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Religion, Spirituality and Psychiatry

Religion, Spirituality and Psychiatry

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.

 


Photo by Jeremy Perkins on Unsplash

Overcoming The Fear of Failure

Overcoming The Fear of Failure

At its most elemental level, people avoid the risk of failure for one simple reason – it hurts. Every single person has experienced failure. If you were to interpret failure by its definition in the dictionary, “the neglect or omission of expected or required action”, wouldn’t you, as a child, have stumbled along the way to achieving those long strident steps you take when strutting along the sidewalk? Yet, nobody feels ashamed of failing to learn to walk as a toddler. Why’s that? You could say that no-one in the right mind would expect that of a human child – we aren’t deer, or gazelles that need to shake off the afterbirth and walk – or risk predation. Our success as a species which put us at the top of the food chain negates that need. Fear is a function of the amygdala, yet failure isn’t. There’s a distinction here that we need to be mindful of. If you’re a parent or have access to YouTube, you’ve probably noticed that there’s an innocence in children that can be quite uplifting to watch, as they try multiple times to succeed at a simple task. They don’t puff their cheeks out and sigh in despair, or bury their heads in their hands. At most, they demonstrate frustration.

Shame is learned behaviour that children integrate into their developing moralities, either from being taught or through observation. Studies done on athletes have shown that perceived parental pressure (or pressure from authority figures) have deleterious effects on how sportspeople experience and interpret failure. Simply put, the fear of failure is a construct of how societies function. For some people, the avoidance of shame that failure brings weighs too heavily on them, and that is the crippling fear of failure. Dr Guy Finch puts this rather more succinctly: “fear of failure is essentially a fear of shame”. How then, do we begin to become more self-aware in the face of these deeply ingrained avoidance mechanisms to start building our best selves?

Evidence-based science suggests that the most efficient way to bring oneself out of the debilitating spiral of negative self-talk – one of the most insidious culprits in perpetuating avoidance based behaviours that stymie growth – is Psychotherapy method, Cognitive Behavioural Therapy (CBT). 

After all, overcoming fear of failure is all about reversing negative thought patterns, and Cognitive Behavioural Therapy (CBT) is designed to help you identify the underlying belief that causes a negative automatic thought (which in turn guides the feelings that come with it).

With the help of a qualified mental health professional, which can be anyone from a trained psychologist, psychotherapist or even psychiatrist, you can be empowered to break the circuit of the pervasive vicious cycle of negativity that prevents the unfettering of fear of failure’s heavy chains.

For instance, think of each deeply held criticism that you can’t let go of as a block in a Jenga game with your friends and the tower represents your thought life as a whole. Even though you’ve suffered through failure after failure, you can’t seem to jettison them from your psyche. Can you imagine a game of Jenga that doesn’t end in peals of laughter? It seems that some re-evaluation is needed to turn the way you handle each soul-sucking gut-punching failure from the darkness of your room. The grip of negativity steadying your trembling hand, an extension of your mind, putting each block up on autopilot because you believe you are not good enough. Instead, we suggest turning the lights on, invite someone you trust into your sanctum of despair, to play the game of Jenga with you. As you ease into their presence, you’ll begin to notice that the tower doesn’t look so intimidating anymore. It’s no longer just a congealed mess of all your shortcomings and toxic thinking, but a simpler thing that can be deconstructed. If each block represents a negative conviction you have about yourself that is too painful to touch, reach for the piece that looks more well-shorn and polished (which represents a perceived positive character trait or accomplishment that you hold dear). Put it back on top of your tower. It is yours, isn’t it? Or perhaps let your confidant handle that splintery block. 

Of course, we all know that Jenga isn’t all laughter and grand gestures. There’s physical tension and the cogitation of making the right choice so the tower doesn’t crumble prematurely. Maybe you aren’t too good at Jenga. That’s fine. But if you start thinking of this special game of Jenga as a collaborative effort instead of a competitive one, you’ll start getting the picture. Who would you like to invite to collaboratively play a game of Jenga?

 

 


  1. Sagar, S and Stoeber, J. Perfectionism, Fear of Failure, and Affective Responses to Success and Failure: The Central Role of Fear of Experiencing Shame and Embarrassment. Journal of Sport and Exercise Psychology, 2009, 31, pp 602-627.
  2. https://www.psychologytoday.com/sg/blog/the-squeaky-wheel/201306/10-signs-you-might-have-fear-failure. Accessed 2/6/2020.
  3. Photo by John Moeses Bauan on Unsplash
Counsellor, Psychotherapist, Psychologist, Psychiatrist. Which is right for you?

Counsellor, Psychotherapist, Psychologist, Psychiatrist. Which is right for you?

If you’ve been pottering around the Promises Healthcare’s ‘Our Team’ page, and are new to the world of mental health in that you’re considering making the leap to seeking help from a mental health professional, it’s our hope that this casual guide to demystifying the titles, designations and dizzying abbreviations that adorn each profile will point you in the right direction.

 

For starters, there’s one thing that each of our mental health professionals have in common. They all possess at minimum a Master’s level certification in their discipline, so you can be assured of all their competencies.

 

Psychiatrists

As we’ve shared in a previous article, a psychiatrist is at their core a medical doctor, which certifies them to prescribe neuropharmacological support – i.e., medication.

But of course, psychiatrists more often than not do indeed possess relevant counselling and psychotherapy certifications, because being well-versed in the craft of patient care in the mental health sector does help them delve deeper into the minds and psyches of their clients, and assist them in skilfully and empathetically overcoming boundaries that some clients may consciously or unconsciously put up that stymie the therapeutic process. 

Prescribing the most effective neuropharmacological support is buttressed by the psychiatrist’s skill in interpersonal communication, both verbal and non-verbal. Psychiatrists often describe themselves as observers, but it goes without saying that navigating these one-on-one interactions requires input from their side of the desk. While you might think that psychiatrists have reached the peak of the career trajectory of a mental health professional, keep in mind that by no means should you think of a psychiatrist as the fount of all mental health knowledge. Think of the ‘helping’ professions encompassed in the form of a large tree, rooted in a common desire to help people in need and supported by a trunk of science and evidence based knowledge , from which grows different branches representing the many ways in which mental health professionals can help someone in need – certain disciplines are applied more rigorously in helping certain conditions or situations. This is why Promises is described on our page as a multidisciplinary team of mental health professionals. Your treatment plan is provided by our team, and under the shade of our tree, you will be prompted to reach for certain branches – but at the end of the day, it is your choice to pick the leaves which seem most lush to you.

Psychologists 

Psychologists differ from psychiatrists in one key authority. They are not medical doctors, and therefore cannot prescribe you medication. You’ll notice that our stable comprises a good number of clinical psychologists – so, what exactly are they, and how can they help you? Clinical psychologists possess doctorate degrees in psychology, and are imbued with the ability to cater to clients who suffer from any number of the discombobulating disarray of mental health conditions which sadly, are still negatively stigmatised in society. Think schizophrenia, bipolar disorder, depression, and their ilk. A clinical psychologist can make a diagnosis for you, if you think you are suffering from a mental health condition. Using the tools in their arsenals which they are trained in, such as psychometric testing, intelligence testing, personality testing, and much more, their diagnoses are firmly rooted in evidence based science. You could then make the logical conclusion that if they deem your condition treatable with medication, they would refer you to a psychiatrist. There’s a lot of symbiosis going on in our clinic!

 

The difference between Counsellors & Psychotherapists 

We’ll deal with counsellors and psychotherapists next, because the two fields are very much intertwined, aligned in some facets, while possessing in granular detail key differences. Counselling and psychotherapy are both broadly concerned with betterment of clients in need, and there is significant overlap in the goals of either mode of therapy. Now, on to the differences, which will help you better distinguish which leaf you’d like to choose. First, there is a temporal difference between the two in both the length of treatment and how far back into your life each mode of therapy delves into in order to solve your current issue.

Counselling, on one hand, tends to favour clients who are more self aware and sensitive to their emotions and thought processes, and need a helping hand in unpacking a recent difficulty or life altering experience that they wish to resolve. This is rather unlike psychotherapy, rooted in a humanistic tradition – some may refer to it as height psychology, a term which gained currency during the time of Abraham Maslow and his espousement of self-actualisation. Psychotherapy, in this sense, takes a long, lingering look at a person’s past, life changing experiences, deep seated traumas and neuroses, or any relevant factors – all to help a client gain mastery of self (self awareness) and challenge them to enact the necessary life changes that lead to self improvement. You might well think of counsellors more as “advisors”, and psychotherapists as the “life guides”. Of course, detract nothing from both disciplines – their practitioners chose their specialities precisely because they fit into their world-views and probably, because they thought that they were good at it!

 

How do you choose?

Of course, given the array of therapeutic modalities and mental health professionals, we understand that choosing the right leaves can be a bewildering experience. That’s why we feel it’s best that you browse the profiles of our therapists, read their biographies and see which of them you feel most comfortable seeing. In the near future, Promises Healthcare intends to refine and streamline your selection process by having a list of issues or conditions that you are having problem(s) with – your input will then guide you to the mental health professional in our team that is best equipped to deal with your issues. For now, take  a deep breath, sit back, read, absorb, think with clarity about what you want to deal with, and pick one to make an appointment with. Choosing the right therapist isn’t a one hit wonder – it takes time and patience, but rest assured that we’ll do our best to help you in that regard. 

 


Featured Photo by Evan Dennis on Unsplash

An interview about Psychosis on Vasantham’s En Ullae S2 with Dr Rajesh Jacob

An interview about Psychosis on Vasantham’s En Ullae S2 with Dr Rajesh Jacob

Vasantham (Mediacorp’s Tamil & Hindi TV Channel) studios reached out to Promises Healthcare’s Senior Consultant Psychiatrist, Dr Rajesh Jacob, in the name of bringing greater mental health awareness to the Indian community in Singapore.

This episode of En Ullae touches on psychosis. This case study was about a man who had developed schizophrenia and became obsessed with the ‘spiritual safety’ of his partner. The building tension served to demonstrate the dangers of ignoring the symptoms of psychosis, which his partner was predisposed to do, in her untoward position as the long-suffering partner in a dangerously unstable relationship. Dr Jacob characterised psychosis as rooted in an unshakeable belief in false delusions – people who suffer from the condition are often willfully blind to reason, which he cautions against trying to impose on them when the time is inclement. 

Prem, the unfortunate man with all the symptoms of hallucinatory schizophrenia, began to cast an evermore imposing spectre in the relationship, causing much distress to Rani. His delusions began to take such a toll on their relationship, with even the good tidings of a baby in the oven twisted into a string of abortion by Rani, afraid that he would bring harm to her and any prospective child she would bequeath upon them – he professed to see the child as a harbinger of doom, as the embodiment of the devil. Midway through the episode, the viewer is treated to the appearance of two ambiguous personalities – a man and a woman, whose blue lanyard faintly conveyed some sense of authority. We are left uncertain as to their actual responsibilities – they are at times quizzical, unwilling to manifest the “good cop, bad cop” trope. No matter, it is not the point of the episode to further entangle the convoluted plotlines – they serve as plot devices which encourage Prem’s own narrative to unfold – to the end, he remains stolidly convinced that his stabbing of Rani had taken her to a better place, the expression on his face almost beatific at times. 

Dr Jacob, at this point, sees fit to caution the viewer against harshly attributing homicidal tendencies to persons with psychosis. He presents the statistic that even less than 15% of homicides are perpetrated by people mentally unsound. Noting the prevalence of drug use and antisocial tendencies that colour this 15%, he confidently steers the viewer away from making too quick a conclusion – it is in everyone’s best interest to step back and evaluate statistics grounded in good science, instead of leaping to the easy conclusion that Prem was beyond rehabilitation.

 

(Click on the link for a version with English subtitles. Remember to click on the ‘Settings’ button to reveal the English subtitle selection. https://www.mewatch.sg/en/series/en-ullae-s2/ep6/952940 )

What to expect during your visit to a Psychiatrist?

What to expect during your visit to a Psychiatrist?

If you’re considering seeking help from a mental health professional / psychiatrist, there’s a pretty good chance that you’ve realised there’s help out there that can assist you with whatever concern you have on your mind. Your mind may be in disarray, but remind yourself that whatever stigma against seeking mental help may exist in your mind, it’s there because of your lived experiences – created by the culture you live within. There’s absolutely nothing wrong with wanting to get better, or better yourself, and to feel constrained by some vague idea of what it means to be “a man” or “a strong woman” is unwarranted.

If you’re fearful of revealing your innermost thoughts and feelings to a stranger (by virtue of it being your first visit), keep in mind that your psychiatrist is first and foremost a doctor, bound by the Hippocratic oath, and second, believes in the value of offering a non-judgmental listening ear through their training and moral code. If that doesn’t comfort you, you should be aware of legal constraints that exist in your favour to protect the information that you share with them. Notwithstanding of course, if there is reason to believe you intend to injuriously harm yourself or another.

Because of the anxiety that may roil your thoughts, it may do you well the night before to sit in silent contemplation and pen down the reasons or thoughts you intend to divulge. Having a concrete list to bring into your psychiatrist’s office will help you ground yourself and serve as a reminder that you’re there for good reason – to get help. Nothing to be ashamed of, nothing to hide, nothing to unconsciously lose behind a preponderance of mistrust or other self-serving attitudes. Your psychiatrist’s office is a safe space.

If you feel that all this is a hard ask, consider bringing along someone whom you trust and knows you well, with your best interests in mind. They can serve as a calming influence that soothes your inner turmoil. Furthermore, they might be able to helpfully point out if there are discrepancies between what you tell your psychiatrist and the truth of the matter.

When you step into your psychiatrist’s office for the first time, you will most likely be greeted with an open-ended question such as “How may I help you today?”, or “What’s been bothering you?”. It’s normal to feel overwhelmed by the variegated ways you can choose to answer their greeting, especially if you have issues with how you are perceived by others. But remember, this is their way of getting to know you, especially since they have nary a clue of why you may have decided to make good on your appointment.

Because of the time constraints on your visit (your psychiatrist’s office is a place of business after all), you can expect them to try their best to elicit responses through a line of inquiry that their best judgment will allow them to evaluate and cohere into an accurate as possible diagnosis of your mental condition, if you are indeed suffering from one. No psychiatrist is a soothsayer or mind-reader, and you should be aware that the help you receive will very much be preponderant both the truthfulness of your responses and the skill of your psychiatrist, who is also trained in reading cues and tells that they feel will help them make a diagnosis.

As your visit comes to a close, based on the personal proclivities of your psychiatrist, you can expect a number of permutations to happen. They may prescribe you medication, if they feel confident in their diagnosis. They may point you towards psychotherapy or counselling (the difference between the two we will delve into in another post), they may prescribe both the former and the latter, or they may hold off on either if they feel that they cannot in good conscience do so.

Of course, it is very much your right to evaluate for yourself if the synergy between your initial choice for a psychiatrist is optimal for you. If you feel comfortable with them, do feel encouraged to continue on course, or if not, seek out another psychiatrist per a trusted friend’s recommendation, or look online for one that seems more promising in terms of a potential therapeutic alliance.

Ultimately, don’t forget that your psychiatrist has your best interests in mind. They are committed to formulate a treatment plan for you that runs parallel to your values and is in line with your goals.

Promises Healthcare is committed to providing mental health services to those in need, and has realigned how we provide these services in light of the current COVID-19 pandemic. Not only do we practice strict social distancing in the clinic, we have a new teleconsultation service up and running. This may be a blessing for those who are not yet comfortable with in person visits. Simply visit our main website and visit our teleconsultations page.

Alternate services of help are also provided by the Ministry of Health & National Council of Social Services in the public health and non-profit sector respectively. The Minister for Health has also written in response to a question regarding the use of Medisave for mental health therapy and counselling treatment: “No Singaporean will be denied access to necessary and appropriate healthcare because of an inability to pay.”