Religion, Spirituality and Mental Health: An Overview

 

Abstract

Introduction 

Religious and Spiritual beliefs are common worldwide. They influence the subjective well-being of individuals. For some, it is the basis of their existence, while some are fairly indifferent. Generally, the disposition towards spirituality and religion varies. 

Despite significant advances in technology and science, about 90% of the world‘s population is currently involved in some form of religious or spiritual practice (Koenig, 2009). In many Middle Eastern and African countries, nonreligious persons make up less than 0.1% of the population. In 8 of 238 countries, more than 25% of the population claim not to be religious; in those countries, there are limitations placed on religious freedom. Atheism is quite rare around the world. More than 30 countries report no atheists and in only 12 of 238 countries, atheists constitute 5% or more of the population. In Canada, 12.5% are non-religious and 1.9% are atheists (Smart et al., 2007). 

Although evidence for religion playing a role in human life dates back to 500,000 years ago when ritual treatment of skulls in China took place during the Paleolithic period (Smart et al., 2007), scientific interest in the relationship between religion and spirituality and mental health only increased in recent years. Recent studies have shown that religion and spirituality have been associated with several different health outcomes both physical and emotional (Moreira-Almeida et al., 2014). Regarding physical health, most studies have found that spirituality and religiosity are related to lower levels of hospitalization and pain, greater survival, and better functional status and cardiovascular outcomes (Powell et al., 2003). However, it is noteworthy that at least 80% of the research in this area has focused on mental health outcomes (Koenig, 2012).

Better mental health, higher quality of life, greater well-being, lower rates of depression, suicide, and anxiety have all been reported among more religious individuals (Koenig, 2004). Despite these positive aspects of spirituality and religion, there is a growing body of research demonstrating that there are also negative effects of spirituality and religion on mental health and that religiously based struggles can be a source of distress to individuals. This dual nature of spirituality and religion in the lives of psychiatric patients demands increased awareness of the religious aspects of patients' lives, and also the resources available to assist those who are struggling. 

This extended essay is not an answer to the questions that might have been raised on religion/spirituality and mental health — if anything, it may add to the questions — but to contribute to the conversation, citing instances in the Bible. 

Definitions 

Although spirituality and religiosity are considered by many as interwoven and used interchangeably, they are not the same. Religiosity is defined as the “extension to which an individual believes, follows, and practices a religion (Koenig et al., 2012) and these beliefs usually influence how people seek to live out their lives and treat others (Parker et al., 2003). Spirituality, on the other hand, is more complex a concept. According to Koenig et al. (Koenig et al., 2012), spirituality means seeking meaning in life, relations with the transcendent or sacred, and connection with a supreme being or higher power. A more comprehensive concept is provided by Puchalski et al. (Puchalski et al., 2009) who define spirituality as the aspect of humanity that refers to the way individuals seek and express purpose and meaning and the way they experience their connectedness to the moment, to self, to others, to nature, and the sacred.

The Buddhist Lama Michel Rinpoche at a time viewed spirituality as a necessity, required to make sense of our existence, understanding each being as unique and subjective, constituted not only of a body but of an internal reality which is as important as the external, both interconnected and synchronous. Spirituality is the inner process of transformation and religion is the route that someone creates to reach this process. The religious institutions create conditions to keep alive this method adopted by the religion (Lama, 2013). According to Salgado (Salgado, 2006), for instance, “spirituality is broader and more open than religion — it implies the universal and religion, the particular, the individual”. Religion can then be viewed as an organized system of beliefs, practices, and symbols devised to facilitate the approach to the sacred, but it most times involves rules on life conduct guided by a community (Moreira-Almeida et al., 2014). Therefore, religiosity offers guidelines for man’s behaviour, influencing self-destructive tendencies, interfering with suicidal thoughts, and stimulating strategies for coping with daily adversities (Thiengo et al., 2019). These different definitions have been discussed by several authors, however, no consensus has been reached (Puchalski et al., 2009).

Brief History of the Feud Between Mental Health and Religion/Spirituality 

The relationship between religion and mental dates back to ancient times. Historically, there has been significant conflict between psychiatry and religion. Religion was quickly labelled as problematic as psychiatry was emerging as a discipline. Sigmund Freud (Freud, 1995), In 1907, described religion as a ‘universal obsessional neurosis’. Psychiatry’s position as unfriendly to religion was further strengthened as Freud’s atheistic viewpoint was widely adopted by the practitioners of psychoanalysis. Also, the medicalization of mental health estranged some clergy who perceived psychiatry as ‘anti-Christian’ (Sullivan et al., 2014). The difference between psychiatry and religion continued through most of the 20th century; some recent authors even suggest that notable figures in religious history such as Abraham, Moses, Jesus, and Saint Paul may have suffered from psychosis (Murray et al, 2012). However, In the last few decades, psychiatry has advanced toward a more positive and receptive stance toward religion and spirituality. This is partly due to a rise in appreciation for the significance of patients’ culture, and increasing evidence that religion and spirituality can have salutary effects on mental health (Aist, 2012). As a result, in 2011, about 79% of medical schools in the U.S. offered some variation of spirituality in their curriculum, and 75% of the schools mandated medical students to take at least one course in spirituality (Dugan et al., 2011).

Positive Aspects of Religion and Spirituality 

Religion and spirituality tend to have a positive influence on patients’ overall quality of life, having been associated with lower levels of depressive symptoms, fewer symptoms of posttraumatic stress and eating disorders, lower risk of suicide, less perceived stress and personality disorders, and many more (Samuel et al., 2014). In substance abuse, a higher level of certainty in one’s belief system is associated with a more optimistic life orientation, increased resilience to stress, greater perceived social support, openness to change and compliance with treatment (Samuel et al., 2014).

Religion is often a positive coping means with difficult situations for many patients. Experiencing connectedness to the moment, to self, to others, to nature, and the sacred helps reduce depression and anxiety and is associated with better mental health, social relations, and general psychological well-being. Religious beliefs and practices help people to better cope with stressful life circumstances and give them greater life satisfaction. Generally, belief in God has been associated with better psychiatry treatment outcomes (Rosmarin et al., 2013).

Negative Aspects of Religion and Spirituality 

Due to the dual nature of spirituality and religion, as there are positive aspects, there are also negative aspects. For instance, people who manifest greater spiritual and religious orientation tend to have lower well-being. In psychosis, religion/spirituality may have more negative than positive influences. Incorporating religious and spiritual beliefs into patients' delusions may lead to greater conviction in delusional beliefs and less compliance with psychiatric treatment (Samuel et al., 2014).

Although participation in a religious community is an important factor when considering the beneficial effects of religion and spirituality as individuals suffering from mental illness appear to benefit from being surrounded by a supportive religious community (Bonelli et al., 2012), there is an increased opportunity for miscommunication and misunderstanding in the interactions among religious group members. Some religious and spiritual beliefs or advice from spiritual leaders may conflict with medical advice and management of the patient. 

For some people, religious beliefs may increase guilt or lead to discouragement as they fall short or fail to live up to the standards of their faith tradition (Bonelli et al., 2012). 

Psychotic Disorders in Religious History

In the Holy books, the Bible, for instance, certain individuals had experiences that resemble those now defined as psychotic symptoms, proposing that these experiences may have been manifestations of primary or mood disorder-associated psychotic disorders. Throughout the Bible, there are many stories about influential men and women of faith, who struggled through dark times of hopelessness and depression. Although the Bible doesn’t use the psychiatric terminologies which have now become popular, there are similar words, such as “brokenhearted,” “troubled,” “downcast,” “miserable,” “despairing,” and “mourning,” among others, used in several verses. These findings indicate the possibility of persons with primary and mood disorder-associated psychotic symptoms having had a monumental influence on the shaping of Western civilization (Murray et al., 2014).

Selected below are personalities whose life stories had a high degree of impact on Western civilization in terms of influencing themes found in literature and art, philosophy, religious thought and practice, concepts of social order, and jurisprudence. And, to some extent, it follows a chronological order.

Abraham

Abraham is a historical figure who is considered the patriarch of Judaism, Islam, and Christianity. Throughout his life, he had interactive mystical experiences of an auditory and visual nature that influenced his conduct. 

Abraham, who was first introduced in chapter 11 of Genesis as Abram, heard God speak to him in chapter 12, asking him to leave his family to an unknown destination, and of course, with a promise of becoming a great nation even though, at the time, he was childless. Although it wasn't the first recording of God "speaking" to someone, at that time, it was unstated what religion Abram practised or if "hearing" from God was an usual thing in such religion. Perhaps, the patriarch of many religions could have had an auditory hallucination and, maybe, delusion of grandeur. Also, the reason he was asked to leave was not stated. Could it be that he felt hated, or unsafe, in which case he could have been suffering from persecutory delusion. 

Specific Bible chapters described in Abraham what could be auditory and visual hallucinations. These include Genesis 12:1–3; 12:7; 13:14; 15:111; 17:1–21;22:1–2; and 22:11–12. He could also have had paranoid type ( paranoid schizophrenia subtype) thought content as Genesis 12:3 implies a worldview centred on Abraham, in which universal curses and blessings are dispensed based on one's interactions with Abraham (Murray et al., 2014).

Abraham also demonstrated mistrust, sending his first-born son and all of his other sons to eliminate competition for his second son as seen in Genesis 12:11–13; 14:22; 17:14; 20:11; 21:11–14, and rejecting intermarriage for his son Isaac with any women in his region. 

Moses

Moses, an emotionally unstable man who had earlier committed murder before fleeing from Egypt. The reason for the killing was the perceived oppression of his countryman. While this also is unjustifiable, Moses displayed aggression and anger on many occasions. 

Exodus 3:2; Exodus 33: 21–23; and 34:5–6 are scriptural references to what could be auditory and visual hallucinations with grandiose delusion. Paranoid Type thought content was also exhibited as seen in Exodus 32:25–29. Exodus 34:33 shows something that could be phobia (Murray et al., 2014).

Abraham and Moses were not documented to have had symptoms of disorganization in speech, catatonic symptoms, and negative symptoms. It can also not be ascertained if they experienced any deterioration in occupational or social functions. However, in both, there were auditory and visual hallucinations, grandiosity, delusions, and paranoia, and the symptoms were present for over a year (for several years in Moses). According to DSM-V diagnostic criteria for schizophrenia, these symptoms are enough to make the diagnosis of schizophrenia.

Jesus

Perhaps the most important figure whose personality Christians are building after. He is the founding figure of Christianity, and several verses of the scripture admonish people to live according to his will and lifestyle. A large part of his life was concealed, bringing about the concept of the "lost years of Jesus." Some pieces of literature state that 'He spent six years in Puri and Rajgir, close to Nalanda, the ancient seat of Hindu learning. Then Jesus went to the Himalayas and spent time in Tibetan monasteries studying Buddhism and through Persia returned to Judea at the age of 29.' However, the Bible was silent about the life of Jesus Christ from age 12 to 30.

The last three years of his life, as depicted in the New Testament, indicate his experiencing and showing behaviour closely resembling the DSM-IV-TR–defined phenomena of auditory hallucinations, visual hallucinations, delusions, referential thinking, paranoid-type (PS subtype) thought content and hyperreligiosity. He however did not appear to have signs or symptoms of disorganization, negative psychiatric symptoms, cognitive impairment, debilitating mood disorder symptoms, or any infirmity (Murray et al., 2014). 

As regards perceptual and behavioural changes, there is no established cause. Due to insufficient information, there is also no established decline in his occupational and social functioning. His experiences appear to have occurred for at least a couple of years before his death, however, the absence of physical ailment or apparent epilepsy makes primary psychiatric etiologies more plausible. Bipolar or schizoaffective disorders are also reasonable possibilities (Murray et al., 2014). 

The features resembling psychiatric phenomena seen in him with biblical references include:

Paranoid-type (PS subtype) thought content: Matthew 10:34–39, 16: 21–23, 24:4–27; Mark 13:5–6; Luke 10:19; John 3:18; and John 14:6–11.

Auditory and visual hallucinations: Matthew 3:16–17, 4:3–11; Luke 10: 18; John 6:46, 8:26, 8:38–40, and 12:28–29.

Referential thought processes: Mark 4:38–40 (Figure 3); and Luke 18:31 (Murray et al., 2014).

There are also figures who struggled with features that strongly resemble that of depression. 

In many verses of the Psalms, David wrote about his anguish, loneliness, fear of the enemy, his heart-cry over sin, and guilt. In 2 Samuel 12:15-23 and 2 Samuel 12:18-33, he wrote about his huge grief in the loss of his sons. 

Elijah was weary, discouraged, and afraid. Despite his great victories against the prophets of Baal, he was seen running for dear life when Jezebel threatened him. In the end, he prayed for his own death (1 Kings 19:4).

Jeremiah, known as the weeping prophet, suffered from constant rejection by the people he loved. God had "called" him, yet forbidden him from marrying and having children. He was then depicted as a man who wrestled with great loneliness, feelings of defeat, and insecurity. He could be said to have despised living (Jeremiah 20:14).

Depression and suicide are not so rare. Many individuals committed suicide in the Bible, including Abimelech (Judges 9:54), Samson (Judges16:30), Saul (1 Samuel 31:4), Saul's armour bearer (1 Samuel 31:5), Ahithophel (2 Samuel 17:23), Zimri (1 Kings 16:18), and Judas (Matthew 27:5). 

Some of these figures are prominent, highly revered and, in the case of Jesus, considered as God. Many people are, in fact, striving to be as "holy" and God-loving as they were and to "walk" with God and have the same experience, or more, as they had. It is therefore sometimes difficult to convince patients, even in the face of obvious pathology, that these experiences could be abnormal.

Conclusion

Religion and spirituality and mental health generally have positive associations, however, there are potentially negative aspects to religion and spirituality. As we get a better understanding of the relationship between religion and spirituality and mental health, there is a need for greater discrimination between differing cultures and traditions, and increased focus on the situated experiences of individuals belonging to specific traditions. 

Currently, most research on this topic focuses on Christianity. It will be much agreed that conclusions cannot be made until there is increased attention to differing religious frameworks beyond Christianity. Hopefully, future research will, to a greater extent, be inclusive and answer the questions that have long been asked. 

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*First Written in July 2022