Psychiatria Danubina, 2017; Vol. 29, No. 3, pp 238-244 https://doi.org/10.24869/psyd.2017.

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RESILIENCE, PSYCHIATRY AND RELIGION FROM PUBLIC

SUMMARY
Psychiatry has increasingly devoted its attention to the role of religion and spirituality in mental health and illness. All religions
offer explanations for meaning and purpose of life, involving rationales for the reality of human suffering and traumas related to
natural disasters, war, civil violence, torture, etc. In many countries different religious organizations have funded and operated
mental health services as well as supported better understanding, empathy and compassion among cultures. A rapprochement
between psychiatry and religion has been predicated on their overlapping goals to promote individual and community resilience,
growth, and well-being. Due to progress in post-secular dialogue, psychiatry, religion and spiritual disciplines have the historical
opportunity to shape the future of individual, public and global mental health as well as building compassionate society and
empathic civilization.

Key words: public and global mental health – resiliency – psychiatry – religion - compassionate society - empathic civilization

* * * * *
Introduction Hope, Organized religion, Personal spirituality and
Psychiatry and religion are fascinating and contro- practices, Effects on medical care and end-of-life issues)
versial fields that many people misunderstand. The both have been developed.
have many debatable and arguable aspects and varied As social practices psychiatry and religion should be
history. The both have been connected with ideology and allies in promotion of the common good, public and
politics in various ways since distant times. Throughout global mental health. Discernment what is good, true,
the history psychiatry and religion made it difficult to valuable, meaningful and decisive in our lives and our
communicate with each other without conflicts about parallel worlds belongs to the domain of both religion
how human beings should understand and define them- and science including psychiatry. Dialogue and mutual
selves, the nature and the world, as well as mental, understanding, and even cooperation between psychia-
moral and spiritual health... Psychiatry has often ignored try and religions have become a matter of the great
spiritual and religious dimension in health and illness importance for promotion of public and global mental
while religions were defining mental disorders as evil health. The aim of this paper is to address and support
spirit possessions or the works of demons which possible cooperation between psychiatry and religion in
penetrated body and mind of sinned individuals. It is promotion of public and global mental health, research,
important to note that transcultural psychiatry has always patient care and education.
taken the spiritual and religious beliefs and practices as
relevant factor in understanding both mental health and Resilience, Spirituality, Well-being,
mental disorders. The confrontation and alienation that and Mental Health: Brief Explanation
existed between psychiatry and religion during most of of the Important Concepts
the 20th century has been overcoming. Increasing num-
Sound mind in sound body on sound
ber of articles and books on religion, spirituality, psy-
society and sound religion
chiatry and mental health have been published (Galanter
2005, Loewenthal 2007, Huguelet & Koenig 2009, Resilience, spirituality, well-being, salutogenesis
Griffith 2010, Jakovljevic et al. 2010). In postmodern and and positive mental health have become commonplace
post-secular psychiatry of the 21st century religiosity has terms and are essential constructs in trans-disciplinary
been considered as a normal personality trait, and integrative psychiatry, positive psychiatry and psycho-
religion as an important component of life and culture. logy (see Jakovljevic 2012, Jeste et al. 2015). However,
According DSM-5 (APA 2013), religion is recognized there is no general agreement on the definitions and
as part of the cultural context of the illness and health relationships of these constructs. So, for the time being
experience. Assessing spirituality and religious beliefs the use of these terms should always be accompanied
has become a standard part of psychiatric history, so by a brief explanation of their respective meanings and
that even different protocols, e.g. HOPE (sources of theoretical framework.

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 Miro Jakovljevic: RESILIENCE, PSYCHIATRY AND RELIGION FROM PUBLIC AND GLOBAL MENTAL HEALTH PERSPECTIVE
Dialogue and Cooperation in the Search for Humanistic Self, Compassionate Society and Empathic Civilization
Psychiatria Danubina, 2017; Vol. 29, No. 3, pp 238-244

Resilience is complex, multidimensional and dyna- with a specific religion, but it is always related to the
mic process, very important for understanding of saluto- subjective experience of something sacred, trans-
genesis and pathogenesis. In psychology, resilience personal, transcendental and greater than self as well as
refers to the ability to bounce back from a negative to feelings of awe, reverence, and love. Transcendental,
experience (stress, adversity, trauma, threats, tragic) vitality, meaningfulness and connectedness are essential
with competent and adaptive functioning (Soutwick & elements of a spiritual experience which can be
Charney 2013). In medicine, resilience refers to one’s understood in either secular or spiritual terms (Slade
capability to recover when having an illness or disease. 2011). Vitality is ability or powerful force of an
Resilience may be defined as a collection of protective organism to maintain its organic existence. It includes a
factors that mediate the relationship between a stressful creative attitude, being spirited, open to new
event, e.g. disease, and positive outcomes. It is an experiences, and growing through inner exploration or
indivisible part of mental health and health in general, meditation. Health, energy and enthusiasm are secular
well-being and quality of life. Resilience is considered terms, while soul, grace and sanctity are spiritual terms
as a dynamic and modifiable process, gradually related to vitality. Spirituality is associated with
developed through the life span, by the facing and emerging of higher values and deeper understandings
overcoming of adversary events. Individuals may be and meanings of life, frequently connected with a
resilient in one domain and not in others, or they may be sense of mystery and awe. Art, science and literature
resilient at one spell of time and not at other periods of are secular terms, while faith, scriptures and revelation
their lives. Resilience enables individuals and are spiritual terms related to meaningfulness. Connec-
communities not only to survive and adapt to challenge tedness refers to a feeling of union or harmony with
but also to be better off and to grow and thrive (post- another being or thing which includes connection with
traumatic growth) in addition to overcoming a specific a living, dead or imagined person, a cultural, ethnic or
adversary. Psychological resilience is an ability to political group, humanity, nature or universe. Family,
bounce back from negative emotional experiences. It is lovers and nature are secular terms, while God, fellow-
a protective collection of thoughts, actions and behavior ship and church are spiritual terms related to
that can be developed and improved by everybody. connectedness. Spirituality can enhance resilience by
Psychological resilience consists of intrapersonal (how promoting a sense of coherence, hope, transcendental
an individual relates to their own thoughts, feelings and meaning and purpose, and by social support within
behaviors) and interpersonal (how an individual relates spiritual community. Spiritual resilience can be defined
to others). According to hybrid model (Shin et al. 2009) as ability to recognize a higher meaning and altruistic
resilience is related to 1.the one’s positive attitude perspective, both during good and bad times. It is
toward restoration (optimistic thinking, having faith in associated with a cluster of positive beliefs, values, and
getting better), 2.the power to reconstruct (ability to re- habits of mind.
integrate overcoming difficulty, confidence to overcome Religion is one of the most distinctive human phe-
difficulties) and control one’s adversary or disease nomena which can be source of individual and com-
(coping skills, ability to control relapse prevention and munity growth, strength, social solidarity and resilience,
illness, practicing health plan well), and 3.positive mu- but also source of personal strain, terrorism and inter-
tual interaction with supportive resource (support from religious conflict (Abu-Raiya 2013). Religion is usually
medical experts, from family members, friends and depicted as a particular institutionalized or personal
other people). Resilient individuals have lower risk of system of beliefs and practices (worship) related to the
disorders, illness and disease, better immune functio- divine (Encarta Concise English Dictionary 2001).
ning, speeder recovery, and higher productivity. Spiri- These beliefs concern the existence, nature, and worship
tuality and religiosity may act as resilience resources to of God, a god, or gods, and divine involvement in the
manage adversity (Reutter & Bigatti 2014). Placebo universe and human life. Pargament’s definition (1997),
response may be an expression of psychological and “religion is a search for significance in ways related to
spiritual resilience (Jakovljevic 2017b). the sacred” (cited according Abu-Raiya 2013) fits the
Spirituality can be defined as a quality of human best in our context. Religious pathways are complex and
beings who are concerned or preoccupied with higher dynamic processes in which people take in search of
meaning or purpose in life rather than with affairs of the whatever they hold significant, including the sacred
material world (Slade 2011). It is a dimension of human itself (Abu-Raiya 2013). The search can include psycho-
experience related to the sacred, the transcendent, or to logical ends, such as meaning and purpose of life and
ultimate reality. It also relates to the inner essence of the self-development, social ends, such as intimacy with
self and the sense of harmonious interconnectedness others and justice in the world, and spiritual ends, such
with self, others, world and the Ultimate Other. Spiri- as closeness to God and living a moral and ethical life
tuality is a growth oriented, motivating and integrating (Abu-Raiya 2013). All major religions provide great
force for physical, biological, psychological and social stories that deliver a meta-narrative how we should live
dimensions of human life and a potential source of the lives of service and offer moral guidance (see
strength and well-being. It may or may not be associated Bloom 2011).

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 Miro Jakovljevic: RESILIENCE, PSYCHIATRY AND RELIGION FROM PUBLIC AND GLOBAL MENTAL HEALTH PERSPECTIVE
Dialogue and Cooperation in the Search for Humanistic Self, Compassionate Society and Empathic Civilization
Psychiatria Danubina, 2017; Vol. 29, No. 3, pp 238-244

Mental health according to the WHO (2014) “is employment opportunities, access to nutritious foods at
defined as a state of well-being in which every indi- reasonable prices, safety, public transportation, a clean
vidual realizes his or her own potential, can cope with environment, and peace (Prilleltensky & Prilleltensky
the normal stresses of life, can work productively and 2012). Emotional well-being refers to the experience of
fruitfully, and is able to make a contribution to her or feeling of happiness and satisfaction, psychological
his community”. Promoting mental health enhances well-being is defined as a meaningful life in which an
resilience, and vice versa, enhancing resilience promo- individual realizes their own capacities, whereas social
tes better mental health. While some use well-being as a well-being is related to the feeling than an individual
proxy measure of resilience, others treat one concept as values and is valued by the society in which he or she
a component of the other, and yet another group views lives (see Fledderus et al. 2010). Spiritual well-being is
one concept as a prerequisite of the other. “Mental related to following and achievement of spiritual values
health is a fundamental element of the resilience, health and higher level of life satisfaction in sense that it does
assets, capabilities and positive adaptation that enable not depend on any materialistic conditions of reality (see
people both to cope with adversity and to reach their full Joshi & Kumari 2011). Religious well-being is related to
potential and humanity” (WHO 2009). Religion is rele- “the feeling of having a personally meaningful, satisfying
vant for better or worse in both mental health and and fulfilling relation with God” (Joshi & Kumari 2011),
illness, as an etiologic, therapeutic, or palliative agent or supreme beings or transcendental world.
(Levin 2010, Griffith 2010). James (1902/1936/1990) Coping mechanisms/skills can be defined as beha-
identified two types of religious expression: 1.“the viours that an individual employ in order to prevent or
religion of the sick sole” characterized by psychic avoid adversity and its consequences (see Hatch et al.
neuralgia, loathing, irritability, self-mistrust, self-des- 2012). According to Aspinwall and Taylor (1977) there
pair, suspicion, anxiety, and fear; and 2.“the religion of are three types of coping: 1.coping with stressful events
the healthy-minded soul” which is implicitly positive, (actions to reduce or minimize perceived harm or
hopeful, optimistic, kind and prone to happiness losses), 2.anticipatory coping (preparation for the stress-
(according Levin 2010). ful event with potential harm or losses), and 3.proactive
Well-being or wellness is a general term for the coping (accumulation of resources and acquisition of
positive outcome or condition of an individual or group. skills for general preparation for possible stressors).
It is frequently used as an indicator of resilience, Religion coping activities include praying, reading
particularly when referring to resilience as a process of sacred scriptures and texts, practicing religious rituals
overcoming difficulties, adversity, or trauma so well and services, etc.
that functioning is even better than before. The WHO Salutogenesis (the latin salus – health; the Greek
(2009) has defined well-being as the ‘presence of genesis – origin) is related to healing that is natural
positive mental health, but the reliable definition of process seen in all forms of life. Although man does not
mental health and well-being remains elusive. Well- possess phantastic healing capacity of reptiles and
being has both noun (being at home in the world) and amphibias, he does show a wide variety of health
verb (living in balance with the trials of life) senses restorative processes involving the cellular repair of
(Pickering 2012). Well-being encompasses the capacity genetic mutations, the elimination of infectious agents,
to 1.actively participate in work and recreation, 2.create and the destruction of incipient neoplasia by immune
meaningful relationships with others, 3.develop a sense mechanisms (Kradin 2008). According to salutogenic
of autonomy, 4.personal mastery and purpose in life, model (Antonovsky 1987) the balance between coping
and 5.to experience positive emotions joy, contentment, mechanisms (generalized resistance resources) and ge-
happiness (see Hatch et al. 2012). According I. neralized resource deficits determines whether stressful
Prilleltensky and O. Prilleltensky (2012) well-being can and adversary factors will be pathogenic, neutral, or
be personal, relational, organizational and collective. salutogenic. Salutogenesis and placebo response is asso-
Signs of personal well-being are self-determination, ciated with resilience resources (see Jakovljevic 2017b).
sense of control, self-efficacy, optimism, meaning and
spirituality. Signs of relational well-being involve Spirituality and religion may play
caring, respect for diversity, reciprocity, nurturance and an important role in individual
compassion, support, collaboration and democratic deci-
and community resilience, quality of life,
sion-making processes. Signs of organizational well-
being appear as art and practice of learning organization and public mental health promotion
(see Senge 2006), respect for diversity, democratic “The health of nations is the wealth of nations”
participation, clarity of roles, engagement and learning William J. Durant
opportunities. Signs of collective well-being include a Religion has had significant effects on mental health
fair and equitable allocation of bargaining powers, directing and modeling social behavior, explanatory
resources, and obligations in society, gender and race styles and world-views that promotes well-being at both
equality, universal access to high quality educational, individual and community level. According to Joshi &
health and recreational facilities, affordable housing, Kumari (2011) it “acts as a social support system,

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 Miro Jakovljevic: RESILIENCE, PSYCHIATRY AND RELIGION FROM PUBLIC AND GLOBAL MENTAL HEALTH PERSPECTIVE
Dialogue and Cooperation in the Search for Humanistic Self, Compassionate Society and Empathic Civilization
Psychiatria Danubina, 2017; Vol. 29, No. 3, pp 238-244

reduces the sense of loss of control and helplessness, logical mechanisms (Levin 2009). The concept of
provide a cognitive framework that reduces suffering healing is an important context for understanding spiri-
and enhances self-esteem, give the confidence that one, tuality in terms of resiliency. Faith can be healing by
with the help of God, could influence the health eliciting healthy behaviors that enhance resilience and
condition, and creates a mindset that enables the patient facilitate salutogenesis through conditioning and regu-
to relax and allow body to heal itself”. Public mental lating the neuroendocrine and neuroimmune systems
health, spiritual well-being and social well-being are (behavioral/conative mechanism). Faith can be healing
very closely inter-related but also distinct issues with by connecting one to groups of like-minded people who
multi-directional relationship. Public mental health is an can offer tangible and emotional support and encoura-
important component of the social well-being while gement (interpersonal resilience and well-being). “Con-
social well-being supports individual and public mental fiding in other, human or divine, and reinforcing reci-
health. Spirituality, well-being and resilience are useful procal bonds of assistance among individuals, or with
concepts for public and global mental health promotion divine others, has both health-promoting and disease-
because they integrate behavior of people and their preventive consequences for populations” (Levin 2009).
mental health at individual and community level. Faith can heal by establishing a mental framework, the
Spiritual thinking modes help in creating peace, mode of thinking and explanatory narrative that affirms
harmony and order at individual as well at community one's innate healing ability by making sense of and
level. A fundamental component of the success of any accommodating individuals to their specific experiences
communities is their ability/capacity to collectively and their place in the world (cognitive resilience). Faith
build resilience in the face of constant and unpredictable can heal by engendering soothing emotions that buffer
change and adversary. So, one can say that individual or mitigate the harmful effects of stress (emotional
and community well-being is an outcome of resilience. resilience). The positive feelings elicited by positive
Spirituality and religion play an important role for many faith-based thoughts, beliefs, and experiences, personal
people in their resilience, well-being and quality of life or communal, both may directly modulate various
across the life span. Religion offers a response to the neurobiological and epigenetic parameters (Feder et al.
problem of human insufficiency and suffering in the 2009, Russo et al. 2012) indicative of pathophysiology
time of adversity and crisis (Faigin & Pargament 2011). (neurobiological resilience). Faith can give one a sense
Spiritual resilience represents a cluster of positive that there is a purpose in what is happening and can help
beliefs, values, and habits of mind that can be learned, find hope, solace and comfort (spiritual resilience in
cultivated and reinforced through positive religious narrow sense). In fact, all these resilience mechanisms
education and practice. There is no firmly determined are psychophysiological, but here the terms are used in
(one fits all size) way to react optimally to any given traditional way of their meaning and defining.
challenge or adversary, but rather an optimal way of res- Religion may be both blessing and curse; it may
ponding to specific circumstances. Spiritual and social heal, it may harm; it may be salutogenic and it may be
resilience can be enhanced within communities, both pathogenic; it may be healthy-minded and it may be
informally (practicing empathy and compassion in every sick-minded (Griffith 2010). Healthy-minded (saluto-
day life) and formally (religious teaching resilience genic) and sick (distorted or pathogenic) expressions of
skills, broadening definitions of “family” and friend on faith are quite distinct – in the objects of faith, in the
everyone in community, society and civilization). expectations of such faith, and in the observed effects
The idea that faith may possess salutogenic capacity and outcomes in the lives of the faithful (Levin 2009).
is as old as both religion and medicine itself. A large Salutogenic faith motivated by intrinsic religion is
body of empirical research has demonstrated relation associated with empathy, compassion, creativity, open-
between religious involvement, religious motivation and mindedness, self-esteem, altruism and social responsi-
religious coping on one side and somatic and mental bility. Healthy minded faith is the fuel that produces
health on the other side (see Abu-Raiya 2013). Salutary constructive social and cultural transformation – it
effects of faith and religion have been demonstrated inspires and directs acts of compassion, mercy, and
with many dimensions of resilience, mental health and justice (Levin 2009). Pathogenic or sick faith suggests
well-being, such as self-esteem and personal mastery, itself as a font of psychopathology, which may have
hope, optimism, purpose and meaning, anxiety, depres- followed by negative somatic consequences and de-
sion. Advances in measurement theory and research in structive behavior. Certain expressions of distorted reli-
psychology and psychiatry suggest that resilience, well- gious faith may serve as a source of or may reflect
being, spirituality and religiosity can be investigated psychological conflict (Levin 2009) and/or psychopa-
with relatively reliable degree of accuracy. Quite a thology. Distorted and pathogenic faith can indeed be an
number of studies have shown that resilience, well- impediment to well-being and healing, no serious obser-
being, spirituality and religiosity are associated with ver would deny this point (Levin 2009). Healthy-min-
personal, health, job, family, and community benefits. ded spirituality and religion are the wealth of nations.
Religious faith can be associated with healing by Public mental health is essential to the attainment of
different mechanisms that are depicted as behavioral, peace and security and religion may give a significant
interpersonal, cognitive, affective, and psychophysio- contribution in their promotion.

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 Miro Jakovljevic: RESILIENCE, PSYCHIATRY AND RELIGION FROM PUBLIC AND GLOBAL MENTAL HEALTH PERSPECTIVE
Dialogue and Cooperation in the Search for Humanistic Self, Compassionate Society and Empathic Civilization
Psychiatria Danubina, 2017; Vol. 29, No. 3, pp 238-244

Global and public mental health promotion to warmongers (Staguhn 2007). Vengeance has been
for compassionate society and empathic claimed to be the very essence of human nature, but it
civilization: Wishful cooperation can also be overcome by virtue of forgiveness. If we
between religions and psychiatry continue practicing the law of an eye for an eye, we will
all end up blind (Tutu 2014). Civilization represents an
It is well known that religion may significantly attempt to confine the aggressive and revengeful part of
affect determinants of public and global mental health. human nature; great religions have made it their
The evidence based and service user opinions suggest mission, too. With increasing globalization, mobility
that spirituality and religion are of significance in cli- and migrations, the world is becoming a cosmopolis
nical practice and research (Royal College of Psychia- deeply interconnected so that what happens in one part of
trists 2013). Mental health promotion is the complex the world may have strong repercussions in other parts
process of enabling people to protect, improve and (the butterfly effect). This has led to an ideology of
promote their mental health at individual and collective cosmopolitism, universalism and empathic civilization
level. From recently public mental health activities have with renewed interest for thinking about what is it that
focused more and more on enhancing a positive, human beings have in common, what is a real human
meaningful, and engaged life rather than on the control nature, and to explore the ethical basis for it (see
and elimination of mental disorders (Fledderus et al. Ricard 2015).
2010). Positive mental health is more than the absence From the global mental health perspective we have
of ill mental health and mental illness. It is a resource to recognize very fundamental fact about ourselves: we
that enables people to realize their goals, satisfy their are a species that has evolved to thrive on love, kindness
needs, and to cope with the environment in order to live and compassion associated with our interconnectedness
a long, productive and satisfying life. Widely acknow- and interdependency (see Jakovljevic & Tomic 2016).
ledged environmental and social resources for mental Empathy is fundamental for establishing and maintai-
health include: peace, home safety, economic security, ning all of our most significant relationships based on
compassionate society, and a stable ecosystem. Public respect, trust, understanding, non-judging, and friend-
and global mental health promotion which strengthens ship (Krznaric 2015). Empathy, the essence of huma-
these resources may significantly increase individual nism and human condition, is social glue that holds
and collective/national well-being (see CDC 2016). humans together which is very important for survival.
Countries all over the world differ substantially in their To empathize means to civilize and humanize, to
levels of well-being as well as in the religiosity of their civilize and humanize means to empathize (Krznaric
people. According to the moral code of all major reli- 2014). With empathizing we see each other’s humanity.
gions one should avoid evil deeds (rage, cruelty, anger, Empathy leads to healthy, creative, flourishing and
pride, and envy) and practice virtues (empathy, com- well-functioning families, communities, nations, socie-
passion, kindness, gentleness, truthfulness, self-control, ties and civilizations. Human beings are biologically
etc.). All these virtues may contribute to inner peace, wired to need connection, attachment, recognition, vali-
satisfaction, well-being and ultimately to positive men- dation and belonging. Empathy is what enables us to
tal health. Both psychiatry and religion have the same extend our social affiliations and connect with other
goal, predicated on positive and optimistic view on people in larger social, political, economic and religious
human nature, to transform destructive behaviors into units, cultures and civilizations. Public and global
constructive ones leading to positive mental and spiri- mental health is the product based on human rights,
tual health (Jakovljevic 2005, Boehmer 2016). love, gratitude, reverence, empathy and compassion.
Selfish exploitation, violence, terrorism and war have Education for love, empathy and compassion are pillars
become the huge source of, hate, violence, suffering, and foundation of the global mental health and an esprit
poverty and waste of human and nature resources, all de corps of the empathic civilization of love (see
associated with a lot of mental health problems and Ferrucci 2007). The promotion of a dialogue among
individual and collective psychopathology. The choice civilizations and creation of an empathic humanistic
between clash of civilizations or creative dialogue cooperative political culture may contribute to the
among them has become a fundamental question, not development of global civilization of love and piece.
only for global mental health but also for the very Love, kindness, gentleness, and compassion are like
survival of mankind (see Jakovljevic & Tomic 2016). basic food for our minds, they are intrinsically related to
According to Staguhn (2007) „a human being seems to our well-being. Good news from the latest neuroscience
be floating over the abyss, in-between contradictories: research is that empathy and compassion can be taught,
war and peace, hatred and love, power and power- learned and cultivated. Envision a future in which
lessness“. According to Desmond Tutu (2014) “people economics, education, medicine, psychiatry, religion
are not born hating each other and wishing to cause and even politics are infused with more empathy and
harm. It is a learned condition.” People are encouraged compassion transforming our world. Empathy and
to engage in conflicts and wars by those benefiting from compassion is an esprit de corps of the humanistic
them, so that one should work on developing immunity civilization of love and the creation of global

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Dialogue and Cooperation in the Search for Humanistic Self, Compassionate Society and Empathic Civilization
Psychiatria Danubina, 2017; Vol. 29, No. 3, pp 238-244

cosmopolitan society governed by law and order as well 12. Galanter M: Spirituality and the Healthy Mind – Science,
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Conflict of interest: None to declare. 20. Jakovljevic M & Tomic Z: Global and public mental health
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Correspondence:
Professor Miro Jakovljevic, MD, PhD
University Hospital Centre Zagreb, Department of Psychiatry
Kišpatićeva 12, 10000 Zagreb, Croatia
E-mail: psychiatry@kbc-zagreb.hr

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