Religion and Spirituality in Psychiatry

Delusions and Hallucinations 85characteristics). However, most studies have notused detailed inventories of personal religiositysuch as the construct of religious centrality.(23,24) Rather, emotional and behavioral aspectsof religious life have simply been described anddetailed. Interestingly, Siddle et al.(25) reportthat the dichotomous self-categorization of beingreligious or not used in their study was as validas more complex measures. The broad definitionof religion may include not only classical formsof religious life but also more exotic beliefs asdescribed in the following :Case ExampleA 50-year-old man with paranoid schizophrenia,who regularly attends the meetingsof a UFO association, reported, “I am a littlestrange. Since childhood, I have strangeexperiences. I regularly see UFOs. Once, Iwent too close to a saucer and was abductedby the aliens. This is why I have visions andI hear voices. These are not hallucinations.Since then I have a passion for UFOs, morethan that – it is a priesthood. I believe in God,but I prefer to call him ‘a highest benevolententity.’ Beside God, there are benevolentalien entities, i.e., Christ alien entities, andmalevolent alien entities, i.e., satanic entities.With those entities, one does not have anyliberty of choice, they influence us.”Indeed, the growing rate of people believingin UFOs and alien abductions has been analyzedin terms of the emergence of a new religiousmovement.(26)In this context, the cultural background isimportant, being likely to influence both worldviewand the contents of delusions. Thus, a cleardefinition of religious delusions is needed to allowthe clinician to be sensitive to cultural diversity.For such a definition, we need to go back to thedefinition of what a delusion is per se.2.3. What Is a Delusion?Defining delusion is not an easy task. The diagnosticapproach sets up qualitative differencesbetween delusions and other beliefs. Accordingto the Diagnostic and Statistical Manual ofMental Disorders, Fourth Edition, Text Revision( DSM-IV-TR ), (27) a delusion is a false beliefbased on incorrect inference about externalreality, which is firmly sustained despite whatalmost everyone else believes and despite whatconstitutes incontrovertible and obvious proofto the contrary. The belief is not one ordinarilyaccepted by other members of the person’sculture or subculture (for example, it is not anarticle of religious faith). When a false beliefinvolves a value judgment, it is regarded as adelusion only when the judgment is so extremeas to defy credibility.Delusional conviction occurs on a continuumand can sometimes be inferred from an individual’sbehavior. It is often difficult to distinguishbetween a delusion and an overvalued idea (inwhich case the individual has an unreasonablebelief or idea but does not hold it as firmly as inthe case of a delusion). Contents of the delusionmay include a variety of themes (for example,persecutory, referential, somatic, religious, orgrandiose).This definition of delusion has frequentlybeen criticized. The falsity criterion of delusionshas been dismissed for being not applicable,not resolved, or even resolved in the sensethat the content of the delusion was in fact true.(28) Especially, delusional religious beliefs lackany clear empirical content.(29) Indeed religiousbeliefs like delusions, lying outside the realm ofobjective falsifiability, subjective certainty, andincorrigibility.(30) The level of conviction maychange with time.(31) Individuals can group andform a community based on delusional beliefs.(32) Notwithstanding, the categorical nature ofthe diagnostic approach underlines a core psychopathologicalfeature indicative of substantialbreak with reality, which holds widespread clinicalacceptance and shows reliability.(33)Th e discontinuity between pathology andnormality has been challenged by epidemiologicalstudies with standardized diagnostic instrumentsthat demonstrate the presence of delusionsin persons without psychiatric disorders. It has