Skip to main content
×
×
Home

Against the Stream: religion and mental health – the case for the inclusion of religion and spirituality into psychiatric care

  • Simon Dein (a1)
Abstract

This paper argues for the inclusion of religion and spirituality in psychiatric care. After discussing the antagonism of psychiatrists and psychologists to religion, I present a critical overview of studies examining the relationships between spirituality, religion and diverse aspects of mental health: depression, suicide, anxiety, delinquency, drug abuse and schizophrenia. The need to assesses the impact of religion in different faith groups is discussed. Measures of religious coping, both positive and negative, may provide a more accurate portrayal as to how individuals deploy religion in their lives than global measures such as belief and attendance. I highlight the fact that there is a dearth of research on ritual, prayer and other aspects of religious experience. While many studies demonstrate positive effects of religion on mental health, others find detrimental effects. Finally I examine the clinical implications of these findings.

Declaration of interest

None.

  • View HTML
    • Send article to Kindle

      To send this article to your Kindle, first ensure no-reply@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle. Find out more about sending to your Kindle.

      Note you can select to send to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

      Find out more about the Kindle Personal Document Service.

      Against the Stream: religion and mental health – the case for the inclusion of religion and spirituality into psychiatric care
      Available formats
      ×
      Send article to Dropbox

      To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Dropbox.

      Against the Stream: religion and mental health – the case for the inclusion of religion and spirituality into psychiatric care
      Available formats
      ×
      Send article to Google Drive

      To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Google Drive.

      Against the Stream: religion and mental health – the case for the inclusion of religion and spirituality into psychiatric care
      Available formats
      ×
Copyright
This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.
Corresponding author
Correspondence to Simon Dein (s.dein@qmul.ac.uk)
References
Hide All
1Crosby, J, Bossley, N. The religiosity gap: preferences for seeking help from religious advisors. Ment Health Relig Cult 2012; 15(2): 141–59.
2Rosmarin, D, Pirutinsky, S, Pargament, K. A brief measure of core religious beliefs for use in psychiatric settings. Int J Psychiat Med 2011; 41(3): 253–61.
3Koenig, H, King, D, Carson, V. Handbook of Religion and Health (2nd edn). Oxford University Press, 2012.
4Koenig, HG. Research on religion, spirituality, and mental health: a review. Can J Psychiatry 2009; 54: 283–91.
5Koenig, HG. Religion, spirituality, and health: the research and clinical implications. ISRN Psychiatry 2012; 2012: 278730.
6Van Praag, HM. The role of religion in suicide prevention. In Oxford Textbook of Suicidology and Suicide Prevention (eds Wasserman, D, Wasserman, C): 712. Oxford University Press, 2009.
7Cook, CCH, Goddard, D, Westall, R. Knowledge and experience of drug use amongst church affiliated young people. Drug Alcohol Depend 1997; 46: 917.
8Johnson, B, Li, S, Larson, D, McCullough, M. A systematic review of the religiosity and delinquency literature: a research note. J Contemp Crim Justice 2000; 16: 3252.
9Shreve-Neiger, AK, Edelstein, BA. Religion and anxiety: a critical review of the literature. Clin Psychol Rev 2004; 24: 379–97.
10Mohr, S, Perroud, N, Gillieron, C, Brandt, PY, Rieben, I, Borras, L, et al. Spirituality and religiousness as predictive factors of outcome in schizophrenia and schizo-affective disorders. Psychiatry Res 2011; 186: 177–82.
11Abu-Rayya, HM, Abu-Rayya, MH, Khalil, M. The Multi-Religion Identity Measure: a new scale for use with diverse religions. J Muslim Ment Health 2009; 4: 124–38.
12Rosmarin, DH, Pirutinsky, S, Pargament, KI, Krumrei, EJ. Are religious beliefs relevant to mental health among Jews? Psychol Relig Spirituality 2009; 1: 180–90.
13Tarakeshwar, N, Pargament, KI, Mahoney, A. Measures of Hindu pathways: development and preliminary evidence of reliability and validity. Cult Divers Ethnic Minor Psychol 2003; 9: 316–32.
14Pargament, KI, Koenig, HG, Perez, LM. The many methods of religious coping: development and initial validation of the RCOPE. J Clin Psychol 2000; 256: 519–43.
15Pargament, KI. Religion and coping: the current state of knowledge. In Oxford Handbook of Stress and Coping (ed Folkman), S: 269–88. Oxford University Press, 2010.
16Dein, S, Swinton, J, Abbas, AQ. Theodicy in palliative care. J Soc Work Palliat Care 2013; 9(2–3): 191208.
17James, W. (1902/1958) The Varieties of Religious Experience. Mentor.
18Jackson, M, Fulford, KWM. Spiritual experience and psychopathology. Philos Psychiatr Psychol 1997; 4(1): 4165.
19Dein, S, Littlewood, R. The voice of God. Anthropol Med 2007; 14: 213–28.
20Dein, S, Cook, CC. God put a thought into my mind: the charismatic Christian experience of receiving communications from God. Ment Health Relig Cult 2015; 18: 97113.
21Dein, S, Littlewood, R. Apocalyptic suicide: from a pathological to an eschatological interpretation. Int J Soc Psychiatry 2005; 51(3): 198210.
22Bhui, K, Everitt, B, Jones, E. Might depression, psychosocial adversity, and limited social assets explain vulnerability to and resistance against violent radicalisation? PLoS ONE 2014; 9(9): e105918.
23Sloan, RP. Blind Faith: The Unholy Alliance of Religion and Medicine: 295. St Martin's Press, 2006.
24Hwang, K, Hammer, JH, Cragan, RT. Extending religion-health research to secular minorities: issues and concerns. J Relig Health 2009; 50: 608–22.
25Dein, S, Cook, CCH, Koenig, H. Religion, spirituality, and mental health: current controversies and future directions. J Nerv Ment Dis 2012; 200(10): 852–5.
26Smith, TB, Bartz, J., Richards, P. Outcomes of religious and spiritual adaptations to psychotherapy: a meta-analytic review. Scott Psychother Res 2007; 17(6): 643–55.
27Pargament, K. Spiritually Integrated Psychotherapy: Understanding and Addressing the Sacred. Guilford Press, 2007.
28This Paper Originated from a Lecture at the Spirituality and Psychiatry SIG. Royal College of Psychiatrists, 2013 (https://www.rcpsych.ac.uk/pdf/Simon%20Dein%20Religion%20and%20Mental%20Health.%20Current%20Findings.pdf).
29Cook CCH. Recommendations for Psychiatrists on Spirituality and Religion. Royal College of Psychiatrists, 2013.
30Moreira-Almeida, A, Sharma, A, Van Rensburg, BJ, Verhagen, PJ, Cook, CCH. World Psychiatric Association (WPA). Position Statement on Spirituality and Religion in Psychiatry. World Psychiatry 2016; 15: 8788.
Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

BJPsych Bulletin
  • ISSN: 2056-4694
  • EISSN: 2056-4708
  • URL: /core/journals/bjpsych-bulletin
Please enter your name
Please enter a valid email address
Who would you like to send this to? *
×

Metrics

Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed

Against the Stream: religion and mental health – the case for the inclusion of religion and spirituality into psychiatric care

  • Simon Dein (a1)
Submit a response

eLetters

We cannot prescribe religion

Rafael Euba, Consultant Psychiatrist, Oxleas NHS Foundation Trust
19 June 2018

The title and clinical implications in Dein's article emphasise the need to think of religion and spirituality in our work, including the possibility of delivering religion-based CBT, which the author argues will be more effective with believers than the standard modality. However, the body of the article does not really lead to that conclusion. Instead, this piece tries to demonstrate that religion has a protective effect against mental illness, which is a different matter, in my view.

Some clinicians may have misgivings about religion after witnessing patients suffer with cruel psychotic religious delusions, or being tortured by conflict between their religious beliefs and sexual orientation, just to mention some examples. Many of us will also be wary of any research on the benefits of religion coming from the other side of the Atlantic, a point the author acknowledges in the article. Even if we were convinced by this research and accepted the prophylactic properties of religion, it is obvious that we, as psychiatrists, cannot, and should not, prescribe, promote or recommend the acquisition of religious beliefs.

As for religion-based therapists, they already exist. They are called priests.
... More

Conflict of interest: None declared

Write a reply

Confronting the Question of Religion and Spirituality in Clinical Practice

Jack Lennon, Doctoral Student in Clinical Neuropsychology, Illinois School of Professional Psychology
08 June 2018

Dein [1] provided a concise correspondence that argues for the inclusion of religious and spiritual practices in psychiatric settings, based in the premise that these elements are often important to individuals under psychiatric care. To the article’s benefit, there is some note of variable results across studies on the impact of religion in those with mental health concerns. However, this article straddles a grey area that is leaning toward a dogmatic view that conforms to the status quo of many countries. This form of clinical practice would willingly introduce ideology into science, potentially increasing stigma and straying from rational thought and empirical inquiry.

Freud and Ellis are noted as prominent anti-theists noted in this article [1]. One could follow the cognitive trajectory of considering these early and long-standing psychiatric tendencies as dogmatic in nature, yet it cannot be forgotten that religion and spirituality, operationally defined in the selective list of references, are unfalsifiable faith systems. The process of science, while slow-moving and incessantly changing, is based on falsifiable questions that can be repeatedly tested. We have come a great distance since those times in many aspects, less distance being traveled in other domains such as suicide prevention. To appeal to discrete, authoritative entities as if one can surmise what they would say in the 21st century is an atavistic, irrefutable form of ad hominem.

Articles utilized to support religion and spirituality in terms of overall health outcomes fail to recognize the complex nature of these questions. Dein1 cites Koenig [2], for example, which reviews religion/spirituality (R/S) and explicitly defines religion and spirituality in significantly different fashions yet reports them in combination. Dew and colleagues [3] are a prime example of how while also stating that measures of these variables are extremely heterogenous. This article reported that strongest associations were among adolescent substance users and that further study is warranted on depression, anxiety, and other psychiatric conditions. In fact, even if we are to further limit ourselves to evidence from religion-specific journals, a variety of studies report substantial limitations, a need for further research, and succumb to the same error in combining spirituality and religion [4,5]. Other studies are even more explicit regarding the limitations and nuances of such research [6] and also reports similar health outcomes among non-believers [7]. Therefore, those who report a religious denomination during treatment would have to be taken at face-value, with the practitioner never being able to know with certainty that the inclusion of religion would benefit the patient. Dein [1] recognizes and reports one of these criticisms but it is but a mere fraction of the article as a whole.

Of greatest concern to the field is inserting ideology into care, which begins to venture from standardized, empirically-supported treatment modalities. Dein [1] cited a systematic review [8] that reported improved outcomes following religion-infused cognitive behavior therapy (CBT) among religious patients. The concern here is the generalizability of such results as well as how critical the inclusion of religion in treatment is to the outcomes over time. Religion alone could potentially improve outcomes in sensical and intuitive manners, such as adding value or meaning to life [9]. It creates the opportunity to further segregate believers and non-believers, as well as those who differ in beliefs. This in-group/out-group mentality has led to increased stigma [10] and could adversely impact the health outcomes emphatically endorsed as sequelae to the inclusion of religion and spirituality.

There is clearly a need to continue researching methods that can improve treatment outcomes and this should not stray from the populations being treated, which includes those who are religious, spiritual, or a combination thereof. At the same time, the field must be cautious to combine ideology and science, which are two distinct concepts that are mutually exclusive – to find a balance would commit a middle-ground fallacy that makes psychiatric research less scientific. This is the same concern being confronted in the United States educational system and there is certainly no excuse for the inclusion of ideology into the treatment of psychiatric conditions. Patients may have particular interests in a wide range of socially-appropriate and -inappropriate beliefs and activities, but they would not be the framework or therapeutic infrastructure within which medical professionals treat these individuals. Diversity issues are important in conceptualization and a major psychiatric paradigm shift is certainly necessary, but there are severe, potentially far-reaching consequences to working “against the stream” [1] with unfalsifiable beliefs.





References

1. Dein S. Against the stream: Religion and mental health – the case for the inclusion of religion and spirituality into psychiatric care. BJPsych Bull. 2018; 42(3): 127-129. doi:10.1192/bjb.2017.13

2. Koenig HG. Religion, spirituality, and health: The research and clinical implications. ISRN Psychiatry. 2012. doi:10.5402/2012/278730

3. Dew RE, Daniel SS, Armstrong, TD. Religion/spirituality and adolescent psychiatric symptoms: A review. Child Psychiatry Hum Dev. 2008; 39: 381-398.

4. Unterrainer HF, Lewis AJ, Fink A. Religious/spiritual well-being, personality and mental health: A review of results and conceptual issues. J Relig Health. 2014; 53: 382-392. doi:10.1007/s10943-012-9642-5

5. Snider A-M, McPhedran S. Religiosity, spirituality, mental health, and mental health treatment outcomes in Australia: A systematic literature review. Mental Health Relig Cult. 2014; 17(6): 568-581. doi:10.1080/13674676.2013.871240

6. Zimmer Z, Jagger C, Chiu C-T et al. Spirituality, religiosity, aging and health in global perspective: A review. SSM Popul Health. 2016; 2: 373-381. doi:10.1016/j.ssmph.2016.04.009

7. Speed D. Unbelievable?! Theistic/epistemological viewpoint affects religion-health relationship. J Relig Health. 2017; 56: 238-257. doi:10.1007/s10943-016-0271-2

8. Smith TB, Bartz, J, Richards PS. Outcomes of religious and spiritual adaptations to psychotherapy: A meta-analytic review. Psychother Res. 2007; 17)6): 643-655.

9. Park C, Edmondson D. Religion as a source of meaning. Meaning, mortality, and choice: The social psychology of existential concerns [e-book]. Washington, DC, US: American Psychological Association; 2012: 145-162.

10. Lee H, An S. Social stigma toward suicide: Effects of group categorization and attributions in Korean Health News. Health Commun. 2016; 31(4): 468-477. doi:10.1080/10410236.2014.966894

... More

Conflict of interest: None declared

Write a reply

×

Reply to: Submit a response


Your details


Conflicting interests

Do you have any conflicting interests? *