Religion and Spirituality in Psychiatry

72 Philippe Huguelet and Sylvia MohrPreliminary results of a study we conducted inGeneva, Switzerland indicate that continuouspositive religious coping improves the outcomein schizophrenia (in terms of symptoms, socialfunctioning, and quality of life). While awaitingmore data, cross-sectional studies can provideinformation pertinent to clinical practice.14. THE ROLE OF RELIGION IN COPINGCross-sectional studies have examined the roleof religion/spirituality in the process of copingwith mental illness.(49) Pargament (50)suggested that religious coping can serve fivepurposes: spiritual (meaning, purpose, hope),self-development, resolve (self-efficacy), sharing(closeness, connectedness to a community), andrestraint (help in keeping emotions and behaviorunder control). Religious coping may be adaptiveor not.But what about patients with severe psychiatricdisorders such as schizophrenia?A qualitative study of Bussema andBussema (51) found that patients with severemental disorders (not only psychotic conditions)used all of these five coping strategies. However,the “restraint” factor, that is, a way to keep themfrom undesirable actions, was the least effective forsymptom management. The authors also identifiednonadaptive religious coping that caused feelingsof guilt and hopelessness or of being ignored,judged, or condemned by the religious community,which at times hindered efforts to managenegative symptoms. Moreover, in the absence offellowship, faith and hope were difficult to sustainwhen confronted with persistent illness.In a recent quantitative and qualitativestudy, (42) we studied the role of religion/spiritualityas a coping mechanism among 115 stabilizedpatients with schizophrenia or schizo-affectivedisorders. For almost half the patients (45percent), religion was the most important elementin their lives. Religion was used as a positiveway of coping for 71 percent of subjects and as anegative way of coping for 14 percent of patients.Recently, we were able to replicate theses findingsin 123 patients living in Quebec, Canada.(52) Thesubjective importance of religion, the religiouspractices, and the rate of positive/negative copingwere remarkably similar to those found in theGeneva cohort.14.1. Positive Religious CopingAt a psychological level , religion gave thesepatients a positive sense of self (for example,hope, comfort, meaning of life, enjoyment oflife, love, compassion, self-respect, and selfconfidence).For two-thirds of these patients,religion provided meaning to their illness,mainly through positive religious connotations(for example, a grace, a gift, God’s test to inducespiritual growth, and spiritual acceptance of suffering),less frequently through negative connotations(for example, the devil, demons, andGod’s punishment). However, even if thosemeanings were negative in religious terms, theywere positive in psychological terms by fosteringan acceptance of the illness or a mobilization ofreligious resources to cope with the symptoms.For example, one patient said, “I think my illnessis God’s punishment for my sins; it gives meaningto what happened to me, so it is less unjust”(30-year-old woman, paranoid schizophrenia).For three-quarters of patients, religious copinghad a positive impact on symptoms (for example,by lessening the emotional or behavioralreactions to delusions and hallucinations and/orby reducing aggressive behavior). A patient whosuffered from delusions of persecution clearlyexpressed this by saying, “I always have a Biblewith me. When I feel I am in danger, I read it andI feel I am protected. It helps me to control myactions of violence” (26-year-old man, paranoidschizophrenia). A patient who had delusions ofcontrol said, “At some time during every day, Ifeel that other people can control me from a distanceand that they can do anything they wantwith me. However, I do not feel anxious like I didbefore. The Buddhist monk told me it was onlymy imagination and he teaches me how to meditate.In this way, I distance myself from this ideaof control; I tell myself that it is just a symptomof an illness, that there is nothing true about it