religions

Article
The Role of Religious Values and Beliefs in Shaping Mental
Health and Disorders
Beata Pastwa-Wojciechowska 1, * , Iwona Grzegorzewska 2 and Mirella Wojciechowska 3

1 Institute of Psychology, University of Gdańsk, 80-309 Gdańsk, Poland

2 Institute of Psychology, University of Zielona Gora, 65-417 Zielona Góra, Poland;
i.grzegorzewska@wns.uz.zgora.pl
3 Department of Health Sciences, Medical University of Gdańsk, 80-210 Gdańsk, Poland;
mirella.wojciechowska@gumed.edu.pl
* Correspondence: beata.pastwa-wojciechowska@ug.edu.pl

Abstract: Mental health is an area of continuous analysis, both in the context of understanding
increasingly precise diagnostic criteria and the impact of therapeutic methods. In addition to
these well-established directions of analysis and search, psychology tries to explore the factors that
bring us closer to understanding the mechanisms of the genesis and development of disorders,
as well as their importance in psychoeducation or therapy. The increased interest in issues of
spirituality/religion observed in recent years translates into the pursuit to explore the relationship
between religion/spirituality and health. This article reviews research into the ability of religion and
spirituality to benefit or harm the mental health of believers. We also examine the mechanism of
developing religious delusions in schizophrenia. Religion and spirituality can promote or damage



mental health. This potential demands an increased awareness of religious matters by mental health

 practitioners, as well as ongoing attention in clinical psychology research.
Citation: Pastwa-Wojciechowska,
Beata, Iwona Grzegorzewska, and Keywords: religiousness/spirituality; mental health; coping mechanisms; psychotherapy
Mirella Wojciechowska. 2021. The
Role of Religious Values and Beliefs
in Shaping Mental Health and
Disorders. Religions 12: 840. https:// 1. Introduction
doi.org/10.3390/rel12100840
For centuries, religion, piety, and spirituality have been the central point of human
life closely linked to history and culture. In many cases, religion is the foundation of
Academic Editors: Michal Valčo, Jove
culture. It builds national identity and creates a sense of community. Religious behavior,
Jim S. Aguas and Kamil Kardis
such as participation in religious services, pilgrimage, fasting, prayer, and related aspects
of spirituality—including trust in God and sense of support of or a bond with a higher
Received: 27 August 2021
Accepted: 27 September 2021
transcendental being—positively affect the meaning of life. They also build hope, shape a
Published: 8 October 2021
positive mindset, and help to build inner peace (Marashian and Esmaili 2012).
There are similarities between religiosity and spirituality, but also differences
Publisher’s Note: MDPI stays neutral
(Boczkowska and Zi˛eba 2016; Iddagoda and Opatha 2017). The researchers define re-
with regard to jurisdictional claims in
ligiosity as the extent to which a particular person believes in and venerates the founder,
published maps and institutional affil- gods, or goddesses of the relevant religion; practices the relevant teaching; and participates
iations. in the relevant activities. Religiosity involves being religious earnestly and genuinely
rather than frivolously and nominally. Religiosity is also known as religiousness (King and
Williamson 2005; Sedikides and Gebauer 2010; Iddagoda and Opatha 2017). Spirituality
appears to mean different things to different people, and its distinction from ‘religion’
Copyright: © 2021 by the authors.
is not clear. For many, spirituality refers to an individual’s attempt to find meaning in
Licensee MDPI, Basel, Switzerland.
life, which can include a sense of involvement with the transcendent outside institutional
This article is an open access article
boundaries (D’Souza and George 2006). Religion tends to refer to aspects of belief and
distributed under the terms and behavior, including spirituality, that is related to the sacred or supernatural grounded in a
conditions of the Creative Commons religious community or tradition. Most of the research in this area to date has focused on
Attribution (CC BY) license (https:// measuring religiosity rather than spirituality (Williams and Sternthal 2007).
creativecommons.org/licenses/by/ Giving meaning to life and value-based goals, combined with the sense of divine
4.0/). presence when solving one’s problems, helps people cope with crises and everyday burdens

Religions 2021, 12, 840. https://doi.org/10.3390/rel12100840 https://www.mdpi.com/journal/religions

Religions 2021, 12, 840 2 of 18

(Yang and Mao 2007). In the face of a crisis, many people look for help, first and foremost, in
faith, religious practices, and contact with clergy. However, research shows that the role of
faith and spirituality is often minimized or even pathologized by professionals (Szafrański
2015). It is difficult not to notice, however, that such an approach has its origin in a
culture where religion-related issues are often treated as non-measurable and unobservable,
whereas science and medicine hyperbolize pharmacology and pharmacotherapy. In social
perception, this translates into mythological expectations that treatment is a saving act,
whereas religion, pushed into a margin, becomes faith in miracles and the impossible.
In addition, ongoing scientific discussions and studies explore various links between
religiosity, health, and disease.
There is a strong association (positive and negative) between religiosity and spirituality
and mental health. It has been a sensitive and contentious issue within psychiatry and
clinical psychology, dating to Freud as a historical point of view. The weight of evidence,
on average and across studies, suggests that religiosity—however assessed—is generally a
protective factor for mental illness (Levin 2010). Despite these positive aspects of religiosity
and spirituality, there is a growing body of research demonstrating a negative aspect of
religion, where religiously-based struggles can be a source of distress for many. This
dual nature of religion and spirituality requires an increased awareness of the religious
aspects in the psychiatric patients’ lives both as protective and risk factors (Weber and
Pargament 2014). Negative religion–health relationship is especially visible with regard to
schizophrenia due to similarities between religious experiences and psychotic episodes.
Religious experiences often include auditory and/or visual hallucinations, whereas people
suffering from schizophrenia often report similar hallucinations. Those are accompanied
by different beliefs commonly considered to be delusional (such as the belief that they
are divine beings, prophets, or that God is talking to them, or that they are possessed by
demons, etc.) (Murray et al. 2012). While religion has a protective effect on many mental
disorders, religious involvement can become a risk factor in schizophrenia. This article
discusses, on the one hand, the role of religion and personal beliefs in shaping the active
and adaptive ability to cope with mental problems. On the other, it attempts to show,
using schizophrenia as an example, how religious involvement can become a trigger for
psychological symptoms. This is because a person’s rational thinking is challenged to
accept the imperceptible and requires a change in the line of thinking, which in turn may
lead to psychotic episodes (Mohr and Huguelet 2004).
It seems that no disorder other than schizophrenia encompasses both religious and
scientific threads that penetrate but also disregard and avoid each other (Sass 1994; Mohr
and Huguelet 2004; Borras et al. 2007). According to the APA Dictionary of Psychology
(VandenBos 2007, p. 815) “schizophrenia is a psychotic disorder characterized by distur-
bances in thinking (cognition), emotional responsiveness, and behavior. Schizophrenia
is still one of the most mysterious mental disorders that are characterized by delusions,
hallucinations, and impaired social behavior.” A similar definition can be found in Merriam-
Webster Dictionary. Schizophrenia is defined there as “a mental illness that is characterized
by disturbances in thought (such as delusions), perception (such as hallucinations), and
behavior (such as disorganized speech or catatonic behavior), by a loss of emotional respon-
siveness and extreme apathy, and by noticeable deterioration in the level of functioning in
everyday life” (https://www.merriam-webster.com/dictionary/schizophrenia, accessed
on 9 August 2021). Schizophrenia is presented as a medical term and more particularly as a
psychiatric concept. Research on schizophrenia also shows that religiosity and spirituality
are of particular importance to many patients and usually play a positive role, which means
better coping with psychosis, giving it meaning and sense (Mohr and Huguelet 2004;
Borras et al. 2007; Szafrański 2015).
The literature search procedure for this review involved systematic searches of title and
abstract fields through online databases (i.e., EBSCOhost, PROQUEST, Medline, PsychInfo,
Google Scholar, and Google Books). As much of the relevant literature is somewhat dated
and limited, there were no restrictions imposed on the date of publication. A combination
Religions 2021, 12, 840 3 of 18

of the following terms was used: religiosity and mental health, spiritual psychosis, spiritual
activity, religious delusions, spiritual struggle, psychological crisis, schizophrenia, religion,
religious practices, and spirituality. These terms were used in different combinations and
all the relevant articles were identified. The reference lists of relevant papers and book
chapters were also perused to aid the identification of additional relevant references.
This article focuses on the relationship between religiosity, spirituality, and mental
health in the context of both, positive and negative associations. An overview of the
theoretical thesis and empirical evidence is presented linking the extent of spirituality or
religious involvement to health and mental disorders, with an emphasis on schizophrenia
analysis and studies. The psychological mechanism underlying the relationship between
religiosity and mental health is outlined, as well as some of the challenges in this area and
priorities for practice. That is why the authors refer to contemporary knowledge about
the factors and mechanisms related to mental health, recovery, and etiology of delusions
in schizophrenia. They also discuss the understanding and application of treatment to
improve the health and quality of life of patients and their families. The article reviews the
evidence and explores the impact that some expressions of spirituality can have, as part of
an integrative approach, on understanding mental health forming a risk factor in people
prone to developing psychotic disorders.

2. The Relation between Religiosity and Mental Health

Over the last few decades, increased emphasis on the holistic understanding of a
human being has paved the way for research into the relationship between religiosity,
spirituality, and human mental health (O’Reilly 2004). This association, common in eastern
cultures, is being duly recognized in Western Europe only now (King 1998; Janus 2004;
Sieradzan 2005, 2015). Religiosity (understood as belonging to a specific church, partic-
ipation in religious services) and spirituality (understood as a connection with a source
greater than self, a sense of transcendence) are important aspects of the everyday life of
many people.
The relationship between religiosity and mental health can cover two domains (pos-
itive/negative) and five main forms. These relationships apply to both healthy people
and patients with mental disorders. Religiosity can (1) be an expressive outlet for present
psychological problems and mental disorders, (2) allow escape or soothe given life prob-
lems that underlie the disorder, (3) inhibit symptoms and foster socialization, (4) provide
an opportunity to constructively cope with stress and problems, and (5) contribute to the
worsening of symptoms and development of disorders. All these relationships also apply
to schizophrenia. Studies on schizophrenia also show that religion and spirituality are
of particular importance to many patients and usually play a positive role, which means
better coping with psychosis, as well as giving it meaning and sense (Szafrański 2015).
Suzanne Heffernana et al. (2016) point out the positive effects the scriptures can have
in a schizophrenia patient’s life. In religion, patients found advice on how to cope with
difficulties in life and how to be a better person. Exemplary in helping others, it reinforced
their belief that they were being helpful to society.

3. The Positive Links between Religiosity and Health

The reviews continue to provide further evidence of an association between religious
involvement and health. Religion-associated variables have been shown to have protec-
tive effects for multiple mental health outcomes, including wellbeing, relieving mental
symptoms, suicidal behavior, and substance misuse (Williams and Sternthal 2007).

3.1. Religiousness as a Way to Relieve Tension Related to Mental Health Problems

The studies have shown that 59% of people worldwide consider themselves to be
religious, regardless of whether they regularly attend services (WIN-Gallup 2012). The
search for links between spirituality and mental health is explored in many ways. Research,
conducted across many scientific disciplines, focuses on several important directions,
Religions 2021, 12, 840 4 of 18

including interdependency, seeking evidence of how religiousness contributes to health,

mental disorders, or recovery (Nicholls 2002; Foskett et al. 2004; Barker and Buchanan-
Barker 2005). Initially, there was a tendency in scientific literature to seek a straight-line
relationship between certain spiritual manifestations and the narrowly defined aspects
of mental health. Emphasis is placed on an integrated approach that assumes two-way,
interactive, and impact-prone correlations (Cornah 2006). Research confirms the positive
impact of faith and religiosity on the patients’ recovery from both somatic (Jim et al. 2015)
and mental illnesses (Lukoff 2007). Relevant correlations have also been shown concerning
mental health in the following aspects: a sense of well-being (Pargament et al. 2013), level of
security (McCullogh and Willoughby 2009), the experience of positive emotions (Abu-Raiya
and Agbaria 2016), or lower levels of anxiety and sadness (Hood et al. 2009).

3.2. Religiosity Is a Form of Escape or Soothes Given Life Problems

Religion can have a significant impact on the way a person lives and experiences life.
A religious person may find several areas in life to be at least somewhat influenced by
their beliefs. Many people find their religious faith to be a source of comfort and solace.
They may find that believing in a higher power gives their life meaning and provides them
with a set of standards or moral codes to live by. Religious faith may make it easier for
some to cope with challenges in life and practice compassion toward others. A review of
3300 studies showed that religiosity can lead to better mental health, increased adaptability
to problems, and a lower risk for physical problems. For many individuals, religious beliefs
have the potential to reduce stress, increase positive emotions, give meaning to adversity,
and enhance one’s sense of purpose (Koenig 2012).
A meta-analysis of 17 studies showed that religious attendance and intrinsic (internal-
ized) religion tend to be associated with reduced anxiety (Shreve-Neiger and Edelstein
2004). Another meta-analysis revealed that positive forms of religious coping were related
to lower levels of depression, anxiety, and distress, which is connected with psychological
adjustment (Ano and Vasconcelles 2005). Religiosity plays a positive role for adolescents,
too. Studies of adolescent behavior have found that higher levels of religious involve-
ment are inversely related to alcohol and drug use, smoking, sexual activity, depressive
symptoms, and suicide risk (Rew and Wong 2006).

3.3. The Role of Religiosity in Inhibiting Symptoms and Fostering Socialization

The essence of the behavioral concept is to treat religion as one of many social human
behaviors, shaped in the process of socialization and education (Zimnicka-Kuzioła 2012).
Health practices and social ties are important pathways by which religion can affect health.
Other potential pathways include the provision of systems of meaning and feelings of
strength to cope with stress and adversity. Both Aaron Beck and Albert Ellis criticized
religion in their early works (Sikora 2019). As K. Sikora (2019) points out, Ellis’ radical
views on religion were based on his personal convictions—i.e., identifying religion with an
oppressive system of irrational beliefs and mental imbalance. While he considered the con-
cept of sin to be a source of psychological distress, he also rejected the inclusion of religion
in a psychotherapy process and even the possibility for therapists to profess any religion.
However, the development of the cognitive behavioral approach and the strengthening of
Wells’ metacognitive approach (Wells 2010, 2011) have led to the recognition of the role of
key and early-childhood experiences in the formation of cognitive schemas, in particular
the self-schemas (Young et al. 2019). As highlighted by K. Sikora (2019), the adopted
theoretical assumptions allowed for the development of religious/spiritual cognitive be-
havioral therapies (R/S CBT). The empirical support for R/S CBT has yielded mixed results.
A meta-analysis of 31 outcome studies of spiritual therapies showed empirical evidence
that spiritual-oriented intervention may be beneficial to individuals with psychological
problems of depression, anxiety, stress, and eating disorders (Smith et al. 2007). Although
the evidence for the efficacy of R/S CBT with schizophrenia is limited, Tabak and Weisman
de Mamani (Tabak and Mamani 2014) suggested that cognitive restructuring could perhaps
Religions 2021, 12, 840 5 of 18

be useful in addressing meaning-making and improving the quality of life in patients with
schizophrenia. However, the authors suggested that this would be more applicable to
patients in recovery. They caution about generalizing the issue when discussing it with
individuals in acute stages of schizophrenia or with severe symptoms.

3.4. Religious Involvement as a Coping Behavior

In many countries, researchers systematically report that the use of religious and
spiritual involvement as a coping strategy is widespread. In the years following the
events of 11 September, 2001, in the US, 90% of Americans managed to cope with stress
by turning to religion (Schuster et al. 2001). Psychiatric patients also often use religion
to cope. A survey of 406 patients with chronic mental illness revealed that, for as many
as 80% of them, religion helped to cope with the effects of the disorder (Tepper et al.
2001). Other studies showed that 79% of psychiatric patients stressed the importance of
religion in their life, 67% stated that spirituality helps them cope with mental problems,
and 82% believed that the therapist should be aware of their religious and spiritual needs
(D’Souza 2002). Why religion, as a coping mechanism, is so common among patients with
mental disorders? Harol Koenig (2009) points to several important arguments. Firstly,
religious beliefs provide sense and purpose in difficult life circumstances, which helps
to integrate the psyche. Religious beliefs tend to be based on a positive world view that
is, in principle, optimistic. Religious beliefs justify suffering and fate, whereas saints and
church fathers act as role models in the Scripture, thus facilitating acceptance of suffering.
Secondly, spirituality and religiousness give people a sense of at least indirect control of
the circumstances, reducing the sense of helplessness. Thirdly, religions offer a community
of support, both at the spiritual (divine) level and the human level. Each of these types
of support is effective and helps reduce loneliness and isolation. Ultimately, unlike many
other means of coping, religion is available to anyone at any time, regardless of financial,
social, physical, or external circumstances.
Studies on schizophrenia also show that religion and spirituality are of particular
importance to many patients by playing usually a positive role. This means better coping
with psychosis, giving it meaning and sense (Szafrański 2015; Żechowski 2015).

4. Factors Affecting the Relationship of Religiosity and Mental Health

Some of the studies investigating the relationship between spirituality and mental
health try to understand the mechanisms underlying the positive impact of religious
activity on mental health. Instead of assuming that the value and spirituality or religious
commitment does not reflect the divine intervention, the researchers consider other factors
that may explain the relationships.

4.1. The Specificity of Religious Involvement and Mental Health

A research review by Bergin (1991) and the Payne team (Payne I. Reed et al. 1991)
concerning the relationship between religiousness and mental health provided mixed
results. It turned out that there are several links between different types of religious activity
and positive mental performance, but the results obtained were not very spectacular. In ad-
dition, religiosity was positively linked to many measures of mental well-being. However,
no general evidence was found on the link between religiousness and the prevention of
mental/fundamental disorders. The researchers concluded that the ambiguity of the results
obtained was due to the misconception of “religiousness”, which due to its multidimen-
sional nature should not be considered uniform. They pointed out that, for mental health,
it is not important how deeply religious a person is, but what is the form of religiosity
(Hackney and Sanders 2003).
A detailed analysis of the relationships between the specificity of religious involve-
ment, mental health, and positive adaptation confirms the above assumptions. The
strongest positive ties were shown for personal involvement in religious practices. Weaker
correlations were related to the professed ideology, and the weakest and exclusively neg-
Religions 2021, 12, 840 6 of 18

ative were linked to institutional religiousness (Hackney and Sanders 2003). Theoretical
explanations of these relationships are sought in Greenberg’s terror management theory
(Greenberg et al. 1991) and the concept of self-determination (Deci and Ryan 1985). The
first one is based on the assumption that the experience of terror is the basic source of
human motivation and certain beliefs resulting from the awareness of unavoidable death.
In this context, participation in religion (understood as an institutional manifestation of a
common view of the world) protects individuals from existential anxiety and enables them
to achieve a sense of their self-value and (probably) satisfaction with life by knowing that
it is an important part of the meaningful universe. However, research indicates that being
a mere member of a church community is not enough. For good mental performance, it
is essential to be a “true believer”, who authenticates the system of religious beliefs and
puts them into practice (Hackney and Sanders 2003). The second concept sees the human
being as an active organism with the potential to act. The sources of human potential are
located both inside individuals (such as drives, emotions) and in the environment in which
they operate. This theory describes a human being as a self-regulating system capable of
self-development and integrating their actions. The coherence of this system contributes to
the achievement of well-being (Ryan and Deci 2001).
The work of Ryan et al. (1993) provides examples of religious internalization. The
researchers focus on two types: introjected (the individual’s involvement in religion is
based on self-esteem and affective conditions) and identified (the individual’s involvement
in religion is based on personally selected and valued convictions). The research results, at
least in part, confirm the relationship between internal, adopted value-based motivation,
and subjective wellbeing (Deci and Ryan 1985; Nix et al. 1999). The results confirm that
the more internalized the motivational style is, the higher the mental health level of the
individual. Thus, the link between religion and mental health can be considered stronger,
since both phenomena (religiousness and mental health) are based on similar mechanisms,
and are consequently applied in a specific, introjected way.

4.2. Religiosity as a Form of Attachment

The search for psychological mechanisms underlying the relationship between re-
ligious involvement and mental health shows several psychological processes, such as
coping styles, sense of control, social support, and social networks (Cornah 2006). The role
of physiological processes involved in mental health building (Larson and Larson 1998)
is also emphasized. Research by Granqvist (2005) and Kirkpatrick (2005) shows that the
relationship of a person believing in “God” meets three criteria of the attachment relation-
ship, namely: (1) searching for and maintaining closeness; (2) searching for the so-called
safe haven at the moment of stress (hiding, protection, safety); and (3) using “stronger and
more powerful” as a secure base when testing the reality. Such an understanding leads
toward attachment theories, which in psychology are important for building relationships
and self-understanding.
The way we communicate with other people, including our children, has a huge
impact on their development (Siegel and Hartzell 2015). Human beings, as social beings,
require a two-way emotional dialogue, which strengthens our sense of security by helping
us to cope with the challenges in many areas of life. The theory behind this phenomenon
is the concept of attachment which explains the need for intimacy with another person,
including God. The concept of the omnipresent God provides a sense of closeness, which
brings a feeling of comfort, support, trust, and hope while reducing tension and anxiety
in stress and risk situations. Thus, according to Kirkpatrick (2005), people project onto
God the internalized relationship with an attachment figure, a kind of model of relations
with important people. These patterns are formed in human life mainly based on ties
with parents. In this sense, in the context of the attachment theory, the relationship with
God can be treated in the same way as an internalized relationship with a human being,
and the figure of God can be treated as an attachment figure (Żechowski 2015). In turn,
according to Mario Mikulincer and Phillip Mikulincer and Shaver (2010), the development
Religions 2021, 12, 840 7 of 18

of a religious, spiritual, or philosophical approach to life is one of the important indicators

of human maturity. The concept of the omnipresent God provides a sense of closeness to
an object and provides a feeling of comfort, support, trust, hope, and reduces tension and
anxiety in stressful and risky situations. According to Mikulincer and Shaver (2010), the
spiritual nature of people with a trusting, safe style of attachment is based on cognitive
openness, exploration of vital existential issues, individual development, and autonomous
reflection. Such attitude toward inner life takes into account the ambiguity, uncertainty and
the ability to eliminate some degree of confusion associated with religious development.
In turn, people with an impaired feeling of safety—i.e., with the so-called mistrust patterns
of attachment direct their frustrated attachment needs to God. In their case, God is an
alternative form of attachment that is intended to compensate for the failed relations and
ties, and consequently to lessen the fear experienced in relations (theory of compensation)
(Kirkpatrick 2005).
In his theoretical article, C. Żechowski (2015, p. 11) emphasizes that “people with mis-
trust attachment use spirituality to build a system of defense against frustration and pain,
completely different from trusting people whose spirituality ties in with an exploration
of reality and development.” When citing John Steiner’s views (2010), he describes the
specific way in which the mind works, which Steiner calls a psychic retreat. In other words,
individuals develop a complex system of defense, which allows them to avoid contact
with another person and reality and shelter themselves in a fantasy world. These defenses,
on one hand, foster a sense of security, and on the other, block development and detain
individuals in the world of illusion and transitional facilities.
In addition, distrustful people may project their insecurity onto God. This issue has
been best described in Polish literature by C. Żechowski who presents skeptical people as
those for whom God is a dismissing, angry, or judgmental figure who demands obedience
and being pleased (Mikulincer and Shaver 2010; after Żechowski 2015). In addition, other
attachment styles present specific relationships with God and attitudes to religion. In the
case of an anxiety attachment, individuals are not sure of God’s love, while in the case
of avoidance attachment, they try to maintain distance and independence. Those with a
disturbed sense of security, in turn, experience considerable difficulties when seeking and
discussing religious attitudes (Żechowski 2015). People with a disturbed sense of security
are more likely to succumb to fundamentalism and dogmatism, which can activate strong
emotions, trigger an illusory experience of life or separation from reality. In contrast, people
with a distrustful attachment style present a high number of sudden conversions, more
frequent interest in New Age practices, spiritualism, esoterism, a “new birth” experience.
In addition, distrustful persons experience sudden emotional changes while using religion
to distance themselves from parents and compensate for the sense of insecurity and crises
experienced (Żechowski 2015).
Numerous studies have shown that insecure attachment styles, especially disorga-
nized attachment, can be an important risk factor for mental disorders (Green and Goldwyn
2002). Research on attachment in schizophrenia showed that avoidant and disorganized
styles are the most common (Tyrrell et al. 1999; Berry et al. 2007) and that the separation
from the mother in the first two years of life is a significant risk for developing schizotypal
symptoms (Anglin et al. 2008; Gabino et al. 2018). Dissociation, changed state of conscious-
ness, de-recognition, and de-personalization are the common features that characterize
people with a disorganized attachment style (Granqvist et al. 2012).

5. Negative Effects of Religiosity

However, the role of spirituality and religiosity in the context of mental health is not
always based on positive impact. While for some people religious affiliation is helpful
and assists the recovery process, in other cases it may pose a risk factor because it leads
to excessive blame, shame, and feeling of abandonment (Faiver et al. 2011). Research has
shown that feelings of religious guilt and the failure to meet religious expectations or cope
with religious fears can contribute to illness (Trenholm et al. 1998). People who manifest
Religions 2021, 12, 840 8 of 18

a greater extrinsic religious and spiritual orientation (i.e., use their religion for nonreli-
gious or antireligious purposes) report lower wellbeing (Abu-Raiya 2013). Malinakova et al.
(2020) assess the associations of religiosity measured more specifically, with mental health in
a secular environment, using a nationally representative sample of Czech adults
(n = 1795). They found that, compared to stable non-religious respondents, unstable
non-religious and converted respondents who perceived God as distant were more likely
to experience anxiety in close relationships, and had higher risks of worse mental health.
Negative aspects of religiosity refer to such processes and mechanisms as negative
beliefs and negative religious coping. Negative beliefs can mean negative or punitive
images of God, which can increase guilt or lead to discouragement as they fail to live up to
the standards of their faith tradition (Bonelli et al. 2012). It can turn religiosity from a po-
tential resource into a source of spiritual struggle as a risk of depression, anxiety, paranoia,
obsession, and compulsion (Koohsar and Bonab 2011). Negative religious coping—referred
to as “religious struggle” or “spiritual struggle”—can be categorized into three types:
(1) divine, or difficulties and anger with God; (2) interpersonal, or negative encounters
with other believers; and (3) intrapsychic, or internal religious guilt and doubt (Weber and
Pargament 2014). Each type of religious struggle has been associated with psychological
distress as depression (Ramirez et al. 2012), greater frequency and intensity of suicidal
ideation (Rosmarin et al. 2013) and more anxiety and grief (Fitchett et al. 2014).
The most negative influence of religion on health can be seen in the case of schizophre-
nia. For psychotic patients, incorporating religious and spiritual themes into their delusions
may lead to greater conviction in delusional beliefs, greater severity of symptoms, and
lower levels of functioning, as well as less compliance with psychiatric treatment (Siddle
et al. 2002; Mohr et al. 2011).

5.1. The Nature of Schizophrenia in the Context of Religiosity

Schizophrenia is a mental disorder of a psychotic nature. This type of disorder is char-
acterized by an affected, inappropriately perceived, deeply experienced reality. A person
suffering from psychosis has a severely impaired ability to critically and realistically assess
self, the environment and relations with others, and is not even able to do so. Schizophrenia
is a mental disorder with a multitude of symptoms. To simplify the understanding of
the disease, clinical literature often groups the symptoms into positive and negative ones.
Positive or negative symptoms do not mean a “positive” or “negative” impact on the
outline and course of schizophrenia. They indicate certain “excess” of experience, thoughts
or “absence/shortage” in perceiving or experiencing reality and in terms of convictions.
Many psychotic patients experience religious delusions, some of which are difficult
to distinguish from so-called ‘normal’ religious or spiritual beliefs. About 25% to 39% of
schizophrenia psychotic patients and 15% to 22% of bipolar patients experience religious
delusions (Koenig 2011). As noted by D. Janus (2004), a person believing themself to be a
prophet, a messiah or a God became a symbol of psychopathology. Grandiose and religious
delusions are common in schizophrenia, which is combined with an extraordinarily high
status in the patient’s mind. However, it should be noted that this picture tends to fluctuate,
and only occasionally the patients are convinced of their unlimited powers, which can be
identified with the figure of God. Grandiose delusions, which most often take the form of
religious delusions, are a unique compromise between isolation and living with people.
Figures such as a ruler, dictator, or messiah are both different and alienated. In other words,
a schizophrenic person cannot live with people, but also, as a human being, cannot live
without them. To maintain valuable isolation and, at the same time, contact with other
people, patients appear as someone surpassing others, while at the same time having
something precious for them. By becoming a “God”, a schizophrenic is freed from the
embarrassing influence of the past, childhood, and family, gets rid of a family- and socially
dependent sense of guilt, which is one of the factors that limit their freedom of self. Just
as the cultural image of God is created by eliminating parents, so does the schizophrenic
patient, to get away from them, become God.
Religions 2021, 12, 840 9 of 18

Interestingly, our clinical studies (Pastwa-Wojciechowska, Grzegorzewska, Wojciechowska,

in progress) of the people in the care of the community assistant (N = 12) showed a
very frequent family pattern. As children, they were being entrusted to the care of their
grandmothers, who were extremely religious persons. This was followed by the family
breakdown (divorce of parents), most often caused by the use of alcohol by the father or
both parents. Patients developed symptoms during childhood or adolescence, whereas
religious content and association with religious practices were particularly important for
them translating into delusions. In addition, D. Janus (2004) emphasizes that patients
identify themselves not as much with the figure of Christ as a whole, but with individual
aspects of that character or its incarnation: a suffering man (most often) or an adored Child,
omnipresent Creator and savior or a silent, helpless Lamb of God, or even—as in the case
of their patient—a sensual, naked symbol of excellence and beauty. The early “selection” of
a given image of Christ reflects the structure of the individual’s self as it represents conflicts
and developmental deficiencies that seek solutions and satisfaction, respectively.
In turn, when referring to the literature on the subject, it should be noted that, in the
case of schizophrenia patients, the most frequent delusions were those regarding hearing
the voice of God or other hallucinations attributed to God or Satan, including a conviction to
be God, Jesus, or an angel or a conviction to be possessed by devil or demons (Persaud 2006;
Sieradzan 2015). In addition, it was stated that: (a) the content of the delusions reflects the
local religious/cultural environment, (b) the religious symptoms are a significant minority
among psychotic symptoms, and (c) the psychosis, instead of pointing to a link to a specific
religion, may precede a change of religious affiliation to a less traditional (“orthodox”) faith
(Sieradzan 2015). On the other hand, other studies show that religious delusions are not
a uniform phenomenon, with a common neurocognitive or neurobiological basis. They
should be placed in the context of life history and environmental factors, therefore they
should not be considered as a distinct group of delusions (so-called religious delusions)
(Sieradzan 2015).

5.2. The Role of Religion in the Genesis of Schizophrenia

To understand the link between religion, spirituality and pathological psychosis, it
is important to see the role that religion plays in the origin of schizophrenia. First, it is
crucial to appreciate the religious involvement in the standard population. For example,
according to the Gallup Poll study, 73% of US respondents were “convinced God exists”
and another 19% indicated that God “probably exists”. In contrast, 3% said they were
convinced that God does not exist. Furthermore, 4% claimed that God probably does not
exist, but they are not sure (Newport 2006). In Polish surveys, 95% of respondents indicated
being believers, of which every eighth (13%) described their faith as deep. More than half
of respondents (54%) take part in religious practices at least once a week, and one in every
20 (5%) people do so several times a week. The perception of religious faith in terms of the
factors that makes life meaningful depends on the involvement in religious practices. Of
those who participate in religious rites more often than once a week, the belief that faith
makes life meaningful is expressed by 57% of respondents and only 5% among those that
do not practice at all. Furthermore, religious faith in the context of life meaningfulness
is more likely indicated by respondents who are older, poorly educated, disadvantaged,
pensioners, and rural dwellers. They are also more often women than men (CBOS 2009).
Religious involvement increases in situations of danger to life or health. In a situation of
severe stress, religious rituals are often used to cope with or adapt to difficult, unfavorable
circumstances: people call for God’s help, pray, commit to service or seek consolation in
religious communities. For example, 90% of Americans turned to religion as a way of
coping with the terrorist attacks that took place on 11 September, 2001, in New York City
(Schuster et al. 2001). It is therefore not surprising that many psychotic patients are religious,
more or less involved in the spiritual development and life of their church. People with
schizophrenia have the same spiritual needs as other people, but their susceptibility to
religious content is different.
Religions 2021, 12, 840 10 of 18

Patients with schizophrenia are particularly sensitive to stress (Mohr 2006). This sensi-
tivity builds their vulnerability to religious delusions (Koenig 2007). Religious delusions
exist on a continuum between the normal beliefs of healthy individuals and the fantastic
beliefs of psychotic patients. Psychotic patients usually experience religious delusions
together with other mental symptoms and behaviors and these delusions do not appear
to serve any positive function (Siddle et al. 2002). The Siddle team (Siddle et al. 2002)
reports a positive correlation between religious delusions and religious activity in 193
inpatients with schizophrenia. Patients with religious delusions scored significantly higher
on self-assessed religiosity and doctrinal orthodoxy than those without religious delusions.
The mechanism linking religious involvement and the genesis of psychosis has not been
fully recognized.
It is pointed out, however, that religious conversion (irrespective of the particular
religious group) may be associated with or result from the psychosis etiology (Koenig 2007).
Much depends on the speed of the conversion. As indicated by Wootton and Allen (1983),
a sudden conversion could be more the cause or consequence of a developing disorder
than a slow one, which is based on spiritual reflection of the conversion. It is also pointed
out that religious conversion can often occur during an emotional shock or mental stress,
which further strengthens susceptibility to delusions.
The delusions may also be not so much the cause but the consequence of the conver-
sion. Studies conducted in India have found that 22% to 27% of patients with schizophrenia
report an increase in religious activity following their diagnosis (Bhugra et al. 1999). This
may reflect an increased turning to religion to cope with the stress of schizophrenic symp-
toms in a highly religious population. A further study showed that many psychotic people
changed to a new religion after the diagnosis of schizophrenia. The researchers suggested
that this recurrence was at least partly an attempt to regain self-control because their image
began to change with the appearance of schizophrenic symptoms (Bhugra 2002). In this
study, it was clear that religious conversion was second to psychotic development rather
than vice versa.

5.3. The Role of Religion in the Manifestation of the Symptoms of Schizophrenia

Distinguishing deep religious involvement from religious psychotic symptoms is not
easy. The mechanisms behind the psychotic symptoms formed in the context of religious
involvement are not fully known. Religious delusions occur in up to 25% of persons with
psychosis and may be used to determine whether psychosis is present (Koenig 2007). Thus,
distinguishing religious beliefs and psychotic experiences become an urgent dilemma
for clinicians.
The literature presents several criteria that distinguish between pathological and
non-pathological religious involvement (Pierre 2001; Lukoff 1985; Sims 1995). Firstly, for
religiosity to be considered pathological, it must affect the ability of a person to function
by impairing work performance, legal problems, unstable behavior, increased aggression,
neglecting daily duties, or experiencing problems when testing reality. Secondly, a person
with pathological religious involvement lacks mental maturity or spiritual development.
Thirdly, psychotic persons usually have no insight into the unrealistic nature of their
religious beliefs. They can even strengthen or embellish the beliefs. Furthermore, the
psychotic person will experience difficulty establishing “intersubjective reality” with other
persons in their psychosocial or religious environment, particularly since they will have
other symptoms of psychotic illness that impair their ability to relate to others. Psychotic
and spiritual states may overlap. This makes it difficult to distinguish one state from
the other without long-term follow-up and observation. Ultimately, psychotic people
experience other symptoms that affect their psyche and behavior, such as hallucinations,
impaired thinking processes, or mood disorders. Of course, as Koenig (2007) claims, there
is always a possibility that a mentally (even psychologically) sick person will have religious
beliefs and mystical experiences which are culturally normative and can help that person
cope better with mental illness.
Religions 2021, 12, 840 11 of 18

5.4. The Roots of Religious Delusions in Schizophrenia

As previously noted, religiousness and spirituality play a special role in psychotic
disorders. Several well-known researchers—such as S. Freud, E. Fromm, R. May, or A.
Lowen—believe that Western culture is schizophrenic, meaning that the Western culture
makes us more vulnerable to mental problems (Sieradzan 2008). Already in the mid-19th
century, psychiatrists considered madness to be the price paid for the development of
civilization (Sieradzan 2005, 2015). Transcultural research conducted by 40 psychiatrists in
the early 1960s in 27 countries across the world showed that religious hallucinations are
the most common among Christians. However, it should be noted that nowadays there
are so many people with mental problems that Robin Persaud (2006) introduced a new
category of “people with poor mental health” and presented the problem of religiosity as
one of both driving and retarding forces of our life.
From a historical point of view, religious issues are mainly reflected in the psychoana-
lytical paradigm, as referred to by Freud—but also Jung, Fromm, and Erikson. Carl Gustav
Jung (1997, 2015, 2017) introduced the concept of archetypes—symbols constituting the
content of the collective unconscious, a product of the earliest experiences of humanity.
Archetypes—i.e., the prototypes of human beliefs, universal models of thinking and actions,
deposits of eternal knowledge—are reflected in dreams, myths, religions, and art. From
this perspective, God is an archetype, a constant element contained both in the conscious
and unconscious sphere of the human psyche. Erich Fromm (1966), in turn, recognizes a
human being as a religious person, but interprets religion broadly, as a reference system
that provides an individual with an orientation system and an object of worship. According
to Fromm, every person needs an ideal and thus an object of adoration. This perspective
results from Fromm reflecting Freud’s views (Freud 1967) in this respect and assuming
that the monotheistic religion stems from a longing for a perfect father, who combines
or integrates the elements of good and evil in an individual. In other words, it will both
reward and punish, depending on the situation. For most people, however, faith in God
means believing in a father who is eager to help—i.e., it is nothing else but a child’s illusion.
Eric H. Erikson (1997, 2004) highlighted the positive and negative aspects of religion in
our development. On one hand, faith allows solving development crises that occur in the
life of each person. On the other hand, it can take pathological forms, such as promoting
intolerance and hostile attitudes toward those who think differently.
The relation between archetypes and religious delusions in schizophrenia provides
a bridge between the healthy and pathological functioning of the psyche. In the light of
Jungian theory, acute psychosis is considered to be an eruption of the collective unconscious
with the fragmentation and dissociation of a weak, undeveloped conscious personality.
The archetypal patterns and images which ordinarily govern life from the depths of
the unconscious are suddenly exposed to view becoming part of a disturbed psychotic
awareness. As Edinger notes (Edinger 1955, p. 626): “Very often the ego undergoes an
inflated identification with a highly charged, numinous archetypal figures, such as the hero
or the savior. It is this pattern we see in the frequent cases of delusional identification with
Christ, who for Christians (and sometimes unconsciously for Jews) carries the projection of
the archetype of the spiritual hero.” In this case, the delusion of Jesus as an archetype of
god is a form of ego defense mechanisms led by the denial and projection is necessary to
such an “ideal” come into consciousness. Religious delusions provide a temporary solution
to personal, existential, and metaphysical problems and also relief, meaning, and even joy.
Unfortunately, the psychotic symptoms persist.
The search for links between schizophrenia and religion has, in a sense, a well-
established position in psychiatric, psychological, philosophical, or social literature. Often
in each of the great world religions, people who—according to psychotic nomenclature—
have psychotic symptoms are treated either as being gifted with extraordinary powers and
knowledge or as being possessed by ghosts or demons (Prusak 2015, 2016). As J. Prusak
(2016) emphasizes, guidelines of the American Psychiatric Association and the American
Psychological Association require clinicians to make a diagnosis that differentiates between
Religions 2021, 12, 840 12 of 18

religious or spiritual problems occurring without a connection with mental disorders and
those that either coexist with symptoms of such disorders (but without a causal link) or act
as triggering or supporting factors for a given pathology. In either case, code V 62.89 may be
used and included in the diagnosis either (a) independently, (b) in addition to the diagnosis
of mental disorder, or (c) as part of the diagnosis of the disorder, when its symptoms show
religious or spiritual aspects. This clinical approach corresponds to the results of research
into the relationship between religion/spirituality and mental health/psychopathology.
S. Dein and R. Littlewood (Littlewood and Dein 2013) link the genealogy of schizophre-
nia to such factors in Christianity as (1) an omniscient deity, (2) a decontextualized self,
(3) ambiguous agency, (4) a downplaying of immediate sensory data, (5) scrutiny of the self,
and (6) its reconstitution in conversion. According to Sieradzan (2015), studies showed that
one-third of those with diagnosed psychosis with religious delusions live in Western coun-
tries. In turn, K. Dyga and R. Stupak (Dyga and Stupak 2018) indicate that the prevalence
of such phenomenon among hospitalized patients is the highest in the United States (36%)
and the lowest in Pakistan (6%), where a significant proportion of grandiose delusions
concerns identification with God, Jesus, or Mahomet. In other studies, the frequency of
religious delusions was estimated to be 21% in Germany and 6% in Japan. As Dyga and
Stupak stress, cultural and religious differences have an important impact on the existence
of specific forms of delusions as well as their image. However, the frequency of delusions
related to identifying oneself with Jesus is difficult to quantify, although probably they form
a small part of all religious delusions. The religious component can, in principle, include
every type of delusion, although most often it happens in the context of grandeur, guilt,
persecution, and secondary delusions. More and more often, delusions are considered to
be a complex and multidimensional phenomenon. Therefore, the psychological assessment
process considers, for example, the number, absorption, omnipresence, distress, and the
role of perception, influence on behavior, effectiveness, and strength of belief (Dyga and
Stupak 2018).

6. Implications for Practice

In the biopsychosocial model, mental disorders are usually treated with medications,
psychological interventions, and familial and social support. However, the model does not
take into account the religious dimension of the patient, i.e., spirituality (concerned with
the transcendent and questions about life’s meaning) and religiousness (concerned with
specific behavioral, social, and doctrinal attributes).
For many professionals (psychiatrists, psychologists, nurses), it might be problematic
to address religious or spiritual issues when working with patients due to the perceived
lack of competence or the rational nature of the so-called professional assistance. However,
to understand patients and help them effectively, comprehensive assistance and support
should be offered instead of focusing on technical, administrative, isolating, or forced
solutions. Unfortunately, such activities are a part of the treatment ‘culture’ and thus
limit the understanding and meaning of religion in the etiology and pathogenesis of
disorders, focusing on symptoms and not on understanding that they are an expression of
the problems of the suffering person. In addition, they reduce the patient to the system’s
element, rather than the subject, which in turn causes patients to search for forms of
assistance that will allow them to feel the subject of treatment.
Various studies show that spirituality and religion are important aspects of the life of
many patients. Their faith and involvement in religious practices are a source of hope and
strength in the fight against illness, giving meaning to the illness and, above all, leading
to better outcomes of treatment (Dyga and Stupak 2018). In addition, the literature on
the subject recommends avoiding confronting patients with their delusions, and instead
focusing first on reducing the suffering associated with the delusions and then on the
positive aspects of spiritual life. It is also important to remember that patients insist more
strongly on religious delusions than any other type, which makes them more challenging
in the therapeutic process (Dyga and Stupak 2018).
Religions 2021, 12, 840 13 of 18

Interesting research on the role of religion in health recovery was presented by Suzanne
Heffernan, Sandra Neil, Yvonne Thomas, and Stephen Weatherhead (Heffernana et al.
2016). The researchers identified eight areas which, in their opinion, explain how religion
can affect health recovery—i.e.: (1) use of scriptures and rituals, (2) a genuine connection
with God, (3) the struggle to maintain rituals, (4) guidelines for living, (5) choice and
control, (6) relating to others, (7) enhancing psychological well-being, and (8) making sense
of experiences.
Thus, it turned out that “the use of scriptures and rituals” was important for patients,
because they believed that frequent praying could help them recover quicker. In turn,
a “genuine connection with God” is important for patients to return to health, while the
omission of this aspect has exacerbated their results. In contrast, the “struggle to maintain
rituals” indicates that the inability to concentrate during rituals increases patients’ tendency
to blame themselves for reducing their ties with God, which means becoming a bad person.
As a result, the symptoms of some patients may have become more severe. The researchers
stress that some patients, despite restrictions in performing rituals, used CDs, for example,
to listen to the Word of God.
However, it should also be remembered that religion may also harm the recovery
process. ‘Guidelines for living’ point out that in religion patients found advice on how
to cope with life difficulties and how to be a better person. For example, helping others
reassured them to believe they were helpful to society. However, some participants noted
that such top-down advice may give rise to increased guilt and return to health being more
difficult. ‘Choice and control’ gives patients a sense of agility because they have a sense of
choice, that is, they can believe in what they want to believe, not what other people tell
them. The personal choice of patient’s beliefs was also important when returning to health.
In addition, the choice and control were very important for patients to return to their
health because, for example, they believed that God had shown them the way, although,
ultimately, they helped themselves. Others preferred to externalize control by being “in
a world where only God can help you”. However, some patients thought that only they
could help themselves through hard work.
‘Relating to others’ showed that religion can strengthen and also hamper ties with
others when a psychotic person returned to health. On one hand, patients noticed a sense
of belonging to the community, being accepted and helped with illness. On the other hand,
some patients felt that they had no acceptance from others. Some participants even feared
persecution due to their illness and lack of understanding (they were considered as ‘others’
and ‘strange’).
‘Enhancing psychological well-being’ highlighted three aspects: the sense of self-
esteem and belief in themselves, hope and purpose, and emotional well-being. Therefore,
in terms of self-esteem and self-belief, the respondents thought that religion helped them
accept themselves and stop criticizing themselves for the illness. They felt less stress about
the difficult experiences of health recovery and felt that religion helped them understand
that they are also unique and can achieve their full potential. In turn, in terms of ‘hope and
purpose’, it was observed that religion contributed to the development of the respondents,
i.e., they began to see themselves in a better light and create goals for the future. In turn,
‘emotional well-being’ translated into the perception of patients that religion has a soothing
effect on them. Even in difficult situations, faith was able to calm them down. Thanks to
religion, they were happier, and for some of them, religion had a cleansing effect. Through
confession, they were able to vent their feelings and God forgave them in return for the
prayers. Moreover, some patients stated that it was religion that saved them from self-harm
and even suicidal attempts.
‘Making sense of experiences’ reflects the patients’ feelings during the disease. Thus,
they considered the beginning of psychosis and a hospital stay as the time to explore
various explanations as to the reasons for their current life situation. They heard different
opinions from health professionals and religious authorities. At the end of the day, patients
experienced a lack of a clear-cut explanation. In the end, some turned to the Scriptures
Religions 2021, 12, 840 14 of 18

to seek religious explanations. However, others relied on medical staff to confirm the
explanation of the disease. In the absence of specific answers as to why they fell ill, the
recovery times was notably longer. The last conclusion relates to the variable nature of the
understanding. For some, religion allowed them to revalue their experiences, while others
benefited from the development of medical-based explanations.
Therefore, it seems that patients could benefit from the clinicians’ interest in non-
standard, in-depth ways of understanding experiences known as delusions or concentration
on religious practices, which at first sight appear ridiculous, absurd, and inadequate to
reality. Sikora (2019) rightly points out that the inclusion of religious beliefs in an interactive
model—and their association with emotions, behaviors, and often strong physiological
reactions of the organism—allow the understanding that a whole range of more complex
emotions can be experienced in connection with religious or spiritual thinking, but they
are still the same common, human emotions. Similarly, ‘behaviors related to religion’ will
include not only externally observable religious practices but also behaviors resulting
from moral or even aesthetic decisions. It is therefore not necessary to undermine the
patient’s convictions, going beyond the religious system to which they admit. However, it
is worth making efforts to learn the religious tradition of patients and to be able to speak
with them in their language. This will not be possible without at least a basic, unbiased
knowledge of at least the main religious doctrines and openness to the diversity of beliefs
and experiences in the field of religion/spirituality. Even this early analysis indicates
that a psychotherapist determined to include and actively involve the patient’s religious
beliefs in the treatment process is facing an extremely difficult task both from a substantive
and ethical point of view (Sikora 2019). It is therefore noted that the diagnosticians and
psychotherapists should broaden their knowledge, self-awareness, own convictions or
emotional disposition regarding religious traditions and doctrines, rituals, and experiences
valued in the community concerned.
In the case of patients with schizophrenia, religion can become both a protective factor
and a risk factor, which is an important aspect when planning the treatment. As already
mentioned, for many patients, religion plays a central role in the processes of reconstructing
a sense of self and recovery. For psychotic patients, however, religion may become both
an element of the problem and part of the recovery. This should be taken into account
in the treatment process. Religion may help to reduce pathology, enhance coping, and
foster recovery. The treatment should incorporate respect for diversity and restriction
of persuasion. Longitudinal research among psychotic patients on the effectiveness of
treatment that took into account their religious involvement shows diverse therapeutic
effects (Mohr 2006). The use of religion can help or significantly hinder recovery. For
persons active in a religious community, religion can also be a highly valuable tool to cope
with the disorder (Helman 2018).
A specific pattern of relationship between psychotic disorder and religion can be
elicited. Spiritual or religious involvement can lead to violent behavior and refusal of
treatment, but also helpful psychiatric care and strategies for coping with the illness
(Mohr and Huguelet 2004). Research suggests that reconstruction of a functional sense
despite persisting dysfunction plays a central role in the recovery from mental disorders
(Davidson and Strauss 1995). Spirituality and religion may play a central role in many
patients’ lives thanks to religious symbols that integrate Self and the sense of being (Corin
1998). Religion provides some patients with identification models which, with the active
support of the religious community, can facilitate recovery (Holm and Järvinen 1996). It
is difficult to differentiate if a religious experience is genuine to the spiritual person, or
if it is a positive symptom of the illness (Koenig 2007). However, this exploration of the
relationships between religion and schizophrenia leads from pathology and coping with
illness to the necessity of taking into account spirituality when caring for people suffering
from schizophrenia. It is entirely possible to combine religion with professional therapeutic
measures and medication to meet the desired goal. While undergoing psychiatric treatment,
those who were religiously involved and spiritual daily reported fewer symptoms and
Religions 2021, 12, 840 15 of 18

a better quality of life. They came to see their religion as a source of hope rather than a
tormenting reality (Mohr and Huguelet 2004).

7. Conclusions
In the article, the authors addressed the role and significance of religion/spirituality
in the development of mental health, recovery and etiology, pathomechanisms, and psy-
chotherapy of disorders on the example of schizophrenia. Although research examining
religion, spirituality, and mental health generally indicate positive associations, there are
also potentially negative aspects. The increasing number of theoretical analyses and clinical
trials on the pathogenesis of schizophrenia paradoxically contributed to the understand-
ing of the significance of religion in salutogenesis. This resulted in a modification of the
perception of religion by professionals, including psychologists or doctors, when assisting
schizophrenia patients in their recovery. In addition, the recognition of the religious and
spiritual needs of patients is proving to have a significant impact on the effectiveness
of cooperation.

Author Contributions: Conceptualization, B.P.-W., I.G.; formal analysis, B.P.-W., I.G.; investigation,
B.P.-W., I.G.; resources, B.P.-W., I.G. and M.W.; data curation, B.P.-W., I.G. and M.W.; writing—
original draft preparation, B.P.-W., I.G. and M.W.; writing—review and editing, B.P.-W., I.G. and
M.W.; supervision, B.P.-W., I.G. All authors have read and agreed to the published version of
the manuscript.
Funding: This research received no external funding.
Conflicts of Interest: The authors declare no conflict of interest.

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