Religious Hallucinations and Religious Delusions Text Notes

Religious Hallucinations and Religious Delusions among Older Adults in Treatment for Psychoses in the Netherlands

Abstract

  • Background: Religious delusions (RDs) are common in geriatric psychiatry, but their frequency and content are not well-known.
  • Objective: To examine the prevalence and content of religious hallucinations (RHs) and RDs, and their relation to diagnosis, denominational background, and other aspects of religiousness among older adults with psychoses.
  • Methods: Semi-structured diagnostic interviews were conducted with 155 inpatients and outpatients (mean age 76.5) at a geriatric psychiatry department in the Netherlands, using the Schedules for Clinical Assessment in Neuropsychiatry 2.1 (SCAN 2.1).
  • Results:
    • The prevalence of RHs was 19%, and RDs was 32%.
    • RHs were mostly auditory.
    • No significant difference in RH prevalence between schizophrenia (17.5%) and psychotic depression (9.4%).
    • RDs were significantly more prevalent in raised and current strict Protestants, especially those with psychotic depression, compared to non-affiliated patients and mainline Protestants.
    • RHs were more prevalent in Evangelical (e.g., Pentecostal) and strict Protestant patients.
    • The presence of RDs was associated with measures of religiousness (e.g., dogmatism, religious coping).
  • Conclusions: Religion acts as a symptom-formation factor for psychotic symptoms in strict Protestant older adults.
    • Detailed research may improve understanding of how strict religious beliefs affect psychotic symptom content and existential suffering.
    • Mental health professionals should recognize and address religious themes, especially in secular contexts like the Netherlands.
  • Keywords: religious hallucination; religious delusion; psychosis; schizophrenia; psychotic depression; old age; older adults; religiousness; religious coping

Introduction

  • Religious delusions (RDs) and religious hallucinations (RHs) are frequent and relevant features of psychosis, yet information about their prevalence, content, and relationship to affective vs. non-affective psychoses is scarce.
  • Cook (2015) noted the challenge of comparing studies on RDs and RHs due to the absence of precise criteria for definition and classification.
  • The prevalence of RDs and RHs varies across time, place, and individual religiousness.
  • Hallucinations can be a core symptom of schizophrenia, schizo-affective disorder, and affective psychoses (depression, mania).
  • Waters et al. (2014) found the mean prevalence of auditory hallucinations to be 59% (range 25–86%) and visual hallucinations to be 27% (range 4–65%) in schizophrenia inpatients and outpatients.
  • Variations likely due to sample types and measurement methods.
  • Auditory hallucinations are most common, followed by visual, somatic, and other hallucinations.
  • The expression of psychiatric symptomatology is likely to be influenced by cultural and religious beliefs.
  • Kent and Wahass (1996) discovered more religious themes in auditory hallucinations among schizophrenia patients in Saudi Arabia (33% and 53%) compared to the UK (6% and 11%).
  • Gecici et al. (2010) reported higher rates of RHs (6%) in central Turkey, where religion is central, compared to western Turkey (2%).
  • Atallah et al. (2001) described RH changes linked to the political and religious climate in Egypt; Muslim and Christian patients had same rates of RHs.
  • Ouwehand et al. (2019) reported prevalences of RHs and RDs also vary between episodes of a disorder
  • Religion and spirituality play a significant role in the lives of many individuals, even with a psychotic disorder.
  • Religious beliefs may have a supportive effect, but RDs and RHs can also reflect or provoke a sense of existential suffering.
  • Mental health professionals should recognize and address religious themes in the diagnostic and therapeutic dialogue to improve patient understanding and therapeutic relationships.
  • In the Netherlands, most older adults were raised in a religious tradition.
  • The study took place in the Dutch Bible Belt which includes mainstream and strict Protestants with reformed minorities, Roman Catholics, and Evangelicals.
  • Strict Protestant traditions include the dogmatic segment of Reformed Protestantism and