Religion and Spirituality in Psychiatry

70 Philippe Huguelet and Sylvia Mohrno assessment could be adapted to every kind ofreligious belief and practice.Mohr et al.(33) developed a semistructuredinterview, based on several different scales andquestionnaires, including the “multidimensionalmeasurement of religiousness/spirituality foruse in health research,” (34) the “religious copingindex,” (35) and a questionnaire on spiritualand religious adjustment to life events.(36)This clinical interview explores the spiritual andreligious history of patients, their beliefs, theirprivate and communal religious activities, andthe importance of religion in their daily lives. Italso explores the importance of religion as a wayof coping with their illness and the consequencesof illness, as well as the synergy versus incompatibilityof religion with psychiatric care. Thesalience of religiousness (that is, the frequencyof religious activities and the subjective importanceof religion in daily life), religious coping,and synergy with psychiatric care is quantified bythe patient by means of a visual analog scale.This questionnaire can be used by clinicianswho wish to get a comprehensive view of theirpatient’s situation. For patients whose religionmay be intertwined with their psychopathology,the most appropriate evaluation method is theclinical interview, which allows clinicians to adapttheir language to the beliefs of each individual.However, clinicians should act cautiouslywhen dealing with patients for whom religionis not important and who currently have no orfew religious practices. Any spiritual stance,including a professed absence of belief, shouldbe respected. Addressing religious coping withpatients with low religiosity could send the messagethat they are missing something, and thusbe harmful. This may be the counterpart of thedismissive message about spirituality that is sofrequently sent when the issue is not addressedwith patients for whom it is central.11. RELIGION AS A PRECIPITANTOF ACUTE PSYCHOTIC CONDITIONSClassification systems describe disorders characterizedby acute psychotic symptoms that cannotbe accounted for by schizophrenia (for example,hallucinations or delusions that last no more thanone month with eventual full return to premorbidfunctioning). It is possible that, at least in somecases, predisposed individuals could be destabilizedby intense religious experiences, which mayrepresent such a disorienting experience that itmay serve as a precipitant.Some case reports have shown that manic episodesmay be induced by religious practices.(37)Concerning acute psychotic conditions, religiousconversion may play a role in precipitating psychosisin vulnerable individuals.(38) Koenig (10)mentions the case of John Cuidad (consideredthe patron saint of psychiatric nurses) and AntonBoisen (founder of clinical pastoral education),who experienced episodes of psychosis followingtheir religious conversions.Further research is needed on the questionof whether religion acts as a stressor involvedin some brief psychotic disorders. Nevertheless,when clinicians are confronted with such a condition,they should examine religion as a possiblestressor. The fact that such a cause may be maskedby delusions with religious content warrants acareful assessment focusing on the temporal relationbetween events and symptoms.12. STUDIES ON RELIGION ANDPSYCHOSIS SHOWING A HARMFULINFLUENCEThere is some evidence that religion and spiritualitycan be harmful for patients with psychosis.Indeed, spiritual and religious concerns maybecome part of the problem as well as part of therecovery: Some people recount that they experiencedorganized religion as a source of pain, guilt,or oppression. For some patients, it was a positiveresource for recovery, and the faith communitywas welcoming and hospitable; for others, it wasstigmatizing and rejecting. Some felt uplifted byspiritual activities; others felt burdened by them.Some felt comfort and strength in religiousness;others felt disappointed and demoralized.(39)Religiousness may exert a harmful infl uencethrough religious movements/churches that