The unique spiritual journey of Ramadhan infused with purification and compassion, is coming to an end tomorrow.
Therefore, I felt this would be the right time to highlight the connection between spirituality and mental health.
The idea of spirituality means different things to different people.
The variety of spiritual beliefs and customs are as varied as the people who practice them.
Our personal relationship with a higher power also defines that meaning.
Spirituality gives an understanding of purpose and meaning to everything we do.
It is what gives us a sense of value or worth in our lives.
Spirituality and religion are undoubtedly closely linked.
Spirituality also affects our mental health in specific ways.
For example, both religion and spirituality, while being rooted in trying to understand the meaning of life, can help a person tolerate stress by generating peace, purpose and forgiveness.
It often becomes more important in times of emotional upheaval or illness. Undoubtedly, spirituality influences many decisions that people make.
As spirituality can help us make sense of our experiences in life, it naturally results in confidence, self-esteem and self-control.
When we are unwell, it can help us harness inner strength and bring about faster recovery. It also helps us better our relationship with others.
Some mental illnesses can be exacerbated when people question their value or purpose in a way that leaves them feeling pessimistic. Therefore, it can be extremely helpful to include spirituality in the treatment of mental health difficulties.
How do we do this?
The biopsychosocial model was first conceptualised by physicians George L. Engel and Jon Romano of the University of Rochester, United States, in 1977.
They were the pioneers of mind-body medicine.
As opposed to the biomedical approach, Engel strived for a more holistic approach by recognising that each patient has his own thoughts, feelings and a personal spiritual journey.
Engel framed this model for both physical and psychological problems.
The biopsychosocial model reflects the development of illness through the complex interaction of biological factors which may be genetic or biochemical, psychological factors such as mood, personality and behaviour, and social factors reflecting cultural, religious and socioeconomic characteristics.
For example, a person may have a genetic predisposition for depression, but they must also have underlying social factors such as extreme stress at work and family life, and psychological factors such as a perfectionistic tendency, which all trigger this genetic code for depression.
Similarly, a person may have a genetic predisposition for a physical illness, but social and cognitive factors must trigger the illness.
A spiritual health assessment then becomes necessary as part of any mental health assessment.
Mental issues like depression and substance abuse can be a sign of a spiritual void in our lives.
Understanding the difference between a spiritual crisis and a mental illness is important to get to the root of the problem.
Guiding light
This spiritual dimension was glaring to me when I volunteered to provide mental health services to survivors of the devastating Asian tsunami of 2004 in Aceh, Indonesia.
During the tragedy, 150,000 lives were lost and 450,000 people were internally displaced.
Needless to say, social support systems and family connections were shattered.
It was expected that the survivors would suffer from such severe psychological decompensation that the development of post-traumatic stress disorder would be rampant.
Paradoxically, while psychosocial interventions played its part, the true resilience of the people of Aceh emerged only because of their spiritual strength to accept what befell them and their conviction to submit to the will of a higher power.
This finding dramatically changed the understanding of the significance of spirituality in psychosocial intervention and recovery.
The Royal College of Psychiatrists, United Kingdom, founded the Spirituality and Psychiatry Special Interest Group to help psychiatrists share experiences and to explore spirituality in mental healthcare.
This move then led to increased research in the link between spirituality and health with the aim of increasing the profile of spirituality in patient care.
Benefits of religious practices
Mental health disorders may be treated with the help of spirituality through a psychotherapeutic method called Spiritually Augmented Cognitive Behaviour Therapy.
This technique involves including spiritual values in cognitive behaviour therapy.
It focuses on four key areas which are acceptance, hope, achieving meaning or purpose, and forgiveness.
At the community level, research suggests that religiosity reduces suicide rates, alcoholism and drug use.
This clearly demonstrates religion’s main mental health benefits.
Religious practices like a remembrance ceremony for the loss of a loved one helps people cope with difficult life situations.
Religious understanding teaches compassion, forgiveness and gratitude, and provides guidelines to live by.
However, on the flip side, some irresponsible people may take advantage of emotionally vulnerable individuals while ostensibly supporting their spirituality.
If we are emotionally susceptible, we can be more easily convinced to take part in unhealthy activities and be instigated to display intolerant behaviours.
The biopsychosocial model has now been popularly and rightfully rebranded as the biopsychosocio-spiritual model of mental healthcare.
Datuk Dr Andrew Mohanraj is a consultant psychiatrist, Green Ribbon Group policy advisor and Malaysian Mental Health Association president. For more information, email starhealth@thestar.com.my. The information provided is for educational and communication purposes only, and it should not be construed as personal medical advice. The Star does not give any warranty on accuracy, completeness, functionality, usefulness or other assurances as to the content appearing in this column. The Star disclaims all responsibility for any losses, damage to property or personal injury suffered directly or indirectly from reliance on such information.
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