Religion and Spirituality in Psychiatry

Religion/Spirituality and Psychosis 71discourage psychiatric care or amplification ofmorbid cognitions by religious considerations.It is difficult to obtain an exact picture reflectingthe extent to which patients with psychosismay be negatively influenced or abused by religiouscommunities. On one hand, people withpsychosis do not usually have much money, thusnot much to be taken, and they may have unpleasantand disruptive symptoms that cause religiouscommunities to reject them. On the other hand,their difficulties, both in terms of interpersonalties and cognitive experiences, may lead them totry to cope with these issues through religion ina way that may be harmful to them. It is difficultto find medical literature quantifying this issue.Psychosis itself may precipitate a change in affiliationto a less traditional religious group (40).But abuse may occur within both traditional andnontraditional religious groups. Anthropologyhas illustrated some examples of patients whowere negatively affected or abused by religiouscommunities.(41) However, a cross-sectionalstudy showed that among 115 patients, only 2had been negatively influenced (for a limitedtime) by religious communities.(42)The concern that religion exerts a deleteriousinfluence on patients with delusions can be supportedby the fact that patients who have delusionswith religious content may experience a worselong-term prognosis.(43) However, it is not possibleto conclude that a causal effect exists. Indeed,among other arguments, it appears unlikely thatdelusions with religious content constitute a unitaryphenomenon, because delusions themselvesproceed from different mechanisms. Research onmedication-free individuals with schizophreniaindicates that delusions can be separated intothree distinct factors: delusions of influence (forexample, delusions of being controlled, thoughtwithdrawal, thought insertion, or mind reading),self-significance delusions (delusions of grandeur,reference, religion, and guilt/sin), and persecutorydelusions.(44) Religious content may befound in each of these categories: A patient mayhave the conviction that he or she is controlledby a god or that a god puts thoughts in his or hermind; he or she may think that he or she is a god;or he or she may be convinced of being persecutedby the devil or some other religious figure.Delusions with religious content may be related toformer personal and social experiences and thusunderstood in the context of a person’s life andculture.(45) Rhodes and Jakes (46) suggest thatreligious experience could represent attemptsmade by patients to interpret their anomalousexperiences, i.e. a way to cope when facing distressingevents such as hallucinations. Delusionswith religious content are encountered in 25 percentto 35 percent of patients with schizophrenia,although they are not specific to that population.13. THE IMPACT OF RELIGIONON OUTCOMEAs mentioned before, when considering the stressvulnerabilitymodel, (23) every factor likely toincrease support and/or relieve stress may improvea patient’s outcome. Religion is likely to play rolesin this regard. Indeed, it can provide assistance incoping with the illness, difficult life experiences,and existential issues, as well as provide interpersonalsupport through peers and clergy.When considered in the light of the recoverymodel (that is, beyond aiming at symptomreduction), religion’s impact becomes even moreobvious. A vast majority of patients with schizophreniado not have work, and their activities andsocial contacts are restricted. Clinicians are confrontedwith the need of these patients for hope,self-fulfillment, and personal growth. Farkas (47)argues that positive psychology (for example,dimensions such as personal accomplishmentand self-esteem) is important for these patients.Keeping in mind the importance religion representsfor these patients, (42) it must be examinedas a resource for recovery. Qualitative researchindicates that religion and spirituality can be amajor resource in recovery, (48) as reported bypatients. To our knowledge, there are still no outcomestudies shedding light on the role religionmay play in the prognosis of psychoses such asschizophrenia (either in terms of symptom reliefor recovery). Neither is it known how religiousnessalone evolves over time in patients with psychosis.