Religion and Spirituality in Psychiatry

14 Religion, Spirituality, and Consultation-Liaison PsychiatryHAROLD G. KOENIGSUMMARYReligious beliefs and practices play an importantrole in enabling medical patients to cope withdisability, dependency, fear, loss of control, andunpleasant medical symptoms. Besides influencingthe development and course of emotionaldisorders such as depression and anxiety, religioncan play a role in a host of other psychiatricconditions that mental health professionals arelikely to encounter in medical settings, includingsomatization, agitation, behavioral problems, andsubstance abuse. In each of these conditions, religioncan serve as either a resource or a liability.Religious beliefs may facilitate psychiatric care,or alternatively, conflict and interfere with it. Forthese reasons, and to provide culturally sensitivecare, psychiatrists and other mental health professionalsneed to understand how religion caninfluence the onset, course, and treatment of conditionsfor which medical physicians are likely toconsult them. In this chapter, I describe researchon and case examples of how religion can influencepatients’ mental health. I also provide recommendationson how to take a religious/spiritual history,what to do with this information, and whenpastoral care collaboration or referral is necessary.Given the wide prevalence of religious beliefs andbehaviors in medical patients, and their potentialimpact on both mental health and medical prognosis,it is essential that clinicians consulting onthese patients be informed.Consultation-liaison psychiatry is growing rapidlyand will continue to do so as our populationsage, chronic illness increases, and persons withacute medical problems are hospitalized or treatedin outpatient settings. The need for a distinct psychiatricapproach to patients with acute, chronic, orterminal medical illnesses is now fully recognized.This chapter focuses on the emotional challengesand psychiatric illnesses that medical patientsexperience. In particular, it explores the rolesthat religion/spirituality play in the presentationand management of these conditions. Research isreviewed, cases are presented, and clinical applications(spiritual interventions) are discussed from amulticultural perspective that includes collaborationwith chaplains, pastoral counselors, and communityclergy.1. REASONS FOR PSYCHIATRICCONSULTATIONThe most common reasons why medical physiciansare likely to consult psychiatrists in acutemedical or surgical settings are the following:anxiety, depression, psychosis, somatoform disorders,pain, posttraumatic stress disorder (PTSD),substance abuse, delirium, agitation, psychosis,and dementia.(1) In one early study conducted ina general hospital setting, reasons for psychiatricconsultation were 35 percent depression, 29 percentuncooperative/management problem, 23percent bizarre behavior or affect, 22 percent delirium,19 percent previous psychiatric history, 16percent maladjustment to illness, and 14 percentsuicidal behavior.(2) Depression, suicidal behavior,and maladjustment to illness, then, make upthe vast majority of consultations. Similarly, psychiatricconsultation for nursing home patients isheavily weighted toward depression or behavioral190