Cross-Cultural Considerations for Differentiating between Religiosity and Psychosis

This paper addresses the question of how to approach religiosity and psychosis within a clinical context. A clinician who is tasked with the differential diagnosis of a client who is apparently either experiencing normative religious phenomenon or psychotic symptoms faces a difficult situation—as clinicians are generally ill-prepared to address topics related to spirituality. It is important for a clinician to be culturally informed and culturally sensitive, and yet religiously-themed hallucinations and delusions are commonly observed among individuals experiencing psychosis. Recommendations are made to help inform culturally appropriate diagnosis and practice. Received: 01/04/2013 Accepted: 03/10/2013 Published: 04/02/2013 © 2013 Waltman. This open access article is distributed under a Creative Commons Attribution License, which allows unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. How do clinicians differentiate between anomalous religious experience and hallucinations? How do clinicians differentiate between religious beliefs and delusions? How does religiosity relate to psychosis? This paper will seek to illuminate the intersection between religiosity and psychosis. Specific attention will be paid to clinical considerations regarding differential diagnosis and culturally-sensitive care. Religion and Mental Health Religious background is a socio-cultural variable that is an important part of a person’s identity. Multicultural guidelines have been given for working with diverse populations (American Psychological Association, 2002), and yet some friction still exists between psychology and religion (Cummings & Cummings, 2009; Ng, 2007). In considering the impact of religion and spirituality upon an individual it is important to be mindful of how complex the impact of religion and spirituality can be upon a person’s values, perceptions, and experiences. Koltko stated that “although we speak of a client’s ‘religious background,’ for many clients religious issues are in the foreground of their lives” (1990, p. 132). For some, religiosity is more than a preference or affiliation, it is an integral part of their identity. It guides how they view themselves and the world around them and impacts the decisions they make. For some, their religious affiliation and spiritual practice is who they are. For the purposes of this paper it will be important to standardize the terms spirituality and religion. Spirituality and religion are thought to be two distinct yet H IP & Religiosity and Psychosis CROSS CULTURAL ISSUE IN CARE 1(4):eP1041 | 2 overlapping concepts. Spirituality refers to an individual’s search for and understanding of meaning in life, as well as a connectedness to others, deity, and nature. Religion is thought to refer to a faith-based community that holds a similar set of spiritual beliefs, practices, and values (Shah et al., 2011). Further it has been suggested that a person may be high or low in one or both their spirituality and religiosity, meaning that a person may be high in spirituality and low in religiosity, low in spirituality and high in religiosity, high in both, or low in both.