Religion and Spirituality in Psychiatry

358 Philippe Huguelet and Harold G. Koenigfocus of treatment, because these deficits couldbe overcome with proper treatment.Psychotherapeutic work might also addressother issues such as spiritual crisis, identity building,and meaning.Group therapy approaches that involve spiritualityhave been developed, at least in the UnitedStates. Other programs may exist elsewhere,but they have not been reported in the literature.Some groups are more supportive and lessorganized and/or psychodynamically oriented;others are more structured, based on behavioralcognitiveprinciples. A group format has someadvantages over individual treatment not only interms of costs but also in terms of the opportunitiesfor interaction among patients.For psychotic disorders, perhaps even morethan for other mental conditions, explanatorymodels may vary across culture and religiousbackground. Assessing the patient’s explanatorymodel is thus important to overcome barriers totreatment.7. HALLUCINATIONS AND DELUSIONSHallucinations and delusions are considered ina separate chapter, because these symptoms mayarise in various psychiatric disorders. A delusionis a false belief based on incorrect inferencesabout external reality, a false belief whichis firmly held despite what almost everyone elsebelieves and despite what constitutes incontrovertibleand obvious evidence to the contrary.The discontinuity between pathology and normalityhas been challenged by epidemiologicalstudies finding that delusions are present in thegeneral population. It has been shown that 10 to28 percent of the general population experiencesdelusions, whereas the prevalence of psychosisremains at around 1 percent.Religious delusions have been described in allmajor cultures across the continents. However,prevalence differs according to the country andsociocultural context. The prevalence of religiousdelusions varies widely not only with geography,but also with time. Also, political changeand technological progress impact the content ofdelusions. In the United States, among psychiatricpatients hospitalized in emergency wards,the rate of religious delusions in one study was36 percent for patients with schizophrenia, butthese symptoms were also observed amongpatients with bipolar disorder (33 percent),other psychotic disorder (26 percent), alcoholor drug disorder (17 percent), and depression(14 percent).Religious delusions may also lead to violentbehavior. Aggression and homicides havebeen perpetrated by religiously deluded people,as they have been by nonreligiously deludedpersons.Religious delusions have also been associatedwith poorer outcome in some studies, althoughnot in others. People with religious delusionshave been found in some studies to be moreseverely ill, with more hallucinations for a longerperiod of time. However, the association betweenreligious delusion and a poorer outcome seemsto be controversial. Further research is needed tobetter understand this phenomenon. Is religiousdelusion in itself a marker of the severity of thepathology?Abnormal perceptual experiences (that is,hallucinations) are not restricted to psychiatricpatients either, and may occur in any sensorymodality (for example, auditory, visual, olfactory,gustatory, and tactile). In the United Kingdom,the annual prevalence of auditory or visual hallucinationsis 4 percent in the general population,with only one out of eight people with hallucinationsmeeting criteria for a psychiatric diagnosis.The basic mechanism of hallucinations lies inthe inability to differentiate an internal from anexternal stimulus. Delusions and hallucinationsoften go together. This association may be partlydue to the fact that some delusions come about inorder to give meaning to hallucinations.For clinicians, it is important to be able todifferentiate religious delusions from “normal”faith. How can we distinguish a religious belieffrom a religious delusion?The more implausible, unfounded, stronglyheld, not shared by others, distressing, and preoccupyinga belief is, the more likely it is to be