Influence of Spiritual Practices on the Treatment of Psychological Abnormalities
by Sonia Gupta
Introduction to Spirituality in a Clinical Sphere
Researchers and mental health care providers all over the world are increasingly recognizing the importance of spirituality in the clinical treatment of mental health issues. However, when compared through history with other non-medical treatments, the two age-old techniques, spirituality and psychiatric treatments have been considered incompatible with each other. Additionally, scientific and clinic psychiatric approaches have dominated available options for treatments. According to the DSM-4, a mental disorder is defined as “a clinically significant behavioral or psychological syndrome or pattern that occurs in an individual and that is associated with present distress or disability or with a significantly increased risk of suffering death, pain, disability or an important loss of freedom” (Maisel, 2013, p. 3). While both approaches recognize mental disorders in the same way, the differences arise primarily due to opposing approaches to treatment (Huguelet & Mohr, 2013). Nevertheless, spirituality and psychiatry continue to coexist and are leveraged for treatments often tailored to the individual. This is especially due to the rapid transformations in society that have resulted in the increasing overlap in the use of several treatment options. Quite simply, individuals from various worldviews may choose to adopt one type of treatment over another or as complementary treatments.
Such changes are resulting in the increased visibility of both spirituality and psychiatry as pertinent forms of treatment of mental disorders (Daaleman, 2004). This is especially prevalent for mental health issues such as depression, anxiety and PTSD (Cornah, 2006). According to Sloan, Bagiella & Powell (1999): “as interest in alternative and complementary medicine has grown, the notion of linking religious and medical interventions has become widely popular” (p. 1).
Given this convergence, this paper attempts to analyze the role played by spiritual practices such as Buddhism as alternative treatments for mental disorders. Spiritual practices such as Buddhism have greatly impacted the treatment procedure for mental disorders such as depression. This paper will attempt to explore such impacts on the treatment procedures of mental health issues. The scientific, restricted and systematic outlook of psychiatry will be balanced against the mystical and religious experiences of spiritual practices (Daaleman, 2004). Some of the positive impacts analyzed include additional means of coping, increasing a sense of control amongst individuals, and social support networks (Cornah, 2006). Both techniques propose varied forms of treatment, such as clinical assessment, or religious rituals. However, despite the growing demand for complementary treatments, there still continues to be a disparate gap between spirituality and psychiatry.
Understanding Spirituality
Spirituality as a concept has various and often ambiguous meanings across contexts and cultures. According to Koenig (2009), the concept of spirituality is seen as a personal experience where an individual defines spirituality based on their relationship with it. Such an experience is largely liberated of the rules, regulations and responsibilities that bind an individual with religion. The experience of the connection to a higher being and a sense of ‘wholeness’ also defines the elements of spirituality (Cornah, 2006; Hoston, 2009).
According to Hoston (2009), such elements include “the degree to which a person’s beliefs and attitudes, or experiences, mirror those who are accomplished with spiritual practice” (p.16). Spiritual practice is driven by the belief in the existence of a “force, energy or reality that is greater than an individual” and is driven by the need to form a relationship with this reality (Hoston, 2009). The creation of a bond or connection with reality usually occurs due to the influence of environmental factors such as churches, temples, mosques and even nature (Cornah, 2014). For instance, in Muslim countries “clients are encouraged to do prayers and to recite the Qur’an specifically in high risk situations. The major focus was to give emphasis to God’s love and caring support and enhance the patient’s ability to recover” (Tahboub- Schulte, Yousif Ali & Khafaji, 2009).
Spirituality and Mental Illnesses: Buddhism as a case study
The study of psychology has begun embracing alternative spiritual techniques that are used for the treatment and care of individuals with mental illnesses. Spirituality is now being explored as an additional dimension to the features that shape an individual, others being the cognitive, emotional, behavioral and interpersonal features (Cornah, 2014). Additionally, the practice has been implemented as a nurturing and emotionally uplifting form of treatment and can be understood through three primary perspectives. First being the idea that spirituality provides positive coping mechanisms for stressful and demanding situations and helps deflect the client’s reliance on drugs and negative activities (Breakey, 2001). Second, such a treatment reinforces a relationship with social support network from which one could seek social and emotional comfort. Thirdly, it enhances the overall sense of well-being and enlightenment within an individual through the relationship of the individual with a higher power (Lukoff, 2007). Such approaches to treating mental illnesses using spiritual practice are an age-old phenomenon that has existed outside the scientific realm, especially in religions such as Buddhism.
The traditions of Buddhism can be traced back to the end of the 8th century in Tibet where the foundation of the essential teachings is mainly the Mahayana Buddhism (Tibetan Buddhism, 2004). Buddhism has been most notably linked under the leadership of the Tibetan monk Dalai Lama and is the largest and most influential traditions in Tibetan culture (Tibetan Buddhism, 2004). According to Brazier (2006), “Buddhism is often seen as the most psychological of the major world religions” (p. 1). The proponents of Buddhist thinking suggest that mental health problems emerge from the afflictions caused by mental distress over an individual’s environment. The main pillars of Buddhist teachings propose an understanding of mental well-being that is driven by a balance in the individual’s mental state. The lack of this balance results in mental illnesses such as depression. According to Brazier (2006):
“A Buddhist approach to mental health is therefore likely to be based on loosening concern with identity, inviting a shift away from rigidity of view, encouraging deeper connection with others and with the environment. A person who is mentally healthy is not self-preoccupied, but is interested in the people and things around him or her” (p. 16).
Treating Depression using Buddhist Spiritual practices
Within Eastern ideologies the practice of Buddhism has played a vital role in reducing the severity of the mood disorders known as depression (Cornah, 2014). In general, depression is solely identified as a syndrome that is characterized by emotional, behavioral and physical symptoms such as significant levels of sadness, loss of pleasure, pessimism, hopelessness and low self-esteem (Pinsky, 2014). Furthermore, depression differs from normal sadness and grief “which are the appropriate emotional responses to the loss of a person or object” (Encyclopedia Britannica, 2014, para.2). It has one of the highest prevalence in the 21st century and has been largely associated with empathy based guilt and distress (O’Connor, Berry, Stiver & Rangan, 2012). However, the cause of depression has remained unknown for it has a wide range of origins such as trauma, sustenance of negative thoughts, biochemical or sociocultural factors (Encyclopedia Britannica, 2014). There has been substantial evidence, which shows that the involvement of Buddhism in the treatment of depression has greatly led to positive outcomes. Refugees and Buddhists such as those in Tibet who have endured immense distress, trauma and torture were more apt to cope with severe depression (O’Connor, Berry, Stiver and Rangan, 2012). In addition, when the refugees embraced the spiritual path of Buddhism, there were significantly lower levels in depression, anxiety, guilt and distress. Negative symptoms were replaced by positive traits such as “compassion, agreeableness and openness to experiences and social activities” (O’Connor, Berry, Stiver & Rangan, 2012). Moreover, these can be quantifiable through brain scans, which show that there is great neural activity during the meditation practice (Daaleman, 2004). In addition, the studies have shown that meditation triggers key qualities of altruism or selflessness towards other people. This characteristic is exclusive to clients with depression who suffer from loss of the meaning of life. They tend to question everything they found security and consolidation in (Cornah, 2014).
However, the practice of spirituality is not necessarily executed during mental illness but it is observed that spiritual experiences can lead to increases in general mental health. According to the proponents of spirituality, mental health has been defined as the absence of symptoms such as depression and anxiety and the presence of positive psychological characteristics such as determination, energy and kindness (Hoston, 2009). Further improvements include empathy, enhanced ability to cope and greater tolerance and patience (Hoston, 2009). In this context, Buddhism may provide the basis to initiate this process of positive mental health through mindfulness training, meditation and yogic techniques (Tibetan Buddhism, 2004; Brazier, 2006). By incorporating such beliefs, Buddhism offers and modifies a person’s perspective of the world where it promotes a ‘positive’, ‘optimistic’ and ‘hopeful’ sense of well-being. The existence of these features is vital in clients with depression as they are void of any feelings of pleasure and hold a very pessimistic and worthless view of their life and the world they reside in (Koenig, 2009).
In addition, these beliefs act as a guide that provides direction, purpose and an indirect sense of control for the person enduring depression (Verghese, 2008). Buddhism provides emotional support, which aids in reducing isolation and loneliness as well as eases a person’s dependence on recreational substances such as drugs and alcohol (Koenig, 2009; Huguelet & Mohr, 2013). According to Lukoff (2007), in general, spiritual practice such as Buddhism protects an individual from the severity of psychiatric symptoms and hospitalization as well as facilitates a speedy recovery. It has been acknowledged that during crisis many psychiatric patients have turned towards spirituality for guidance and counseling (Lukoff, 2013).
Limitations of Spirituality in the treatment of mental health issues
The rise of holistic religious practices over the years has drastically challenged the scientific and clinical methods of psychiatry. Principally, psychiatrists have been greatly critical of spiritual procedures in clinical treatment. This may be chiefly due to the fact that psychiatrists are largely less religious in nature (Verghese, 2008). Furthermore, psychiatry holds a very methodical and precise definition where it is described as the science and practice of diagnosing and treating mental disorders (Encyclopedia Britannica, 2013). It is completely independent of the sphere of spirituality and its practices (Verghese, 2008). There has been substantial emphasis on physical symptoms for the cause of mental disorders and is more likely to explain the origins of abnormalities in psychological terminology (Lukoff, 2007). The psychiatric outlook is mainly scientific in nature. This aspect commonly leads to the likelihood of prejudice against spirituality as psychiatrists are acquainted with the field exclusively through the morbid religious symptoms of the patients (Verghese, 2008). It was during the late 19th century that notable psychologist Sigmund Freud had associated the idea of religion to the state of illusion and neurosis (Koenig, 2009). Furthermore, this uncertainty led Freud to term religion as “the universal obsessional neurosis of humanity” where it is argued that the relationship between mental health and spirituality/religion is solely non-existent (Cornah, 2014, p.11). The clash of perspective led to the idea that during the assessment process psychiatrists do not take into account the religious background and beliefs of the client (D’Souza & Kuruvilla, 2006). In many cases, about 45% of mental health psychologists believed that religion and spirituality were the source of mental ill health (Cornah, 2014). One reason for such contradictory views would be that research studies in spirituality do not present statistically significant findings and are limited to a small number of case studies (Koenig, 2009). Psychiatry may dominate the treatment procedures in terms of its added advantage of being able to test the cause of an illness compared to spirituality’s lack of quantifiable data. However, this does not entirely confirm the idea that spirituality cannot measure the mystical experiences and religious impulses of its clients (Daaleman, 2004). Initially, a psychiatrist views every illness through a biological perspective and this, in turn, leads to conflicts between the spheres of spirituality and psychiatry (Verghese, 2008). Through the psychiatrists lens spirituality is viewed as primitive, untestable and unscientific especially when they themselves struggle to establish psychiatry as scientific in nature (Bhugra & Osbourne, 2004). Furthermore, psychiatrists have misinterpreted the effects of spiritual practices for they believe that it brings about the feelings of pure guilt and dependence in patients with mental disorders (Verghese, 2008). The role of spirituality is largely underemphasized and considered outdated and irrational by psychiatrists (D’Souza & Kuruvilla, 2006). A common belief held by many psychiatrists is that if they were to engage in spiritual practices as a form of assessment then the treatments are more likely to be affected by population biases, such as non-religious individuals, and cross-cultural comparisons (Bhugra & Osbourne, 2004). Occasionally, this dimension of psychiatry has been accused of a ‘materialistic’ and ‘reductionistic’ approach to understanding the human anatomy, which in turn has devalued the spiritual perspective. (Breakey, 2001).
Convergence of spiritual and psychiatric practice in treatment
Although there is a gap between perspectives on spirituality and psychiatry, there is evidence to suggest a convergence according to Huguelet & Mohr (2013); in recent years, there has been a significant increase in the practice of spirituality in psychiatric care of mental disorders. There have been cases where psychiatric patients have adopted religious exercises to cope with their mental illness (Koenig, 2009). It has been proven that religion has served as a “pervasive and potentially effective” mode for coping with psychological disorders (Koenig, 2009). At present, psychologists are increasingly integrating spiritual approaches in treating mental illnesses in psychotherapy.
By adopting spirituality, psychiatrists may be provided with a better understanding of the difference between ideas of curing and healing. From the spiritual perspective, healing is described as a process rather than a state where a person emerges into a new being on a mind-body-spirit level rather than simply returning to a prior sense of being (Quinn, 1997). Alternatively, curing is solely defined in terms of the elimination of symptoms of a disease in an individual thus making it more quantifiable when compared to healing (Quinn, 1997). At times, it is possible that the process of healing may occur without curing but at all times healing is achievable whereas curing is not. An individual’s healing process cannot be manipulated or forced compared to curing, as it is a process unique and distinct to an individual’s well-being (Quinn, 1997). For this reason, it is essential that psychiatrists should focus on the spiritual and religious aspects of the client’s lives (D’ Souza & Kuruvilla, 2006).
One such approach that has greatly exhibited a profound effect on psychotherapy has been the forgiveness programs which mainly aim at resolving interpersonal conflicts (Pargament, 2013). Other programs include acceptance, gratitude and meditation. As a practice and a form of methodology, spirituality has been effective due to the fact that it provides its clients with the freedom to express their deepest values, invoke self-awareness and enhance the process of meaning making (Pargament, 2013).
Additionally, assessing a spiritual history of the client through questions such as “is faith important to you?” or “would you like to explore religious or spiritual matters with someone?” provides a potent factor in evaluating a client’s mental health (D’Souza & Kuruvilla, 2006). Such an assessment provides ‘intrinsic’ view of the inner sense of meaning and purpose to understanding the client’s spiritual perspective (Breakey, 2001). The incorporation of spiritual practice in psychiatric method allows for a holistic approach to a patient’s treatment. For instance, they promote ‘healthy lives, personal growth, freedom from anxiety and peaceful resolution of conflicts’ (Breakey, 2001). Such approaches have made a mark in health care institutions in Europe and America that are notable and prestigious at present and have had founders who were from religious groups (Breakey, 2001). In time, health care will observe the merging of these two very distinctive and contrasting phenomena wherein treatments for psychological abnormalities will use a quantitative and qualitative approach.
Conclusion
In conclusion, this paper has briefly explored the dimensions of spirituality and psychiatry in relations to psychological abnormalities. The various contrasts between the process of healing and curing have been examined concisely in the paper. It has thoroughly focused on the particular aspect of spirituality, which is the practice of Buddhism and its core contributions to the healing process and the possible cure of depression. On the other end of the spectrum, the paper highlights the idea that psychiatrists have been critical of the spiritual perspective but due to the recent involvements of spirituality in psychiatric therapy, there have been significant developments in the field. Nevertheless, as the two fields are flourishing with each other’s evolving perspectives there is yet a great deal of knowledge to discover in the near future.
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Sonia Gupta graduated from the American University of Sharjah in 2017 with a bachelors in Mass Communications, Journalism and a Minor is Psychology. She is currently a member of the AIESEC volunteer organization. Sonia is an avid reader and a writer, who is also a photography enthusiast. She enjoys everything from History to Archaeology, Psychology and Mythology. She enjoys traveling without a map and guide because she values spending money on experiences and memories. She hopes to pursue her Masters and PH.D in Psychology and eventually pursue a career in it. Moreover, she aspires that one day she will be able to work for National Geographic and that through her love for Photography and Psychology she can cause a small change in the large world she lives. All in all, she relishes everything that is extraordinary and quirky which not only help her learn about the people and places she visits but also challenge and help her grow beyond her expectations.