Religion and Spirituality in Psychiatry

Religious and Spiritual Assessment 235highlighted the relationships between religionand mental health. (17) These studies encouragethe search for the specific dimensions of religionthat may have an effect on mental health. Theworking group of the Fetzer Institute has identifiedsome of the specific physiological, behavioral,psychological, and social mechanisms ofspirituality and religiousness and provides a multidimensionalquestionnaire for use in clinicalresearch ( however, this should be distinguishedfrom spiritual assessment tools used in clinicalpractice).At the physiological level, religious practicesprompt a relaxation response that reduces stressreactions. At the behavioral level, spirituality andreligiousness may indirectly protect against diseaseby encouraging healthy lifestyles. In particular,a robust inverse relationship has beenestablished between religiosity and substancemisuse. (28) At the social level, religious and spiritualgroups may provide supportive, integrativecommunities for their members. At the psychologicallevel, spirituality and religiousness providebeliefs about life and death that can directlyhelp patients to cope with illness. (29)Any instrument devoted to S/R assessmentmust be adapted, because no questionnaire canfit every kind of religious belief and practice. (30)In clinical practice, the most appropriate evaluationmethod is the clinical interview, whichallows clinicians to understand their patients’views on the world. Nevertheless, the researchabove has provided categories of spirituality andreligiousness that are useful guidelines for clinicalpractice.Psychiatric assessment is a time-consumingtask. To minimize the time devoted to spiritualassessment, some authors suggest a short listof screening questions. For example, Koenigand Pritchett (31) refer to four systematic questions(FICA) developed by Dale Matthews andChristina Puchalski:Faith: “Is religious faith an important part of yourlife?”Influence: “How has faith influenced your life(past and present)?”Community: “Are you currently a part of a religiousor spiritual community?”(A) Needs: “Are there any spiritual needs that youwould like me to address?”As a mnemonic reminder, Anandarajah proposedthe HOPE questions, which systematicallyaddress four domains, that is, the sourcesof hope, strength, comfort, meaning, peace, love,and connection (H); the role of organized religionfor the patient (O); private spirituality and practices(P); and the effects on medical care (E). (32)These instruments emphasize the dimensions ofspirituality and religiousness that are relevantfor patient care. In clinical practice, S/R assessmentaims to understand this dimension in thepatient’s life. As spirituality and religiousnesstake on so many different individual meaningsand evolve over the course of a lifetime, particularlywith illness, a concrete framework helps theclinician to elicit relevant data.3. HOW TO CONDUCT A SPIRITUALASSESSMENT IN CLINICAL PRACTICEDuring the screening phase of the S/R assessment,we suggest establishing an outline of the patient’sspiritual and religious history. Spirituality andreligiousness are loose concepts, not only for clinicians,but also for patients. Creating a temporalorganization of significant events and significantothers in his/her spiritual/religious life helps thepatient to clarify cultural influences, significantchanges, current involvement and interactionwith the illness. Domains and questions to considercan be found in Table 16.1.3.1. Religious/Spiritual HistoryAt the beginning of an S/R assessment, establishthe patient’s cultural background by askinga few open-ended questions about religiouspractices of the family of origin and significantothers and about religious education. Spiritualityis known to evolve over the course of a lifetime.What is of importance for the clinician isthat these experiences may affect mental health