Are we doing harm by omission? Addressing religiosity of the mentally ill

Abstract

In ancient days, the main hindrance in treating the mentally ill was prejudice related to the therapist's own religious views. Religious leaders used exorcisms to treat mental disorders, often through cruel, harsh, and barbarous methods. They believed demon possession was the main cause of mental illness. In modern days, we are experiencing a problem on the other side of the spectrum. In order not to impose religious beliefs on the patient, therapists are not addressing the issue of religiosity at all in the management of mental disorders. This is harmful as well, since there is often a spiritual component involved. We, as spiritually concerned medical workers, should attempt to reach a balance. The role of religion may be perceived differently by psychiatrists and their patients (1). Psychiatrists are often less religious than their patients and may not appreciate the value of religion in helping patients cope with their illness. Furthermore, psychiatrists may experience religion through the pathological expressions of individuals with religious delusions, which may bias them against religion as a therapeutic resource. Third, psychiatrists may focus on the biologic components of mental illness and may view the religious component as subjective and not supported by empirical evidence. Finally, psychiatrists may believe that religion always causes dependence and guilt (2). The possible negative effects of religion on mental health, or our personal past experiences with religion, should not prevent us from acknowledging a spiritual component in mental illness and at least offering resources for, if not personally suggesting, spiritual help. This includes collecting a spiritual history, supporting healthy religious beliefs, challenging unhealthy beliefs, praying with patients (in highly selected cases), and consultation with, referral to, or joint therapy with trained clergy (3). Globally, we can see a vast difference between therapies in the East and the West, due to different overriding spiritual beliefs. In the West, monotheism and the heavy influence of individualism have produced much resistance to acknowledging spirituality in mental illness. In the East, perspectives are very different, due to wide acceptance of polytheism and firmly held beliefs that the causes of distress and disorders may in fact be spiritual in nature. This, of course, produces less resistance. Pargament and Lomax rightly emphasize the need for further studies beyond the Western perspective. In some Eastern countries, spirituality and religion are part of daily life, and religiousness cannot be ignored in the therapy setting. As almost every physical ailment is associated with some religious beliefs, or lack thereof, treating a patient without addressing religiosity would be considered incomplete treatment. In conclusion, when attempting to understand religion, and its influence, in the mentally ill, we need to ask some questions. Are we doing justice to our clients if we are not addressing the religious influence in their clinical presentation? Can we train ourselves to seriously confront our “take it easy” attitude toward spiritual influence in the mentally ill? Psychiatry and religion are the unfortunate enemies of yesterday and forgotten friends of today. How can we, in the mental health field, find a way to bridge the gap and acknowledge that they actually work in parallel with one another?