Religion and Spirituality in Psychiatry

362 Philippe Huguelet and Harold G. Koenigwith God, gods, or good spirits pitted againstdemons, whereas manipulation can be understoodas a from of religious coping that involvescompromise with those demons.How can psychiatrists and religious authoritiescooperate when treating such patients? Whatshould the clergy or religious authority (priest,pastor, exorcist, or shaman) be responsible for andwhat should the psychiatrist be responsible for?The efficacy of the intervention largely dependson the extent to which the possessed person andhis or her family accept the underlying explanationfor the particular approach. The psychiatristshould attempt to establish links between the twoworlds of meanings. The challenge is to include(if possible) the patient’s worldview, the spiritualcounselor’s worldview, and the clinician’s worldviewin the discussion. An ethnopsychiatricconsultation can also be helpful. During such asession, a psychiatrist and co-therapists from thepatient’s cultural-religious background meet withthe patient to discuss his symptoms and specificproblems. The goal is to allow both participants,the psychiatrist as well as the patient, to continuethe treatment without each being locked into hisor her own system of reference.12. SELF-IDENTITYThe “self ” represents how individuals think ofthemselves over the long term. The feeling ofidentity, the feeling of “being oneself,” and theindividual’s self-image are the result of an ongoingprocess of construction. This process is ultimatelyculture dependent.Parental figures are the first figures that theperson identifies with. The attachment relationshipis a foundation and a vector for theinternalization of the parental figures. Theseparental figures are stable and formative in asecure attachment; they are much less formativewhen the forms of attachment are insecure andbuilt on anxiety.Later, religious figures can play the role ofattachment figures, because they offer a securerelational bond. God, priests, pastors, or membersof the religious community can be attachmentfigures. Thus, in various religious traditions,exemplary figures contribute to the foundationsof identity. For example, identity can be built bycomplete or partial appropriation of the figuresfound in religious belief systems or, on the contrary,by antagonistic reaction to these figures.Also, religious rites may influence identification.Religion/spirituality can help restore identitywhen facing threatening conditions such asthose experienced by patients with severe mentalsymptoms. However, religious experiencescan also disturb and destabilize. Thus, keepinga critical eye on the role played by the religiousdimension in identity construction is important.In a multicultural context, the medical treatmentshould aim to construct a therapeutic frameworkbased on a conception of the self that is consistentwith the cultural tradition of the patient.13. PERSONALITY DISORDERSA personality disorder (PD) represents a rigidand ongoing pattern of thoughts and behaviorsthat deviate markedly from the expectations ofthe patient’s culture and social group. What is therelationship between personality disorders andreligion?There are many personality traits. Recentresearch has discovered that the majority of thesetraits cluster themselves around five broaderdimensions. This is known as the Five FactorModel of Personality (FFM). Research has shownthat spirituality and religiousness represent qualitiesthat are distinct from the FFM domains.What is the role of spirituality in treatingPDs?Patients with a schizotypal PD can be helpedto foster a connection to the transcendent thathelps them to gain a sense of self and develop abetter sense of personal support. Involvement insupportive religious communities can also helpbreak down the stigmas associated with having apsychiatric label and provide increased personalmeaning.Spiritual techniques can help to promote moreinternally stable emotional states in patients withborderline and narcissistic PD (for example, by