Spiritual Practices and Mental Health: Safety, Coercion and When to Seek Care

If you or someone else is in danger

In the United States, call or text 988 (the 988 Suicide & Crisis Lifeline) if you are in emotional distress or thinking about suicide, or call 911 or go to the nearest emergency room in a life-threatening situation. [1] The 988 Lifeline is described as available 24/7, free and confidential. [2] Outside the US, use your local emergency service. Faith and spiritual care can sit alongside this help, not instead of it.

Respect first

Faith, prayer and spiritual practice are sources of meaning, comfort and community for many people. Nothing here questions anyone's beliefs. This page is about a narrower safety question: when a spiritual explanation or practice stands between a person and care that could help, or when force is used. For the wider picture, see Prayer, faith and health and spiritual healing and medical treatment compared.

Spiritual life and mental health: what research shows

• A meta-analysis of 97 outcome studies (7,181 participants) found psychotherapy adapted to a client's religion or spirituality was as effective as standard approaches at reducing psychological distress and produced greater spiritual well-being. [3] Evidence label: promising.
• A review of 75 studies found religion and spirituality overall were associated with lower suicidality, but distressing dimensions such as religious struggles correlated with higher rates, and most studies were cross-sectional. [4] Association is not proof of cause.
• A JAMA review concluded spiritual care should be incorporated into care for people with serious illness. [5]

So belief can help, and spiritual struggle can be a warning sign worth telling a clinician or counselor about.

Experiences described as possession or spirits

Many cultures understand some distress as spirit possession. Researchers describe it as an idiom of distress. A Uganda study of 119 possessed patients found local symptoms such as changes in consciousness, shaking movements and speaking in a voice attributed to spirits that matched clinical criteria for possession trance disorder and dissociative identity disorder. [6] A review of 21 articles in 14 low- and middle-income countries found a strong relationship between trauma exposure and pathological possession states. [7] A review of dissociative trance notes real cultural variation and debate over cross-cultural validity. [8]

This is not saying that anyone's experience is "just" illness. It says that when someone suffers, loses function or is in danger, a clinical assessment can sit beside the family's spiritual understanding. Cultural sensitivity matters on both sides; see susto, mal de ojo and cultural illness concepts.

Documented harms of coercive or exclusive approaches

• Delays: A systematic review in Africa found about half of people seeking care for mental disorders chose traditional or religious healers first (26.2 percent religious healers, 17.0 percent traditional healers), and reports link this choice to delays in reaching formal services. [9]
• Exorcism in place of treatment: A published Spanish case describes a patient with diagnosed schizophrenia led to believe symptoms were demonic and who underwent multiple exorcisms, disrupting her response to clinical treatment. [10] It is one case, but it shows the pattern.
• Restraint and chains: Human Rights Watch reported people with mental health conditions chained or locked in confined spaces in about 60 countries, often by families who believe the cause is evil spirits or sin. It also reported people in religious healing centers being forced to fast. [11]
• Prayer camps: In interviews at nine Christian prayer camps in Ghana, staff reported frequent use of fasting and chained restraints, and biomedical providers were concerned by chains, fasting and living conditions. [12] In a randomized trial there, adding indicated psychiatric medication to usual prayer camp activities lowered symptom scores compared with camp activities alone. [13]

Physical force, isolation, withholding food or water, or pressuring someone to stop medication are not part of safe care in any tradition. If this is happening to someone, contact emergency services or local protection authorities.

Warning signs

• A leader says you must stop prescribed medicine, therapy or doctor visits.
• Distress is blamed on lack of faith, sin or curse in a way that increases shame or hopelessness.
• Anyone is restrained, confined, hit, deprived of food or sleep, or kept from leaving.
• A person is in danger from thoughts of self-harm and is told to "just pray."
• Large payments are demanded for a promised release.

See red flags in traditional healing practice.

Working with both

Many clinicians welcome a patient's faith. You can ask a mental health professional whether they will respect your beliefs, and you can ask a spiritual leader whether they support treatment. See traditional healers and modern health systems and, for trauma, trauma and PTSD.