Religion and Spirituality in Psychiatry

16 Religious and Spiritual Assessment in Clinical PracticeSYLVIA MOHR AND PHILIPPE HUGUELETSUMMARYSpirituality/religion are rarely assessed in psychiatry.However, for many reasons, such an assessmentis useful. The primary reasons are the manydomains of interdependence between mentaldisorders and culture, including religion.What should be evaluated in a spiritual/religious(S/R) assessment? Although several instrumentshave been developed for this purpose, the clinicalinterview, which allows clinicians to adapt theirlanguage to the beliefs of each individual, appearsto be the most appropriate evaluation method.Specific aspects elements of this assessment aredetailed in this chapter, such as religious/spiritualbackground and preferences, the illness’s effect onspirituality and/or religiousness over time, currentspiritual/religious beliefs, religious practices inprivate and in the community, amount of supportfrom the community, and the subjective importanceof religion in the patient’s life. Dependingon how important religion is to the patient, furtherquestions should be asked about the spiritualmeaning of the illness, the way patients copewith symptoms, the degree to which their spiritualbeliefs comfort them, and the relationship (that is,synergy versus antagonism) between spirituality/religiousness and psychiatric care.Examples of individual situations warrantingspecific approaches are provided at the end of thechapter.Evidence exists that spirituality and religionare rarely assessed by clinicians caringfor psychiatric patients. A Swiss study aimingto assess clinicians’ knowledge of the spiritualityand religiosity of their patients sufferingfrom chronic psychosis found that only onethirdof them reported discussing spiritual andreligious issues with their patients. Moreover,none of the clinicians initiated discussionsof the topic themselves. (1) The replication ofthe study in Québec, Canada, elicited similarresults. (2) In another Canadian study, only onethirdof psychiatric patients reported that theirpsychiatrist had inquired about spirituality/religiousness. (3) Psychiatrists reported severalreasons for not discussing religion/spiritualitywith their patients: insufficient time, concernabout offending patients, insufficient knowledge/training,general discomfort, concern thatcolleagues would disapprove, and lack of interestfrom the patient.( 3 , 4 )Several factors may account for the neglect ofspiritual and religious issues in psychiatric practice.First, religiously inclined professionals areunderrepresented in psychiatry, as compared tothe general population. This has been reportedfor United States, (5) Canadian, (3) British, (6)and Swiss psychiatrists. (1) Second, mental healthprofessionals often lack the necessary educationin religion/spirituality.(7 , 8 ) Third, mental healthprofessionals tend to pathologize the religiousdimension of life (Lukoff, 1995).(8 , 9 ) Fourth, theneglect of religious issues in psychiatry may alsobe linked to the rivalry between medical and religiousprofessions that stems from the fact that bothaddress the dilemma of human suffering.(10 , 11 )Clinical and existential concerns overlap acrossissues of identity, hope, meaning and purpose,232