Religion and Spirituality in Psychiatry

206 Harold G. Koenigdown or cooperate with care, they wouldquietly sing “Amazing Grace” with her.When patients with dementia have a religiousbackground that includes a heavy emphasis on rituals(if Catholic, for example, saying the rosary orreceiving communion), then engaging the patientin such rituals or prayers may help to reduce agitationand increase cooperation. Repeating theTwenty-Third Psalm or the Lord’s Prayer with thepatient may have the same effect. Again, however,a thorough religious history is necessary from thepatient (or from the family, if the patient cannotremember or communicate). Several types of religiousinterventions may need to be tried, althoughfinding out which religious behaviors, rituals,prayers or hymns, were particularly meaningful tothe patient will probably be most successful. If thepatient has never been particularly religious, however,such interventions are unlikely to help.Religion can also assist patients cope with thestress involved in the development of dementia,especially the early stages when patients still haveinsight into what is happening to them. This isa time when emotional distress (depression oranxiety) is common. If religion has been of valueto patients in the past, then it may be used to helpcalm them as they recognize that they are losingcontrol. Praying with patients, reading religiousscriptures to them, or singing favorite religioushymns may all serve to calm their emotions,just as described above for patients with moreadvanced dementia with agitation.There is even some evidence suggesting thatreligious involvement may forestall the developmentof cognitive impairment in older adults(38) or may slow its progression in Alzheimer’sdisease.(39) Because depression and high stressmay increase levels of serum cortisol, andbecause cortisol has adverse effects on the brain(particularly on the large pyramidal cells in thetemporal lobes), (40) a mechanism does exist bywhich religious involvement could help to preservememory functions. By reducing depressionor speeding its remission, and/or decreasingstress levels, religion could prevent the increasein serum cortisol that adversely affects braincells. Lower cortisol or healthier cortisol rhythmsamong those who are more religious have alreadybeen demonstrated in several studies.(41–43)Whether or not religious involvement helpsto prevent cognitive decline in normal aging ordementia, we know that such involvement can behelpful to those caring for patients with dementia.It is often the caregiver who brings the patientwith dementia to see the psychiatrist, and level ofcaregiver burden is a strong predictor of whetherpatients with dementia can be cared for at home(versus placement in a nursing home). Caregiverstress also affects both the mental and physicalhealth of the caregiver. A number of studies havedemonstrated that religious beliefs and practicesare associated with lower caregiver stress.(44–46)Religious belief often gives the caregiver a senseof meaning and purpose in their caregiver dutiesand provides a community of support that canhelp counteract the isolation and loneliness ofthe caregiver role.10. SUBSTANCE ABUSEPsychiatrists are often called in when medicalpatients are withdrawing from alcohol or illicitdrug use. Co-morbid substance abuse is widespreadamong patients with chronic physical healthproblems, as self-medication with these substancespromises at least temporary relief of their suffering.What is the role of religion in substance abuse disorders,and how might religious factors influencethe management of these patients?First, as noted earlier, there is a large research literatureshowing that religious persons are less likelyto abuse alcohol and drugs. The result is that theseconditions are less likely to be a problem in patientswho are more religiously involved. Religious involvementfrom an early age helps to prevent the onsetof alcohol/drug abuse and addiction. Furthermore,it provides an alternative coping behavior (prayer,scripture reading, rituals, and community support)that can counter the stress that may drive people touse these substances. In addition, religious experiencesand spiritual interventions have been shownto be effective in helping persons recover from substanceabuse and addiction. In a study published in