Religion and Spirituality in Psychiatry

Religious and Spiritual Assessment 233morality, and autonomy versus authority. (12)However, in recent years, the historic divisionbetween psychiatry and religion has narrowed. Inthe United States, all psychiatric residencies mustinclude didactic sessions on religion/spirituality,(13) and recent findings tend to indicate thatpsychiatrists may be more comfortable and havemore experience in addressing religious/spiritualissues, as compared to other physicians. (4)In the present chapter, we adopt a broad definitionof religion, including spirituality (concernedwith the transcendent, addressing the ultimatequestions about life’s meaning) and / or religiousness(specific behavioral, social, doctrinal, anddenominational characteristics). (14)1. WHY SHOULD SPIRITUALITY/RELIGION BE SYSTEMATICALLYASSESSED?S/R assessment is recommended as part ofpsychiatric evaluation in several evidence-basedguidelines for good clinical practices. According tothe American practice guidelines for the psychiatricevaluation of adults, the developmental, psychosocial,and sociocultural history domain mustbe systematically evaluated. Religious and spiritualassessment is included in that domain with aquestion to consider: “What are the patient’s cultural,religious, and spiritual beliefs, and how havethese developed or changed over time?” Religionand spirituality are emphasized because they maygive meaning and purpose to the patient’s life andprovide support. Moreover, cultural factors andexplanatory models of the illness can affect attitudestoward, expectations of, and preferences fortreatments. Therefore, the spirituality/ religiousnessassessment may play a crucial role in developing atherapeutic alliance, negotiating a treatment plan,and enhancing treatment adherence. (15) Theseissues are discussed in more detail below.1.1. Religion/Spirituality as a Componentof Cultural SensitivityIncluding spirituality/religion in the more generalcategory of culture could suggest that it’s ofgeneral interest but not worth spending valuabletime on during the clinical encounter. Culturalpsychiatry makes the opposite argument. Indeed,culture can “1) define and create specific sourcesof stress and distress; 2) shape the form and qualityof the illness experience; 3) influence the symptomatologyof generalized distress and of specificsyndromes; 4) determine the interpretation ofsymptoms and hence their subsequent cognitiveand social impact; 5) provide specific modes ofcoping with distress; 6) guide help- seeking andthe response to treatment; and 7) govern socialresponses to distress and disability.” (16) Religionand spirituality are considered cultural factorsinfluencing the process of diagnosis and treatment.So, S/R assessment is a component of aclinical practice that is sensitive to culture.1.2. Religion and Mental HealthAre Interdependent PhenomenaNumerous studies have emphasized the relationshipsbetween religion and mental health. (17)These reviews have indicated that religion generallyhas a positive effect on mental health, well-being,drug and alcohol use, suicide, and familial issues.Religion may play a central role in the psychologicalrecovery process in mental illness (18) andsubstance abuse. (19) So, the therapeutic approachshould take into account the spiritual resourcesand needs of individuals in the recovery process.However, not all spiritual/religious practicesare healthy. Many patients cope with their illnessthrough spirituality and religiosity, but this maytake place in either positive or negative ways. (14)Therefore, the clinician needs to differentiatebetween religion as a resource and religion as aburden. Sometimes, patients do not benefit fromneeded psychiatric treatment due to religiousbeliefs (see Chapter 18), or spiritual crises may leadto emotional, behavioral, or social disturbances.1.3. Motive for Psychiatric ConsultationIn 1994, the American Psychiatric Associationincluded the category “religious and spiritualproblems” in the Diagnostic and Statistical