The negative effects of religious involvement
Negative psychological effects of religious involvement include excessive devotion to religious practice that can result in a family breakup. Differences in the level of religiosity between spouses can result in marital disharmony. Religion can promote rigid thinking, overdependence on laws and rules, an emphasis on guilt and sin, and disregard for personal individuality and autonomy. Excessive reliance on ritual and prayer may delay seeking psychiatric help and consequently worsen prognosis. At its most extreme, strict adherence to the ideology of a movement may precipitate suicide.
Religious issues are important in the assessment and treatment of patients, and therefore clinicians need to be open to the effect of religion on their patients’mental health. It is, however, important that clinicians do not overstep boundaries.
How then can clinicians enter into their patients’ spiritual lives? Blass42 and Lawrence and Duggal43 have emphasized the importance of teaching on spirituality in the psychiatric curriculum, with residents learning about the principles of spiritual assessment. There are a number of protocols about how to ask about spirituality, such as the HOPE questionnaire (Sidebar).44
After taking a detailed spiritual history, health professionals need to help patients clarify how their religious beliefs and practices influence the course of illness, rather than giving advice about religion. Whatever his or her religious background, the professional’s moral stance should be neutral, with no attempt to manipulate the patient’s beliefs. Clinicians must be aware of how their own religious beliefs affect the therapy process.45 Direct religious intervention, such as the use of prayer, remains controversial.46
A secular therapist who does not share the religious beliefs of the patient can still be effective as long as he is alert to the need for sensitivity to religious issues and the need to become educated about the religion’s beliefs and practices. At times, patients’ religious views may conflict with medical/psychotherapeutic treatment, and therapists must endeavor to understand the patient’s worldview and, if necessary, consult with clergy. It might be appropriate to involve members of the religious community to provide support and to facilitate rehabilitation.
Religion or spirituality may have therapeutic implications for mental health. Randomized trials indicate that religious interventions among religious patients enhance recovery from anxiety and depression.47,48 Psychoeducational groups that focus on spirituality can lead to greater understanding of problems, feelings, and spiritual aspects of life.49
A focus for future research
In addition to broadening the current research focus on the effects of Christian beliefs on mental health, there are a number of other issues that warrant empirical scrutiny:
• The relationships between anxiety/depression and specific types of religious coping
• The relationships between psychosis and normative religious experiences
• The development of novel religious therapies and assessment of their effectiveness
• The ethics of clinician involvement in religious matters
• How collaboration between clinicians and clergy can be facilitated
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