Spirituality and psychiatry
- on the face of it, they do not seem to have much in common. But
we are becoming increasingly aware of ways in which some aspects of
spirituality can offer real benefits for mental health.
This leaflet is for:
- anyone who has an interest
in spirituality and mental health
- anyone with a mental health
- carers and relatives
- professionals who may not
be sure about how to explore spiritual concerns with their
It looks at:
- how spirituality, mental health and mental healthcare can
- how to make a place for spiritual needs within a mental health
- how spirituality can help mental health.
You don't need to hold a
formal religious belief, to take part in religious practices, or
belong to an established faith tradition to read this leaflet - or
to experience spirituality.
There is no one definition,
but in general, spirituality:
- is something everyone can experience
- helps us to find meaning and purpose in the things we
- can bring hope and healing in times of suffering and
- encourages us to seek the best relationship with ourselves,
others and what lies beyond.
These experiences are part of being human - they are just as
important to people with intellectual disability or
other conditions, such as dementia and head injury, as
they are in anybody else.
Spirituality often becomes
more important in times of emotional stress, physical and mental
illness, loss, bereavement and the approach of
All health care tries to
relieve pain and to cure - but good health care tries to do more.
Spirituality emphasises the healing of the person, not just the
disease. It views life as a journey, where good and bad experiences
can help you to learn, develop and mature.
How is spirituality different
certainly include individual spirituality, which is universal. But
each religion has its own distinct community-based worship,
beliefs, sacred texts and traditions.
Spirituality is not
necessarily tied to any particular religious belief or
tradition. Although culture and beliefs can play a part in
spirituality, every person has their own unique experience of
spirituality - it can be a personal experience for anyone, with or
without a religious belief. It's there for everyone. Spirituality
also highlights how connected we are to other people and the
What is spiritual health
People with mental health
problems have said that they want:
- to feel safe and
- to be treated with dignity
- to feel that they belong,
are valued and trusted
- time to express feelings to mental health carers
- meaningful activity such as creative art, work or enjoying
- the chance to make sense of
their life – including illness and loss
- permission/support to
develop their relationship with God or the Absolute.
Someone with a religious
belief may need:
- a time, a place and
privacy in which to pray and worship
- the chance to explore
- to be reassured that the
psychiatrist will respect their faith
- encouragement to deepen
- sometimes – to be helped
What difference can
Patients say that they
- better self-control,
self-esteem and confidence
- faster and easier recovery
(often through healthy grieving of losses and through
recognising their strengths)
- better relationships – with
self, others and with God/creation/nature
- a new sense of
meaning, hope and peace of mind. This has enabled them to accept
and live with continuing problems or to make changes where
This should be considered as
part of every mental health assessment. Depression or substance misuse, for
example, can sometimes reflect a spiritual void in a person's life.
Mental health professionals also need to be able to distinguish
between a spiritual crisis and a mental illness, particularly when
A helpful way to begin is to
be asked "Would you say you are spiritual or religious in any way?
Please tell me how." Another useful question is, "What gives you
hope?" or "What keeps you going in difficult times?" The answer to
this will usually reveal a person's main spiritual concerns and
Sometimes, a professional
may want to use a questionnaire. They will want to find out:
- what helpful knowledge or
strengths do you have that can be encouraged?
- what support can your faith
A gentle, unhurried approach
is important – at its best, exploring spiritual issues can be
therapeutic in itself.
What is your life all about?
Is there something that gives you a sense of meaning or
Emotional stress is often
caused by a loss, or the threat of loss. Have you had any major
losses or bereavements or suffered abuse? How has this affected
Do you feel that you belong
and that you are valued? Do you feel safe and respected? Are you
and other people able to communicate clearly and freely?
Do you feel that there is a
spiritual aspect to your current situation? Would it help to
involve a chaplain, or someone from your faith community? What
needs to be understood about your religious background?
What do the next few weeks
hold for you? What about the next few months or years? Are you
worried about death and dying, or about the possibility of an
afterlife? Would you want to discuss this more? What are your main
fears about the future? Do you feel the need for forgiveness about
anything? What, if anything, gives you hope?
What kind of support
would work for you? How could you best be helped to get
it? Is there someone caring for you with whom you can explore your
These span a wide range,
from the religious to non-religious. You may:
- belong to a faith tradition
and take part in services or other activities with other
- take part in rituals,
symbolic practices and other forms of worship
- go on pilgrimage and
- spend time enjoying nature
- give of yourself in acts of compassion (including work,
- spend time in meditation,
deep reflection or prayer
- follow traditions of yoga,
Tai Chi and similar disciplined practices
- read scripture
- listen to singing and/or
playing sacred music, including songs, hymns, psalms and devotional
- join team sports or other activities that involve co-operation
- spend time in contemplative
reading (of literature, poetry etc.)
- appreciate the arts
- be creative - painting,
sculpture, cookery, gardening etc.
- make and keep good family
- make and keep friendships,
especially those with trust and intimacy.
Over recent years there has been increasing interest in
treatments that include the spiritual dimension. In addition to
established 12-step programmes for alcohol and substance misuse,
new approaches such as mindfulness-based cognitive therapy for the
treatment of stress, anxiety and depression (MBCT),
compassion-focussed therapy and forgiveness therapy are now
being actively researched and supported.
Spiritual values and
Spiritual practices can help
us to develop the better parts of ourselves. They can help us to
become more creative, patient, persistent, honest, kind,
compassionate, wise, calm, hopeful and joyful. These are all part
of the best health care.
- being honest – and able to
see yourself as others see you
- being able to stay focused
in the present, to be alert, unhurried and attentive
- being able to rest, relax
and create a still, peaceful state of mind
- developing a deeper sense
of empathy for others
- finding the capacity for forgiveness
- being able to be with
someone who is suffering, while still being hopeful
- learning better judgement,
for example about when to speak or act, and when to remain
silent or do nothing
- learning how to give
without feeling drained
- being able to grieve and
Spirituality emphasises our
connections to other people and the world, which creates the idea
of ‘reciprocity’. This means that the giver and receiver both get
something from what happens, that if you help another person, you
help yourself. Many carers naturally develop spiritual skills and
values over time as a result of their commitment to those for whom
they care. Those being cared for, in turn, can often give help to
others in distress.
How to start …..?
Spirituality is deeply personal. Try to
discover what works best for you. A three-part daily routine can be
- a regular quiet time (for
prayer, reflection or meditation)
- study of religious and/or
- making supportive
friendships with others with similar spiritual and/or religious
aims and aspirations.
You can find out about
spiritual practices and traditions from a wide range of religious
organisations. Secular spiritual activities are increasingly
available and popular. For example, many complementary therapies
have a spiritual or holistic element that is not part of any
particular religion. The internet, especially internet bookshops,
the local yellow pages, health food shops and bookstores are all
good places to look. There is also a wide range of papers about
spirituality and mental health that can be downloaded from the
publications archive of the Royal
College of Psychiatrists Spirituality and Psychiatry Special
Interest Group's website.
The place of
Times have changed. Hospital chaplaincy now
involves clergy and others from many faiths, denominations and
humanist organisations. Chaplains (also called spiritual advisors)
are increasingly part of the teams that provide care both in and
A modern mental health chaplaincy or
department of spiritual care should:
- get on well with local clergy and faith communities
- provide information about local religious groups, their
traditions and practices
- recognise that in some circumstance for an individual to
be focussing on religious beliefs and activities can be
unhelpful and even harmful
- be able to give advice on difficult issues, such as paranormal
influences, spirit possession and the ministry of deliverance
- work closely with the mental health team so that spiritual
needs can be recognised and helped
- make sure that patients know about the help available from
departments of spiritual care.
Education and research
There is evidence that people who belong
to a faith community, or who hold religious or spiritual beliefs,
have better mental health. So, the relevance of spirituality is
now being recognised in courses for mental health care
students and practitioners.
About the Spirituality and Psychiatry Special Interest
The Spirituality and Psychiatry Special
Interest Group of the Royal College of Psychiatrists was
founded in 1999 to:
- help psychiatrists to share experiences and to explore
spirituality in mental healthcare
- increase knowledge of the research linking spirituality with
- raise the profile of spirituality in patient care.
The SPSIG has a membership of
around 3000 psychiatrists. It runs an active programme
of one-day events for members, and holds occasional
conferences open to the general public. Information about these
meetings (and the texts of all the talks given) can be found in the
- Barker P. & Buchanan-Barker P. (Eds).
(2003) Spirituality and Mental Health: Breakthrough.
- Butler-Bowen T. (2006) 50 Spiritual
Classics. Nicholas Brealey Publishing.
Cook, C., Powell, A. & Sims, A. (Eds) (2009) Spirituality and
Psychiatry. RCPsych Publications.
- Coyte M. Gilbert, P. & Nicholls V. (Eds.)
(2007) Spirituality, Values and Mental Health: Jewels for the
Journey. Jessica Kingsley.
- Culliford L. (2007)
Love, Healing and Happiness. O Books.
- Fontana D. (2003)
Psychology, Religion and Spirituality. BPS Blackwell.
- Forest J. (2007) The
Road to Emmaus: Pilgrimage as a Way of Life. Orbis Books.
- Galanter M. (2005)
Spirituality and the Healthy Mind: science, therapy, and the
need for personal meaning. Oxford University Press.
- Kabat-Zinn J. (2004)
Wherever You Go, There You Are. Piatkus Books.
- Koenig H.G. (2013) Spirituality in Patient Care: Why, How,
When, and What, West Conshohocken, PA, Templeton.
- Kornfield J. (1994) A
Path With Heart. Rider.
- Nataraja S. (2008) The
Blissful Brain. Gaia Books.
- Post S. & Neimark J.
(2007) Why Good Things Happen to Good People. Broadway
- Royal College of Psychiatrists (2013) Recommendations
for psychiatrists on spirituality and religion.
- Scott Peck M. (1997)
The Road Less Travelled. Rider.
- Swinton J. (2001)
Spirituality and Mental Health Care: Rediscovering a Forgotten
Dimension. Jessica Kingsley.
- Whiteside P. (2001)
Happiness: The 30-Day Guide. Rider.
- Anandarajah G. & Hight E. (2001)
Spirituality and Medical Practice: using the HOPE questions as a
practical tool for spiritual assessment. American Family
Physician, 63, 81– 92.
- Cook C.C.H (2009) Substance Misuse. In Cook,
C., Powell, A. & Sims, A. (Eds) Spirituality and
Psychiatry 139-168 RCPsych Publications.
- Cook C.C.H. (2013) Controversies on the Place of Spirituality
and Religion in Psychiatric Practice. In Cook C.C.H. (Ed.)
Spirituality, Theology and Mental Health, London, SCM,
- Craigie F.C. (2008) Positive Spirituality in Health
Care. Minneapolis, Mill City.
- Culliford L. (2002) Spirituality and Clinical
Care. British Medical Journal. 325:1434-5.
- Culliford L. (2007) Taking a Spiritual
History. Advances in Psychiatric Treatment, 13,
- Culliford L. (2009) Teaching Spirituality and
Healthcare to 3rd Year Medical Students. The
Clinical Teacher, Volume 6, Issue 1, pages 22-27, March
- Eagger S. (2005)
guide to the assessment of spiritual concerns in mental
- Faulkner A. (1997)
Knowing our own minds. London: Mental Health
- Gilbert P.
& Nicholls V. (2003) Inspiring Hope: Recognising the
Importance of Spirituality in a Whole Person Approach to Mental
Health. London: National Institute for Mental Health in
- Gilbert, P. (2009) Introducing compassion-focused therapy
Advances in Psychiatric Treatment, 15, 199-208.
- Koenig H., McCullough M., & Larson D. (2011) Handbook of
Religion and Health. Oxford: Oxford University Press.
- Neely D. & Minford E.
(2009) FAITH: spiritual history-taking made easy. Clinical
Teacher. 6: 181-185.
- Swinton J. (2002)
Spirituality and the Lives of People With Learning Disabilities.
The Tizard Learning Disability Review. 7, 4: 29-35.
- World Health Organization.
(1998) WHOQOL and Spirituality, Religiousness and Personal Beliefs:
Report on WHO Consultation. Geneva: WHO.
This leaflet was produced by
the Royal College of Psychiatrists’ Spirituality and Psychiatry
Special Interest Group Executive Committee.
Editor: Dr Philip Timms
Review: Dr Andrew Powell, Professor Chris Cook, Dr Larry
Illustration by Lo Cole:
This leaflet reflects the best available evidence at the time of
Under Review April
2018 Royal College of
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