by Kenneth Gilbert, MD

There is a substantial body of experience and slowly growing research that supports the use of spiritual values and/or religion in relation to Mental Health issues. Consider these examples: the Recovery movement recognizes Spirituality as one of the five key elements in recovery; multiple surveys have reported a correlation of low alcohol use with regular church attendance; NAMI considers religious support so important to its families that it sponsors a weekly email post on religion and mental illness to any pastor who will sign up for it; a 2011 study of religious faith among homeless people in supported housing found that those who “gained faith” in the first year of housing reported doing more volunteer work, feeling more engaged in community activities, and having a higher quality of life than those who reported a loss of faith in the same year. (Psychiatric Services 62:1222-1224, 2011). Religious coping and quality of life was assessed in 63 outpatients with diagnosis of schizophrenia. 91% reported participation in private religious or spiritual activities. Positive religious coping was related to quality of life and positive psychological health (Psychiatric services 63: 1051-1054, 2012). A ten year prospective study found a link between religiosity/spirituality and reduced risk of major depression (Psychiatric News, October 7, 2011).
So why is it that when our clients try to talk to us about their religious life, we end up acting like we are choking on a toothpick? Why is it that we find it necessary to redirect anybody who starts talking about their religious experience in our groups? Why is it that we carefully ask our clients about their religious and spiritual histories when we do an intake, but then fail to do anything further with that information?

There is the professional value that we would not impose our personal religious beliefs upon our clients. We also know by experience that some of our clients have pretty odd religious beliefs and we don’t want to be caught supporting homophobic or racist or superstitious assertions. For some of us, our own religious experience has been painful so that we are antagonistic to organized religion or even the concept of theism. Those may all be legitimate reasons to take care when we engage our clients in conversations about religion – but none of them trump the fact that spirituality is a known positive value in quality of life for mentally ill persons as well as in maintaining sobriety.

My experience has led to the conclusion that it works quite well to engage with patients in conversation about their religious practices. Religious practices, after all, are remarkably similar across the spectrum of major faith groups. To talk in terms of religious practices permits you to re-enforce the things your clients have already figured out about using spirituality to strengthen their recovery without getting mired into questions of belief systems.

Prayer, and its closely related cousin, Meditation: Whether your client prays to the Virgin Mary every morning, or sits and tries to be “open to all of creation” as they meditate, you can engage with them about their practice of prayer/meditation without getting involved in their belief system. Asking questions such as who taught them to pray/meditate, what is it about the practice of prayer that results in their continuing to do it on a regular basis, why do they think the practice of meditation works for them when it doesn’t work for others, how has their practice changed over years of experience will honor their experience without resulting in you as a clinician getting tangled into questions of belief or dogma.

Listening to Sermons/ Dharma talks/ radio preachers: This is a very ancient religious practice. You might ask, “Do you use recordings so that you can listen over and over to a sermon? Do you listen to talks by yourself or sitting in a group with other people? Do you think it’s important to know much about the life of the speaker or are you just focused on the message that they deliver? Do you talk with friends or co religionists about the talks or do you just hold them in your personal awareness? Is this exercise for you more about the ideas of the talk or more about the serenity of listening to the message?”

Study of the sacred documents and study of commentaries on the documents: Focus on such documents would be a hallmark of “organized” religion as opposed to spontaneous spirituality. Reading the “Big Book” in AA can certainly become a religious practice, just as daily reading of the Bible or Koran. Questions about pattern of reading (daily, early morning, as preparation for bed, etc) and how they pick which text to read are likely to be more useful than questions about the content of the reading.

Sacred objects, sacred symbols: These may be simple talismans, like a mustard seed encased in plastic that attaches to a key chain or more complex and historically rooted objects such as Muslim prayer beads or Catholic rosaries. The person may have religious reminders in a consciously assembled desktop altar, or may just have objects randomly spotted in their home. Many people have symbols that are tattooed or scarified on the body and are eager to talk about them if we communicate our openness to these ideas. Objects may carry ideas that the person feels are too complex to be put into words, so when you ask questions, don’t expect well developed theological responses. Was there a specific event that lead to your decision to hold onto this stone/crystal/carving/icon or get this tattoo/scar? Now that you think back about it, why was it so significant to you at that point in your life? How have you used this object since you first obtained it? What is your relationship to that person now that you have made this object your special token? Have you ever thought about getting rid of this object and what consideration leads you to keep it? For you does it have to be this specific set of prayer beads/ this icon of the virgin/ this pebble from the beach, or is it true for you that any reminder of prayer/the Virgin/ nature would work as a practice?

Symbolic Acts: Lighting candles, observing the ban on labor for Sabbath, touching our forehead in a mark of deference, daily repeating our life affirmation, uttering a word of blessing before a meal, or burning incense are all examples of symbolic acts. Generally they serve both as a shorthand way of referencing a whole belief system and as a way of being connected with our larger community of co-religionists. Because modern society is less likely to create symbolic acts, the person who uses such acts is frequently rehearsing their family or cultural tradition. Respectful questions about the acts themselves almost always lead to talk about the person’s relationship with their larger religious community.

Public Worship: Public worship integrates multiple religious practices, and also requires a lot of social awareness and capacity to manage things, like getting to the service on time and dealing with social expectations for appearance and behaviors. The person’s relationship to public worship is often tightly connected to their relationship to the worship leader, and by extension, his/her articulation of belief. Persons who regularly engage in Public Worship are generally pleased to be able to tell you what congregation they worship with and who is the worship leader. They are open to conversation such as, “When you think about your worship practice, what is really central for you? The listening to preaching? The reading of the Scriptures? The being with your community?  The singing?”

A conversation of religious practices may sometimes lead to a specific question or request for advice about a religious issue.   Keep clear that you are a Mental Health counselor, not a religious authority. The first response from you needs to honor the legitimacy of the question – for example, by asking why this is an important question, or what efforts have already been made to sort out a reply to this question. Avoid giving your own position. Institutional chaplains are trained in dealing with this kind of question in a non-denominational manner and are normally more than pleased to get a phone call from you with a referral for a person who gets to this point in your conversation with them. Your job is to deal thoughtfully with the question, not feel compelled to make an answer.