AN EXTENDED ESSAY

ON

ROLE OF RELIGION AND

SPIRITUALITY IN MENTAL HEALTH

ASSESSMENT AND INTERVENTIONS

WRITTEN BY OBERE C. M.

MATRIC NO: 184715

GROUP B, 2017

PSYCHIATRY 2 POSTING

MARCH 2021

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 TABLE OF CONTENTS

 TITLE PAGE

 TABLE OF CONTENTS 2

 ABSTRACT 3

 INTRODUCTION 4

 HISTORICAL PERSPECTIVES ON RELIGION, SPIRITUALITY AND MENTAL

HEALTH 5

 DEFINITION OF RELIGION AND SPIRITUALITY

 POSITIVE IMPACT OF RELIGION AND SPIRITUALITY IN MENTAL HEALTH

ASSESSMENT AND INTERVENTIONS

 NEGATIVE IMPLICATIONS OF RELIGION AND SPIRITUALITY ON MENTAL

HEALTH

 TOOLS FOR ASSESSING RELIGION AND SPIRITUALITY IN MENTAL HEALTH

 RECOMMENDATION

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 CONCLUSION

12

 REFERENCES 12

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ABSTRACT

Background

There has been an increasing interest in psychiatry research in determining the relationship

between religion, spirituality and mental health. Some studies have shown positive impacts of

religion and spirituality on mental health while others have reported their negative clinical

implications. Also, tools for assessing religion and spirituality are increasingly being reviewed.

Aim

To determine the role of religion and spirituality in mental health assessment and interventions.

Method

Information was obtained from many papers on the subject matter from numerous relevant

sources. They were being reviewed, summarized and organized to achieve the aim of this

extended essay.

Result

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In this review, it was found that religion and spirituality enhance mental health assessment and

interventions. They are associated with greater wellbeing, hope, optimism, higher social support,

greater mental satisfaction and stability. Although they might sometimes have some negative

implications such as worsening religious delusions in psychotic patients. Studies have also

reported the need to extend the biopsychosocial model to the biosocial/psychospiritual model in

approaching mental illnesses.

Conclusion

There is sufficient scientific evidence to show that religion and spirituality promote better mental

health. It is, therefore, necessary for mental health physicians to be well educated in their training

as regards understanding the concept of religion and spirituality.

INTRODUCTION

In recent years, there has been an increase in scientific interest in finding out the role of religion

and spirituality in mental health assessment and interventions. Religion and spirituality are key

determinants of physical, emotional, social and mental health. Religion and spirituality are often

not adequately assessed and addressed in the medical practice of today (Mohinder Singh and

Ajinkya, 2012).

According to Camp (2011), research has shown that many people appreciate the significance of

religion and spirituality in solving life challenges but these reports usually do not take into

consideration those who are non-religious, agnostic, or atheistic in their worldview and how they

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respond to life challenges especially mental illnesses. Religious or spiritual issues are very often

encountered by many psychiatrists in the hospital.

The effect of religion and spirituality has been studied in many areas in medicine such as in

chronic diseases and mourning (Da Silva and Pereira, 2017). Also, religious beliefs and practices

have been associated with hysteria, neurosis, psychotic and delusional disorders (Koenig, 2009).

It is, therefore, necessary for religion and spiritual issues to be placed within the psychological

scope as seen in the creation of Division 36 of the American Psychological Association (APA)—

the Society for the Psychology of Religion and Spirituality—or the Spirituality and Psychiatry

Special Interest Group (SPSIG) of the Royal College of Psychiatrists. SPSIG aims at promoting

an integrated clinical approach, for routine use in psychiatric assessments, with an emphasis on

spiritual issues (Culliford and Eagger 2009).

HISTORICAL PERSPECTIVES ON RELIGION, SPIRITUALITY AND MENTAL

HEALTH

The discussion on the relationship between religion, spirituality, mental health and medicine has

been ongoing for quite several years. According to Koenig (2009), ‘Religion and spirituality

have been playing a significant role in human life as far as 500,000 years ago during China’s

Paleolithic period when ritual treatment of skulls was done’.

Before the 19th century, religion, spirituality and psychiatry practice were closely interrelated.

For example, many first psychiatry hospitals were situated in monasteries and managed by

priests. Also, mental health reforms were often led by religious people such as Dorothea Dix and

William Tuke. In the United State of America, the first form of mental health care was the moral

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treatment which encompasses humane and compassionate treatment of individuals with mental

illness (Koenig, 2009).

However, in the 19th century, Jean Charcot and Sigmund Freud began to link religion with

hysteria and neurosis (Koenig, 2009). In 1907, Sigmund Freud called religion a ‘universal

obsessional neurosis’. Freud’s atheistic belief was widely accepted by psychoanalysts, which

consequentially made psychiatry appear unfriendly to religion. Also, around the same period, the

medicalization of mental health alienated many clergies who perceived psychiatry as ‘anti-

Christian’ or ‘dangerous’. This enmity between psychiatry and religion persisted through most of

the 20th century (Weber and Pargament, 2014).

In the last few decades, however, psychiatry has now evolved toward a more positive and

receptive stance toward religion and spirituality. This is as a result of the increased awareness of

the significance of patients’ culture, as well as increasing evidence that religion and spirituality

can have positive impacts on mental health (Aist CS, 2012).

DEFINITION OF RELIGION AND SPIRITUALITY

There has been a great difficulty in defining and differentiating between the terms religion and

spirituality because they have overlapping meanings, though they are distinct (Hage et al., 2006).

According to Sullivan (2009), ‘the term religion is being used to describe behavior that is more

closely associated with defined sacred traditions and practices in formal settings. Spirituality, by

comparison, is a broader term that is more personally defined and commonly includes notions of

purpose, the meaningfulness of life events, and may involve the acceptance of an overarching

code of conduct’.

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We can also define religion as ‘an organized system of beliefs, practices, rituals, and symbols’

that facilitate closeness to the transcendent or a community. Spirituality can be defined as ‘the

personal quest for understanding answers to ultimate questions about life, about meaning, and

about relationships to the sacred or transcendent’, and this may or may not involve an outside

community (Camp, 2011).

Furthermore, religion implies an affiliation with institutionalized religion and affirmation of

theological doctrine or dogma while spirituality most often refers to a connection to the

transcendent which for some is disconnected from organized religion (Sperry and Shafranske,

2005). Accordingly, a person can be religious and spiritual, religious but not spiritual, spiritual

but not religious, or neither religious nor spiritual (Post and Wade, 2009).

POSITIVE IMPACT OF RELIGION AND SPIRITUALITY IN MENTAL HEALTH

ASSESSMENT AND INTERVENTIONS

Over the years, studies have shown that religion and spirituality play a positive role in psychiatry

practice. According to a review by Weber and Pargament in 2014, religion and spirituality have

been found to increase patients’ overall quality of life. Various studies have associated religion

and spirituality with lower suicide rates, less anxiety, less substance abuse, less depression and

faster recovery from depression, fewer symptoms of posttraumatic stress, fewer eating disorder

symptoms, less negative symptoms in schizophrenia, less personality disorder, etc. (Mohr, 2006;

Koenig, 2009; Weber and Pargament, 2014).

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Furthermore, research has also shown that religion and spirituality are associated with better

psychological health and can also serve as a protective factor with a positive effect on adherence

to psychiatric medications and interventions (Weber and Pargament, 2014).

Swinton (2000) also believed that religion and spirituality have helped in improving mental

health by enhancing wellbeing through one’s self-esteem, hope, comfort, value and meaning,

spiritual support, social and emotional support through religious communities, coping and

positive mediation to explain and understand life events (as cited in Thompson, 2002).

Meditative prayer, mindfulness, and religious rites are all positively associated with mental

health. A religious or spiritual belief system has been suggested to help people find meaning in

stressful life events that are otherwise difficult to explain and also to cope with physical illness

by providing a new meaning to a disease (Garssen, Visser and Pool, 2021).

NEGATIVE IMPLICATIONS OF RELIGION AND SPIRITUALITY ON MENTAL

HEALTH

Some studies have shown that religion and spirituality are associated with negative physical and

mental health outcomes (Mohr, 2006). It is believed that religious beliefs can worsen psychotic

patients’ delusional beliefs which may lead to greater severity of symptoms, lower levels of

functioning and poor compliance with a psychiatric intervention (Weber and Pargament, 2014).

There is a debate about the impact that religious delusions have on the course of psychotic

disorder. While some studies show that patients with schizophrenia and religious delusions have

a worse long-term prognosis, others do not (Koenig, 2009).

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Furthermore, negative religious coping and spiritual struggles have been associated with

psychological distress, greater depression rate, greater frequency and intensity of suicidal

ideation, worse anxiety, less wellbeing, increased distress, more grief and increased alcohol

problems (Weber and Pargament, 2014).

Substance use can also be abused severely when religious people who previously promoted total

abstinence start drinking alcohol or taking drugs. Their mental health can be worsened as a result

of depression, feelings of guilt and shame, and consequentially resulting in social isolation and

complete withdrawal from religious activities (Koenig, 2009).

Also, there can be miscommunication and misunderstanding of mental illness as a result of over

religiosity and spirituality. This may have a negative influence on medical decision-making and

may counter medical advice (Weber and Pargament, 2014). This can also give rise to poor health

seeking behavior thereby making patients with mental illnesses present late to the hospital. In a

West African mental health clinic, patients usually attributed delirium and dementia to a spiritual

cause, and they may delay medical treatment by first seeking traditional or religious healers

(Camp, 2011).

Additionally, negative beliefs or punitive images of God have shown higher symptoms of

depression, anxiety, paranoia, obsession, and compulsion. For some people, religious beliefs may

increase guilt or lead to discouragement as they fail to live up to the standards of their faith

tradition. (Weber and Pargament, 2014).

Studies have also reported that doubts about religious teachings or beliefs, although common,

may give rise to emotional distress, including depression and anxiety. For some individuals,

religion and spirituality play a role in inducing suicide. Some patients wish to die in order to be

with God or to live another life after death. Others attempt suicide after a break with a religious

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community or because of delusions and hallucinations with religious content (Huguelet P, et al.,

2007).

TOOLS FOR ASSESSMENT OF RELIGION AND SPIRITUALITY IN MENTAL

HEALTH

Suggestions have been made to expand the biopsychosocial model of conceptualizing patients to

include a spiritual dimension which will aid physicians in the recognition of spiritual issues in

their patients, and raise awareness of spiritual resources that are available to support them (Olson

MM et al., 2012). Cox and Gray, in a review of the Psychiatry for the Person Program of the

World Psychiatric Association, also called for a biosocial/psychospiritual approach to achieve

these goals (Cox and Gray, 2009).

Despite controversies in definitions, there are also some guidelines in addressing religion and

spirituality in mental health assessment and interventions. An example of such is the American

Psychiatric Association (APA) Practice Guidelines for Psychiatric Evaluation of Adults, which

includes inquiry about religion/spirituality within the sociocultural history. The Fifth Edition of

the Diagnostic and Statistical Manual of Mental Disorders (DSM-V) also outlined a part of

section 3 for Cultural Formulation which aids in understanding the cultural and religious context

of mental disorders.

However, the first step in assessing a patient’s religion or spirituality is taking a

religious/spiritual history (Moss Q et al., 2006). In taking this history, different acronyms have

been developed to help the physician capture the various components of religion and spirituality.

Examples are ‘FICA’ (Faith, Influence, religious Community, how to Address spiritual needs),

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‘HOPE’ (sources of Hope, meaning, comfort, strength, Organized religion, Personal spirituality

and practices, Effects on medical care and end of life issues) and ‘SPIRIT’ (Spiritual Belief

System, Personal Spirituality, Integration and Involvement in a Spiritual Community, Ritualized

Practices and Restrictions, Implications for Medical Care, Terminal Events Planning) (Verhagen,

2010 and Lucchetti G et al., 2013).

Other main instruments for assessing spirituality are: the Daily Spiritual Experience Scale

(DSES), the Spirituality Index of Well-Being (SIWB) or the Spiritual Assessment Inventory

(SAI) (Da Silva and Pereira, 2017). Monod et al. (2011) found 35 instruments available for

assessing spirituality while they reviewed literature. They further classified them into measures

of general spirituality, spiritual well-being, spiritual coping, and spiritual needs.

While taking a spiritual history, physicians should focus on strengthening the therapeutic

alliance, using natural conversation, being flexible, and having a patient-centered approach as

this may promote trust in the doctor-patient relationship (Weber and Pargament, 2014).

These tools or other screening protocols may help with the early identification of patients

experiencing religious or spiritual struggle, which is a common problem among hospitalized

patients. Those having spiritual struggles should be evaluated further and referred for appropriate

intervention (Fitchett G et al., 2013).

RECOMMENDATION

As religion and spirituality play a vital role in mental health, patient’s needs, desires and

perspectives on religion and spirituality should be addressed in standard clinical care. Therefore

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medical education and curriculum design should point towards the inclusion of competence,

communication, and training in spirituality (Mohinder Singh and Ajinkya, 2012).

Physicians need to be aware of the religious and spiritual activities of their patients, appreciate

their value as a resource for healthy mental and social functioning, and recognize when those

beliefs are distorted, limited and contribute to pathology rather than alleviate it (Koenig, 2009).

Understanding the patient’s and physician’s perspectives of religion and spirituality will provide

insight and perhaps a roadmap for developing spiritual assessments and holistic care in the

psychiatric practice (Ho et al., 2016). Also, congregation-based platforms such as the healthy

beginning initiative (HBI) can be used to train church-based lay health advisors to conduct

mental health screening in community churches and link people to care (Iheanacho et al., 2021).

Finally, psychiatrists need to consider their own inherent religious biases and how they may

result in the minimizing or pathologizing of a patient’s religiosity or spirituality (Weber and

Pargament, 2014).

CONCLUSION

Various studies have reported that religion and spirituality have a positive role in mental health

assessment and interventions, but not without some negative implications sometimes. However,

there is a need for more studies on the effect of the physician’s religious belief and level of

knowledge about religion and spirituality in managing mental disorders. Also, more studies

should take into consideration those who are nonreligious with an atheistic or agnostic

worldview. As scientific findings of religion, spirituality and mental health increase, there is

hope for holistic care in managing mental illnesses.

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