Role of Religion and Spiritual Mental Health

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Role of Religion and Spirituality in Mental Health: A Review

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68 | P a g e PIJPS ISSN No. 2456 – 5180 (Online) http://www.phonixcentre.in/journals.php

Role of Religion and Spirituality in Mental Health: A Review


Vikas Kumar*

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.

Keywords: Religion, Spirituality, Mental health

* Clinical Psychologist, Sri Sri University, Bidyadharpur - Arilo, Cuttack - 754006, Odisha
E-mail: [email protected], Mob: +91 9559170575

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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

usually call God (Puthenangady, 2005).

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

experience. Thus, religiousness represents an institutional, formal, outward, doctrinal,

authoritarian, inhibiting, subjective, emotional, inward, unsystematic, freeing expression

(Koenig et al., 2001).

In other words, religion can be seen as fundamentally, a social phenomenon whereas

spirituality is usually understood at the level of the individual within specific contexts.

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Certain such superstitious and dogmatized practices may restrict healthy growth and lead to

negative mental health (Bahere et. al., 2013).

Spirituality involves the recognition of a feeling or sense or belief that there is

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

we are a significant part of a purposeful unfolding of Life in our universe.

Spirituality involves exploring certain universal themes - love, compassion, and

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

contribute a lot to mental health.

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

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skills and capacities that can be seen as components or consequences of good mental health

(Korkeila, 2000).

Religious beliefs can shape a person’s psychological perception of pain or disability

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

and motivational processes (Sahoo, 2009).

Historically and even today, religion and mental health are conflicting subjects.

Present belief circulates around foundational myths of psychology to be the emancipation of

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

create considerable anxiety in the believer (Agarwal, 1989).

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

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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).

IMPACT OF RELIGIOSITY ON MENTAL HEALTH

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

inconsistent and contradictory findings (Koenig, 2009). 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 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

relieving suffering and helping people to live more fulfilling lives.

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

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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

masses. Finally, religion has a great influence on psychiatry including symptoms,

phenomenology, and outcome (Behere, et al., 2013).

The strongest and most consistent results have been found among different religious

denominations, but by comparing different degrees of religious involvement (from a non-

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

religious involvement. Other questions are non-organizational religiosity (time spent in

private religious activities such as prayer, meditation, and religious reading texts) and

subjective religiosity (the importance of religion in someone's life). However, caution is

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

orientation may be intrinsic and/or extrinsic:

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

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distraction, status and self-justification. The embraced creed is lightly held or else selectively

shaped to fit more primary needs.

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

associated with better mental health.

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

(depression, suicide, and drug abuse).

Religion as a Coping Behavior:

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

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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

(Tepper et al., 2001).”

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,

physical, or mental circumstances.

Depression:

A recent systematic review with meta-analysis summarized the results of 147

independent investigations involving a total of 98,975 subjects on the association between

religiousness and depressive symptoms. The authors found that religiousness is modestly but

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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

for people under psychosocial stress (Smith et Al., 2004).

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

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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

related both to religion and to depression, confounding the relation.

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

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“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

inclination to judge themselves harshly.”

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

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therapy. Investigators at the University of Saskatchewan explored coping and motivation

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

up at 6 and 12 months after baseline evaluation. Self-rated importance of religion was a

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

(Boscaglia et al., 2005).

Substance use/abuse -

Religious beliefs and practices provide guidelines for human behavior that reduce

self-destructive tendencies and pathological forms of coping. This is particularly evident

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

starting to establish patterns of alcohol and drug use.

A study by Dunn, M. S. (2005)., provided a descriptive profile of the alcohol,

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

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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,

employment and political beliefs of adolescents.

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

and alcohol use among adolescents.

A cross-sectional study of students’ ages 17–35 years in college undergraduate

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

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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

adolescent heavy drinking (Bahr and Hoffmann, 2010).

SUMMARY AND CONCLUSION

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

behavioral tendencies. In other instances, especially in the emotionally vulnerable, religious

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

defensive ways to avoid making necessary life changes.

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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

health. Rather, in general, studies of subjects in different settings (such as medical,

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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