Author: Dr. Malladi Srinivasa Sastry MBBS MRCPsych(UK)
Senior Consultant Psychiatrist, Arogyaraksha Beachfront Clinic, Visakhapatnam
Spirituality starts with sincere practice of self-awareness. This process of self-awareness, which in colloquial terms is often referred to as “listening to the heart” involves introspection and learning from life lessons, perceiving and being true to emotions, accepting and owning responsibility, making clear choices and do all these while being content and passionate about life. Spirituality teaches us to strive for progress within. The key is to understand and follow its universal principles. We become aware that we have no ownership of results and that material gain or loss is a mere by-product. While following principles of spirituality, we appreciate that we may go wrong in this human world but we will not go wrong in the cosmic or spiritual world.
In this paper we shall cover two main areas to understand the relation between spirituality and mental health. Firstly, I would like to propose that conceptually mental health should be a science with its foundation predominantly on subjective research and validation which we should not hesitate to accept as the core attribute and practice accordingly. Secondly, I would like to make a case for adding spirituality as the fourth domain, apart from the biological, psychological and social domains, to assess and manage patients with mental health problems. For now, the role of spirituality in psychotic disorders would not be discussed as the relation is lot more complex and therefore requires more understanding and research.
The field of mental health has come a long way in bringing in the acceptance of mental wellbeing as an essential aspect of health, in society. This has been achieved through evolution of the institutional model of care towards the community model of care, carrying out awareness campaigns to educate public about mental illnesses and treatment and, stamping out stigma towards mental illnesses. However, given that we are dealing with the functioning of mind there still remain certain conceptual challenges, particularly in the areas of science and philosophy. Unlike the other medical specialties, in mental health objective evidence does not apply in aetiology, pathology and investigations due to the subjective nature of mind and its illnesses. However, it applies well in the area of pharmacological and certain forms of psychological treatments as is witnessed through several research studies. In my observation, the field of mental health, as a branch of medical sciences, is predominantly focused on objective research, in which evidence has to be measurable or be proved. In the process we forget that its’ core feature is of subjective experience, of the patient and the clinician. However, if subjective experience and subjective research is its core feature, is the field of mental health still compatible with evidence based practice? The answer to this question is yes.
Let us look at how subjective research applies to mental health. If one person reports his findings from his mind and if the same or similar findings can be replicated by hundreds or thousands of other subjects then the chances of considering this as evidence is greater. Even then, it cannot be compared with objective findings. But then there is a problem with the reporting bias of each individual. Their expressions can be biased based on their own attitudes to life, cultural and religious beliefs too. In addition, the conscious mind has a tendency to reason and apply logic to all that the mind wishes to convey. The knowledge of who we really are as souls is so difficult for many of us to reach through our conscious minds1.
To overcome this it is better to access the subconscious mind to arrive at the truth we wish to find. Why is it that the subconscious mind is better than conscious mind with regards to the authenticity of the information? Through the subconscious mind the limitations of the logical mind are reduced and we are also able to access the vast reservoir of its memory. It is possible because the subconscious mind is conceptually understood to be not bound by time, logic and space2. This can be facilitated by deep meditative states as was the ancient method of subjective research or hypnosis as has been demonstrated by some modern psychiatrists and psychologists. Starting with the ancient Indian scriptures Vedas, followed by later Eastern texts, the invisible regions of astral planes have been experienced by people over thousands of years through meditative, out-of-body observations of the mind1.
As a scientific practitioner we should always strive to be true to science and at the same time embrace any new concepts through a scientific perspective. However, in the field of mind sciences it is perhaps never possible to develop an objective framework of research methodology to confirm findings related to mind. Hence, as stated previously, gathering larger sample size of subjective findings using standard methods of enquiry of the subconscious mind are required. Now, let us look at how science and spirituality are similar and different. They are similar in that both are forever evolving, explorative and research oriented. However the differences are as follows. Science is an outward exploration whereas spirituality is an inward exploration. Reality according to science is as validated by senses. Anything which is not validated by senses is unreal. However, according to spirituality, divine energy is the only reality which, as of now, is not measurable. By inference, according to spirituality, everything else is unreal. Here we can see the completely opposite view point of what is actually real. Hence, it can be argued that both methods of enquiry have to run parallel to each other to find meaningful answers to our eternal questions of “who we are and why we are here?”
Spiritual science has been discussed in detail from ancient times to contemporary times with remarkable consistencies in the independent enquiries of various proponents at different times and geographical settings. For instance, evidence from diverse fields of research, as well as a growing body of ethnographic and therapeutic accounts, strongly supports a historical trajectory in which reincarnation has become an increasingly believable possibility without dependency upon any specific religious convictions3.
Although well documented and replicated, yet it doesn’t find a place in mainstream mental health practice. In ancient east, spirituality was an integral part of health and education such as in the concepts of Ayurveda and Yoga. Yoga, a holistic intervention that treats mind and body, can lead to physical, cognitive and emotional improvement4. A typical example of “De-Spiritualization” is of Yoga. Devoid of spirituality, the way Yoga is practised in modern world is heavy on aesthetics, physical fitness and commodification. The process of de-spiritualization of education and health is unique to modern east. This came from the firm understanding that science requires objective evidence, and spirituality, which belongs to subjective science, doesn’t fit in. In addition, spirituality was tagged to religion. In modern times, it is not uncommon to see application of spiritual wisdom often without giving due credit to the original source of the knowledge. This is perhaps done to garner wider acceptance.
Several modern practitioners in the field of mental health in the various parts of the world have conducted thousands of hypnotic sessions as part of past life regression therapy and through their clients understood the essence of spirituality quite independent of any ancient findings. The striking similarity between the ancient and contemporary findings and our own individual realizations is testimony for the validity of spirituality.
It is essential to briefly describe what is meant by spirituality and its’ attributes. Spirituality can be defined as an individual’s search, within, to find the truth. Truth has to be understood as that one permanent reality in this cosmos which is unchanging. At this juncture, it is important to understand the opposite concepts, vidya and avidya4. Vidya, which is the knowledge of Truth, concludes that the unseen, unchanging immortal soul within us and at the cosmic level is real whereas the rest is unreal as all matter in this cosmos is perishable. There are several attributes to spirituality and if a word can be used to capture the essence we call it “divine”. It is all pervasive with no exception. As Bhagavad Gita5 says it can be seen in life forms as well as inanimate objects. All material is created from the same energy and this material goes through cycles of creation and destruction. It is an intelligent energy that is beyond our complete grasp. According to psychologist Michael Newton, souls can become rocks to capture the essence of density, trees for serenity, water for a flowing cohesiveness, butterflies for beauty and freedom and whales for power and immensity. Souls can also become amorphous without substance and totally integrate into a particular feeling, such as compassion, to sharpen their sensitivity1.
Every life form has the divine energy, within the body, that is qualitatively the same as cosmic energy but quantitatively a tiny speck. Human body is the material manifestation which is to be considered as a vehicle for this energy. How does this energy, which we call soul, even get embodied? What is the necessity for it to be trapped in the body? Is it by choice that the soul takes birth in human form or any other life form? Or is it out of compulsion that it has to go through the journey. While these questions are very important, it is understood that we take birth after birth as there are several lessons to learn and several issues to resolve in our eternal journey towards ultimate merger with the cosmic soul. Why does the human mind not realize that its’ real identity is with the soul it is carrying within? Wouldn’t it make our lives so easy to know which lessons to learn and which issues to resolve? The answer is that it is not possible as once we take birth in human form, and until we are released from it, we are constantly covered in a cosmic delusional wrap “Maya”4. This is perhaps considered essential as otherwise no soul would ever want to part with the cosmic soul or its presence. That we take rebirth is because of certain divine laws, which is beyond the scope of this paper. Brian Weiss referred to the concept of Maya with the observation “It was as if my mind, when not focused, tended to drift back into the old patterns, beliefs, and skepticism6.” Michael Newton explains Maya as leading to a built-in-amnesia about our soul identity which, on a conscious level, aids in the merging of the soul with human brain1.
The extension of spiritual attributes into psychological wellbeing is where I would like us to now focus. As stated above, a clear understanding that, I am that same universal energy but a tiny spark within this body brings in a paradigm shift and comfort at a cognitive level as it has the potential to expand our sense of belonging in this universe. In his book “Many Masters Many Lives” Psychiatrist Brian Weiss says “As I gradually accepted and believed the messages, my life became simpler and more satisfying. There was no need to play games, to pretend, to act out roles, or to be other than what I was. Relationships became more honest and direct6.” It is the individual’s journey to find meaning in life with the realization that I have come from this energy and will eventually merge in it.
The field of mental health has been conceptualized on the basis of bio-psycho-social model. The idea is to ensure that our care towards patients is centered on that particular individual and is provided with a comprehensive understanding called holistic care approach. Yet, despite that understanding, we often disregard spiritual awareness or orientation of that particular individual. Reasons for this disparity can be manifold. The concern is that science and spirituality are incompatible, that spirituality is a pseudoscience, and that religious dogma may seep in. Some of these are indeed valid concerns and have to be addressed sincerely. As discussed above, a shift in focus towards subjective science gives us an excellent opportunity to include and explore subjective studies on mind. Regarding whether spirituality is a pseudoscience, well one can argue that the foundations of psychotherapies in modern mental health practice are based on theories proposed by individual experts in that field at that time. Even without actual replication or validation using subjective research methodology they are taught and practiced in mainstream mental healthcare mainly based on their utility. Interestingly, spiritual concepts have the advantage of consistency across not just time but geographical locations as well. Instead of one proponent there are several proponents describing almost the same findings with universal applicability. Spiritual practices foster an awareness that serves to identify and promote values such as creativity, patience, perseverance, honesty, kindness, compassion, wisdom, equanimity, hope and joy, all of which support good healthcare practice8.
Beyond that, spiritual concepts can be healing in nature once understood at cognitive level and applied in daily life. In addition, it can be learnt by self or be guided. The best benefit is obtained by self-exploration and discovery. We should also be deeply concerned with the possibility of a future scientific discovery that the concepts of spirituality and its benefits are indeed true. Until such time, do we then risk denying the majority population of its rightful connection with their inner self? Would we also be contributing to significant and perhaps irreversible damage to the process of human evolution towards realization of universal consciousness or cosmic knowledge? In current times, despite the lack of endorsement for spirituality in mainstream education and medical space, a significant proportion of world population from all backgrounds continues to explore spirituality for their spiritual growth and wellbeing. Mental health practitioners are not trained or equipped to incorporate this domain into assessment and management. Patients themselves may have limited understanding as they have not explored this with anyone in confidence. This is resulting in loss of opportunities to have a therapeutic or healing experience in formal mental healthcare services. As a result, they may continue to seek help through other informal spiritual systems such as faith healers and various other pathways.
In conclusion, just as we are able to accept the subjective space of mind and accept subjective reporting of thoughts and emotions, should we therefore include the subjective spiritual awareness, insights and experiences as the 4th domain of mental health assessment and management to truly value the concepts of “holistic” and “patient centred care”? Patients are the beneficiaries as they develop an understanding of concepts of spirituality with the therapist guiding him or her. If they already have spiritual awareness this can be utilized in therapy to resolve their problems. The therapeutic benefit, feasibility, acceptance rates and therapists attitudes need to be continuously researched to be part of mainstream mental healthcare practice. The indications so far are encouraging.
1. Newton, M. (1994). Journey of Souls. Jaico Publishing House, India.
2. Weiss, B. (1998). Through time into healing. Piatkus.
3. Irwin, L. (2017). Reincarnation in America: A Brief Historical Overview. Religions.
4. Schmid, AA, Puymbroeck. MV. (2018). Yoga therapy for stroke. Jessica Kingsley Publishers.
5. Subramaniam, K. (1979). Srimad Bhagavatam. Bharatiya Vidya Bhavan.
6. Srimad Bhagavad Gita. (1997). Gita Press, Gorakhpur.
7. Weiss, B. (1994). Many Masters Many Lives. Piatkus.
8. Chaudhary, HR. (2008). Psychiatric care in Asia: spirituality and religious connotations. International review of psychiatry.