Search

Leah is a woman in her 40s hearing voices in the context of a recently diagnosed first episode of psychosis. Her voices represent a dynamic interplay between conflicting psychological and spiritual forces within her, which are various externalized, collaborated with, and related to, in an attempt to cope with, and make meaning amidst, multiple traumatic life events. This brief case study shows not only that voices may be meaningful and beneficially attended to, but also that an episode of psychosis may provide the context for spiritual growth and positive religious coping.

Whereas previous research in the medical humanities has tended to neglect theology and religious studies, these disciplines sometimes have a very important contribution to make. The hearing of spiritually significant voices provides a case in point. The context, content and identity of these voices, all of which have typically not been seen as important in the assessment of auditory–verbal hallucinations (AVHs) within psychiatry, are key to understanding their spiritual significance. A taxonomy of spiritually significant voices is proposed, which takes into account frequency, context, affect and identity of the voice. In a predominantly Christian sample of 58 people who reported having heard spiritually significant voices, most began in adult life and were infrequent experiences. Almost 90% reported that the voice was divine in identity and approximately one-third were heard in the context of prayer. The phenomenological characteristics of these voices were different from those in previous studies of voice hearing (AVHs). Most comprised a single voice; half were auditory; and a quarter were more thought-like (the rest being a mixture). Only half were characterful, and one-third included commands or prompts. The voices were experienced positively and as meaningful. The survey has implications for both clinical and pastoral work. The phenomenology of spiritually significant voices may be confused with that of psychopathology, thus potentially leading to misdiagnosis of normal religious experiences. The finding of meaning in content and context may be important in voice hearing more widely, and especially in coping with negative or distressing voices.

Mental health has become a domain of professional and scientific endeavor, distinguished in the modern mind from spirituality, which is understood as a more subjective, transcendent, and private concern. This sharp separation has been challenged in recent decades by scientific research, which demonstrates the positive benefits of spirituality/religion (S/R) for mental health. Increasing scientific interest in the topic is to be welcomed, but the contribution of theology to the debate has been neglected. It is proposed here that Jesus’ life and teaching are presented in the synoptic Gospels as fundamentally concerned with what we now call mental health. Jesus’ teaching on worry, for example, offers various psychological strategies for dealing with anxiety. Moreover, it presents prayer as an effective and constructive response to worry, involving disciplined attention rather than avoidance. Critical interdisciplinary conversations between science and theology on matters such as worry offer a constructive approach to understanding the human condition in the context of adversity.

Research on the causes of human sexual orientation has been marshaled in support of predetermined and opposing theological viewpoints. Whilst acknowledging that there is still much that is not known, the peer reviewed scientific literature clearly shows that a combination of genetic and environmental factors contribute to sexual orientation, with approximately one third of variance currently attributed to the former. Much of the known environmental influence appears to be intra-uterine and there is no currently convincing evidence that social environment plays a significant part. This body of evidence is relevant to theology. Greater attention should be given to critical interdisciplinary engagement of the theology and science of sexual orientation.

The Spirituality and Psychiatry Special Interest Group (SPSIG) of the Royal College of Psychiatrists was established in 1999 in the historical context of increasing research and clinical interest i...

SUMMARYReligious concerns, manifested in thought and behaviour, have a complex, bidirectional and sometimes conceptually overlapping relationship with mental health and mental disorder. Psychiatry, concerning itself with what is measurable in research, and with the relief of distress in clinical practice, has a different perspective on these complex interrelationships than does theology or religion. That which is transcendent, and therefore not measurable, is often important to patients, and sometimes distress may (theologically) be a sign of human well-being. The giving of careful attention to transcendence and distress may variously be conceived of as prayer, religious coping or clinical care. Applications of research to clinical practice, addressing as they do a sensitive and controversial boundary between psychiatry and religion, must therefore be patient centred and culturally sensitive.

In many contexts, emotional ailments have been considered problems of religious or spiritual origin. Historically, religious groups were often the primary providers of mental health care. This changed over time with advances in medicine and Freud’s writings framing religion/spirituality (R/S) as a sign of neurosis. In the early- to mid-twentieth century, mental health and R/S were often viewed by Western clinicians and patients as separate and antithetical. Recent decades have been marked by another shift in thought, with increased interest in the overlap between mental health and R/S, and recognition that R/S may in fact serve protective and healing roles in the face of emotional suffering. There has been a concomitant increase in research investigating the connections between R/S and mental health, along with increased development and application of clinical interventions addressing the two in combination. In this narrative review, we summarize the history of how mental health and R/S have been viewed as relating to one another, recent research evidence on the effects of R/S on mental health, and clinical implications of these findings. We conclude with a discussion of ongoing challenges and opportunities in the study and application of how mental health and R/S affect one another.

Hearing Voices and Other Matters of the Mind seeks to bring the theories and discoveries of the Cognitive Science of Religion to broader discussions of mental health. In doing so, the authors introduce auditory verbal hallucinations as one example of a supposed continuity between religious experiences and mental disorder. Based on up-to-date research into the phenomenological overlap between the voice-hearing experiences of those with and without a mental health diagnosis and those who report hearing spiritually significant voices, this essay elucidates the complexity of presupposing such continuities. We critique the notion that the cognitive mechanisms implicated in religiosity are inadvertent “by-products” of the mind’s operations and propose, rather, that they are the inevitable outcomes of human meaning-making.

Psychotic symptoms and spiritual phenomena may either be understood as being on a continuum or else as being discontinuous, categorically separate phenomena. Christian scripture and tradition may be interpreted within either model, but in either case, there is a need for discernment in diagnosis and pastoral care. Hearing the voice of God and belief in demon possession are particularly complex phenomena, being both a part of normal Christian life in many churches worldwide and also potentially symptoms of psychosis for some. For those who are suffering from psychosis, the relationship between faith and illness needs to be treated with sensitivity and respect. Christian spirituality has a significant part to play in recovery. A spiritual assessment and integration of spirituality/faith in treatment will be important. Much more mutual understanding and collaborative work are needed between clergy and clinicians to achieve optimum pastoral and clinical care.

Mental disorders are both common and disabling worldwide. They affect beliefs, emotions, identity and relationships in such a way as to impact upon the very essence of human experience. They are associated with stigma and prejudice, and they disproportionately affect those who are poor and those who belong to marginalized groups within society. Increasing attention has been given in recent years to the importance of spirituality for mental health, but in research it is impossible to distinguish between spirituality and the psychological variables that it purports to influence. Those things that are identified as being the concerns of mental health professionals overlap significantly with the concerns of religion. This overlap is examined here in relationship to the Synoptic Gospel accounts of the mission, ministry and teaching of Jesus. It is proposed that Jesus’ teaching on the kingdom of God was centrally concerned with things that we now consider to be the domain of mental health. For Christians, mental health may be understood as the ability to fulfil vocation within the kingdom of God. A more critical theological understanding of mental health is needed to better inform the mission of the Church of England.

Research and debate on the importance of spirituality and religion in psychiatry has led to a number of national and international policy initiatives, intended to clarify the boundaries of good practice and improve the way in which such matters are managed for the benefit of patients. Significant amongst these is the 2015 position statement of the World Psychiatric Association, the only such policy statement to date which has been internationally agreed. Preliminary evidence available suggests that this is having good effect in generating professional debate and further national policy initiatives in different countries. There is a need for further research on such policy initiatives to confirm whether or not they have the intended impact upon clinical practice and whether or not this in turn is beneficial for patients.

To counter a growing sense of the fragile nature of human existence within Western society, a number of stratagems have been proposed as means of increasing resilience among those who are deemed to lack it. In addition to the use of resilience within many academic fields – ranging from psychology to ecology, political theory, and engineering – resilience has become a part of everyday discourse, being used to describe everything from sports teams that overcome various setbacks to the purported effect of various self-help treatments. Amidst the variety of definitions of the construct, resilience in human beings is generally seen to include three core components: the experience of significant risk or adversity, the utilisation of resources to cope amidst adversity, and a positive outcome. Protective and promotive factors have been dubbed ‘the defining attributes of resilience’. Conceptions of resilience are contextually dependent and influenced by environmental considerations.

The WPA and the World Health Organization (WHO) have worked hard to assure that comprehensive mental health promotion and care are scientifically based and, at the same time, compassionate and culturally sensitive1, 2. In recent decades, there has been increasing public and academic awareness of the relevance of spirituality and religion to health issues. Systematic reviews of the academic literature have identified more than 3,000 empirical studies investigating the relationship between religion/spirituality (R/S) and health3, 4. In the field of mental disorders, it has been shown that R/S has significant implications for prevalence (especially depressive and substance use disorders), diagnosis (e.g., differentiation between spiritual experiences and mental disorders), treatment (e.g., help seeking behavior, compliance, mindfulness, complementary therapies), outcomes (e.g., recovering and suicide) and prevention, as well as for quality of life and wellbeing3, 4. The WHO has now included R/S as a dimension of quality of life5. Although there is evidence to show that R/S is usually associated with better health outcomes, it may also cause harm (e.g., treatment refusal, intolerance, negative religious coping). Surveys have shown that R/S values, beliefs and practices remain relevant to most of the world population and that patients would like to have their R/S concerns addressed in health care6, 7, 8. Psychiatrists need to take into account all factors impacting on mental health. Evidence shows that R/S should be included among these, irrespective of psychiatrists’ spiritual, religious or philosophical orientation. However, few medical schools or specialist curricula provide any formal training for psychiatrists to learn about the evidence available, or how to properly address R/S in research and clinical practice7, 9. In order to fill this gap, the WPA and several national psychiatric associations (e.g., Brazil, India, South Africa, UK, and USA) have created sections on R/S. WPA has included “religion and spirituality” as a part of the “Core Training Curriculum for Psychiatry”10. Both terms, religion and spirituality, lack a universally agreed definition. Definitions of spirituality usually refer to a dimension of human experience related to the transcendent, the sacred, or to ultimate reality. Spirituality is closely related to values, meaning and purpose in life. Spirituality may develop individually or in communities and traditions. Religion is often seen as the institutional aspect of spirituality, usually defined more in terms of systems of beliefs and practices related to the sacred or divine, as held by a community or social group3, 8. Regardless of precise definitions, spirituality and religion are concerned with the core beliefs, values and experiences of human beings. A consideration of their relevance to the origins, understanding and treatment of psychiatric disorders and the patient's attitude toward illness should therefore be central to clinical and academic psychiatry. Spiritual and religious considerations also have important ethical implications for the clinical practice of psychiatry11. In particular, the WPA proposes that: A tactful consideration of patients’ religious beliefs and practices as well as their spirituality should routinely be considered and will sometimes be an essential component of psychiatric history taking. An understanding of religion and spirituality and their relationship to the diagnosis, etiology and treatment of psychiatric disorders should be considered as essential components of both psychiatric training and continuing professional development. There is a need for more research on both religion and spirituality in psychiatry, especially on their clinical applications. These studies should cover a wide diversity of cultural and geographical backgrounds. The approach to religion and spirituality should be person‐centered. Psychiatrists should not use their professional position for proselytizing for spiritual or secular worldviews. Psychiatrists should be expected always to respect and be sensitive to the spiritual/religious beliefs and practices of their patients, and of the families and carers of their patients. Psychiatrists, whatever their personal beliefs, should be willing to work with leaders/members of faith communities, chaplains and pastoral workers, and others in the community, in support of the well‐being of their patients, and should encourage their multi‐disciplinary colleagues to do likewise. Psychiatrists should demonstrate awareness, respect and sensitivity to the important part that spirituality and religion play for many staff and volunteers in forming a vocation to work in the field of mental health care. Psychiatrists should be knowledgeable concerning the potential for both benefit and harm of religious, spiritual and secular worldviews and practices and be willing to share this information in a critical but impartial way with the wider community in support of the promotion of health and well‐being. Alexander Moreira‐Almeida1,2, Avdesh Sharma1,3, Bernard Janse van Rensburg1,4, Peter J. Verhagen1,5, Christopher C.H. Cook1,6 1WPA Section on Religion, Spirituality and Psychiatry; 2Research Center in Spirituality and Health, School of Medicine, Federal University of Juiz de Fora, Juiz de Fora, Brazil; 3‘Parivartan’ Center for Mental Health, New Delhi, India; 4Department of Psychiatry, University of the Witwatersrand, Johannesburg, South Africa; 5GGZ Centraal, Harderwijk, the Netherlands; 6Department of Theology and Religion, Durham University, Durham, UK

SummaryThe consensus within psychiatry is that patients' religion/spirituality are legitimate topics in assessment and treatment. Religion/spirituality can help people cope with mental illness, but their use as therapeutic tools is controversial. Despite the publication of position statements by national and international psychiatric organisations, there is no clarity over therapeutic boundaries.Declaration of interestR.P. and R.H. are atheists. C.C.H.C. is an ordained Anglican and a past Chair of the Royal College of Psychiatrists Spirituality and Psychiatry Special Interest Group. He writes here in a personal capacity.

Few studies have examined the perceptions of health professionals towards spiritual care in the UK despite recent policies from the National Health Service (NHS) surrounding spiritual care provision. To the authors’ knowledge, no studies have examined the perceptions of physiotherapists either in the UK or worldwide. The aim of this study was to examine the perceptions of Scottish physiotherapists in relation to spirituality and spiritual care in health care, including the role of spirituality in health, barriers to spiritual care provision, and training. Questionnaires were sent to Physiotherapy Departments in all 14 NHS Trusts in Scotland in order to achieve a representative random sample from across Scotland. There was participation from all 14 Trusts with participants self-selecting to complete the questionnaire. A 30% response rate (274/916) was achieved. All returned questionnaires were completed with minimal or no omissions. The majority of physiotherapists agreed that spirituality is an important ...

Christian debates about human sexuality are often presented as being concerned primarily with differences regarding authority of scripture. It is proposed here that they might more constructively be understood as debates about science and theology. Just as cosmology, evolution and demonology have variously been perceived as presenting conflict between scientific theories and biblical texts, so human sexuality presents similar points of tension. The issue at stake is not really about biblical authority, but rather about how the “book of nature” and the book of scripture are understood to mutually interpret each other. Lessons learned from debates between science and theology in other domains, may usefully facilitate a more constructive debate on sexuality.

In addiction psychiatry, spirituality and religion present a set of ethical challenges associated with the various ways in which recovery is linked to particular spiritual and religious programs, such as those offered by the 12-step mutual help groups, related professional rehabilitation programs, and other explicitly religious programs of recovery. In addition, individual patients construct their own narratives of recovery in the light of their personal spiritual/religious beliefs. Potential clashes between the different spiritual/religious perspectives of a recovery program, and patient and professional attitudes need to be managed sensitively and with a patient centered approach The issues arising here are illustrated by way of two case studies.

Background: Religious themes are commonly encountered in delusions and hallucinations associated with major mental disorders, and the form and content of presentation are significant in relation to both diagnosis and management. Aims: This study aimed to establish what is known about the frequency of occurrence of religious delusions (RD) and religious hallucinations (RH) and their inter-relationship. Methods: A review was undertaken of the quantitative empirical English literature on RD and RH. Results: A total of 55 relevant publications were identified. The lack of critical criteria for defining and classifying RD and RH makes comparisons between studies difficult, but prevalence clearly varies with time and place, and probably also according to personal religiosity. In particular, little is known about the content and frequency of RH and the relationship between RH and RD. Conclusion: Clearer research criteria are needed to facilitate future study of RD and RH, and more research is needed on the relationship between RD and RH.

Background: Since 2001, a policy of positive mental health recovery has been promoted in the UK, with service user involvement. This has not been easy to implement in the clinical setting.\ud \ud Aims: To develop and validate a brief self-report, service user-designed, outcome measure (Mini-SeRvE), for clinical use, including spiritual and religious issues.\ud \ud Methods: From the previously developed Service user Recovery Evaluation scale (SeRvE), 15 questions were selected for Mini-SeRvE which was self-completed by 207 people; 100 service users and, for comparison, 107 staff. Results were analysed using SPSS software (SPSS Inc., Chicago, IL).\ud \ud Results: Mini-SeRvE is reliable, Cronbach’s alpha 0.852. Correlation with another recovery scale, Mental Health Recovery Measure, was high, r = 0.819. Three reliable subscales emerged; existential well-being (EWB), mental ill-being (MIB) and religious well-being (RWB). Scores of the EWB and MIB subscales were higher for staff, consistent with higher mental well-being. Religious well-being scores were higher in service users, who also rated religion as more important to them.\ud \ud Conclusions: Mini-SeRvE is a valid measure of service user recovery. The importance of religion/spiritual belief for our users is highlighted, this being reflected in the subject matter of Mini-SeRvE. Mini-SeRvE assessments could show individual priorities, evaluate therapy and aid clinical decision-making.

A variety of themes are explored as the basis for developing a contextual theology of dementia. These include impairment, loss, dislocation, isolation, decline, and death. These themes represent immanent human concerns with various kinds of experiences of “self-emptying.” It is suggested that dementia presents a kind of “malaise of immanence,” within which there is progressive inability to focus on abstract transcendent concerns, and increasing preoccupation with the immediate immanent context. A contextual theology of dementia that exaggerates the importance of the immanent frame is likely to emphasize, and draw to our attention, concern about such things within that frame as cognitive decline, dependence upon others for care, and loss of hope. However, a Christological perspective is offered within which it is acknowledged that such places of self-emptying are also places of transcendent encounter, and that in Christ we may understand the participation of God in the darkest moments of human experience.

Many service users would like their spiritual needs to be taken into account during treatment and doing so has been shown to have positive benefits. However, this rarely happens in practice. Barriers to healthcare professionals providing spiritual care include embarrassment, lack of awareness and training, fear and lack of time. This article describes the development of a spirituality care pathway as part of a wider organisational initiative to offer spiritual support in mental health services. The process highlighted the importance of developing awareness and ownership of the need for spiritual care in all service areas and among service users. A range of spiritual interventions were identified and a process of monitoring and review introduced. The approach was appreciated by service users and staff, and was developed within existing professional and management processes.