Religion and Spirituality in Psychiatry

250 René Hefticharacteristics. A majority of the patients reportedthat religion was an important aspect of their lives,but only 36 percent of them had raised this issuewith their clinicians. Fewer clinicians were religiouslyinvolved, and, in half the cases, their perceptionsof patients’ religious involvement wereinaccurate. Some patients considered treatment tobe incompatible with their religious practice, butclinicians were seldom aware of such conflicts.These findings about religious coping reflect theexperiences we are having at the SGM-Clinic forpsychosomatics, psychiatry, and psychotherapyin Langenthal, Switzerland ( inpatient and outpatientdepartment). For a majority of our patients,religious or spiritual coping is an essential partof their coping behavior. Religion providespatients with a framework to cope with diseaserelatedstruggles. Existential needs such as beingsecure, being valued, and having meaning andpurpose are addressed by clinicians and pastoralcounselors, despite and beyond psychiatricconditions. (51) To illustrate this, I quote somepassages from open, unstructured interviews thatwere performed with depressed patients as part ofa qualitative study conducted in our clinic. (52)32 year old male patient: The patient ismarried and has a 1-year-old son. He hasbeen working in the same company formany years and is a member of a Protestantchurch. He was hospitalized because of asevere depressive episode. How did heuse religious coping to overcome hisdepression?■■By reading scriptures/psalms: “Readingpsalms helped me a lot to feel closer toGod in difficult times. I realized thatothers (the writers of the psalms) hadto cry also and felt desperate in theirsituation. They argued with God andpleaded to him.”By getting spiritual support: “In the verydark moments, when I felt totally lost andabandoned by God, I couldn’t cope withmy situation any more. I couldn’t fightnegative thoughts about the future andmyself. I needed somebody from outsideto tell me that these are lies, that I am notabandoned either by God or by my family,that I am not worthless but loved.”65 year old female patient: The patient grewup in a small village in the countryside. Shehad five brothers and sisters. Her fatherwas an alcoholic. The patient left home atan early age. Her first marriage collapsedbecause of her husband’s alcoholism.They had two children. After the divorce,the patient experienced her first depression.Later she married again and becamea member of a Methodist church (after areligious conversion). Depressive episodesbecame less frequent and less severe. Whatdid the patient do to help her cope withdepression?■■Controlling depression by faith/prayer:“When I feel sad and my thoughtsbecome gloomy, when I wake up earlyin the morning and can’t sleep anymorethen I go outside into nature and speakwith God, thanking him for being incontrol and for not letting me go down.”Not asking why: “In past times I alwaysbegan to ask why, why did I marry thisman, why did God let this happen?But this made things worse. I began toturn in circles. Today I stop this kind ofthinking and focus on God.”Our task as a physician, psychotherapist,or mental health worker is to support the copingcapacities of patients by understanding andempowering them.3.2. The Key Role of Religious Copingfor Family CaregiversResearch that has examined the outcomes of religiouscoping has generally found that religiosityamong caregivers is linked to enhanced adjustment.For example, in a longitudinal study ofsixty-two caregivers of persons with Alzheimer’s