God in the Hospital: The Interface of Spirituality and Psychiatry at End of Life

Consultation-liaison (C-L) psychiatrists are often an integral part of the medical care for hospitalized patients nearing the end of their lives. During this time, many people attempt to make sense of their lives as they face the unknown abyss of death. They often organize their inner experience in the context of spiritual or religious beliefs regardless of whether they are a “religious” person. At times, these existential struggles can result in feelings of sadness, anxiety, and/or social withdrawal, leading medical teams to request a consultation by C-L psychiatry. C-L psychiatrists can work with patients to facilitate their contemplation of their religious or spiritual beliefs, which may enhance their mood and outlook at this difficult time.

Consider the role of the C-L psychiatrist in the following case:

Mrs. J was a 71-year-old Catholic widow with a history of metastatic ovarian cancer who was admitted for failure to thrive. She was found to have a urinary tract infection and mild delirium. After treatment with intravenous antibiotics, she gradually improved. While her alertness returned to baseline, she continued to be withdrawn and interacted minimally with the medical staff. Her sister told the team that Mrs. J had been depressed for some time before her hospital admission. The medical team consulted the C-L psychiatry service.

Despite some reluctance, Mrs. J agreed to speak with the consulting psychiatrist. She spoke of her disappointment regarding her cancer. After her initial surgery, the surgeon had told her “you’re cured.” However, two months later she was found to have widely metastatic disease. Mrs. J felt this was “very unfair.” She had been a devout Catholic her entire life but felt angry with God for “giving me cancer.” She also quietly worried that her disease may even be punishment for “my sins.” Frustrated and scared, she had stopped attending church services and stopped communicating with her church community.

Simply being able to talk about her religious distress with a medical professional provided comfort to Mrs. J. With her permission, the Catholic priest on the hospital chaplaincy staff was invited to speak with her. After several conversations, Mrs. J felt comforted and less anxious, and her mood began to brighten. The only psychiatric medication prescribed was methylphenidate for cancer-related fatigue. She was discharged to home hospice and passed away several weeks later.