Religion, Spirituality and Psychiatry - Promises Healthcare
ENQUIRY

Written by: Dr Rajesh Jacob, Senior Consultant Psychiatrist, Promises Healthcare

 

The basic characteristics of all religions are similar. There is a firm belief in a higher unseen power who is the supreme master.

 

Religion and Spirituality, Is There A Difference?

Religion Is an organized system of beliefs, practices, rituals, and symbols designed to facilitate closeness to the sacred or transcendent (God, higher power, or ultimate truth/reality).

Spirituality is the personal quest for understanding answers to the ultimate questions about life, about meaning, and about the relationship with the sacred or transcendent, which may (or may not) lead to or arise from the development of religious rituals and the formation of a community. Spirituality is thus a more inclusive concept than religion.

 

Mental Illness In The Middle Ages

The idea that religion and psychiatry have always been in conflict is still very prevalent. Today, most people believe that in the medieval ages, most mental disorders were considered as witchcraft or demonic possession. People with mental disorders were recognized as different and treated in various ways. Early medicine men, considering such individuals to be possessed by demons, introduced a technique called trephination, which Involved drilling a hole in the head of the individual to let evil spirits out of the body. Many other civilizations independently developed such a procedure. For example, among the remains of the Incas in Peru are skulls with holes and trephination devices. The treatment of mental illness deteriorated in the late Middle Ages and remained poor through the eighteenth century. As the medieval years progressed, insanity became linked to witchcraft and demon possession. Those considered to be possessed with demons were exorcised. This ritual, performed by a priest, would call upon the demon to come out of the individual and to transfer itself into an animal or inanimate object. Both the Greeks and Romans thought that the mentally ill were capable of causing major social problems, as well as harm to themselves. They made provisions for guardians to take care of the insane. Realizing that these people could hurt themselves or others and could destroy life and property, laws were passed that set specific guidelines. Since there were no lunatic asylums, people with mental illness were a family responsibility. The seriously impaired were restrained at home, but others were permitted to wander in the hope that evil spirits might fly out of them.

Certain saints were thought to be more active in the domain of madness. In northern France, the shrines of Saint Mathurin at Larchant and Saint Acairus at Haspres were known for healing. In Flanders, now Belgium, citizens of Geel developed a shrine to Saint Dymphna that became a hospice to house the mentally ill. During the early years of the Middle Ages, the community took care of the mentally ill. Later, hospices, then asylums were developed to house them. London’s Bethlem asylum—better known as Bedlam—was founded in 1247, making it one of the oldest institutions of its kind. The term “bedlam” became associated with chaos, confusion, and poor treatment, which reflected the general attitude toward mental illness at the time. It was only in the nineteenth century that scientists and society began to reconsider deviant behaviour from the perspective of mental illness rather than as a manifestation of evil spirits.

 

Religion And Psychiatry

Persons with mental disorders can sometimes present with symptoms such as hyper-religiosity (manic episodes as part of bipolar disorder) or delusional beliefs such as possessing godly or religious powers. Rates of religious delusions in schizophrenia remain high. These symptoms and signs need to be carefully assessed by mental health professionals. Certain groups in Christianity such as Pentecostal Christians “speak in tongues”, which is not a symptom of mental illness, but an expression of their religious beliefs. “Speaking in tongues” is mentioned in the Bible. 

In the last two decades, rigorous scientific research has been done and published in mainstream medical and psychological journals. David B. Larson, Jeffrey S. Levin and Harold G. Koenig were some of the authors. They have conducted a series of studies looking at the relationship between religious involvement and mental health in mature adults, either living in the community or hospitalized with medical illness. Since then, many other researchers have produced a large body of research that has usually, but not always, shown a positive association between religious involvement and mental health.

According to the Harvard psychologist, Gordon Allport, a person’s religious orientation may be intrinsic and/or extrinsic.

  • Extrinsic Orientation
    Persons with this orientation are disposed to use religion for their own ends. Many find religion useful in a variety of ways – to provide security and solace, sociability and distraction, status and self-justification. 

 

  • Intrinsic Orientation
    Persons with this orientation find their master motive in religion.

    • Other needs, strong as they may be, are regarded as of less ultimate significance, and they are, so far as possible, brought in harmony with the religious beliefs. Having embraced a creed, the individual endeavours to internalize it and follow it fully. Usually, the intrinsic orientation is associated with healthier personality and mental status, while the extrinsic orientation is associated with the opposite. Extrinsic religiosity is associated with dogmatism, prejudice, fear of death, and anxiety, it “does a good job of measuring the sort of religion that gives religion a bad name.
    • Physical health:  Religiousness was related to decreased smoking and alcohol consumption. Religious commitment and participation seemed to affect longevity, as well, especially in men.
    • Suicide rates were consistently found to have a negative correlation with religiosity. In Hinduism, if you take your life prematurely, you have to suffer in the next birth. Most research findings support that religious affiliation, especially participation, lowers the rate of alcohol consumption. Being religious results in more hope and optimism and life satisfaction.

 

Belief Systems, Cognitive Framework

Beliefs and cognitive processes influence how people deal with stress, suffering and life issues.

Religious beliefs can provide support through the following ways: Enhancing acceptance, endurance, and resilience. They generate peace, self-confidence, purpose, forgiveness to the individual’s own failures, and positive self-image. On the other hand, they can sometimes bring guilt, doubts, anxiety and depression through an enhanced self-criticism. ‘Locus of control’ is an expression that arises from the social learning theory and tries to understand why people react in different ways even when facing the same problem. An internal ‘locus of control’ is usually associated with well-being and an external one with depression and anxiety. A religious belief can favour an internal ‘locus of control’ with an impact on mental health.

 

Religious practices

Public and private religious practices can help to maintain mental health and prevent mental diseases. They help to cope with anxiety, fears, frustration, anger, anomie, inferiority feelings, despondency and isolation. The most commonly studied religious practice is meditation. 

It has been reported that it can produce changes in personality, reduce tension and anxiety, diminish self-blame, stabilize emotional ups and downs, and improve self-knowledge. Improvement in panic attacks, generalized anxiety disorder, depression, insomnia, drug use, stress, chronic pain and other health problems have been reported. Follow-up studies have documented the effectiveness of these techniques.

 

Role of the Psychiatrist

During assessment, the psychiatrist should be able to determine whether the religion in the life of his patient is important, has a special meaning and is active or inactive. Four basic areas should be remembered when taking a spiritual history.

  1. Does the patient use religion or spirituality to help cope with illness or is it a source of stress, and how?
  2. Is the patient a member of a supportive spiritual community?
  3. Does the patient have any troubling spiritual question or concerns?
  4. Does the patient have any spiritual beliefs that might influence medical care?

The clinician who truly wishes to consider the bio-psycho-social aspects of a patient needs to assess, understand, and respect his/her religious beliefs, like any other psychosocial dimension.

 


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