Spirituality and psychiatry

Editor's Notes

• #2 The Guru is Brahma, the Guru is Vishnu, the Guru Deva is Maheswara (Shiva),The Guru is Verily the Para-Brahman (Supreme Brahman); Salutations to that Guru.
• #4 I will be presenting the topic under the following headings
• #6  IPS Spirituality & Mental Health Task Force (2008-09), Recommendations
• #7 Implications for prevalence (especially depressive and substance use disorders), diagnosis (e.g., differentiation between spiritual experiences and mental disorders), treatment (e.g., help seeking behavior, compliance, mindfulness, complementary therapies), outcomes (e.g., recovering and suicide) and prevention, as well as for quality of life and wellbeing3,4. The WHO has now included R/S as a dimension of quality of life
• #8 The word itself has biblical origins and derives from the Latin translation of the Hebrew word variously meaning breeze, wind, breath, and by extension the life principle or breath of life studies and descriptions of it almost always mention transcendence  short-lived moments during which the personal self blissfully merges with God, the Void, or the universe. This merging is accompanied by an unutterable understanding of external truths, insights, and ultimate reality. This epiphany is also called a mystical experience. Some have proposed that transcendence may occur on a continuum ranging from a peak experience or losing the sense of self during a special connection with nature, with art or music, or becoming one with a beloved in romantic love.
• #9 The word itself has biblical origins and derives from the Latin translation of the Hebrew word variously meaning breeze, wind, breath, and by extension the life principle or breath of life studies and descriptions of it almost always mention transcendence  short-lived moments during which the personal self blissfully merges with God, the Void, or the universe. This merging is accompanied by an unutterable understanding of external truths, insights, and ultimate reality. This epiphany is also called a mystical experience. Some have proposed that transcendence may occur on a continuum ranging from a peak experience or losing the sense of self during a special connection with nature, with art or music, or becoming one with a beloved in romantic love.
• #10  Spirituality is a distinctive, potentially creative and universal dimension of human experience arising both within the inner subjective awareness of individuals and within communities, social groups and traditions. It may be experienced as relationship with that which is intimately ‘inner’, immanent and personal, within the self and others, and/or as relationship with that which is wholly ‘other’, transcendent and beyond the self. It is experienced as being of fundamental or ultimate importance and is thus concerned with matters of meaning and purpose in life, truth and values spirituality usually refer to a dimension of human experience related to the transcendent, the sacred, or to ultimate reality. Spirituality is closely related to values, meaning and purpose in life
• #11  IPS (2009) Dr SC Malik- CONCEPTS OF SPIRITUALITY AND ANCIENT WISDOM IN RELATION TO MODERN PSYCHIATRY Spirituality refers to personal views and behaviours that express a sense of relatedness to a transcendental dimension or to something greater than the self IPS – 2009 Dr Russell D’Souza  Spirituality can encompass belief in a higher being, the search for meaning and a sense of purpose and connectedness. There can also be a wide over lap between religiosity and spirituality.
• #12 Spirituality is a complex and multidimensional part of the human experience. The cognitive or philosophic aspects include the search for meaning, purpose and truth in life and the beliefs and values by which an individual lives. The experiential and emotional aspects involve feelings of hope, love, connection, inner peace, comfort and support. These are reflected in the quality of an individual’s inner resources, the ability to give and receive spiritual love, and the types of relationships and connections that exist with self, the community, the environment and nature, and the transcendent (e.g., power greater than self, a value system, God, cosmic consciousness). Behavior aspects of spirituality involve the way a person externally manifests individual spiritual beliefs and inner spiritual state
• #14 Religion is an Organised system of faith Involves beliefs, binds believers to their own community, and is imposed from without. Concerned with socially and traditionally shared beliefs and experience
• #16 What are the other Purusharthas ?
• #17  Brahmacharya (student), Grihastha(householder), Vanaprastha (retired) and Sannyasa (renunciation) – Dharma, Artha, Kama, Moksha
• #18 Automatic thoughts : Cognitive appraisal of self : He is a righteous and valiant warrior. Threat : He is doing an immoral act. Anticipation : of outcome – negative. Emotions : Anxious, tense, sad. Physiological reactions : His limbs quivering, mouth drying up, body trembling and hair standing on end, bow ‘Gandiva’ slipping, skin burning, unable to stand, forgetting himself and feeling mind-reeling. Behaviour : Inaction, “I want to get away from the battle field, I don’t want to fight”.
• #22 For the first time, there is acknowledgment of distressing religious and spiritual experiences as nonpathological problems * Mystical experience *New Religious Movements and cults * Psychic opening * Visionary experience * Kundalini awakening * Near-death experience * Possession experience * Shamanic crisis *Loss of faith * Alien encounters *Terminal & life-threatening illness *Changes in membership, practices & beliefs
• #24 PFC) mediates both the preparedness of religious experience and conscious cognitive process involved in the appreciation of religious experience (mPFC) along with the posterior cingulate is involved in self-reflective thought and this helps the person to have an insight into his own experience and the perception of self in relation to the divine being Neuroimaging studies have demonstrated activation of PFC during meditative/ spiritual practices. PFC provides cautious rationality to the emotional experiences surfacing from limbic system mastery Religious experiences is a cognitive process, mediated by a pre-established neural circuit, involving DLPFC, dorsomedial frontal and medial parietal cortex. The preparedness for religious experiences is probably mediated by the dorsomedial frontal cortex. The experience becomes religious by conscious identification of the experience. This cognitive process most probably involves the DLPFC and medial parietal cortex temporal lobe epilepsy is characterized by religious experiences as part of the ictus and the inter-ictal behaviour. Activation of temporal cortical areas (mainly left) is associated with hyperreligiosity in TLE.
• #25 N-acetyl-aspartyl-glutamate
• #31  awareness  The psychologist Abraham Maslow, for example, depicted a hierarchical pyramid ranging from basic physiological needs upward to safety, love, esteem, and self-actualization needs. At the top of the triangle is the “peak experience,” which consists of a sudden moment of well-being, wonder, awe, and at times an awareness of a higher truth and the unity of everything in the world Mysticism intense altered state of consciousness, which has traditionally been described within a religious context Meditation ->Eastern meditation practices, especially Buddhist ones, focus on the primacy of the mind without reference to religion or faith. Spiritualist is achieved when the foundations of the self are transcended by comprehending that the self is an illusion and by elimination of all thoughts. In both traditions when meditation practices are mastered—no easy task—they can cause decreased activation of the RPL that may result in transcendent moments Dhyana. Dhyana is a form of concentrated meditation taught by the Buddha Zen. The core practice of Zen Buddhism is zazen, the Japanese word for seated meditation Transcendental Meditation. Transcendental meditation, derived from Hindu meditative practices, is the most popular form of New Age meditation. It was trademarked by its founder, Maharishi Mahesh Yogi, in 1958. Although it is “officially” nonreligious, its goals are to attain “God Consciousness” and “Unity Consciousness Criticism for levitation Mindfulness Meditation. The concept of mindfulness meditation and its practices derives from a Buddhist tradition that focuses on the true nature of reality.
• #32 Body Modification and Mortification Confession, Penance, and Reconciliation
• #33 Charity and altruism New age spirituality
• #35 Defining Three (3) Domains of Spiritual Health Self-evolution has been defined as a state of Becoming where the individual is analyzing and applying the self in terms of thoughts and actions with respect to the wider perspective and nurturance-art. Self-actualization has been defined as reaching to a state of Being where the individual is consciously aware and responds to the situation, events, people and environment with engineering from within and Deeper Meaning-Purpose of Life. Transcendence has been defined as a state of inner happiness and behaving accordingly through universal love-sublimating jealousy and considering oneself as a part of the supreme (beyond self).
• #37 Levels of spiritual well being – 3 levels Spiritual care in practice has three main stages: • The first is a spiritual assessment. The purpose of this is to identify the person’s spiritual state and their particular spiritual needs. • The second is making a spiritual care plan. This describes a planned intervention, constructed to meet these needs, according to the person’s wishes. • The third is the actual delivery of the care described in the care plan. Exactly who, when and how will depend on their spiritual state.
• #39 Coping styles : Religious coping acts can act as a mediator between spirituality and mental health, particularly during stress. a) Collaborative approach : Individual enters into collaboration with God and the problem solving process and the responsibility for a solution is considered as a shared process. b) Deferring approach : Individual acts passive in problem solving and trusts God to fully resolve the problem without their own intervention. c) Self-directing approach : Person feels full responsibility for problem solving and believes that God has provided the strength required for successful coping (Fabricatore et. al, 2004). d) Plead approach : Individual refuses to accept the current problem and wants God to intervene in a miraculous way for desirable outcomes.
• #40 The way an individual attributes, interprets and gives meaning to various events and experiences in life, associate spirituality and mental health. Locus of attribution helps in developing insight about the illness, which is often lost in psychotic states and some control over the situation may help in developing confidence and bringing down hopelessness of an individual. Two mechanisms: A) Optimistic attribution style : Perceiving negative events as externally caused and positive events as internally caused and is associated with better mental health b) Internal locus-of-control : Individual’s belief that they have some control over the outcome is associated with better mental health than an external locus of control
• #42 prevalence (especially depressive and substance use disorders), diagnosis (e.g., differentiation between spiritual experiences and mental disorders), treatment (e.g., help seeking behavior, Spiritual therapies – Alcoholic Anonymous compliance, mindfulness, complementary therapies), outcomes (e.g., recovering and suicide) and prevention, as well as for quality of life and wellbeing
• #44 A tactful consideration of patients’ religious beliefs and practices as well as their spirituality should routinely be considered and will sometimes be an essential component of psychiatric history taking. 2. An understanding of religion and spirituality and their relationship to the diagnosis, etiology and treatment of psychiatric disorders should be considered as essential components of both psychiatric training and continuing professional development. 3. There is a need for more research on both religion and spirituality in psychiatry, especially on their clinical applications. These studies should cover a wide diversity of cultural and geographical backgrounds. 4. The approach to religion and spirituality should be person-centered. Psychiatrists should not use their professional position for proselytizing for spiritual or secular worldviews. Psychiatrists should be expected always to respect and be sensitive to the spiritual/religious beliefs and practices of their patients, and of the families and carers of their patients. 5. Psychiatrists, whatever their personal beliefs, should be willing to work with leaders/members of faith communities, chaplains and pastoral workers, and others in the community, in support of the well-being of their patients, and should encourage their multidisciplinary colleagues to do likewise. 6. Psychiatrists should demonstrate awareness, respect and sensitivity to the important part that spirituality and religion play for many staff and volunteers in forming a vocation to work in the field of mental health care. 7. Psychiatrists should be knowledgeable concerning the potential for both benefit and harm of religious, spiritual and secular worldviews and practices and be willing to share this information in a critical but impartial way with the wider community in support of the promotion of health and well-being.
• #45 acknowledge and respect the spiritual lives of patients and always keep interventions patient-centred. Acknowledging the spiritual dimensions of patients involves taking a spiritual history 26. A consensus panel of the American College of Physicians have suggested four simple questions that physicians may ask ill or seriously ill patients27: (i) “Is faith (religion, spirituality) important to you?”, (ii) “Has faith been important to you at other times in your life?” (iii) “Do you have someone to talk to about religious matters?”, and (iv) “Would you like to explore religious, spiritual matters with someone?”. Taking a spiritual history is often a powerful intervention in itself25. The doctor may then consider whether supporting the patients’ spiritual religious beliefs will aid in coping. It is acknowledged that religious and spiritual patients’, whose beliefs often form the core of their system of meaning, almost always appreciate the doctor’s sensitivity to these issues. The doctor can thus send an important message that he or she is concerned with the whole person, a message that enhances the patient-physician relationship, the corner stone in medical care, which may increase the therapeutic impact of the intervention.