Religion and Spirituality in Psychiatry

248 René Heftiintrinsic spirituality or faith based on internalizedbeliefs. (36) Spirituality correlates with lower levelsof general anxiety ( 31 , 36 , 37) and with positiveoutcomes in coping with anxiety. (38) Higher levelsof spirituality among individuals recovering fromsubstance abuse are related to resiliency to stressand optimism,( 39) and spiritual coping methodsare found to have positive effects for persons diagnosedwith schizophrenia. (40) Participation inspiritual and religious activities helps to integrateindividuals into their families. (41)Religion and spirituality also deliver socialand community resources ( 10 , 33 ) beingenhanced by the “transcendent nature” of thesupport. Belonging to and finding acceptance ina religious community may have special importancefor people who are often rejected, isolated,or stigmatized. (42) Spiritual experiences facilitatethe development of a fundamental sense ofconnectedness. Religion and spirituality foster asense of hope and purpose, a reason for being,as well as opportunities for growth and positivechange.( 5 , 33 , 43) These are ways in whichthe patients have expressed the experience ofenhanced personhood or empowerment.2.3. Religion and Spirituality as a BurdenIt is important to be aware of the “negative” (or atleast challenging) effects that religion and spiritualitycan have on mental health outcomes andrecovery.Negative religious coping involves beliefs andactivities such as expressing anger at God, questioningGod’s power, attributing negative eventsto God’s punishment, and discontent with religiouscommunities and their leadership. Negativereligious coping in community samples has beenlinked to greater affective distress, includinggreater anxiety and depression and lower selfesteem(44) and more PTSD symptoms. (45)Religious struggles involving interpersonalstrain rather than social support, conflictswith God rather than perceived collaborationand support, struggles with belief rather thanclear meaning and coherence, and difficultiesrelated to imperfect striving after virtue havebeen linked to higher levels of depression andsuicidality. (46) Negative experiences with religiousgroups can aggravate feelings of rejectionand marginalization. (47)Religious convictions can intensify excessesof self-blame and perceptions of unredeemablesinfulness. If they are woven into obsessive ordepressive symptom patterns, they can be evenmore distressing. Furthermore, they can be reinforcedby religious communities that see mentaldisorders as signs of moral or spiritual weaknessor failure. Prayer or other religious rituals canbecome compulsive and interfere with overall dailyfunctioning. (11) Finally, beliefs involving themes ofdivine abandonment or condemnation, unrelentingrejection, or powerful retribution may makerecovery seem unattainable or unimportant. (48)2.4. An Interdisciplinary ApproachApplying a holistic or whole person approach tomental illness demands an interdisciplinary concept.Different competencies have to be representedin the therapeutic team ( inpatient setting,Figure 17.3 ). (28) The pastoral/spiritual counselorshould be a full member of the interdisciplinaryteam with rights and responsibilities equal tothe other therapists. This guarantees working oncommon therapeutic goals and prevents playingoff pastoral counseling against the other disciplines,what we consider an important aspect inthe psychiatric and psychotherapeutic context.3. RELIGIOUS AND SPIRITUAL COPINGIN MENTAL DISEASE3.1. The Key Role of Religious Copingfor PatientsSeveral surveys showed a high prevalence ofreligious coping among patients with severeand persistent mental illness. Tepper et al. (11)investigated 406 patients at one of thirteen LosAngeles County mental health facilities. Morethan 80 percent of the participants used religious