Religion and Spirituality in Psychiatry
Religion and Spirituality in Psychiatry
Religion and Spirituality in Psychiatry
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<strong>Religion</strong>, <strong>Spirituality</strong>, <strong>and</strong> Anxiety Disorders 135every morn<strong>in</strong>g at 7:00 a.m. at the local Catholicchurch <strong>and</strong> prayed the rosary at least five timesper day. She rose up early each morn<strong>in</strong>g becauseit took her several hours to get dressed <strong>and</strong> getready for work <strong>and</strong> church. When she attendedreligious services, she would always light a c<strong>and</strong>lefor her two sons, which she believed would protectthem physically <strong>and</strong> help them to lead goodlives. Pray<strong>in</strong>g the rosary was also for her sons,but also for her ail<strong>in</strong>g mother <strong>and</strong> for protectionaga<strong>in</strong>st the dangers of liv<strong>in</strong>g alone.Whenever circumstances prevented her fromeither attend<strong>in</strong>g daily Mass or say<strong>in</strong>g the rosaryon time, Roberta became very upset <strong>and</strong> angryat whoever <strong>in</strong>terfered with her rout<strong>in</strong>e; she alsobecame extremely anxious <strong>and</strong> had to call eachson <strong>and</strong> her mother to assure herself that theywere OK. When anyth<strong>in</strong>g disturbed her religiousrout<strong>in</strong>e, she would call her sons <strong>and</strong> motherexactly three times each. Although they tried tounderst<strong>and</strong>, this upset her sons who had busylives themselves. Although such behaviors werenot new for Roberta, they had <strong>in</strong>creased <strong>in</strong> frequency<strong>and</strong> <strong>in</strong>tensity s<strong>in</strong>ce her husb<strong>and</strong> died.Roberta also had some other strangebehaviors that members of her church simplyexpla<strong>in</strong>ed as, “that’s Roberta.” She would walkfrom her house to the church every morn<strong>in</strong>gat the exact same time <strong>and</strong> us<strong>in</strong>g the sameroute <strong>and</strong> could be seen walk<strong>in</strong>g from squareto square on the sidewalk, be<strong>in</strong>g careful not tostep on the l<strong>in</strong>es. She also avoided open<strong>in</strong>g thedoor of the church (<strong>and</strong> her home) without firsttak<strong>in</strong>g out her h<strong>and</strong>kerchief <strong>and</strong> clean<strong>in</strong>g off thedoorknob (or wrapp<strong>in</strong>g it with the h<strong>and</strong>kerchiefas she turned the knob). If she touched any partof the doorknob with her h<strong>and</strong>s, then she wouldimmediately go wash her h<strong>and</strong>s.One day Roberta was hospitalized for a shortperiod follow<strong>in</strong>g a small stroke. She was unableto attend Mass dur<strong>in</strong>g this time. She became veryupset <strong>in</strong> the hospital <strong>and</strong> dem<strong>and</strong>ed that the nurseallow her to leave so that she could attend Mass. Asa result, a psychiatric consultation was obta<strong>in</strong>ed,<strong>and</strong> Roberta was diagnosed with obsessive-compulsivedisorder (after the psychiatrist obta<strong>in</strong>eda full history from her sons). She was placed onmedication, <strong>and</strong> arrangements were made forfollow-up after hospital discharge with a behavioraltherapist. Although medication reduced her<strong>in</strong>tense need for attend<strong>in</strong>g Mass daily <strong>and</strong> pray<strong>in</strong>gthe rosary, she refused to see the behavioraltherapist <strong>and</strong> cont<strong>in</strong>ued to have active symptoms,especially when her rout<strong>in</strong>e was disrupted.4.5. Trouble Cross<strong>in</strong>g StreetsPhil is 52 years old, divorced, <strong>and</strong> lives <strong>in</strong> a largecity where he moved about six months ago afterlos<strong>in</strong>g his job <strong>in</strong> the small town where he hadlived <strong>and</strong> worked most of his life. S<strong>in</strong>ce mov<strong>in</strong>g tothe city, Phil obta<strong>in</strong>ed work as a nurse’s assistant(orderly) on the even<strong>in</strong>g shift of a large hospital.Although he liked his job, Phil had one particularproblem that made his life difficult: cross<strong>in</strong>gstreets. Because he lived fairly close to his workplace,Phil was able to make it almost all the wayto work without cross<strong>in</strong>g any major streets. Thistook considerable effort <strong>and</strong> time. If he walkeddirectly to work from his apartment, he couldget there <strong>in</strong> about two m<strong>in</strong>utes. The circuitousroute that he took to avoid cross<strong>in</strong>g streets, however,took him about twenty m<strong>in</strong>utes. Despite thisroute, however, he had to cross one large street toget to the hospital. This was not a new problemfor Phil. He had had trouble cross<strong>in</strong>g large streetseven <strong>in</strong> the small town where he had lived. Priorto <strong>and</strong> dur<strong>in</strong>g a street cross<strong>in</strong>g, his heart wouldrace <strong>and</strong> he would experience extreme anxiety.That anxiety quickly abated whenever he was ableto either avoid cross<strong>in</strong>g or after he had crossedover. His fear of cross<strong>in</strong>g streets, however, hadgotten much worse s<strong>in</strong>ce tak<strong>in</strong>g this new job <strong>in</strong>the city, which had much larger <strong>and</strong> busier streets.Phil had actually missed a couple of shifts at workbecause he had become so anxious try<strong>in</strong>g to crossthe street <strong>in</strong> front of the hospital that he had toreturn home <strong>and</strong> call <strong>in</strong> sick for the day.Phil was reluctant to seek help from a psychiatrist,because the cost of liv<strong>in</strong>g <strong>in</strong> the city was high,<strong>and</strong> his medical <strong>in</strong>surance paid only half of thecost of mental health visits. However, if this cont<strong>in</strong>ued,he might lose his job. So Phil obta<strong>in</strong>ed anappo<strong>in</strong>tment with a psychiatrist who prescribed