Many studies have found an inverse correlation between religious/spiritual involvement and depression. Yet several obstacles impede spiritually integrated treatment of depressed individuals. These include specialization and fragmentation of care, inexperience of clinicians and spiritual care providers, ideological bias, boundary and ethical concerns, and the lack of an accepted conceptual framework for integrated treatment. Here I suggest a framework for approaching these obstacles, constructed from a unified view of human experience (having emotional, existential, and spiritual dimensions); spirituality seen as a response to existential concerns (in domains such as identity, hope, meaning/purpose, morality, and autonomy in relation to authority, which are frequently distorted and amplified in depression); a rationale for locating spiritually oriented approaches within a clinician's assessment, formulation, and treatment plan; and recognition of the challenges and potential pitfalls of integrated treatment. 1. Introduction Depressed individuals often feel not only unfortunate but also that the world is oppressive, life is meaningless, and/or God is disapproving. They may question: “Am I clinically depressed, Or lacking in faith?” “Is life as unfair and empty as it seems?” “Is God punishing me?” or “Should I take an antidepressant, or pray more?” Because depression can so closely resemble ordinary spiritual experience, some sufferers resist treatment because they feel they should have more faith. Religious traditions and the communities that interpret them at times regard depression as an illness, at times as evidence of spiritual weakness, and at times even as a punishment. For their part, mental health professionals may hesitate to address the spiritual dimension of their patients’ experience. Some view spirituality as an epiphenomenon of more basic neurobiological or evolutionary processes and as such of only peripheral interest to psychiatry. Others regard religion as a potentially harmful, immature form of wish fulfillment. Still others have ethical concerns about charging patients and/or their insurance companies for spiritually oriented interventions or about influencing patients on the basis of their own personal values. Many lack sufficient familiarity with their patients’ spiritual traditions and/or experience to collaborate effectively with religious professionals and/or retain unresolved conflicts in their own relationship with spiritual authorities. A growing literature describes the spiritual dimension of depression as experienced by its
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