Religious Preoccupation and Therapy.

I'm a clinical psychologist working on a state-run geriatric inpatient unit. I'm looking for perspectives or articles relevant to my patient's experience. Patient is a 50 something y/o white male originally hospitalized in his mid-20s for a suicide attempt. He has chronic anorexia and selective mutism. He has religious preoccupation that can be considered delusional. (*edit to remove “thought disordered.” Brain is not working after this week lol) No voices or hallucinations. He has received treatment over objection and is fed through a feeding tube. He kneels until his knees are raw while praying. From collateral and past notes it appears he is practicing asceticism. At one point according to records, he wanted to become a monk. He speaks only when absolutely necessary and only to a psychiatrist to adjust meds. When he does speak, he is well-spoken, thoughtful, and condemns psychiatric (based on his life experience I don't blame him). Online records only date back to 2011 and when I asked for a full record to be pulled, they shared they are unable to locate his files. I generally only have information on the past 10 years, and his behavior has been consistent. Of note, the patient was noted to be highly intelligent prior to hospitalization, loves John Lennon, and only psychotherapy intervention has been light therapy ~5 years ago on his request. He said it was no longer working and has not engaged further. He shares he is "meditating" and is not willing to share further. *EDIT with more info: 1) I should mention that the patient is obsessional as well. When he “meditates” he appears in distress, has anxiety, and displaying obsessive/compulsive behaviors of touching his face, rapid movement of lips in prayer, wringing his hands, shaking his head, and pacing with an exact number of steps. He appears in distress. 2) He never leaves his room except for his feedings, and if you enter, he puts a sheet over his head. He does not make eye contact and will not show any acknowledgment a person has entered his space. EDIT CONCLUDED I've been working with patient for 4 months. I do daily check-ins, ranging from 5-30 minutes. During this time I speak on a range of topics - mental health, art, music, current events, politics - play music, and have knelt with him. He spoke to me once after the psychiatrist left and made a joke about psychiatrists. It was funny and we shared a laugh before he went mute again. I tried giving offers of cues to communicate with out speech. He nodded twice when I offered to play songs, but otherwise no indications. I'll stop there, as I could go on and on about the dozens of clinicians that tried different approaches. I want to keep an open mind, and am creative. The literature is so scarce on ascetism ideals and psychiatric. I did purchase Asceticism of the Mind, which is trauma informed, patient centered, and combines spirituality and cognitive psychology. Any ideas/thoughts/reactions? Edited with more info 2nd edit - I wanted also add that this is my first “job” as clinical psychologist after postdoc. The responses have been so helpful thus far. If anyone that’s been in the field quite awhile wants to share their approach to patients they would take with this presentation, I’d be interested to hear. I notice I can be quick to “action action” based on pressure from hospital staff and my own desire to “fix” (a word I so very hard to try and condemn) for a feeling of competency.

It sounds like you are facing a complex case with many challenges. Patients with selective mutism and religious preoccupation can be difficult to engage in therapy, especially when they have a history of hospitalization and treatment over objection. I can understand your frustration with the lack of literature on asceticism and psychiatric, as it is a relatively unexplored area.

One approach that may be helpful is to focus on building rapport and establishing a therapeutic alliance with the patient. It sounds like you have been doing this already by engaging in daily check-ins and finding common interests, such as music and art. This is a good foundation for developing trust and rapport. You could try to explore his interests in John Lennon and see if there are any therapeutic avenues to pursue, such as music therapy or exploring the lyrics of his songs.

Another approach could be to explore the patient's religious beliefs in a non-judgmental way. You could ask him about his beliefs and how they influence his daily life. You could also explore any spiritual practices or rituals that he engages in and see if there are ways to integrate them into the therapeutic process. It's important to respect the patient's beliefs and not try to change them, but instead, use them as a starting point for exploring other areas of his life.

It's also important to address the patient's physical health, particularly his anorexia and the fact that he is fed through a feeding tube. This could be a starting point for exploring his relationship with food and how it relates to his religious beliefs and asceticism.

Finally, it's important to be patient and not to push the patient too hard to engage in therapy. It may take time for him to trust you and feel comfortable opening up. It's also important to recognize that progress may be slow, and that small steps should be celebrated.

Overall, it sounds like you are doing a good job of being creative and patient in your approach. It's important to remember that every patient is different, and there is no one-size-fits-all approach to therapy. It's also important to seek support from colleagues and supervisors, as this can be a challenging case to manage.