Religion and Spirituality in Psychiatry

Religion, Spirituality, and Anxiety Disorders 135every morning at 7:00 a.m. at the local Catholicchurch and prayed the rosary at least five timesper day. She rose up early each morning becauseit took her several hours to get dressed and getready for work and church. When she attendedreligious services, she would always light a candlefor her two sons, which she believed would protectthem physically and help them to lead goodlives. Praying the rosary was also for her sons,but also for her ailing mother and for protectionagainst the dangers of living alone.Whenever circumstances prevented her fromeither attending daily Mass or saying the rosaryon time, Roberta became very upset and angryat whoever interfered with her routine; she alsobecame extremely anxious and had to call eachson and her mother to assure herself that theywere OK. When anything disturbed her religiousroutine, she would call her sons and motherexactly three times each. Although they tried tounderstand, this upset her sons who had busylives themselves. Although such behaviors werenot new for Roberta, they had increased in frequencyand intensity since her husband died.Roberta also had some other strangebehaviors that members of her church simplyexplained as, “that’s Roberta.” She would walkfrom her house to the church every morningat the exact same time and using the sameroute and could be seen walking from squareto square on the sidewalk, being careful not tostep on the lines. She also avoided opening thedoor of the church (and her home) without firsttaking out her handkerchief and cleaning off thedoorknob (or wrapping it with the handkerchiefas she turned the knob). If she touched any partof the doorknob with her hands, then she wouldimmediately go wash her hands.One day Roberta was hospitalized for a shortperiod following a small stroke. She was unableto attend Mass during this time. She became veryupset in the hospital and demanded that the nurseallow her to leave so that she could attend Mass. Asa result, a psychiatric consultation was obtained,and Roberta was diagnosed with obsessive-compulsivedisorder (after the psychiatrist obtaineda full history from her sons). She was placed onmedication, and arrangements were made forfollow-up after hospital discharge with a behavioraltherapist. Although medication reduced herintense need for attending Mass daily and prayingthe rosary, she refused to see the behavioraltherapist and continued to have active symptoms,especially when her routine was disrupted.4.5. Trouble Crossing StreetsPhil is 52 years old, divorced, and lives in a largecity where he moved about six months ago afterlosing his job in the small town where he hadlived and worked most of his life. Since moving tothe city, Phil obtained work as a nurse’s assistant(orderly) on the evening shift of a large hospital.Although he liked his job, Phil had one particularproblem that made his life difficult: crossingstreets. Because he lived fairly close to his workplace,Phil was able to make it almost all the wayto work without crossing any major streets. Thistook considerable effort and time. If he walkeddirectly to work from his apartment, he couldget there in about two minutes. The circuitousroute that he took to avoid crossing streets, however,took him about twenty minutes. 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 crossing large streetseven in the small town where he had lived. Priorto and during a street crossing, his heart wouldrace and he would experience extreme anxiety.That anxiety quickly abated whenever he was ableto either avoid crossing or after he had crossedover. His fear of crossing streets, however, hadgotten much worse since taking this new job inthe city, which had much larger and busier streets.Phil had actually missed a couple of shifts at workbecause he had become so anxious trying to crossthe street in front of the hospital that he had toreturn home and call in sick for the day.Phil was reluctant to seek help from a psychiatrist,because the cost of living in the city was high,and his medical insurance paid only half of thecost of mental health visits. However, if this continued,he might lose his job. So Phil obtained anappointment with a psychiatrist who prescribed