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When To Counsel, When To Refer
This category can be used when the focus of clinical attention is a religious or spiritual problem. Examples include distressing experiences that involve loss or questioning of faith, problems associated with conversion to a new faith, or questioning of spiritual values that may not necessarily be related to an organized church or religious institution.Loss of or Questioning Faith: Frequently people present a problem that centers on the loss of a firmly held faith. Both religious and psychiatric issues are associated with such loss. Shfranske (1991) described a well respected professional man whose life was rooted in Roman Catholicism. He came to doubt the principles of his religion. Because of his doubts he lost his zest for life. In this case, the crisis was solely a spiritual one. Such a crisis can also happen with people who have a mental illness, but a crisis such as this one does not, in and of itself, point to mental illness.
Religious conversion: If a person has recently converted to a particular faith or greatly intensified a faith connection, the pastor should discern what potential conflicts exist between this person's former and current lifestyle, beliefs, and attitudes. Spero (1987) writes about a case of a 16-year-old adolescent from a reform Jewish family who underwent a religious transformation to orthodoxy. The dramatic changes in her life, including long hours studying Jewish law, avoidance of friends, and sullenness at meals, led to her referral to a psychoanalyst. A mental status examination determined that she did not have a mental illness. The article goes on to discuss the impact of religious transformation on her self-image and relationships. The process of religious change challenged important areas of her stability. Spero notes, "to some degree the sense of historical dislocation represents a crisis for all nouveau-religionists" (Spero, 1987, 69)
Search for Spiritual Answers: People in this situation may be searching for spiritual and religious answers to existential questions. They may be wrestling with the meaning of life, amid illness, including mental illness, and tragedy. Or, they can be attempting to change former patterns of behavior or thinking, and are searching for new possibilities. They might be trying to recover a sense of personal integration, or attempting to come to grips with the extent of their need for God. They may realize that their problems may never go away, but that God can be with them and with this connection to God, perhaps they can find support in dealing with these problems.
People in this group generally have a realistic perspective on their problems. They accept their illness, are rebuilding their lives and are willing to take responsibility for their behavior. For example, a woman with mental illness has started a Jewish spiritual support group for people who have a mental illness. It is called "Achraiyut" the Hebrew word which means "to take responsibility." Although a spiritual connection is an essential element of the recovery process for many people, including those in this support group, it is only one component. People may also need the ongoing assistance of a mental health professional and/or program to continue their progress.
Some people may be searching for spiritual answers and meaning but may also be experiencing mental disorders, such as psychotic delusions or ritualistic behavior. They may have an exaggerated sense of guilt and are unable to accept forgiveness. They may have some bizarre religious ideas. They may also have other levels of concern. In this situation people may have more difficulty evaluating their concerns because of their mental illness which can lead to confusion and disordered thinking (Weisinger, 1991, 32).
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