Religion and Spirituality in Psychiatry

234 Sylvia Mohr and Philippe HugueletManual of Mental Disorders, Fourth Edition( DSM-IV ) to describe problems that may leadto psychiatric consultation and that are not tobe avoided or considered as psychopathological.“Examples include distressing experiences thatinvolve a loss or questioning of faith, problemsassociated with conversion to a new faith, or aquestioning of spiritual values that may not necessarilybe related to an organized church or religiousinstitution” (20) (p. 685).Spiritual life has been conceptualized as aprocess with stages of development. Problemsmay arise during transitions from one stage toanother, which are often experiences involving acrisis of faith. (21) A loss or questioning of faithcould be compared to the grief process with itsassociated clinical problems: anger, resentment,emptiness, despair, sadness, and isolation. Forsome individuals, a loss of faith involves questioningtheir whole way of life, purpose for living,and source of meaning. This problem canoccur when an individual is ostracized by hisor her religious community. (8) Struggling withreligious beliefs during an illness diminishes thechances of recovery. (22) Changes in membership,practices, and beliefs often disrupt people’s livesand may be misdiagnosed as mental disorder,especially when conversion to a new faith occurs.New religious movements may be dangerous andgenuinely destructive. But these are not the rule.Membership in cults isn’t necessarily oppressiveand detrimental to mental health. Some cults arehelpful to their adherents. Moreover, belongingto a new religious movement is typically a transientexperience, because 90 percent of adherentsleave within two years. (23)Case ExampleAs an example of religious and spiritualtransformation, a 45-year-old manwithparanoid schizophrenia reported atbaseline that he had greatly suffered whenhis religious community had rejected him.“What happened to me was very hard. Thespirit group cannot put up with the factthat I go on to smoke cannabis. I tried toquit several times, but I failed. I have lost allmy friends. I have lost the meaning of mylife. I do not believe in spiritism any more.”Three years later, he reported that he hadspent a few months at the hospital after asuicide attempt. During his stay, he met thechaplain regularly and he joined a Christiancommunity in his neighborhood. He said,“Now, when I feel very deep sorrow, I readthe Bible and I find consolation in JesusChrist. This is what helps me, what restoresmy hope.”Sometimes, spiritual experiences involve distressand may be misdiagnosed as psychopathological.The most common spiritual problemsinvolving distress are related to mystical experiences,near-death experiences, spiritual awakening,meditation, and medical illness. (8) An S/Rassessment is necessary to make a differentialdiagnosis, which is often not an easy task.1.4. Satisfaction with Psychiatric CarePsychiatric care is not only oriented toward psychopharmacologyand psychosocial treatments,but also toward promoting psychological recoveryfor people with severe mental disorders. Despitepersistent symptoms and disabilities, people maylive fulfilling lives and develop a positive sense ofself founded on hope and self-determination. (24)In a patient-centered approach, examining theindividual’s spiritual and religious history is atherapeutic tool in itself. Indeed, patients whovalue spirituality and religion will appreciatethe doctor’s sensitivity and feel understood andrespected. As a result, the patient’s satisfactionincreases and the quality of therapeutic relationshipis improved. (25) A qualitative study using aphenomenological approach showed that patientswish to have their spiritual needs addressed inmental health care. (26)2. WHAT SHOULD BE ASSESSED?Numerous scales and questionnaires have beendeveloped to assess religion, which is a multidimensionalconstruct. (27) Numerous studies have