The Recovery of Religious and Spiritual Significance in American Psychiatry

This paper reviews a body of data that identifies underlying influences that have contributed to an evolving change in American Psychiatry toward a more positive and receptive stance toward religion and spirituality over the past three decades. This development, surprising in light of the remedicalization of psychiatry and its predominantly neuro-biological orientation, is attributed to five foundational ideas that have helped to leverage this change. These are significance of culture, creative power of ritual, psychic function of belief, neuro-biology of spirituality, and relevance of recovery narratives. The impact of these factors for psychiatric assessment and treatment is described, as well as the contribution of the Oskar Pfister legacy and award to the ongoing dialogue between religion and psychiatry. Adapted from the American Psychiatric Association's 2011 Oskar Pfister Lecture in Religion and Psychiatry.     

Perceived Spirituality,Mindfulness and Quality of Life in Psychiatric Patients

There is some evidence of the relationship between spirituality and quality of life, but there are few bibliographic references on these constructs for patients suffering from mental illness; thus, this study was aimed at revealing the possible role of spiritual outlooks as a protective factor in these individuals. The sample consisted of 96 Portuguese psychiatric patients, selected from a psychiatric hospital and assessed based on parameters for quality of life, spirituality and mindfulness. The data support some theories about the nature of the spirituality. Spiritual beliefs are poorly correlated with the quality of life index, and there is a moderate association between these beliefs and some aspects of mindfulness. It is suggested that a spiritual outlook of psychiatric patients should be taken into account in psychological interventions.     

A church-based peer-led group intervention for mental illness

Religion and spirituality (R/S) can be powerful supports and provide important coping resources for individuals in recovery. Faith communities seem to offer many advantages for recovery-oriented support, but have rarely been the setting for empirically examined psychosocial rehabilitation efforts. This study describes the outcomes for individuals in Living Grace Groups (LGGs), a peer-led group intervention for mental illness that is based in churches and integrates R/S. Persons at all active LGGs were surveyed before and after participation using well-validated scales for recovery, psychiatric symptoms, and spirituality. LGGs attracted individuals with a broad range of persistent psychiatric difficulties, who described religion as important to them and rated the groups as very helpful. Participants reported improvements in recovery and spirituality as well as reductions in psychiatric symptoms. R/S-integrated support groups may improve care by increasing cultural match, as well as providing more access to recovery-oriented care by tapping the resources of faith communities.     

Is Evidence Able to Persuade Physicians to Discuss Spirituality with Patients?

Patients believe that spirituality informs health; frequently, they wish to share their beliefs with physicians. Although a large number of physicians believe it their responsibility to be aware of patient beliefs, many do not address spirituality because they do not believe it their role to do so. These physicians would perhaps feel differently if presented with evidence that associated spirituality with positive health outcomes. This national sample of family medicine residents were asked if, presented with evidence that spirituality was associated with improved outcomes, they would be more likely to initiate discussions of spirituality with patients. To varying degrees, most residents agreed that they would be more willing to initiate spirituality discussions if presented with good evidence. Geographic region of training, religious preference, and Spiritual Well-Being Scale quartile predicted both strength of agreement and whether a resident would be as responsive to spirituality oriented research as to investigations of traditional therapeutic modalities. Although residents indicated that they would be more responsive to publications on traditional medical therapies, familiarity with the spirituality literature as part of a residency educational curriculum may help break down barriers to addressing this issue with patients.     

Representations of God uncovered in a spirituality group of borderline inpatients

We present aspects of a psychoanalytically-oriented, exploratory spirituality group for nine female psychiatric inpatients diagnosed with borderline personality disorder. Through drawings and group process, the patients uncovered and elaborated on their representations of God. Two patterns of representations were identified: (1) representations of a punitive, judgmental, rigid God that seemed directly to reflect and correspond with parental representations and (2) representations of a depersonified, inanimate, abstract God entailing aspects of idealization that seemed to compensate for parental representations. Interestingly, the second pattern was associated with comorbid narcissistic features in the patients. Those patients who presented punitive God representations were able to begin the process of re-creating these representations toward more benign or benevolent images in the context of this group, while those participants who presented depersonified God representations seemed unable to do so.     

Perceptions of mental healthcare consumers regarding their conditions

Distress is experienced, understood and communicated differently across various cultures. The aim of the study was to investigate the role of culture, religion and spirituality in patients’ understanding of and coping with mental problems. A quantitative survey was done at a psychiatric institution. A questionnaire was designed to explore patients’ cultural and religious beliefs about mental illness, and how these beliefs and perceptions influenced their actions in search for recovery. Questionnaires were completed by 94 patients. The majority of participants were Christian (79.8%), followed by African traditionalists (17.0%). Seventy-two per cent believed that faith in God, and 34.4% that help from religious leaders, could contribute to mental wellness. Approximately a third (29.0%) believed that by keeping their ancestors happy, they would be protected from sickness and bad luck. Mental healthcare providers’ sensitivity to cultural and religious beliefs will translate into a more comprehensive management plan, ensuring a satisfying therapeutic relationship.     

Are Residents Willing to Discuss Spirituality with Patients?

Family medicine is redefining itself in the wake of the Future of Family Medicine Project, the move to the Patient-Centered Medical Home, and the 2010 Patient Protection and Affordable Care Act’s emphasis on primary care. This effort has included representing family doctors as physicians who “care for the whole person” and who “specialize in you.” Many patients believe that whole person care involves attention to spirituality and wish to share their beliefs in the medical encounter. This national survey investigated whether a random sample of family medicine residents were willing to address spirituality upon patient request. With varying degrees of willingness, most doctors said that they would discuss patient beliefs if asked. Denominational preference, residency training in addressing spirituality, and self-rated spirituality were all predictive of the strength of reported willingness. These results indicate that training in addressing spirituality may create residents more likely to discuss the topic in clinical practice.     

From Transcendence to Ethics: Shaping spirituality to schools

Although Education Acts require schools in England and Wales to make provision for the spiritual development of pupils, there is continued debate about the meaning of the word 'spirituality' and what it should mean for schools. This article explores these issues using interview material collected from ten people from a variety of faiths and worldviews. The interviews documented individuals' personal understandings of spirituality. Synopses of these different accounts are presented here. The interviews also documented individuals' perceptions of spirituality for school and it was observed that these involved much greater agreement than the accounts of personal spirituality. Agreement was reached by a common shift of emphasis away from transcendent phenomena toward ethical values. The shift toward ethics and consensus is discussed here in relation to National Curriculum Council and OFSTED definitions of spirituality. It is suggested that a drive toward consensus is detrimental to the spirit of spiritualities.     

The Role of Personal Spirituality and Religious Social Activity on the Life Satisfaction of Older Widowed Women

We examined the impact of personal spiritualityand religious social activity on the life satisfactionof older widowed women. Fifty-one White, femaleretirement community residents completed measures of personal spirituality, religious socialactivities, and life satisfaction. Ten residents werealso interviewed about their religious beliefs andactivities. Although the interviews revealed bothpersonal spirituality and religious social activity tobe central to the life satisfaction of these women,quantitative results suggested only involvement withreligious social activities was related to lifesatisfaction. Interviews revealed thatchurch activitiesprovided the women a loving family and a supportivecommunity. Religious activities helped these older womenovercome hardships, gave them a chance to sustainfriendships, and provided a vehicle through which they couldcontribute to their community.     

A systematic review of research on religion and spirituality in the Journal of Traumatic Stress: 1990–1999

Surveys reveal that religion and spirituality are highly valuable to many people in times of crisis, trauma, and grief. The relationship between coping with trauma and the use of various spiritual beliefs is well established. The importance of clergy in trauma recovery is also well documented. A review of the 469 research and non-research articles published between 1990 and 1999 in the Journal of Traumatic Stress revealed that 8.7% (6/69) of non-research articles, 4.1% (15/366) of quantitative research articles and 2.9% (1/34) of qualitative research articles considered religion or spirituality in their work. Analysis of variance found a significant overall increase in the percentage of articles that mentioned religion/spirituality between the first half (1990–1994) and the second half (1995–1999) of the study period. The results are discussed in the context of the trauma research and in comparison to related disciplines. Recommendations for future research and clinical application are suggested for both traumatologists and religious scholars.     

Religious Affiliation,Religiosity, and Spirituality in Pediatric Residents: Effects on Communication and Self-Efficacy with Adolescents in a Clinical Setting

Religion and spirituality are known influences on medical providers’ care of patients, but no studies have assessed resident beliefs related to patient perception of clinical care. The main objective of our study was to assess resident religious affiliation, religiosity, and spirituality in relation to self-efficacy and communication with patients during adolescent clinic visits. We found that religious affiliation and religiosity appear to affect patient perception of communication with residents during adolescent visits; spirituality had little noted effect. Further research is warranted, especially regarding resident and patient gender correlations and differences in religious affiliation effects on patient perception of care.     

The Gender‐Specific Associations Between Religion/Spirituality and Suicide Risk in a Sample of Austrian Psychiatric Inpatients

Most studies have found religion/spirituality to be protective against suicide risk, with a stronger effect among women. To understand this effect, theories of suicide and clinical samples are needed, but related studies are lacking. We applied two established suicide models in 753 psychiatric inpatients. Religion/spirituality correlated protectively with components of the suicide models, with stronger associations among women. The protective effect emerged especially for the capability aspect of suicide among men and for the motivational aspect among women, suggesting very different causal mechanisms, but this has to be replicated with longitudinal studies.     

Religion and spirituality. Linkages to physical health

Evidence is presented that bears on 9 hypotheses about the link between religion or spirituality and mortality, morbidity, disability, or recovery from illness. In healthy participants, there is a strong, consistent, prospective, and often graded reduction in risk of mortality in church/service attenders. This reduction is approximately 25% after adjustment for confounders. Religion or spirituality protects against cardiovascular disease, largely mediated by the healthy lifestyle it encourages. Evidence fails to support a link between depth of religiousness and physical health. In patients, there are consistent failures to support the hypotheses that religion or spirituality slows the progression of cancer or improves recovery from acute illness but some evidence that religion or spirituality impedes recovery from acute illness. The authors conclude that church/service attendance protects healthy people against death. More methodologically sound studies are needed.     

Handling Spirituality/Religion in Professional Training: Experiences of a Sample of Muslim Psychology Students

With increasing research interest in the relationship between spirituality/religion and mental health, the present study uses semi-structured interviews on a select group of Muslim students to explore their understanding and handling of spirituality in a secular training programme. Their understanding of spirituality, its perceived role in therapy and their training experiences are subjected to qualitative analysis using the framework approach (Ritchie & Spencer, 1994. In A. Bryman & R.G. Burgess (Eds), Analysing Qualitative Data. London: Routledge). All five participants perceived spirituality as central to human functioning. Probes into their training experience uncovered issues of bias against religious applicants, apprehension about demonstrating religious commitment, fear of punishment for compromising religious integrity, better rapport with Muslim patients but general uncertainty about handling spiritual issues in therapy, and a strong desire for the integration of spirituality/religion in the program.Cynthia Joan Patel, M.A., is a Lecturer in the School of Psychology at the University of Kwazulu-Natal, Westville Campus, Durban, South Africa. She is a Registered Counselling and Research Psychologist with the Health Professions Council of South Africa). Her research interests include women and religion, attitudes toward abortion, and the meaning of work in women’s lives. Armas E. E. Shikongo, M.A., is a Lecturer in the Department of Psychology at the University of Namibia. His research area is the psychology of spirituality.     

Seeking spirituality through physicality in schools: learning from ‘Eastern movement forms’

This paper argues that we might learn from the ways in which Eastern movement forms with a self-cultivation focus approach the development of spirituality through physicality. It also argues that these movement forms have potential to assist in the development of children’s spirituality in school and Physical Education (PE) settings. First, the paper highlights a distinctive orientation to self-cultivation at the heart of which lies a focus on uniting body and mind through regular movement-based practice. Next, differing relationships between these movement forms and spirituality are identified as: fragments of established religious spirituality; spiritual exercise; and secular religious spirituality. Finally, three common pedagogic principles of these movement forms are highlighted and applied to the school and PE context: identifying self-identity and emotions; prioritising direct experience and changing the body-self through practice. It is suggested that these understandings of self-cultivating Eastern movement forms may help sensitise educators to approaching the cultivation of spirituality through physicality in schools using, not only Eastern movement forms but also Western activities delivered in accordance with these principles.     

Spirituality and Recovery from Cardiac Surgery: A Review

A large research literature attests to the positive influence of spirituality on a range of health outcomes. Recently, a growing literature links spirituality to improved recovery from cardiac surgery. Cardiac surgery has become an increasingly common procedure in the United States, so these results may provide a promising indication for improved treatment of patients undergoing surgery. To our knowledge, a comprehensive review of the literature in this area does not exist. Therefore, this paper reviews the literature relevant to the influence of spirituality on recovery from cardiac surgery. In addition, it proposes a conceptual model that attempts to explicate relationships among the variables studied in the research on this topic. Finally, it discusses limitations, suggests directions for future research, and discusses implications for the treatment of patients undergoing cardiac surgery.     

Suicide in Psychiatric Patients: Age Distribution

ABSTRACT: In eight years, 21183 San Diego County residents killed themselves. Of these, 52 had been at some time patients of one private psychiatric group. The suicide rate increased with age for the county population but not for the psychiatric patients. This difference was highly significant. Although older people generally are at greater risk for suicide, older psychiatric patients may be more responsive to treatment.     

Complexity of ethical decision making in psychiatry

Psychiatric residents and psychiatrists have little difficulty in making judgments about a clinical course of action to take with patients. However, making ethical clinical decisions is more challenging, because psychiatric residents are usually provided little formal training in ethics. Further, many ethical dilemmas are complex, requiring knowledge of the psychiatric profession's ethics code, moral principles, law, and practice standards and of how they should be weighed in the decision-making process. The purpose of this article is to demonstrate this complexity in regard to the identification of potential ethical dilemmas, understanding the issues that these dilemmas raise, and formulating potential solutions to them. Two common but important areas of treatment in which ethical dilemmas arise (informed consent and competence of care) are used as examples for our presentation. The article demonstrates that to successfully engage in ethical analysis in psychiatry is impossible without substantial formal training in the process.     

Providing Guidance on the Health Effects of Religious/Spiritual Involvement: A National Assessment of University Counseling Professionals

This study assessed the perceptions and practices of a national sample of university counseling professionals (n = 306) regarding their provision of guidance on the health effects of religious/spiritual involvement. Relatively few (21%) discussed the physical health effects of religiosity/spirituality with their clients. The majority (52%) were unsure that such discussions would result in lower health risks; however, nearly half (48%) indicated that these would promote recovery. Almost two-thirds (64%) indicated that discussions of religious/spiritual involvement and health “should occur only with clients who indicate that religion/spirituality is important to them.” A plurality (36%) of the respondents had received no formal training on this topic. Implications for clinical training, university counseling centers, and future research are discussed.