Spiritual psychosis in a Balinese patient with cultural and religious influences
Case illustration
Keywords:
cross-cultural diagnosis, cultural competence, cultural syndromes, religious psychosis, spiritual beliefsAbstract
This case study presents a unique intersection between cultural beliefs, religious practices, and psychosis in a Balinese patient, observed during a 14-day hospitalization in the Intensive Psychiatry Care Unit (IPCU) at the Provincial Psychiatric Hospital, Bali. The patient, a middle-aged Balinese man with minimal formal education, exhibited symptoms of psychosis interwoven with his deep religious convictions and a belief in his role as a devout follower ("ngiring") of deities. He reported auditory and tactile hallucinations that he interpreted as divine messages, compelling him to perform religious rituals to prevent disaster. These experiences, perceived by the patient as sacred, ultimately culminated in aggressive behavior leading to his hospitalization. This case highlights the diagnostic and therapeutic challenges in differentiating spiritual practices from psychotic symptoms and underscores the importance of culturally sensitive psychiatric care.
Downloads
References
Adebayo, Y. O., Adesiyan, R. E., Amadi, C. S., Ipede, O., Karakitie, L. O., & Adebayo, K. T. (2024). Cross-cultural perspectives on mental health: Understanding variations and promoting cultural competence. World Journal of Advanced Research and Reviews, 23(01), 432-439.
Ahmed, K., & Bhugra, D. (2006). Diagnosis and management of depression across cultures. Psychiatry, 5(11), 417-419. https://doi.org/10.1053/j.mppsy.2006.08.010
Aishammari, Y. F. H., Alharbi, M. N., Alanazi, H. F., Aldhahawi, B. K., Alshammari, F. M., Alsuwaydan, R. H., Alenezi, S. G., Alshammari, B. A., Alshammari, R. M., Alshammari, B. M., Jabal, A. M. B., & Alruwaili, E. S. R. (2019). Cultural competence in health care practice. International Journal of Health & Medical Sciences, 2(1), 45-54. https://doi.org/10.21744/ijhms.v2n1.2258
Al Taher, R., Fox, A., & Wilson, C. (2024). Spiritual understandings of psychosis: the perspectives of spiritual care staff. Journal of Spirituality in Mental Health, 26(4), 368-387.
Cai, D. Y. (2016). A concept analysis of cultural competence. International Journal of Nursing Sciences, 3(3), 268-273. https://doi.org/10.1016/j.ijnss.2016.08.002
Dubey, M. J., Ghosh, R., Das, G., Roy, D., Das, S., Chakraborty, A. P., ... & Benito-León, J. (2024). Beyond belief and practice: an exploratory literature review and discussion of the differential impact of spirituality and religiosity on mental health disorders. Journal of Religion and Health, 1-14.
Guinart, D., Kane, J. M., & Correll, C. U. (2019). Is transcultural psychiatry possible?. Jama, 322(22), 2167-2168.
Jimenez, D. E., Park, M., Rosen, D., hui Joo, J., Garza, D. M., Weinstein, E. R., ... & Okereke, O. (2022). Centering culture in mental health: Differences in diagnosis, treatment, and access to care among older people of color. The American Journal of Geriatric Psychiatry, 30(11), 1234-1251. https://doi.org/10.1016/j.jagp.2022.07.001
King, M., Speck, P., & Thomas, A. (1999). The effect of spiritual beliefs on outcome from illness. Social Science & Medicine, 48(9), 1291-1299. https://doi.org/10.1016/S0277-9536(98)00452-3
Kirmayer, L. J., & Minas, H. (2023). The future of cultural psychiatry: an international perspective. Medical Anthropology, 135-143.
Kirmayer, L. J., Bennegadi, R., & Kastrup, M. C. (2016). Cultural awareness and responsiveness in person-centered psychiatry. Person centered psychiatry, 77-95.
Lemelson, R. B. (2004). Traditional healing and its discontents: efficacy and traditional therapies of neuropsychiatric disorders in Bali. Medical anthropology quarterly, 18(1), 48-76.
Lemelson, R., & Suryani, L. K. (2006). The Spirits, NGEB, and the social suppression of memory: a complex clinical case from Bali: Clinical Case Study. Culture, Medicine and Psychiatry, 30, 389-413.
Marriott, M. R., Thompson, A. R., Cockshutt, G., & Rowse, G. (2019). Narrative insight in psychosis: The relationship with spiritual and religious explanatory frameworks. Psychology and Psychotherapy: Theory, Research and Practice, 92(1), 74-90.
Moreira-Almeida, A., & Koenig, H. G. (2006). Retaining the meaning of the words religiousness and spirituality: A commentary on the WHOQOL SRPB group's “A cross-cultural study of spirituality, religion, and personal beliefs as components of quality of life”(62: 6, 2005, 1486–1497). Social Science & Medicine, 63(4), 843-845. https://doi.org/10.1016/j.socscimed.2006.03.001
Ogundare, T. (2020). Culture and mental health: Towards cultural competence in mental health delivery. Journal of Health and Social Sciences, 5(1), 023-034.
Rosmarin, D. H., Bigda-Peyton, J. S., Öngur, D., Pargament, K. I., & Björgvinsson, T. (2013). Religious coping among psychotic patients: Relevance to suicidality and treatment outcomes. Psychiatry research, 210(1), 182-187. https://doi.org/10.1016/j.psychres.2013.03.023
Sharifi, N., Adib-Hajbaghery, M., & Najafi, M. (2019). Cultural competence in nursing: A concept analysis. International journal of nursing studies, 99, 103386. https://doi.org/10.1016/j.ijnurstu.2019.103386
Taknint, J. T., Depestre, S., Alshabani, N., Martin, A. M., Virkar, S., & Milord, J. (2024). Assessing psychotic spectrum disorders in partnership with patients: Three culturally responsive therapeutic assessment cases. Practice Innovations.
Thacore, V. R., & Dharwadkar, N. P. (2024). Diagnosing mental disorders in diverse cultures. Journal of Indira Gandhi Institute Of Medical Science, 10(1), 6-9.
Trinh, N. H., Tuchman, S., Chen, J., Chang, T., & Yeung, A. (2020). Cultural humility and the practice of consultation-liaison psychiatry. Psychosomatics, 61(4), 313-320. https://doi.org/10.1016/j.psym.2020.03.002
Turner, E. A., & Mills, C. J. (2016). Culturally relevant diagnosis and assessment of mental illness. Handbook of mental health in African American youth, 21-35.
Virdee, G., Frederick, T., Tarasoff, L. A., McKenzie, K., Davidson, L., & Kidd, S. A. (2016). Exploring the contours of religion and spirituality in creating community: A focus on persons with psychosis. Journal of Community Psychology, 44(8), 1081-1087.
Westermeyer, J., & Sines, L. (1979). Reliability of cross-cultural psychiatric diagnosis with an assessment of two rating contexts. Journal of Psychiatric Research, 15(3), 199-213. https://doi.org/10.1016/0022-3956(79)90013-X
Published
How to Cite
Issue
Section
Copyright (c) 2024 International journal of health & medical sciences
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
Articles published in the International Journal of Health & Medical Sciences (IJHMS) are available under Creative Commons Attribution Non-Commercial No Derivatives Licence (CC BY-NC-ND 4.0). Authors retain copyright in their work and grant IJHMS right of first publication under CC BY-NC-ND 4.0. Users have the right to read, download, copy, distribute, print, search, or link to the full texts of articles in this journal, and to use them for any other lawful purpose.
Articles published in IJHMS can be copied, communicated and shared in their published form for non-commercial purposes provided full attribution is given to the author and the journal. Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgment of its initial publication in this journal.
