Religion, Spirituality, and Mental Health

Theoretical and Clinical Perspectives

By Simon Dein, FRCPsych, PhD | January 10, 2010

Dr Dein is senior lecturer of anthropology and medicine at University College London, School of Life and Medical Sciences, Division of Population Health. He reports no conflicts of interest concerning the subject matter of this article.

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.

Clinical implications

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

Pages: 1 2 3

by J D | August 20, 2010 4:41 PM EDT

I'm the baby who has been thrown out with the bath water. An atheist who has been diagnosed with a number of psychiatric diagnoses. Years ago, I found hope and personal strength by educating myself about the advances that are occurring in neuroscience. Unfortunately, this current recovery movement which requires me to become "spiritual"has actually made my life worse.

Today, every mental health professional is required to ask me about my religious beliefs. Psychiatrists and Psychologists are generally open and supportive. But, Social Workers and paraprofessionals (particularly the new Peer Specialists) who work for many of the agencies I've had to request help from often recoil in shock when I answer ATHEIST.

Years ago, I was one of those "consumers" who shouted for the need for "culturally competent" mental health services. But it appears that the system is moving in a direction, which will support every client but me.

by Alistair Bain | April 26, 2010 8:18 PM EDT

Part of the problem here is the generalised nature of the study. I continue to believe that a huge difference exists between religion and spirituality, and that the real issues concern the spiritual maturity of the patient rather than their religious affiliation.

by Bernardo Mora | January 26, 2010 4:57 PM EST

The citation from Watters' book is unsupported opinion at best, and anti-Christian at worst. Such a citation has no place in an objective paper especially on this topic.

Jan 2010 SR

Introduction: Cross-Cultural Psychiatry

Religion, Spirituality, and Mental Health

Cultural Considerations in Child and Adolescent Psychiatry

Cultural and Ethnic Issues in Psychopharmacology

References

1. Charcot JM. Leçon d’ouverture. Progrès Médical. 1882;10:336.
2. Freud S. Future of an illusion. In: Strachey J, trans-ed. Standard Edition of the Complete Psychological Works of Sigmund Freud. Richmond, UK: Hogarth Press; 1927.
3. Crossley D. Religious experience within mental illness: opening the door on research. Br J Psychiatry. 1995;166:284-286.
4. Ellis A. Psychotherapy and atheistic values: a response to A. E. Bergin’s “Psychotherapy and religious values.” J Consult Clin Psychol. 1980;48:635-639.
5. Watters WW. Deadly Doctrine: Health, Illness and Christian God-Talk. Buffalo: Prometheus Books; 1992.
6. Mandel AJ. Toward a Psychobiology of transcendence: God in the brain. In: Davidson RJ, Davidson JM, eds. The Psychobiology of Consciousness. New York: Plenum Press; 1980.
7. Neeleman J, Persaud R. Why do psychiatrists neglect religion. Br J Med Psychol. 1995;68:169-178.
8. Koenig HG, McCullough ME, Larson DB. Handbook of Religion and Health. Oxford: Oxford University Press; 2001:514-554.
9. D’Souza R. Do patients expect psychiatrists to be interested in spiritual issues? Australas Psychiatry. 2002;10:44-47.
10. Tepper L, Rogers SA, Coleman EM, et al. The prevalence of religious coping among persons with persistent mental illness. Psychiatr Serv. 2001;52:660-665.
11. Baetz M, Griffin R, Bowen R, et al. The association between spiritual and religious involvement and depressive symptoms in a Canadian population. J Nerv Ment Dis. 2004;192:818-822.
12. Curlin FA, Odell SV, Lawrence RE, et al. The relationship between psychiatry and religion among U.S. physicians. Psychiatr Serv. 2007;58:1193-1198.
13. Lawrence RM, Head J, Christodoulou G, et al. Clinicians’ attitudes to spirituality in old age psychiatry. Int Psychogeriatr. 2007;19:962-973.
14. Smith T, McCullough M, and Poll J. Religiousness and depression: evidence for a main effect and the moderating influence of stressful life events. Psychol Bull. 2003;129:614-636.
15. Wink P, Dillon M, Larsen B. Religion as moderator of the depression—health connection. Research on Aging. 2005;27:197-220.
16. Koenig HG. Religion and remission of depression in medical inpatients with heart failure/pulmonary disease. J Nerv Ment Dis. 2007;195:389-395.
17. Bosworth HB, Park KS, McQuoid DR, et al. The impact of religious practice and religious coping on geriatric depression. Int J Geriatr Psychiatry. 2003;18:905-914.
18. Levav I, Kohn R, Golding JM, Weissman MM. Vulnerability of Jews to affective disorders. Am J Psychiatry. 1997;154:941-947.
19. Rasic DT, Belik SL, Elias B, et al; Swampy Cree Suicide Prevention Team. Spirituality, religion and suicidal behavior in a nationally representative sample. J Affect Disord. 2009;114:32-40.
20. Petts RJ, Jolliff A. Religion and adolescent depression: the impact of race and gender. Rev Religious Res. 2008;49:395-414.
21. Ano GG, Vasconcelles EB. Religious coping and psychological adjustment to stress: a meta-analysis. J Clin Psychol. 2005;61:461-480.
22. Dew RE, Daniel SS, Goldston DB, et al. A prospective study of religion/spirituality and depressive symptoms among adolescent psychiatric patients. J Affect Disord. 2009 May 16; [Epub ahead of print].
23. Pargament KI Koenig HG, Perez LM. The many methods of religious coping: development and initial validation of the RCOPE. J Clin Psychol. 2000;56:519-543.
24. Baetz M, Bowen R, Jones G, Koru-Sengul T. How spiritual values and worship attendance relate to psychiatric disorders in the Canadian population. Can J Psychiatry. 2006;51:654-661.
25. Fehring RJ, Miller JF, Shaw C. Spiritual well-being, religiosity, hope, depression, and other mood states in elderly people coping with cancer. Oncol Nurs Forum. 1997;24:663-671.
26. Nelson CJ, Rosenfeld B, Breitbart W, Galietta M. Spirituality, religion, and depression in the terminally ill. Psychosomatics. 2002;43:213-220.
27. Shreve-Neiger A, Edelstein BA. Religion and anxiety: a critical review of the literature. Clin Psychol Rev. 2004;24:379-397.
28. Freud S. Obsessive acts, religious practices. In: Strachey J, trans-ed. Reprinted (1953–1974) in the Standard Edition of the Complete Psychological Works of Sigmund Freud. Vol 7. London: Hogarth Press; 1907.
29. Lewis CA. Cleanliness is next to godliness: religiosity and obsessiveness. J Religion Health. 1998;37:49-61.
30. Tek C, Ulug B. Religiosity and religious obsessions in obsessive-compulsive disorder. Psychiatry Res. 2001;104:99-108.
31. Connor KM, Davidson JR, Lee LC. Spirituality, resilience, and anger in survivors of violent trauma: a community survey. J Trauma Stress. 2003;16:487-494.
32. Harris JI, Schoneman SW, Carrera SR. Approaches to religiosity related to anxiety among college students. Men Health Religion Cult. 2002;5:253-265.
33. Abdel-Khalek AM. Death anxiety in Spain and five Arab countries. Psychol Rep. 2003;93:527-528.
34. Mohr S, Huguelet P. The relationship between schizophrenia and religion and its implications for care. Swiss Med Wkly. 2004;134:369-376.
35. Siddle R, Haddock G, Tarrier N, Faragher EB. Religious delusions in patients admitted to hospital with schizophrenia. Soc Psychiatry Psychiatr Epidemiol. 2002;37:130-138.
36. Lindgren KN, Coursey RD. Spirituality and serious mental illness: a two-part study. Psychosoc Rehab J. 1995;18:93-111.
37. Mohr S, Brandt PY, Borras L, et al. Toward an integration of spirituality and religiousness into the psychosocial dimension of schizophrenia. Am J Psychiatry. 2006;163:1952-1959.
38. National Center on Addiction and Substance Abuse at Columbia University. So help me God: substance abuse, religion and spirituality. November 2001. http://www.casacolumbia.org/templates/publications_reports.aspx. Accessed November 20, 2009.
39. Nasim A, Utsey SO, Corona R, Belgrade FZ. Religiosity, refusal efficacy, and substance use among African-American adolescents and young adults. J Ethn Subst Abuse. 2006;5:29-49.
40. Marsiglia FF, Kulis S, Nieri T, Parsai M. God forbid! Substance use among religious and non-religious youth. Am J Orthopsychiatry. 2005;75:585-598.
41. Stone RA, Whitbeck LB, Chen X, et al. Traditional practices, traditional spirituality, and alcohol cessation among American Indians. J Stud Alcohol. 2006;67:236-244.
42. Blass DM. A pragmatic approach to teaching psychiatry residents the assessment and treatment of religious patients. Acad Psychiatry. 2007;31:25-31.
43. Lawrence RM, Duggal A. Spirituality in psychiatric education and training. J R Soc Med. 2001;94:303-305.
44. Anandarajah G, Hight E. Spirituality and medical practice: using the HOPE questions as a practical tool for spiritual assessment. Am Fam Physician. 2001;63:81-89.
45. Fallot R. Spirituality and religion in recovery: some current issues. Psychiatr Rehabil J. 2007;30:261-270.
46. Koenig HG. Religion and mental health: what should psychiatrists do? Psychiatr Bull. 2008;32:201-203.
47. Azhar MZ, Varma SL. Cognitive psychotherapy for inherently religious clients: a two year follow-up. Malaysian J Psychiatry. 1999;7:19-29.
48. Propst LR, et al. Comparative efficacy of religious and nonreligious cognitive-behavioral therapy for the treatment of clinical depression in religious individuals. J Consult Clin Psychol. 1992;60:94-103.
49. Kehoe N. Spirituality groups in serious mental illness. South Med J. 2007;100:647-648.

FROM PHYSICIANS PRACTICE

Five Steps to Improving Patient Access
Judy Capko, May 21, 2013
Patient access is getting increased attention through reform initiatives. Here are five steps you can take to make sure patients get appropriate access to care in your office.

Growing HIPAA Threat – Ignore Windows XP at Your Own Peril
Marion K. Jenkins, May 21, 2013
Chances are good that you have some major ticking software time bombs lurking in your medical practice's computer environment, namely Windows XP and Server 2003.

Finding Physician Work-Life Balance in the Small Moments
Jennifer Frank, MD, May 21, 2013
At my practice and at home, things are always busy. There's laundry or homework, or a patient with needs.

Three Areas to Reduce Costs at Your Medical Practice
Greg Mertz, May 19, 2013
By taking a hard look at reducing costs for staffing, overhead, and technology at your medical practice, you may see increased physician compensation.

Dos and Don’ts for Starting a Physician Blog
Michael Woo-Ming, MD, May 18, 2013
Starting a physician blog can provide your medical practice with marketing benefits, but it's important to do it right.

Religion, Spirituality, and Mental Health

Theoretical and Clinical Perspectives

Join the Conversation