Religion and Spirituality in Psychiatry

Consultation-Liaison Psychiatry 207the American Journal of Psychiatry in 1953, Lamerereported, “In the generations covered by this survey,religion was often a powerful force in promotingabstinence [from alcohol] and 13, or 24% of these53 who quit [outside of a terminal illness], did soin response to spiritual conversion.” (47) In his classicstudy of the life history of alcoholics, Harvardpsychiatrist George Vaillant likewise notes, “In thetreatment of addiction, Karl Marx’s aphorism ‘religionis the opiate of the masses’ masks an enormouslyimportant therapeutic principal. Religionmay actually provide a relief that drug [and alcohol]abuse only promises.” (48)Spiritual principles of recovery have beenoperationalized in AA and NA. These programs,run by recovered substance abusers, have beenenormously successful worldwide. The key tothat success have been the following factors:1 Admission of powerlessness (that the addictedperson does not have within them the powerto overcome their problem alone; that is,“I have sinned and cannot beat this problemon my own”)2 Surrender to a Higher Power (for many, thisis God, and such surrender involves religiousconversion; however, this is not always thecase)3 Commitment to help other brothers or sisterswith alcohol addiction by supporting themand helping them to remain sober (that is,“love thy neighbor”)Thus, from a religious view, the process is confession,surrender, and loving others – often consideredthe key and most essential doctrines ofthe religious faith (at least in the Judeo-Christiantradition).Thus, in managing patients with substanceabuse problems, the psychiatrist may considerreferring these patients to an AA or NA group.If those groups are not readily available, thensimilar resources should be identified and theaddicted person connected to them. The faithcommunity often provides supportive relationshipsnot centered on drinking alcohol or use ofdrugs as the addicted person’s prior communityof support was. Getting away from relationshipswith other active substance abusers may be key tomaintaining sobriety.11. RELIGION AS A DETERRENTTO PSYCHIATRIC CAREAlthough religious beliefs and practices may helpmedically ill patients and their families to copewith the stress of medical illness, they can sometimeslead to the avoidance of mental health care.Although I have already discussed this above inthe example concerning suicidal risk, I will elaboratefurther here because the potential for conflictis so serious. Given the long and generally antagonisticrelationship between religion and mentalhealth professionals, beginning with Freud in theearly 1900s, devoutly religious patients may avoidpsychiatric treatments with medication or psychotherapy.They may argue that praying, trustingin God, reading the Bible or other religiousscriptures, and going to religious services is allthat is necessary to cope with the stress of medicalillness, and the need to seek professional mentalhealth care may be viewed as having insufficientfaith or religious commitment. Although todaythis is becoming less common and occurs primarilyin small fundamentalist religious groups,such negative views of psychiatry and mentalhealth care may be subtle and prevent or delaypsychiatric care. For example, clergy may providecounseling to persons with chronic medicalillness without recognizing the development ofsevere depression or suicidal thoughts, resultingin a delay in referral for antidepressant treatment.Although no systematic research exists on howfrequently this occurs, anecdotal cases and newsreports illustrate the disastrous consequences thatcan result.Just Pray MoreCatherine is a 36-year-old housewifeand mother. She has three children, allunder the age of 5 years. Catherine firstnoticed that she was becoming depressedafter the birth of their third child when shebegan experiencing extreme fatigue, lack