Health care providers are much more savvy these days about picking up on abuse in patients than they used to be. Physicians, particularly those practicing primary care, are trained to screen patients for physical, emotional, and sexual abuse. When it comes to child abuse, along with other professionals in positions of public trust like teachers and social workers, they are mandated in every state to notify the authorities if we even suspect it. Many states have similar laws covering the reporting of elder abuse and domestic violence.

What’s not showing up on their radar is spiritual abuse.

What is it? For a vivid description, read the memoir Ex-Gay No Way, in which Jallen Rix EdD writes with great insight about the religious abuse [his term] that he endured for years as a gay man born into a conservative Protestant family. “Spiritual abuse” comes up in religious contexts. The term seems to have made an early appearance in the medical literature in 1998:

Spiritual abuse is the act of making people believe–whether by stating or merely implying–that they are going to be punished in this life and/or tormented in hell-fire forever for failure to live life good enough to please God and thus earn admission to heaven. Spiritual terrorism is the most extreme form of spiritual abuse and may cause serious mental health problems. Those people who have not been spiritually terrorized have not necessarily been spared from spiritual abuse and therefore may still be in need of competent, spiritual counseling. Spiritual abuse, which may be active or passive, can best be conceptualized on a continuum from terroristic to zero abuse. Severity is determined by intensity, age of onset, duration, and individual reaction. The underlying issue in all forms of abuse is control.

“Serious mental health problems”–like suicide.

Such abuse is a daily fact of life for many LGBTQ people. This study interviewed a group of them living in the Bible Belt:

In the Bible Belt, Christianity is not confined to Sunday worship. Christian crosses, messages, paraphernalia, music, news, and attitudes permeate everyday settings. Consequently, Christian fundamentalist dogma about homosexuality-that homosexuals are bad, diseased, perverse, sinful, other, and inferior-is cumulatively bolstered within a variety of other social institutions and environments in the Bible Belt. Of the 46 lesbians and gay men interviewed for this study (age 18-74 years), most describe living through spirit-crushing experiences of isolation, abuse, and self-loathing. This article argues that the geographic region of the Bible Belt intersects with religious-based homophobia. Informants explained that negative social attitudes about homosexuality caused a range of harmful consequences in their lives including the fear of going to hell, depression, low self-esteem, and feelings of worthlessness.

And suicide.

There are very, very few articles on spiritual abuse in the medical literature–the 1998 articles on the topic by a West Virginia hospice worker did not provoke a flurry of follow-up research. There is a small body of work in the psychology literature, mostly in studies of people involved in cults. But I daresay there’s hardly a primary-care doctor in the land who thinks about this problem or looks for it in her patients. This is a grave oversight. The medical profession should study the health effects of this distinct type of emotional abuse [it may well also be a distinct type of domestic violence]. I suspect research will quickly demonstrate what we already intuitively grasp–that it is not only a risk factor for disease, but also a potentially lethal public health issue. Like secondhand smoke, it harms at least two parties at once. Like malaria, it’s more common and more dangerous in certain regions. Like obesity, there may well be a lower prevalence among people with more education. In short, if spiritual abuse affects health, as seems likely, then we can and should study it.

Doctors are trained to warn parents about guns in the home, no matter what their private convictions about gun ownership may be. They routinely look for signs of physical and emotional abuse in their patients and refer them to sources of help. Courts have allowed physicians to give blood transfusions to the children of transfusion-averse Jehovah’s Witnesses over the parents’ strenous objections, based on the argument that to do otherwise would allow parental religious belief to kill a child. So why not teach providers to screen for spiritual abuse?

After all, if a religious, closeted gay patient is convinced he’s worthless and headed for hell because of his sexuality, that belief is overwhelmingly likely to harm that patient’s mental health, and could quite possibly end his life. That this is a common plight among children makes the problem even more urgent. These points ought to be all the justification physicians need to study spiritual abuse, look for it, and think about ethical ways to intervene.