In a psych unit setting - where do you draw the line between religion and delusion?

I'm a student nurse, who is currently having clinical experience in a psychiatric unit in a hospital. I thought psych nursing was something that I would love, but I'm really having a hard time figuring out the lines with mental illness and religious belief. There was a schizophrenic patient, recovering from an episode of psychosis, who stated that “God talked to him
every night.” To me, that’s a red flag, but when I reported it to the nurses
and therapists on the unit, they just stated that the patient was “spiritually
well connected.”


So, I’m confused. I'd like to ask other people in the
medical field their feelings about the line between religion and delusion, and maybe
some insight on how to appropriately deal with it.

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This is a hard one to deal with. Working in the emergency room, I see many schizophrenic patients who are, of course, extremely religious. I find it funny that schizophrenia and hyper religion go hand in hand. When I was a new nurse I had a hard time with this as well. I even asked a more seasoned nurse why she thought these patients were so hyper religious and she told me that she believed they were possessed. After that most ludicrous answer, I didn't ask anymore. My bit of advice is just to document what you see and hear, no bias or judgment should be placed in the documentation. For this particular patient, you could ask him about his nightly experiences with god. Does he describe more of a nightly prayer, is god's voice in his head telling him to do certain things. Further assessment of his statement should help you figure out if he is having an episode or if he is just having what most xtians would consider a normal interaction. Hope this helps.
You are right. There are an aweful lot of mentally ill folks who incorporate religiousity into their pathology.

I think all religious peopole are delusional, but the DSM would exclude "normal" religious beliefs from pathology as abnormal behavior is defined by culture.
Maybe that will change one day. After all, homosexuality used to be listed in the DSM.
I do think that religion is just another delusion, but I don't think that a psych hospital is good place to let that opinion be known. If there's an extremely nervous patient who feels better when she prays (if she's not delusional) I'll encourage her to pray to relax. Their hospital stay is about getting them well enough to be independent again, it's not about being 100% rational. You're not going to cure a patient of all of their strange thoughts, much less their religious ones. You've got to pick your battles.

It's possible, that with that particular patient, those nurses just happened to know his baseline. Maybe he's always that way... With the repeat admits you get to know them pretty well - he might be overly religious all the time even when he functions well otherwise. The nurses I work with, even the really conservative, religious ones, seem to realize that most patients can't handle religious conversation without disturbing others or feeding into other delusions. Most of them seem to know how to put common sense ahead of their own beliefs. The nurses you were with are probably smart enough to realize this. Give them another chance. :)

Of course, There are times when religious beliefs actively harm the patient. Like, we have a lady with leg pain from a surgery who interprets it as devils biting her legs. She'll sit there and yell about devils instead of doing her physical therapy or asking for pain medication. It this case I would definitely say "Jane (fake name), I think your legs hurts because of you hip surgery. I don't see any devils. Why don't we walk around the day room a few times and see if you stop seeing those devils." Or something like that...

In general, we do try to play down the religion as much as we can though. If you don't you get people who think they're Jesus running around preaching, two of the women start fighting over the unit's Bible, and there's this one lady who starts yelling "Fuck you, holy ghost!" which really seems to upset the other residents, lol.

If they are speaking/praying loudly to god/jesus/etc in front of other patients. I always tell them, "He can hear you just as well inside your head as he can when you say it out loud. Try not to disturb the others. Thank you." (Of course no one is hearing anything, but the patients don't know I think that if I word it that way.)

So in general, treat it like any other delusion. Don't contradict it directly unless you absolutely have to, but don't let it disturb anyone else either. There are a lot of discussion on about supporting patients' religion without being sucked in yourself that might help you with the non-delusional patients. Good luck and try not to think too badly of those nurses - psych nursing is definitely not easy.
I'm not a medical professional, but I'll offer that any adult who talks to or puts their imaginary friends at the center of their life isn't what I'd call a picture of mental health. Doesn't matter if they are in a lockdown ward somewhere or living it up in the Vatican. Same same.
Stacey, I'm not a medical professional, but I sympathize. That has to be a fine line to walk, with your patients, their families, and your coworkers. Your private opinion is most likely not going to line up with your public comments from time to time.

I usually think of religion as delusion, and the more pious, the more deluded. On the other hand, it seems to me that a lot of religous people are not so much delusional as they are duped, by others, but also by themselves. Everybody they know says there's a god who talks to them, so what the hell? Maybe they just mistake that little voice of conscience that everybody hears for god. I'm not sure I'd put being thoroughly mistaken or deceived in the same category as delusion or mental illness. But there's definitely a point where that line is crossed, where talking to yourself becomes hallucination. I guess it's a matter of whether they listen more to the inner voices or to voices that everybody else can hear.




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