Atlas›Domain XIV · Western esoteric, divinatory & new spiritual movements›Guide 086
Guide XIV-086

Christian Science and its schisms

Mary Baker Eddy1866Boston, USA
A 36 · L 53 · M 1114 interventions in the Trinity explorer
Client cardCompare
[source: …] where a claim comes from[uncertain] not confirmed in a primary source[synthesis] the writer's reconstruction

1. Introduction

Version followed: The Church of Christ, Scientist (The Mother Church, Boston) as it describes itself on christianscience.com and in its published scope-of-services documents for practitioners and Christian Science nurses; the Augusta E. Stetson schism as described by the World Religions and Spirituality Project (WRSP) and the Mary Baker Eddy Papers. The harm account follows court records, peer-reviewed and legal scholarship and major news reporting.

Christian Science is a religious and healing movement, not a psychotherapy. It was founded by Mary Baker Eddy (1821–1910), whom the Church calls the "Discoverer" of Christian Science; she founded The Church of Christ, Scientist, wrote the textbook Science and Health with Key to the Scriptures, and founded The Christian Science Monitor [source: Christian Science FAQ]. The Church dates the discovery to 1866, after what it describes as a dramatic recovery from injuries following an accident [source: Christian Science FAQ]. First publication of Science and Health is usually dated 1875 [uncertain: not verified]. The relationship between Eddy's teaching and Phineas P. Quimby's mental healing, and the historians' priority debate, are covered in 084 (Quimby) and the wider mind-cure current in 085 (New Thought).

Core idea of change, as the movement holds it: God is wholly good and spiritual; disease, sin and death have no ultimate reality in God's spiritual creation, so healing follows a change in spiritual understanding reached through prayer, which members understand to bring healing to the body [source: HSE intercultural guide; Christian Science practitioners page]. The Church stresses that this is turning to God, not "positive thinking" or human willpower [source: Christian Science practitioners page]. Evidence status in one line: no controlled evidence in the cited sources shows that Christian Science treatment cures physical disease; the documented record instead includes deaths of children from treatable conditions when medical care was withheld (see Harm account) [source: Hughes 2005; Hall 2013]. Nothing in this guide presents Christian Science treatment as a treatment for any physical disease.

For the psychotherapist, this guide covers two kinds of client: (a) adults who are members, former members or family of members and who bring faith, illness, medical decisions, family conflict, grief or leaving into therapy; and (b) situations involving children, where religiously motivated delay or refusal of medical care raises safeguarding duties. The therapist's role is never practitioner, healer or spiritual adviser.

Schisms. Augusta E. Stetson (1842–1928), a student of Eddy listed as a practitioner and teacher from 1885 to 1909, organised First Church of Christ, Scientist, New York (1887), was ordained its pastor (1890) and later served as First Reader after Eddy abolished pastors (1894) [source: WRSP Stetson timeline; MBE Papers]. After a dispute over a plan to open a further branch church in breach of Eddy's Church Manual, and an investigation Eddy requested in 1909, The Mother Church excommunicated her in November 1909 [source: WRSP Stetson timeline]. About half of her estimated 800 students reportedly remained loyal; she continued teaching, published sermons and letters, ran a New York radio station (WHAP) from 1926, and asserted she would not die [source: WRSP Stetson timeline; MBE Papers]. Later independent or breakaway Christian Science groups exist [uncertain: not verified]. Clinically, schism history matters mainly because clients from independent or breakaway groups may hold stricter or idiosyncratic positions on medical care than the Church's current public statements.

2. Framework

This is a movement, so the "framework" is (A) the pathway through the movement as the Church publishes it, which the therapist needs to understand, and (B) the therapist's own phased work with clients from this background [synthesis].

A. The movement's structure and healing pathway (as published) [source: Christian Science FAQ; practitioners page; nursing pages]

  • Church life. The Mother Church in Boston and local branch churches; Sunday services at which two lay members read the weekly Bible Lesson-Sermon from the Bible and Science and Health; Wednesday testimony meetings with hymns, readings, silent prayer and members' accounts of healing; public Reading Rooms run by local churches. The Irish health-service guide notes there is no ordained clergy [source: HSE].
  • Practitioners (C.S.). Self-employed members who devote themselves full time to praying "for you, and along with you"; they are paid by the person, not by the Church, at what the Church calls "a reasonable fee" discussed in advance; contact is by phone, email, text, in person or remotely; conversations are described as "completely confidential" [source: practitioners page].
  • Becoming a listed practitioner. Primary class instruction (a 12-day course) from an authorised teacher (C.S.B.), then an evaluation by The Mother Church including verified healing references, after which the practitioner may advertise in the Christian Science Journal directory [source: FAQ; practitioners page].
  • Christian Science nursing. A religious vocation distinct from licensed nursing, offering practical, non-medical care (personal care, mobility, food and feeding, cleansing and bandaging, a quiet setting for prayer) to people relying on Christian Science treatment and working with a practitioner [source: nursing page; scope of services]. The scope of services excludes medical diagnosis or prognosis, medication, supplements or remedies, medical devices (for example IV feeding, feeding tubes, catheters, oxygen), and care for anyone currently taking medication or under medical treatment [source: scope of services]. Accredited facilities exist in the US, Canada, Switzerland and the UK [source: nursing page].
  • Medical care as choice. The Church states that members are "free to choose their own form of healthcare" and calls the idea that they cannot see doctors a misperception [source: FAQ]. The Irish health-service guide adds that members do not normally accept medical intervention, that exceptions may include childbirth and accidents, that blood transfusion, transplantation and life support are generally seen as incompatible with prayer-based treatment, and that the Church says children's healthcare decisions rest with families and that medical treatment of children is permitted in line with national law [source: HSE]. Because Christian Science nursing is not provided to someone under medical care, choosing medicine can in practice mean leaving the movement's care system for that episode [source: scope of services; inference: synthesis].
  • Change over time. In 2010 The New York Times reported the Church seeking a "truce" with medicine [source: bioethics.com summary of NYT, 24 March 2010]; details of the policy shift in the 2010s are [uncertain: not verified].

B. The psychotherapist's work (phases) [synthesis unless tagged]

  • Phase 1: Engagement and cultural assessment (first sessions). Goals: establish safety and respect; learn the client's own account of their faith, health practices and community using the Cultural Formulation Interview, including its spirituality, religion and moral traditions supplementary module [uncertain: module wording not verified]; screen for any current untreated medical condition, any children in the household who may need medical care, and risk. Move on when the client feels understood and any urgent medical or safeguarding issue has been actioned.
  • Phase 2: Focused work on the presenting concern. Typical strands: decision support around a medical choice; family conflict between members and non-members; guilt, shame or fear (for example believing illness reflects wrong thinking); grief after a death, including a death where care was delayed; leaving or doubting. Move on when the client has a working plan and the immediate concern has eased.
  • Phase 3: Consolidation. Relapse plans for future health crises, coordination arrangements with the medical team, support networks inside or outside the faith, and a clear plan for what the client will do if a child or dependant becomes ill.
  • Format and length. Individual, couple or family sessions as the concern requires; no source specifies session counts, so length follows the presenting problem.
  • Overriding rule at every phase. A safeguarding concern about a child, or an adult at serious medical risk who may lack capacity, interrupts the phase structure and is acted on immediately (Section 4, interventions 6–7).

3. Guiding principles

[synthesis unless tagged]

  • Respect belief; do not argue theology. The work is about the client's life and choices, not whether Christian Science is true.
  • Use the client's language with a gloss. Terms such as "treatment", "demonstration", "error", "Mind" (God) or "practitioner" have specific meanings in the movement; ask what they mean to this client rather than assume.
  • Do not assume refusal. The Church says members are free to choose medical care and the Irish health-service guide tells staff not to assume a Christian Scientist will refuse treatment [source: FAQ; HSE]. Ask each person what care they will accept.
  • Adult autonomy is real; so is the duty to make choices informed. A capacitous adult may decline medical care; the therapist's task is to make sure the choice is informed, free of coercion and revisited as circumstances change.
  • Children's safety overrides religious preference. A child cannot weigh the risk of religious non-treatment; courts have held that parents have a duty to seek medical care for a seriously ill child [source: Commonwealth v. Twitchell, 416 Mass. 114 (1993)]. Know and follow your jurisdiction's reporting law.
  • Coordinate, never substitute. The therapist does not give medical advice, does not tell a client to start, stop or change any medicine, and with consent links the client to a physician.
  • Stay out of the healer role. The therapist does not pray for healing in session, give metaphysical interpretations of illness or act as an alternative practitioner; client-led prayer or reflection is the client's own.
  • Do not pathologise belief. Faith-based healing beliefs held by a community are not delusions; differential assessment looks for idiosyncratic, fixed, distressing beliefs out of keeping with the client's own community, or for mood, anxiety or psychotic disorders [source: DSM-5-TR Cultural Formulation approach; uncertain: not verified].
  • Watch for shame and blame. Teaching that illness is unreal or reflects error can be experienced as self-blame when illness persists; respond to that suffering without attacking the faith.
  • Former members and bereaved parents need specific care. Leaving can mean loss of community, identity and family ties; parents whose child died after delayed care may carry grief, guilt, legal stress and public exposure together.
  • Ethics. Competence in religious and spiritual diversity, avoiding dual roles, informed consent and confidentiality limits are core professional obligations [synthesis; spiritual competencies: Vieten et al. 2013, uncertain: not verified].

4. Intervention inventory

The movement's own practices (practitioner treatment, Christian Science nursing, testimony meetings, study of the weekly Bible Lesson) are described in Section 2 as the Church publishes them; they are the client's religious life, not techniques for the therapist to use. The interventions below are the psychotherapist's work with clients from this background. All are [synthesis] built on the cited sources unless tagged otherwise.

1. Opening the client's own account of faith and healing

  • Purpose / when: First sessions with any member, former member or relative; whenever faith, illness or care decisions come up.
  • Steps: (1) Ask how the client describes their relationship with Christian Science now (lifelong member, convert, independent, former member, relative). (2) Ask what the faith gives them (community, meaning, peace, healing experiences) before asking about difficulties. (3) Ask what words they use for prayer, treatment, healing and illness, and note the meanings. (4) Ask whether a practitioner, teacher or Christian Science nursing facility is involved now. (5) Reflect back without endorsing or disputing. (6) Agree how faith will be talked about in therapy.
  • Example language (illustrative): "Before we get to what brought you here, I'd like to understand what Christian Science means in your life, in your own words." "When you say 'treatment', what does that look like for you?"
  • Watch for: Guardedness from past experiences of being judged by health professionals; the client testing whether you will ridicule them. Working: the client uses their own terms freely and can name both what the faith gives and what is hard.

2. Cultural Formulation Interview with the spirituality, religion and moral traditions module

  • Purpose / when: Structured cultural assessment early in therapy, especially before any differential diagnosis or care plan [source: DSM-5-TR CFI; uncertain: not verified].
  • Steps: (1) Use the core CFI domains in your own words: the client's definition of the problem, cultural explanations, sources of support and stress, role of cultural identity, past and current help-seeking, and preferences for help. (2) Add the supplementary questions on spiritual, religious and moral traditions: affiliation, practices, importance, how the tradition views the problem, and any spiritual or religious stressors. (3) Ask specifically about help-seeking: practitioner, prayer, medical care, and how the client and family decide between them. (4) Record the client's explanatory model alongside, not in place of, your clinical formulation.
  • Example language (illustrative): "How does your faith understand what you're going through?" "Who else have you turned to for help with this, and how did that go?"
  • Watch for: Over-reading normative religious belief as pathology; under-reading genuine symptoms because they are framed religiously. Working: you can state the client's explanatory model accurately and the client agrees with your summary.

3. Medical-status screen and coordination with the client's physician

  • Purpose / when: At intake and whenever the client mentions physical symptoms, a diagnosis, pregnancy, an injury or a dependant who is unwell.
  • Steps: (1) Ask neutrally whether the client has any current physical health concern and how it is being cared for. (2) Ask whether they have a physician and when they last saw one. (3) If a serious or worsening condition is described, say plainly that it falls outside your role and that you would like them to be medically assessed. (4) With consent, contact or write to the physician; without consent, record your advice. (5) In an emergency follow your service's emergency procedure regardless of belief. (6) Never advise on starting, stopping or changing any medicine.
  • Example language (illustrative): "I respect how you approach healing. I'm not a doctor and I'm concerned about what you've described, so I'd like to help you get a medical assessment so you have full information."
  • Watch for: Minimising of symptoms; fear that seeing a doctor means losing Christian Science nursing support or standing with a practitioner (the published nursing scope excludes people under medical care) [source: scope of services]. Working: the client accepts assessment, or makes an informed, documented decision.

4. Autonomy-respecting decision support for adults

  • Purpose / when: An adult client faces a choice between relying on prayer, combining prayer with medical care, or medical care alone.
  • Steps: (1) Confirm decision-making capacity in the usual way. (2) Separate the decision into parts: what the medical team has said (from them, not from you), what the client's faith means to them, what they fear from each option, and who else is affected. (3) Ask whether the choice feels free or pressured, and by whom (family, practitioner, congregation, self). (4) Note the Church's public statement that members are free to choose their healthcare and the health-service guidance that members' wishes are paramount, so the client can see that choosing medicine need not mean rejecting the faith [source: FAQ; HSE]. (5) Help the client set review points (for example, "if X happens, I will see a doctor"). (6) Respect the final decision of a capacitous adult and document it.
  • Example language (illustrative): "It's your decision. My job is to help you make it with your eyes open and without anyone else's pressure." "What would need to happen for you to reconsider?"
  • Watch for: Ambivalence voiced only in private; secrecy from family; signs that capacity is affected by illness. Working: the client can state the risks in their own words and has a pre-agreed review point.

5. Differential assessment without pathologising belief

  • Purpose / when: When beliefs about illness, mind or reality appear to be causing distress or danger.
  • Steps: (1) Compare the client's beliefs with what their community holds (ask, or with consent consult a trusted member). (2) Look for markers of disorder independent of content: fixity beyond the group's norms, idiosyncratic elaboration, hallucinations, mood elevation or depression, functional decline, OCD-like scrupulosity about "wrong thoughts" causing illness. (3) Screen for depression and suicidality, which may present as passive refusal of care. (4) Where a religious or spiritual problem is the focus and no disorder is present, the DSM-5-TR "Religious or Spiritual Problem" may apply; it is coded Z65.8 (ICD-10-CM: other specified problems related to psychosocial circumstances, which includes religious or spiritual problem) [source: ICD-10-CM Z65.8 (Unbound Medicine); DSM-5-TR wording uncertain: not verified].
  • Example language (illustrative): "Is this how others in your church see it, or is this more your own way of seeing it?"
  • Watch for: Anchoring on religion and missing a medical cause of psychiatric symptoms. Working: a formulation that separates faith from symptoms.

6. Recognising possible medical neglect of a child

  • Purpose / when: Any client who is a parent, carer, relative or neighbour of a child in a family relying on spiritual healing; any mention of an ill child.
  • Steps: (1) Ask routinely who lives in the household and whether any child has a health concern. (2) Listen for red flags drawn from documented cases: a child ill for days with worsening symptoms (vomiting, fever, lethargy, breathing difficulty, weight loss, excessive thirst or urination), a known treatable condition left untreated, a practitioner or Christian Science nurse being called instead of a doctor, or parents unsure what the law requires [source: Commonwealth v. Twitchell; Hughes 2005; Hall 2013]. (3) Ask directly whether the child has been seen by a doctor. (4) If the child may be seriously ill now, act at once (emergency services, or your local child-protection route). (5) Record what was said verbatim where possible.
  • Example language (illustrative): "You've mentioned your daughter has been unwell since the weekend. Has a doctor seen her? I need to ask because children can become seriously ill quickly."
  • Watch for: Your own wish not to offend; reassurance that "we're praying about it". Working: a clear answer about medical assessment and, if needed, timely action.

7. Child-protection response, consent and assent

  • Purpose / when: Reasonable concern that a child's medical needs are not being met, whatever the reason.
  • Steps: (1) Know your jurisdiction: US states differ in whether and how religious exemptions apply to civil neglect and criminal charges, and these laws have changed over time [source: Hall 2013]; elsewhere follow national child-protection law and professional guidance [uncertain: jurisdiction details not verified]. A religious exemption in one statute does not remove a professional's reporting duty [synthesis]. (2) Consult your supervisor or designated safeguarding lead. (3) Where safe, tell the parent what you are worried about and what you must do. (4) Report to child protection or, if urgent, emergency services. (5) Continue supporting the parent where possible. (6) With older children and adolescents, seek their views and assent in an age-appropriate way, and explain what is happening; never place the decision on the child.
  • Example language (illustrative): "I can see how much you love him and how much your faith matters. My legal duty is to make sure he gets a medical check, so I'm going to contact children's services today and I'd like to do that with you."
  • Watch for: Delay while hoping the parent will act; splitting with team members. Working: the child is medically assessed and the parent remains engaged.

8. Working with shame, guilt and self-blame about illness

  • Purpose / when: A client believes persisting illness, a relapse or a death shows their or someone else's spiritual failure.
  • Steps: (1) Elicit the exact self-statements. (2) Validate the pain without disputing doctrine. (3) Ask whether their tradition itself, or people they trust in it, would judge them this harshly. (4) Use compassion-focused or cognitive methods on the self-blame, not on the faith. (5) If scrupulosity or intrusive fears about "wrong thoughts" causing harm dominate, assess for OCD and consider ERP adapted with the client's consent [synthesis].
  • Example language (illustrative): "It sounds like you're carrying the illness and a verdict on yourself at the same time."
  • Watch for: Hidden suicidal thinking. Working: lower self-condemnation and more freedom in care choices.

9. Family conflict in mixed-belief families

  • Purpose / when: Conflict between members and non-members, between generations, or between a member and a spouse over healthcare.
  • Steps: (1) Meet together only if safe and agreed. (2) Let each person state their values and fears. (3) Identify shared goals (the ill person's wellbeing, a child's safety). (4) Negotiate concrete agreements, such as when a doctor will be called, who decides, and how disagreement is handled. (5) Child safety is not a negotiable item.
  • Example language (illustrative): "You both want her to be well. Let's look at where you agree before we look at where you don't."
  • Watch for: Ultimatums; family members using the therapist as an ally against the faith. Working: written or spoken agreements both sides keep.

10. Grief work, including deaths after delayed care

  • Purpose / when: Bereavement in a member family; above all when a death followed reliance on prayer instead of medical treatment.
  • Steps: (1) Offer standard grief support first; do not open with how the death could have been prevented. (2) Make room for complicated mixtures of love, guilt, anger at self, church or spouse, and doubt. (3) Ask about practical stressors: investigations, prosecution, media attention, family rifts. (4) Coordinate with the client's legal representative only with consent and keep your role clinical. (5) Screen for prolonged grief, depression, PTSD and suicide risk, following standard risk assessment. (6) For surviving siblings, check that their own medical needs are being met.
  • Example language (illustrative): "Whatever you decide to think about your faith now, your grief for your child comes first here."
  • Watch for: Pressure to reach a verdict on the faith quickly; isolation if the congregation withdraws. Working: the client can grieve without the session becoming a trial.

11. Supporting doubt and leaving

  • Purpose / when: A client questions the faith, has left, or was raised in it and now lives outside it.
  • Steps: (1) Do not push in either direction. (2) Map losses: community, family approval, identity, a way of understanding illness. (3) Map gains and new supports. (4) Address practical health gaps, such as never having had a regular doctor, missed childhood vaccinations or screenings, or not knowing how to use medical services, by linking to a physician. (5) Work on fear or guilt about using medicine. (6) Point to peer and advocacy resources for former members, such as CHILD (Children's Healthcare Is a Legal Duty), founded by Rita Swan, a former Christian Scientist, after her own child's death [source: Hall 2013].
  • Example language (illustrative): "Some people leave, some stay and change how they practise, some stay as they are. We don't need to decide that here today."
  • Watch for: Swinging to wholesale rejection that cuts the client off from all support; health anxiety after a lifetime without medical care. Working: a stable identity and an ordinary relationship with medical services.

12. Liaison with community figures at the client's request

  • Purpose / when: The client wants their practitioner, a Christian Science nursing facility or church contact involved in planning.
  • Steps: (1) Get explicit written consent and agree what may be shared. (2) Keep the contact to coordination (for example, end-of-life wishes, visiting, a quiet room for prayer as the Irish health-service guide suggests [source: HSE]). (3) Do not ask the practitioner to change their religious practice, and do not take advice on clinical matters from them. (4) Child safety and emergency decisions are never delegated to a community figure.
  • Example language (illustrative): "You'd like me to speak with your practitioner about visiting arrangements. What would you like me to share, and what should stay between us?"
  • Watch for: Pressure on the client through the liaison. Working: the client feels supported by both.

13. Health-care planning and end-of-life preparation

  • Purpose / when: Serious illness, older age, planned surgery or childbirth.
  • Steps: (1) Help the client clarify which treatments they will and will not accept; the Irish guide notes that blood transfusion, transplantation and life support are generally seen as incompatible with prayer-based treatment and that a period of prayer may be requested before serious procedures [source: HSE]. (2) Encourage written advance decisions, made with the medical team. (3) Name a trusted contact. (4) Plan for what happens if capacity is lost.
  • Example language (illustrative): "Let's make sure that if you can't speak for yourself, your doctors and family know your wishes."
  • Watch for: Conflict between family and the client's stated wishes. Working: clear, documented wishes the team knows about.

14. Holding the therapist's role

  • Purpose / when: Throughout; especially if the client asks the therapist to pray for healing, to endorse or condemn the faith, or if the therapist is personally a member or former member.
  • Steps: (1) Decline the healer or spiritual-adviser role kindly. (2) Keep personal faith or non-faith out of the work unless brief self-disclosure clearly helps the client. (3) If you share the client's faith or have left it, take that to supervision. (4) Refer to the client's own religious community for spiritual guidance if they want it.
  • Example language (illustrative): "Prayer is yours, and I'm glad it supports you. My part is to help with the other things you've brought here."
  • Watch for: Over-identification or hidden hostility. Working: the client experiences you as neither recruiter nor critic.

5. Handling problems

[synthesis unless tagged; the movement's sources do not address psychotherapy problems]

  • Client refuses to discuss physical health. Explain why you ask everyone, keep it brief, and return to it at agreed points. If you have specific concern about serious illness, say so directly and document your advice.
  • Client expects you to share or endorse the faith (or to attack it). Name your role: you will respect their beliefs and will not argue theology; your focus is their wellbeing and choices.
  • Stuck between faith and medicine. Use the decision-support steps (intervention 4); separate the fear of losing community or nursing support from the medical question; agree a review point instead of forcing a decision.
  • Overwhelm after a diagnosis or a death. Slow down, stabilise (sleep, support, practical help), defer existential questions, and screen for suicide risk using your service's standard assessment.
  • Non-adherence to a medical plan the client agreed to. Explore without blame what got in the way: guilt, a practitioner's or relative's reaction, fear of being seen as faithless. Offer to help the client tell their doctor.
  • Rupture after a safeguarding report. Expect anger and a sense of betrayal. Acknowledge it, restate that the duty was about the child's safety, not a judgement of the parent's love or faith, and offer to continue. Seek supervision. If the parent ends therapy, offer a referral.
  • Family pressure on an adult client. Meet the client alone; check capacity and freedom of choice; help them state their own wishes to family, with you present if wanted.
  • Client from a breakaway or independent group. Do not assume the Church's current public statements on medical choice apply; ask what their group teaches and how strictly it is enforced [synthesis; schism context: WRSP].
  • Therapist's own reactions. Strong feelings (anger at the faith, or protectiveness of it) are common, particularly after child deaths. Use supervision so they do not leak into the work.
  • Requests to see private records or join church activities. Decline participation; any reading of the client's materials happens only at the client's invitation and for the client's purpose.

Harm account

What was actually done

  • Withholding of medical care from seriously ill children in favour of spiritual treatment. Asser and Swan's study, published in Pediatrics in 1998, examined deaths of children whose parents withheld medical care on religious grounds [source: Hall 2013; Hughes 2005]. As summarised in the Journal of Law and Religion, it estimated 172 child deaths between 1975 and 1995; 140 of the children had conditions with survival rates above 90% given timely treatment and 18 more had better than a 50% chance; parents from five churches, including the Christian Science Church, accounted for 83% of the deaths [source: Hughes 2005]. The study collected 172 deaths across 23 denominations or sects in 34 states and the true number is likely higher [source: Hall 2013]. Conditions reported in Christian Science child deaths documented by Rita Swan include meningitis, diabetes, diphtheria, measles, kidney infection, septicaemia, cancer and appendicitis [source: Hall 2013].
  • A representative case, as the Massachusetts Supreme Judicial Court recorded it. In April 1986 a two-and-a-half-year-old boy in a Christian Science family became ill and died after five days of illness of peritonitis caused by a bowel perforation, from an obstruction that evidence showed could be corrected surgically with a high success rate. During the illness the parents relied on spiritual treatment: they retained a Christian Science practitioner and a Christian Science nurse and consulted the Church's Committee on Publication, after which the father read a church publication on the legal rights and obligations of Christian Scientists in Massachusetts. That publication stated that state law precluded criminal liability as a negligent parent for not providing medical care for religious reasons and did not mention liability for manslaughter [source: Commonwealth v. Twitchell, 416 Mass. 114 (1993)]. No child or family member is named here.
  • Legal protection for the practice. Many US states had "religious exemption" or "shield" provisions in child-abuse, neglect or criminal law; at the time of the 1998 study, only five states had no religious exemption in child abuse or neglect law [source: Hall 2013]. A 1975 Massachusetts Attorney General opinion addressing negligent failures was read, the court found, in a way that could lead a reasonable person to believe parents could not be prosecuted at all [source: Commonwealth v. Twitchell].

How it caused harm

  • Mechanism. Treatable conditions progressed without diagnosis or treatment while care consisted of prayer and non-medical nursing. The published Christian Science nursing scope excludes diagnosis, prognosis, medication and medical devices, and nursing care is offered to people relying on Christian Science rather than medical treatment [source: scope of services], so an untrained eye may be the only check on how ill a child is becoming [inference: synthesis].
  • Who was at risk. Infants and young children, who cannot describe symptoms, seek care or refuse a parent's decision; children with conditions that deteriorate fast (infection, bowel obstruction, diabetic crisis) [source: Hughes 2005; Hall 2013; Twitchell].
  • Deaths and suffering. The documented outcomes are deaths, most from conditions with a good prognosis under timely treatment [source: Hughes 2005].
  • Legal and family consequences. Parents have faced prosecution. In the 1986 case above the parents were convicted of involuntary manslaughter; the Supreme Judicial Court held that parents have a common-law duty to seek medical care for a child in such circumstances and that the statute's spiritual-treatment provision did not bar a manslaughter prosecution, but reversed the convictions because the jury had not been allowed to consider the parents' reliance on the Attorney General's opinion [source: Commonwealth v. Twitchell]. Bereaved parents, siblings and wider families may therefore face grief, guilt, legal proceedings and community division at once [synthesis].
  • Wider harms. Families who later left the faith have described grief and anger; Rita Swan, whose own son died in 1977 after care was delayed, left the Church and founded the advocacy group CHILD [source: Hall 2013].

Recognising it today

  • Rationales and phrases. A child is said to be "having treatment" or "being prayed for" when no doctor has been involved; illness described as not real, as "error" or a "belief" to be overcome; a practitioner or Christian Science nurse called instead of a doctor; confidence that the law allows spiritual treatment instead of medical care [synthesis from Twitchell and Hall 2013].
  • Red flags in a family. A child ill for days with worsening symptoms and no medical contact; a known chronic condition (for example diabetes) unmanaged; missed routine care; reluctance to let professionals see the child.
  • Red flags in a group or adviser. Teaching or advice that medical care for a child is a failure of faith; reassurance about legal immunity; independent or breakaway groups holding stricter positions than the Church's current public statement that members are free to choose healthcare [source: FAQ; synthesis].
  • How legitimate practice differs. The Church's current public materials state that members may choose medical care, and the Irish health-service guide records the Church as saying medical treatment of children is permitted in line with national law [source: FAQ; HSE]. Prayer alongside timely medical care, and religious support in hospital, are not the harm described here. In 2010 The New York Times reported the Church seeking a "truce" with medicine [source: bioethics.com summary of NYT]; the content and practical effect of that shift are [uncertain: not verified].
  • Law today. Exemption laws have changed: South Dakota was the first state to repeal a religious shield law; the federal government removed religious exemptions from federal mandates in 1983; the American Academy of Pediatrics called for eliminating religious exemptions in 1988; Oregon repealed some exemptions in 1999 and removed religious belief as a defence for denying children medical care in 2011; about 30 states still had religious shield provisions as of 2013 [source: Hall 2013]. Check current law in your jurisdiction [uncertain: post-2013 changes not verified].

What to do instead and how to help those harmed

  • Safer alternative. Timely medical assessment and treatment for any seriously ill child, alongside whatever prayer or religious support the family chooses. The therapist supports parents in reconciling these and never treats prayer as a substitute (interventions 6–7).
  • Child protection. Know and follow your mandatory reporting duty; consult your safeguarding lead; act immediately when a child may be seriously ill; involve older children's views with age-appropriate assent; never name a child in records shared beyond need.
  • Adults delaying their own care. Respect capacitous choice, make it informed and free of pressure, agree review points, coordinate with a physician with consent (interventions 3–4, 13).
  • Affected parents. Offer grief and trauma-informed support; screen for depression, prolonged grief and suicide risk using standard practice; keep the clinical role separate from legal processes (intervention 10).
  • Siblings and adult survivors. Assess for unmet medical needs, health anxiety, guilt and religious trauma; link them to ordinary medical care; consider trauma-focused therapy where PTSD is present (interventions 8, 11).
  • Former members. Support identity reconstruction, community rebuilding and practical health literacy; offer peer and advocacy resources such as CHILD if the client wishes [source: Hall 2013].
  • Ethical and legal duties. Mandatory reporting, emergency action, informed consent, confidentiality limits explained at the outset, documentation, and supervision when your own reactions are strong [synthesis].

Sources

Cross-references: 084 Quimby's mental healing; 085 New Thought.

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