Religion and Spirituality in Psychiatry

106 Arjan W. Braamemphasis on factors relating to the (cyclic) course.Moreover, becoming aware of one’s chronic vulnerabilitywill not be easy for most patients. Anacceptance of this unfortunate condition is conceptualizedas a loss situation, a loss of career possibilitiesand social roles, relational losses, and aloss of mental stability itself. Any loss evokes griefreactions and complicated losses, in turn, complicatethe grief process itself. The basic stages of griefaccording to Kübler Ross are outlined above.Regarding the relationship between facets ofreligiousness and bipolar disorder, four aspectsdeserve special mention.1 Symptom formation . Symptom formationfactors play a role in the stress-vulnerabilitymodel, but in the case of mania, religiousnesscannot be regarded as a peripheral factor.During mania, many patients experience statesof enlightenment and increased religiousmotivation, which easily shift to the level ofreligious delusions. Although religious delusionsare discussed in chapter 7, the questionremains as regards the extent to which aspectsof religiousness such as the religious traditioninfluence the emergence of increased religiousinsights and emotions during the manic state.2 Religious experiences during mania . Bipolarpatients sometimes tend to conceal the experiencesthey have during the mania frommental health professionals, but still ponderabout them or even cherish the memory oftheir enlightened state or spiritual insights,irrespective of the negative consequences ofthe manic episode. How should these religiousinsights be viewed? Would they underminethe grief process? Or would they serve tohelp to maintain self-esteem?3 Religious preoccupations as early signs . Whenbipolar patients intensify their religiousinvolvement, this may in turn lead to religiousand spiritual preoccupations. Mental healthprofessionals often recognize religious preoccupationsas early signs of a new manic episode.This provides an opportunity to preventa recurrent episode, but patients discover thattheir religious life leads to distrust from theirclinicians, who feel the urge and responsibilityto focus on the biological treatment regime. Sothe element of religiousness is not only a specialdomain in the contact between the patient andthe clinician, it is also laden with suspicion.4 Disillusionment with religion . There is a fourthaspect that may be relevant to the depressiveepisode as well as the symptom-free interval.After the mania, enlightened spiritual experiencesoften lose their charm once the euphoriahas faded away. In the depressive state and thesymptom-free interval, disillusionment withreligion and spirituality may be experienced.This may obstruct the grief about having tocope with a chronic mental disorder and representan additional loss in life, the loss oftrust in one’s religion. Religiousness and bipolardisorder may thus be deeply intertwinedin the dramatic euphoric manifestation aswell as in the component of loss. Religion maybecome the subject of cycling itself.So far, very few studies have been conductedon religiousness or spirituality and bipolar disorder.In 1969, Gallemore and colleagues describedthat conversion experiences were more than twiceas prevalent in patients with mood disorders.(38)However, patients with bipolar disorder did notdiffer from a control group with respect to otheraspects of religiousness. Similarly, the abovementionedstudy by Levav and colleagues did notreveal any differences in the prevalence of manicepisodes in people of various religious affiliations.(21) In a small sample of psychiatric inpatients,Kroll and Sheehan (39) noted that manic patientsreported higher personal religious experience rates(55 percent) than depressed patients (25 percent)or a national sample (35 percent). Two other studieson patients with psychosis (40, 41) showed thatthe prevalence of religious delusions was aboutequal among manic patients and patients withschizophrenic psychosis and about twice as highas among patients with a psychotic depression.Findings of this type show how religionemerges in the phenomenology of the mania. Ahypothesis can be formulated about symptomformationeffects in that people with a religious