Faith in a higher power has sustained mankind since time immemorial. This faith – which often is demonstrated through organized religion – also can help alleviate some of the suffering symptomatic of mental illnesses. "Perhaps more than other conditions that are treated by physicians, disorders of the mind raise questions about the meaning of life ... and the possibility that forces beyond our senses our influencing our lives," Dr. Samuel B. Theilman wrote in the first edition of the Handbook of Religion and Mental Health (Waltham, Mass.: Academic Press, 1998).
By Dr. Gurprit S. Lamba
Yet, discussion of such issues by psychiatrists in clinical practice is limited for multiple reasons, including time and reimbursement issues, according to Dr. Farr A. Curlin and colleagues at the University of Chicago (Psychiatr. Serv. 2007;58:1193-8). Dr. Curlin surveyed 1,144 physicians, including 100 psychiatrists, on the relationship between psychiatry and religion among U.S. physicians. They found that psychiatrists are less religious than other physicians.
In addition, they concluded, religious physicians are less willing than nonreligious physicians to refer patients to psychiatrists. "These findings suggest that historic tensions between religion and psychiatry continue to shape the care that patients receive for mental health concerns."
As humanists, perhaps we psychiatrists should be more open than our counterparts in other specialties to the value that religious beliefs can have for some of our patients – especially older men, as it turns out. Michael J. McFarland of the University of Texas, Austin, recently sought to examine ways in which religious involvement and mental health vary by sex among U.S. adults aged 66-95 (J. Gerontol. B. Psychol. Sci. Soc. Sci. 2010;65:621-30).
He analyzed two waves of the Religion, Aging, and Health Survey, and found that men get more mental health benefits from religious involvement than women. Also, Mr. McFarland found that men with "high levels of organizational religious involvement had much higher levels of mental health than other men."
Older women who had higher levels of organizational religious involvement were found to have levels of mental health that were similar to those of older women with moderate and lower levels of organizational religious involvement.
Positive associations between religiousness and mental health also were found in a cross-sectional study of older adults conducted by Dr. Giancarlo Lucchetti of the São Paulo (Brazil) Medical Spiritist Association and his associates.
Dr. Lucchetti and his colleagues interviewed 110 patients aged 60 and older who were attending an outpatient rehabilitation service. The patients were asked to fill out a questionnaire that sought to assess how they perceived their religiousness, quality of life, anxiety, depression, and physical activity limitations. The investigators found a connection between religiousness and fewer depressive symptoms, better quality of life, and less cognitive impairment and perceived pain. "Clinicians should consider taking a spiritual history and ensuring that spiritual needs are addressed among older patients in rehabilitation settings," Dr. Lucchetti wrote.
Problems can arise, however, when people become hyperreligious. As Dr. Jeffrey L. Saver and Dr. John Rabin have discussed, patients with frontotemporal dementias show hyperreligiosity, and among a subset of patients with "chromosome 17–linked frontal dementias, 3 of 12 affected individuals showed hyperreligious behavior" (J. Neuropsychiatry Clin. Neurosci. 1997;9:498-510). Dr. Saver and Dr. Rabin also examined religious experiences within the context of epilepsy, schizophrenia, and other psychotic illnesses; the use of hallucinogens; and delusional disorders.
"Clues to the neural substrates of religious-numinous experience may be gleaned from temporolimbic epilepsy, near-death experiences, and hallucinogen ingestion," they wrote. "These brain disorders and conditions may produce depersonalization, derealization, ecstasy, a sense of timelessness and spacelessness, and other experiences that foster religious-numinous interpretation. Religious delusions are an important subtype of delusional experience in schizophrenia, and mood-congruent religious delusions are a feature of mania and depression."
As psychiatrists, we must take these findings seriously and educate our colleagues in other specialties about the role of religion in medicine. Understanding our patients’ perspectives on religion/spirituality will allow us to provide better care.
Dr. Lamba is a geriatric psychiatry fellow with Partners HealthCare, Boston.