Aug. 28, 2000 -- For nearly a year, Bob had been struggling with deep depression. The depression eventually reached the point where he resigned from his law firm and left his home in Washington, D.C., to move back in with his parents.
"I had been raised a Catholic ... but I hadn't been to Mass in about eight years. At this point, religion was not central to the core of my beliefs," says Bob, who requested that his last name not be used.
Even though he was not religious or spiritually motivated, Bob did go to a church one day and experienced an episode, which he credits as the beginning of his recovery. "One reason I don't like to talk openly about it," he says, "is because it sounds like I am overdramatizing. But this really happened. ... I felt like I was being washed. It was an epiphany for me, a sense of love, recovery, and wellness that took hold."
From that point on, the depression was behind him and he picked up life again. While he acknowledges that there were many factors involved in his recovery, he considers the spiritual support and rebirth of his spiritual faith to be at the center of it.
Is it possible for psychiatry and religious/spiritual beliefs to coexist, or even to be entwined? For most of this century, medicine and religion have remained far apart, even to the point of viewing each other with suspicion. But within in the past decade, the role of spirituality in health care has become more prominent, due partially to the coining of the phrase "mind-body medicine," and the plethora of books that have hit the consumer market.
In addition, scientific research has begun to delve into such topics as prayer and healing, and studies have shown that spiritual practices may indeed exert a positive influence on a person's health and well being, including those experiencing mental health problems.
"Many people turn to prayer and religious faith when they are experiencing emotional distress," says Harold G. Koenig, MD, "And I believe that a person's religious and spiritual beliefs need to be incorporated into the evaluation of every psychiatric patient." Koenig, who is an associate professor of both psychiatry and medicine at Duke University in Durham, N.C., has written a number of books on related issues.
Some experts have questioned the appropriateness of incorporating the spiritual dimension into the arena of psychiatry and psychotherapy, and a number of mental health professionals have considered religion itself to be a strong contributor to mental illness. On the flip side, many believe that spiritual counseling is the domain of clergy, and should not be entwined with psychotherapy.
"As a therapist, I personally believe that spirituality is important in anyone's life -- including individuals experiencing mental illness," says Jody L. Friesen Grande, MSW, LICSW, a Minnesota therapist who is affiliated with the National Alliance for the Mentally Ill. "I facilitate a group ... [where] prayer is considered an important skill for individuals to use. Out of 24 individuals, I would say at least 20, if not all, of them use prayer in their daily lives. These individuals are all diagnosed with depression, [manic depression], anxiety, and personality disorders."
She adds that one client who was dealing with depression and posttraumatic stress disorder reconnected with her church and through her involvement there, along with bible study groups, found her mental health stabilizing.
"It doesn't mean that she is not still experiencing symptoms," says Grande, "But it gives her the hope and strength to make it through the day."
Historically, the relationship between religion and psychiatry was not always controversial. The first psychiatric institutions in America were established by the Quakers, Koenig points out, and the first form of psychiatric treatment was called the moral treatment.
"Chaplains were included as part of the health care team for patients admitted into the early psychiatric institutions," says Koenig, who is also director and founder of the Center for the Study of Religion/Spirituality and Health at Duke. "And patients were rewarded for good behavior by [being allowed] to go to church services that were held on the grounds. So we can see how American psychiatry grew out of religion, that it had an enormous influence."
Psychiatrists themselves may be less religious than the public at large, according to surveys. Whereas 96% of the American population are said to believe in God or some type of higher power, a recent poll found that only 76% of psychiatrists felt the same way. The number of psychiatrists who believed in an afterlife -- 48% -- was also significantly less than the general population.
However, in their professional practice, nearly half of psychiatrists surveyed reported that religious or spiritual issues were frequently involved in treatment and almost 50% stated that they knew the religious background of their patients and more than half said they recommended these practices.
But a professional's own religious and spiritual views don't necessarily affect their ability to deal with these issues, at least, not any differently than other issues that come up, according to Brian Vandenberg, PhD, a professor of clinical psychology at the University of Missouri in St. Louis. "Can a person's ethnic background influence the way they view someone, or [that person's] gender orientation -- of course it will affect it. As therapists, we need to be alert to those issues."
Religion, Vandenberg adds, can also be the source of problems, such as heavy feelings of guilt or sinning. And when people conjure up mental images deemed inappropriate, such as claiming to see religious figures or hear voices, that is often used as an example of mental illness.
But again, this is a complex issue and a cultural one as well, says Vandenberg. "If someone says they hear the voices of God, ... is [that] person crazy or just religious?" Likewise, he points out that we usually don't think a person with Christian beliefs who discusses being saved as needing psychiatric help, but on the other hand, Haitian immigrants discussing voodoo tend to make many people nervous.
What it comes down to is that there's a balance that needs to be addressed, says Koenig. "The spiritual aspects, the medical aspects, and the psychological aspects all need to be evaluated. People are not just biological organisms. You can't really do it all by religion, psychiatry, or medication. The patient is a whole person, which means they have a spirit, a mind, and a body.