Nothing in life is more wonderful than faith -- the one great moving force which we can neither weigh in the balance nor test in the cruciblemysterious indefinable known only by its effects faith pours out an unfailing stream of energy while abating neither jot nor tittle of its potency.
Sir William Osler (1910). The faith that heals British Medical Journal 11470-72.
2 The Forgotten Factor 3 Are Religion and Science Mutually Exclusive
Religion and science are mutually exclusive realms of thought whose presentation in the same context leads to misunderstanding of BOTH scientific theory and religious belief.
National Academy of Science (1984). Science and creationism A view from the National Academy of Science.
4 Are Religion and Science Mutually Exclusive
Religion and science seem to be mutually exclusive perspectives.
Stark (1963). Journal for the
Scientific Study of Religion 33-20.
5 Scientist and Clinician Beliefs Rates of Atheism and Agnosticism
U.S. Population 6
American Men and Women
of Science 1916 and 1996 55
Vermont Family Practitioners 36
Psychologists 28
Psychiatrists 21
Bergin and Jensen Psychotherapy 1990 273-7.
Maugans and Wadland Journal of Family Practice
1991 32210-213.
6 Religion Has Been Labeled
A universal obsessional neurosis...infantile helplessness...a regression to primary narcissism.
Freud S. Civilizations and its Discontents 1959.
7 Religion Has Been Labeled
Borderline psychosis . . . a regression an escape a projection upon the world of a primitive infantile state.
Group for the Advancement of Psychiatry.
Mysticism Spiritual Quest or Mental Disorder 1976.
8 Religion Has Been Labeled
A psychotic episode.
Horton PC. American Psychoanalytic
Association Journal 22(1-2) 364-380 1974.
Temporal lobe dysfunction.
Mandel AJ. In The Psychobiology
of Consciousness. Ed. by RJ Davidson 1980.
9 DSM-III-R Misrepresentation of Religion
Of 45 case examples used to illustrate psychopathology in the DSM-III-R Glossary of Technical Terms
10 (22.2) had religious content.
2 (4.4) had occupational content.
1 (2.2) had family content.
NONE had sexual ethnic racial age gender educational or cultural content.
Larson DB et al. (1993). American Journal of Psychiatry 15012.
10 Unresolved Religion Dynamics
In their training our generation of analysts have not received the detailed understanding I think is necessary to appreciate the specific contribution of the God representation to psychic balanceAs in many other areas if the analysts personal analysis has not helped them to come to terms with their religious beliefs or lack of them there is a risk of unchecked countertransference in this realm.
Rizzuto A. The Birth of the Living God. University of Chicago Press 1979.
11
A national survey of psychologists found that
Only 5 had received training on handling religious issues during their education.
Yet
More than one-half of psychologists believed that religion was a relevant topic for training and
Nearly two-thirds believed that such supervision and training was desirable.
Shafranske EP Malony HN. Psychotherapy 1990 27(1)72-78.
12
A recent survey of members of the American Association of Directors of Psychiatric Residency Training found that while religion was viewed as an issue of significant clinical importance religious issues were infrequently addressed in training.
Sansone RA et al. Academic Psychiatry 1990 434-38.
13 The Art and Practice of Medicine
Medicine is the art and practice of understanding and treating physical and emotional illnesses so as to
1) Prolong life
2) Restore health
3) Fend off death
Levin Vanderpool (1990). Journal of
Religion and Health 299-20.
14 Religion and spirituality are among the most important factors that structure human experience beliefs values behavior and illness patterns.
Lukoff D et al. Journal of Nervous
and Mental Disease 180673-682 1992.
15 The R Word 16 The R Word
Religion is a comprehensive picturing and ordering of human existence in nature and the cosmos.
Levin Vanderpool (1990). Journal
of Religion and Health 299-20.
17 Perspectives Concerning The R Word
Abraham Joshua Heschel
Religious thinking then is an intellectual endeavor out of the depths of reason. It is a source of cognitive insight into the ultimate issues of human existence.
Heschel AJ. The abiding challenge of religion. The Center Magazine. March/April 1998 pp. 43-51.
18 Perspectives Concerning The R Word
Clifford Geertz religion and stress
The force of religion in supporting beneficial social values rests then on the ability of its symbols to formulate a world in which those values as well as the forces (e.g. stressful events) opposing their realization are fundamental ingredients.
Geertz C 1973. The Integration of Cultures. Basic Books.
19 Religious and Spiritual Measures
Duke University Religion Index (DUREL)
How often do you attend church or other religious meetings
How often do you spend time in private religious activities such as prayer meditation or Bible study
In my life I experience the presence of the Divine (i.e. God).
Koenig HG et al. Religion index for psychiatric research (DUREL).
Am J Psychiatry 1997154885-6.
20 Religious and Spiritual Measures
Duke University Religion Index (DUREL)
My religious beliefs are what really lie behind my whole approach to life.
I try hard to carry my religion over into all other dealings in life.
Koenig HG et al. Religion index for psychiatric research (DUREL). Am J Psychiatry 1997154885-6.
21 The S Word 22 The S Word
Spirituality is a belief system focusing on intangible elements that impact vitality and meaning to lifes events.
Maugans (1995). The SPIRITual history.
Archives of Family Medicine 511-16.
23
Spirituality Self-transcendence which gives integrity and meaning to life by situating the person within the horizon of ultimacy
The religious meaning of spirituality is based on the conception of what constitutes the proper and highest actualization of the human capacity for self-transcendence in personal relationships namely relationship with God.
Conn JW 1987. In The New Dictionary of Theology. The Liturgical Press Collegeville MN.
24 Questions That Can Be Used to Facilitate Clinical Discussions About Patient Spirituality
From SPIRITual History
What does your spirituality/religion mean to you
What aspects of your religion/spirituality would you like me to keep in mind as I care for you
Would you like to discuss the religious or spiritual implications of your health care
As we plan for your care near the end of life how does your faith impact on your decisions
Maugans TA. The SPIRITual history.
Arch Fam Med 1996 511-6.
25 Questions That Can Be Used to Facilitate Clinical Discussions About Patient Spirituality
From Inspirit
How close do you feel to God or a higher power
Have you ever had an experience that convinced you that God or a higher power exists
How strongly religious (or spiritually oriented) do you consider yourself to be
McBride JL et al. The relationship between a patients spirituality and health experiences. Fam Med 1998 30(2)122-6.
Kass JD et al. Health outcomes and a new index of spiritual experience. J Scientific Study of Religion 1991 30203-11.
26 Questions That Can Be Used to Facilitate Clinical Discussions About Patient Spirituality
From McBride et al.
How has your religious or spiritual history been helpful in coping with your illness
How has your belief system been affected by your illness
McBride JL et al. The relationship between a patients spirituality and health experiences. Fam Med 1998 30(2)122-6.
Hatch RL et al. The spiritual involvement and beliefs scale development and testing of a new instrument. J Fam Pract 1998 46476-486.
27 Religious and Spiritual Measures
For further reading
Hill Peter C. Wood Ralph W. eds. (1999). Measures of Religiosity Birmingham AL Religious Education Press.
28 Measures of Spirituality and Religion
Pargament Kenneth I. (1997) The Psychology of Religion and Coping Theory Research Practice. New York The Guilford Press.
Also Pargament KI et al. Patterns of positive and negative religious coping with major life stressors. J Scientific Study of Religion 199837(4)710-724.
29 Why Is This Clinically Important
Patient Need
The Forgotten Factor
Clinical Relevance
30 Patient NeedU.S. Religious Beliefs and Attitudes
Item U.S. Population
Feel God loves you 90
Belief in power of prayer 88
God performs miracles today 85
Mind over matter -
God not involved 11
Emerging Trends Princeton Religious Research Center 1996.
31 Patient NeedPersonal Priorities in the U.S.
Very strongly committed to
90 Family
79 Relationship and friends
54 Job
52 Religion
18 Ones political party
USA Today survey of US adults February 10 1997.
32 Patient NeedU.S. Beliefs Faith Prayer and Health
82 Believe in healing power of
personal prayer
77 Believe that God can intervene
to cure those with a serious
illness
73 Believe that praying for another
can help cure their illness
Time June 24 1996.
33 Patient NeedU.S. Beliefs Faith and Health
79 Believe spiritual faith can help one
recover from illness injury or disease
56 Believe their faith helped them recover
from illness injury or disease
63 Believe doctors should talk to patients
about their spiritual faith
Only 10 of doctors have done so
USA Weekend April 5-7 1996.
34 Patient NeedU.S. Beliefs Faith Prayer and Health
64 Believe physicians should pray
with their patients if asked
28 Believe faith healers can make
people well
Time June 24 1996.
35 Patient NeedSpirituality and Religion
Psychiatry Medical/Surgical
Inpatients Inpatients
Consider self
Spiritual or religious 80 86
Deeply religious 48 38
Need for prayer 80 88
Religion important source
of strength and comfort 68 72
Fitchett et al. J Nerv Ment Dis 1997185(5).
36 Patient NeedCoping with Illness
Hospitalized
Most Important Factor Patients Physicians
The Patients Faith 44 9
Koenig HG et al. Religious perspectives of doctors nurses patients and families. J Pastoral Care 1991 45(3)254-67.
37 Patient NeedPatient Views Regarding Spirituality When Seriously Ill
Pulmonary
Patients
Consider self religious 51
Welcome religious questions in medical history 66
Not welcome religious questions 16
Ehman JW Ott BB Short TH. Do patients want physicians to inquire about their spiritual or religious beliefs if they become gravely ill Arch Intern Med 1999 159 (15) 1803-1806.
38 Patient NeedPatient Views Regarding Spirituality When Seriously Ill
Pulmonary
Patients
Believe prayer can aid in recovery from illness 90
Agree physicians should ask religious questions
if they became gravely ill 94
Ehman JW Ott BB Short TH. Do patients want physicians to inquire about their spiritual or religious beliefs if they become gravely ill Arch Intern Med 1999159 (15) 1803-1806.
39 Patient NeedTeaching Spirituality in Medical Schools
Study sample More than one half of U.S. medical schools have courses in spirituality and medicine many are required.
Medical school curricula include
Teaching students to make a spiritual assessment.
Viewing and collaborating with chaplains as relevant part of the health care team.
Puchalski CM Larson DB. Developing
curricula in spirituality and medicine. Acad
Med. 1998 73(9)970-74.
40 Patient NeedTeaching Spirituality in Medical Schools
Medical school curricula include
Showing students how to care for dying patients even when disease specific treatment no longer available.
Exploring major religions to identify aspects that might affect health care choices illness coping or social support value.
Puchalski CM Larson DB. Developing
curricula in spirituality and medicine. Acad
Med. 1998 73(9)970-74.
41 Patient NeedProvider and Patient Views-When to Include Spirituality
Physicians Patients
Counseling terminal illness 69 61
Handling death 68 60
Major illness 45 36
Intake history 31 ------
Birth of a child 23 48
Major surgery 7 47
Maughans and Woodland (1991).
Journal of Family Practice 32210-213.
42 Patient ReligiousnessWhen Should Physicians Include In Care
Attend church
weekly or more
Doctors should refer to chaplain or clergy 90
Doctors should discuss religious issues 59
A religious evaluation should
be part of medical record 68
Doctors should ask patients about their religion 63
Daaleman and Neare. J Fam Pract
199439564-568.
43 Patient NeedClergy Referral by Physicians
Study sample survey of Am Acad of Fam Med
Study results Family Physicians
80 had recommended clergy referral
30 had referred 10 or more times per year
40 clergy referrals depression mood disorder
20 clergy referrals alcohol drug abuse
Daaleman TP Frey B. Prevalence and patterns of physician referral to clergy and pastoral care providers. Arch Fam Med 1998 7548-53.
Physicians view of top 5 barriers to addressing patient spiritual concerns
Lack of time 71
Lack of training to take spiritual history 59
Uncertainty about how to identify
patients w/spiritual needs 56
Concern about projecting own beliefs onto patients 53
Uncertainty about how to manage patients
spiritual issues 49
Ellis MR et al. Addressing spiritual concerns of
patients family physicians attitudes and practices.
J Fam Pract 199948(2)105-9.
46 Patient NeedFamily Physicians View of Spirituality
National survey of family physicians
Felt somewhat close to God 77
Attend religious services monthly 74
Daaleman TP Frey B. Spiritual and religious beliefs and practices of family physicians a national survey. J Fam Pract 1999 48(2)98-104.
47 Patient NeedFamily Physicians View of Spirituality
National survey of family physicians
35 pray spend time in spiritual practice daily
5 did not believe in God higher power force
Daaleman TP Frey B. Spiritual and religious beliefs and practices of family physicians a national survey. J Fam Pract 1999 48(2)98-104.
48
Why Is This Clinically Important
Patient Need
The Forgotten Factor
Clinical Relevance
49 Finding the Forgotten FactorSystematic Reviews
50 The Forgotten FactorSystematic Reviews
Assess the quantity as well as the quality of analyzing a factor in a field or body of research
51
For many people religion forms a basis of meaning and purpose in life. The profoundly disturbing effects of illness can call into question a persons purpose in life and work responsibilities to spouse children and parents and motivations and fidelity priorities. Healing the restoration of wholeness (as opposed to merely technical healing) requires answers to these questions.
Foglio Brody. Journal of Family Practice 1988.
52 A systematic review of 2348 studies published in the four leading psychiatry journals from 1978-1982 found that
2.5 of the studies included a quantified religious or spiritual variable.
Less than 1 assessed religion or spirituality with minimal standards of acceptability.
Only 1 study employed a state-of-the-art approach to measuring religion or spirituality.
The majority of studies measured religion with denomination -- a much less useful measure of religiousness.
Larson et al. (1986). American Journal
of Psychiatry 143329-334.
53 Systematic ReviewsPsychiatrys Handling of Religion - A Second Look
Study sample 1991-95 systematic review of leading journals of psychiatry 2766 quantitative studies
Study results 32 of 2766 studies (1.2) included a religious or spiritual variable.
This result was one-half (2.5) of a previous 1978-82 psychiatry systematic review.
Weaver AJ et al. A systematic review of research on religion in four major psychiatric journals 1991-1995. J Nerv Ment Dis 1998186(3)187-190.
54 The Forgotten FactorFrequency of Study
Systematic Reviews of Clinical Fields
Fields with Religion
Psychiatry I 2.5
Geriatrics 3.6
4 Fields Psychology 2.7
Family Medicine 1.9
Psychiatry II 1.2
Primary Care 1.1
Mean 2.3
55 Systematic ReviewsPsychology Research Concerning the Clergy
Study sample 1991-94 systematic review of eight leading psychology journals.
2400 studies reviewed
four assessed the role of clergy -- OR
one in 600 studies
In contrast when in personal distress at least 4 in 10 Americans seek help from clergy.
Weaver AJ et al. What do psychologists know about working with the clergy An analysis of eight APA journals 1991-94. Professional Psychology Research and Practice 199428(5)471-74.
56 Systematic ReviewsSpirituality in Mental Health Nursing
Study sample 1991-95 systematic review of all research published in Archives of Psychiatric Nursing Journal of Psychosocial Nursing and Issues in Mental Health Nursing
Study results
Of 311 quantitative studies 31 (i.e. 10) included a spiritual or religious variable.
Like other fields most studies (61) assessed with a single item.
Weaver WJ et al. An analysis of research on religious
and spiritual variables in three major mental health
nursing journals. Issues Ment Health Nurs 199819263-76.
57 The Forgotten FactorExamining Denomination
Findings of the Penn Psychotherapy Project
Christian Jewish None
Penn Study 37 34 29
National Surveys 87 3 6
No Other Category
Luborsky et al. Archives of General Psychiatry 1990 37471-481.
58 Systematic ReviewsAssessing Religious Affiliation
Could not be determined 12.5
By cemetery type w/reliability 12.5
Pre-death subject interview 25
By cemetery type w/out reliability 50
McCullough ME et al. The mismeasurement of religion in mortality research. Mortality 19994(2)183-194.
59 Systematic ReviewsAssessing Religious Affiliation
Five Class Taxonomy 12
Four Class Taxonomy 19
Three Class Taxonomy 63
Two Class Taxonomy 6
Total 100
McCullough ME et al. The mismeasurement of religion in mortality research. Mortality 19994(2)183-194.
60 The Forgotten FactorSystematic Reviews - Quality of Study
Research Studies
Method Number With The
Deficiency of SRs Deficiency
Single item measure 5 79
Denomination only 6 46
No research citation 6 77
61 The Forgotten FactorSystematic Reviews Clinical Findings
Clinical Harm
or
Clinical Benefit
62 The Forgotten Factor
Of those studies examining religion in the leading psychiatry journals
83 found a positive relationship
14 found a neutral relationship
3 found a negative relationship
...between religion and mental health
Larson DB et al. American Journal
of Psychiatry 1992 149557-559.
63 The Forgotten FactorPhysical Health
Craigie (1990) evaluating 10 years of the Journal of Family Practice where measures of religious commitment were measured demonstrated
- 81 showed positive association
- 15 were neutral
- 4 were negative
Craigie et al. References to religion in the Journal of Family Practice dimensions and valence of spirituality. Journal of Family Practice 1990 4477-480.
64 The Forgotten FactorPhysical Health
Levin and Vanderpool (1987) when examining the epidemiological research which used a measure of frequency of religious attendance found results strikingly similar in proportions
- 81 showed benefit
- 15 were neutral
- 4 showed harm
Levin JS Vanderpool HY. Is frequent religious attendance really conducive to better health toward an epidemiology of religion. Social Science and Medicine 1987 24589-600.
65 The Forgotten FactorSystematic Reviews of the Findings
Of studies examining religious commitment
variables in clinical research
Family Frequency
Psychiatry Medicine of Worship
Clinical harm --ALL less than 5--
Clinical benefit -- ALL greater than 80--
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