The Role of Spirituality in the Treatment of Depression - Literature review Example

The dysfunctional relationship between spirituality, religiosity, and psychiatry has existed ever since the secularization of psychology in the era of psychoanalysis. Sigmund Freud, who was fiercely critical of religion and religious claims, created a system of clinical practice devoid of attention to a person’s spirituality outside of considering those thoughts and desires as mere illusions. As Bienenfeld and Yager (2007) state, Freud himself “in The Future of an Illusion, dismissed all religion as ‘comparable to a childhood neurosis’” (p. 178). However, as psychiatry and psychology in general have shifted away from classical psychoanalysis as the proper means of evaluating and treating mental illness, so too have attitudes shifted away from secularization of treatments. Although the pace has been rather slow, as Neeleman and Persaud (1995) are quick to point out, empirical research today is demonstrating the inextricable link between success in treatments of depression and spiritual/religious beliefs. This is hardly the approach of Freud or any other classical psychologists, who tended to focus on a secular philosophy or on a dependence of objective behavioral data (Bienenfeld & Yager, 2007). However, as psychiatry begins to shift away from these older perspectives, it will nevertheless begin to find a practical and theoretical use for spirituality and religiosity in the treatment of moderate to severe cases of mental illness. Despite claims of the founder of psychoanalysis that “religious teachings…(are) neurotic relics,” Bienenfeld and Yager (2007) show that positive spiritual beliefs and religiosity have been correlated with longevity, diminished levels of stress, healthier blood pressure and other dimensions of physical health, as well as lower risks for suicide and drug abuse. Setting aside the nature of the complex causal chains, the correlations are undeniable. These signs of physical health inevitably arise out of belief systems, or views of the world that are based in thought and feeling. The connection between the mind and the body in this case is such that physical health is a manifestation and direct result of mental health that one might ascribe to spiritual or religious belief. Insofar as psychiatry is attempting to heal the mind of a person, it should be in tune with the positive changes that can result from religious and spiritual practices as demonstrated in the research literature (Dein, 2006). For those reasons, patients want and expect that their spiritual lives be addressed. In a study of attitudes and preferences for depression treatment, Cooper-Patrick et al. (1997) comment, “As expected, patients made more comments than professionals regarding the impact of spirituality, social support systems, coping strategies, and life experiences on their help-seeking behavior and treatment preferences for depression” (p. 433). Accordingly, this seems to suggest a disconnect between the needs of patients and the assistance that psychiatrists are willing to give. Rather than forge new ways of intervening to help patients, it seems psychiatry in general is stuck in the old ways of thinking left over from the days of classical Freudian psychoanalysis. For many, religious beliefs and identities are core parts of the core ‘self,’ providing fundamental schemas that structure meaning in life (Bienenfeld & Yager, 2007). Thus, the application of prayer and meditation in the treatment of depression is proving more important than Freud appeared to realize. The challenge for psychiatrists is whether prayer and psychotherapy can be integrated into common, widely accepted practice. For the empirically-oriented modern world, Neeleman and Persaud (1995) insist that “the psychology of religion has provided empirical support for (the) idea… that a positive relation exists between religion and mental health” (p. 169). The conclusion, they believe, that religion can provide valuable insight to the treatment of depression and psychiatry in general, lies in stark contrast to the prevailing ideological history of the field. They point to a number of reasons why psychology has, in the past, neglected religion, which includes the perceived link between religious attitudes and “phenomena such as dependence and guilt, which are frequently seen as undesirable” (p. 169). However, the association between these two categories of concepts is based on the assumption that religion relies on dependence and guilt to uphold its faith. Nevertheless, this assumption comes from the kind of views of religion typified by Freud and classical psychoanalysis (Neeleman & Persaud, 1995). The challenge of psychiatry today, they conclude, is “to accommodate this evidence into theory and practice” (p. 169). In Epstein (2004), the author advocates for a new generation of psychiatrists who take into account the importance of religion and spirituality in the lives of their patients. Basing his arguments on the fundamental role of a clinician, Epstein’s admission is illuminating. What it implies is that modern science may have taken the wrong road—and that, while new research concludes that spirituality plays a role in the treatment of mental disorder, many psychoanalysts refuse to accept the fact—the very notion of spirituality goes against their chosen profession. Epstein argues against that central belief by stating the opposite: as clinicians, “we must be true to ourselves, without hedging our bets by holding onto a system that is contrary to the spirit of Spirit” (p. 19). Of course, not every psychiatrist specializing in the treatment of depression would agree with Epstein (2004) or the methods proposed; however, the approach the author takes in arguing in favor of integration is enlightening in that it questions commonplace assumptions about the role of psychiatrists in the lives of their patients. Galanter (2008) agrees insofar as the author also views a positive relation between religion and mental health. The author argues that spirituality is prominent within contemporary culture in the form of theistic orientation, as evidenced in the probability sampling of American adults, among whom 95% of respondents reply positively when asked if they believe in ‘God or a universal spirit.’ The mere prevalence of theistic convictions, Galanter (2008) suggests, indicates the need for a response to those believes in the psychiatric setting and, in particular, in the treatment of depression. Responses to a follow-up on this question suggest that this belief affects the daily lives of the majority (51%) of those sampled, as they indicated that they had talked to someone about God or some aspect of their faith or spirituality within the previous 24 hours (p. 125). Accordingly, within 24 hours of any given depression treatment for mentally ill patients, 51% of patients will correspond with, think about, or talk about some religious belief outside of a psychiatric session. In Piper (2007), which offers a theistic perspective on the root of mental illness, God, therefore, is the prime reality—and to be united to God is the purpose of man’s life. In other words, if man is depressed, it is because he has forgotten his purpose in life; his purpose is to be united to God: God is essence itself. If life is worth living, it is only because it is to be lived for God—God who is: omnipresent, omnipotent, all-knowing, and all-seeing. Anselm states in the Proslogium that God is “that than which nothing greater can be conceived” (Deane trans., 1903, p. 6). Because God created the world, it is ordered to a natural law—but through sin, nature is corrupted. To those who believe in the truth of these sentiments, depression is an imminent and real threat to one’s well-being and is solvable only by addressing it in this way, not through secular analysis. One objection posed to the integration of spiritual or religious values into psychiatric practice is that if psychiatrists attempt to integrate the two spheres, psychiatrists will become proselytizers, who impose their values and beliefs on their patients in order to solve their mental problems, or that psychiatrists will advocate for any kind of religion. A Canadian mental health specialist, for instance, was accused in 2011 for proselytizing on behalf of Scientology (Touzin, 2011). However, in the American Psychological Association (APA) Committee on Religion and Psychiatry’s report (1990), there is an emphasis the observation that “psychiatrists should maintain respect for their patient’s beliefs… and not impose their own religious, antireligious, or ideological systems of belief on their patients” (p. 542). This statement of non-coercion is based on long-standing ethical precepts that the APA abides to, and is independent of any religious ethical foundation. On a similar note, the APA believes that religious and spiritual values play a large enough role in people’s lives that “the inclusion of ‘religious or spiritual problem’ as a diagnostic category for the first time in the DSM-IV acknowledges that religious and spiritual issues can be the focus of psychiatric consultation and treatment” (p. 542). Recognition from the APA on matters such as religion and spirituality seems to be a large step forward in integrating the two realms of knowledge; however, the APA cannot enforce strict standards on individual psychiatrists or psychologists on how to bring together reliable treatments and religious values. Psychiatry and religion have had a troubled past, starting with the earliest psychologists and ending today with empirical research that demonstrates the faulty assumptions of earlier thinking. Psychology has certainly made great strides since The Future of an Illusion and classical psychoanalysis, so it is remarkable that psychiatry, particularly with respect to progress in treating the whole person in its treatment of depression, has not followed. By understanding the religious and spiritual perspectives of individuals, psychiatrists can make better, more well-informed decisions about how to treat those individuals and achieve better results. Relying on clinical traditions does not allow a science to move forward, and we are finding that to be the case with modern psychiatry. Based on empirical research and on fundamental principles of what a clinician should be, there is a convincing case to be made on behalf of encouraging more psychiatrists to take into account religious and spiritual values in their treatments. References Anselm, S. (1903). Proslogium. (S. Deane, Trans.) Chicago: Open Court. APA Committee on Religion and Psychiatry. (1990). Guidelines regarding possible conflict between psychiatrists religious commitment and psychiatric practice. The American Journal of Psychiatry, 147 , 542. Bienenfeld, D., & Yager, J. (2007). Issues of spirituality and religion in psychotherapy supervision. Israel Journal of Psychiatry & Related Sciences, 44 , 178-186. Cooper-Patrick, L., Powe, N., Jenckes, M., Gonzales, J., Levine, D., & Ford, D. (1997). Identification of patient attitudes and preferences regarding treatment of depression. Journal of General Internal Medicine, 12 , 431-438. Dein, S. (2006). Religion, spirituality and depression: implications for research and treatment. Primary Care and Community Psychiatry, 11 , 67-72. Epstein, G. (2004). "Never the twain shall meet": spirituality or psychotherapy? Advances in Mind-Body Medicine, 20 , 12-19. Galanter, M. (2008). Spirituality, evidence-based Medicine, and alcoholics anonymous. American Journal of Psychiatry, 165 , 1514-1517. Neeleman, J., & Persaud, R. (1995). Why do psychiatrists neglect religion? British Journal of Medical Psychology, 68 , 169-178. Piper, J. (2007). Battling unbelief: Defeating sin with superior pleasure. New York: Multnomah Books. Touzin, C. (2011, July 28). Église de scientologie: un physiothérapeute blâmé de prosélytisme. Retrieved September 11, 2011, from La Presse: http://www.cyberpresse.ca/actualites/quebec-canada/justice-et-faits-divers/201107/27/01-4421522-eglise-de-scientologie-un-physiotherapeute-blame-de-proselytisme.php Read More