Religion and Spirituality in Psychiatry

66 Philippe Huguelet and Sylvia Mohr■■■■■Are patients with psychosis more prone toengage in religious activities?Can religious coping help patients withpsychosis?Does religion have an effect on patients’outcomes?What about delusions with religious content(this point will be discussed in Chapter 7)?How can clinicians deal with the religious issuesbrought forth by patients with psychosis?The goal of this chapter is to answer thesequestions.2. OUTLINEAfter defining certain terms, the history of therelationship between psychosis and religion willbe briefly described. Some of the medical aspectsof schizophrenia and other psychoses will thenbe presented, that is, diagnostic and epidemiologicalissues, descriptions of known risk factorsfor schizophrenia, particularly the relativecontribution of biological versus psychosocialfactors. These aspects provide justification forthe paradigms that shed light on psychosis asa construct. Given the advantages of a holisticapproach to psychosis in its biological, psychological,and social dimensions, the role that religion/spiritualitymay play will be described.Studies on psychosis and the role religion mayplay – negative or positive in terms of coping andoutcome – will be described.Practical notions of how to deal with religious/spiritual aspects of the care of patients with psychosiswill be discussed, including assessment,individual and group treatments, and how towork with the clergy and religious leaders.Finally, we will describe a multicultural perspectiveon ways that psychosis is understoodand treated across countries, taking religious factorsinto account.3. DEFINITIONSPsychosis is not equivalent to schizophrenia. Infact, the term psychosis – and psychotic – is usedeither to describe symptoms (that is, psychoticsymptoms) or diagnoses, which can be definedas “mental disorder[s] in which the thoughts,affective response, ability to recognize reality, andability to communicate and relate to others aresufficiently impaired to interfere grossly with thecapacity to deal with the reality.” (8)In the present chapter, we use the term schizophreniawhen the aim is to discuss elements pertinentto this diagnosis. The term psychosis is used torefer to the broader group of psychotic disorders,that is, schizophreniform disorder, schizoaffectivedisorder, delusional disorder, brief psychotic disorder,and so on.Some patients may present with psychoticsymptoms such as delusions and hallucinationswithout suffering from psychotic disorders (forexample, in mood disorders). That’s why thisbook includes a special chapter, distinct fromthe present one, on delusions and hallucinationswith religious content.The definitions of religion and spirituality arefound in the first chapter. To simplify the reading,the term religion will be used to refer to both religionand spirituality, unless both terms are necessary.4. RELIGION AND PSYCHIATRYIN THE HISTORY OF PSYCHOSISLittle is known about how psychosis wasexpressed in very ancient times. The lack of literatureon this topic leads some authors to believethat psychosis was rare, if not absent, in antiquity.(9) This controversial view gives some weight tothe argument that psychosis may be – at leastpartially – due to infectious causes, that is, factorsthat may have become more salient whenhumans began to move across continents.Religions affect how the mentally ill areunderstood and cared for. In the early Christianchurches, mental illnesses were thought to becaused by possession by demons, and sacramentalhealing and exorcism were practiced. The Christiannotion of compassion for the poor and sufferingled to the creation of hospitals for the mentallyill. However, during the Inquisition, Christianchurches showed great cruelty toward the mentally