Religion and Spirituality in Psychiatry

8 Religion/Spirituality and Mood DisordersARJAN W. BRAAMSUMMARYThe spectrum of mood disorders is extensive,ranging from melancholia and bipolar disorderat the clinical end to milder depression, adaptationreactions, and mourning at the other end. Inempirical studies, several aspects of religiousnessare often found to be associated with lower levelsof depressive symptoms. The findings generallypertain to community-based studies. Althoughthe studies rarely address clinical samples, thereis evidence that religiousness predicts a betterrecovery from depression. However, more andmore studies demonstrate that depressive symptomsare often accompanied by religious discontentmanifested as negative feelings toward Godor a sense of having been abandoned by God.There is hardly any evidence of how religiousnessis related to the presentation and course of bipolardisorder. It is hypothesized that religiousnessitself may become a subject of mood swings, butcould also evoke disillusionment in the patient,and suspicion in the clinician. Religiousness hasbeen reported to be associated with better outcomesamong those suffering from grief. Studiesof suicide statistics show that, to a limited extent,religiousness can protect people from suicide.One initial aim of a clinical approach involvingreligion is to include spirituality and religiousnessin the examination of psychiatric symptoms.Another aim is to establish a mutual understandingof how spirituality and religiousness arerelevant, which in the case of some patients canbe a meaningful investment in the therapeuticrelationship.Depression is common throughout the lifecourse. With a lifetime prevalence in the UnitedStates of 16.6 percent (1) and a twelve-monthprevalence of 6.7 percent, (2) it is one of the mentalhealth problems with the highest prevalencein the population, second to anxiety disorders –although there is a considerable overlap betweendepression and anxiety. Moreover, studies indicatethat people who recover from a depressive episodeare still at risk for recurrence. The World HealthOrganization (WHO) (3) notes that depression isone of the major causes of disability worldwide inall age groups and accounts for about 12 percentof all disability. Melancholia is the most typicaland classical presentation of depression with severalcompelling features such as impoverishmentof emotional life and delusions of nihilism orguilt. Milder depressions and subthreshold levelsof depression known to be persistent and to easilydevelop into depressive disorder are, however,much more frequent.Manic episodes that occur in bipolar disorderare among the most dramatic presentations inclinical psychiatry. Although the lifetime prevalence(3.9 percent) and twelve-month prevalence(2.6 percent) of bipolar disorder are much lowerthan of unipolar depression, (1, 2) the core featuresare well known, such as delusions of grandiosity,marked euphoric states, severe sleepdeprivation, and continuous agitation sometimesleading to humiliating and socially devastatingsituations. The subsequent depressive episodesare characterized by painful efforts to reverse thesocial effects of the manic episodes, the acceptanceof psychiatric vulnerability, a tendency todemoralize, and problems with side effects frommedication.97