Religion and Spirituality in Psychiatry

Religion/Spirituality and Mood Disorders 105In its myths and beliefs, religion has a greatpotential for helping people cope with the endof life, bereavement, and dying. It is possible tospeculate on how religiousness relates to each ofthe five stages of grief. In the opinion of atheists,for example, the belief in an afterlife may be aform of denial. Anger might evoke problematicfeelings among religious people, such as guiltabout rebelling against the Creator or troubleexpressing anger at God. Bargaining can be donein an effort to influence one’s fate by altruisticbehavior or adherence to rituals, as is observedamong Roman Catholics. Calvinists might havecompelling questions about whether or notthey are predestined for salvation. Depressionmay follow any of the various religiousness anddepression patterns outlined above. As to acceptance,the role of religiousness may relate to theoutcomes of the previous stages. In any of thestages of grief, the religious community can oftenprovide a certain degree of consolation, moralsupport, human contact, and sharing in ceremoniesof mourning.An intriguing hypothesis about the psychologyof religion and bereavement derives from attachmenttheory. Kirkpatrick (33) stated that a personalrelationship with God resembles a secureattachment to a primary caregiver. Along theselines, the emotional compensation hypo thesisnotes that the relationship with God providescomfort if a loved one dies and helps compensatefor the lack of a love relationship.Becker and colleagues (34) evaluated thirtytwostudies on the relationship between religiousand spiritual beliefs and bereavement. Abouthalf the studies reported a positive association.Nevertheless, the approaches exhibited considerablevariation as regards the measures and outcomes.The vast majority of the studies examinedsamples consisting of white American Protestantfemales. One exception was a British study onthe fourteen-month outcome of bereavementamong 135 relatives of patients admitted to acenter for palliative care.(35) Spiritual beliefs, asassessed with the Royal Free interview on religiousand spiritual beliefs, (36) had a modest butrobust association with a better grief outcome,even after adjustment for baseline depressionscores. Because of the mixed and modest effects,Becker and colleagues concluded that the issue ofwhether religion is related to the grief outcomehas not been resolved.(34) They comment thatreligious and spiritual beliefs can be expectedto affect many other aspects besides depressivesymptoms, such as autonomy, personal growth,or engagement in social activities.6. RELIGION AND BIPOLAR DISORDERBy definition, the question of how religionrelates to bipolar disorder requires an approachthat addresses both poles. First, an approach tothe depressive pole would need to fit into thevulnerability-stress model described above.Other, complementary principles might have todo with the relationship between religiousnessand the manic phase. This simple suggestiondoes not consider the fact that the depressiveand manic phases occur in succession and oftendepend on each other. Furthermore, the vulnerability-stressmodel also applies to the manic pole,at least in the first episodes of bipolar disorder.(37) In view of the sensitization phenomenon,the provoking effect of environmental stressorsincreases over time with successive recurrentepisodes of mania. This means that, over time,minor stressors or even minimal stress may besufficient to provoke a new episode. A relatedfeature of bipolar disorder over time is the kindlingphenomenon , (37) where the frequency ofthe recurrent episodes gradually increases andsymptom-free intervals tend to shorten. Bipolardisorder medical treatment regimes not only aimto minimize the affective disturbances during theepisodes, but also to prevent recurrent episodesand at least prevent the bipolar cycle from accelerating.Besides prolonging the symptom-freeintervals, another task in the treatment of bipolardisorder is to help patients accept that they havea chronic mental disease, assist with social rehabilitation,and prevent demoralization.The relationship between religiousness and thetwo poles of bipolar disorder spectrum may thusfollow the vulnerability-stress model, with an