Mental Health, Religion & Culture

December 2005; 8(4): 263–276

Religious attributions pertaining to the causes and

cures of mental illness

KRISTINE HARTOG & KATHRYN M. GOW

School of Psychology & Counselling, Queensland University of Technology, Australia

Abstract
In this Australian study, 126 Protestant Christian participants, 52 females and 74 males, were
assessed for their beliefs about the importance of 26 causal variables and 25 treatment variables
for two mental disorders: Major Depression and Schizophrenia. Factor analysis revealed four
causal factors, common to both conditions, labelled as religious factors, physical factors, coping
style and social/environmental stressors. Furthermore, four treatment factors emerged: religious
means, professional help, help from others (non-professional) and self-initiated means.
Explanatory variables for these beliefs were assessed using: a Religious Beliefs Inventory (RBI) to
measure religious beliefs; a Values Survey (VS) including a measure of Christian religious values;
and a Religion and Mental Health Inventory (RMHI) to measure cognitive dissonance (cf.
Festinger, 1957) between religious faith and perceptions of mental-health principles. The results
revealed that religious beliefs, religious values and cognitive dissonance function as predictors of
the attribution of the causes and treatments, for Major Depression and Schizophrenia, to religious
factors. An additional finding of this study was that 38.2% of the participants endorsed a demonic
aetiology of Major Depression, and 37.4% of the participants endorsed a demonic aetiology of
Schizophrenia.

Introduction
While religion, modern psychiatry and psychology address the same subjects, significant
differences exist between them with respect to fundamental world views, concepts and
vocabularies used to describe, explain and understand human behaviour, adjustment,
well-being and illness (Theilman, 1998; Tjeltveit, 1991). This paper focuses primarily
on the Christian religion, which is uniquely based upon a religious text called the Bible.
The Christian faith centres around God, his son Jesus Christ and the internal work of
the Holy Spirit (Favier, O’Brien, & Ingersoll, 2000; Loewenthal, 1996).
The historic relationship between psychology and religion has been characterized by
conflict and mutual disregard. Naturalism, agnosticism and humanism have dominated
the field of psychology (Bergin, 1980; Guinee & Tracey, 1997; Kudlac, 1991). However,

Correspondence: Kathryn Gow, School of Psychology & Counselling, Queensland University of Technology, QUT
Carseldine, Beams Road, Carseldine QLD 4034, Australia. E-mail: k.gow@qut.edu.au

ISSN 1367-4676 print/ISSN 1469-9737 online ß 2005 Taylor & Francis

DOI: 10.1080/13674670412331304339
264 Kristine Hartog & Kathryn M. Gow

a growing body of recent research into the area of ‘‘psychology and religion’’ shows that the
psychology profession has begun to consider seriously the importance of religion in people’s
lives. With regard to psychotherapy and counselling, it has been proposed that religion is
almost as integral to the religious client as their family structures and relationships
(Payne, Bergin, & Loftus, 1992). Research suggests that if the therapist does not integrate
therapeutic solutions that take into account religious values, then effective outcomes may be
temporary and benefits can be restricted (Bergin, 1980; Cunningham, 1983; Gass, 1984;
Kuyken, Brewin, Power, & Furnham, 1992).
Gass (1984) constructed a ‘‘values’’ survey to measure specific beliefs, attitudes and
values, which might test the hypothesis that Christians possess a distinctive set of beliefs
and preferences related to the process of psychotherapy, and conceptualize and define
mental health in a particular way. Gass’s results supported this hypothesis and revealed a
strong preference in Christian clients towards consulting religious, rather than secular,
mental-health services. Religious communities have tended to foster stereotypical beliefs
about health professionals, which in turn have influenced the uptake or non-uptake of
mental-health services (Nickerson, Helms, & Terrel, 1994).
Prior to the 1940s, few systematic studies of public attitudes towards mental illness had
been conducted. This situation was partly rectified in a six-year study conducted by
Nunnally (1961), which involved an exploration of general public knowledge of mental
illness, in terms of their causes and treatments. However, this study, like previous ones,
was characterized by ambiguous and inconsistent responses. This prompted Furnham
(1988) later to design an investigation of the possible reasons for individual or group
differences in the structure and content of beliefs (Furnham, 1988). The results of this
investigation showed systematic features of the general population including their
education, sex, age, class and religion, which significantly influenced their attitudes and
beliefs (Furnham & Henley, 1988).

Origin of Christian beliefs about mental illness

Prior to the 18th century, social and religious sanctions ensured that the mentally ill were
isolated and treated with both fear and neglect. This is still true in some developing coun-
tries where a mixture of religious and cultural beliefs about the nature of mental problems
and issues stigmatize patients (see the chapter by Gureje and Alem in Arboleda-Flórez,
2003). While most Protestant religious groups have ‘‘officially’’ renounced belief in the
demonic aetiology of mental illness, replacing it with natural and psychological explana-
tions, several recent qualitative studies conducted by Loewenthal (1996) have revealed
that among lay Christians, there are still widespread views of mental illness being caused
by separation from God and demonic possession (Dain, 1992; Favazza, 1982;
Loewenthal, 1996). How did mental illness first come to be associated with demon posses-
sion? Key elements of early biblical Christianity were the healing of both physical and
mental illness through religious practices (Idler & George, 1998). There are numerous
accounts, in the Bible, of Jesus healing people of illnesses caused by demon possession
(Favazza, 1982).
Favazza (1982) conducted a comprehensive investigation of the practices and techniques,
utilized by many modern Christian healers, in relation to mental illness. The most
frequently endorsed practices included regular prayer, scripture reading, receiving
sacraments and participating in a supportive Christian community (Favazza, 1982;
Loewenthal & Cinnirella, 1999).
 Causes and cures of mental illness: Religious attributions 265

General attribution theory

General attribution theory provides a widely applied theoretical explanation for how
individuals come to terms with illness. It begins with the assumption that people seek to
make sense of their own experiences, and the events they witness, in an attempt to control
and predict these events (Spilka, Shaver, & Kirkpatrick, 1985). Pargament and Hahn
(1986) observed that the religious framework and meaning system provides the religious
person with an understanding and means of dealing with life’s challenges, while maintaining
a sense of justice and control in their lives (Loewenthal & Cornwall, 1993; Pargament et al.,
1990; Spilka et al., 1985). Various social influences, such as upbringing and education,
influence whether the cause of events is attributed to either naturalistic or religious factors
(Spilka et al., 1985). However, the plausibility of a religious, or non-religious, explanation
still rests on the amount of knowledge the attributer has about that particular issue (Spilka
et al., 1985).

Different protestant perspectives

Among the Protestant Christian religious denominations, there are significant differences in
the perceived relationship between religion and mental illness. These denominations can be
identified along a continuum, ranging from Fundamentalism to Liberalism (Malony, 1998).
At the Fundamentalist end of the continuum, the predominant view is that there is no entity
such as mental health that is not synonymous with spiritual health. To the fundamentalist,
much of mental and emotional suffering is due to sin or moral failings; therefore therapy, to
address such suffering, should consist primarily of confession and forgiveness (Adams,
1970; Bobgan & Bobgan, 1979; Dain, 1992; Ferngren, 1986; Ritzema, 1979). Liberal
Protestants, however, do not deny the reality of a separate mental-health entity (Malony,
1998). They recognize that there are psychological, as well as spiritual, dimensions to
human life, and therefore not all personal problems have easy religious solutions
(Malony, 1998).

Cure of mental illness

Furnham (1988) conducted specific research to test the hypothesis that the type of
explanation or attribution people offer for a particular problem relates to the type of
remedy they consider necessary to cure or eradicate it. The findings of Lederach and
Lederach’s (1987) study of cognitive dissonance in nursing students lend support to
this hypothesis. The focus of their study was on nursing students with strong Christian
affiliations, who were tested for cognitive dissonance at the commencement of, and
eight weeks into, their psychiatric nursing training. The researchers observed considerable
conflict between the nursing students’ faith values and their beliefs about how these
values did, or did not, appear to fit with the mental-health principles they were being
taught. Among the nursing students who participated in the study, those who indicated
a stronger allegiance to ‘‘faith’’ values also attributed a high responsibility to God’s
necessary intervention for the healing of mental illness, while the commonly accepted
psychiatric approach to healing was considered less important. This resulted in a state
of cognitive dissonance, given the demands of their future nursing role in the treatment
of patients with a mental illness. According to Henley and Furnham (1988), beliefs
266 Kristine Hartog & Kathryn M. Gow

about the ways in which problems may be overcome or treated are likely to influence
help-seeking behaviour, as well as responsiveness and compliance with different treatment
strategies.
Several studies have focused on cultural and religious differences in the definition and
categorization of two prevalent mental disorders: Schizophrenia and Major Depression.
Cinnirella and Loewenthal (1999) conducted a qualitative interview study in Britain
that focused specifically on the degree to which beliefs about religion were seen to inter-
twine with lay beliefs about depression and schizophrenia. Responses revealed significant
variances between groups, in their perception of religious coping strategies in the face of
depressive and schizophrenic symptoms. While religious coping strategies were endorsed
by a significant number of participants, Schizophrenia was seen as more serious and
more likely to be associated with organic problems, thus reducing the perceived relevance
of religion as a coping strategy for this condition (Henley & Furnham, 1988). A team of
researchers, led by Loewenthal (2000), recognized that one of the limitations of these
previous studies was their reliance on qualitative thematic analyses of beliefs. They
suggested that the results of these qualitative studies should be seen as a complement
to more quantitative, large-scale survey methods, thus enabling an improved exploration
of the causal processes that might impact upon belief systems. Consequently, on the
basis of previous qualitative responses (Loewenthal et al., 2000), a questionnaire was
constructed to measure participants’ beliefs about both the causes and cures of depres-
sion. Religious participants, asked to complete this questionnaire in the original study
(Loewenthal et al., 2000), generally endorsed an active style-coping pattern, involving
religious coping, and social support resources, as well as the possible use of medical
and other professional help.
The current study aimed to explore in greater depth the relationship between religion and
mental health, with a particular focus on the relationship between religious beliefs, religious
values and beliefs about the causes and cures of mental illness. It sought to identify to what
extent religious attributions could provide an additional contribution to traditional causal
and treatment attributions for Major Depression and Schizophrenia.

Hypothesis 1
Following the work of Lederach and Lederach (1979), it was hypothesized that Christians,
with low scores on the counselling/psychology knowledge component variables of the
Values Survey (VS) and scoring highly on the Religious Belief Inventory (RBI), would
show high scores on the Religion and Mental Health Inventory (RMHI). (High scores
indicate high levels of cognitive dissonance between participants’ religious beliefs/values
and perceptions of mental-health principles.)

Hypothesis 2
Following the work of Loewenthal and Cinnirella (2000) and Loewenthal and Cornwall
(1993), it was hypothesized that religious beliefs/values and cognitive dissonance, would
function as significant predictors of religious attributions for the causes and treatments
for Major Depression and Schizophrenia.
An exploration was made into the frequency with which participants endorsed the belief
that ‘‘mental illness is related to demon possession/influence/oppression.’’ This was meas-
ured by responses to question 5 of the RMHI, and responses to question 26 on both the
‘‘Causes of Major Depression’’ and the ‘‘Causes of Schizophrenia’’ questionnaires.
 Causes and cures of mental illness: Religious attributions 267

Method
Participants
The participants (N ¼ 126) included 52 females and 74 males. Sixteen participants were
aged 18–22, 37 were aged 23–35, 38 were aged 36–50, 18 were aged 51–65, and 17
were aged 66–80. The participants’ education levels are presented in Table I.
The participants were drawn from the following Protestant Christian Church denomina-
tions: Baptist, Reformed, Wesleyan Methodist, Uniting, Anglican, Brethren, Churches of
Christ, Presbyterian, Christian Life Centre, Assemblies of God, Evangelical and The
Christian Missionary Alliance. Prospective participants were excluded from the survey if
they were currently seeing, or had in the immediate past seen, a medical practitioner for
any psychiatric reason, or if they were on any form of psychotropic medication.

Materials
Subject Information Package. The Subject Information Package provided details including
the project title, the names of researchers involved, assurance of confidentiality, a brief
outline of the study, the potential benefits of the study and contact details should they
have any further queries or concerns.

Instruction Page. The Instruction Page detailed how to complete the questionnaires con-
tained within the package. Instructions were also given regarding the return of the question-
naires via post, using the supplied self-addressed, stamped envelope.

Background details. Participants indicated their sex, age, highest education level attained,
occupation, religion, nationality, parents’ religion and parents’ nationality.

Religious Belief Inventory. This RBI questionnaire is a replica of Holland et al.’s (1998)
Systems of Belief Inventory (SBI-15R). The 15 items have been designed to measure
both religious beliefs and practices. The 10 items loading onto Subscale 1 (Beliefs and
Practices) met tests of internal consistency, with a Cronbach alpha of 0.86. The five
items loading onto Subscale 2 (Social support) also satisfied tests of internal consistency,
with a Cronbach alpha of 0.79. Convergent validity of the original scale was demonstrated,
following high correlations (r ¼ 0.84) with the Religious Orientation Inventory (ROI).
Discriminant validity of the original scale was demonstrated through a significant difference

Table I. Frequency of participants’ highest education level completed.

Highest education level completed Frequency

Grade 8 1
Grade 9 2
Grade 10 5
Grade 11 6
Grade 12 24
University 27
Post-graduate university degree 24
Post-school education other than university 25
Trade qualification 12
268 Kristine Hartog & Kathryn M. Gow

between religious and lay groups (t (295) ¼ 11.23, p < 0.001, two-tailed). Participants were
scored on each subscale, with high scores indicating greater agreement.

Values Survey. This 51-item, Likert-type instrument was constructed by Gass (1984) for
the purpose of measuring Christian beliefs and values related to psychotherapy and mental
health. Analysis of the original survey included a principal-components analysis with a
varimax rotation yielding seven orthogonal factors. Differences between mean item scores
of the group on each factor revealed significant results to t tests for: Factor 1 Orthodox
Christian Values, t(202) ¼ 4.73, p < 0.001; Factor 5 Conformity: Social-practical,
t(202) ¼ 2.19, p < 0.05; and Factor 6 Self-Reliance, t(202) ¼ 4.55, p < 0.001. In the current
study, items loading onto the original Orthodox Christian Values factor met tests for inter-
nal consistency ( ¼ 0.91).

Religion and Mental Health Inventory. The RMHI, developed by Lederach (1979),
comprises positive and negative statements with a 5-point Likert-type response. Items 4
and 14 are negatively scored. The inventory was originally developed to measure cognitive
dissonance between nursing students’ religious values and perceptions of mental-health
principles. However, in this study, cognitive dissonance referred to a poor fit between
religious beliefs and perceptions of mental-health principles, leading to psychological
discomfort and tension.
A good test–retest reliability was demonstrated (0.71). A two-tailed t test yielded a signif-
icance level of p < 0.01. In this study, the 18 items constituting the RMHI met tests for
internal consistency ( ¼ 0.70).

Beliefs about Major Depression and Schizophrenia. This four-part ‘‘Beliefs about Major
Depression and Schizophrenia’’ questionnaire investigates beliefs about the ‘‘causes’’ and
‘‘treatments’’ for each disorder. Loewenthal et al. (2000) developed the questionnaire, on
the basis of 59 semi-structured interviews reported in Cinnirella and Loewenthal (1999)
and Loewenthal and Cinnirella (1999). The questionnaire is in a 7-point Likert format,
with causes of Schizophrenia and Major Depression being rated between 1 ¼ very unlikely
and 7 ¼ very likely. Treatments for Schizophrenia and Major Depression were rated
between 1 ¼ not at all helpful to 7 ¼ very helpful.

Procedure
Participants were contacted initially by notices in the churches’ newsletters and by a public
address. Interested persons collected a questionnaire following the church service, to be
completed and returned via post within 2 weeks.

Design
The study was a single group design. The independent variables were religious beliefs
(measured by the RBI), Christian values (measured by the VS) and cognitive dissonance
(measured by the RMHI). The dependent variables were beliefs about the causes and
treatments for Major Depression and Schizophrenia. This study focused on the additional
contributions of religious beliefs over traditional beliefs about mental illness (Pargament
et al., 1990).
 Causes and cures of mental illness: Religious attributions 269

Results
Preliminary analysis
Prior to analysis, all variables were examined utilizing the SPSS programs to assess accuracy
of data entry, missing values, the presence of outliers and the assumptions of: normality,
linearity, homoscedasticity and multicollinearity. Missing values were replaced with a 4,
representing a neutral response on the 7-point Likert scale. Using the Mahalanobis D2
measure, three multivariate outliers were detected and removed. Breaches of normality
for the independent variables were detected, but they were disregarded given that the
participants in this study were drawn from a homogeneous subgroup of evangelical
Christians and chosen for vivid illustration, rather than for representativeness of the
Australian population.
Analysis via a paired-samples t test revealed significant differences ( p < 0.001) between
mean scores on each factor for Major Depression and Schizophrenia, justifying separate
analyses of the two disorders.

Data reduction
The small sample size of this study and large number of dependent variables necessitated
the employment of a factor-analysis data-reduction technique (Comrey & Lee, 1992).
This was carried out in four parts, reflecting the separate measures of ‘‘beliefs about
causes’’ and ‘‘beliefs about treatments’’ for the two disorders: Major Depression and
Schizophrenia. Data consisted of participants’ beliefs regarding 26 causal factors and 25
treatments for each condition, measured on a 7-point Likert scale.

‘‘Beliefs about the causes of major depression’’

Using factor analysis, data were reduced, and four new variables were computed from items
1 to 26 of the ‘‘Beliefs about the causes of Major Depression’’ questionnaire. At the first
step, the scales were subjected to a principal-components analysis. Using the Kaiser–
Meyer–Olkin measure (msa ¼ 0.87) and Bartlett’s Test of Sphericity: p < 0.001), factorabil-
ity was confirmed. Following the extraction of five factors with eigenvalues greater than 1,
accounting for 65.88% of the variance in the data and examination of the scree slope, four
factors were retained for further analysis.
An exploratory factor analysis employing principal axis factoring with promax rotation
and a suppressor value of 0.3 was then performed on the data. Factor 1 was labelled
‘‘social/environmental stressors,’’ Factor 2 was labelled ‘‘religious factors,’’ Factor 3 was
labelled ‘‘coping style,’’ and Factor 4 was labelled ‘‘physical factors.’’ The four factors
accounted for 61.56% of the total variance explained.

‘‘Beliefs about the causes of Schizophrenia’’

This data-reduction technique was replicated with the ‘‘Beliefs about the causes of
Schizophrenia’’ questionnaire. Factorability was confirmed (msa ¼ 0.914; Bartlett’s Test
of Sphericity: p < 0.001). Following the extraction of five factors with eigenvalues greater
than 1, accounting for 71.73% of the variance in the data, and examination of the scree
plots, four factors were retained for further analysis.
Three correlations between the factors exceeded 0.3, so an oblique rotation was selected.
The four factors were conveniently labelled in the same way as the causes of Major
Depression and accounted for 67.38% of the total variance explained.
270 Kristine Hartog & Kathryn M. Gow

Following the deletion of three incongruent items, factors for Major Depression were
found to be very reliable ( ¼ 0.94 for Factor 1;  ¼ 0.80 for Factor 2;  ¼ 0.81 for
Factor 3) and moderately reliable ( ¼ 0.66 for Factor 4). Factors for Schizophrenia were
found to be very reliable ( ¼ 0.94 for Factor 1;  ¼ 0.79 for Factor 2;  ¼ 0.88 for
Factor 3) and moderately reliable ( ¼ 0.57 for Factor 4).

‘‘Beliefs about treatment for Major Depression’’

Data reduction was repeated for items 1 to 25 of the ‘‘Beliefs about treatment for Major
Depression’’ questionnaire. Factorability was confirmed (msa ¼ 0.87; Bartlett’s Test of
Sphericity: p < 0.001). Following the extraction of six factors with eigenvalues greater
than 1, which accounted for 70.14% of the variance in the data, and an examination of
the scree slope, it was decided to retain four factors for further analysis.
An exploratory factor analysis, employing principal axis factoring with promax rotation,
with a suppressor value of 0.3 was then performed on the data. Factor 1 was labelled
‘‘religious means,’’ Factor 2 was labelled ‘‘help from others (non-professional),’’ Factor 3
was labelled ‘‘professional help,’’ and Factor 4 was labelled ‘‘self initiated means.’’
These four factors accounted for 61.62% of the total variance explained.

‘‘Beliefs about treatment for Schizophrenia’’

This data-reduction technique was replicated with the ‘‘Beliefs about treatment for
Schizophrenia’’ questionnaire. Factorability was confirmed (msa ¼ 0.87: Bartlett’s Test of
Sphericity: p < 0.001). Following the extraction of six factors with eigenvalues greater
than 1, which accounted for 70.26% of the variance in the data, and an examination of
the scree slope, four factors were again retained for further analysis.
Three correlations between the factors exceeded 0.3, and therefore an oblique rotation
was selected. Factor 1 was labelled ‘‘self initiated means,’’ Factor 2 was labelled ‘‘religious
means,’’ Factor 3 was labelled ‘‘professional help,’’ and Factor 4 was labelled ‘‘help from
others.’’ These four factors accounted for 61.17% of the total variance explained.
Following the deletion of three incongruent items, Major Depression factors were found
to be very reliable ( ¼ 0.91 for Factor 1;  ¼ 0.86 for Factor 2;  ¼ 0.72 for Factor 6 and
 ¼ 0.89 for Factor 4). Factors for Schizophrenia were found to be very reliable ( ¼ 0.86
for Factor 1;  ¼ 0.90 for Factor 2;  ¼ 0.80 for Factor 3; and  ¼ 0.86 for Factor 4).

Bio data tests

Visual inspection of the means for gender, age, education and Church denomination
revealed no meaningful pattern, and so further exploration of significant differences was
considered unnecessary.

Hypothesis 1: Findings
The results supported the validity of utilizing Lederach’s (1979) RMHI in the current
study. In support of Hypothesis 1, the results showed that little familiarity with the area
of psychology/counselling and high measures on the RBI were significant predictors of cog-
nitive dissonance. A standard multiple regression revealed that, overall, religious beliefs and
counselling/psychology knowledge accounted for significant amounts of variance in levels of
cognitive dissonance, R ¼ 0.48, R2adj. ¼ 0.21, F(2, 120) ¼ 17.49, p < 0.001. Stronger reli-
gious beliefs ( ¼ 0.391, p < 0.001) and less counselling/psychology knowledge ( ¼
0.23,
 Causes and cures of mental illness: Religious attributions 271

p < 0.001) were each significant predictors of cognitive dissonance. This suggested that the
more important the participants considered their religious beliefs, the more cognitive disso-
nance they would experience. Additionally, the less knowledge participants had of the area
of counselling/psychology, the more cognitive dissonance would be experienced.

Hypothesis 2: Findings
Following the work of Loewenthal and colleagues (Lederach & Lederach, 1987;
Loewenthal & Cinnirella, 2000; Loewenthal & Cornwall, 1993), it had been hypothesized
that religious beliefs, religious values and cognitive dissonance, would function as predictors
of the attribution of the causes and treatments for Major Depression and Schizophrenia, to
religious factors. At the first step, correlations between the independent and dependent vari-
ables were examined (see Table II).
According to Hair, Anderson, Tatham, and Black (1995), reduced predictive power—
associated with the moderate to high correlations between the RBI Subscale 1, RBI
Subscale 2 and Orthodox Christian Values—could be expected (see Table III). A
second-order principal-components factor analysis was subsequently run on these three
variables, in order to reduce the number of variables. Factorability was confirmed
(msa ¼ 0.71; Bartlett’s Test of Sphericity: p < 0.001). A single factor emerged (see
Table IV for factor loadings for each variable), thereby supporting a decision to
combine the scores of these three independent variables into a single religious beliefs/
values predictor variable in further regression analyses. According to Wearing and Brown
(1972), although there are conceptual differences between religious beliefs and religious
values, these distinctions do not necessarily imply any empirical difference given their
close functional relationship.

Table II. Correlations between scores on the Religious Beliefs Inventory, Religion and Mental Health Inventory,
Values Survey, Causal and Treatment Religious Factors.

RBI RBI DC SC DT ST
Variable Subscale 1 Subscale 2 RMHI VS Religion Religion Religion Religion

RBI Subscale 1 1.00

RBI Subscale 2 0.63 1.00
RMHI 0.40 0.34 1.00
OCV 0.75 0.61 0.43 1.00
DC Religion 0.41 0.24 0.66 0.47 1.00
SC Religion 0.37 0.25 0.63 0.40 0.70 1.00
DT Religion 0.53 0.44 0.29 0.58 0.43 0.34 1.00
ST Religion 0.49 0.37 0.25 0.48 0.38 0.34 0.83 1.00

Note. p < 0.001. RBI ¼ Religious Beliefs Inventory; RMHI ¼ Religion and Mental Health Inventory; VS ¼ Values
Survey; DC Religion ¼ Causes of Major Depression Religion Factor; SC Religion ¼ Causes of Schizophrenia
Religion Factor; DT Religion ¼ Treatments for Major Depression Religion Factor; and ST Religion ¼
Treatments for Schizophrenia Religion Factor.

Table III. Component Matrix for Religious Beliefs/Values Factor.

Variable Component 1

Religious Beliefs Inventory: Subscale 1 0.917

Christian Values 0.909
Religious Beliefs Inventory: Subscale 2 0.834

Note. One component extracted.

272 Kristine Hartog & Kathryn M. Gow

Table IV. Standard Multiple Regression Analyses of religious beliefs/values and cognitive dissonance, functioning
as predictors of the attribution of religious causes and religious treatments for Major Depression and
Schizophrenia.

DV Variable B SE B  R2

Causes of Major Depression 0.40

Religious Beliefs/Values 0.05 0.018 0.25**
Cognitive Dissonance 0.83 0.013 0.49*
Causes of Schizophrenia 0.42
Religious Beliefs/Values 0.04 0.018 0.16***
Cognitive Dissonance 0.10 0.013 0.56*
Treatments for Major Depression 0.35
Religious Beliefs/Values 0.20 0.028 0.58*
Cognitive Dissonance 0.01 0.021 0.04
Treatments for Schizophrenia 0.26
Religious Beliefs/Values 0.20 0.035 0.50*
Cognitive Dissonance 0.01 0.027 0.03

Note. DV: dependent variable; B: B weight; SE B: standard error; : beta weight; R2: multiple coefficient of
determination.
*p < 0.001; **p < 0.01; ***p < 0.05.

At the second step, utilizing a standard multiple regression design, scores relating to
religious beliefs/values and cognitive dissonance were used to predict beliefs about the
causes of, and treatment for, Major Depression and Schizophrenia. Sixteen separate
multiple regression analyses were performed for each of the dependant variables (factors).
The interplay between sample size (N ¼ 123), the significance level ( p < 0.01) and two
independent variables (religious beliefs/values combined and cognitive dissonance), was
examined to assess the predictive power in detecting a significant R2. The results (see
Table IV) showed that the R2 in each instance exceeded the minimum R2 of 0.13 for a
power of 0.80 (Cohen & Cohen, 1975).
The results showed that religious beliefs/values and cognitive dissonance were significant
predictors of the attribution of religious causes for Major Depression and Schizophrenia
(see Table IV), accounting for 40% of the variance. These two variables accounted for
42% of the variance in the attribution of religious causes for Schizophrenia. The results
also indicated that while religious beliefs/values were a significant predictor of the attribu-
tion to religious factors for Major Depression and Schizophrenia, cognitive dissonance
was not found to be a significant predictor (see Table IV).
The two religious predictors, religious beliefs/values (combined) or cognitive dissonance,
applied in a multiple regression design to the remaining non-religious dependent variables,
failed to show significant results.

Hypothesis 3: Findings
The frequency distribution of scores in question 5 of the RMHI, item 26 of the ‘‘Beliefs
about the causes of Major Depression’’ questionnaire and item 26 of the ‘‘Beliefs about
the causes of Schizophrenia’’ questionnaire were examined to investigate participants’
endorsement of the belief that mental illness is related to demon possession/influence/
oppression.
The results revealed that 38.2% of participants disagreed that mental illness might be the
result of demon possession, 25.2% were neutral, while 36.6% agreed that mental illness
might be the result of demon possession.
 Causes and cures of mental illness: Religious attributions 273

The results revealed that 38.2% of the participants considered it unlikely that Major
Depression could be caused by demonic influence/oppression, 23.64% were neutral,
whereas 38.2% considered it likely that Major Depression could be caused by demonic
influence/oppression. The results also revealed that 44.8% of the participants considered
it unlikely that Schizophrenia could be caused by demonic influence/oppression, and
17.9% were neutral, whereas 37.4% considered it likely that Schizophrenia could be
caused by demonic influence/oppression.

Discussion
These findings provided support for the predictions made on the basis of previous empirical
research and literature. Following a summary of the data and the resultant status of the
hypotheses, the implications of these findings for mental-health service providers, educators
and the Christian religious population will be discussed.

Cognitive Dissonance
The third hypothesis, which predicted that Christians, with low scores on the counselling/
psychology knowledge component variables of the VS and scoring highly on the RBI, would
show high scores on the RMHI, was supported. This finding is consistent with that of
Lederach and Lederach (1987), who found that the magnitude of dissonance experienced
by the Christian individual was a direct function of the two elements in conflict: religion and
psychology. While religious beliefs increased cognitive dissonance, knowledge of the area of
counselling/psychology served to reduce cognitive dissonance.

Religious causal and treatment attributions

The findings of this study supported the second hypotheses, which predicted that religious
beliefs, religious values and cognitive dissonance, would function as significant predictors
of the attribution of the causes and treatments of Major Depression and Schizophrenia to
religious factors.
The ‘‘religious’’ causal and treatment factors, identified in this study, indicate that
previous studies of lay beliefs concerning mental illness had failed to detect the significance
of religious beliefs (Furnham & Henley, 1988; Pargament et al., 1990).
It is important to note, from the results of the current study, that perceptions of religion,
as a causal factor, did not diminish the likelihood of seeing other agents as causes
(Loewenthal & Cornwall, 1993). Furthermore, it might have been expected that partici-
pants who rated religious means as a likely treatment for mental disorders would be less
likely to endorse help from professionals, friends and family. However, the pattern of
results from this study suggests an active style of treatment involving religious means, use
of social support, self-initiated means and the use of professional help. This pattern is
consistent with findings in an earlier study, conducted by Loewenthal et al. (2000) that
employed the ‘‘beliefs about causes’’ and ‘‘belief about treatment’’ questionnaire. The
findings of both studies identify a contemporary Christian approach to the healing of
mental illness that accepts psychiatric interpretations as a likely cause (Favazza, 1982).
In fact, in the current study, it is rated as the most likely cause of both Major Depression
and Schizophrenia.
274 Kristine Hartog & Kathryn M. Gow

Demon possession
The findings of this study also testify to the continuing belief in demonic activity by as many
as one-third of the participants in this study. According to Weber (1986), in the majority of
Protestant denominations, sanctioned belief in the demonic aetiology of mental illness has
been replaced by natural and psychological explanations.

Limitations
Several limitations of this study have been identified, in association with the particular
participant sample used. First, given that this study was of an exploratory nature, resources
did not allow a large enough representative probability sample to be used. The character-
istics of this sample were clearly homogeneous in terms of ethnic origin, geographical loca-
tion and Christian tradition, thus limiting the generalizablity of the findings. The cultural
homogeneity in this sample also prevents any conclusions from being made, regarding
the potential confounding effect of culture of origin and participants’ current nationality,
on the relationship between religion and causal/cure attributions. Further, it could be
argued that because the participants volunteered for the study, their responses may have
been contaminated by social desirability. Despite assurances of confidentiality, participants
may have been motivated to respond to the questionnaire in ways believed appropriate for a
religious person to respond.

Future research and implications

Future research may overcome some of the limitations inherent in the present investigation,
by implementing designs to extend the generalizability of the findings. This would involve
the inclusion of participants from other religious groups, cultural backgrounds and
Protestant denominations.
Despite the apparent limitations, it is compelling that the beliefs emerging from the
data overlap with those found by researchers investigating similar domains (Cinnirella
& Loewenthal, 1999). The findings of the current study add to a growing understanding
of religiously based beliefs and practices of different religious groups that have the poten-
tial to conflict with those of orthodox medicine and psychiatry (Loewenthal, 1995).
However, while theological explanations of mental illness may conflict with scientific
explanations, they may also contribute to, or be complementary to, science (Tjeltveit,
1991). The outcomes of this study may assist Christians to increasingly rise above the
pre-eighteenth century tradition of seeing mental illness solely as demonic possession or
the result of sin, and therefore something to be feared and kept at distance.
Psychology’s disciplinary tools and strong emphasis on research can give both science
and religion careful attention and thus help to reduce the science–faith tension
(Tjeltveit, 1991).
The results also verify the importance for further integration of religious concepts within
the general attribution literature (Pargament & Hahn, 1986). It is apparent, in the findings
of this study, that religious faith provides cognitive resources for interpreting and under-
standing mental illness (Idler & George, 1998).
Finally, the outcomes of this study have provided support for the employment of quanti-
tative, in addition to qualitative, methodology for future research exploring the link between
religion and lay beliefs about mental illness.
 Causes and cures of mental illness: Religious attributions 275

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