Chair’s Column January 2012

The relevance of religion and spirituality to mental health
J. Lake

Emerging research findings suggest that spirituality and religion are in fact not only related to
physical and mental health and well-being but often play important roles in both the prevention
and treatment of mental illness. The social roles of healers and priests have overlapped since the
beginning of recorded history. Until historically recent times priests and other spiritual adepts
were regarded as healers, and gifted healers were elevated to the status of priest or shaman. By
the early 20th century psychoanalysis had pathologized or outright dismissed the psychological
dimensions of spiritual experience and the relevance of spirituality in mental health.

While conventional biomedicine does not acknowledge a direct role of spirituality in health,
other World systems of medicine assume that spirituality or “energy” are centrally involved
in health and illness. For example in Chinese medicine, Ayurveda, Tibetan medicine and
other non-Western healing traditions, symptoms are interpreted as indicators of imbalances of
postulated fundamental energetic principles. In these healing traditions the causes of symptoms-
-including mental illness–are not reduced to discrete physiological changes in immune function,
neurotransmitter function or other biological “indicators” of illness. Examining the relationship
between religion, spirituality and health does not require endorsing any philosophical
assumptions about the ontological reality of God or the spiritual realm. Rather, investigators use
established research methods to determine whether measures of religious or spiritual beliefs or
behaviors are associated with beneficial changes in health (Almeida 2003; Miller 2003; Levin
2005).

Physicians are not a homogeneous group with respect to religious and spiritual beliefs. For
example, approximately 4 out of 5 family physicians believe in God (Daaleman 1999) in contrast
to only 1 out of 4 psychiatrists however over 90% of psychiatrists believe it is important to
know about their patients’ beliefs (Neeleman 1993.). It has been suggested that the gap between
psychiatry and religion is at least partly related to psychiatry’s progress in elucidating the
biological and psychological causes of mental illness, rendering religious explanations irrelevant
(Neeleman & Persaud 1995). In addition, psychiatry has until recently viewed religion in a
negative light associating it with undesirable attributes including dependence and guilt. Both
psychiatrists and psychologists tend to be less religious or spiritual than their patients. A search
of PubMed and other medical databases found that patients mention religion as an important
factor in their lives roughly twice as often as psychiatrists (Seyringer et al 2007).

In contrast to psychiatry’s long-standing neglect of religious and spiritual issues, recent research
findings support beneficial effects of religious affiliation and spiritual beliefs on mental health.
These emerging findings provide legitimate reasons for psychiatry to re-assess its traditionally
negative or skeptical regard for this important dimension of human experience. Omitting
considerations of patients’ religious and spiritual beliefs from mental health care may have
detrimental effects on coping and support systems that are important to emotional wellbeing
and recovery from mental illness (D’Souza 2007). A consensus panel of the American College
of Physicians has recommended that physicians should know how to take an adequate spiritual
history and should avoid imposing their religious or spiritual beliefs on patients. Patient requests
for in-depth religious counseling should always be referred to trained clergy. When asking

about religious and spiritual beliefs the psychiatrist is telling the patient that she is concerned
with the whole person, not just a psychiatric diagnosis. Regarding the patient as a whole
person—including his or her religious or spiritual beliefs—will strengthen the patient-clinician
relationship and may have beneficial effects on treatment adherence and outcomes.