Religion and Spirituality in Psychiatry

92 Sylvia Mohr and Samuel Pfeiferrespectful attitude toward the spirituality and religiosityof the persons involved. To label a delusionas “religious” often leads to an attributionof pathology to the spiritual and religious lifeof patients; this labeling is indeed stigmatizing.Like many people who turn toward religion tocope with stressful events in their life, psychiatricpatients often rely on religion to cope with theirsymptoms and the consequences of their illness.(24) However, the spiritual needs of psychiatricpatients are often neglected.(77) Just becausesomeone displays delusions with religious contentdoes not mean that all his or her spiritual and religiouslife is symptomatic of psychiatric illness.3.5. Functional Impact of DelusionsAccording to Pierre, (30) deciding whether religiousexperience is pathological should dependon its functional impact (if it causes distress anddysfunction). “Delusional” therefore refers not tothe content of a belief per se, but to how a beliefis held and its consequences (that is, with excessivepreoccupation, conviction, and emotionalvalence, and resulting in functional impairment).When looking for the content-free dimensions ofdelusions (conviction, pervasiveness, preoccupation,action, inaction, and negative affect) acrosstypes of delusions, delusions with religious contentseem to be accompanied by more intensesuffering than other forms of delusions.Do these approaches, focused on the dimensionsof delusions and the process of formationand conservation of delusion, imply that the contentmay be ignored? Definitely not. The greatvariation of delusional themes across cultures isevidence of their importance for the individual.Culture gives words and images for the expressionof suffering. The content of delusions is alsorelated to the person’s history.3.6. Psychodynamic ConsiderationsTherapy for delusions and hallucinations with religiouscontent requires a broad understanding ofthe underlying processes. It is not enough to givemedication to treat the pathological symptoms.Understanding the delusional person in the initialphase of the treatment is equally important.In a Swiss study, (78) four functions of delusionswith religious content were described:explanation, context, exculpation, and wishfulfillment/significance.Explanation refers to the interpretation orcognitive reframing of threatening hallucinations,psychotic experiences, and delusional perceptions.What is vaguely perceived as an evil,life-threatening, and overwhelming threat to aperson’s existence, obtains a new significance ifit is labeled “demonic.” “Why me?” is one of themost tormenting questions of the delusional person.Whereas normal life would give no explanationfor singling out an individual in such adestructive way, the events receive significance inthe light of religious writings, where the just isthreatened and attacked, even in the absence ofpersonal wrong-doing. But there are also positiveconnotations, such as identifying a comfortingvoice as the voice of Jesus or an angel in the midstof puzzling and threatening events.Context refers to the ultimate human desireto understand individual suffering in a largerframework of reference. Culture is a majorsource for such contextualization. For the religiousperson, accounts in the Bible, the Koran,or other holy books can serve as the over- archingscenario for his or her personal revelations, sensations,and fears. The end of the world, theapocalypse, is a common theme, but so is theadvent of a new era or of a savior. In grandiosereligious delusions, the person ascribes suchmeaning to herself, which is logical for her inthe delusional context but offensive to the religioussurroundings, resulting in rejection andsocial isolation. Delusional context can serve asa coping mechanism in persecutory delusions:The more powerful the subjects feel in the faceof their persecutors, the less depressed they areand the greater their self-esteem.(74)Exculpation or “ dis-egoification ” refers to thepsychodynamic mechanism of guilt reduction.Some patients report sexual desires and eroticsensations that they would never acknowledgein their healthy ego state. The delusion of Jesus