Spirituality and mental health.

How is spirituality relevant to mental health and to the busy practice of medicine? Until recently, a supplement devoted to this question wouid have been highly improbable— owing in part to Sigmund Freud's antireligious bias and to the subsequent focus of American psychiatry on the biologic aspects of mental illness. Consider briefly what has changed: Palliative medicine, which has long valued spiritual care and Alcoholics Anonymous, which views the Twelve Steps as a spiritual approach, have both grown over the last quarter century. Within psychiatry, object relations psychoanalysts such as William Meissner and Ana-Maria Rizzuto have revised Freud's interpretation ofthe dynamic significance of religious faith. Investigators such as David Larson and Harold Koenig have reported research, epidemiologic at first, on the associations between health outcomes and religiousness/spirituality. That literature has now grown to include studies of intrinsic versus extrinsic religiosity, and religious coping. Authors such as Richard Bergin and Allan Richards have published books with the American Psychological Association on various forms of spiritually oriented psychotherapy, including mindfulness. Educational programs in medical schools and residency training programs have proliferated, many supported by the John Tcmpleton Foundation. More recently, psychiatrists have called attention to the clinical importance of both the therapist's and the patient's worldviews.