Issues in Mental Health Nursing, 35:236–237, 2014 Copyright© 2014 Informa Healthcare USA, Inc. ISSN: 0161-2840 print / 1096-4673 online DOI: 10.3109/01612840.2014.890476

FROM THE GUEST EDITOR

Introduction to This Special Issue on Spirituality and Mental Health

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Inez Tuck, PhD, RN, MDiv, Guest Editor

This special edition of Issues of Mental Health Nursing focuses on spirituality and mental health and suggests that the topic warrants the attention of those who practice psychiatricmental health nursing. Religion and faith have often been seen as problematic in the field of psychiatry where concerns are expressed about religiosity, paranoid ideations, and delusions associated with religious figures that often distort reality. Obsessions and compulsions with religious overtones often make intervening with clients a difficult challenge for mental health professionals. Spiritualism brings images of voodoo, spirits, or dysfunctional thought processes that disrupt the problem solving ability of mental health clients. Guilt and shame associated with some religious doctrines have made recovery difficult for those with depressive illnesses or overly burdensome for others with addictions or other concerns. Hope is often mitigated by the reality of the limitations of current interventions, such as various talk therapies, and the side effects of psychotropic medications or electroconvulsive therapies. Spirituality seems to have made minimal foray into the field of mental health treatment. Members of the health care team have divergent and often conflicting opinions about the role of spirituality; additionally, religion and spirituality are often presented as one concept. Some team members willingly pray and are present with others, while others see no reason to include spirituality in the treatment process. There have been several studies that explored the religious orientation of psychiatrists. As early as 1975, the American Psychiatric Association released a study of psychiatrists’ religious characteristics and found that psychiatrists were more likely to be nonreligious or Jewish and less likely to be Protestant or Catholic, which mirrored the faith tradition of their clients. Shafranske (2000) reported that less than half of the interventions made by psychiatrists included spirituality. According to Curlin et al. (2007), psychiatrists are less religious than other physicians, and religious physicians are less willing than nonreligious physicians to refer patients to psychiatrists. This view is not limited to one discipline. A national survey conducted by Bergin and Jensen in 1990 found that only 41% of 425 marriage and family therapists, clinical social workers, psychiatrists, and clinical psychologists attended religious services regularly although 80% expressed a religious preference. The

authors expressed concern about the potential lack of empathy due to possible unfilled expression of the providers’ personal faith. These findings suggest that historic tensions that exist between religion and psychiatry are likely to shape the treatment received for mental health concerns. Professionals are selective about the types of diagnoses for which it is appropriate to use discussions of spirituality as part of treatment. Some client types and diagnostic categories are viewed as more appropriate for spiritual care than others, as if some persons lack a human spirit. Clients come with their own views of spirituality and religion that might differ from those of the provider, indicate spiritual and moral distress, and vary in their daily expression. Making spiritual interventions optional for certain patient populations is troubling. The fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (American Psychiatric Association, 1994) reflected some forward movement in the integration of spirituality into practice. According to Turner et al. (1995), the language was modified from previous editions to acknowledge that religiosity may go awry but is not intrinsically maladaptive. There is growing legitimacy of religion and spirituality within the medical profession and greater emphasis on issues of religion and spirituality in graduate medical education. Recommendations made for the DSM-5 included spirituality and religion, although limited in scope due to medicalization and the biases of experts (Chandler, 2012). Chandler warns of the potential harmful effects of spiritual interventions made by uninformed providers and recommends knowledge of published criteria and understanding of the cultural expressions of religion and spirituality. By embracing spirituality earlier than most disciplines, nursing has been in the forefront. These efforts began early in nursing practice and were shaped by Florence Nightingale (McCrae, 1995). Nursing and other disciplines, such as positive psychology, have attempted to separate spirituality and religion with mixed success. My colleagues and I reported that psychiatricmental health nurses were as likely to engage in spiritual practices as parish nurses. In a series of related studies (Pullen, Tuck, & Mix, 1996; Tuck, Wallace, & Pullen, 2001), my colleagues and I examined the spiritual perspectives and interventions made by mental health and parish nurses and found that both groups

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FROM THE GUEST EDITOR

of nurses reported having personal affiliation with a religion and high levels of spirituality and yet both reported reluctance in making spiritual interventions; mental health nurses reported a greater reluctance. While spiritual interventions have not been fully accepted across interdisciplinary mental health care delivery settings, there are increased publications on the topic written over the last two decades and progress has been made in research. The overlap between spirituality and religion has resulted in a unified concept frequently used for inquiry and analysis. Research findings often reflect related concepts of hope, forgiveness, healing and resilience. The articles in this special edition of the journal highlight recent work done in the field of psychiatric-mental health nursing and support the need for inclusion of spirituality and religion as part of psychiatric treatment. It is hoped that the readers of these works in this special issue of the journal will embrace the findings and incorporate them into their practice. Declaration of interest: The author reports no conflicts of interest. The author alone is responsible for the content and writing of the paper.

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REFERENCES Bergin, A. E., & Jensen, J. P. (1990). Religiosity of psychotherapists: A national survey. Psychotherapy: Theory, Research, Practice, Training, 27(1), 3–7. doi: 10.1037/0033-3204.27.1.3 Chandler, E. (2012). Religious and spiritual issues in DSM-5: Matters of the mind and searching of the soul. Issues in Mental Health Nursing, 33, 577–582. Curlin, F. A., Odell, S. V., Lawrence, R. E., Chin, M. H., Lantos, J. D., Meador, K. G., & Koenig, H. G. (2007). The relationship between psychiatry and religion among U.S. physicians. Psychiatric Services. doi: 10.1176/appi.ps.58.9.1193 Franzblau, A. N., D’Agostino, A., Draper A. et al. (1975). Psychiatrists’ viewpoints on religion and their services to religious institutions and the ministry. Washington, DC: American Psychiatric Association Task Force on Religion and Psychiatry. McCrae, J. (1995). Nightingale’s spiritual philosophy and its significance for modern nursing. Image—The Journal of Nursing Scholarship, 27(2), 294–303. Pullen, L., Tuck, I., & Mix, K. (1996). Mental health nurses’ spiritual perspectives. Journal of Holistic Nursing, 14(2), 85–97. Shafranske, E. P. (2000). Religious involvement and professional practices of psychiatrists and other mental health professionals. Psychiatric Annals, 30(8), 525–532. Tuck, I., Wallace, D., & Pullen, L. (2001). Spirituality and spiritual care provided by parish nurses. Western Journal of Nursing Research, 23(5), 441–453. Turner, R. P., Lukoff, D., Barnhouse, R. T. et al. (1995). Religious or spiritual problem: A culturally sensitive diagnostic category in the DSM-IV. Journal of Nervous and Mental Disease, 183, 435–444.

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