Religion and Spirituality in Psychiatry

Religion/Spirituality and Mood Disorders 99the behavioral, cognitive, affective, and motivationaldimensions. The behavioral dimensionpertains to organized religious behavior suchas church attendance as well as nonorganizedreligious behavior such as private prayer. Thecognitive dimension pertains to religiousbeliefs and convictions and traditions ofreligious beliefs representing the context ofsocialization. The motivational dimensionpertains to the relative importance or salienceof religion in personal life. Here, one conceptoften emerges in the literature: that is, intrinsicreligious motivation defined as the extent towhich people live from within their religion,with faith as a supreme value in its own right,permeating life with motivation and meaning.Another variation is extrinsic religious motivation,defined as the utilitarian type of religiousness,useful to the self in granting safetyand social standing.With respect to the relationship betweenreligiousness and depression (an affectivedisorder), one may assume that the affectivedimension of religiousness is of crucial importance.This affective dimension, however, didnot receive much attention in empirical studiesuntil recently. Glock (6) conceptualizedthe affective dimension as religious experience .Although unintended by Glock, the term experiencebears a connotation of relatively eccentricor, at any rate, very private emotions, as arelinked to conversion, mysticism, or exaltation.These sudden emotions may come up less indaily life and presumably do not apply to allreligious believers. Thus, the question remainsas to how basic religious feelings in commonlife should be interpreted.From a psychodynamic perspective, the affectivedomain of religiousness also includesobject-relational aspects of the God image asconceptualized by Ana-Maria Rizzuto.(7) Objectrelations are ongoing, internalizing representationsof relationships with significant others,especially with regard to the emotional functionsof the relationships. Rizzuto elaborated onpsychoanalytic ideas on the mental representationof the relationship with God. This specialtype of object relation bears some resemblanceto relationships with early attachment figures,but the God object relation also firmly relates tocultural traditions.(8) The God object relationor God image may nurture a sense of basic trust,but can also arouse a sense of awe, anxiety, discontent,or anger.Another domain of religiousness pertains toreligious coping. Initially, the conceptualizationof religious coping followed fairly random patterns.Pargament, (9) however, contributed to adeeper understanding. He distinguished betweenreligious destinations – objects of significancerelated to the sacred – and religious pathways –religious attitudes and behaviors. Pargamentargued that religious coping is determined byhow an individual either conserves or transformsreligious destinations and religious pathways.By no means does religiousness represent amonolithic concept. It involves a system withvarious dimensions, various aspects within eachdimension, and a range of positions and varietiesfor each aspect. Moreover, aspects of religiousnessnot only belong to various dimensions, theycan also change over time. Of course the aspectsof religiousness are interrelated, but here againa range of combinations can be discerned. Oneshould bear in mind that statements about associationsbetween religiousness and mental healthalways require specification about the dimensionsor specific aspects of religiousness.All the aspects of religiousness can be assumedto act as factors related to depression in variousways ranging from vulnerability factors to recovery-promotingfactors. The integral examination ofthe relationship between religiousness and depressioncan thus be depicted as a matrix, a chessboardwith numerous combinations (Table 8.1). In thecolumns, the types of factors related to depressioncan be distinguished, and in the rows, thedimensions of religiousness appear with theirmain aspects. For example, religious cognitionssuch as the conviction that every human carriesguilt throughout life may give rise to exaggeratedfeelings of guilt in times of depression, or even toreligious delusions about trespasses interpretedas having committed the unforgivable sin. This