Religion and Spirituality in Psychiatry

18 Explanatory Models of Mental Illness and Its TreatmentLAURENCE BORRAS AND PHILIPPE HUGUELETSUMMARYDespite overwhelming evidence that psychopharmacologyis effective in the acute treatmentand maintenance therapy of psychiatric disorders,40 to 60 percent of patients do not taketheir medication and thus are at increased riskfor relapse. Episodes due to nonadherence havenegative consequences for both the patient (bylowering quality of life and treatment outcome)and society (by increasing costs). “How to finda cure?” is a question that these suffering peopleask themselves, especially when medicinedoes not heal, or when one is facing a chronicdisease. Many psychiatric therapies and mutualaid groups have their foundations in differentreligions and still use values, concepts, andtherapeutic methods that have their origins inreligious beliefs and practices. However, thereare many people who resort to alternativetherapies, over-the-counter products, and traditionalapproaches to healing. In this chapter,we will describe the treatment of mental disordersacross history and according to variouscultural settings. Then we will describe howreligion may influence patients’ perceptions ofillness and its treatment. The positive and negativeimpacts of spirituality on the outcome ofillness and adherence to treatment will be discussed.This will lead to considerations as tohow clinicians should address these issues.Many people with chronic mental disorderare in search of healing, living a deep identitycrisis caused by their increasing marginalization.Understanding the individual’s point of view bytaking into account the biological, psychological,and social dimensions is essential, becauseit enables a better understanding of our patientsand their pathologies. When referring to “socialdimension,” we mean culture in its broadest senseas well as the religion and spirituality that usuallycome along with it.“Where to find a cure?” This is the questionthat most suffering people ask themselves,especially when medicine fails to heal or whensome chronic disease takes hold of the individual.Many psychiatric therapies and supportgroups inspired by various religions promotevalues, concepts, and therapeutic methods thathave their origins in religious beliefs and practices.In spite of this, many people continue toprefer alternative therapies. Do patients’ spiritualand religious beliefs influence the understandingthey have of their disorder? To what extentdo religious beliefs about illness influence theirunderstanding of the treatment and the relationshipwith the medical staff? Would it be possibleto improve the patient-doctor relationship bytaking into account the patient’s religious beliefs?And if so, how?In this chapter, we will attempt to describethe different understandings of mental disordersthroughout history and according to various culturalsettings. Then we will describe how theseperspectives may influence patients’ understandingof their disorders and treatments. This willlead to considerations of how clinicians shouldapproach this issue.268