PSYCHIATR

Y AND
SPIRITUALI
TY
MODERATOR- DR M PRAVALLIKA
MAM
PRESENTER- DR YASHWANTH G
IMH HYDERABAD
IN THE PAST DECADE OR SO, RESEARCHERS
ACROSS A RANGE OF DISCIPLINES HAVE
STARTED TO EXPLORE AND
ACKNOWLEDGE THE POSITIVE
CONTRIBUTION SPIRITUALITY CAN MAKE
TO MENTAL HEALTH. SERVICE USERS AND
SURVIVORS HAVE ALSO IDENTIFIED THE
WAYS IN WHICH SPIRITUAL ACTIVITY CAN
CONTRIBUTE TO MENTAL HEALTH AND
WELLBEING, MENTAL ILLNESS AND
RECOVERY.
 INTRODUCTION

SPIRITUALITY
WHAT IS
IN INDIAN
SPIRITUALITY?
CONTEXT

SPIRITUALITY
FORMS OF
AS AN
SPIRITUALITY

OVERVIEW
INERVENTION

HUMAN
ASSESSMENT
DEVELOPMENT
OF
AND
SPIRITUALITY
SPIRITUALITY

SPIRITUAL
SPIRITUALITY
MODEL OF
IN PSYCHIATRIC
MENTAL
DISORDERS
HEALTH
Introduction-

■ The word ‘Spirituality’ comes from the Latin word

“spiritus”. The word “spiritus” itself is a translation from a
Greek word ‘pneuma’ which is originated from Hebrew word
meaning ‘breeze’, ‘wind’, ‘breath’
 ■ Spirituality is a word used in an abundance of
contexts that means different things for
different people at different times in different
cultures.
■ Some of the more common themes in the
literature describe it using one or more of the
following elements:

BACKGROUN 1.
2.
A Sense of purpose1
A sense of connectedness- to self, nature,’

D- 3.
God’ or Other1
A quest for wholeness2
DEFINITION 4. A search for hope or harmony3
5. A belief in higher being or beings1
6. Some level of transcendence, or the sense that
there is more to life than the material or
practical4
7. Those activities that give meaning and value
to peoples life
 ■ A spiritual person- neither participate in a
religion or is religious
may participate in religion but lack religiosity
may participate and have religiosity.

What is ■ Multidimensionality of spirituality5-

1. Behavioral

sprituality? 2.
3.
Cognitive
Affective
4. Motivational dimensions
 Religion Spirituality

Beliefs Emotion and trust

Authoritarian Democratic

Binds believers to their own community Accepts the experiences of others as valuable

Imposed from without Imposed from within

Religion vs Strict rules No rules

Spirituality Based on fear

tells you truth

Based on love

Lets you discover truth

Separates Unites

Talks about punishment, the threat of Talks about karma

hell

Tells stories about angels and God Encourage you to make your own path create
your own story
SPIRITUALITY
• RELIGIOUS
• NONRELIGIOUS
ONE MAY NOTICE THAT SPIRITUALITY’S DEFINITION IS MORE SUBJECTIVE,LESS
MEASURABLE. FROM A CLINICAL PERSEPTIVE,HAVING A TERM THAT IS BROAD
AND DIFFUSE IS GOOD BECAUSE THIS ALLOWS PATIENTS TO DEFINE WHAT IT
MEANS TO THEM

ROOF(1999) • A source of values and ultimate meaning or

argues that purpose beyond the self, including a sense
of mystery and self-transcendence
spirituality • A way of understanding
encompasses • Inner awareness
• Personal integration
4 themes
 Forms of spirituality

Prayer and meditation

Transcendental meditation
Samadhi
Zen
Mysticism
Spirit possession
Human development and Spirituality

Human development and

spirituality

Cognitive-Structuralistic
Genetic perspective approach Integrative Approaches
Religious perspective
1.G Stanley hall 1.Jean piaget 1. Ken Wilber
1.Christian
2.James mark baldwin 2.Lawrence Kholberg 2. James Lober
2.Hinduism
3.James fowler
3.Islamic
4.Fritz oser
4.Buddhism
 Evagrius ponticus- THEOSIS

1.Religious In his writing 4 aspects of

perspective- process of theosis has been
i.Christian mentioned
• Effort and noneffort
• Transformation
• Unification
• Love and freedon
■ On the other hand western
Christians approached
human development and
the journey to God into 3
stages
1. Purgativa(purgation)
2. Iluminativa(Illumination)
3. Unitiva(union)
ii.Hinduism perspective

■ Traditional hindu thought sees spiritual development in the context of human

life span
Laws of manu divided human life into 4 ashrama
1. Bramacharya
2. Grihastha
3. Vanaprastha
4. Saanyasa
iii.Buddhism
perspective
■ In buddhism spirituality development
happens in relation to meditation
practice
Ten Oxherding pictures
- These series of pictures depicts the
journey toward the buddhist goal of
discovering the emptiness of the false
self and leaving it behind for our true
self and a state of nondualism
- It is a journey that begins with a state
of emptiness and ends with a
different experience of it
 According to him the various states of
development in the individual( ontogeny)
recapitulate or repeat the stages in evolution
or development of the species( phylogeny)

2.Genetic
perspective- The time period of adolescence is supposed

i.G Stanley to be the key time for religious development

Hall
Hall argued that adolescengt transition
should include ba change in one’s attitude
towards religion’ which can help us achieve
our true place in the world.
 First he accepted the concept of recapitulation

Second- social dimension- Dialectical social

relationship between the individual and others
ii.James mark
baldwin He thought that spiritual development
proceeded through a number of stages
• Prelogical
• Logical
• Hyperlogical
• Extralogical
 He was concerned about rational base of
morality rather than its affective aspect

3.Cognitive – He referred to those rules as ‘the deepest

structuralist functional constant of human nature
Approaches
i.Jean piaget According ti him 2 types of morality
evolve during development
• Heteronomous
• Autonomous
ii.Lawrence Kohlberg

■ He tried to explain spiritual/religious development in parallel with

moral development
■ He believed that ‘morality was a logically independent realm’
- Morality development occurs in people with no religious beliefs
- Individuals at each stage of moral development can have a very
different religious view
iii.James Fowler

■ Faith development
■ Faith-” an evolving sense of spirit and relatedness to others that provides meaning and coherence and
allow participation in ‘an ultimate environment”
■ Faith involves-1. knowing or belief
2. Valuing or commitment
3. meaning construction
Faith creates a Triadic relationship between ourself, others and ‘shared centers of value and power’
-Polytheists
-Henotheists
-Monotheists
iv. Fritz oser- ■ RELIGIOUS JUDGEMENT- How the

RELIGIOUS
individual deals subjectively wit the process of
meaning making, coping with contingencies
and creating subjective security in a world of

JUDGMENT
objective insecurity
4.Integrative approaches- i.Ken wilber

■ Spiritual development happens through a stage like progression

■ Each stage ‘transition structures’ are developed
TERMS
■ Outward arc
■ Inward arc
■ Centauric stage
ii. James loder

■ His work is unique as it offers both theological and psychological elegance

■ According to him human development is shaped by spiritual transformation.
Development takes place in 2 orders
1. Divine
divine
2. Contingent

Spiritual
development contingent
Spiritual model of Mental health
■ Freud had blamed religion as a kind of psychological pathology
■ Spiritual problems might involve issues of balance more than a specific and predictable
set of psychological problems. So, one can experience that spirituality on occasions, may
be cause for exacerbation of pathology
■ Medical model has its own issues
1. Definition of health
2. Individual belief
3. Individualistic view of mental disorder and treatment over emphasized
4. Ignores moral component in mental disorders
Negative effect of spirituality/ religion on
mental health
1. Interpersonal problems or religious struggles related to belief, community participation
or the effect of religious practices
2. Unbalanced beliefs, such as stress on sinfulness leading to excess guilt
3. Spiritual abuse
Dissatisfaction with the negative medical model approach to mental health has led
psychologist to consider alternative approaches

■ HEDONIC APPROACH-SWB
■ EUDAIMONIC APPROACH- PWB

POSITIVE PSYCHOLOGY AND SPIRITUALITY

1. Spirituality can be seen as source of moral inspiration and dialogue partner
2. Spirituality can be seen as a kind of goal-directed activity or striving that can have
positive benefits
■ The lack of this meaning can be important pathology
■ Maddi gave 3 components for this
1. Vegetativeness
2. Nihilism
3. Adventurousness
Factors mediating the relationship
between spirituality and mental health
■ Some of the research exploring the association between spirituality and mental health
attempts to understand the mechanisms through which potential benefits may occur.
• coping styles
• locus of control
• social support and social networks
• physiological mechanisms, and
• architecture and the built environment.
 Spirituality and psychosis

Spirituality and depression

Spirituality in
psychiatric Spirituality and addiction

disorders
Spiritualit and anxiety disorders

Spirituality and the brain

Spirituality and psychosis
■ Does religion affect the development of psychosis?
■ Are there situations in which religion may be harmful to patients with psychosis?
■ Are patients with psychosis more prone to engage in religious activities?
■ Can religious coping help patients with psychosis?
■ Does religion have an effect on patients’ outcomes?
■ What about delusions with religious content?
■ How can clinicians deal with the religious issues brought forth by patients with
psychosis?
 Religious involvement and affiliation appears to be
related to fewer problems with depression, higher
level of well being, and quicker recovery from
depressive episodes when problem occur especially in
those with an intrinsic religious motivation.1

Spirituality Exline et al, found that college students reporting

religious strain, such as religious doubts or
and disagreement with family members overe religious
issues, reported higher level of depression and
depression suicidality

Spirituality when separated from reliogion does not

have the same positive effect
 Mechanism for the relationship
between religiosity and deprerssion
• Buffering mechanism
• Help cope emotional effect of depression
Spirituality • By discouraging behavior that increase the risk of
stress or depression such as substance use
and
Specific factors that buffer provide
depression
• Specific belief-after life belief, god image, beliefs
that reduce hopelessness
• Positive coping by seeing God as a partner
• Social support from others in religious
community
Spirituality and addiction

■ Virtually all studies on alcohol use or abuse and other drug problems have found that
religiousness-especially intrinsic religiosity- is associated with fewer problems
 It depends on number of factors-
• Childhood religiosity
• Current religious affiliation
• Level of commitment or participation
• How the person interprets his or her religious tradition
 Qualitative studies also found that spirituality plays an important role in therapeutic
program on alcohol use like Alcohol Anonymous(AA)
Spirituality and addiction

■ GERALD MAY(1982)
According to him there are many ways to deal with addiction spirituality is one of the way
1. Avoid emptiness of freedom and to fill it up with another less damaging addiction
2. Psychological techniques
3. Spiritual technique
Spirituality and the Brain

■ Neurotransmitters-Serotonin and dopamine have mostly been studies in terms of

spirituality
■ Anatomy- prefrontal cortex and its connection with the thalamus,posterior superior
parietal lobe, and limbic system( amygdala and hippocampus)
- Medial temporal lobe
■ Autonomic nervous system
■ Neurotransmitter receptor
Assessment of Spirituality

■ Biopsychosocial model of disease is not sufficient

■ we should consider cultural aspect- A cultural formulation is incomplete without
assessment of spirituality
■ Assessment of spiritual needs of patient would serve following needs-
1. Source of vitality or motivation
2. Patients wishes as well as of carers
3. The epidemiology of spirituality and mental health
4. Influence of spirituality on the attitudes and decisions of psychiatric staff
Quantitative methods

1. Royal free interview for religious and spiritual beliefs

2. The spiritual involvement and beliefs scale
3. The multidimensional instrument by Fetzer institute
4. Hill & Hoods measure of religiosity
Drawbacks
 Inability to capture humans subjective experience
 Unnecessary intrusiveness & patient may feel and be valued insufficiently as an individual
So they are used mainly for research and audit purpose
Qualitative methods

■ Rapid assessment in clinical setting

1. What helps you most when things are difficult?
2. Do you think yourself as being either religious or spiritual?
■ Detailed assessment guidelines
1. Guide published by spiritual and competency and resource centre.
2. Guide to the assessment of spiritual concerns in mental healthcare, Eagger(2006)
3. The leaflet spirituality and mental health( Royal college of psychiatrists,2006)
Qualitative methods
■ Puchalski(2000)-FICA
Faith and belief
Importance
Community
Address in care
■ Anandarajah(2001)-HOPE
Source of Hope
Organized religion
Personal spirituality and practices
Effects of medical care and end of life issues
■ Maugans(1996)-SPIRIT
Spiritual belief
Personal spirituality
Integration in religious community
Ritualised practices
Implication for medical carwe
Terminal events planning
Other methods

■ Spiritual timeline
■ Spiritual genograms
■ Spiritual lifemaps
■ Spiritual eco-maps
Spirituality as an intervention

■ 12 step Alcohol anonymous

■ Spirituality augmented CBT
■ Religious IPT
Spirituality in Indian context
■ Ramakrishna paramahamsa
Advaita Vedanta philosophy
Nirvikalpa samadhi
■ Mahesh prahad varma (Maharishi Mahesh Yogi)
Connected science and spirituality
Deep meditation- Transcedental meditation
Role of psychiatrist
1. Important that we incorporate spirituality and religious practices in our treatment
protocol.
2. We must propagate the Bio-psycho-socio-spiritual model in our approach in psychiatry.
3. Psychiatric history should be catered to the patients’ spiritual orientation and religious
practices. The psychiatric history should gather information about patient’s religious
background and experiences in the past and what role religion plays in coping with life
stresses. We should respect and support patients’ religious beliefs if these help them
to cope better or do not adversely affect their mental health.
4. Partnership with the religious workers is an useful area
Clinical and research findings related to
spirituality and mental health
1. Miller et al. made a 10-year follow up study on depressed mothers and their offsprings and
reported that maternal religiosity and mother-child concordance in religiosity were protective
against depression in the offspring. They also reported that low level of religiosity was
associated with substance abuse in the offsprings.
2. J. Scott Tonigan, a research professor of psychiatry at the University of New Mexico, followed
up 226 patients of alcohol dependence and reported that spirituality predicts behavior such as
honesty and responsibility which in turn promoted alcohol abstinence.
3. study on the factors in the course and outcome of schizophrenia was conducted in the.
Department of psychiatry, Christian Medical College, Vellore.. It was a collaborative
study among three centers—Vellore, Madras and Lucknow. A two-year and five-year follow up
showed that those patients who spent more time in religious activities tended to have a better
prognosis.
Take home message

■ The above talk we realize that religious beliefs and practices of psychiatric patients
should be given importance. The sense of hope and spiritual support that patients
get by discussing religious matters help them to cope better.
■ the importance of religion and spirituality is not sufficiently recognized by the
psychiatric community.
■ Mental health workers must take it seriously since psychiatry cannot afford to ignore
References

1. Hassed, C. S., 2000, Depression: dispirited or spiritually deprived?: Med.J.Aust., v. 173,

no. 10, p. 545-547.
2. Humphreys, J., 2000, Spirituality and distress in sheltered battered women:
J.Nurs.Scholarsh., v. 32, no. 3, p. 273-278.
3. McSherry, W., 2000, Education issues surrounding the teaching of spirituality:
Nurs.Stand., v. 14, no. 42, p. 40-43.
4. Oldnall, A., 1996, A critical analysis of nursing: meeting the spiritual needs of patients:
J.Adv.Nurs., v. 23, no. 1, p. 138-144.
5. Glock CY. On the study of religious commitment. Relig Edu Res Suppl. 1962;57:98–110.
References

6. Textbook of postgraduate psychiatry;JN Vyas, Shree Ram Ghimire;3rd ed,vol 2,chap

60;page 1863:80
7. Sadock, B. J., Sadock, V. A., & Ruiz, P. (2017). Kaplan & Sadock's comprehensive
textbook of psychiatry (Tenth edition, 50th anniversary edition.). Philadelphia: Wolters
Kluwer
8. Sadock, B., Sadock, V. and Ruiz, P. (2017). Kaplan & Sadock's Synopsis of Psychiatry.
11th ed. Philadelphia, Baltimore, New York, London, Buenos
THANK
YOU