Nearly 80% of McLean patients turn to spirituality or religion to cope with stress or adversity. And nationally, 50-60% of patients want their spirituality addressed in their mental health care. But historically, psychiatry has overlooked these facts.
“There’s a disconnect between what we’re doing as a field and what people want,” said David H. Rosmarin, PhD, ABPP, director of McLean’s Spirituality and Mental Health Program. “As a result, the reach of psychiatry is limited in some cases if we don’t attend to the spiritual needs of our patients.”
Rosmarin is working to remedy that disconnect in two ways. First, he and his collaborators are conducting research establishing a firm evidence base upon which to build treatments incorporating spirituality. Second, he is working with McLean’s chaplain, Rev. Angelika Zollfrank, MDiv, to launch a new clinical pastoral education (CPE) program, one of only a few in the country, to train future chaplains for work in mental health settings. A generous $2 million gift from the Orange Crimson Foundation is supporting both initiatives.
“There are no words to express my gratitude for the opportunities this gift will enable,” said Rosmarin. “We are uniquely positioned to advance the field of spirituality and mental health. And the impact on care will be significant because research dictates clinicians’ engagement with these issues.”
“We are so pleased to support Dr. Rosmarin’s work,” said Christopher Laconi of the Orange Crimson Foundation. “Patients have made it clear how important spirituality is to their recovery, and psychiatry has started to listen. Dr. Rosmarin and his collaborators have been on the vanguard of this awakening.”
Creating an Evidence Base
Rosmarin is planning a collaborative study with Matthew Sacchet, PhD, and Diego A. Pizzagalli, PhD, from McLean’s Center for Depression, Anxiety and Stress Research to look at the effects of prayer on the brain using functional magnetic resonance imaging (fMRI). “We will be examining how brief prayerful states impact brain activity, and how this relates to coping with depression, anxiety, and stress,” explained Rosmarin.
Another study with Brent P. Forester, MD, MSc, chief of McLean’s Division of Geriatric Psychiatry and director of the Geriatric Psychiatry Research Program, is examining how elderly patients’ spiritual and religious lives predict the course of their mood disorders. For example, could patients’ loss of faith foreshadow an exacerbation of their depression?
On the other end of the age spectrum, a joint investigation with Marisa M. Silveri, PhD, and her Neurodevelopmental Laboratory on Addictions and Mental Health is examining whether spiritual and religious lives have any bearing on the development or prevention of substance use disorders among adolescents. With the foundation’s support, Rosmarin has hired a neuroscience post-doctoral fellow and several research assistants to help with these projects.
In addition to McLean-based projects to advance the science of spirituality in psychiatry, Rosmarin is consulting with Divine Mercy University, a Virginia-based private graduate school of psychology and counseling, to help grow their research program. “Disseminating our research expertise is critical to McLean’s mission,” he said. Rosmarin will help train DMU students to conduct this kind of research and work with the university to set up its own research laboratory to examine the interplay of spirituality and mental health.
Training Psychiatry Chaplains
The foundation’s generosity will also help McLean spread its expertise in clinical pastoral care. Launching as early as next fall, the new CPE program will provide the specialized training required for clergy to help within mental health settings. According to Rosmarin, these types of programs are few and far between, “which makes no sense because clergy are the first people to get referrals when someone is in crisis. People are twice as likely to see a member of the clergy for counseling as they are to see a mental health professional,” he said. Zollfrank, who is a certified CPE educator, will direct the program.
Once students have some training under their belts, they’ll be able to provide pastoral counseling to McLean patients. It has been challenging for Rev. Zollfrank to keep up with patient requests for her services, so the student chaplains will be a welcome addition, added Rosmarin.
There are no billing codes for spiritual care, so the Spirituality and Mental Health Program has been completely dependent on philanthropy since its inception. The program is indebted to donors like the Rev. Dr. Barbara H. Nielsen, David and Susan Fowler, Ann O’Keefe, David Barlow, and the John Templeton Foundation, who have embraced the importance of this work.
The Benefits of Spiritual Coping
Dr. David H. Rosmarin explains the relevance of spirituality to mental health and discusses nondenominational spiritual coping techniques to find inner peace that help us get through our darkest times and carry forward with us.
Some days Rev. Angelika Zollfrank, MDiv, BCC, ACPE, is unsure she’ll get through her to-do list because the demand for pastoral care at McLean is so great. But soon, she will be training a cohort of chaplain interns who will not only assist her with counseling but also add diversity of life experiences and religious backgrounds. “It’s so important to have people who speak different spiritual languages,” said Zollfrank, who came to McLean in 2019 to launch a new Clinical Pastoral Education program. She is also the hospital’s first full-time chaplain in many years.
Unlike a priest, minister, rabbi, or imam, as a professional health care chaplain, Zollfrank uses people’s own faith traditions as a starting point to help them grapple with any spiritual questions or struggles they’re facing. It involves empathic listening and conversations about grief and loss, the meaning and purpose of suffering, joy and blessings, and even end-of-life concerns. Sometimes she offers resources: the Qur’an, the Hebrew Bible, the New Testament, a prayer rug, or a book of Christian reflections.
Clinicians ask her to consult on cases, like that of a recent patient who refused his medication because he believed his religion frowned upon it. She helped him understand that his faith absolutely endorsed the curative powers of medicine. “I create an alliance with someone who is a person of faith, but I’m also assessing the situation based on what is appropriate for a particular stage of recovery,” she explained.
Zollfrank also offers spiritual support to staff members, which has been invaluable during the pandemic. In addition to one-on-one sessions, she launched Spirit Matters, a weekly video message of inspirational spiritual reflections for staff. The popular series is now disseminated throughout the Mass General Brigham health care network.
Zollfrank doesn’t romanticize mental illness, but she does believe it often goes hand-in-hand with pondering the big questions: “Suffering raises so many questions about meaning, purpose, and identity,” she said. “Patients are very thoughtful and earnest in their spiritual seeking. I learn so much from them.”