To the Editor: Churches have long been considered community resources offering support to persons in need. Clergy are readily available in times of crisis and enjoy high levels of public trust (1). Their relationships with individuals and families are often long term, and many pastors can mobilize sizable numbers of volunteers. Collaborative activities between mental health programs and churches, especially social clubs, integrate social resources and increase the community support available to persons with mental disorders (2). However, we know little about clergy members' knowledge of and attitudes toward mental disorders and formal treatment services, especially psychotropic medications. To what extent are their views consistent with current biomedical knowledge, or instead based on religious interpretations?
At our initiative, three conference offices of the United Methodist Church distributed surveys about the causes of mental disorders, perceptions of people with mental disorders, and views of medications and other treatments to 1,718 pastors in Indiana and Virginia. A total of 1,031 surveys (60 percent) were completed.
Results indicated that most pastors have mainstream, up-to-date views about the causes of mental disorders. Three causes of mental disorders that are based in biology—chemical imbalance, excessive use of drugs or alcohol, and inherited genes—were all perceived as more important than three psychosocial causes—inconsistent parenting, social pressure, and spiritual poverty. Each of these six biopsychosocial variables was seen as a very important or somewhat important cause of mental disorders by more than half of the sample (54 to 94 percent). All remaining causes, which included explicit religious interpretations and "fate or luck," were seen by more than half the sample (from 60 to 83 percent) as not important in causing mental disorders.
Most of the pastors (from 53 to 86 percent) agreed or strongly agreed that medication helps people control symptoms, deal with day-to-day stresses, manage relationships, and feel better about themselves and that "mental illness is like any other illness." Most pastors (76 percent or more) were neutral about or disagreed with statements that prayer and counseling are more important than medication in treating mental disorders. Eighty to 90 percent also disagreed that people with mental illnesses cause their own problems or can control their behavior and symptoms and that no one can really do anything to solve a patient's problems.
Interestingly, 484 respondents (47 percent) disagreed with the statement "Mental patients are no more dangerous than an average citizen," while only 243 (24 percent) agreed. That is, almost half of the pastors perceived that people with mental disorders are more dangerous than the average citizen, which may reflect negative stereotyping of individuals with mental disorders.
In summary, most pastors in this large, mainline Protestant denomination appear to have an informed, scientifically based understanding of the causes of mental disorders and of the importance of medications in effective treatment, which suggests a promising basis for useful communication and collaboration with psychiatrists and other professionals.
Dr. Lafuze is professor of biology at Indiana University East in Richmond and research associate in pediatrics at Indiana University School of Medicine in Indianapolis. Dr. Perkins is professor and chair of psychological science at Ball State University in Muncie, Indiana. Dr. Avirappattu is assistant professor of mathematics at Kean University. This research was supported by grant MH-51669 from the National Institute of Mental Health to the Indiana Consortium for Mental Health Services Research (Bernice Pescosolido, principal investigator).