Spirituality and Mental Health: A Case Against Ignorance

1 Spirituality and Mental health : A Case Against Ignorance >>> David H. Rosmarin, , is an Instructor in the Department of Psychiatry at Harvard Medical School and Assistant Psycholo-gist at McLean Hospital. My professional colleagues routinely greet me with surprise during discussions about my program of research on Spirituality and Mental health . Most are simply astounded to learn that 93% of the population holds belief in God or a Higher Power1, and that over 50% of men-tal health patients in national studies desire to discuss spiritual/religious issues with their psychotherapist2. !eir jaws literally drop when I report "ndings from a recent study I conducted with patients Harvard s McLean Hospital. Despite its location in Eastern Massachusetts one of the least religiously dense ar-eas in the country over 50% of subjects reported high levels of belief and over 1/3 reported a strong desire to integrate Spirituality into their treatment3.

2 Most of my colleagues are also completely unaware that nearly 50,000 academic articles, book chapters and review papers describe the interface of Spirituality and Mental health . !is body of work suggests that like almost anything in life there are both positive and negative e#ects. On the one hand, spiritual be-lief and practice can serve as a vital resource in times of crisis4, and thereby protect Against hopelessness, self-injury and even suicidality5. For example, in our laboratory, we recently found that faith in a benevo-lent God was associated with increased tolerance for life s uncertainties as well as less worry6. On the other hand, spiritual struggle ( , religious guilt, anger at God) can exacerbate and possibly even facilitate the onset of psychiatric symptoms7. I suppose I should be the one who is surprised though.

3 Even in this increasingly secular age, spiri-tuality continues to play a central role in political, economic, and other trends across cultures globally. Despite these facts though, the majority of Mental health clinicians I have encountered fail to even in-quire about Spirituality in the context of clinical care, aside from a perfunctory (and relatively meaningless) assessment of religious a$liation during a structured diagnostic interview. Why the Ignorance ? Historically speaking there were a number of factors. Previously, many feared that religion would be misused in treatment as it was in the 1800s when Mental illness was attributed to demonic possession and met with exorcism and other forms of religious torture8. More recently ( , early 1900s) anti-religious sentiments promulgated by Sigmund Freud in his open call to pathologize religion as neurosis 9 facilitated a disdain for patient Spirituality .

4 A simpler explanation though one which seems much more pertinent in the modern day now that fear of exorcism has waned as has en-thusiasm for Freudian theory in favor of psychologi-cal science and evidence-based treatments is that psychiatrists, psychologists, and other Mental health professionals are simply less personally involved with Spirituality /religion than the general population10. As such, they fail to recognize when it is relevant to oth-ers as well. Regardless of why we are ignorant though, available evidence suggests our failure to appreciate Spirituality may be a signi"cant problem. It is not inconsequential that the general public is more likely to approach clergy about personal problems than Mental health professionals11. It is also not insigni"-cant that the most widely practiced Mental health treatment program is the spiritually-based Alcohol-ics Anonymous an approach so widespread that its bi-annual international conventions draw a crowd of over 50,000 people.

5 For these and other reasons, over 40 clinical trials of spiritually-integrated treatments have been conducted to date, and initial "ndings are promising12. In our laboratory, through a treatment program that utilized traditional spiritual readings as well as gratitude exercises, we observed dramatic shifts in anxiety symptoms over a relatively brief pe-riod13. It goes without saying that spiritually-based treatments are only appropriate for self-selecting pa-tients who so desire such treatment. However, con-sidering that of the adult population ex-periences a full blown Mental disorder each year and less than half of these individuals receive adequate treatment14, it behooves our "eld to better develop knowledge of and competencies in this area. Doing so may make dissemination of e#ective treatments an easier task nationwide.

6 What is necessary to facilitate a shift? As with all things in the "eld of medicine, change starts in the halls of the academy: Research, research and more research will set us free from Ignorance . Despite the proliferation of research on Spirituality and Mental health , no dedicated funding exists for this area of study. Consequently, most studies have been cross-sectional, conducted within community samples, and many are plagued by methodological limita-tions. Answering many basic questions about spiri-tuality and Mental health will require studies within clinical samples using experimental methodologies and biomarkers of functioning ( , fMRI), however this cannot happen without federal funding through the NIH and its subsidiaries. Given the widespread prevalence of religion within the population it is somewhat odd that these tax-dependent entities have not committed dedicated resources to expand our knowledge of this subject.

7 My hope (and prayer) is that health policy will recognize the importance of Spirituality and commit itself to a responsible, em-pirical approach to this subject matter just as we have for other areas that were historically ignored such as domestic violence, sexual abuse, and Poll. Graph illustration of results from the 2011 Gallup Poll on religion. Accessed June 1, EM, Westefeld JS, & Ansely TN. Spiritual is-sues in counseling: Clients beliefs and preferences. J Couns Psychol. 2001;48(1): Spirituality into treatment of Mental dis-orders. Invited lecture. Inter-American University of Puerto Rico (Universidad Inter-Americana de Puerto Rico), Ponce, PR. March, 2012. 4 Pargament, KI, Koenig, HG, & Perez, LM. !e many methods of religious coping: Development of the RCOPE. J Clin Psychol. 2000;56:519 P, Ciarrocchi J, Piedmont R, Cheston S, Peyrot M, Fitchett G.

8 !e belief and practices, and hopelessness in persons with clinical depression. J Consult Clin Psychol. 2000;68(6) DH, Pirutinsky S, Auerbach RP, et al. In-corporating spiritual beliefs into a cognitive model of worry. J Clin Psych. 2011;67 , S, Rosmarin, DH, Pargament, KI, & Midlarsky, E. Does negative religious coping accom-pany, precede, or follow depression among Ortho-dox Jews? J A#ect RE, Muniratnam, MCS. J Cogn Psy-chother. 2011;25(4) S. Future of an Illusion. New York, NY: W. W. N o r t o n & C o m p a n y, 1 9 8 9 .10 Delaney HD, Miller WR., & Bisono AM. Religi-osity and Spirituality among psychologists: A survey of clinician members of the APA. Prof Psychol Res Prac. 2007;38(5):538-546. 11 Norris FH, Kaniasty KZ, & Scheer DA. Use of Mental health services among victims of crime: Fre-quency, correlates, and subsequent recovery.

9 J Con-sult Clin Psychol. 1994;58(5) TB, Bartz J, & Richards PS. Outcomes of spiritual adaptations to psychotherapy: A meta-ana-lytic review. Psychother Res. 2007;17:643 DH, Pargament KI, Pirutinsky S, Ma-honey A. A randomized controlled evaluation of a spiritually- integrated treatment for subclinical anxiety in the Jewish community, delivered via the Internet. J Anxiety Disord. 2010;24(7):799-808. 14 National Institute of Mental health . Graph illus-tration of results. Accessed March 18, Highlights34 Harvard health Policy Review