Eugen Bleuler, a Swiss psychiatrist, defined schizophrenia as a condition where individuals have incoherent coordination between thoughts and emotions. With a prominent inward orientation, away or split from reality (Butcher et al., 2012a). Which came to be known as ‘psychosis’, the hallmark of schizophrenia (Butcher et al., 2012b). Though it must be noted that psychosis is not exclusively manifested in schizophrenia alone (Loch, 2019). Psychosis is a collection of symptoms exhibiting a loss of reality which includes hallucinations and delusions (Carey, 2021). And according to DSM-IV-TR (2000), delusion is one of the diagnostic and central criteria for schizophrenia. There are lots of studies on religious delusions in schizophrenia, but new interests in religion as an independent body in influencing schizophrenia have been growing (Mohr & Huguelet, 2004). This blog will address the influence of religion on schizophrenia by analyzing the papers that have supported and argued against the claim.
A survey was carried out in India, with 40% of patients diagnosed with schizophrenia being forced by their family members to seek magico-religious treatment (faith healing) instead of consulting the medical treatment (Kulhara et al., 2000). The reluctance to adhere to medical treatment might be related to the stigmatized label attached to mental disorders. It is found that in the cultural context of a country like India, knowing someone as ‘possessed’ is less stigmatized than having schizophrenia or any other mental disorders (Ventriglio et al., 2018). In possession, the presence of a supernatural presence and religious content are reiterated back and forth. Where religion could possibly play a vital social factor in the treatment-seeking behavior of people with schizophrenia. Pietkiewicz (2021) found out that religious leaders or groups had overall control over the treatment trajectories, where either they recommended the patients for further medical assessment or exorcism to reinforce the people’s belief in possession. Another study carried out in India (Tamil Nadu) on psychiatric patients showed that 58% of the patients had already been to a religious healer prior to coming to the clinic (Grover et al., 2014a). Religion has preceded clinical assessment in such a study, suggesting the association between high religiosity with a lower preference for approaching medical treatment (Grover et al., 2014b). The aforementioned association considers religion as an important factor influencing the patient or the family of the patient to decide whether to treat them medically or not. This brings to attention, the impact of religion on the prognosis and the treatment of schizophrenia. First, religion creates its own body of treatment on the basis of prognosis and denies individuals the right to access medical treatment. This might lead to individuals believing they are possessed and more inclined to seek help from priests instead of medical care. Second, due to the denial of treatment, individuals could face more emotional distress, become more vulnerable to comorbid other disorders, and have more ideation of suicidal thoughts (What Can Happen If Schizophrenia Goes Untreated, 2019). Where an approximation of 4.9% of individuals with schizophrenia die by suicide, which is a greater rate than the general population (Schizophrenia, 2013). Religion contributes to the probable debilitating factor for individuals with schizophrenia and might be fatal to one’s life.
On the contrary, Huguelet proposed that religious practices were vital for people who were tormented with psychotic disorders (Huguelet, 2006a). Individuals with schizophrenia were observed to be more frequent participants in religious activities in comparison to the general population (Hueguelet, 2006b). Religion is a social construct, that provides identity, and a sense of belongingness to people (Connell et al., 2012a). Religion is also diverse in different cultures, which might influence one's life on a different spectrum in improving the quality of life. The WHO (World Health Organization), approved the inclusion of religion, personal beliefs, and spirituality as one of the most important factors in improving the quality of life (Shah et al., 2011a). Ruchita Shah carried out a cross-sectional study, quantifying the quality of life using the WHO Quality of life-Spirituality, Religiousness, and Personal Belief (WHOQOL-SRPB) scale, which concluded with the strong correlation between religion and spirituality’s positive effect on the quality of life in individuals with schizophrenia (Shah et al., 2011b). This correlation between the quality of life with schizophrenia could possibly provide a new direction in the method of treatment, from just reducing the symptoms to a more inclusive model of focusing on the quality of life. In the UK, mental health services have been observing a gradual shift from an overemphasis on treatment just for the reduction of the symptoms (Connell et al., 2012b). To a more focused integrative model of improving well-being and quality of life (Connell et al., 2012c). Vice versa having poor quality of life threatens the individual to feel more distressed, lack control, have low self-esteem, and lack confidence (Connell et al., 2012d). And then when such distressed individuals turn to religion to alleviate the negative emotional repercussions of stressful living conditions, it is called ‘religion coping’ (Grover et al., 2014). People with schizophrenia use religion as a coping mechanism. First, to elevate themselves from emotional distress. And second, religion could be relevant to the treatment of schizophrenia by enhancing the quality of life and reducing pathological symptoms. Third, for a better recovery from drug abuse and also reduction in relapse. Patients with schizophrenia are known to be more vulnerable to drug abuse, which poses more severe problems on top of distress (Khokhar et al., 2018). And they used religion to cope with recovery from drug abuse, which has been found to be effective in recovery and reducing relapse (Rund, 1990).
Though religion posits both negative and positive influences on schizophrenia and its treatment. The positive impacts outweigh the negative consequences. While the knowledge of knowing only the negative consequences can posit more danger than being ignorant. The ideation of religion as incompatible with medical treatment arises. On top of that, religion as a positive influence is overlooked by the overshadowing notion of the biopsychosocial model of treatment. According to the biopsychosocial model, typical treatment involves prescribing medications, therapies, and familial and social support (Lalonde, 1999, as cited in Mohr & Huguelet, 2004). Religion is not given much importance in the biopsychosocial model of schizophrenia, although it accounts for social and family support. Although DSM-IV has added diagnostic criteria for religious disorders, it has failed to consider the diagnostic criteria to differentiate between normal and abnormal religious behavior (Nolan et al., 2012). Thus, culturally normative religious delusion could be mistaken for disorders. It should be strongly recommended to train clinicians more rigorously on religious diversity and competency.
References
Butcher, Susan & M.Hooley. (2015). Abnormal Psychology (15th ed.). Pearson.
Connell, J., Brazier, J., O’Cathain, A., Lloyd-Jones, M., & Paisley, S. (2012). Quality of life of people with mental health problems: a synthesis of qualitative research. Health and Quality of Life Outcomes, 10(1), 138. https://doi.org/10.1186/1477-7525-10-138
Grover, S., Davuluri, T., & Chakrabarti, S. (2014).Religion, Spirituality, and Schizophrenia: A Review. Indian Journal of Psychological Medicine, 36(2), 119–124. https://doi.org/10.4103%2F0253-7176.130962
Huang, C. L.-C., Shang, C.-Y., Shieh, M.-S., Lin, H.-N., & Su, J. C.-J. (2011). The interactions between religion, religiosity, religious delusion/hallucination, and treatment-seeking behavior among schizophrenic patients in Taiwan. Psychiatry Research, 187(3), 347–353. https://doi.org/10.1016/j.psychres.2010.07.014
Huguelet, P., Mohr, S.,Gillieron, C., Brandt, P.Y. (2006). Spirituality and Religious Practices Among Outpatients With Schizophrenia and Their Clinicians. Psychiatric Services, 57(3), 366-372. https://doi.org/10.1176/appi.ps.57.3.366
Khokhar, J. Y., Dwiel, L. L., Henricks, A. M., Doucette, W. T., & Green, A. I. (2018). The link between schizophrenia and substance use disorder: A unifying hypothesis. Schizophrenia Research, 194, 78–85. https://doi.org/10.1016/j.schres.2017.04.016
Mohr, S., & Huguelet, P. (2004, July). The Relationship between Schizophrenia and Religion and Its Implications for Care. ResearchGate, https://doi.org/ 10.4414/smw.2004.10322
Nolan, Jennifer A., McEvoy, Joseph P., Koenig, Harold G., Hooten, Elizabeth G., Whetten, Kathyrn., Pieper, Carl F. (2012).Religious Coping and Quality of life among individuals living with Schizophrenia. Psychiatric Services, 63(10),1051-1054
Pietkiewicz, I. J., Kłosińska, U., & Tomalski, R. (2021). Delusions of Possession and Religious Coping in Schizophrenia: A Qualitative Study of Four Cases. Frontiers in Psychology, 12. https://doi.org/10.3389/fpsyg.2021.628925
Rund, B. R. (1990). Fully Recovered Schizophrenics: A Retrospective Study of Some Premorbid and Treatment Factors. Psychiatry, 53(2), 127–139. https://doi.org/10.1080/00332747.1990.11024494
Roystonn, K., Cetty, L., Jeyagurunathan, A., Devi, F., Abdin, E., Tan, S. T., Tang, C., Verma, S., & Subramaniam, M. (2021). Quality of Life and Its Associations with Religiosity and Religious Coping among Outpatients with Psychosis in Singapore. International Journal of Environmental Research and Public Health, 18(13), 7200. https://doi.org/10.3390/ijerph18137200
Shah, R., Kulhara, P., Grover, S., Kumar, S., Malhotra, R., & Tyagi, S. (2011). Relationship between spirituality/religiousness and coping in patients with residual schizophrenia. Quality of Life Research, 20(7), 1053–1060. https://doi.org/10.1007/s11136-010-9839-6
Schizophrenia. (2013). National Institute of Mental Health (NIMH). https://www.nimh.nih.gov/health/statistics/schizophrenia#part_154881
Carey, E. (2021). Psychosis. Healthline; Healthline Media. https://www.healthline.com/health/psychosis
Comments
Post a Comment