Psychiatry Must Get Right With God

At the start of the pandemic, economist Jeanet Bentzen of the University of Copenhagen looked at Google searches for the word “prayer” in 95 countries. She identified that they had reached an unprecedented global high in March 2020, and that the increases have occurred alongside the number of COVID-19 cases identified in each country. In the United States, according to the Pew Research Center, 55% of Americans prayed to end the spread of the novel coronavirus in March 2020, and nearly a quarter said their faith increased the following month, despite an attack limited to places of worship.

These are not only interesting sociological trends, they are clinically significant. Spirituality has always been rejected by psychiatrists, but the results of a pilot program at McLean Hospital in Massachusetts indicate that attention to it is an essential aspect of mental health care.

In 2017, my multidisciplinary team of mental health clinicians, researchers and chaplains created Spiritual Psychotherapy for Hospital, Residential and Intensive Treatment (SPIRIT), a flexible and spiritually integrated form of cognitive behavioral therapy. We subsequently trained a group of over 20 clinicians, located in 10 different clinical units across McLean Hospital, to deliver SPIRIT and evaluate the approach. Since 2017, SPIRIT has been delivered to more than 5,000 people. Our results suggest that spiritual psychotherapy is not only feasible but highly desired by patients.

In the past year, America’s mental health has fallen to an all-time low: the incidence of mental disorders increased by 50% compared to before the pandemic, alcohol and other substance abuse increased, and young adults were more than twice as likely to seriously consider suicide than they were in 2018. Yet the only group to see improvements mental health during the past year were those who attended religious services at least once a week (virtually or in person): 46% report having “excellent” mental health today compared to 42% there is one year old. As former Congressman Patrick J. Kennedy and journalist Stephen Fried wrote in their book A common struggle, the two most underrated treatments for mental disorders are “love and faith”.

It’s no wonder that almost 60% of psychiatric patients want to discuss spirituality as part of their treatment. Yet we rarely offer such an opportunity. Since Sigmund Freud called religion “mass delirium” nearly 100 years ago, mental health professionals and scientists have avoided the spiritual realm. Current efforts to flatten the COVID-19 mental health curve have been almost entirely secular. The American Psychological Association’s extensive body of consumer resources make no mention of spirituality. And the Centers for Disease Control and Prevention’s only spiritual recommendation is to “connect with your community or faith-based organizations.” Of the more than 90,000 active projects currently funded by the 27 National Institutes of Health institutes and centers, fewer than 20 mention spirituality anywhere in the abstract, and only one project contains this term in its title. Needless to say, the lack of funding for spiritual research hinders clinical innovation and dissemination.

This situation goes beyond the separation of Church and State. Healthcare professionals mistakenly disconnect common spiritual behaviors and experiences from science and clinical practice. As a result, we ignore potential spiritual solutions to our mental health crisis, even when our well-being is worse than ever.

My own research has shown that a belief in God is associated with better treatment outcomes for acute psychiatric patients. And other labs have shown a link between religious belief and the thickness of the cerebral cortex, which may help protect against depression. Of course, belief in God is not a prescription. But these compelling findings warrant further scientific exploration, and patients in distress should certainly be given the opportunity to include spirituality in their treatment.

Recently, one of my patients, a conspicuously secular 22-year-old woman, presented with a slight increase in depression and anxiety. She said she felt “defeated” and said she was losing hope of ever improving. I have learned from my research that many secular people believe in Something, and therefore I assess spirituality with all patients, regardless of their religious affiliation or absence. In this context, this particular patient shared with me that she believed in God and also believed that she had been brought to this earth for a specific purpose. In just three sessions focused on these ideas, she felt increased hope that she could overcome the challenges in her life, and her symptoms of depression began to subside.

In another case, a devout Christian in his 60s presented to McLean Hospital with severe depression and acute suicidal tendencies. Her treatment team was aware of her faith but did not know how to approach her in therapy. I was asked to see the patient, who reported to me that he had difficulty praying and thinking about God in his depression. We set aside time for prayer and religious study, and I encouraged conversations with his pastor. Within a month, her depression began to ease for the first time in over a year.

Countless anecdotes of this nature occurred during a recent one-year clinical trial of SPIRIT that my research team completed with funding from the Bridges Consortium (supported by the John Templeton Foundation). Over 90 percent of patients reported receiving some kind of benefit, regardless of their religious affiliation.

The study also revealed key opportunities in patient care, particularly for younger and seemingly secular patients. Psychiatric folklore has long suggested that psychotic, manic, and obsessive patients gravitate more towards spirituality, just like the elderly. Our results suggest, however, that patients benefited from SPIRIT regardless of their diagnosis or age. Apparently, depressed millennials are just as likely to want and benefit from spiritual psychotherapy as are geriatric patients.

Our results also suggest that spiritual care is do not only for religious people. The largest group of patients to voluntarily attend SPIRIT (39 percent of our sample) were individuals with no religious affiliation. Apparently, many non-religious people still seek spirituality, especially in times of distress. In fact, these people may be more likely to undergo spiritual psychotherapy because their spiritual needs are otherwise ignored. In this vein, recent declines in church membership may increase the need for spiritual care.

Perhaps most interestingly, patients responded better to SPIRIT when issued by clinicians without religious affiliation. This startling finding suggests that lay clinicians may be particularly effective in providing spiritual treatment. This is good news because psychiatrists are the least likely of all doctors to be religious.

It remains to be seen if God can solve our mental health crisis. But the potential clinical benefits of spirituality and the patients’ desire for spiritual treatments provide reason to believe.

IF YOU NEED HELP
If you or someone you know is having difficulty or having thoughts of suicide, help is available. Call the National Suicide Prevention Lifeline at 1-800-273-8255 (TALK), use Lifebuoy cat or contact the Crisis Text Line by calling TALK on 741741.


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