Religion and Spirituality in Psychiatry

Religion/Spirituality and Psychosis 75religious practices than abstinent patients becauseof the social impairment, inappropriate affects,and reduced motivation to cope with the outsideworld brought about by both their illnessand substance use and abuse. Some patientswith schizophrenia who were drug abusers saidthey had been rejected by their faith communitywhen they became ill, but others said that, evenif they could have found help and support inreligion, they lost contact because of their lackof motivation or because they lost their pointsof reference.16. TOWARD AN INTEGRATIVE VIEWReligion/spirituality can help patients with psychosisin the following ways:First, spirituality/religion may be used to copewith current difficulties, that is, symptoms andsocial and interpersonal problems.Second, it may help to prevent potentiallyharmful behaviors, such as interpersonal violence,substance abuse, and suicidal or parasuicidalattempts.Third, it can be a key element in the recoveryprocess that every individual with a severepsychiatric disorder should engage in. A personwithout long-term life goals is like a bicycle thatisn’t moving: It falls down. Religion and spiritualitycan play a role that goes beyond cognitivealterations, symptoms, and stigma by allowingeven patients with severe forms of schizophreniato experience personal growth (as part of therecovery process).Examining these issues unearths some cluesabout what to consider when treating patientswith psychosis. Before going into further detail,it must be emphasized that the context in whichthese elements are implemented should alwaysbe kept in mind. Indeed, cultural elements mustbe taken into account when considering religion/spiritualityin the individual care of patientswith psychosis, but the kind of therapeutic workunderway is also important. A therapist engagedin a psychoanalytically oriented approach will notproceed in the same way as a cognitive therapistor a clinician practicing supportive therapy.17. INDIVIDUAL TREATMENTSpecific therapies involving religion are discussedin Chapters 17 and 19 to 21. Aspects concerningillness representation and treatment adherenceare discussed in chapter 18. We would like tofocus here on elements to be considered principallywhen practicing behavioral-cognitive orsupportive therapy with patients with psychosis.To our knowledge, no specific guidelines existin the scientific literature on how to incorporatereligious issues in the individual care of patientswith psychosis. In fact, we do not even knowwhether patients want to speak about religiousissues or not. But, based on research on copingand religious involvement in patients who sufferfrom psychosis, we can tentatively examinesome issues that may be relevant for them.The first step is to assess the religiousnessof the patient (see above and Chapter 16). Thepatient may report no participation in any religiousactivity or some extent of involvement inspirituality and/or religion. The spiritual assessmentmay also reveal a problem(s) warrantingintervention.The following section describes which issuescould be components of individualized treatment.Research on coping in patients with psychosisshows that the personal dimension of religion isnot correlated with its social dimension, that is,that many patients have religious beliefs and prayalone but do not have social contacts related totheir faith. In fact, they replicate what happens inother areas of their lives because they have problemscreating and maintaining an interpersonaland social network. This area can be a focus oftreatment; these deficits should be overcome (orat least the goal should be made to overcomethem) through social skills training or individualcounseling.For any one of various reasons, patients maybe in a period of spiritual crisis. This can happento anyone, but in patients with psychosis,their crisis may be to some extent embedded indelusions or other “bizarre” thoughts. In suchcases, the situation cannot be resolved by sendingthe patient to a chaplain or member of the