Religion and Spirituality in Psychiatry

74 Philippe Huguelet and Sylvia Mohrpsychosis, as it can for other, “healthy” people.The main difference is that patients with psychosismay find it difficult to develop social contactsin this area. This has important therapeuticimplications (see below).15. RELIGION’S INFLUENCE ON OTHERBEHAVIORSCoping may also be used to deal with other issuessuch as suicidal behavior and substance abuse.Religion may indeed play positive and negativeroles in the frequent comorbidities associatedwith schizophrenia.15.1. Suicidal BehaviorsReligion may protect against suicide attempts . Theaforementioned research showed that 25 percentof all subjects acknowledged that religion playeda protective role with regard to suicide, primarilythrough ethical condemnation of suicide andreligious coping.(53) However, one out of tenpatients reported that religion played an exacerbatingrole, not only due to issues with negativeconnotations but also due to the hope for somethingbetter after death.15.1.1. Protective Role of ReligionOne patient said, “When I feel such despairthat I want to jump out of the window, I thinkabout God. This helps me to live, even if life isso hard sometimes” (41-year-old man, paranoidschizophrenia).For patients who had previously attempted suicide(fourteen patients), the positive role of religionincluded not only religious coping and ethical condemnationof suicide, but also rediscovery of meaningin life through religion and, for one patient,a mystical experience after a suicide attempt thatrestored hope and the courage to live.Psychotic patients who had never attemptedsuicide (twenty patients) reported several aspectsthat played a protective role: religious coping thathelped them fight despair and suicidal thoughtsand restore hope, “finding the joy to live in God’slove” (six patients), finding a reason to live inreligion (three patients), and religious beliefs thatcondemn suicide (four patients).15.1.2. Exacerbating Role of ReligionOne patient said, “Spirituality is essential inmy life; I know that there is a life after death.Once, I took medication to die in order to experiencedeath and know what it’s like afterwards”(36-year-old man, schizo-affective disorder).The patients who had previously attemptedsuicide (nine patients) reported some negativeaspects of religion: suicide attempts followinga break with a religious community (threepatients), suicide attempts involving religiousdelusions and hallucinations (three patients),wishing to die in order to be with God or to liveanother life after death (one patient), the loss of afaith which was the meaning of life (one patient),and a mystical experience of death (the patientbelieved in life after death and wanted to experienceit) (one patient).Two patients who had never attempted suicidereported negative aspects of religion: wishingto die in order to be with God and angerwith God.15.2. Substance AbuseReligion provided guidelines for some patientsthat protected them from substance abuse .(54)Religious involvement was indeed significantlyinversely correlated to substance use and abuse.A content analysis showed that religion mayplay a protective role in substance misuse in 14percent of the total sample, especially for patientswho had stopped substance misuse (42 percent).It played a negative role in 3 percent of cases.Patients’ stories indicated how the various protectivemechanisms of religion worked or howreligion led them to use substances to cope. Onepatient said, “I felt bad. I smoked a lot of hashishevery day. Once I had a religious conversion aftera mystical revelation that the way I was behavingwas not what God wanted for me” (34-year-oldman, paranoid schizophrenia). Conversely, somepatients who misused drugs may have been lesslikely to participate in private and/or collective