Religion and Spirituality in Psychiatry

210 Harold G. Koenigused these services more appropriately (that is,those with diagnosed mental illness sought mentalhealth services, while those without mentalillness were unlikely to seek such services). Thus,even among fundamentalist religious groups,those who are active in their faith community usemental health services as much or even more frequentlythan those from more mainline or liberalreligious traditions (and use those services moreappropriately).The psychiatrist may also wish to expand thespiritual history to obtain a deeper understandingof the role of the patient’s religious/spiritualbeliefs in health or pathology. (See Spirituality inPatient Care for a more in-depth spiritual historyfor the mental health patient.(51) ) If any issuescome up that the psychiatrist is not familiar withor competent to address, then referral to a chaplain(in the hospital) or a trained pastoral counselor(in the community) is indicated.13. WHAT SHOULDPSYCHIATRISTS DO?What should the CL psychiatrist do with thisinformation? How might it change his or herassessment and management of the patient? Inmy discussion above, I inferred numerous waysthat psychiatrists could take advantage of theinformation presented in this chapter. However, Isuccinctly summarize here some common assessmentand management strategies.13.1. Take a Spiritual HistoryThe initial assessment of the medical patientshould always include a spiritual history as partof the social assessment. The following questionsshould be asked:■■■■■■What is the patient’s religious or spiritualbackground (denomination, faith tradition)?Is religion/spirituality used to cope withstress?Is religion/spirituality a source of support or acause of stress and conflict?Are there religious/spirituality beliefs thatmight influence psychiatric care or conflictwith psychiatric treatments (psychotherapyor medication)?Is the patient a member of a religious/spiritualcommunity, and is that community supportiveor nonsupportive (and how)?Are there any spiritual needs that someonewith expertise in pastoral care could helpaddress?13.2. Take a Spiritual Historyfrom Other SourcesIf the patient is unable to give a spiritual historybecause of altered mental status or dementia, thentake the spiritual history from family, friends, orthe patient’s minister. Note, however, if obtainingthe history from anyone but a competentpatient, it is necessary to obtain approval fromthe patient’s power of attorney (POA) for healthcaredecisions or guardian. If this person knowsthe patient well (such as a family member), thePOA/guardian would be the recommended personto obtain the spiritual history from. Becausethis is a delicate and personal area, special careneeds to be taken when exploring spiritual issueswith anyone but the patient.13.3. Anticipate Religious ResistancesSome patients will use religious beliefs as a defenseagainst making needed life changes for health andgrowth or as a defense against taking medicationwith unpleasant side effects. For example, bipolaror schizophrenic patients may refuse mood stabilizersor antipsychotics on religious grounds, whenin reality they simply don’t like the side effects ofthese medications. This also applies to treatmentsfor medical disorders. The hypertensive patientmay refuse blood pressure medications for similarreasons, claiming that God will heal him orher (or that God’s will be done). Religious teachingsmay also be used to avoid changing behaviorsthat are adversely affecting mental or socialhealth. For example, the patient with an obsessiveor compulsive personality is involved in so much