Role of Religion and Spiritual Mental Health
Role of Religion and Spiritual Mental Health
Role of Religion and Spiritual Mental Health
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ABSTRACT
Religious and spiritual factors are increasingly being examined in mental health research.
Religious beliefs and practices have long been linked to various mental illnesses e.g.,
hysteria, neurosis, and psychotic delusions. However, recent studies have identified another
side of religion that may serve as a psychological and social resource for overcoming from
the psychological problems. After defining the terms religion and spirituality, this paper
reviews research on the relation between religion and (or) spirituality, and mental health,
focusing on depression, suicide, anxiety, and substance abuse etc. The results of an earlier
systematic review are discussed, and more recent studies in the United States, India, and
other countries are described. While religious beliefs and practices can represent powerful
sources of comfort, hope, and meaning, they are often intricately entangled with neurotic and
psychotic disorders, sometimes making it difficult to determine whether they are a resource
or a liability.
* Clinical Psychologist, Sri Sri University, Bidyadharpur - Arilo, Cuttack - 754006, Odisha
E-mail: [email protected], Mob: +91 9559170575
INTRODUCTION
The birth of religion can be traced back to the advent of mankind itself. The word
religion is derived from the Latin word, “religio” which means to bind fast or fasten up. It is
defined as reverence for God, or Gods, or the fear of God. Religion could be best defined as a
human attempt to achieve the strongest and the best power in-universe. This power they
The term religion refers to beliefs, practices, and rituals related to a specific
established religious tradition. Religion has been defined by the different psychologists from
time to time. Galloway has defined religion as the faith in a power beyond himself whereby
he seeks to satisfy emotional needs and gain stability of life (Joshi and Kumari, 2011).
William James (1985) has regarded religion as the “feeling, acts, and experiences of
individual men in their solitude……. in relation to whatever they may consider the divine”.
All religions are based on a single construct of a strong faith in a higher, invisible
power that controls life and its elements. This can mean that humans have a psychological
necessity/dependence which pushes them to face the challenges and uncertainties of life.
However, the evolution of religion has made it lose its basic essence on “belief” and
metamorphosed into superstitious practices. Some psychologists use the term religion and
spirituality interchangeably (Wood et al., 2009). But there are differences between religion
and superstition. Spirituality is used to refer to the personal, subjective side of religious
spirituality is usually understood at the level of the individual within specific contexts.
Certain such superstitious and dogmatized practices may restrict healthy growth and lead to
something greater than myself, something more to being human than sensory experience, and
that the greater whole of which we are part is cosmic or divine in nature. Spirituality means
knowing that our lives have significance in a context beyond a mundane everyday existence
at the level of biological needs that drive selfishness and aggression. It means knowing that
altruism, life after death, wisdom and truth, with the knowledge that some people such as
saints or enlightened individuals have achieved and manifested higher levels of development
than the ordinary person. Aspiring to manifest the attributes of such inspirational examples
often becomes an important part of the journey through life for spiritually inclined people.
Mental health as a concept reflects the equilibrium between the individual and the
environment in a broad sense. Although there are many determinants of mental health such as
individual factors and experiences, social support and other social interactions, societal
structures and resources and cultural values (Lahtinen, et al., 1999) but religious values
WHO defines mental health as “a state of well-being in which the individual realizes
his or her own abilities, can cope with the normal stresses of life, can work productively and
fruitfully and is able to make a contribution to his or her community”. Mental health is now
viewed as an essential element of our general health, well-being, and quality of life. The
individual value of mental health is realized by positive feelings and different individual
skills and capacities that can be seen as components or consequences of good mental health
(Korkeila, 2000).
as it creates a mindset that enables the person to relax and allows healing on its own (Joshi et
ai., 2008). Religiosity plays a major part in the life of an individual. It can provide hope in
despair. In daily life, people report that they are able to experience deep peace even in the
midst of mental distress (Underwood, and Teresi, 2002) such as psychosis, prejudice, self-
esteem, and intelligence. There are some studies which report that religion is also associated
with some indicators of poor mental health. But sometimes religiousness is accompanied by
irrational thinking and emotional disturbance (Ellis, 1980). The manner in which the
individual adheres to religion has tremendous effects on his personality, attitudes, behavior
and overall outlook of life. It is closely related with the development and change of attitudes
and beliefs, the arousal and reduction of anxiety and guilt and the determination of cognitive
Historically and even today, religion and mental health are conflicting subjects.
humankind from clasps of superstitious medieval practices of witchcraft and the like. Middle
ages were considered as Dark ages where insanity was confused with demonology and the
insane tortured mercilessly. Contradicting, natural causes of mental disorders were proposed
and accepted as well. Religion is said to provide guidelines for one’s course of action in life,
hurdles and stresses, making coping easier. However, the violation of religious norms can
Literature reveals that statements made about the impact of religion and mental health
are based on clinical experiences rather than empirical studies and hence often biased. Some
patients use religion as a positive coping mechanism while others expressed a depressive,
psychotic or anxious understanding. David B Larson, Jeffery S Levin, and Harold G King are
pioneers in this field. Religious commitment reflects the influence of religion on one’s
decisions and lifestyle. According to Gordon Allport, it may be extrinsic or intrinsic. Persons
with an extrinsic orientation use religion to meet their own ends, to provide security, solace,
sociability, distraction, status and self-justification while those with an intrinsic orientation
find their master motive in religion, bringing in harmony with religious beliefs by
intrinsically internalizing it, they are happier, well-adjusted while extrinsically oriented
people are more concerned with dogmatism and prejudice (Moreira-Almeida et al., 2006).
A large part of the research involving religion and health did not have religion as the
focus of the study. Because of that, frequently, the measurement of religiosity involved only a
single question, often simply religious denomination. However, the religious affiliation tells
us little about what religiosity is and how important it is in someone's life. On account of that,
studies using only the subject's religious affiliation have provided, with few exceptions, many
frequent and has associations with mental health, it should be considered in research and
clinical practice. The clinician who truly wishes to consider the bio-psycho-social aspects of
a patient need to assess, understand, and respect a person’s religious beliefs, like any other
psychosocial dimension. Increasing our knowledge of the religious aspect of human beings
will increase our capacity to honor our duty as mental health providers and/or scientists in
Religious methods have often been used to treat the mentally ill. Initially, the priest
was the most important counselor because he had the authority of religion along with
psychological expertise. Faith and belief systems are very important constituents of
psychological well-being and could be fruitfully utilized in psychotherapy. Their usage must
be carefully evaluated. Hence, psychiatrists need to study religion vis-a-vis mental health
more carefully as it is likely to increase the efficiency and acceptability of psychiatry to the
The strongest and most consistent results have been found among different religious
religious to a deeply religious person). Church attendance, i.e. how often someone attends
religious meetings, is one of the most widely used questions to investigate the level of
private religious activities such as prayer, meditation, and religious reading texts) and
necessary for interpreting the relationship between private religious practices and health in
cross-sectional studies. People may pray more while they are sick or in stressful
situations. Turning to religion when sick may result in a spurious positive association
between religiousness and poor health. Conversely, a poor health status could decrease the
capacity to attend a religious meeting, in that way creating another bias in the association
between religiousness and health. Finally, a very important dimension of religiosity religious
commitment, which reflects the influence that religious beliefs have on a person's decisions
and lifestyle. According to the Harvard psychologist Gordon Allport, a persons' religious
Extrinsic Orientation: Persons with this orientation are disposed to use religion for
their own ends (...) (religion) is held because it serves other, more ultimate interests. (...) may
find religion useful in a variety of ways - to provide security and solace, sociability and
distraction, status and self-justification. The embraced creed is lightly held or else selectively
Intrinsic Orientation: Persons with this orientation find their master in religion. Other
needs, strong as they may be, are regarded as of the ultimate significance, and they are, as far
as possible, brought in harmony with the religious beliefs and prescriptions. Having
embraced to believe the individual endeavors to internalize it and follow it fully (Allport, and
Ross, 1967).
Usually, the intrinsic orientation is associated with healthier personality and mental
status, while the extrinsic orientation is associated with the opposite. Extrinsic religiosity is
associated with dogmatism, prejudice, fear of death, and anxiety, it does a good job of
measuring the kind of religion that gives religion a bad name (Donahue, 1985). This very
important and consistent finding totally contradicts Ellis (1988) who argued that one way that
religiosity sabotaged?? Mental health was a lack of self-interest (...) rather than be primarily
self-interested, devout deity-oriented religionists put their hypothesized god (s) first and
themselves second - or last. It is exactly this behavior that has been most consistently
Although the research on religion and mental health involves many other outcomes
(e.g.: psychosis, personality, marital satisfaction and stability, anxiety, delinquency), we will
focus on the four that have been investigated more thoroughly, findings: one indicator of
positive mental health (psychological well-being); and three indicators of mental disorder
Systematic research in many countries around the world finds that religious coping is
widespread. For the general population, research published in The New England Journal of
Medicine found that 90% of Americans coped with the stress of September 11th (2001) by
“turning to religion” (Schuster et al., 2001). Even prior to the year 2000, more than 60 studies
had documented high rates of religious coping in patients with an assortment of medical
disorders ranging from arthritis to diabetes to cancer. One systematic survey of hospitalized
medical patients found that 90% reported they used religion to cope, at least to a moderate
extent, and more than 40% indicated that religion was the most important factor that kept
them going (Koenig, 1998).Psychiatric patients also frequently use religion to cope. A survey
of patients with persistent mental illness at a Los Angeles County mental health facility found
that more than 80% used religion to cope. In fact, most patients spent as much as one-half of
their total coping time in religious practices such as prayer. Researchers concluded that
religion serves as a “pervasive and potentially effective method of coping for persons with
mental illness, thus warranting its integration into psychiatric and psychological practice
Religious beliefs provide a sense of meaning and purpose during difficult life
circumstances that assist with psychological integration; they usually promote a positive
worldview that is optimistic and hopeful; they provide role models in sacred writings that
facilitate acceptance of suffering; they give people a sense of indirect control over
circumstances, reducing the need for personal control; and they offer a community of
support, both human and divine, to help reduce isolation and loneliness. Unlike many other
coping resources, religion is available to anyone at any time, regardless of financial, social,
Depression:
religiousness and depressive symptoms. The authors found that religiousness is modestly but
robustly associated with lower level of depressive symptoms. The size of this association,
although modest, is similar to that found between gender and depressive symptoms. The
association between religiousness and depression did not vary among the different age,
gender or ethnic groups. However, the studies used several types of religious measures and
included people under various levels of stress. Therefore, performing the analysis of all these
studies together may have decreased the strength of the association that might exist in more
specific situations. Corroborating this hypothesis, the review showed that the association
between religiousness and depressive symptoms is higher for people under severe life stress
than for people with minimal life stress. The association was also stronger for samples having
a moderate instead of a minimal level of depression. These findings are in line with those
described above for well-being, the protective effect of religiousness appearing to be stronger
The same meta-analysis discussed above showed that the association between
religiousness and depressive symptoms differed across the type of religiousness measured.
Two specific measures of religiousness had a positive association with high frequency of
depressive symptoms: extrinsic religious orientation and negative religious coping. On the
other hand, intrinsic religious orientation was associated with low levels of depression.
Koenig et al. conducted the only prospective study investigating the impact of religiousness
on the course of depressive disorders. They found out that among 87 depressed senior adults
hospitalized for medical illness, intrinsic religious motivation was associated with faster
remission from depression in a median follow-up time of 47 weeks. For every 10-point
increase in intrinsic religiosity scores (score range 10-50), there was a 70% increase in speed
of remission after controlling for functional status, social support, and family psychiatric
history. Among patients whose physical disability did not improve during the one-year
follow-up (that means a poor response to medical treatment), the speed of remission from
depression increased by 106% for every 10-point increase on the scale of intrinsic religiosity
(Koenig et al., 1998). Thus studies in medical patients, older adults with serious and disabling
medical conditions, and their caregivers suggest that religious involvement is an important
factor that enables such people to cope with stressful health problems and life circumstances.
However, this may not be true in all populations, as studies of pregnant unmarried teenagers
and nonstressed community populations above suggest. Critics say that most studies
reporting positive results are observational and that some unmeasured characteristic may be
Suicide:
Lawrence, Oquendo, and Stanley (2016) noted that suicide and religion are both
complex dimensions (e.g. suicide ideation versus attempts versus death, religious affiliation
versus attendance.) Being part of a majority religious community was found to be a greater
protective factor against suicide than a minority community, but that attending religious
services was not as important as having social supports (whether religious or not.) Norko et.
al. (2017) noted that all major faith communities (including Islam, Hinduism, Judaism,
Buddhism, and Christianity) have strong objections to suicide, and in the study by Lawrence
et. al. (2016) reveal that a sample of clinically depressed patients in a hospital setting was
found to have a higher rate of suicidality if they identified a religious affiliation, the more
they attended religious services, and the more they indicated religion was important. Another
study analyzing over 5000 participants across several large studies identified the three
elements that are responsible for the protective factor of suicide: being of a western culture,
being older, and living in an area with religious homogeneity (Wu, Wang, and Jia, 2015).
Spirituality can be examined through a lens different from organized religion. While
religion may entail specific doctrine, spirituality instead examines one’s relationship with
“self, others and ‘God’”, in whatever form that takes. Mandhoui et. al. (2016) surveyed
individuals who were in the hospital for suicide attempts. Those individuals lower in
spirituality were more likely to attempt suicide at 18 months, with the “value of life” tending
to reduce the chance that someone re-attempts. Amato, et. al. (2016) noted that spirituality
can be integrated into suicide prevention programs such as case management, therapy, and
suicide assessment to determine the impact for that individual. He summarizes the impact of
spirituality by noting that “some individuals at high risk of suicide may find fellowship in an
affirming community of faith; others may be helped by rituals that confer atonement or a
state of exaltation; still others may learn, through mindfulness meditation, to suspend their
Anxiety:
While religious teachings have the potential to exacerbate guilt and fear that reduce
the quality of life or otherwise interfere with functioning, the anxiety aroused by religious
beliefs can prevent behaviors harmful to others and motivate pro-social behaviors. Religious
beliefs and practices can also comfort people who are fearful or anxious, increase the sense of
control, enhance feelings of security, and boost self-confidence (or confidence in Divine
beings).
Many recent studies had examined the relationship between religious involvement
and anxiety.47 Sixty-nine studies were observational. Among the observational studies, 35
found significantly less anxiety or fear among the more religious, 24 found no association,
and 10 reported greater anxiety. However, all 10 of the latter studies were cross-sectional,
and anxiety and (or) fear is a strong motivator of religious activity. People pray more when
they are scared or nervous and feel out of control (Koenig et al., 2001). Religious
involvement may also interact with certain forms of psychotherapy to enhance response to
factors related to treatment response in patients with panic disorder participating in a clinical
trial. Subjects were treated with group cognitive behavioral therapy and then were followed
significant predictor of panic symptom improvement and lower perceived stress at the 12-
month follow-up. While positive forms of religious coping may reduce anxiety in highly
stressful circumstances, negative forms of religious conflict may exacerbate it (Bowen et al.,
2006). For example, one recent study of women with gynecological cancer found that women
who felt that God was punishing them, had deserted them, or did not have the power to make
a difference, or felt deserted by their faith community, had significantly higher anxiety
Substance use/abuse -
Religious beliefs and practices provide guidelines for human behavior that reduce
from research that has examined associations between religious involvement and substance
abuse. As a form of social control, most mainstream religious traditions discourage the use
and abuse of substances that adversely affect the body or mind. In a review of studies
published prior to 2000, Koenig et al identified that had examined the religion–substance
abuse relation, 90% of which found significantly less substance use and abuse among the
more religious. Most of these studies were conducted in high school or college students just
cigarette, marijuana and cocaine use practices among adolescents and to examine the
relationship between employment, political beliefs, religious beliefs and substance use
behaviors among high school Analysis showed that males and females who believed religion
was very important were less likely to have initiated alcohol use, to be a current user, and to
have binge drank. A significant association was found for all alcohol use variables for those
individuals who worked moderate amounts at an after-school job. Political beliefs were found
to be associated with initiation and current alcohol use but not for binge drinking. Political
beliefs, religion, and employment were all significantly associated with cigarette use and
cocaine use. Conceptualization of substance use behavior and its prevention and treatment
should include consideration of such key cultural and social factors as religiosity,
Analyses by Mason and Windle, (2001) revealed that family social support was
indirectly associated with decreased alcohol consumption among the respondents, primarily
through variables measuring religiosity, school grades and peer alcohol use. In addition,
adolescent alcohol use was directly associated with subsequent increases in peer alcohol use
and later decreases in school performance. Results also showed that receiving good grades in
school predicted moderate increases in family social support. The findings of this study are
discussed in terms of the interrelationships that exist among multiple socializing influences
general education classes at three large schools in Utah, may–July 2003 revealed that the
highest use of tobacco smoking and marijuana or other illicit drug use was among those with
no religious preference. Catholics had the highest level of alcohol drinking during
adolescence. The lowest use of tobacco, alcohol, or illicit drugs was among Latter-day Saints
(LDS or Mormons). Family church attendance and religiosity among parents during the
participants' adolescent years were both significantly protective against substance use in LDS
but not among those of other religions or in those with no religious preference. LDS were
most likely to agree that they chose to abstain or quit using tobacco, alcohol, or illicit drugs
during their adolescent years because such behavior was inconsistent with their religious
beliefs. LDS were also more likely to agree that current substance use was inconsistent with
their religion, thus family weekly church attendance and parental religiosity during the
participants' adolescent years were associated with lower substance use among LDS (Merrill
et al., 2005).
Adolescents whose parents were authoritative were less likely to drink heavily than
adolescents from the other three parenting styles, and they were less likely to have close
friends who used alcohol. In addition, religiosity was negatively associated with heavy
drinking after controlling for other relevant variables. Authoritative parenting appears to have
both direct and indirect associations with the risk of heavy drinking among adolescents.
Authoritative parenting, where monitoring and support are above average, might help deter
adolescents from heavy alcohol use, even when adolescents have friends who drink. In
addition, the data suggest that the adolescent's choice of friends may be an intervening
variable that helps explain the negative association between authoritative parenting and
Many people suffering from the pain of mental illness, emotional problems, or
situational difficulties seek refuge in religion for comfort, hope, and meaning. While some
are helped, not all such people are completely relieved of their mental distress or destructive
beliefs and doctrines may reinforce neurotic tendencies, enhance fears or guilt, and restrict
life rather than enhance it. In such cases, religious beliefs may be used in primitive and
However, systematic research published in the mental health literature to date does
not support the argument that religious involvement usually has adverse effects on mental
psychiatric, and the general population), from different ethnic backgrounds, in different age
groups (young, middle-aged, and elderly), and in different locations (such as the United
States and Canada, Europe, India, and countries in the East) find that religious involvement is
related to better coping with stress and less depression, suicide, anxiety, and substance abuse.
While religious delusions may be common among people with psychotic disorders, healthy
normative religious beliefs and practices appear to be stabilizing and may reduce the
tremendous isolation, fear, and loss of control that those with psychosis experience.
Clinicians need to be aware of the religious and spiritual activities of their patients, appreciate
their value as a resource for healthy mental and social functioning, and recognize when those
beliefs are distorted, limiting, and contribute to pathology rather than alleviate it. Considering
that religiousness is frequent and has associations with mental health, it should be considered
in research and clinical practice. The clinician who truly wishes to consider the bio-psycho-
social aspects of a patient needs to assess, understand, and respect his/her religious beliefs,
like any other psychosocial dimension. Increasing our knowledge of the religious aspect of
human beings will increase our capacity to honor our duty as mental health providers and/or
scientists in relieving suffering and helping people to live more fulfilling lives.
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