Hey everyone, and welcome back to My Weird Prompts. I am Corn, and I am sitting here in our living room in Jerusalem with my brother.
Herman Poppleberry, at your service. It is good to be back at the microphones, Corn. This week felt especially relevant because our housemate Daniel sent us a prompt that really hits close to home, literally and figuratively.
Yeah, Daniel was asking about the intersection of magical thinking, religion, and clinical psychiatry. And being here in Jerusalem, we see this play out in the streets and the shops every single day. It is such a layered topic.
It really is. Daniel mentioned he had been looking into the prevalence of schizophrenia and how it relates to religious belief. Specifically, he was curious about how doctors tell the difference between a deeply held religious faith and a pathological symptom of psychosis.
It is a heavy question, but a fascinating one. Before we dive into the clinical side, Herman, maybe we should define what we actually mean by magical thinking. Because that term gets thrown around a lot, but in psychology, it has a very specific meaning.
Right. At its core, magical thinking is the belief that one's thoughts, words, or actions can cause a specific effect in the physical world without any known causal link. It is that feeling that if I think about something bad happening, I might actually make it happen. Or if I wear my lucky socks, my favorite team will win the game. In clinical circles, we sometimes call this thought-action fusion.
Most of us do that to some extent, right? Like not walking under a ladder or knocking on wood.
Exactly. We all have these little cognitive shortcuts. It is actually a normal part of child development. If you look at the work of Jean Piaget, he noted that children between the ages of two and seven often believe their internal world and the external world are directly connected. If they are angry at their sibling and the sibling trips, the child might genuinely believe their anger caused the fall.
But we are supposed to outgrow that, aren't we? As we get older, we learn about physics and biology and how the world actually works.
We do, but magical thinking never fully disappears. It just gets more sophisticated. We see it in obsessive compulsive disorder, where a person might feel they have to flip a light switch ten times to prevent a fire. But we also see it in very healthy, functioning people who just have superstitions. The real tension, and what the prompt is getting at, is when this looks like religion. Because if you think about it, prayer is, by definition, a form of magical thinking. You are performing a mental or verbal act with the expectation that it will influence external reality through a non-physical mechanism.
That is the part that makes people uncomfortable, especially in the scientific community. If you define magical thinking that way, then billions of people are engaging in it every single day. So, how does a psychiatrist in a place like Jerusalem walk into a room and decide that one person is having a religious experience and the other person is experiencing a delusion?
That is the million dollar question. And the answer really lies in the diagnostic manuals, like the text revision of the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders, or the D S M five T R. Interestingly, the D S M has a very specific carve out for religion. When they define a delusion, they explicitly state that it is a fixed belief that is not amenable to change in light of conflicting evidence, but they add that the belief must not be one that is ordinarily accepted by other members of the person's culture or subculture.
So it is essentially a popularity contest? If enough people believe it, it is no longer a mental illness?
It sounds cynical when you put it that way, but there is a profound logic to it. Psychiatry is fundamentally concerned with function and social cohesion. If a belief is shared by your community, it provides a framework for meaning, a social bond, and a way to navigate life. It is not isolating you; it is connecting you. A true psychotic delusion is almost always idiosyncratic. It is a private world that only the patient inhabits.
I see. So if I say I believe a divine being created the universe, and millions of others agree, I am part of a tradition. But if I say a divine being is sending me secret messages through the barcodes on my cereal boxes, and nobody else in my church thinks that is happening, then the clinician starts looking for other symptoms.
Exactly. And that brings us to the importance of cultural competence, which is something clinicians here in Jerusalem have to be incredibly sensitive to. Think about the diversity in this city. You have ultra-orthodox Jews, secular Israelis, devout Muslims, Armenian Christians, and everything in between. Each of those groups has a different baseline for what is considered a normal spiritual experience. As of twenty twenty-six, Jerusalem’s population has climbed toward one million people, making it one of the most complex clinical environments on earth.
I remember reading about a case where a woman was brought into a clinic because she claimed she was hearing the voice of a deceased relative giving her advice. In some secular contexts, that might be flagged as an auditory hallucination. But in her specific cultural background, that was seen as a perfectly normal part of the grieving process and a sign of spiritual connection.
Right. And if the clinician pathologizes that, they risk not only misdiagnosing the patient but also destroying the therapeutic relationship. The patient will feel judged and misunderstood. They might stop seeking help altogether. That is why modern psychiatry uses something called the Cultural Formulation Interview. It is a set of sixteen questions designed to help the doctor understand the patient's background and how they personally interpret their symptoms.
But Herman, doesn't that create a bit of a loophole? Could someone who is genuinely suffering from schizophrenia hide behind their religion to avoid treatment?
That definitely happens, and it is one of the hardest parts of the job. But doctors look for other markers that go beyond just the content of the belief. They look at the person's level of distress and their ability to function. If someone says they are waiting for the Messiah, that is a standard religious belief. But if they stop eating, stop bathing, and quit their job because they believe the Messiah told them to sit on a specific street corner for twenty-four hours a day, that represents a functional decline. The issue isn't just the belief; it is the impact on the person's life.
So it is about the "how" and the "why" rather than just the "what."
Precisely. Another key factor is the degree of organization. Religious beliefs are usually part of a coherent system. They have a history, a logic, and a community of scholars. Psychotic delusions are often fragmented and bizarre. They don't follow a theological structure. Also, clinicians look for what are called negative symptoms of schizophrenia, like a lack of emotional expression, a loss of motivation, or disorganized speech. These things don't usually accompany healthy religious practice.
You know, it makes me think about the Jerusalem Syndrome that we talked about a few episodes back. It is such a perfect example of this. You have people who come here and are so overwhelmed by the religious history that they start to believe they are a biblical figure.
Yes, and the way hospitals here, like Kfar Shaul Mental Health Center, handle that is actually quite beautiful. They don't just throw people into a locked ward and tell them they are crazy. They often involve religious figures in the treatment. They might have a rabbi or a priest talk to the person to help bridge the gap between their internal experience and the reality of the situation. It is a holistic approach.
That feels like a much more humane way to handle it. But I wonder, does the religious community ever push back? If a doctor says, "Your son isn't having a vision; he is having a psychotic break," that must be an incredibly difficult conversation for a family that values spiritual experiences.
It is. There is often a lot of stigma around mental health in religious communities. Some people might interpret mental illness as a lack of faith or even a spiritual attack. This is where the second-order effects come in. If the medical community and the religious community are at odds, the patient is the one who suffers. They get caught in the middle.
So, how do we fix that? How do clinicians build that trust?
It starts with humility. A doctor has to be willing to say, "I respect your faith, and I am not here to tell you your religion is wrong. I am here to help you with the parts of your experience that are causing you pain or making it hard for you to live your life." They might use religious language to explain the treatment. For example, they might describe medication as a gift from God that can help clear the mind so the person can pray more effectively.
That is fascinating. It is almost like they are translating psychiatry into the language of the patient's soul.
That is exactly what it is. And we are seeing more and more collaboration between mental health professionals and religious leaders. In many neighborhoods here in Jerusalem, rabbis are often the first people a family goes to when someone starts acting strangely. If the rabbi is trained to recognize the signs of psychosis, he can encourage the family to see a doctor while still providing spiritual support. It is a partnership.
It feels like this is especially important when we talk about the prevalence of these issues. As Daniel mentioned in the prompt, schizophrenia affects about one percent of the population worldwide. That is a huge number of people. In a city of nearly a million people like Jerusalem, that is ten thousand individuals. If we don't have a way to distinguish faith from pathology, we are failing a lot of people.
Absolutely. And the stakes are high. If someone is experiencing a first-episode psychosis, getting them treatment early is critical for their long-term outcome. If the diagnosis is delayed because everyone assumes it is just a religious phase, the brain can suffer permanent damage. On the flip side, if we over-diagnose and put someone on heavy antipsychotics for a profound spiritual awakening, we might be stripping them of something deeply meaningful.
It makes me think about the history of psychiatry, too. Back in the early twentieth century, someone like Sigmund Freud was very dismissive of religion. He called it a universal obsessional neurosis. For a long time, the field was very hostile toward faith.
Oh, definitely. There was this idea that as we became more scientific, religion would just wither away. But that didn't happen. If anything, the world is as religious as ever. Modern psychiatry has had to realize that you can't just ignore a patient's spiritual life. It is too central to who they are. If you ignore it, you are only treating half the person.
So, let's get into some specifics. What are some of the actual red flags a clinician looks for when someone is talking about their religious experiences?
One big one is the command hallucination. If a person says they hear God's voice, a doctor will ask, "What is the voice saying?" If the voice is giving general comfort or moral guidance, that is usually seen as within the realm of religious experience. But if the voice is telling the person to harm themselves or others, or to do something completely irrational and dangerous, that is a psychiatric emergency.
Right. That makes sense. Another one I have heard about is the feeling of being controlled.
Yes, that is a classic symptom of schizophrenia called an influence delusion. The person feels like their thoughts or actions are being inserted into their mind by an outside force, like a radio transmitter or a demon. While some religions talk about spiritual influence, the psychiatric version is usually much more mechanical and intrusive. It feels like a violation of the self.
And what about the bizarreness factor? I know that is a bit subjective, but how do they define it?
The D S M used to have a very strict definition for bizarre delusions, which were beliefs that were clearly implausible and not derived from ordinary life experiences. For example, believing that your internal organs have been replaced by someone else's without leaving a scar. In a religious context, things get trickier. Is believing in a talking bush more bizarre than believing in aliens? It often comes down to whether the belief is grounded in a tradition. If it is a new, unique, and highly detailed revelation that contradicts everything the person previously believed, that is a red flag.
It is interesting to think about how this plays out in different parts of the world. Jerusalem is unique, but these same questions must be happening in places like New York or London or Cairo.
They are. But the baseline changes. In a very secular city, the threshold for what is considered weird might be lower. In a place like Jerusalem, the baseline for spiritual intensity is much higher. You can walk down the street and see people praying fervently at a wall or rocking back and forth in a trance-like state. To an outsider, that might look like a catatonic state or a manic episode. To a local, it is just Tuesday.
That is such a good point. Context is everything. It makes me wonder about the training that doctors get here. They must have to take courses on comparative religion just to do their jobs.
They do. Many residency programs in Israel include training on cultural sensitivity. They learn about the specific customs and beliefs of the different groups they serve. For instance, they learn how to talk to an ultra-orthodox family about the side effects of medication, or how to respect the fasting requirements of a Muslim patient during Ramadan while still managing their treatment.
I think this actually leads to a broader point about magical thinking in general. We often talk about it as something negative, but is there a positive side to it?
That is a great question, Corn. There is actually a lot of research suggesting that certain types of magical thinking—like ritual and prayer—can be very beneficial for mental health. They can reduce anxiety, provide a sense of control in uncertain situations, and foster a sense of community. It is only when it becomes rigid, isolating, and dysfunctional that it turns into a problem.
So, it is like a bell curve. On one end, you have the total absence of any non-causal belief, which might feel a bit cold and meaningless to some. In the middle, you have healthy rituals and faith. And on the far end, you have pathological delusions.
Exactly. And the clinician's job is to figure out where on that curve the patient is sitting. It is not about judging the truth of the belief. Psychiatrists aren't theologians. They aren't there to decide if God exists or if miracles happen. They are there to look at the human experience of those beliefs and see if it is helping or hurting the person.
I want to go back to something Daniel mentioned about the prevalence. One percent of the population having schizophrenia is a constant across almost all cultures. Why is that? If religion and culture shape the content of the delusions, why don't they shape the amount of people who get the illness?
That is one of the strongest pieces of evidence that schizophrenia has a biological and genetic basis. The hardware of the brain seems to be susceptible to this condition at a fairly consistent rate regardless of where you live. But the software—the culture, the language, and the religion—determines how that biological glitch is expressed. In a religious society, the delusions will be religious. In a high-tech society, the delusions might be about government surveillance and microchips.
That is a brilliant way to put it. The brain is trying to make sense of a malfunctioning internal signal, so it grabs whatever cultural narratives are available to explain it.
Exactly. If you are experiencing a feeling of intense, cosmic significance because your dopamine system is overactive, your brain looks for a reason. If you live in Jerusalem, you might think, "I am the Messiah." If you live in Silicon Valley, you might think, "I have discovered the secret code to the universe." The underlying feeling is the same, but the story is different.
So, if we are looking for practical takeaways here, especially for people who might be worried about a friend or family member, what should they look for? How can they tell if a sudden increase in religious fervor is a good thing or a sign of something else?
I would say the first thing to look for is change from baseline. If a person has always been religious and they are just getting more involved in their community, that is usually fine. But if someone who was never religious suddenly becomes obsessed with it to the exclusion of everything else, that is a reason to be curious.
And the second thing would be the social aspect?
Definitely. Is this new belief bringing them closer to people or pulling them away? Healthy religion is social. It involves going to services, studying with others, and performing acts of charity. Pathological delusions are usually secretive and isolating. If they are spending all their time alone in their room writing down revelations, that is a concern.
And finally, the functioning piece we talked about.
Yes. Are they still eating? Are they sleeping? Are they able to hold a conversation that isn't about their specific obsession? If the religious behavior is interfering with their basic survival and well-being, it is time to seek professional help. And ideally, as we discussed, you want to find a professional who understands and respects the person's cultural background.
It is a delicate balance. We don't want to pathologize faith, but we also don't want to ignore a serious illness by labeling it as just a spiritual journey.
Precisely. It requires a lot of nuance and a lot of compassion. And I think that is why this city, Jerusalem, is such an interesting place to study this. We are forced to confront these questions every single day. You can't just ignore religion here. It is built into the stones of the buildings.
You know, it makes me think about how much we still don't know about the brain. We are getting better at identifying the symptoms, but we are still in the early stages of understanding why some brains are prone to these types of breakdowns.
We are. But the fact that we are even having these conversations—that psychiatry is moving toward a more culturally informed model—is a huge step forward. It is a more humble approach. It acknowledges that the scientific view isn't the only way people experience the world.
I agree. It is about treating the whole person, not just a set of symptoms. And that includes their beliefs, their community, and their sense of meaning.
Well said, Corn. I think we have covered a lot of ground today. From the definition of magical thinking to the specific challenges of practicing psychiatry in a multicultural city like ours.
Yeah, it is a lot to chew on. I hope this gave Daniel and our listeners a bit more insight into how these distinctions are made. It is not a simple yes or no answer; it is a process of understanding a person's entire life context.
Exactly. And before we wrap up, I want to say that if anyone out there is struggling with these issues, or has a family member who is, please reach out to a professional. There are amazing resources available, especially here in Israel, where clinicians are so experienced with these intersections.
Absolutely. And hey, if you found this discussion interesting, we would really appreciate it if you could leave us a review on your podcast app or on Spotify. It helps other curious minds find the show and join the conversation.
It really does. We love seeing this community grow. You can find us at our website, myweirdprompts dot com, where you can see all our past episodes and even send us your own prompts through the contact form.
We have been at this for over five hundred episodes now, and it is the prompts from people like Daniel that keep us going. There is always something new to explore.
There really is. Jerusalem is full of stories, and we are just scratching the surface.
Well, I think that is a good place to leave it for today. Thanks for the deep dive, Herman. I always learn something new when we sit down to do this.
Same here, Corn. It is always a pleasure.
This has been My Weird Prompts. Thanks for listening, and we will talk to you next time.
Shalom from Jerusalem. Goodbye!
