On My Mind: Psychiatry and spirituality


At least once a month, as part of the MV Times ongoing Mental Illness series, Dr. Charles Silberstein will write a column that directly addresses issues Islanders have with mental health. Dr. Silberstein is a psychiatrist at Martha’s Vineyard Hospital.

A study by the American Psychiatric Association in the 1990s found that while 90 percent of Americans believe in God, only 43 percent of psychiatrists do. For most of my life, I would have counted myself among the 57 percent of psychiatrists who are atheists. And so, though I always considered religious affiliation an important factor in any psychiatric assessment, I didn’t think of an individual’s spiritual and religious beliefs as central. My training was steeped in a culture that viewed religion as neurotic, or even delusional. But my orientation has changed.

A career in psychiatry has taught me that people who pray, meditate, and/or feel a strong sense of spirituality in their lives often do better physically and emotionally. There is good research to support this idea. People with religious beliefs and affiliations are less likely to be depressed and/or die after a variety of medical ailments ranging from hip fractures to strokes to open heart surgery. Spirituality and religion are also associated with a decreased risk of suicide. In my practice, I see the power of spiritual connection firsthand every day.

In the past, perhaps intuiting my resistance to the idea of God or higher power or spirituality, my patients rarely told me about their beliefs. But now, when I am doing an assessment, I ask about spiritual and religious beliefs, because I have noticed that spirituality is a powerful treatment for excessive worries, fear, interpersonal angst, blue moods, irritability, and all kinds of craving. When a person feels burdened by these feelings, an act as simple as walking outside and contemplating the light, trees, and sky, even for a few moments, can bring relief. It is good psychiatry and good psychotherapy to encourage a patient’s sense of connection with something greater than him or herself.

Sometimes when I suggest 12-step meetings such as Alcoholics Anonymous or Al-Anon to my patients, the response is, “I have tried it. I don’t believe in God, and that’s what AA is all about.” I get it. The word “God” can be off-putting, and for many people, it is associated with guilt, judgment, and/or irrational hocus-pocus. But when I ask the same people about whether they ever feel a sense of awe, they almost always tell me that they frequently feel awe in nature, and this is often one of the main reasons why they choose to live on Martha’s Vineyard. When they contemplate the beauty of a sunset, a brewing storm in the corner of a vast oceanic horizon, or the stars on a dark winter night, they feel amazement, often accompanied by a sense of peace and serenity. And curiously, some of the atheists in my practice turn out to be some of the most spiritual people I know.

As the New York Times recently pointed out in an article titled “An Upbeat Emotion That’s Surprisingly Good for You,” research demonstrates that awe can be a potent medicine. Merriam-Webster defines awe as “an emotion variously combining dread, veneration, and wonder that is inspired by authority or by the sacred or sublime.” Awe is the emotion that is catalyzed by a sense of higher power.

What I have learned in my practice is that a connection to God, nature, or another higher power enriches most of the lives I encounter. Depressed people who are seeking meaning and a reason for their existence, people who have overused drugs or alcohol to stave off bad feelings, people who have lost touch with reality and imagine conspiracies against them, all find relief, hope, meaning, and purpose when they feel a connection to forces greater than themselves.

Looking at oneself through a spiritual lens is similar to using a psychotherapeutic lens. In both processes, looking inward with a sense of guidance from a wise self or higher power can be comforting and help to put our problems and place in the world into perspective. Both lenses may make it easier to address the world with a sense of calm. From there, looking outward at our place in our communities or the larger universe can offer purpose and meaning.

Many people feel that they have a personal relationship with God or a higher power. While this is an idea that may be particularly hard for Western rationalists to accept, it is a concept that has the potential to be enormously useful in finding relief from psychic angst. My patients who feel that they have this personal relationship can turn to it and find relief from loneliness, fear, and other painful emotions.

People I know who have embraced a notion of God, higher power or spirituality — people who attend 12-step meetings, belong to a church, synagogue, or the Bodhi Path, practice yoga, or otherwise actively engage in activities that feel spiritual to them — seem to find pathways to contentment. Often, these grow out of a consequently enhanced sense of community, increased acceptance of self, or an internal drive to do good in the world. Any or all of these can lead to a comforting sense of empowerment — an antidote to feeling helpless, alone, and useless — and an increased ability to focus on the compassionate, calm, and courageous parts of ourselves while allowing our angry, envious and numb parts to take a back seat.

Twelve-step suggestions for those who want a more spiritual life but can’t tolerate the word “God” include substituting “good” for “God,” or identifying nature, the vastness of the universe, humanity, or a particular group of one’s fellows as one’s “higher power.”

Whatever the mechanism, it is clear that a sense of spirituality can powerfully enhance a person’s connectedness to others as well as to something greater than him- or herself, and be enormously healing.