Religion and Spirituality in Psychiatry

364 Philippe Huguelet and Harold G. Koenigoccurs are highly publicized. Examples of physicalmanifestations of psychological conflictsrelated to religion include the phenomenon ofstigmata, where a physical wound (or bleeding)appears spontaneously in the same location asthe wounds suffered by Jesus, or the “faint” thatoccurs when someone is “slain in the spirit” at aPentecostal healing service.Religious beliefs – particularly if rigid and inflexible– may worsen pain, but more often, patientsturn to religion in an attempt to cope with pain. Inchronic pain patients, mindfulness meditation (aBuddhist practice) as part of a stress-reduction andrelaxation program (SRRP) has produced a significantreduction in pain, mood disturbance, andother psychological symptoms. Religious involvementmay also help to reduce the complicationsseen in chronic pain patients, including substanceabuse and pain medication addiction.When patients with dementia have a religiousbackground, engaging the patient in rituals orprayers may help to reduce agitation and increasecooperation. Religion can also help patients copewith the stress involved in the development ofdementia, especially during the early stages whenpatients still have insight into what is happeningto them. There is also some surprising evidencethat religious involvement may slow the developmentof cognitive impairment in Alzheimer’sdisease and perhaps even slow the natural progressionof memory loss with aging.What can liaison clinicians do? In a few words:Take a spiritual history; show respect for all religiousor spiritual beliefs and practices that aresupportive for patients; actively support healthyreligious practices; anticipate religious resistanceto psychiatric treatments; use religious beliefs incounseling, as appropriate; and if necessary, seekcollaboration with chaplains, pastoral counsellors,or community clergy.15. COMMUNITY PSYCHIATRYAbout one quarter of people with a psychiatricdiagnosis will have first sought help from clergy.This warrants an understanding of the role thatclergy play in counseling, as well as an attemptto collaborate with clergy when treating religiouspatients.Barriers to psychiatric treatment include socialstigma, self stigma, cost issues, or explanatorymodels outside the medical realm. Cliniciansoften have few relationships with religious professionals,and the reverse is also true. To overcomethis problem, the author encourages the establishmentof forums that invite leaders in the spiritual,psychiatric, and medical communities together toconsider models of referral and collaboration.Sometimes spiritual themes may help toreduce the stigma associated with mental illness(examples of depression in the Bible, forexample). Conversely, some religious perspectivesmight add to stigma by (like some medicalmodels) labeling the illness in a narrow andnegative way (that is, depression resulting fromnot having sufficient faith in God).Religious professionals can help to inform clinicianson various aspects of the patient’s illness:Spiritual leaders might know some commonpractices within their own traditions that help;they may provide information about culture andregional norms influencing individual mentalhealth; or a faith-based counselor may help withtransference issues (for example, when askedabout one’s own spiritual orientation).How is it possible to improve communication/referrals?Both clinicians and spiritual leaders can beassisted by supervision (even if it is foreign to oneor the other).Training programs (for example, continuingeducation) that blend spiritual and psychologicalinsight in training and case discussions are likelyto help professionals on both sides.Building referral networks can help individualizecare. This involves knowing what the otherthinks and knows about each other’s respectivedomains.More generally, professionals should be awarethat healing usually stems from multiple elements,not only those of our field!And finally, it should be remembered thatpastoral counselors are professionals with specifictraining and a code of ethics.