Wednesday, August 7, 2013
"Words of Knowledge" Versus Evidence-Based Practice
It will be no news to anyone that some religious groups reject the materialistic explanations given by modern science and medicine, and consider human lives to be rightly considered as deeply interwoven with the supernatural. Members of some of these groups reject medical treatment in favor of prayer or other religious practices and similarly seek religious treatment for psychological conditions. They may attribute psychological problems entirely to supernatural events. Jenny McCarthy, the anti-vaccination celebrity, is famous for stating that she saw her autistic child’s soul go out of his eyes as he was vaccinated, a statement apparently based on the idea that autistic children have no souls. (Can this be due to a confusion of “soul” with “emotion”, as in “soul music”? It’s hard to say.)
Scientific medicine and clinical psychology are based on the assumption that all human phenomena are in essence material events, although they may not feel that way to the person experiencing them. There is a further assumption that collecting information about material, observable events can eventually allow us to understand causes and effects in human life, and in some cases to correct problems and bring about healthier physical and mental conditions. Although it is clear that some individuals feel comforted by the practice of prayer, a scientific approach does not assume that any supernatural events are actually involved in the sense of comfort.
The clash between these two views of the world, one characteristic of a fundamentalist Christian mind-set and the other of an approach that rejects supernatural explanations, is almost unresolvable, although there are people who manage to compartmentalize the two even in their most contradictory forms. There are also many who are Christians of mainstream groups and who are no part of this conflict because their beliefs do not involve supernatural influences or phenomena as part of everyday life today.
The culture conflict just discussed seems to be most serious for people belonging to charismatic Christian groups such as the Pentecostals. These groups believe themselves to be potential recipients of the gifts of the Holy Spirit described in the New Testament as occurring at the first Pentecost. Recipients of those gifts were said to have shown the presence of the Holy Spirit by “speaking in tongues”, and to have the abilities to detect, identify, and cast out demons who caused physical or mental disorders. While mainstream Christian groups have long held that such abilities, while genuinely given in the early days of Christianity, are no longer part of life even for the most devout, charismatic groups hold that true believers (i.e., themselves) who have shown their baptism in the Spirit by speaking in tongues are also given the abilities attributed to the early Christians by the description in the book of Acts. This belief in supernatural events and abilities as part of ordinary life is completely at odds with attempts to explain and manage disorders on a foundation of scientific materialism.
Beyond this obvious conflict of world-views, there is another issue that further divides charismatics from mainstream Christians and secular thinkers who are committed to a scientific approach to medicine and psychotherapy. This issue has to do with how evidence for any claim of effective treatment is gathered and displayed. In the last few months, two posts on this blog have been related to the evidence issue but have not entered into a full discussion of the question. These were http://childmyths.blogspot.com/2013/06/conversion-therapy-reparative-therapy.html and http://childmyths.blogspot.com/2013/08/behind-kickstarter-request-helping.html. In the first, I commented on a hearing on New Jersey legislation to prohibit the use of “conversion therapy” to change minors’ same-sex orientation, in which members of the Assemblies of God argued that the treatment was an effective way to correct a condition which they predicted would have terrible repercussions if untreated. (This bill became law, by the way.) In the second, yesterday, I referred to a Ukrainian charismatic pastor who has been taking children from the street and treating them in some way for drug and alcohol addiction; I asked whether his methods were known to be safe and effective.
Practitioners of scientific medicine and clinical psychology generally share a viewpoint about how we know whether a treatment is safe and effective, or safe but not effective, or effective but unsafe, or both unsafe and ineffective. This shared viewpoint requires empirical research that identifies a specific treatment, then follows outcomes for persons who have received the treatment and compares them to another group who have received another treatment of known effectiveness. Ideally, people are assigned randomly to one treatment or another, although this is not always practical. Researchers examine not only the immediate outcome, but events several years after treatment, as we want treatment methods to provide long-term benefits.
Why would charismatic groups not follow the same procedure in making decisions about the safety and effectiveness of treatments? There are several reasons, which I have discussed in a published paper (“Deliverance, demonic possession, and mental illness: Some considerations for mental health professionals.” Mental Health, Religion,& Culture, 2013, 16 (6), 595-611). One is the fact that charismatic Christians do not expect problems of mental health, mood, or behavior to be cured permanently; attributing these difficulties to the individual’s spiritual condition, and acknowledging the sinful nature of human beings, they believe that most humans will “backslide” spiritually and periodically show symptoms of their problems. The most important part of their cure, commitment to religious beliefs, is accomplished, but the observable outcome may not show this-- in fact, repeated worsening of observable symptoms is very much to be expected. Considering mood and behavior alone as the foundation of supportive evidence is simply ignoring the essential spiritual change, whose long-term benefits are to be assumed even when observable outcomes are poor.
In addition, charismatic groups reject the traditional scientific view that investigation is a public process in which communication to and correction by others is essential to the development of reliable evidence. Instead, they are committed to the belief that knowledge is given by God to individuals, who correctly identify it as truth. Acording to D.H. Boshart, writing in 2006 at www.christcenteredmall.com, such truth may appear in the form of a “word of knowledge”, which is “a definite conviction, impression, or knowing that comes to you in a similitude (a mental picture), a dream, through a vision or by a scripture that is quickened to you. It is supernatural insight or understanding of circumstances, situations, problems, or a body of facts by revelation; that is, without assistance by any human resource but solely by divine aid. Furthermore, the gift of the word of knowledge is the transcendental revelation of the divine will and plan of God.”
One aspect of God-given knowedge is the capacity for “discernment”. This is a form of spiritual diagnosis, and a person with this gift is able to identify whether the spiritual causes behind an event are of God, or whether they are Satanic in nature and thus require treatment by the casting out of demons. Evidence-based practice that does not include discernment would presumably seem to charismatics to be highly ineffective and even dangerous (because of the demonic factors), even though science-oriented practitioners might consider that their evidence shows a treatment to be safe and effective.
It is hard to imagine how this culture war can be resolved or even how skirmishes like the fight about the Ukrainian pastor Gennadiy Mokhnenko will turn out. However, it would be a mistake for the scientific side to assume that their opponents are simply lacking in knowledge, when in fact they are operating within a complex belief system of their own and interpreting the observable world in terms of a posited invisible realm to which only they have access.