Religion and Spirituality in Psychiatry

242 Sylvia Mohr and Philippe Hugueletreport distressing spiritual struggles and conflictssimilar to those that anyone may endure in timesof hardship. In these cases, the S/R assessmenthelps the clinician to identify which religious professionalscan best provide spiritual counseling tothe patient. Spirituality and religiousness may benegative for the self when they intermingle withpsychopathology. Indeed, current spirituality andreligiousness may be by-products of the patient’sdisorder. This aspect is discussed in several chaptersof this book. In manic states, patients sometimespresent delusions of grandeur with religiouscontent; for example, they believe they are Christor Buddha. In persecutory delusions, the agentsof persecution may be spiritual entities, especiallydemons (see Chapter 7). People with depressionmay lose all interest and motivation, includingspiritual and religious involvement. In anxietydisorders, people may be excessively tormentedby worry about sins and hell. In obsessive-compulsivedisorder, religious rituals may becomepathological, with an intense focus on avoidingsin or error (see Chapter 10). In personality disorders,spirituality and religiousness may be usedin unhealthy ways to cheat others, serve personalneeds, or dismiss the individual from personalresponsibility (see Chapter 13). However, it isimportant to keep in mind that even if a patient’sspiritual life may be distorted by the mental illnessat times, this doesn’t mean that the spiritual lifeof those patients is only – and always – psychopathological.Spiritual and religious assessmentcan provide some indication of how to orienttreatment in those cases. In addition to the usualclinical care, the clinician can decide whether toaddress spirituality or not, in collaboration withclergy if needed.5. SYNTHESISS/R assessment is an important part of thepsychiatric evaluation. It should be performedat the beginning of treatment and at regularintervals in cases of mid- or long-term care. Theprincipal elements of this assessment have beendescribed in this chapter. Other elements specificto different diagnoses or clinical situations aredescribed in other chapters of this book. Whatall these situations have in common is that (1)psychiatrists are confronted with patients’ cultural/religiousbackgrounds even more thanother clinicians, so this dimension must be takeninto account; (2) particularly when involved inpsychotherapy, the question of meaning shouldbe addressed, including its religious/spiritualdimension; (3) the phenomenology of psychiatricsymptoms may be characterized by religiouselements; (4) when treating patients withpersistent mental disorders, recovery-orientedcare should involve a religious dimension whenneeded; and (5) all spiritual orientations must berespected when addressing spirituality/religionwith patients, including a professed absence ofbelief.REFERENCES1. Huguelet P , Mohr S , B or r as L , Gi l l ieron C , Br andtPY . Spirituality and religious practices amongoutpatients with schizophrenia and their clinicians. Psychiatr Serv . 2006; 57 (3): 366 –372.2. Borras LMS , Brandt P-Y , Gillieron C , Czellar J ,Huguelet P . Religious coping among patients withschizophrenia in Quebec vs. Geneva, Switzerland.Submitted. 2009.3. B aet z M , Gr i ffi n R , B owen R , Marc ou x G .Spirituality and psychiatry in Canada: psychiatricpractice compared with patient expectations . CanJ Psychiatry . 2004; 49 (4): 265 –271.4. Curlin FA , Lawrence RE , Odell S , et al. Religion,spirituality, and medicine: psychiatrists’ and otherphysicians’ differing observations, interpretations,and clinical approaches . Am J Psychiatry .2007 ; 164 (12): 1825 –1831.5. Curlin FA , Lantos JD , Roach CJ , SellergrenSA , Chin MH . Religious characteristics of U.S.physicians: a national survey . J Gen Intern Med .2005; 20 (7): 629 –634.6. Ne eleman J , Ki ng M B . Psychi at r ist s’ rel i g iousattitudes in relation to their clinical practice: asurvey of 231 psychiatrists . Acta Psychiatr Scand .1993 ; 88 (6): 420 –424.7. Shaf ranske EP . Religion and the Clinical Practiceof Psychology . Washington, DC : AmericanPsychological Association ; 1996 .8. Lu koff D , Lu FG , Turner R . Cultural considerationsin the assessment and treatment of religiousand spiritual problems . Psychiatr Clin North Am .1995; 18 (3): 467 –485.9. Crossle y D . R el i g ious ex p er ienc e w it hi n ment a lillness. Opening the door on research . Br JPsychiatry . 1995; 166 (3): 284 –286.