Religioossed ja spirituaalsed kriisid vaimse tervise valguses
RELIGIOUS AND SPIRITUAL CRISIS IN THE CONTEXT OF MENTAL HEALTH
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In addition to the biological body and psychological and social aspects, humans are spiritual beings. There is much in the world that we are yet unable to explain, but to what human experience reacts, either positively or negatively. This article treats the possible negative interpretations of spiritual experiences that manifest in different crises. Spirituality can be defined in various ways and it can, in turn, be divided into core categories that relate to human spiritual needs. In order to provide help that corresponds to the multidimensional human experience, it is important for health care to consider spiritual crises. Several of the spiritual crises entail good opportunities for personal development and therefore represent, in a hidden form, a potential for treatment and positive dynamics rather than psychopathology. Meanwhile, people outside the health care system would need to acknowledge the mental health problems that accompany spiritual experiences. There is a big risk of romanticizing several paranormal experiences or even mood shifts, which can result in the person not getting the needed help or treatment. Unfortunately, not even religious persons or those active in spiritual practices are immune to mental disorders. A growing interest in different New Age practices, which mix the search for fast spiritual experiences and solutions with several cultural and religious settings, quickly bring the downside of spirituality to the attention of mental health specialists. Spiritual needs are common to human experience and they often arise during illness and treatment. There are several methods for collecting information and spiritual history on the patient’s needs, and sometimes simple questions asked during obtaining the medical history are sufficient to provide the specialist with necessary information that can be considered in developing the treatment plan. Changing the perspective can lead to a completely different understanding of the cause of several illnesses or disorders. As an example, a patient suffering from alcoholism can be seen as a person searching for connection or wholeness with higher forces. Spiritual issues are clinically related to the pathological risk that reminds us of the importance of including mental and existential issues in clinical practice. The religious/spiritual gap may become an obstacle. There is a considerable literature examining whether patients would prefer their physicians to inquire about their religious or spiritual beliefs as part of the routine history taking. Physicians maintain that the foremost reason they cannot provide spiritual care to patients is that they do not have enough time during the medical encounter. The second most common reason given is that they do not have adequate training to provide spiritual care to patients and that such care is better provided by others. Thirdly, physicians express discomfort about engaging in discussions on spirituality and faith with patients. In regard to the psychopathology of mental disorders, there are two basic classifications: the first one was created by the American Psychiatric Association (Diagnostic and Statistical Manual of Mental Disorders – DSM) and the second one was published by the World Health Organisation – WHO (The International Statistical Classification of Diseases and Related Health Problems – ICD). The development of the DSM, in its fourth edition, brought a change into the approach to religion and spirituality in the context of clinical diagnosis. Introducing V-code 62.89 (religious or spiritual problem) has increased the possibility of differential diagnosis between religion/spirituality and health/psychopathology. Unfortunately, there are no such developments in ICD-10. It sets boundaries to dealing with the R/S issues in psychiatry.
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