiatrist who has worked and studied addiction for 35 years, i know that it is an ordinary disease of human beings. most of us got little or no education in addiction in medial school or in our residency. my text book of psychiaty defined the addictive personality totally inaccurately. they described an active addict’s behavior as the addictive personality. we have good evidence of a genetic susceptibility and biological changes in liver organels. the genetic transmission of addiction is the same as we see in diabetes. do we call diabetes a the spirit
  24. First, I’d suggest we think of human beings as psychosomatic unities of body (soma) and soul (psyche). Addiction, as well as any other “disease,” will then have physical and psychic symptoms; illness in one aspect of human nature will inevitably be manifested with symptoms in the other aspect.

    Second, the AA 12 Step distinction of religion and spirituality is one originally made by William James in his work, “The Varieties of Religious Experience,” between what he referred to as institutional religion and personal religion (spirituality)—essentially how the individual experiences the divine.

    Third, the acceptance of divinity or transcendence is not necessarily opposed to the science of medicine IF you view religion and spirituality as does Emile Durkheim.

    Given these three points, there is much to value in a 12 Step-based approach to addiction; and it does not conflict with treating the physical aspects of addiction medically.

    Chuck (differnt than the first Charles)

  25. ” Feeding the soul a spiritual program or religious training teaches one to follow a path that puts G-d first. “
    What is this crap? I’m ten years sober and an atheist. The mental device/tool that gave me the strength to quit drinking was Cognitive Behaviour Therapy. Let’s stick to the science and leave the supernatural to charlatans.
  26. Because of the bias of secondary gain and manipulative behavior it is difficult to manage these kind of cases. When the field of competence is well established and stable in time it is possible to measure the performance at certain level of functioning, to measure de degree of change, the need for reward,…from medical point of view is a disease but the same as hipertension, diabetes, where if you don’t put limits to yourself the complications will appear( and from the point of view of the society” is only your foult”)..
  27. thank you for mentioning this burgeoning problem that is often overlooked and thought of as a babysitter or just a phase people go through. It is a real problem and I agree it is “a disease of the spirit”. People are taken over by this obsession and lives/relationships are ruined.

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