Spiritual

Why spirituality may be important to your quality of life

Ninety percent of people in the world participate in some sort of spiritual or religious practice.1 ‘Spirituality’ looks different to each of us and is often  based on our culture. It captures a wide variety of things that can give life hope, meaning, direction and fulfillment, beyond daily life. It includes feelings of connection, compassion and belonging to something larger than oneself, or with something that feels sacred, awe-inspiring, or that transcends the everyday.

While some people engage in spirituality through religion (organized or not), many others express spirituality outside of formal religious practice. If you already know that spirituality and/or religion is not an area of focus for you, there are many secular (not related to religion) communities that can help fill this role in your life.

Spirituality can become more important to people in times of difficulty, discouragement and distress when life feels scary, out of control and full of suffering. People facing illness can turn to spirituality to help make sense of their suffering and cope with the stress of their condition. Spirituality looks at the whole person and the big picture: it asks if we can learn and grow from difficult situations, rather than simply relieving the symptoms of our conditions or solving the things that are stressing us.

Key Messages

What to know about spirituality:

  • Spirituality and/or religion can be important for health and quality of life for some people
  • Both positive and negative coping styles can occur in spiritual/religious practice
  • Some bipolar disorder symptoms (e.g., hyper-religiosity) can complicate spiritual/religious life

How spirituality can be expressed

Spirituality can be expressed in a range of ways, such as:2

  • Belonging to a faith tradition or cultural community
  • Ritual or symbolic practices and other forms of worship
  • Retreats and pilgrimages
  • Meditation or prayer
  • Reading spiritual teachings
  • Deep engagement with, for example, nature, music, art…
  • Acts of compassion
  • Deep reflection or contemplation
  • Yoga, Tai Chi and similar practices
  • Thoughtful reading of literature, poetry, etc.

Of course, this is not an exhaustive list – activities that express spirituality are highly personal.

Benefits of spiritual practices

Spiritual practices have been shown to have many benefits for emotional wellbeing, especially during stressful times, such as providing social support and a sense of belonging3, offering a sense of meaning and purpose3, increasing self-confidence3, promoting optimism and hope; helping to improve the ability to protect yourself (your ‘resilience’)4, and developing stronger coping styles5.

Studies have shown that spirituality relates to physical health benefits, such as6 a better immune system, better function of hormones, lower blood pressure, cholesterol, heart disease, and risk of stroke, less cigarette smoking, more exercising, lower rate of death from cancer, and increased lifespan. Specifically, participating in spiritual practices has been linked to benefits for mental health problems, such as, recovery from depression, reducing risk from suicide, lessening feelings of anxiety and fear, and reducing substance misuse.6,7 There is also some evidence of less depression8 and better wellness over time9 in people living with bipolar disorder, but while the early research on the relationship between religion and/or spirituality in bipolar disorder is promising, it is still evolving.

A close-up on the hands a white statue with legs crossed. In the hands are dark purple flower petals.

Research has identified two different styles of practicing spirituality or religion. Positive spiritual/religious coping can be described as using spirituality as a source of comfort, compassion, direction and growth. This positive style of coping is linked to many of the benefits already discussed here8. Negative spiritual/religious coping, on the other hand—which is less common than positive coping—can be harmful to health. Where negative coping styles occur, spirituality can be a source of guilt, rigid thinking, shame, fear, or feeling you or others are to blame for things.  One challenge is that some religious systems of belief can be discriminatory10. For example, people may be rejected for their sexual orientation.

A study that followed people living with bipolar disorder for two years found that positive spiritual/religious coping predicted better quality of life, while negative spiritual/religious coping predicted worse quality of life and mania symptoms12.  Another study showed that positive spiritual/religious coping in bipolar disorder predicted fewer depressive symptoms and better quality of life8.  Another possible challenge is that some people living with bipolar disorder may sometimes find that their spiritual beliefs don’t agree with accepting medical treatment and advice11. For example, you may feel that you shouldn’t take medications or accept therapy or professional support because your faith should be sufficient to help you cope with your condition. Or you may delay seeking medical help to explore spiritual solutions first. Finally, and in extremely rare occasions, people can become involved in groups that can abuse them through unnecessary emotional dependence or separation from society10 (i.e., cults).

Spiritual experiences and bipolar disorder

A sudden increase in thinking about or practicing spiritual or religious activities can be a symptom of bipolar disorder. Increased spiritual experiences, often called ‘hyper-religiosity’, can be a symptom of mania or psychosis. Therefore, many people living with bipolar disorder (and the healthcare providers working with them) wonder whether their spiritual experiences are “real” or a symptom of their illness13. Problems separating spiritual experiences from psychotic symptoms may lead to misdiagnosis—which could be harmful if, on one hand, people get unnecessary treatments, or, on the other, if a manic episode continues untreated.

Different cultural factors also determine whether spiritual experiences are seen as a sign of illness or not. Having visions or hearing voices may be admired in one culture and seen as a sign of severe illness in another. Because of this, the psychiatric diagnostic manual (the DSM) has separate ways of thinking about spiritual problems, so as to not turn spiritual beliefs into medical problems. At the same time, it acknowledges that symptoms of illness can have a spiritual content that may need to be explored. For example, the DSM recognizes a true delusion as a firmly held, false belief that is not “shared by members of religion/culture/subculture”, such as an “article of religious faith” would be14.

A single candle burning against a dark background. The candle holder is brown and green.

How you can take action

If you are interested in learning more about spirituality, there are many possible ways to include spiritual practice in your life. You may be part of a cultural group that has religious traditions that you can learn about from your family and community. You may be interested in  learning more about practices from a spiritual practice  that does not traditionally belong to you and your ancestors. This can also be a rich learning experience, if done respectfully. Perhaps you may want to start with asking yourself about what keeps you going during difficult times. This might include important inner resources or outside supports from your community.

You can find out about different spiritual practices from a wide variety of organizations. People vary in the level of their involvement in organized spiritual practice—that is, joining a group of like-minded people—versus learning about and experiencing spiritual practices on their own (such as studying spiritual books or having a quiet time every day for reflection, prayer, or meditation). In general, finding a community can be a healthy way to nurture and support your spirituality.

A black man in his late twenties or thirties is sitting outdoors on a yoga mat, engaged in meditation.

One example of a practice that many find useful for coping with mental health challenges is mindfulness. Mindfulness practice aims to develop an attitude of acceptance and purposeful awareness of the present moment to cope with life’s suffering and to increase overall wellness. Mindfulness can be practiced with an emphasis on Buddhist teachings and community, or in a secular (non-religious) way, such as through groups at a medical clinic or community centre, as well as on your own.

It can be helpful to openly discuss spiritual matters with your healthcare team and other supports so that others can have a fuller understanding of who you are and what’s important to you. Additionally, finding healthcare providers and spiritual counselors or advisors who can work together allows you to include all the aspects of wellness that are important to your recovery. This helps with the potential problem of only focusing on one thing—either spiritual practice or medical treatment—at the cost of ignoring the other, very important, piece of treatment and recovery15.

Finally, if they are important to you, spiritual matters are important to how you manage your health. Spiritual ideas or activities can be very intense in times of mania or depression, so remembering to include these topics when you talk with your healthcare providers and support people can help identify early symptoms of an episode. Having discussions with trusted supporters about intense spiritual events experienced in a mood episode can help you make sense of these experiences, perhaps helping you to know the difference between what parts of the experiences may be explained by symptoms of your bipolar disorder.

Take Action

Ways to take action with your spirituality:

  • Remember spirituality/religion is highly personal – no ‘right’ way to practice
  • Openly discuss spiritual matters with healthcare providers, and health with spiritual advisors

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References

  1. Koenig, H.G. (2000) Religion, spirituality and medicine: Application to clinical practice. Journal of the American Medical Association, 284: 1708.
  2. The Royal College of Psychiatrists. Spirituality and Mental Health. http://www.rcpsych.ac.uk/mentalhealthinformation/therapies/spiritualityandmentalhealth.aspx, accessed June, 2006.
  3. Ellison, C.G., & Levin, J.S. (1998) The religion-health connection: Evidence, theory, and future directions. Health Education and Behavior, 25: 700-720.
  4. Taylor, S.E. (1989) Positive Illusions: Creative Self-Deception and the Healthy Mind. New York: Basic Books.
  5. Fabricatore, A. N. Handal, P. J, Rubio, D. M., &. Gilner, F. H. (2004) Stress, Religion, and Mental Health: Religious Coping in Mediating and Moderating Roles: I. Journal for the Psychology of Religion, 14(2): 91-108.
  6. Koenig, H.G., King, D.E., & Carson, V.B. (2012). Handbook of Religion and Health (2nd ed.). New York: Oxford University Press.1.
  7. Huguelet P, Mohr SM, Olié E, et al. Spiritual Meaning in Life and Values in Patients With Severe Mental Disorders. J Nerv Ment Dis. 2016;204(6):409-414. doi:10.1097/NMD.0000000000000495
  8. Stroppa, A., & Moreira-Almeida, A. (2013). Religiosity, mood symptoms, and quality of life in bipolar disorder. Bipolar Disorders, 15: 385–393.
  9. King, M., Speck, P., & Thomas, A. (1994). Spiritual and religious beliefs in acute illness—is this a feasible area for study? Social Science & Medicine, 38: 631–636.
  10. Pargament, K.I. (2007). Spiritually Integrated Psychotherapy. New York: Guildford Press.1.
  11. Mitchell, L., & Romans, S. (2003). Spiritual beliefs in bipolar disorder: Their relevance for illness management. Journal of Affective Disorders, 75: 247–257.
  12. Stroppa A, Colugnati FA, Koenig HG, et al. Religiosity, depression, and quality of life in bipolar disorder: a two-year prospective study. Brazilian Journal of Psychiatry. 2018;40(3):238-243. doi:10.1590/1516-4446-2017-2365
  13. Michalak, E.E., Yatham, L.N., Kolesar, S., & Lam, R.W. (2006). Bipolar disorder and quality of life: A patient-centered perspective. Quality of Life Research, 15(1): 25-37.
  14. American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed., text rev.). Author: Washington, DC.
  15. Ouwehand E, Wong K, Boeije H, Braam A. Revelation, delusion or disillusion: subjective interpretation of religious and spiritual experiences in bipolar disorder. Mental Health, Religion & Culture. 2014;17(6):615-628. doi:10.1080/13674676.2013.874410