Can spirituality be a scientific topic and how?: A rigorous but open-minded scientific approach of studies on religion, spirituality, and mental health

Science and spirituality are at odds, due to the history of enlightenment. This led to freeing human inquiry from dogmatic and clerical bondage by religion. And because religion has been left behind by the new scientific narrative of a self-evolving world, driven by random accidents and mutations and natural laws, there seems to be no place for spirituality either. This contribution disentangles those conceptual problems. It first points out the history of this separation and its consequences. It is important to realize that spirituality and religion are two different things. While religion is a conceptual, ethical, ritual, and at times also a political framework, spirituality is the experiential core of all religions. As a human experience, it is universal and independent of religious belief systems. Spirituality, as a form of inner experiential access to reality, is also at the bottom of the scientific process—for instance, in important theoretical insights. 150 words

Sexual Minorities and Spirituality

For some lesbian, gay, bisexual, and transgender (LGBT) individuals, organized religion can sometimes be a major source of stress and difficulty in identity formation and acceptance whereas others may find solace in it. Belonging to a religion and following it are different aspects of an individual, and often an important part of the culture they have been brought up in. One of the micro-identities for the individual is religion and associated rites, rituals, and taboos. Multiple micro-identities can play a major role in the smooth functioning of an individual. ‘Coming out’ is a process of self-validation and religious views of the individual and those around them can sometimes create major difficulties. Clinicians need to be cognizant of social and religious attitudes of their patients to their own sexuality and also to specific stages of coming out. It is likely that religion and spirituality can be both obstructive or facilitatory for LGBT individuals depending upon a number of factors including homophobia or transphobia related to strong religious views. Various tenets of religions are described briefly in this chapter and their attitudes to alternate sexuality or sexual variations referred to. An attempt is made to advise clinicians and other mental health professionals on how to engage with LGBT individuals. Spirituality can play a major role in some people’s lives even when they do not follow specific organized religions.

Spiritually integrated psychotherapy

There is growing recognition that it is important to understand how spirituality is related to mental health and distress, and how it can be integrated into psychotherapy. Spiritually integrated psychotherapy (SIP) involves the adaptation of secular psychotherapies in order to be more culturally sensitive and client-centred to spiritually and religiously inclined clients. Literature shows that SIPs are at least as effective as conventional psychotherapy for treating different mental disorders, and cognitive behavioural therapy (CBT) is the most widely investigated clinical modality that has been adapted to include spiritual content. The objective of this chapter is to describe the adaptation of traditional CBT techniques by integrating spirituality to enhance cognitive restructuring, behavioural activation, coping, psychoeducation, and to facilitate greater motivation for treatment. Several practical examples are given, including the use of meditation and prayer in the treatment process.

Religious and spiritual struggles and mental health: Implications for clinical practice

This chapter reviews the growing literature on religious and spiritual (R/S) struggles and their implications for clinical practice, with a focus on people with psychiatric problems. The empirical literature indicates that R/S struggles: (a) take a variety of forms that reflect tensions and conflicts around the sacred; (b) are not uncommon among people with psychological problems; (c) are robust predictors of poorer mental health; (d) may be a cause and/or effect of psychological problems; and offer the potential for positive psychological growth and transformation, depending on how they are understood and handled. Practical recommendations are then offered to help psychiatrists draw on basic clinical skills to assess and address R/S struggles in treatment. Specifically, this chapter considers how practitioners can help patients name and normalize their struggles, accept and reflect on these conflicts, and access R/S resources that offer potential resolutions to their struggles.

Principles and practices of Buddhism in relationship to mental health

This chapter explores how the Buddhist framework can assist clinicians in treating mental health suffering. It highlights the Buddha’s ‘four noble truths’ and the ‘eight-fold path’ as frameworks for clinical applications. It describes the distinguishing features of the calm and insight aspects of meditation, their indications, and how they can be used in clinical presentations. It also describes mindfulness from a Buddhist perspective and compares this ancient traditional perspective with contemporary approaches to mindfulness. It also underscores the importance of cultivating four relationship qualities, known as the ‘four divine abodes’ (loving-kindness, compassion, appreciative joy, and equanimity). These qualities help to balance mindfulness, harmonize intra- and inter-personal relationships, and support the therapeutic endeavour. Finally, it provides some reflections on the possible benefits of using a Buddhist framework and Buddhist practices in the delivery of mental health services.

Non-religion, atheism, and mental health

Based on the well-established link between religiosity and positive mental health outcomes, it has been argued that non-religiosity is a health liability. However, most of this research suffers from methodological problems that limit their generalizability to non-religious populations, such as atheists and agnostics. In this chapter, we draw attention to these methodological issues, and argue in favour of a richer conceptualization of non-religion than has been theorized in previous literature. We further review recent work from various countries around the world, which challenges the notion that non-religiosity presents a health risk, finding instead that the non-religious experience similar levels of health and well-being benefits as the religious. We end by briefly discussing the limitations and recent backlash at this literature, while suggesting that the study of the non-religious may transform how we understand the interaction between beliefs, rituals, and health.

Differentiating spiritual experiences from mental disorders

It is not uncommon for patients with mental disorders to have symptoms with religious or spiritual (R/S) contents, and, on the other hand, spiritual experiences often involve psychotic-like phenomena. This frequently creates difficulties in differentiating between a non-pathological R/S experience and a mental disorder. Clinical differentiation between a non-pathological R/S experience and a mental disorder with R/S content brings risks in both extremes: to pathologize normal R/S experience (promoting iatrogenic suffering) or neglecting pathological symptoms (delaying proper treatment). In order to mitigate these risks, this chapter will gather the best current scientific evidence and propose clinical guidelines to help the distinction between R/S experiences and mental disorders with R/S content. Scientific studies in people who have spiritual experiences should be encouraged, especially investigations of the phenomenology, neurobiology, precipitants, and outcomes in order to enlarge the empirical base needed to advance the criteria for this differential diagnosis.

Mechanisms: Religion’s impact on mental health

This chapter examines the genetic, psychological, social, behavioural, environmental, individual-level, and biological pathways that may help explain the relationship between religion/spirituality (R/S) and mental health. I use spirituality interchangeably with religion, since my use of the term ‘religion’ goes far beyond institutional religion—that is, it includes individual beliefs, practices, and intrinsic commitments related to the Transcendent. No doubt, there are many different ways that R/S might influence mental health in either positive or negative ways. Not only are there likely to be many pathways of direct influence, but also indirect effects that may be difficult to appreciate unless a comprehensive approach is taken. First, I briefly review research on the relationship between R/S and mental health, and then, having established a relationship, attempt to explain it by the multiple pathways noted above.

Spirituality and end-of-life experiences: Meeting the spiritual needs of the dying

Most patients in palliative care report that it is very important to receive health care that is respectful, compassionate, and culturally sensitive to their spiritual needs. Providing spiritual care to people approaching the end of life and understanding that their mental and spiritual experiences constitutes a key aspect to providing a more effective treatment and quality of life at this moment. End-of-life experience (ELE) provide comfort, and represents a source of spirituality and meaning to the dying. Spiritual experiences also give hope, meaning, and strength to family members and healthcare professionals dealing with terminal conditions and suffering. This chapter reviews the scientific evidence about ELEs and discusses the potential clinical implications of these experiences to healthcare practice. Different patients’ vignettes are presented to illustrate and provide practical guidance to understanding and addressing ELE and spiritual care in end-of-life care settings.

Judaism

Judaism was the first monotheist religion and has about 18 million adherents in the world today. This review covers the historical development of biblical Israelite religion in the ancient land of Israel beginning 1000 BCE and how it gradually developed into the very different rabbinical Judaism that exists today. While most Jews today are secular participants in Western democratic liberal cultures, Orthodox, and especially ultra-orthodox Jews are a rapidly growing minority with special needs for culturally sensitive psychiatry acceptable to their religious lifestyle and observance to the commandments. The traditional Jewish beliefs in a future Messiah is also a component of some manic states and the differential diagnosis between ‘religiosity’ and mental illness can be important in psychiatric settings with orthodox Jewish patients.