Religion and Spirituality in Psychiatry

Consultation-Liaison Psychiatry 209I Need HelpGeorge is a 46 year-old electrician whoattends a local Baptist church with his wife.George is a deacon in the church and makesregular mission trips to Guatemala to helpbuild houses for poor families. One day atwork when fixing a transformer on an electricalpole, he tripped on a loose wire andfell about thirty feet to the ground, landingon his side. George was hospitalized withfive broken ribs, a crushed pelvis, a fracturedfemur (upper leg) and radius (wrist).After surgical stabilization of his fractures,he was transferred to the rehabilitation sectionof the hospital. Recovery was slow, andafter about six weeks of little improvement,George got discouraged and start to giveup hope that he was ever going to recoverenough to go home and resume his workand ministry. Actually, his physical recoverywas right on schedule, and now it washis emotional state that was holding himback. One day, he told his physical therapist,“I need help. I’m so discouraged that Idon’t want to try any more. But I know thatGod has a plan for my life, and I won’t beable to live out that plan unless I started tofeel better.” The therapist asked George ifhe would mind if the therapist spoke withhis physician and ask him to obtain psychiatricconsultation. George replied, “If apsychiatrist can do something to make mefeel like praying again, reading the Bible,and getting back on the mission field, thenI want to see him.”Systematic research has examined the relationshipbetween religious activity and use of mentalhealth services. For example, investigators analyzeddata from the 2001–2003 National Surveyon Drug Use and Health to examine the relationshipbetween religion and use of mental healthservices.(49) Two large subgroups were identified:those with moderate (n = 49,902) and withserious mental illness/emotional distress (n =14,548). Sophisticated probit models were usedto examine past twelve-month use of outpatientmental health care and prescription medications.Religious measures were frequency of religiousattendance, strength of religious beliefs, andinfluence of religious beliefs on decisions. Othervariables controlled in the analyses were DSM-IVdisorders, symptoms, substance use and relateddisorders, self-rated health status, and sociodemographiccharacteristics.Researchers found that in those with moderatemental illness/emotional distress, there wasa positive relationship between religious attendanceand increased outpatient mental healthcare use; however, importance of religious beliefswas inversely related to outpatient use. In thegroup with serious mental illness/emotional distress,religious attendance and importance ofreligious beliefs were both positively related tooutpatient mental health service use and medicationuse; however, influence of religious beliefson decisions was inversely related to outpatientmental health services. The authors concludedthat these findings argued against the widespreadnotion that religious involvement discourageduse of mental health services, especially amongthose with serious mental illness.Other research that has examined the relationshipbetween religion and use of mental healthservices is the NIMH Epidemiologic CatchmentArea Survey (the first large community studyto determine rates of psychiatric illness in thecommunity based on criteria established in theDSM ).(50) This study reported that Pentecostals(fundamentalist Christians) in North Carolinawere less likely to use psychiatric services thanmainline Protestants. However, when analyseswere stratified by frequency of religious attendance,the low rate of mental health services usewas almost completely confined to Pentecostalswho attended religious services infrequently. Infact, despite a 30 percent prevalence of mentalillness in this subgroup of Pentecostals, not asingle person had seen a mental health professionalin the previous six months. In contrast,Pentecostals who attended religious services atleast weekly used mental health services at twoto six times the rate of other Protestants. In fact,Pentecostals who attended church frequently