Religion and Spirituality in Psychiatry

Religion, Spirituality, and Anxiety Disorders 141who are not living up to her high religiousstandards. She is often critical of others,especially members of her family but alsoothers outside the family as well. This hasinterfered with her relationships, causingrifts within the family and also isolationfrom others in her community and congregation.By feeling better than others,Stephanie covers up a deep-seated insecurityand poor self-image. She is scrupulousand controlling, fearful that if she is notin control, then bad things will happen –as they have happened before. As a childshe was quite sensitive and needy, and shewas criticized mercilessly by a judgmentalmother with similar emotional problems.She wonders whether her husband is havingan affair, and at times can’t understandwhy he would love her.Patients may also misinterpret or misapplyreligious teachings, using them in a rigidand inflexible way that leads to excessive guiltand compulsive behaviors. Religious teachingsencourage persons to regularly perform religiousrituals, pray without ceasing, practice selfsacrifice,and focus on others’ needs. Each ofthese, while healthy if done in moderation, canalso be unhealthy if taken to an extreme.Bob is a married 32-year-old computerscience teacher with two young children.He is active in his church, where he is adeacon. He attends every social event atchurch and spends many hours cleaning upand putting things back in order at the endof church functions. Bob has to put everythingback in exactly the same place orhe feels anxious. He must check the lockson the church several times after lockingup, and sometimes has driven back to thechurch fearing he has left it unlocked. Hehas similar fears about locking up his ownhome at night. Bob’s wife has complainedto him on more than one occasion that hehardly ever spends time with his two children,and she would like to do other thingswith him besides going to church. Bob,however, explains that he is serving Godand is committed to the church, and that ifhe doesn’t do it then no one else will do itright. Because his wife has now threatenedto leave him, and he cannot seem to alterhis behavior, Bob has come to see a psychiatristfor help.As noted earlier, patients may also use religiondefensively to avoid addressing issues intherapy. Here, the patient uses religious justificationsfor ways of thinking or behaving thatreally have nothing to do with religion, buteverything to do with the patient’s desire toresist needed change.Sarah is a divorced 42-year-old sales clerk.Sarah has as history of being raped andbrutally beaten about twenty years agowhen someone broke into her home duringa robbery. She continues to suffer nightmaresof the attack, cannot watch violentmovies, and suffers from chronic depressionand anxiety. She is quite religious anduses much religious jargon in talking abouther past and present life. She has attendedmany religious revivals and healing servicesand reports having demons exorcisedfrom her on more than one occasion. Sinceher divorce, she has had many male boyfriendsin brief relationships but is unableto establish a lasting, intimate relationshipbecause of the fear that comes over herwhenever the relationship deepens. A psychiatristdiagnosed her with PTSD. In additionto treating her with medication, thepsychiatrist referred her for therapy to helpin her relationships with men. Wheneverthe therapist talks to her about the rapeevent, she immediately begins using religiousexplanations to minimize the event,claiming that the Lord healed her of all thatwhen she underwent exorcism. She thentries to change the subject. She has been intherapy for almost a year but is not makingmuch progress.