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

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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

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Religion, Spirituality, and Mental Health

Theoretical and Clinical Perspectives

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