What Is the Role of Religion in Psychiatry and Psychotherapy?

For much of modern psychiatry’s history, religion has been treated as a private matter, a background belief, or a regressive force to be overcome. Yet in most parts of the world, religious narratives and rituals are the primary ways people explain distress, seek help, and imagine recovery.

In an editorial in Transcultural Psychiatry, cultural psychiatrists G. Eric Jarvis and Laurence J. Kirmayer address the relevance of religion to mental health care. Their article introduces a special issue devoted to the role of religion and spirituality in mental health across diverse settings, from ultra-Orthodox Jewish communities to Christian healing practices in Sierra Leone and Spiritist mediumship in Brazil.

“The significance of religion in any given situation depends on attributed existential meaning, cultural concepts of the person, and social context. There is a need for research to unpack the many dimensions of religious experience and practice that can contribute to mental health and coping as well as to predicaments that lead to seeking help. Clinicians need greater familiarity with the range of religious traditions to better understand their patients and to work in concert with faith communities to promote recovery and wellbeing,” they write.

“Integrating religious competence, safety and humility into clinical training and practice is an especially urgent agenda for cultural psychiatry at a time when basic efforts to respect equity, diversity and inclusion are under attack from reactionary politicians.”

Jarvis and Kirmayer, both based at McGill University’s Division of Social and Transcultural Psychiatry, argue that religion is not a marginal cultural factor that clinicians might or might not ask about, but is “central to the theory and practice of cultural psychiatry.” Religion, they note, shapes identity, offers models for understanding affliction, organizes communities, and mediates broader social determinants of health such as discrimination and exclusion.

The special issue gathers empirical and conceptual papers that explore this terrain. Some describe how religious practices buffer despair, including self-transcendence through relationships with ancestors in India, China, and the United States, or Sufi music as a form of therapy for Turkish Muslims in the United Kingdom. Others document how religious communities frame mental distress as spiritual failure, stigmatize those who struggle, or become targets of discrimination themselves. Taken together, the collection shows that faith and spirituality are woven into the fabric of distress, resilience, and care.

Jarvis and Kirmayer review decades of epidemiological research showing that religious affiliation and practice often correlate with lower rates of depression, suicide, and substance use, as well as higher levels of well-being and marital stability. At the same time, they highlight studies on spiritual crises, adverse meditation experiences, and religious communities that impede access to care or intensify shame.

Conceptually, they distinguish religion, spirituality, and secular moral visions. Religion typically involves institutions, shared beliefs, and communal practices. Spirituality emphasizes a personal relationship to what is taken as transcendent, and in contemporary societies often circulates beyond formal institutions. Secular moral projects, such as commitments to social or ecological justice, can function in similar ways, providing overarching systems of meaning even for those who reject religion as such.

The editorial then walks readers through the special issue paper by paper. The studies include online surveys of spiritual and religious experiences in Brazil, qualitative work on evangelical Christian communities in the UK, ethnography of reincarnation stories in the Druze community of Israel, intervention research on Sufi music therapy, and analyses of blended biomedical and religious healing in Sierra Leone. Together, these pieces map how religion is entangled with mental health systems worldwide.

Religion as Meaning, Belonging, and Protection

Jarvis and Kirmayer emphasize that for many people, religions respond to basic human questions about suffering, death, limitation, and injustice. They offer narratives that locate distress within a larger story, moral guidelines for living, and communal practices that can foster solidarity and hope.

Several studies in the special issue show how this can protect mental health. A survey of more than 1,000 adults in Brazil found that 92 percent reported at least one spiritual or religious experience in their lifetime, including feeling the presence of the dead or receiving messages in dreams. These experiences, far from being automatically pathologized, were often woven into ordinary life in a context where belief in spirits is common, and Spiritist traditions influence both everyday practices and psychiatric theory.

Another paper, by Choi and colleagues, examines “self-transcendence” in India, China, and the United States. Self-transcendence is described as a way of experiencing the self as part of a larger fabric of life, rather than as an isolated individual, and is linked to lower depression and anxiety.

In India and the United States, higher levels of self-transcendence and a perceived relationship with ancestors were associated with fewer symptoms of anxiety and depression. In China, where public religious expression has been discouraged, the picture was more complicated. Only those who reported a felt relationship with ancestors showed the same protective pattern. Here, religious experience appears to buffer distress in some contexts and increase risk in others, depending on local norms and state policies.

A case study from Brazil followed bereaved parents who seek a Spiritist medium to communicate with their deceased son. The editorial notes that the family “draw comfort from the medium’s apparent ability to obtain information about the deceased that they could not have learned by conventional means,” which they take as evidence of authentic contact and a source of hope. Whether one accepts this ontology or not, the case illustrates how spiritual practices can structure mourning and make unbearable loss more survivable.

When Religion Hurts

The editors insist that religion cannot be romanticized.

“Negative experiences with religious practices” are common, they write, and some people find religious communities “problematic or even toxic to their well-being.

Lloyd and Hutchinson’s qualitative study of evangelical Christian communities in the UK offers one example. Participants described how mental distress was often framed as evidence of spiritual weakness or sin, with prayer and pastoral counseling positioned as the only acceptable forms of help. When symptoms persisted, some felt blamed for their lack of faith or ostracized for seeking secular mental health care.

Other harms come from outside religious communities. A study of Jewish migrants from the former Soviet Union in Germany and Austria found that experiences of xenophobia and antisemitism were tied to poorer mental health. Discrimination, in other words, becomes part of the religious landscape that shapes distress.

Jarvis and Kirmayer also point to dangers linked to certain spiritual practices, such as intensive meditation without adequate guidance, which can trigger severe anxiety, dissociation, or psychotic-like experiences.

Working with Faith in Clinical Settings

The editorial argues that attending to religion and spirituality should be part of any good cultural formulation and person-centered care. That includes taking a religious history, asking how faith and community shape the person’s understanding of their difficulties, and exploring which practices feel supportive or burdensome.

Several papers in the special issue examine how clinicians and health systems are already trying to do this. Bloch and colleagues interview psychiatrists who work with ultra-Orthodox Jewish communities. These clinicians described adjusting hospital routines, collaborating with rabbinic authorities, and disclosing more of their own beliefs than usual in order to build trust.

In Portugal, Marques describes the rise of “spiritual and religious assistance” within public hospitals. Rather than simply providing traditional Catholic chaplaincy, these services bring together leaders from multiple faiths to offer spiritual accompaniment, assess spiritual needs, and refer people to appropriate religious resources. The aim is not to impose doctrine but to listen, support, and help transform emotions such as guilt and fear.

In Sierra Leone, where trained mental health professionals are scarce, Matakas and colleagues describe a blended system in which caregivers of children with mental illness move between churches, traditional healers, and psychiatric clinics. Many caregivers trust Christian pastors but are wary of non-Christian healers, whom they view as expensive or dangerous. Mental health staff, in turn, recognize that religious healing plays a central role in people’s lives but worry about competition and conflicting explanations.

Humility, Safety, and the Politics of Religion

Jarvis and Kirmayer situate these cases in a longer history. They recall how psychiatry’s alliance with science made religious explanations seem suspect, and how Freud and later theorists portrayed religion as a regression to infantile dependence. At the same time, they recount episodes in which religious institutions have been vehicles of oppression, including the use of Christian boarding schools to destroy Indigenous cultures in Canada, a policy the Truth and Reconciliation Commission later described as “cultural genocide.”

For the editors, this history means that there can be no simple celebration of religion. They point to a record of religiously justified violence and exclusion and warn that this “should caution us against simplistic views of the impact of religion or any blanket endorsement of religious institutions.” At the same time, they insist that religious communities are often key sites of moral imagination, mutual aid, and resistance to injustice.

To navigate this complexity, they call for what they term religious “competence, safety and humility.” This includes basic knowledge of local religious traditions, skills for building trust with people from diverse faith backgrounds, and openness to ontologies that may unsettle secular assumptions. It also requires attention to structural discrimination against religious minorities and to the ways mental health systems themselves can silence or pathologize religious meanings.

This argument challenges dominant biomedical models in several ways. First, it widens the lens of what counts as a “treatment,” including rituals, songs, pilgrimages, and ancestor relationships alongside medications and psychotherapy. Second, it reframes symptom change as only one dimension of healing. A bereaved parent may still feel waves of sadness yet experience their grief differently when held within a spiritual community or a cosmology in which the dead remain present. Third, it raises ethical questions about how mental health professionals engage with religious worlds that may themselves be sites of inequality, violence, or exclusion.

The questions raised in this special issue sit inside a much larger conversation about language, culture, spirituality, and mental health. Kirmayer has previously traced “the poetics and politics of our mental health metaphors,” illustrating how diagnostic idioms such as “chemical imbalance” or “trauma” can organize experience, redirect attention away from structural injustice, and narrow the range of imaginable futures. He argued that metaphors are central to how symptoms and suffering come to be understood by both clinicians and the people who seek help.

Following this framework, recent scholarship has argued for bringing Indigenous knowledge and healing traditions into direct conversation with psychology.

Similarly, mad-studies approaches have integrated religious and theological resources to articulate the borderlands between mystical experience and what psychiatry calls psychosis.

In their conclusion, Jarvis and Kirmayer note that some people seek “freedom from religion,” especially when religious institutions have been sources of trauma or control. Many more, however, look for ways to practice their traditions while navigating illness, loss, and injustice. For both groups, the meaning of religion in any given situation “depends on attributed existential meaning, cultural concepts of the person, and social context.”

At a time when efforts toward equity and inclusion are themselves under attack, they conclude, integrating these forms of humility into psychiatric training is “an especially urgent agenda for cultural psychiatry.”

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Jarvis, G. E., & Kirmayer, L. J. (2025). Religion and spirituality in cultural psychiatry. Transcultural Psychiatry, 62(4), 413–421. https://doi.org/10.1177/13634615251367860