Religion and Spirituality in Psychiatry

6 Religion/Spirituality and PsychosisPHILIPPE HUGUELET AND SYLVIA MOHRSUMMARYPsychotic disorders such as schizophrenia arefrequent around the world and account for agreat amount of disability. Antipsychotic treatmentsimprove symptoms, but do not often allowpatients to regain their full social capacities. Inthis context, it is crucial to help patients recover,that is, to find ways to lead a fulfilling life andto develop a positive sense of identity foundedon hopefulness and self-determination. In thisperspective, it appears that religion/ spiritualitycan be an important component of recovery.Additionally, it can be an essential coping mechanism,helping patients to deal with the symptomsof illness, social difficulties, and so on. Even ifreligion/spirituality may cause distress to patientswith psychosis, studies show little evidence thatreligion/spirituality fosters or triggers psychoticrelapses. Psychosocial approaches (both individualand group) can address religious issuesthrough fostering social integration in patients’religious communities and working on identityand meaning. Individual treatments may alsoaddress spiritual crisis. Overall, the clinician’sgoal should be to negotiate a common worldviewwith patients in domains concerned withtheir care, integrating both their beliefs and secularpsychiatric knowledge. This is particularlycrucial in cultural contexts in which traditionaland/or religious healing may be of more importancethan in Western countries.1. THE RELATIONSHIP BETWEENPSYCHOTIC DISORDERS ANDRELIGION/SPIRITUALITYReligious issues have only recently been consideredin relation to psychiatry. This may be dueto several factors: an underrepresentation of religiouslyinclined professionals in psychiatry thatcan be observed among both North American (1)and European psychiatrists, (2, 3) a lack of educationon religion or spirituality for mental healthprofessionals, (4) and the tendency of mentalhealth professionals to pathologize the religiousand spiritual dimensions of life.(4, 5) The neglectof religious issues in psychiatry may also reside inthe rivalry between medical and religious professions,which issues from the fact that both professionsdeal with human suffering.(6, 7) Thingsmay be even more complicated when consideringpatients with psychotic disorders, mostly dueto entanglement of religion with the illness. Asdescribed later, some patients may present withsymptoms involving religious content; others (perhapsthe very same patients) may consider religionthe most important thing in their lives.Many questions arise about the relationshipbetween religion and psychiatry in individualswith psychotic disorders:■■Does religion affect the development ofpsychosis?Are there situations in which religion may beharmful to patients with psychosis?65