Holy Apparition or Hyper-Religiosity: Prevalence of Explanatory Models for Religious and Spiritual Experiences in Patients with Bipolar Disorder and Their Associations with Religiousness

Abstract

One point that emerges from qualitative research on religion and bipolar disorder (BD) is the problem patients with BD experience in distinguishing between genuine religious experiences and hyper-religiosity. However, clinical practice does not obviously address communication about differences in explanatory models for illness experiences. The aim of the current study is first to estimate the frequencies of different types of explanations (medical versus religious) for experiences perceived as religious and related to BD, second to explore how these types relate to diagnosis and religiousness, and third to explore the frequency of expectation of treatment for religiosity. In total, 196 adult patients at a specialist outpatient center for BD in the Netherlands completed a questionnaire consisting of seven types of explanations for religious experiences and several items on religiousness. Of the participants who had had religious experiences (66%), 46% viewed the experiences as 'part of spiritual development' and 42% as 'both spiritual and pathological,' 31% reported 'keeping distance from such experiences,' and 15% viewed them as 'only pathological.' Measures of religiousness were positively associated with 'part of spiritual development' and negatively associated with 'keeping distance from the experiences' and 'only pathological.' Half of the sample viewed religiosity as an important topic in treatment. It can be hypothesized that strength of religiousness may help people to integrate destabilizing experiences related to BD into their spiritual development. However, the ambiguity of strong religious involvement in BD necessitates careful exploration of the subject in clinical practice.

Religious or Spiritual Experiences and Bipolar Disorder: A Case Study from the Perspective of Dialogical Self Theory

“…DST proved to be a helpful instrument in gaining more insight into the religious and medically informed voices of a person who has religious or spiritual experiences and is diagnosed with BD. The 'both religious and pathological' explanatory model for religious experiences of people with BD, that came to the fore in former qualitative and quantitative research (Larsen 2004;Ouwehand et al 2019bOuwehand et al , 2020, appeared to consist, in this case, of a rich and changing variety of I-positions. DST analysis showed the nuanced relations and coalitions between I-positions, the influence of mood elation on I-positions and the transitions in Peter's position repertoire, owing to a continuous religious reflective process.…”

“…Addressing the (religious) content of manic or psychotic experiences regularly happens in clinical practice, but is not included in the guidelines for standard treatment. In a specialized outpatient department for BD, almost half of the patients with religious experiences had shared these with a mental health professional (Ouwehand et al 2020). However, in other studies, patients report that their religious needs are not being sufficiently met (Ouwehand et al 2019b;Van Nieuw Amerongen-Meeuse et al 2020).…”

“…Some qualitative studies in Western societies show, however, that medical and personal (religious or spiritual) explanations for illness experiences are often intertwined or co-exist for the person concerned (Larsen 2004;Marriott et al 2019;Ouwehand et al 2019bOuwehand et al , 2020. This is not surprising, because in most Western societies, mental health care is easily accessible.…”

“…DST takes a biographical, developmental perspective and, in a more specific way than Kleinman's theory of explanatory models, zooms in on the organizational and developmental processes of the self in relation to the external environment. Religious explanatory models appear to be relevant for persons with bipolar disorder (Ouwehand et al 2019b(Ouwehand et al , 2020, but data on the detailed interpretation process of religious experiences over time within those individuals and on the role of the disorder is in this process, are scarce, and could be clarified by Hermans' theory. In this article, we will therefore explore the interpretation process of religious experiences over the years in a single case, from the perspective of DST.…”

“…According to a quantitative study in the Netherlands, more than half of the patients in an outpatient department for BD who had such experiences wished to address them in treatment (Ouwehand et al 2020). Although recently more attention is being paid to spiritual narratives in psychiatric practice (Cook et al 2016), research indicates that patients do not always feel that their quest for meaning is being adequately met in treatment (Ouwehand et al 2019b;Van Nieuw Amerongen-Meeuse et al 2018).…”