When evaluating suicidal patients, it is often indicated to ask them about their religious beliefs about suicide because many patients believe that their spiritual or religious beliefs1 are closely linked to their mental health (Yamada et al., 2020). For example, some patients in significant emotional distress say they would not kill themselves because their religion strongly condemns it. For them, religion includes a life-protecting belief that prohibits them from attempting suicide.
Nonetheless, the relationship between religion, spirituality, and suicide goes deeper than just prohibitions against suicide. Instead, religious and spiritual beliefs influence how people care for themselves, interact with others, think about themselves, and interpret their life histories. For example, some people have religious or spiritual beliefs that command them to live their lives productively, express their talents and abilities, and show love for others while experiencing joy. For them, religion includes life-promoting beliefs that encourage them to flourish and thrive.
The goals for treating suicidal patients are to keep them alive and to help them create lives worth living. While life-protecting beliefs may help keep many patients alive (at least temporarily), life-promoting beliefs help keep patients alive and also help them to create lives worth living. This article suggests ways psychologists can encourage life-promoting beliefs when working with suicidal patients.
Religious and Spiritual Beliefs
When treating suicidal patients, it may be clinically indicated to ask them about their religious or spiritual beliefs and the relationship of those beliefs to their suicidal thoughts. Of course, some patients may not see religion or spirituality as relevant to their problems, and others may not wish to discuss their beliefs. Nonetheless, many patients see a relationship between their beliefs and their suicidal behavior (Lusk et al., 2018) and want to talk about them.
If patients are interested and if religious or spiritual beliefs appear related to the clinical issues being discussed, then psychologists can ask their patients about the nature of their religious or spiritual beliefs, their religious affiliation and their involvement with religious activities, the role that religion or spirituality plays in their lives, including their day-to-day thoughts and interpretations of events, any changes in their religious activities or beliefs over time, and what, if any, circumstances led to those changes, how religion has helped or harmed them during periods of stress (Alonzo & Gearing, 2021), what link, if any, between religious or spiritual beliefs and their emotional wellbeing, including their moods, their beliefs about suicide, and their beliefs about religion and their personal well-being. During these conversations, psychologists should remember that beliefs are not a lump. Instead, religious and spiritual beliefs can be fluid, nuanced, unique, and multidetermined.
Beliefs May Be Fluid
The salience of religious and spiritual beliefs can wax and wane depending on the circumstances. Similarly, the desire to kill oneself may wax and wane as well. Patients may say they would not try to kill themselves because doing so would violate a sincerely held religious belief. However, under stress, the influence of that belief may wane, and suicidal urges may become more salient. Although religious and spiritual beliefs often deter many patients from attempting suicide, they do not necessarily veto the option of suicide for all patients, at all times, or under all circumstances.
Beliefs May Be Nuanced
Although religions may have certain beliefs that they consider orthodox, few are ideological monoliths, and most have some wiggle room in their belief systems. For example, evangelical Christianity may look like a conservative monolith to outsiders. Although evangelical or “born again” Christians tend to be more conservative, many have adopted moderate or liberal positions on social justice issues, political affiliations, or relationships with non-Christians (Lancaster et al., 2021).
As it applies to suicidal thoughts, some patients have religious beliefs that condemn suicidal behavior but find passive suicidal thoughts more acceptable (e.g., “I wish the Lord would just take me away”). That is, they do not plan to attempt suicide but nonetheless would prefer to die. Nonetheless, passive suicidal thoughts are a risk factor for developing active suicidal thoughts, and over time people with passive suicidal thoughts have high rates of suicide attempts. This points to the importance of distinguishing between life-protecting and life-promoting beliefs. Life-promoting beliefs not only discourage suicide, but they can also urge patients to promote their well-being and address the life conditions or psychological vulnerabilities that lead them to wish to die.
Beliefs May Be Individually Unique and Multidetermined
Psychologists should attend closely to what their patients say about their religion or spiritual beliefs and should not be overly influenced by denominational labels or general descriptors. Life circumstances and experiences influence people’s thoughts about religion and spirituality beyond denominational doctrine. For example, no two Christians are alike in all ways. Psychologists should not assume that they and their patients share the same beliefs only because they belong to the same religion. Brief descriptors of one’s religious affiliation or spiritual inclinations may mask essential differences in the impact of these beliefs on one’s life.
For example, many people are influenced by more than one faith tradition. These influences may be concurrent or consecutive. For example, some Latinx patients may identify with the Christian tradition but nonetheless be influenced by Santeria or Espiritismo (Baez & Hernandez, 2001). Although they do not usually practice the rituals associated with those traditions, they may visit a Santeria or a Spiritualist when under extreme stress. Other people may have consecutive religious traditions wherein their previous religious tradition still influences their current beliefs and behavior.
Addressing Beliefs in Psychotherapy
Religious affiliation and participation are usually correlated with lower rates of suicidal behavior, at least in Western countries with religious homogeneity (Wu et al., 2015). However, even in Western cultures, these beliefs or affiliations are not life-protecting for everyone under all circumstances. At times, psychologists may be able to activate the life-promoting dimensions of religion or spirituality to reduce the risk of suicide and help their patients create lives worth living. At other times, psychologists may need to help patients to address harmful religious or spiritual beliefs that reinforce psychopathology, self-hatred, and thoughts of suicide.
When Religion Is Life-Promoting
Although psychologists can welcome their patients’ life-protecting beliefs, they are insufficient to help patients create lives worth living. Some of the psychological vulnerabilities associated with suicidal thoughts are perfectionism, shame or excessive guilt, impulsivity, loneliness, perceived burdensomeness (a sense that one is a burden to others), or a feeling of entrapment (a belief that one’s pain is unbearable and that there is no end to it). These can be addressed through religious or spiritual beliefs that promote self-compassion, self-forgiveness, connections with others, hope, and a conviction that every person in God’s creation has value. Although some psychologists may not believe in God or may believe in a God who is distant and uninvolved in human lives, their role is to work through their patients’ belief systems, not their own.
If patients are interested, psychologists can reference religious scriptures or doctrines to reinforce life-promoting beliefs. When patients are distressed, psychologists may encourage them to engage in the religious or spiritual activities of their choice, such as praying, singing, engaging in religious meditations, attending religious services, or spending time with nature (Yamada et al., 2020). When patients encounter crises, they can engage in positive religious coping in which they see God as an ally who loves them and will assist them in dealing with life’s difficulties (Pargament, 2007). Finally, they can rely on fellow church members for assistance during times of stress.
When Religion is Toxic
Psychologists should keep an open mind about how religion has impacted their patients. Religion could harm patients if they believe that God has abandoned them or is deliberately punishing them for some misdeed or indiscretion in their past. They may also feel cut off from a supportive spiritual community. The lack of self-forgiveness is often associated with suicidal thoughts (Hall et al., 2020). This negative religious coping may lead to a sense of entrapment or perceived burdensomeness.
Psychologists may challenge harmful religious beliefs when it is necessary to ensure the health or safety of their patients. Even then, it is best done with curious and supportive questions and gentle probes as part of a respectful confrontation (Johnson, 2016). Discussions will be more profitable if psychologists remember that religious or spiritual beliefs are nuanced, fluid, and multi-determined. Psychologists can ask their patients about their religious or spiritual lives and listen carefully to their stories and interpretations and try to understand how their beliefs and life circumstances led them to consider suicide as an option. While acknowledging positive elements in their patients’ beliefs whenever possible, psychologists can also help them look for harmful idiosyncrasies in their beliefs or scriptural interpretations and help patients identify a linkage between their beliefs and their psychological distress.
Finally, psychologists may encounter patients who have experienced religion-related traumas or have been rejected by their religious communities because of interpersonal clashes, differences in their beliefs, or their sexual orientation. Although religious and spiritual beliefs can be crucial in promoting well-being and warding off suicidal thoughts, it is possible that the sense of social support from a religious community may be as important, or even more important, than the content of the beliefs themselves. Therefore, psychologists must take rejection from a religious community very seriously, as it may represent a significant trauma or disruption in a patient’s social network. They may need to help their patients process these experiences and find new sources of social support.
Other Considerations When Addressing Religion and Spirituality
Religion is an aspect of culture. Psychologists need to show cultural humility and accept the role of learners who are striving to understand the influence that religion has on the lives of their patients. They should have examined the potential for their own biases or blind spots to ensure that they do not act as either implicit evangelists or implicit cynics. Effective psychotherapists always prioritize the patient’s treatment goals and narrowly focus their discussion of religious or spiritual issues on those goals. While psychologists can encourage these religious activities, they need to ensure that they keep their appropriate roles. They are not there to answer religious questions, be a spiritual guide, or strengthen a person’s adherence to a religion. Instead, they may make referrals to appropriate spiritual or religious leaders when necessary (Vieten & Lukoff, 2022).
Religious or spiritual beliefs can be related to suicide insofar as they prohibit suicide or encourage patients to create lives worth living. Therefore, when discussing religious or spiritual beliefs with suicidal patients, psychologists should remember that:
- Religious or spiritual beliefs often, but not always, protect patients from suicide. and
- The content or salience of their religious or spiritual beliefs may be fluid, nuanced, unique, and multidetermined.
Psychologists can reinforce healthy beliefs among most patients but may need to gently challenge harmful beliefs among some other patients. The most effective psychologists:
- Are self-aware and take appropriate accommodations to control their biases.
- Recognize religion as an area of culture that requires cultural competence. and
- Understand and keep within their psychotherapeutic role.
Cite This Article
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