Religion and Spirituality in Psychiatry

110 Arjan W. Braamassociations about which the relevance is uncertain.It can thus frequently take some time forthe clinician to conclude to which extent thereis disorder in the structure of thought. Once thatclinical conclusion is arrived at, the contents ofthoughts seem to escape further consideration.It may nevertheless be fascinating to continueand to record what manic patients reveal abouttheir religious and spiritual insights. Patientsfrequently report feeling in contact with cosmicenergies and having religious experiences.Whether these experiences are classified asspiritual, religious, or delusional does not alwaysreceive sufficient attention. An important caveatis that, during the mania, mixed emotions maybe hidden: the religious perspective, once the clinicianasks about it, may reveal thoughts abouthumility toward God, shame about their currentstate of overconfidence, unfortunate expectationsabout the future, or even suicidal thoughts.9.2.3. GriefAlthough not a regular reason for consultingmental health services, encounters with individualswho have lost a spouse or someone they wereclose to are not exceptional and often require thebest skills of tactful and empathic communication.An early inquiry about whether religionmay in some way be a source of consolation orrelief may reflect the clinician’s personal reactionto manage a difficult and emotionally demandingsubject. Emotional reactions to unanticipated situationstend to come in waves. Empathic listeningand a focus on primary needs such as contactwith relatives or friends may be more relevant inthe first phase than inquiring about religion. Abrief allusion to the subject of religion or spiritualitycan let the patient know that the subject willbe open for discussion when the time comes. Themental health care professional can ask whetherthere are any religious rituals that can or shouldtake place.9.2.4. Suicidal ThoughtsProfessional guidelines in several Westerncountries recommend a systematic suicide riskassessment. A rigid systematic approach should,however, be more than counterbalanced by anempathic approach to facilitate an alliance withthe patient, which can serve as a life-saving bridgein moments of crisis. Two elements in the riskassessment may relate to religion or spirituality.First, the estimate of remaining hope: hopelessnessoccupies a central position in the developmentof suicidal thoughts. What sources of hoperemain? For those with religious or spiritualfaith, a perspective of hope may still be attainable.Second, to a certain extent religion itselfhas been shown to prevent suicide. However,this effect, examined in suicide statistics at aggregatedlevels, should not be estimated as morethan modest. As a rule, the risk of suicide in situationsof loss, severe depression, or psychosis andin people who experience hopelessness cannotcompletely be compensated by religiousness orspirituality.9.3. Connect: Abridging Personal StylesDiscussing the patient’s religious and spiritualhistory and experiences may provide anopportunity to examine the expression of psychopathologyin religious terms, as well as toaddress existential questions and the potentialof hope. Nevertheless, knowledge about whatwe can conclude from empirical research maynot be sufficient. Patients may inquire aboutthe religious preferences of the clinician, nurse,or therapist. Moreover, they may express theirbeliefs in a way that evokes uneasy feelings.Individual religious convictions will almostalways differ between two individuals (clinicianand patient) and tend to be very personal.Small differences might be noticed with evengreater sensitivity than huge differences thatare simply there because someone was raised ina different culture.Another reason for feelings of uneasinessmight be more relevant in that it is not the contentsof the religious or spiritual beliefs that differbut the cognitive, emotional, and moral style.James Fowler, as a scholar of the psychology ofreligion, provides some organizing principles inthis connection.(51) In his monograph Stages