Religion and Spirituality in Psychiatry

212 Harold G. Koenigreligious therapy according to protocol because itwas less familiar to them.13.8. Prescribe Religious Beliefs/ActivitiesPrescribing religious beliefs or practices for nonreligiouspatients is not recommended. This canbe viewed as coercive and should be avoided.If the patient is religious and is using religiousbeliefs to cope, then pointing out the benefits ofreligious practice as demonstrated repeatedly inthe research literature as described here, wouldbe supportive and encouraging to the patient.Doing so with nonreligious patients, however,would not be supportive in most cases and confusingand upsetting, particularly in patientsstruggling with medical stressors.13.9. Collaboration with Chaplains,Pastoral Counselors, and CommunityClergyThere will be many instances when the psychiatristwill wish to seek assistance or counsel froma chaplain or pastoral counselor in the managementof religious patients. This would be particularlytrue when religious conflicts are present orwhen religion is important to the patient and thepsychiatrist is unfamiliar with the patient’s religionor uncomfortable dealing with it. In hospitalsettings, chaplains are readily available to assistin this way and are trained to address religious/spiritual issues from a multifaith perspective.Of course, the psychiatrist must obtainapproval from the patient before bringing in areligious professional. Many patients, however,may not understand what chaplains or pastoralcounselors do or the type of training thatthey receive to address emotional and spiritualissues. Thus, the psychiatrist should explain thisto the patient, and if the psychiatrist doesn’tknow the competencies of a chaplain/pastoralcounselor, then further information should besought (see Spirituality in Patient Care ).(51) Insome instances, the mental health professionalwill want to include the patient’s clergy, especiallyif (1) chaplains or pastoral counselors areunavailable, (2) the patient prefers, and/or (3)the religious tradition of the patient is not wellknown.14. CONCLUSIONSPsychiatrists will often be called on to see medicalpatients with psychiatric disturbances, especiallyas our population ages and the number of personswith chronic, disabling medical conditionsexpands. Medical physicians without specialtraining and expertise in these matters will callon psychiatrists to assist them in the managementof patients with emotional disorders suchas depression and anxiety related to difficultiescoping with medical illness. Psychiatrists will alsobe consulted on issues related to somatoform disorders,chronic pain syndromes, agitation, behavioraldisturbances, and substance abuse. Religiousbeliefs and practices play a key role in enablingmany medical patients to cope with overwhelmingcircumstances. They may also play a role inother psychiatric disorders as well, either as aresource or as a liability. Religious beliefs mayfacilitate psychiatric care and compliance withtreatment, or they may conflict with and impedepsychiatric care. CL psychiatrists and other mentalhealth professionals working in medical settingsneed to learn about the religious/spiritualbeliefs of patients by conducting a thorough anddetailed spiritual history, findout what to do withthis information, and recognizing when pastoralcare collaboration or referral is necessary.REFERENCES1. Leigh H , Streltzer J . Handbook of Consultation-Liaison Psychiatr y . New York, NY : Springer ;2007 .2. Karasu TB , Plutchi k R , Stei nmu l ler R I , C onteH , Sie gel B . Patter ns of psychi at r ic c onsu lt at ion i na general hospital . Hosp Community Psychiatry .1977 ; 28 : 291 –294.3. Callegari CM , Menchetti M , Croci G , Beraldo S ,Costantini C , Baranzini F . Two years of psychogeriatricconsultations in a nursing home: reasonsfor referral compared to psychiatrists’ assessment .BMC Health Serv Res . 2006 ; 6 : 73.4. Ko enig HG , G e orge L K , Pe ters on BL , Pie p er C F .Depression in medically ill hospitalized older