Religion and Spirituality in Psychiatry

Consultation-Liaison Psychiatry 203seizures nearly completely subsided. Thispatient’s story is based on a case reportedin the literature.(32)The resolution of this case depended on thetherapist addressing the patient’s symptomsfrom her religious viewpoint. The therapist onlygradually introduced the notion that there wereother possible explanations for her symptoms,including unresolved guilt over the death of hergrandmother. The therapist also used rituals inline with espiritismo beliefs to help the patientassist the grandmother out of her trapped placein the spirit world and on to a more peaceful andrestful existence.8. PAINThe topic of religion often comes up when talkingabout pain and suffering. In fact, many ofthe world’s great religions may have arisen inresponse to the difficulties that self-conscioushumans faced when struggling with difficult lifeand death situations. These religions all addresssuffering as a central part of their rituals andtheological traditions. Religious beliefs may be acause for, a response to, or a way of coping withpainful medical conditions, and consultationliaisonpsychiatrists need to be familiar with howreligion and pain interact and are connected.First, religious beliefs, particularly if rigid andinflexible, may worsen pain. Religious patientsmay feel guilty for having a painful condition andseek to understand why God is allowing them tosuffer so. They may feel that God is punishingthem for past sins, or doesn’t care, or isn’t ableto make a difference in their pain. Such religiouscognitions may worsen the patient’s psychologicalstate, which can exacerbate the pain, addingspiritual suffering to physical suffering. Althoughsuch “negative religious coping” in response topain is not particularly common in medical settings,(33) it does occur, and patients need to beasked about it. Pastoral care referral is often necessaryto help patients deal with such religiousstruggles.Second, and much more common in medicalpatients, is that religion is turned to in anattempt to cope with the pain. Patients may pray,read religious scriptures, or engage in religiousrituals to help them deal with pain, especially theemotional consequences of the pain, that is theanxiety, sense of helplessness, and hopelessnessthat chronic pain frequently causes. The followingclinical case, which illustrates the positiverole that religion can play in coping with pain,appeared a few years ago in the Journal of theAmerican Medical Association . This is a real case,although the name has been changed to ensureconfidentiality.I PrayMargaret is an 83-year-old widowedwoman who sees a physician in Boston,Massachusetts. Her doctor is an attendingphysician at Beth Israel Deaconess Hospitaland is a professor of medicine at HarvardMedical School. Margaret has multiplechronic medical problems, includingadvanced diabetes mellitus and hypertension.The diabetes is probably the cause fora diffuse polymotor and sensory neuropathythat has resulted in chronic, progressivepain. Margaret has had chronic pain foralmost fifteen years now, and the pain hasproven resistant to most traditional treatments,including gabapentin, topiramate,mexiletine, tramadol, rofecoxib, celecoxib,acetaminophen, codeine, oxycodone, and afentanyl patch. The pain appears to be neuropathicin nature and is narcotic-resistant.Her neurologist has signed off the case, sayingthere is nothing more he can do for her.When she goes to see her internist, the doctordoesn’t have much to offer her. Most ofthe time, Margaret and her doctor just sitand talk about her pain and the challengesshe faces with functioning, because littleelse can be done. Despite her long-standingchronic pain, Margaret is doing well from apsychological standpoint. She is optimistic,hopeful, and positive in her outlook. Whenher doctor asks her how she maintains such