In exploring culturally competent mental health diagnoses, I found Paganism and Counseling: The Development of a Clinical Resource by Harris, Panzica, and Crocker (2016) illuminating and thought-provoking. The article highlights how Pagan clients, often misunderstood or stigmatized, may present beliefs and experiences (such as magical thinking, animism, and mystical experiences) that risk being pathologized when viewed through a traditional clinical lens.
One key takeaway is that Paganism is not a fringe identity but a legitimate, diverse set of religious traditions, often grounded in nature reverence, polytheism, and feminist values. The authors emphasize that these worldviews can include mystical experiences, personal rituals, and alternative healing practices. If clinicians are unaware of this context, they may mistakenly interpret these as symptoms of psychosis or delusion, especially in settings where religious norms are primarily Judeo-Christian.
The article underscores a crucial point: beliefs outside the mainstream are not inherently pathological. Diagnosing clients without understanding their spiritual and cultural framework can lead to misdiagnosis, loss of trust, and real harm. It reminds me that the DSM-5 includes a Cultural Formulation Interview because context matters.
The interviews with Pagan college students also revealed how many Pagans remain “in the broom closet,” fearful of disclosing their beliefs due to past experiences of marginalization. This secrecy can affect the therapeutic alliance and disclosure during assessment. If a counselor assumes Judeo-Christian norms, they may unintentionally reinforce this mistrust.
From a diagnostic perspective, the article challenges us to distinguish between culturally normative beliefs and clinically significant symptoms. Just as we would not pathologize a devout Christian's belief in the Holy Spirit speaking to them, we should not pathologize a Pagan’s communication with deities or belief in energy healing—unless there is evidence of distress, impairment, or dysfunction.
I wanted to post this based on part of our discussion last week concerning awareness of psychosis and how clinicians are sometimes willing to look at alternative beliefs as out of touch with reality. It’s not just about knowing major world religions or using inclusive language. It’s about actively interrogating our own assumptions, recognizing spiritual diversity, and treating clients’ beliefs with the same care we give to any other deeply held worldview.
Reference
Harris, K. A., Panzica, K. M., & Crocker, R. A. (2016). Paganism and counseling: The development of a clinical resource. Open Theology, 2, 857–875. https://doi.org/10.1515/opth-2016-0065
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