Spirituality and Its Contribution to Mental Health
A neglected construct in an age of anxiety, depression, and addiction.
Posted August 6, 2022 | Reviewed by Vanessa Lancaster
Sebastian Salicru
Psychology Insights for a New World
KEY POINTS
• Spirituality has been defined as an expression of the transcendent ways in which to fulfill human potential.
• Spirituality is a recognized psychological construct that is different from religiosity and has transcultural applicability.
• Extensive research evidence indicates that spirituality is important in treating psychological conditions.
Spirituality has become a topic of much interest in recent times in the scientific community. This includes the convergence of advances related to the role of spirituality in self-help groups, health psychology, psychiatry, and consciousness research.
Spirituality as a Psychological Construct and Therapeutic Factor
Spirituality has traditionally been considered an elusive concept that is difficult to investigate. Hence, its role in psychological well-being has been seen as largely absent.
More recently, however, spirituality has been rightfully placed in contemporary psychology. This includes metatheoretical propositions that explain it as a legitimate psychological construct, which differs from religiosity and has transcultural applicability.
While spirituality may include religion, it has been defined as an expression of the transcendent ways to fulfill human potential and as a synonym for constructs such as hope, meaning, wholeness, harmony, and transcendence (O’Reilly, 2004). Spirituality has been recognised as an important feature of the therapeutic process and a contributor to improving life satisfaction and well-being and reducing antisocial behavior, substance abuse, and suicide rates (Brawer et al., 2002).
For example, recent contributions in schema therapy, an increasingly popular model embraced by clinicians for working with people with multiple disorders, explain spirituality as “a natural wisdom or spirituality that is not necessarily channeled through institutional religion, and which provides a sense of strength and direction in the face of loss and adversity” (Edwards, 2022, p. 5).
Similarly, recent advances in health psychology have developed measures to assess spirituality (Braghetta et al., 2021). A new framework in healthcare for a better understanding of spirituality is proposed as an important aspect of healthcare research (de Brito Sena et al., 2021).
Research Evidence Supporting Spirituality
A body of research evidence indicates that spirituality plays an important role in treating medical and psychological conditions (Stanard et al., 2000) and that any form of psychotherapy exploring the depth of the human psyche will eventually reach the spiritual domain (Elkins, 2005). Meta-analytic results of 31 studies investigating spiritually oriented psychotherapies provide empirical evidence of their benefits to individuals experiencing various psychological conditions such as anxiety, eating disorders, depression, and stress (Smith et al., 2007).
Contemporary contributions in consciousness report the positive and causal associations between spiritual well-being and mental health (Saad et al., 2022), as well as supporting evidence for using spiritual experiences to treat conditions such as addiction, depression, and anxiety to positively transform lives (Corneille & Luke, 2021).
Recent contributions to psychiatry assert that “state-of-the-art clinical psychiatry seeks to provide successful treatment of persons with mental illness in a comprehensive approach integrating … social, and spiritual aspects” (Huber & Schneeberger, 2020, p. 1).
Finally, recent advances derived from rigorous scientific research examining the efficacy of 12-step programs (12SP), initially spawned from Alcoholics Anonymous (AA) and the treatment of addiction, have been found to be effective stand-alone interventions for substance use disorder (SUD), as well as effective adjunct professional clinical practices (Kelly et al., 2020). Despite earlier doubts and criticisms from academia, today, “the evidence for the efficacy of 12-step interventions is compelling” (Greene, 2021, p. 19). Spirituality is a central construct, therapeutic factor, and mechanism of change inherent in 12SP (Kelly et al., 2011).
Neuroscience, Consciousness, and Spirituality
Given the progress and convergences outlined thus far, it’s not at all surprising that neuroscience and the clinical benefits of spiritual practices have become major drivers of recent scientific inquiry.
Contemporary consciousness research provides emerging proof-of-concept evidence of spirituality by asserting that: (1) the mind is separate from the brain; (2) spirit and soul are comparable to energy and information that exist in the vacuum of space; (3) individuals can receive intuitive information that is accurate and useful in their individual and collective lives; and (4) physical and psychological health can be fostered by active loving spiritual processes.
The Wisdom of Carl Jung
Almost a century ago, Carl Jung noticed that many people in his day were afflicted by debilitating feelings of insignificance, inadequacy, and hopelessness. In his Collected Works, Jung concluded that such feelings were caused by what he called the “Spiritual problem of modern man.”
Spiritual Practices–Where to Begin?
From a personal perspective and professional capacity, I dare to say (without exaggeration) that spiritual practices could save anyone years of suffering and/or psychotherapy.
Not surprisingly, in recent times, multiple authors/spiritual teachers – some of whom have become international bestsellers (e.g., Tolle, Singer) – have been disseminating the message of spirituality.
Finally, an alternative starting point to access your spirituality is to consider the following distinction of the self, provided over a century ago by William James–a founder of the psychological movement. In brief, this relates to the "I" and the "Me" in self-referential awareness. The self as “I” (the knower or higher self) relates to the self as the subject of experience (self as subject), which also relates to meditation experiences and studies linked to the notion of mindfulness and other Buddhist constructs.
The causal agent, the thinker or observer who does the thinking or observing, is also responsible for self-awareness and self-knowledge. The “Me” (the known self) relates to the self as the object of the experience or cognition (self as object). This distinction in self-referential awareness has re-emerged recently in neurocognitive science, particularly in experimental studies investigating the phenomenological self and consciousness.
References
Braghetta, C. C., Gorenstein, C., Wang, Y. P., Martins, C. B., Leão, F. C., Peres, M. F. P., ... & Vallada, H. (2021). Development of an instrument to assess spirituality: Reliability and validation of the Attitudes Related to Spirituality Scale (ARES). Frontiers in Psychology, 12, 764132. https://doi.org/10.3389/fpsyg.2021.764132
Elkins, D. N. (2005). A humanistic approach to spiritually oriented psychotherapy. In L. Sperry & E. P. Shafranske (Eds.), Spiritually oriented psychotherapy (pp. 131–151). American Psychological Association. https://doi.org/10.1037/10886-006
Ho, D. Y., & Ho, R. T. (2007). Measuring spirituality and spiritual emptiness: Toward ecumenicity and transcultural applicability. Review of General Psychology, 11(1), 62-74. https://doi.org/10.1037/1089-2680.11.1.62
Jung, C. G. (1928). The spiritual problem of modern man. Collected Works, 10, 74-94. https://www.degruyter.com/document/doi/10.1515/9781400850976.74/html?lang=en
Miller, L. J. (Ed.). (2013). The Oxford handbook of psychology and spirituality. Oxford University Press.
Schwartz, G. E. (2012). Consciousness, spirituality, and postmaterialist science: An empirical and experiential approach. In L. J. Miller (Ed.), The Oxford handbook of psychology and spirituality (pp. 584–597). Oxford University Press. https://doi.org/10.1093/oxfordhb/9780199729920.013.0037
Singer, M. (2007). The untethered soul: The journey beyond yourself. New Harbinger Publications.
Tolle, E. (2006). A new earth: Awakening to your life’s purpose. Penguin Life.
Walach, H., Schmidt, S., & Jonas, W. B. (Eds.). (2011). Neuroscience, consciousness and spirituality (Vol. 1). Springer Science & Business Media. https://www.springer.com/series/10195
Sebastian Salicru is a registered psychologist, psychotherapist, and board-approved supervisor, with over 25 years of professional experience in both clinical and corporate settings. He is the author of Leadership Results.
Speaking of Psychology: What can science teach us about the benefits of religion?
With David DeSteno, PhD
Episode 167
For thousands of years, people have turned to religion to answer questions about how to lead a happy, moral and fulfilling life. David DeSteno, PhD, a psychology professor at Northeastern University and author of the book How God Works, discusses how the structures and traditions of religion contribute to people’s well-being, what behavioral scientists can learn from studying religion, and how those lessons can be applied outside the context of religious belief.
About the expert: David DeSteno, PhD
David DeSteno is a professor of psychology at Northeastern University, where he directs the Social Emotions Group. At the broadest level, his work examines the mechanisms of the mind that shape vice and virtue. Studying hypocrisy and compassion, pride and punishment, cheating and trust, his work continually reveals that human moral behavior is much more variable than most would predict. David is a fellow of the Association for Psychological Science and the American Psychological Association, for which he served as editor-in-chief of the journal Emotion. His work has been repeatedly funded by the National Science Foundation and has been regularly featured in the media, including The New York Times, The Wall Street Journal, CBS Sunday Morning, NPR's Radiolab and On Point, and USA Today. He is the author of How God Works, Emotional Success, The Truth About Trust, and co-author of The Wall Street Journal spotlight psychology bestseller Out of Character. He frequently writes about his work for major publications including The New York Times, The Atlantic, Harvard Business Review, The Washington Post, and The Los Angeles Times.
Kim Mills: For thousands of years, people have turned to religion to answer questions about how to lead a happy, moral and fulfilling life, how to meet life's challenges and how to be resilient in the face of hardship. For many people, religion's answers have proven satisfying. A 2019 Pew Research poll found that people who described themselves as actively religious—those who were affiliated with a religion and attended religious services regularly—were more likely to say that they were very happy than people who didn't go to services or who were unaffiliated with any organized religion.
Why is that? How do the structures and traditions of religion contribute to people's health, happiness, and well-being? What can behavioral scientists learn from studying the religious rituals that scaffold people’s lives, from birth to coming of age, to marriage, to death? Can those lessons be applied outside the context of religious belief? What about the perennial question that pits science against religion? Can one be a scientist and still believe in a higher power?
Welcome to Speaking of Psychology, the flagship podcast of the American Psychological Association that examines the links between psychological science and everyday life. I'm Kim Mills. My guest today is Dr. David DeSteno, a professor of psychology at Northeastern University in Boston, where he directs the Social Emotions Lab. Dr. DeSteno studies the ways in which people’s emotions influence their social behavior and moral decision making in areas including trust, altruism, cooperation, resilience, dishonesty, and prejudice.
In recent years he's been particularly interested in what behavioral science can learn from religious traditions about how to help people improve their well-being and lead happier lives. He explores this topic in his book, How God Works: The Science Behind the Benefits of Religion, published in September, and in a podcast by the same name, which debuted in September. Thank you for joining us, Dr. DeSteno.
David DeSteno, PhD: Hi Kim. Thank you for having me on.
Mills: Many discussions of science and religion are framed in terms of conflict, that these are two opposing ways of looking at the world. But in your book, you argue that scientists can learn a great deal from studying religion, particularly behavioral scientists. So let's start with them. As a research psychologist, what sparked your interest in religion and made you decide that it was something you needed to study?
DeSteno: Yeah. Thank you for that question. I want to be clear that I didn't have an agenda in this. I didn't start out on this line of work to prove religion was beneficial or harmful to people. I just simply followed the data like any good scientist. For a long time in my lab—we study things like how people become more kind and compassionate, how they form connections, how they become more resilient—every time we would find some new mechanism or some new strategy or life hack to help this, I'd look around and see it being used in all types of religious rituals. I finally had one student who was very much interested in meditation itself and what its original theological purpose was according to the Buddhists, which is not to improve your memory, not to raise your standardized test scores, but to reduce the suffering of all sentient beings.
So we ran some studies where we actually showed that after eight weeks of meditation, people became more spontaneously kind. That as—we would use actors and have them looking like they were in pain and needing help, and we would find people who engaged in meditation compared to randomized controls would suddenly become more willing to help them. What I began to realize is a lot of the work we were doing, a lot of the mechanisms we were studying, have been intuited by religious thinkers long, long ago. For scientists, that's humbling, right? When someone has your idea, that's humbling enough, but when they beat you to it by thousands of years, it's really humbling.
I don't think we're going to learn much about the nature of the cosmos or the biology of disease from religion, but it would be strange if thousands of years of thought meant to help people meet the challenges of life didn't have something to offer. The analogy I use is sometimes when pharmaceutical companies are looking for medications to help people, they will look to traditional cultures. Sure, a lot of those medications that traditional cultures use might not help, but some do, and we found wonderful medications to treat different types of cancer and other ailments from those examinations. I think we should do the same when it comes to psychology and human well-being.
We've done that a little bit with meditation. We know it reduces stress and anxiety, but mindfulness can't be the only spiritual technique that has something to offer. So my argument here is let's put our “isms” aside. We can't answer the question, does God exist? Any scientist worth their salt will tell you they may see no evidence of it, but they can't prove with finality that God doesn't exist. So let's not argue about that. Let's respect everybody's views, put those to the side and focus on what we can focus on, which is how these practices make life better for people and what knowledge, what wisdom can we take from that?
Mills: One of the central themes of your book is the power of ritual. First of all, how do you define a religious ritual, and what makes it different from any other type of habit or ritual? Why, essentially, are rituals so powerful?
DeSteno: That's a really good question. Religious thinkers for a long time have been trying to define rituals. It's hard to define a ritual based on a certain set of actions because sometimes those actions are part of rituals, sometimes they're not. I mean, what's the difference between lighting a candle so I can see my food better versus lighting a candle for Shabbat or for some other religious purpose. You're doing the same action. Really the best definition out there is that rituals are actions that are done with a special intention. Besides that, there's not much that combines them all. Sometimes people do them in synchrony. Sometimes they sing. Not always. Sometimes they chant. Not always. Sometimes it's alone, sometimes it's together, but really what it is, is an action that has some intention, special purpose attached to it.
But, what is brilliant behind religious rituals and the way they exist now is you can think about them as mechanisms that leverage our mind and our body. One thing we always see in many rituals are people doing things in unison. We will stand and kneel in unison, we will sing or chant in unison. Well, there's work from my lab and others that shows when people do things in unison, even if they simply move their arms in time and unison with each other, it makes them feel more connected, more compassionate, and more likely to help each other. We know that when you chant or when you say the rosary or sing Hindu Kirtan, it reduces your breathing rate. By reducing your respiration rate, it slows your heart rate, which then through the vagus nerve signals to your mind that this is a safe environment, one that's more able for connection.
So what you're seeing is these mechanisms are packaged together in ways that aren't just random acts that we give attention to, but that actually work on our physiology and the mind's hidden language to accomplish certain goals. So the beauty about religious rituals, it's not just saying, "Let's just light a candle, and this act we're going to say is special," but they've intuited over time ways to manipulate our physiology and our thinking to help achieve the goal that they want.
One of the best terms I've heard is you can think about rituals as debugged technologies. Over the millennia they've been honed to have effects on our mind and body to leverage our physiology, to help us nudge our minds toward the goals we want to achieve in that ritual.
Mills: You arranged your book around the human life cycle and discuss how different religious traditions can help people at different times in their lives, from birth to childhood, to coming-of-age rituals in adolescence, to adulthood, and finally death and mourning. What are some of the more compelling examples of rituals you looked at that help people at these different times?
DeSteno: Let me start with the end, because to me in some sense that is some of the most compelling that I have seen. So as you say, the book is laid out along the path of life. I try to look at both the convergences in these rituals because in some senses those things that you mentioned on the road of life are commonalities we all face. But then do some face, that for whatever reason have slightly potentially better packages of ritual elements.
So if you think about grief and loss, it's something no matter who you are in life, you're going to come to that time when you lose somebody you love, likely. One thing that all really just rituals do in that instance is we all eulogize the person who has passed, which seems kind of normal because we all do it. But if you think about it psychologically, it's kind of odd at first. If I just lost a job that I really love, or if my wife who I dearly love just decided she was going to divorce me, I wouldn't want to think about that job or my wife because thinking about what I've lost would make the pain that much worse. Yet it's something we always do when somebody passes, and there's wonderful new research, relatively new research, by the psychologist George Bonanno, who's one of the leading bereavement researchers in the world, who shows that it's people who can consolidate positive memories of the deceased who pass through grief more resiliently. By that I mean in a quicker time and with less debilitating anxiety or depression.
But on top of that, if you look at certain rituals, there's even other elements that are packaged. One of my favorite is the Jewish ritual of sitting shiva. So if you haven't been to shiva, many things happen, but it's a seven-day period of mourning. The first thing that is true is it is called a mitzvah, which is a sacred obligation. When someone passes, you must go to their house, you must bring them food, you must visit them, you must help them out. That's providing what's called in psychology instrumental support, which is one of the leading predictors of helping people through grief. It's not giving them a like or a message on Facebook. It's showing up when you're needed. It makes sure that the community does this and repeatedly for a period of days.
Mirrors are covered in a household during shiva. It might seem kind of strange, and there's a theological reason for it. But there's also psychological research that shows when you look into a mirror, whatever emotion you are feeling becomes amplified. So if you're feeling happy, you get happier. If you're feeling sad, you become sadder. At a time of grief, that would mean more grief. So by covering the mirrors, what you're doing is reducing grief a bit.
You sit low to the ground or on low chairs or on the ground. There's new neuroscience research that shows—if you sit low to the ground, ergonomically that's going to start to cause discomfort in your lower back and knees, and then when you get up to welcome people, it goes away. There's new neuroscience research that shows when you have mild onsets and offsets of discomfort like that, it reduces rumination and grief.
People come together in groups of 10 called a minyan, 10 or more, to say prayers together and chant them, recite them together. Again, there you see that synchrony happening, synchrony that we know we have experimental evidence that increases feelings of compassion and willingness to help each other.
This is just one example, but what you can see is these aren't random elements. They through the ages have figured out certain nudges to the mind and the body that help us deal with whatever challenge we're facing.
Mills: You write about how people who are not religious can derive psychological benefits from secular rituals. Are the effects the same if someone say, joins a chorus or an orchestra, or joins a softball team, or even becomes a Mason, for example? Are there psychological and physiological benefits that are similar to those that are derived from essentially performing together? That's what you were just talking about.
DeSteno: Yeah. So there are two parts to that. One is, people often say, "Well, aren't these benefits of religion?" Just to be clear, besides the work you mentioned from Pew, there's research from the Mayo Clinic and research from the Harvard Center for Human Flourishing program showing that people who engage in the activities of their faith—not just saying, "I believe," but actually engaging regularly in the activities of their faith — predicts lower mortality, better cardiovascular health, better mental health, all types of things like that. So as a scientist, what that tells me is something that they're doing matters. One thing that people often say, as you suggested, "Well, isn't it just coming together?" Sure, community is an important part of well-being for humans. Being lonely is terrible for our mental and physical well-being. But the data suggest that the benefits are more than just what you get from joining into any club.
I think that's because in these faith traditions, there are these other practices that bring people together, and we can talk more about them. But that example of ritual, as I just said, that not only bring people together, but build that sense of community and belief. So, yes, if you engage in actions like synchrony, like I was saying—so rather than saying prayers together, chanting together, do other motions together — that will make you feel closer to one another. We have data in my lab to show that. But the data also suggest that when you add on these other elements of belief, et cetera, that the effects are stronger. So we don't really know how much stronger overall. So the best that I can say right now is, is if you do these rituals in a very secular way, you will get benefits from them. Is the benefit exactly equivalent to what you would get if you add on the multi-layered aspects of belief? We don't know that for sure.
Mills: So, not to be flippant, but is there a difference if I'm say, in a chorus singing the Verdi Requiem versus singing the Sound of Music? Would I be getting different benefits because it's non-secular music?
DeSteno: In that case I don't think so. But there are certain rituals where the belief element is strongly important. So for example, one area is if we look at healing rituals. We know that the placebo effect is very powerful. In fact, it accounts for about 30% of therapeutic effect of any medication. People hear the idea of the placebo effect, they think of that as kind of a derogatory thing or a derisive thing, but it's actually not. It's the evidence of the body to heal itself, and physicians have been using this forever.
There's wonderful evidence suggesting that belief in something, in its ability to heal you, can actually account for a good deal of the healing that goes on. In fact, there's something amazing now even called open-label placebos, which are placebos work for you, even when you know they're placebos, if you believe in the placebo effect.
I think what belief really does from a psychological standpoint is it sets your mind's expectations and predictions about what's going to be, what's going to happen. Whether you ascribe that happening to the influence of a divine being or whether you ascribe that happening to the belief of the power of something else doesn't matter in the sense of how it's going to affect your body. But I think that element of belief is where you can get a stronger benefit than just the actions of the breathing or singing on its own.
Mills: So a few moments ago you were talking a little bit about meditation. It's a religious practice that's been studied by scientists. But it's also moved into the secular world as well. How do the scientific findings about meditation fit into the traditional religious understanding of the purpose of meditation?
DeSteno: Yeah. So meditation has been being studied scientifically for a decade or two now. A lot of that actually happened because the Dalai Lama himself is very open to scientific study of it and actually funded a lot of research. But initially it was picked up by cognitive neuroscientists who were interested in what does it do to your brain. We found out wonderful things. Meditation actually alters the physical structure of your brain, it increases your memory, it increases your ability to have attention, focus your attention, it reduces stress. But if you talk to the monks like I have and the Buddhist Lamas, what they'll tell you is, "Yes, it will reduce your stress. Yes, it will increase your memory, but that is not its purpose. Those things happen along the way."
Its purpose is as a tool to reduce the suffering of all sentient beings. That is, yourself through meditation, you suffer less, as you have less depression, less anxiety, et cetera. But it also is designed to awaken in people this sense of compassion and willing to help other individuals who are in need. So surprisingly, no one had ever looked at that, and so we decided to take that seriously. So we conducted a study where we brought people from the Boston area who had never meditated before, but were interested in starting, and we assigned them to either meditate for eight weeks where they had training with a Buddhist Lama, or we put them on a wait list. So two groups that were equally interested in meditation, none of them had meditated before. One got treatment, one got the intervention, one didn't.
At the end of those eight weeks, we bring them into our lab one at a time telling them, "We're going to give you some memory tests." That wasn't true. When they got to the lab, the real experiment took place in the waiting room. In the waiting room, there were three chairs, two of which were occupied by actors that we hired, which our participants didn't know. When the participant came in, they'd of course take the third and last remaining chair. About two minutes later, another actor came in and she was on crutches wearing one of those boots on her foot that you wear when your foot is broken. It wasn't broken, but she would pretend she's in pain and wince and come in and there is no seats. Of course, the other actors were, are told to thumb their phones and ignore her.
The question was, what would the true research participants do? What we found is that on average, only about 15% of the people who didn't meditate decided to get up and give them her chair. You might say, "Well, that's pretty terrible," but you see this on the subway or the bus all the time.
Mills: Right. Right.
DeSteno: People just, they, "Oh, I don't want to give up my seat." There's a mom with a toddler in tow or a person in pain. But among the meditators, 50% did. Now that's a threefold difference, which is huge. We've replicated this study so we know it's not a fluke. What this tells us is the Buddhist idea was right. Just engaging in this meditation practice after this eight weeks of time actually increased peoples' compassion.
We've done subsequent studies where we have, through long shenanigans I'm not going to bore you with, we have people actually get insulted by actors in a way that usually makes them pretty angry. Then we give them a way that they think they can seek vengeance on this person. Of course, they can't really do it, but they think they can. What we find is that after so many weeks of meditation, people reduce the vengeance they want to take on this person who insulted them. They don't rise with aggression to provocation. So what this tells us is that there is some truth here.
Another thing we work on in my lab is this notion of what gratitude does. We found time and again, that when people feel grateful, by expressing their gratitude to God for what they have, to friends, family, whatever it might be, we find that it makes them more generous, it makes them more patient, it makes them more willing to share what they have and trust other people. Not just the people to whom they're grateful. Anybody.
If you look at religions, every religion has ways to foster gratitude. Christians say prayers of grace when they eat. Jews every day in the morning, they get up, they say the Modeh Ani prayer, which is a thank-you to God for returning me to this earth for another day, et cetera. The interesting thing about religions, any behavioral scientist will tell you, we all have intentions. We all have things that we want to do, like in this case, be a better person, but unless we have strategies or tools, we don't get there. Think about New Year's resolutions. By mid-January 25% have failed. By the end of the year, only 8% have been kept all the way through. We need tools to help us reach our goals. What religions are doing in these rituals is not just telling us how we should be, but giving us the tools to make it more likely that we can be that way.
Mills: So meditation sounds kind of magical, and you have talked about finding the next meditation. If meditation itself is so great, why do we need the next meditation? What are we looking for? What do you mean when you say that?
DeSteno: Yeah. So meditation is a wonderful tool for becoming kinder, becoming more compassionate. But there's other things that we want to do in life. How do I become happier? So yes, meditation will reduce anxiety and depression, but does it help you find meaning in life? Not exactly.
So another thing that people do—if you look at happiness across the lifespan, it tends to hit its nadir around 40 and 50, and then begins to go up. There's wonderful evidence from psychologist Laura Carstensen that shows that as people age, they turn their desires from kind of wanting to get ahead in life, building skills, building status, to focus on friends, family, and service. Things that actually have been shown to bring more happiness in life.
But although it looks like it's a function of age, what her work has really shown is that it's a function of what she calls a time horizon, which is how long I have left until I die. So what you see in her work and work of other folks is that during pandemics like we've all been facing now, that age difference goes away because suddenly even young people, even people in their 20s and 30s, are thinking, "I may not have as much time left." Suddenly they look like they're seniors. They are valuing friends, family, finding meaning through service in life. But we don't want to face a pandemic to have to make this kind of correction to find a new way to find happiness.
So what you see in religious rituals is before periods of taking stock—if you're a Jew, during the Days of Awe before Yom Kippur is a time to take stock of your life. If you're a Christian, it's during the period of Lent a time to take stock of yourself. Before each of those, for Christians, there's Ash Wednesday, which is a reminder of your own mortality. The priest actually puts ashes on your head and says, "From dust you came, onto dust you shall return." On Rosh Hashanah and Yom Kippur, Jews say a prayer called the Modeh Ani, which has in it a part that says, "Who is going to live and who's going to die in the coming year before their time? Who by fire, who by sword, who by flood, who by plague?" This year, that one kind of hit really hard. Again, it's a reminder that your time here, it may not be as long as you think.
What that does is it begins to shift your values. Even Laura Carstensen showed that if you make older people say—she said, "Imagine that you're going to live a lot longer than you thought, because there's this new medicine that will help you live a healthier life for 20 or 30 years more than you expected." Suddenly they start focusing on skills and their idiosyncratic desires as they look like younger people. So just these little nudges can matter. What you're seeing in these rituals is a way to help us focus at times that we should be taking stock of our lives on what really matters and ways to bring happiness. It's why both Jewish scholars, Christian scholars, Muslim scholars have said, "Don't wait for just once a year either." Every day think about, "What am I doing, and is this what I'd want to do if I weren't going to see tomorrow?"
So there's lots of examples like that. There's lots of other ways, people now are getting very into taking psychedelics for transcendent experiences. But what they're not adopting is also the rituals that typically surrounded those use of psychedelics, which put people in a physiological state of calmness and connectedness so that when that moment of ego death came, it would be pleasurable and not terrifying.
Because right now 10, 20% of the time people have these experiences on psychedelics and they're frightening. They're not wonderful. Eighty percent of the time they actually seek psychiatric care after. It's because as Michael Pollan has said, if you're not in the right state of mind when that moment comes, the experience can go very badly. What these rituals do is they make sure you're in that frame of mind. So while we're taking the psychoactive chemicals and giving them to people, by ignoring the rituals that put that body and mind in the right frame we are increasing the odds that things aren't going to go as well as they should.
Mills: But now that doesn't have to be a religious preparation, right? I mean, there are psychologists who are doing this work right now with psychedelics, and they will also sort of walk people through, prepare them so that when you take the psychedelic, you won't have, as you're describing, a bad trip.
DeSteno: That's right. So if you look at some of the best research coming out right now is coming from Johns Hopkins, Roland Griffiths' lab, and I've talked to people there and what's basically happening is you're absolutely right, the researcher spends time with you. They build that sense of trust and rapport beforehand. They sit with you during it. If you start to have a bad reaction, they'll hold your hand, they'll put their hand on your chest, and afterward they will help you make sense of it.
In essence, they're doing exactly what a shaman would do without the religious symbology around it. But because they're putting you in that state of calm, trusting feeling with them, that's the scaffold that is there to help make sure that the experience goes the right way. Whereas with a shaman, you would do that, and he or she would help guide you, but they also sing these chants together and use these drumming rhythms that, again, change people's breathing and respiration rate, make them feel calm, make them feel connected again before it happens.
So you're right, you don't need the religious symbology. That's the point I'm trying to make here, which is when I talk about this, people say, “Well, Dave, isn't that cultural appropriation what you're saying?" Or, "If I'm a Christian, why do I want to a Jewish ritual or a Hindu ritual?" I'm not in favor of cultural appropriation. I would never want to take these rituals and take the actual prayers and the symbols and the theological meaning from them because those belong to the faiths that originated them and should be respected.
But there are elements of them that can be taken, in the breathing people use, in the way they interact together, in the way they sing, in the way physiologically that they interact during prayer. That can be taken and used in a secular context. Don't just take it from me. Those don't belong to any one religion. You see a lot of those things used in multiple of religions, just with different vocabularies and different theologies and different symbologies. My argument is let's learn what they're doing to the body and mind in a secular sense, put that under the scientific microscope, see when it matters and how we can use that to help people while respecting the cultural symbols and theologies of the religions themselves.
Mills: So we've been talking a lot about how religion can make people happier and provide comfort, but there's another side of religion as well, which is the threat of punishment, of eternal damnation. Is that something that you have looked at, and is threatening people in that way effective in making them behave ethically? What's happening in your brain when you're being threatened by your religion?
DeSteno: Yeah. Well, two things there. One, religions can cause guilt and cause shame. As a psychologist who studies social behavior, I can tell you guilt and shame are extremely motivating and can be very effective in small brief doses, but used over the long haul are not helpful and cause a lot of pain. So again, what I tell people is, "I'm not an apologist for religion." Steve Pinker and I always get into arguments about this. He says, "Dave, you're cherry picking. There's lots of religion, about religion, that's bad. It causes people guilt and shame. It's perpetuated discrimination, it's caused war and strife." I'm like, "Steve, you're absolutely right."
But I am cherry picking because I want to know what works and what's helpful. I'm not here to defend religion. My argument is, if you look at these practices, religion—so take the theology out for a moment. The tools that religion has developed are powerful tools to motivate us, to shape what we feel and do. They can be used for good or for ill. It all depends upon the intentions of the people using it. Just like science. I mean, Richard Dawkins has said, "If you want to find the most efficient way to kill the most people possible, science is your friend." He's right. "If you want to find the way to save people from COVID, science is your friend." He's right.
I think about religion the same way in the sense that the tools of spiritual practices I tend to separate from the institutions and the purposes and goals that those institutions have. So yes, religion has caused people lots of pain and caused them to deny science even. But you see that now, even with political ideologies. We're seeing as a function of political ideology people deny science when it comes to vaccines and COVID. So I don't think that's a problem so much of religion as much of ideological institutions. But even if that's what you believe, then it's still worthwhile studying how these tools work so that you can prevent and remediate the problematic aspects of them.
Mills: Last topic that I want to cover here. You talked a little bit about how religious or irreligious Americans are these days. A 2021 Gallup Poll found that for the first time since they started polling in the 1940s, less than half of Americans said they belong to a church, a synagogue or a mosque. So given your research, what do you think the effects of that will be? Will people be less happy because they're not engaged in religion? Or less moral? Or are they replacing religion with something else?
DeSteno: So it is true, as you said, that people are leaving traditional faith in droves. But the interesting thing is when you look more closely at those data, most of them aren't becoming atheists. Most of them are calling themselves "nones," N-O-N-E-S, which is none of the above. I'm not Christian. I'm not Jewish. I'm not Hindu. I'm not Muslim. But they're looking for new ways to be spiritual. I think it's because they, in leaving these institutions that in some ways, there are good reasons to leave for people—they fail them, there have been financial scandals, abuse scandals, gender discrimination, sometimes you don't just believe the theology—people recognize that they're leaving behind that sense of community and those tools that help them find meaning and meet the challenges of life.
So I think right now, we're going through a time period of people are looking for another way. Now, when Nietzsche said, "God is dead and we have killed him and the world's going to fall into chaos," he wasn't right. I mean, we've become much more secular. The world isn't full of chaos. You can certainly be a good person without religion, but I do think it fills psychological needs and helps us meet the challenges of life. It's not just the opiate of the mass, it's actually a cultural tool that we've developed to help us meet challenges.
I do worry a bit that you're going to see declines in well-being that track this leaving of spirituality unless people do find new ways. To me, that's why I think science needs to take this seriously. If you look at that data in a dose response framework, people who are more engaged with spiritual practices live longer, healthier and happier lives. That means as psychologists, it's our job to figure out why. What are those practices doing, and if people are giving them up, how can we find ways to replace them?
Mills: Thus, the search for the next meditation.
DeSteno: Yeah, that's right.
Mills: Well, Dr. DeSteno, thank you so much for joining me today. This has been really fascinating. Thank you.
DeSteno: Thank you, Kim.
Mills: You can find previous episodes of Speaking of Psychology on our website at www.speakingofpsychology.org or on Apple, Stitcher, or wherever you get your favorite podcasts. If you like us, give us a review. If you have comments for future podcasts, you can email us at speakingofpsychology@apa.org. That's speakingofpsychology, all one word, at apa.org. Speaking of Psychology is produced by Lea Winerman. Our sound editor is Chris Condayan.
Thank you for listening. For the American Psychological Association, I'm Kim Mills.
MENTAL HEALTH
Psychiatry Needs to Get Right with God
By not making more of an effort to incorporate spirituality in treatment,
we are doing a disservice to patients
• By David H. Rosmarin on June 15, 2021
In the early days of the pandemic, economist Jeanet Bentzen of the University of Copenhagen examined Google searches for the word “prayer” in 95 countries. She identified that they hit an all-time global high in March 2020, and increases occurred in lockstep with the number of COVID-19 cases identified in each country. Stateside, according to the Pew Research Center, 55 percent of Americans prayed to end the spread of the novel coronavirus in March 2020, and nearly one quarter reported that their faith increased the following month, despite limited access to houses of worship.
These are not just interesting sociological trends—they are clinically significant. Spirituality has historically been dismissed by psychiatrists, but results from a pilot program at McLean Hospital in Massachusetts indicate that attention to it is a critical aspect of mental health care.
In 2017 my multidisciplinary team of mental health clinicians, researchers and chaplains created Spiritual Psychotherapy for Inpatient, Residential and Intensive Treatment (SPIRIT), a flexible and spiritually integrated form of cognitive-behavioral therapy. We subsequently trained a cadre of more than 20 clinicians, stationed on 10 different clinical units throughout McLean Hospital, to deliver SPIRIT and evaluated the approach. Since 2017, SPIRIT has been delivered to more than 5,000 people. Our results suggest that spiritual psychotherapy is not only feasible but highly desired by patients.
In the past year, American mental health sank to the lowest point in history: Incidence of mental disorders increased by 50 percent, compared with before the pandemic, alcohol and other substance abuse surged, and young adults were more than twice as likely to seriously consider suicide than they were in 2018. Yet the only group to see improvements in mental health during the past year were those who attended religious services at least weekly (virtually or in-person): 46 percent report “excellent” mental health today versus 42 percent one year ago. As former congressional representative Patrick J. Kennedy and journalist Stephen Fried wrote in their book A Common Struggle, the two most underappreciated treatments for mental disorders are “love and faith.”
It’s no wonder that nearly 60 percent of psychiatric patients want to discuss spirituality in the context of their treatment. Yet we rarely provide such an opportunity. Since Sigmund Freud’s characterization of religion as a “mass-delusion” nearly 100 years ago, mental health professionals and scientists have eschewed the spiritual realm. Current efforts to flatten the COVID-19 mental health curve have been almost entirely secular. The American Psychological Association’s extensive set of consumer resources makes no mention of spirituality. And the Centers for Disease Control and Prevention’s only spiritual recommendation is to “connect with your community- or faith-based organizations.” Of more than 90,000 active projects presently funded by all 27 institutes and centers within the National Institutes of Health, fewer than 20 mention spirituality anywhere in the abstract, and only one project contains this term in its title. Needless to say, a lack of funding for research on spirituality hamstrings clinical innovation and dissemination.
This situation goes beyond separation of church and state. Health care professionals falsely disconnect common spiritual behaviors and experiences from science and clinical practice. As a result, we ignore potential spiritual solutions to our mental health crisis, even when our well-being is worse than ever before.
My own research has demonstrated that a belief in God is associated with significantly better treatment outcomes for acute psychiatric patients. And other laboratories have shown a connection between religious belief and the thickness of the brain’s cortex, which may help protect against depression. Of course, belief in God is not a prescription. But these compelling findings warrant further scientific exploration, and patients in distress should certainly have the option to include spirituality in their treatment.
Recently, one of my patients—an ostensibly secular 22-year-old woman—presented with an uptick in depression and anxiety. She reported feeling “defeated” and stated that she was losing hope of ever getting better. My research has taught me that many secular individuals believe in something, and I therefore assess for spirituality with all patients irrespective of their religious affiliation or lack thereof. In that context, this particular patient shared with me that she believed in God and also believed that she was brought to this earth for a specific purpose. Over the course of just three sessions focused on these ideas, she came to a sense of increased hope that she could overcome her life challenges, and her symptoms of depression started to abate.
In another case, a devout Christian man in his mid-60s came to McLean Hospital with severe depression and acute levels of suicidality. His treatment team was aware of his faith but unclear about how to address it in therapy. I was asked to consult with the patient, who reported to me that he was struggling to pray and think about God in the throes of his depression. We scheduled times for prayer and religious study, and I encouraged conversations with his pastor. Within one month, his depression began to remit for the first time in more than a year.
Countless anecdotes of this nature occurred during a recent year-long clinical trial of SPIRIT that my research team completed with funding from the Bridges Consortium (supported by the John Templeton Foundation). More than 90 percent of patients reported experiencing some kind of benefit, regardless of religious affiliation.
The study also revealed key opportunities in patient care, particularly for younger and seemingly secular patients. Psychiatric folklore has long suggested that psychotic, manic and obsessive patients gravitate more toward spirituality, as do older adults. Our findings, however, suggest that patients benefited from SPIRIT irrespective of their diagnosis or age. Apparently, depressed millennials are just as likely to want and benefit from spiritual psychotherapy as geriatric patients.
Our results also suggest that spiritual care is not only for religious individuals. The largest group of patients to voluntarily attend SPIRIT (39 percent of our sample) were individuals with no religious affiliation at all. Apparently many nonreligious people still seek spirituality, especially in times of distress. In fact, such individuals may be most likely to attend spiritual psychotherapy because their spiritual needs are otherwise ignored. In this vein, recent declines in church membership may increase the need for spiritual care.
Perhaps most interesting, patients responded better to SPIRIT when it was delivered by religiously unaffiliated clinicians. This surprising finding suggests that secular clinicians may be particularly effective in providing spiritual treatment. This is good news because psychiatrists are the least likely of all physicians to be religious.
It remains to be seen whether God can solve our mental health crisis. But the potential clinical benefits of spirituality, and patients’ desire for spiritual treatments, provide a reason to believe.
IF YOU NEED HELP
If you or someone you know is struggling or having thoughts of suicide, help is available. Call the National Suicide Prevention Lifeline at 1-800-273-8255 (TALK), use the online Lifeline Chat or contact the Crisis Text Line by texting TALK to 741741.
Are you a scientist who specializes in neuroscience, cognitive science, or psychology? And have you read a recent peer-reviewed paper that you would like to write about? Please send suggestions to Mind Matters editor Gareth Cook. Gareth, a Pulitzer prize-winning journalist, is the series editor of Best American Infographics and can be reached at garethideas AT gmail.com or Twitter @garethideas.
ABOUT THE AUTHOR(S)
David H. Rosmarin is an associate professor at Harvard Medical School and director of the McLean Hospital Spirituality & Mental Health Program. He received his Ph.D. from Bowling Green State University and certification in clinical psychology from the American Board of Professional Psychology.
No comments:
Post a Comment