Religion and Spirituality in Psychiatry

Consultation-Liaison Psychiatry 201began to calm down. Her breathing slowed,and she became less frantic. After about 10minutes, the nurse on duty came into theroom, apologizing profusely for her tardiness(there had been another emergencyon the ward and the nurse was preoccupiedwith that situation). By the time she arrived,however, Janet was feeling better and incontrol. The prayer had helped.7. SOMATOFORM DISORDERSSomatoform disorders are physical complaintsor signs for which no physical etiology can beidentified and are therefore thought to be due topsychological causes (that is, are somatic manifestationsof psychological pathology). Amongthe most common and well-known somatoformdisorders are conversion disorder, somatizationdisorder, and hypochondriasis.There is little systematic research on whethersomatoform disorders are more or less frequentamong religious persons compared with the nonreligious.Only four studies have examined therelationship between religion and somatization(two studies coming out of our research group).In the first of these, Chaturvedi and Bhandarireported religious differences in beliefs about theunderlying cause of psychosomatic complaints.(22) In a small sample of thirty-one psychiatricoutpatients (twenty-four Hindu, seven Muslims)in Bangalore, India, they found that Muslimswere more likely than Hindus to report that theirillnesses were the result of physical causes despitethe fact that they were told they were of psychologicalorigin.Second, a study by Koenig and colleaguesreported results from the North Carolina site ofthe National Institutes of Mental Health EpidemiologicCatchment Area survey (n = 2,969).(23) No difference was found in rates of somatizationdisorder based on any religious characteristic,including religious attendance, prayer/Biblestudy, religious TV/radio, importance of religion,religious affiliation, or “born again” status (the latterinvolves making a conscious commitment toturn one’s life over to God and live life in a waythat reflects the life of Jesus Christ). This is theonly study that examined a random sample ofcommunity-dwelling residents diagnosed withsomatization disorder using a structured psychiatricinterview (Diagnostic Interview Schedule) andusing DSM-III criteria.Third, in a study of 300 primary care patientsin Greece, Androutsopoulou and colleaguesfound that Muslims scored significantly higherthan Christians on the somatic complaints subscaleof the General Health Questionnaire, a differencethat persisted after controlling for othercovariates including gender.(24) It is not clear,however, what this finding means because complaintof somatic symptoms by primary carepatients does not necessarily indicate a somatizationdisorder.In the most recent study, Flannelly and colleaguesconducted an Internet survey of 1,403readers of Spirituality & Health magazine usingthe Symptom Assessment-45 Questionnaire,with a subscale that measures somatization.(25)They found no relationship between somatizationand frequency of religious attendance orreligious fundamentalism. Although a weak positiveassociation was found between frequency ofprayer and somatization, there was also a weaknegative association between belief in an afterlifeand somatization. Overall, then, there is littleevidence for a relationship between somatizationdisorder and religious involvement.Although not associated in general, a connectionbetween somatization disorder and religionmay sometimes occur, even if not very frequently.Such cases received an unusual amount of attentionduring the late nineteenth century because ofhistorical trends at the time they were reported.During this period, the French Revolution hadsucceeded in throwing off the last vestige of religiousinfluence. This is when the famous Frenchneurologist Jean-Martin Charcot claimed thatthere was a connection between religion, hysteria(a form of conversion disorder), and otherneurological illnesses.(26) Charcot emphasizedthe physical positioning and posture of Catholicsaints as depicted in famous religious paintings