Psychiatry 2005 [ S E P T E M B E R ] 20

SPIRITUALITY IN
PSYCHIATRY?
DEAR EDITOR:
An 83-year-old woman was
brought into my office by her 60-
year-old daughter for evaluation
of her recurring depression.
Soon after the daughter left the
room (after introducing her
mother), the patient, without
delay, reported that she had lost
three childrenan 18 year old
son who died in an auto crash, a
24-year-old son who committed
suicide, and a 54-year-old son
who died three years ago after
suffering from a painful cancer-
ous condition for three years.
She recalled having wished that
he had not lived that long with
the painful
suffering.
We never understand these
things, but it certainly is not
Gods fault. We will never know,
she told me.
She believed that it was her
faith in God alone that gave her
the strength to continue living.
She asked me how it could be
expected that she not be
depressed. She was also deeply
concerned about her only surviv-
ing daughter who brought her to
the office. She believed that her
daughter had chosen to remain
single for her sake.
It is the emotions emanating
from such an interaction that
activates the thought that a bio-
psycho-socio-spiritual model
would be a more compassionate
and encompassing approach to
patient care. This is even more
evident when a patient brings it
up in therapy.
Spirituality and religion
How are they different? In
several circumstances we see the
terms religion and spirituality
being used in an interchangeable
manner. Let us examine some
definitions of religiosity and spir-
ituality. Religiosity refers to
participation in or endorsement
of practices, beliefs, attitudes, or
sentiments that are associated
with an organized community of
faith.
1
Spirituality refers to per-
sonal views and behaviors that
express a sense of relatedness to
a transcendental dimension or to
something greater than the
self.
2
There is obviously a wide
overlap, but spirituality seems
more clearly a personalized,
internalized versiona compos-
ite of both.
Can spirituality or religion
mix with science? It was Albert
Einstein (1950) who said,
Science without religion is lame;
religion without science is blind.
Science always searches for what
can most easily be measured.
Science and ethics have become
increasingly secular. Freud saw
religion as universal obsessional
neurosis; Jung differed and dis-
cussed the search for spiritual
enlightenment as the central core
of human experience. This differ-
ence of opinions is one of the rea-
sons Freud and Jung parted com-
pany.
3
Spirituality in health. We
know that faith and religion play
important roles in the lives of
many patients and physicians, but
such concepts are yet to be
incorporated into routine clinical
care.
The World Health
Organization defines health as ,
a state of complete physical,
mental, and social well-being and
not merely absence of disease or
infirmity, and also suggests spir-
itual well being as a fourth
dimension to health.
Religion and spirituality in
psychiatry. Despite unprece-
dented levels of longevity, physi-
cal health, relative affluence,
social freedom, and advances in
technology, there is an increas-
ing incidence of depression in
the 21st century. This seems
paradoxical but may reflect
increased recognition by patients
and/or physicians rather than an
absolute increase in prevalence.
Stress, real or perceived, among
people living a rushed Western
lifestyle, has risen by 45 percent
over the last 30 years.
4
Many studies have linked a
lack of religious beliefs to
depression. Religious commit-
ment is associated with reduced
incidences of depression
5
and
quicker recovery from depres-
sive illness for the elderly.
6
The
reasons why religiously commit-
ted individuals are less likely to
become depressed may include
feelings of social connectedness,
messages of healthy living, per-
haps reduced drug-seeking
behavior, beliefs that justice pre-
vails at the end, belief that
adverse events always have a
message and a meaning, and that
there is a caring, ever-present
God.
3
Negative effects of religion
make headlines (e.g., when a
parents religious views delay
medical care resulting in a
childs death). Spiritual and reli-
gious protective factors, which
may unlock the secrets of pre-
ventive psychiatrythe extent
of which are yet to be deter-
minedhave been less
publicized.
3
It is said that mainstream
psychiatry, for nearly five
decades, has ignored religious
and spiritual issues brought by
patients into treatment. While
less than 10 percent of psychia-
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[ S E P T E M B E R ] Psychiatry 2005 21
trists believe spirituality is
important in their practices,
Janelle reports that 65 percent
of patients with depression, anx-
iety, and other psychiatric condi-
tions indicate that they want
spirituality to play a part in their
treatment.
7
Likewise, in a study to exam-
ine attitudes about spirituality, a
group of medical students were
exposed to didactic material on
spirituality. They reported
greater understanding of the
spiritual issues compared to stu-
dents who did not receive this
didactic instruction. There was
no difference, however, in their
clinical performance. The two
comparative groups received
identical scores for their spiritu-
al history.
8
Physicians stand on this
issue. A complete explanation
of spiritualitys positive explana-
tion is not so important. We do
not understand the mechanisms
of many drugs. We know, from
observing cause and effect, that
they work. Likewise, we can see
the effects of a persons spiritual
consciousness on his outcome,
so why not use that? explains
Martin Jones, a psychiatrist at
Howard University College of
Medicine.
9
Some physicians believe that
religious faith contributes to bet-
ter health and recovery. Despite
a lack of solid scientific evi-
dence, there appears to be a
growing trend to integrate reli-
gion with medical treatment. In
our illness model, while often
concerned with risk factors,
physicians may have underem-
phasized the less publicized pro-
tective human factors, such as
connectedness and spirituali-
ty.
10
Religious commitment was
inversely related to suicide in 13
of 16 studies reviewed.
11
Eighty-
nine percent of alcoholics lost
interest (disconnected) in reli-
gious issues during their teenage
years.
11
People who attended
church weekly were not as likely
to be hospitalized, and when
they were, they did not spend as
much time in the hospital as
those who went to church less
frequently.
12
According to
Gartner
5
and Larson,
11
doctors
can enhance their effectiveness
as medical healers by consider-
ing, inquiring about, and attend-
ing to the spiritual needs of their
patients. This view, however, is
controversial. For example, oth-
ers argue that, Spiritual coun-
seling is an abuse of a physicians
authority. It has the power to
coerce people who are vulnera-
ble and afraid. That is not what
medicine is about.
What is being done to
incorporate spirituality into
healthcare? In an effort to
make healthcare more compre-
hensive, medical educators are
increasingly advocating a bio-
psycho-social-spiritual model.
Recent psychiatric literature
suggests the need to reconsider
the place of religion and spiritu-
ality in psychiatry. Religious and
spiritual dimensions for millions
of people are among the most
important factors that structure
their experience, values, behav-
ior and illness pattern.
13
Additionally, spirituality is
incorporated into some training
programs where the faculty clini-
cal supervisors are sensitive to
the bio-psycho-social-spiritual
model, and focus on whole-per-
son care that recognizes the
importance of spiritual aspect of
patient and respects their belief
systems and autonomy.
A survey that may be helpful
for use in psychiatric practices is
from Baetz, et al., at the
University of Saskatchewan, who
developed the Survey on
Spirituality.
14
Conclusion. Consideration
should be given by clinicians to
address relevant spirituality
issues in patient care when
appropriate, and this may help
broaden the scope of their total
and compassionate care.
REFERENCES
1. Matthews DA, McCullough ME, Larson
DB, et al. Religious commitment and
health status: A review of the research
and implications for family medicine.
Arch Fam Med 1998;7(2):11824.
2. Reed P. Spirituality and well-being. Res
Nurs Health 1987;9:3541.
3. Hassed CS. Depression: Dispirited or
spiritually deprived? Med J Austr
2000;173:5457.
4. Miller R. Life changes scaling for the
1990s. J Psychosom Res
1997;43:27992.
5. Gartner J, Larson DB, Allen G.
Religious commitment and mental
health: A review of empirical literature.
J Psychol Theol 1991;19:625.
6. Koenig H, George L, Peterson B.
Religiosity and remission of depression
in medically ill older patients. Am J
Psychiatry 1998;155:53642.
7. Miles J. Treatment combines
Spirituality with psychiatry. Presented
at the AAP. 2002 May 1.
8. Musick DW, Cheever TR, Quinlivan S,
Nora LM. Spirituality in medicine: A
comparison of medical students atti-
tudes and clinical performance. Acad
Psychiatry 2003;27(2):6773.
9. The healing power of faithWhat doc-
tors know now. Readers Digest May,
2001
10. Pai BR. Total Wellness Management.
India: Vijay Foundation,2002.
11. Larson DB, Wilson WP. Religious life of
alcoholics. South Med J
1980;73(6):7237.
12. Koenig HG, Larson DB, Lays JC, et al.
Religion and survival of 1010 male vet-
erans hospitalized with medical illness.
J Religion Health 1998;37:1529.
13. Javed A. Religion, spirituality, and psy-
chiatry. Presented at the 6th
International Congress of the WIAMH;
1999 August; Tulza, Bosnia.
14. Baetz M, Griffin R, Bowen R, Marcoux
G. Spirituality and psychiatry in
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with patient expectations. Can J
Psychiatry. 2004;49(4):26571.
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Psychiatry 2005 [ S E P T E M B E R ] 22
With Regards,
Murali S. Rao, MD; DFAPA
Associate Professor and Vice-
Chair, Department of
Psychiatry and Behavioral
Neurosciences
Loyola University Medical
Center, Maywood, IL 60153
E-mail: mrao1@lumc.edu
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