Reflections on “Religious Coping in Schizophrenia Patients: Spiritual Support in Medical Care and Pastoral Counselling”

The role of religious belief and experience in psychopathology has been a focus for recent psychological research. The religious dimension for patients with schizophrenia is an especially interesting question. For example, L.J. Danbolt, P. Møller, L. Lien, and K.A. Hestad examined the religiousness and spirituality of thirty-one men and women diagnosed with schizophrenia spectrum disorders.¹ They found that the majority of patients reported a positive effect for religion and spirituality in their coping with psychotic symptoms. A further question is the use of religion and spirituality in intervention as proposed in the opening essay of this issue.

The authors conduct their study within the context of a recent rapprochement between psychology and religion. It was only in the 1990s that the American Psychological Association published a major work on this topic.² They examined the role of religion/spirituality in psychotherapy and clinical work.³ As a result, clinical psychologists, psychotherapists, and counsellors have begun to question the importance of a new paradigm for their work, a “bio-psycho-social-spiritual” model. Within clinical settings the religious belief and spirituality of a patient or client are beginning to be recognized as important aspects and assets in intervention.

As Zinnbauer and Pargament point out, the definitions of religion and spirituality are multiple.⁴ For example, they list eight different definitions for religion, and nine for spirituality, ranging from religion as a system of beliefs and practices to the use of symbolic forms and acts in relation to the ultimate, and from the description of spirituality as living out faith to a human potential for dealing with ultimate issues. They suggest that the broader, more fluid definitions allow for wider inclusion of these variables in research.

In “Religious Coping in Schizophrenia Patients” the authors give a brief definition of religiousness as “beliefs systems, behavioural, social, and denominational characteristics” and spirituality as “concern with the transcendent, addressing the ultimate questions about life’s meaning.”⁵ They do say that “a general evaluation of the role of religion . . . was based on religious affiliation, private and public practices, and the salience of spirituality in their daily lives.”⁶ The authors investigated “the importance of religion to people with schizophrenia,” and the extent of religious and spiritual knowledge that “should be integrated into the education of clinicians and, more generally, of all caregivers, including chaplains in psychiatric hospital units.”⁷ They summarize the importance found in their own studies⁸ and parallel studies. Finally, they examine how patients utilize the religious/spiritual aspect in treatment to cope with their illness.

In the reported study, the authors recruited 115 outpatients in Geneva, Switzerland, and 126 in Trois Rivières, Quebec. Although differing in their religious involvement, these two samples appeared to have common features: the majority considered religion or spirituality as important in life, and over half engaged in private religious practices. Religion or spirituality was seen as important for coping with their illness by 60 per cent of the Genevans and 71 per cent of the Quebec patients. The authors conclude that these patients are invested in the religious aspect of their illness.

The clinicians who offered treatment differed from the patients in religious attitudes. They tended to undervalue the role of religion in a patient’s life. Only one-third of the clinicians seemed to have some grasp of their individual patient’s religion and discussed this with their patients. Several clinicians expressed concern about lacking skills to do so or thought the topic irrelevant in treatment—a concern that was reinforced after three months of treatment.⁹

The researchers offered religious supervision to the study clinicians. The instruction on how to assess religion, instruction, and supervision appears to have been minimal. Eight of the eleven psychiatrists involved in treatment in the two settings were offered training on integrating the religious dimension into their therapy in a ninety-minute session on the use of a religious and spiritual assessment interview. Since the researchers have already remarked that the clinicians seemed unfamiliar with religion or spirituality, such an...