Introduction
Spirituality and psychiatry
- on the face of it, they do not seem to have much in common. But
we are becoming increasingly aware of ways in which some aspects of
spirituality can offer real benefits for mental health.
This leaflet is for:
- anyone who has an interest
in spirituality and mental health
- anyone with a mental health
problem
- carers and relatives
- professionals who may not
be sure about how to explore spiritual issues with their
clients/patients.
It looks at:
- how spirituality, mental health and mental healthcare can
connect
- how to make a place for spiritual needs within a mental health
service
- how spirituality can help mental health.
You don't need to hold a
formal religious belief, to take part in religious practices, or
belong to an established faith tradition, to read this leaflet - or
to experience spirituality.
What is
spirituality?
There is no one definition,
but in general, spirituality:
- is something everyone can experience
- helps us to find meaning and purpose in the things we
value
- can bring hope in times of suffering and loss
- encourages us to seek the best relationship with ourselves,
others and what lies beyond.
These experiences are part of being human - they are as clearly
present in people with a learning disability and other
conditions, such as dementia or head injury, as they are in
anybody else.
Spirituality often becomes
more important in times of distress, emotional stress, physical and
mental illness, loss, bereavement and the approach of
death.
All health care tries to
relieve pain and to cure - but good health care tries to do more.
Spirituality emphasises the healing of the person, not just the
disease. It views life as a journey, where good and bad experiences
can help you to learn, develop and mature.
How is spirituality different
from religion?
Religious traditions
certainly include individual spirituality, which is universal. But
each religion has its own distinct community-based worship,
beliefs, sacred texts and traditions.
Spirituality is not tied to
any particular religious belief or tradition. Although culture and
beliefs can play a part in spirituality, every person has their own
unique experience of spirituality - it can be a personal experience
for anyone, with or without a religious belief. It's there for
anyone. Spirituality also highlights how connected we are to the
world and other people.
What is spiritual health
care?
People with mental health
problems have said that they want:
- meaningful activity such as
creative art, work or enjoying nature
- to feel safe and
secure
- to be treated with dignity
and respect
- to feel that they belong,
are valued and trusted
- time to express feelings to
members of staff
- the chance to make sense of
their life – including illness and loss
- permission/support to
develop their relationship with God or the Absolute.
Someone with a religious
belief may need:
- a time, a place and
privacy in which to pray and worship
- the chance to explore
spiritual concerns
- to be reassured that the
psychiatrist will not try to undermine their faith
- encouragement to deepen
their faith
- to feel universally
connected
- sometimes – the need for
forgiveness.
What difference can
spirituality make?
Service users tell us that
they have gained:
- better self-control,
self-esteem and confidence
- faster and easier recovery
(often through healthy grieving of losses and through
recognising their strengths)
- better relationships – with
self, others and with God/creation/nature
- a new sense of
meaning, hope and peace of mind. This has allowed them to accept
and live with continuing problems.
A religious/spiritual
assessment
A helpful way to begin can
be to ask "Would you say you are spiritual or religious in any way?
Please tell me how." Another useful question is, "What sustains
you?" or "What keeps you going in difficult times?" The answer to
this will usually reveal a person's main spiritual concerns and
practices.
Sometimes, a professional
may want to use a questionnaire. They will want to find out:
- what helpful knowledge or
strengths do you have that can be encouraged?
- what support can your faith
community offer?
A gentle, unhurried approach
works best – at its best, exploring spiritual issues can be
therapeutic in itself.
What is your life all about?
Is there anything that gives you a sense of meaning or purpose?
Emotional stress is often
caused by a loss, or the threat of loss. Have you had any major
losses or bereavements? How has this affected you and how have you
coped?
Do you feel that you belong
and that you are valued? Do you feel safe and respected? Are you
and other people able to communicate clearly and freely?
Do you feel that there is a
spiritual aspect to your current problem? Would it help to involve
a chaplain, or someone from your faith community? What do I need to
understand about your religious background?
What do the next few weeks
hold for you? What about the next few months or years? Are you
worried about death and dying, or about the possibility of an
afterlife? Would you want to discuss this more? What are your main
fears about the future? Do you feel the need for forgiveness about
anything? What, if anything, gives you hope?
What kind of support would
help you? How could you get it? Have you thought about
self-help?
A spiritual assessment
should be considered as part of every mental health assessment.
Depression and
substance misuse, for example, can sometimes reflect a spiritual
void in a person’s life. Mental health professionals also need to
be able to distinguish between a spiritual crisis and a mental
illness, particularly when these overlap.
Spiritual
practices
These span a wide range,
from the religious to secular – which may not be obviously
spiritual. You may:
- belong to a faith tradition
and take part in services or other activities with other
people
- take part in rituals,
symbolic practices and other forms of worship
- go on pilgrimage and
retreats
- spend time enjoying nature
- give of yourself in acts of compassion (including work,
especially teamwork)
- spend time in meditation,
deep reflection or prayer
- follow traditions of
yoga,Tai Chi and similar disciplined practices
- read scripture
- listen to singing and/or
playing sacred music, including songs, hymns, psalms and devotional
chants
- spend time in contemplative
reading (of literature, poetry, philosophy etc.)
- appreciate the arts
- be creative - painting,
sculpture, cookery, gardening etc.
- make and keep good family
relationships
- make and keep friendships,
especially those with trust and intimacy
- join in team sports or
other activities that involve cooperation and trust.
Spiritually-informed therapies
Over recent years there has been increasing interest in
treatments that include the spiritual dimension. In addition to
established 12-step programmes for alcohol and substance misuse,
new approaches such as mindfulness-based cognitive therapy for the
treatment of stress, anxiety and depression (MBCT) and
compassion-focussed therapy are now being actively researched and
supported.
Spiritual values and
skills
Spiritual practices can help
us to develop the better parts of ourselves. They can help us to
become more creative, patient, persistent, honest, kind,
compassionate, wise, calm, hopeful and joyful. These are all part
of the best health care.
Spiritual skills
include:
- being honest – and able to
see yourself as others see you
- being able to stay focused
in the present, to be alert, unhurried and attentive
- being able to rest, relax
and create a still, peaceful state of mind
- developing a deeper sense
of empathy for others
- being able to be with
someone who is suffering, while still being hopeful
- learning better judgement,
for example about when to speak or act, and when to remain
silent or do nothing
- learning how to give
without feeling drained
- being able to grieve and
let go.
Spirituality emphasises our
connections to other people and the world, which creates the idea
of ‘reciprocity’. This means that the giver and receiver both get
something from what happens, that if you help another person, you
help yourself. Many carers naturally develop spiritual skills and
values over time as a result of their commitment to those for whom
they care. Those being cared for, in turn, can often give help to
others in distress.
The place of
chaplaincy/pastoral care
Times have changed. Hospital
chaplaincy now involves clergy and others from many faiths,
denominations and humanist organisations. Chaplains (also called
spiritual advisors) are increasingly part of the teams that provide
care both in and outside hospital.
A modern mental health
chaplaincy or department of spiritual care should:
- have access to a sacred space
- get on well with local clergy and faith communities
- provide information about local religious groups, their
traditions and practices
- be aware that, sometimes, an individual’s engagement
with religious beliefs and activities can be unhelpful and
even damaging
- be able to give advice on difficult issues, such as paranormal
influences, spirit possession and the ministry of deliverance
- work closely with the mental health team so that spiritual
needs can be recognised and helped
- make sure that service users and patients know about them.
Education and
research
There is evidence that
people who belong to a faith community, or who hold religious or
spiritual beliefs, have better mental health. So, the relevance of
spirituality is now being recognised in courses for
mental health care students and practitioners.
About the Spirituality and
Psychiatry Special Interest Group (SPSIG)
The Spirituality and
Psychiatry Special Interest Group of the Royal College of
Psychiatrists was founded in 1999 to:
- help psychiatrists to share
experiences and to explore spirituality in mental healthcare
- increase knowledge of the
research linking spirituality with better health
- raise the profile of
spirituality in patient care.
The SPSIG has now over
3000 psychiatrists. It runs an active programme of one-day
events for members and holds occasional conferences open to the
general public. Information about these meetings (and the texts of
all the talks) can be found in the SPSIG Newsletters at the
SPSIG website.
How to start …..?
Spirituality is deeply personal. Try to
discover what works best for you. A three-part daily routine can be
helpful:
- a regular quiet time (for
prayer, reflection or meditation)
- study of religious and/or
spiritual material
- making supportive
friendships with others with similar spiritual and/or religious
aims and aspirations.
You can find out about
spiritual practices and traditions from a wide range of religious
organisations. Secular spiritual activities are increasingly
available and popular. For example, many complementary therapies
have a spiritual or holistic element that is not part of any
particular religion. The internet, especially internet bookshops,
the local yellow pages, health food shops and bookstores are all
good places to look. There is also a wide range of papers about
spirituality and mental health that can be downloaded from the
publications archive of the SPSIG website.
Further reading
- Barker P. & Buchanan-Barker P. (Eds).
Spirituality and Mental Health: Breakthrough. Whurr.
- Butler-Bowen T. (2006) 50 Spiritual
Classics. Nicholas Brealey Publishing.
-
Cook, C., Powell, A. & Sims, A. (Eds) (2009) Spirituality and
Psychiatry. RCPsych Publications.
- Coyte M. Gilbert, P. & Nicholls V. (Eds.)
(2007) Spirituality, Values and Mental Health: Jewels for the
Journey. Jessica Kingsley.
- Culliford L. (2007)
Love, Healing and Happiness. O Books.
- Fontana D. (2003)
Psychology, Religion and Spirituality. BPS Blackwell.
- Forest J. (2007) The
Road to Emmaus: Pilgrimage as a Way of Life. Orbis Books.
- Galanter M. (2005)
Spirituality and the Healthy Mind: science, therapy, and the
need for personal meaning. Oxford University Press.
- Kabat-Zinn J. (2004)
Wherever You Go, There You Are. Piatkus Books.
- Kornfield J. (1994) A
Path With Heart. Rider.
- Nataraja S. (2008) The
Blissful Brain. Gaia Books.
- Post S. & Neimark J.
(2007) Why Good Things Happen to Good People. Broadway
Books.
- Royal College of
Psychiatrists (2013) Recommendations for psychiatrists on
spirituality and religion.
- Scott Peck M. (1997)
The Road Less Travelled. Rider.
- Swinton J. (2001)
Spirituality and Mental Health Care: Rediscovering a Forgotten
Dimension. Jessica Kingsley.
- Whiteside P. (2001)
Happiness: The 30-Day Guide. Rider.
Websites
References
- Anandarajah G. & Hight E. (2001)
Spirituality and Medical Practice: using the HOPE questions as a
practical tool for spiritual assessment. American Family
Physician, 63, 81– 92.
- Cook C.C.H (2009) Substance Misuse. In Cook,
C., Powell, A. & Sims, A. (Eds) Spirituality and
Psychiatry 139-168> RCPsych Publications.
- Culliford L. (2002) Spirituality and Clinical
Care. British Medical Journal. 325:1434-5.
- Culliford L. (2007) Taking a Spiritual
History. Advances in Psychiatric Treatment, 13,
212-219.
- Culliford L. (2009) Teaching Spirituality and
Healthcare to 3rd Year Medical Students
- Clinical Teacher. 6: 22-27.
- Eagger S. (2005)
‘A
guide to the assessment of spiritual concerns in mental
healthcare’.
- Faulkner A. (1997) Knowing
our own minds. London: Mental Health Foundation.
- Gilbert P.
& Nicholls V. (2003) Inspiring Hope: Recognising the
Importance of Spirituality in a Whole Person Approach to Mental
Health. London: National Institute for Mental Health in
England.
- Gilbert, P. (2009) Introducing compassion-focused therapy
Advances in Psychiatric Treatment, 15, 199-208.
- Koenig H., McCullough M., & Larson D. (2001) Handbook of
Religion and Health. Oxford: Oxford University Press.
- Murray R. & Zentner J.
(1989) Nursing Concepts for Health Promotion. London: Prentice
Hall. (Adapted)
- Nathan M. (1997) A study of
spiritual care in mental health practice: patients’ and nurses’
perceptions. MSc thesis. Enfield: Middlesex University.
- Neely D. & Minford E.
(2009) FAITH: spiritual history-taking made easy. Clinical
Teacher. 6: 181-185.
- Post S., Puchalski C.&
Larson D. (2000) Physicians and Patient Spirituality: Professional
Boundaries, Competency, and Ethics. Annals of Internal Medicine.
132: 578-583.
- Puchalski C. & Larson
D. (1998) Developing curricula in spirituality and medicine.
Acad Med. 73(9), 970-974.
- Swinton J. (1999) Building
a Church for Strangers: Theology, Church and Learning Disabilities.
Edinburgh: Contact Pastoral Trust.
- Swinton J. (2002)
Spirituality and the Lives of People With Learning Disabilities.
The Tizard Learning Disability Review. 7, 4: 29-35.
- World Health Organization.
(1998) WHOQOL and Spirituality, Religiousness and Personal Beliefs:
Report on WHO Consultation. Geneva: WHO.
This leaflet was produced by
the Royal College of Psychiatrists’ Spirituality and Psychiatry
Special Interest Group Executive Committee.
Series
Editor: Dr Philip Timms
Expert
Review: Dr Larry Culliford, Dr Andrew Powell, Professor
Chris Cook
Illustration by Lo Cole:
www.locole.co.uk
This leaflet reflects the best available evidence at the time of
writing.
© January 2013. Due for review:
January 2015. Royal College of Psychiatrists. This leaflet may be
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