Most Americans identify as religious, spiritual, or both. According to the Pew Research Center,

• 58% think of themselves as religious or consider religion very important in their lives (including 48% who consider themselves both religious and spiritual and 10% who are religious but not spiritual).
• 22% consider themselves spiritual but not religious
• 21% are neither spiritual nor religious

Yet when it comes to mental health care, especially for serious conditions like psychosis, religion and spirituality are often not considered. A new study in Psychiatric Services suggests that for people facing mental health challenges, religion and spirituality are often central to how they understand symptoms, seek help, and engage with treatment.

Psychosis refers to a set of symptoms characterized by a loss of touch with reality due to a disruption in the way that the brain processes information. When someone experiences a psychotic episode, the person’s thoughts and perceptions are disturbed, and the individual may have difficulty understanding what is real and what is not. It can be a very distressing experience. When someone has the first episode of psychosis, they often reach out to those people and communities closest to them, including family members, faith leaders, and spiritual healers. Religious and spiritual connections and beliefs can influence a person’s understanding and approach, including

• Whether they seek help at all
• Who they turn to first
• Whether they stay engaged in treatment

The researchers looked at how religion and spirituality influence the way individuals and communities understand and give meaning to psychosis, and shape approaches to seeking help and coping. For example, past research has identified several spiritually based explanations, such as beliefs that psychosis represents weak faith, divine will, punishment for sin, or a test from God. The review focused on three traditions with different ways of explaining psychosis and different roles of spiritual leaders and paths to care: Christian, Muslim, and Indigenous American and tribal communities.

 

• Christian communities may interpret symptoms through medical and/or supernatural lenses. Sometimes, psychotic experiences are viewed as spiritual trials; other times, faith may be integrated with clinical care.
• Muslim communities may take a holistic approach that blends medical care with spiritual explanations, such as supernatural influences. Imams may provide guidance.
• Indigenous American traditions emphasize balance and interconnectedness. Experiences of psychosis may be understood as meaningful.

The research highlights influences and actions that occur outside of the clinical setting, including the influence of religion and spirituality, which may happen before and after engagement with clinical care. Disregarding or discounting the roles of spirituality and religion in mental health care may contribute to delays in accessing services and misinterpretation of an individual’s actions, the authors argue. Rather, they suggest a culturally responsive, collaborative approach “between clinicians and religious or spiritual healers, rooted in humility and bidirectional learning” is essential for building trust and improving access to care.