Religion and Spirituality in Psychiatry

240 Sylvia Mohr and Philippe HugueletGod (collaborative style). These styles are notpositive or negative per se, but depend on thescope of the individual’s power to influence thecourse of the illness in the context of a specificsituation.3.9.4. ComfortTh is item examines the emotional influenceof spiritual beliefs. Inquiring about this aspectis especially necessary when the patient hasrecounted only the cognitive dimension of hisor her spiritual beliefs. The strength and comfortprovided by spiritual beliefs are associatedwith lower levels of depression. (29) Often, spiritualbeliefs bring hope and comfort; however,they may be a source of suffering too. The illnessmay call attention to the fact that spiritualstruggles are a necessary stage of any spiritualjourney.3.10. Synergy of Religion withPsychiatric CareTh e literature examining the pathways to psychiatriccare points out that spiritual and religiousbeliefs about mental illness may influencehelp-seeking behavior and adherence to psychiatrictreatment. (37) Different kinds of relationshipsexist between spirituality/religiousnessand psychiatric care. For some patients, the twoareas have nothing in common; psychiatry andreligion are two separate areas in their lives.However, when religion is central in people’slives, it encompasses almost all areas, includingpsychiatric care. This spiritual meaning may fosteror hinder adherence to psychiatric treatment.Some patients believe that God gives knowledgeto the clinician to care for them; thus, they trustin psychiatric care. Other patients first put theirtrust in religious professionals who advocatedpsychiatric care, thus allowing the patients totrust psychiatry. But other patients experienceconflicts between their spiritual beliefs and psychiatriccare. These conflicts may lead to noncomplianceand distress, so this issue must beaddressed.4. S/R ASSESSMENT: OTHER ELEMENTSThe semistructured interview guide providedhere (see Table 16.1) outlines a first spiritual/religiouscase formulation in a single assessment lastingabout half an hour. Based on a global clinicalimpression, the first element to examine is thecentrality of spirituality/religion. If it is low, theS/R assessment is of no importance for currentclinical care. However, because spirituality andreligiousness tend to change over time, especiallyin association with mental illness, drastic changesmay occur over the course of a lifetime. We recommendregular checks of this dimension, likeother areas assessed in long-term follow-up casemanagement.Th e second element to examine is thepatient’s relationships with his or her religiouscommunity. Does the patient currently belongto a religious community? Is he or she supportedby this community or does he or she feelrejected or in conflict? Does the patient ask forsupport from the religious community for hisor her mental illness or does he or she feel tooashamed or guilty? Do his or her symptoms hinderhim or her from participating in religiousactivities? Do religious professionals from thereligious community collaborate with the psychiatriccare network or are they in conflict?Could they be integrated into psychiatric care?To summarize, is the religious community anasset or a burden?Patients’ relationships with their religiouscommunities deserve special attention becausethey provide a natural social network that maybe a powerful resource for social integration andpsychological recovery. Like family, the clergymay need psycho-education and support fromclinicians to deal with people suffering fromsevere mental illness. (37)The third element to examine is the positive ornegative role of spirituality and religiousness forthe patient. Is spirituality/religiousness a sourceof hope, comfort, meaning in life, and joy or asource of suffering? Is the individual upheld inhis or her identity by spirituality/religiousness orundermined?