MHM Magazine

Issue 3 | 2022 | MENTAL HEALTH MATTERS | 21 MHM lie ‘beyond’. Spirituality, beyond religious definitions has many benefits: • Can help us to find meaning and purpose in life. • Can give us a sense of hope. • Can support us in the times of suffering and loss that we all experience. But, sometimes, spirituality can itself be a source of stress, especially for clients that also have a strong institutional religious. In this article, I want to especially focus on clients that struggle with integrating their sense of spirituality, religious traditions and psychological and psychiatric care. It feels more of a burden for those who are spiritual and religious than those not bound by expectations and dogma of their religious context, which I experience mostly challenging for those in the Judeo-Christian traditions. CLINICAL SPLITTING Unfortunately, the structure of academic disciplines has created an artificial separation of the arts from the sciences, medicine from psychology and psychology from theology and western medicine from traditional medicine. The history of western medicine and public health care started as a church ministry, which set up the first hospitals and psychiatric care facilities. There was no separation of spiritual care from what we now call clinical care. Pastors and priests were referred to as 'doctors of the soul'. Most clinical curriculums have a minor reference to spirituality, which sets up the conditions for its exclusion in practice. PRACTITIONER DISSONANCE As a trainee psychologist from a Christian background, I wanted to integrate my faith and understanding of spirituality into my clinical practice. I remember the awkwardness of my thesis review panel when I presented my master's research proposal on stress and burnout amongst the clergy. Integrating spirituality was an uncomfortable turf for academics who considered psychotherapy a secular enterprise. I wonder how this plays out for GPs, psychologists and psychiatrists. They may experience dissonance between their belief systems and values, clinical training and the multifaith context of patients that want to integrate spirituality in treatment planning. THE PATIENT'S PERSPECTIVE Our ethical codes require that we consider the diversity of our patients. Informed consent requires that we understand from our patients what informs their therapy choices and not impose our secular-agnostic approach. Informed consent also calls on our clinical competence in understanding the role of spirituality in healing. Incorporating spirituality is less about the practitioner than it is about the patient. Putting the patient first requires practitioners to be comfortable with including spirituality as a valid variable in treatment planning which may require consultation and collaboration with other professionals such as pastors, rabbis and priests. SPIRITUALITY – ANXIETY & DEPRESSION Anxiety and depression, among the many psychological conditions, are especially referenced in the Judeo- Christian Bible and theology. Given this context, it becomes vital to understand the 'theology' of mental illness and especially anxiety and depression. The bible speaks of guarding our hearts and the place from which our psycho- spiritual distress emanates. The influence of evil and Satan influencing our hearts is part of this spiritual understanding. Anxiety and depression from a Judeo-Christian perspective are phenomena described in ancient texts and deeply connected to spirituality and not just a clinical diagnosis removed from deep religious traditions, as we know it now. Similarly, as an example, Islamic scholars speak of 'waswasa', the whisperings of the devil which create anxiety. All religions have some meaning-making around our understanding of mental illness. Christianity is making a progressive shift toward mental illness but are far from de- stigmatised. This religious shift is also true for other religions, as I gather from my interaction with multifaith practitioners. I share a few case studies with Christian clients offering lessons applicable for spiritual integration irrespective of religious/spiritual orientation. So, how do spirituality and mental illness intersect in real life? CASE STUDY ONE: MY PASTOR SAID In addition to psychotherapy, I proposed to my Christian client that she considers medication as part of her treatment plan for severe depression. She was immediately anxious about my suggestion. With further clarification, I understood that she believed that the use of medication was wrong. This belief came from her church understanding and teaching that God/Jesus was enough. That medication gave way to the devil, and she needs to strengthen her faith in God. It's