Religion and Spirituality in Psychiatry

Religion/Spirituality and Psychosis 77how their beliefs may help in their recovery and/or create conflicts. Interestingly, none of thepatients decompensated during the group meetings,and staff concerns about this issue thusseemed unfounded.Phillips et al.(60) developed a psychoeducationalgroup, a more structured format involvingseven sessions. This program is defined assemistructured; information is provided on specifictopics such as spiritual resources, striving,and struggles, followed by discussions. Theirresearch was based on the study of ten subjects,and the authors concluded that this interventionappeared to reach most of its objectives.Wong-McDonald (61) described the outcomeof an optional spirituality rehabilitation program,as compared with an ordinary program. Thisspirituality group, added to a psychosocial rehabilitationprogram, consists of discussing spiritualconcepts, encouraging forgiveness, listeningto spiritual music, and encouraging spiritual andemotional support among members. Comparedto the usual treatment, this additional groupallowed patients to achieve their goals in 100percent versus 57 percent of cases.Revheim & Greenberg (62) developed theSpirituality Matters Group (SMG) for hospitalizedpatients. SMG aims to offer comfort andhope through structured exercises focusing onspiritual beliefs and coping. These exercisesinvolve more activities with a specific orientation,such as reading from the book of Psalmsor reciting and writing prayers, in addition tocognitively oriented activities, such as emotionfocusedcoping. Created in the United States,this group is conducted both by clinicians andreligious representatives. It involves a mixtureof psychological and religious features, whichshould be implemented, at least in public facilities,with caution in other areas, such as Europe.According to reports in the literature, groupactivities involving spirituality are bourgeoning,at least in the United States. Other programsmay exist elsewhere, but without being reported.However, the development of such activities warrantsa careful evaluation of the social and culturalcontext in which they are implemented.19. A MULTICULTURAL PERSPECTIVEOur goal is not to describe health systems indeveloping countries where western-style careis implemented. Rather, we highlight somealternative ways of conceptualizing and treatingpsychosis, that is, integrating spirituality intopatient care.The first point to clarify is that developingcountries do not have a monopoly on attributingsupernatural causes to psychiatric disorders. Forexample, Pfeifer (63) showed that in a rural areaof Switzerland, more than a third of psychiatryoutpatients believed that an evil influence wasa possible cause of their problem. Moreover,30 percent of patients sought help through ritualssuch as prayer and exorcism. Those patientssuffering from schizophrenia reported the highestrate of rituals involving exorcism.Conversely, some research has shown thatmental illness may be recognized as such indeveloping countries. For example, Younis (64)reported that in Sudan, schizophrenia was identifiedin 76 percent of cases, both in urban andrural populations. Psychiatric treatment wasadvised for more than half of them.Nonetheless, spiritual factors in the treatmentof mental illness have a place of their ownin developing countries, as shown by Campion &Bhugra.(65) These authors report that in SouthIndia, almost half the patients seeking treatmentin a psychiatric hospital had previously solicitedhelp from religious healers. The highest rate wasin the group diagnosed with schizophrenia (58percent). Less than a third of patients reportedan improvement through these treatments,which consisted of chanting mantras, ingestionof holy water or ash, use of animal sacrifice, orother rituals. Ninety-nine percent of patients hadstopped any religious treatment at the time of thepsychiatric consultation.In Uganda, Africa, Teuton et al.(66) carriedout a qualitative investigation of the conceptualizationof “madness” across indigenous, religious,and “allopathic” healers. For indigenous healers,“madness” is seen as a sign of a deviation or aform of harm instigated by a jealous party. For