Religion and Spirituality in Psychiatry

Consultation-Liaison Psychiatry 191disturbances related to depression, anxiety,dementia, pain, and mal adjustment to illness.(3)Many of these same conditions are related to oraffected by religious beliefs and practices, as istheir management.2. COPING WITH MEDICAL ILLNESSPsychiatrists need to understand psychologicaland social factors that underlie common emotionaland other psychiatric problems found inmedical patients. Unlike psychiatric patients,who often have prior personal and family historiesof psychiatric illness, childhood trauma,and/or personality issues, medical patients haveusually been psychologically stable until theydeveloped medical illness. The onset of healthproblems, then, often underlies depression, anxiety,and other psychiatric disturbances.Chronic medical conditions, and especiallyacute exacerbations of those illnesses, pose enormouschallenges to the patient’s ability to cope. Ifthere is also a history of prior psychiatric illness,then coping with medical problems may be evenmore difficult. Challenges include adjustment toloss of health and vigor, loss of energy and sleep,acute or chronic pain, increases in disability,changes in roles played in family and society, difficultymaintaining social relationships, troublemaking new friends, loss of ability to work, loss ofability to meet life goals, loss of the ability to makea positive difference in others’ lives, and most difficultof all, loss of a sense of purpose and meaningin life. The result of these losses and changes:anxiety, humiliation, despair, and loss of hope.commodity that cannot be bought, and when diseasetakes it away, there may be nothing that onecan do to get it back.2.2. Loss of Energy and SleepHealth problems often drain the patient’s vitality,as the body tries to fight off the illness. This mayleave little energy for physical or emotional activitiesthat bring pleasure and enjoyment. If themedical condition also interferes with sleep (asdo illnesses such as congestive heart failure, restlessleg syndrome, painful neurological conditions,and arthritis), then the fatigue of insomniaadds to and magnifies the physical and emotionalexhaustion. Feeling tired all the time can itselflead to depression or other psychiatric problems,because this interferes with meaningful activitiesand relationships.2.3. Acute or Chronic PainThere is a heavy overlap between pain and depression,which reinforce one another. Pain forces one’sattention to the body part affected, making it difficultto think about anything else except a desireto relieve or escape the pain. Pain, especially whenchronic, can completely dominate the patient’s life,affecting sleep, hobbies, work, and relationshipswith family and friends. The treatments for pain, infact, may also have negative consequences becausethey interfere with level of alertness, ability to communicate,drive, and function effectively. This canresult in anxiety and depression, which furthermagnify or worsen the physical pain experienced.2.1. Loss of Health and VigorHealth and physical vigor are usually taken forgranted until they are lost, but once lost their valuesuddenly becomes apparent. To be free of physicalsymptoms and able to work and play withoutrestriction are perhaps the most precious abilitiesthat humans possess. No matter how much financialresources, power, or influence one has, withoutphysical health, independence, and energy, itis difficult to enjoy life. Physical health is that one2.4. Increase in DisabilityAs chronic illness affects physical function andability to care for the self, there is an increasingneed to depend on others. There are few thingsthat people value more than independence andability to control the direction of their lives. Noone wants to be a burden on others, especially inindependent societies such as the United Statesand Europe. Dependency can be particularly disturbingin situations where caregivers become