The debate between Professors Poole and Cook ^{Reference Poole and Cook1} appears to ignore the fact that spirituality, transcendency and individual religious beliefs expressed in prayer are historically and culturally bound to the social institution of organised religion: the first estate. Neither author acknowledges how the sociology of religion and its place in our society affects whether prayer should be shared between doctor and patient. The Christian religion has been firmly bound to the functioning of organised Western society for well over a thousand years. Consideration of the spiritual needs of patients has been part of holistic care models for decades and is present in the delivery of individualised care plans in most mental health services. However, prayer in day-to-day life does not have an individual identity that is divorced from structured religion. There is a potent social boundary here and it should not be crossed, for sociocultural reasons as well as individual professional ethics.

Poole focuses on the individual boundaries that are appropriate in the doctor–patient relationship, but we have social boundaries based on our religious history that have resulted in our modern social institutions having a broad secular base. When in the UK in 2011, religious assassination of police officers occurs within ‘the single-faith Christian tradition’, when football managers receive bullets in the post because of their particular Christian tradition, when the UK still has regions where religion is more about the fire in the belly and less about the angst between the ears, less ‘happy clappy’ and more ‘happy slappy’, it seems a little naive of Cook to view prayer as a therapeutic tool that can exclude the history of Christianity in this country and the challenges this may pose.

Cook’s arguments emphasise the individual’s connection to the Divine through prayer and the potential benefits this may bring. Historically, this is the argument of the ‘dissenter’, the evangelical Protestant tradition which is a rich faith that can deliver spiritual fulfilment, as can all the branches of the Christian church that exist in the UK today. But again historically, prayer is not just about an individual’s spiritual needs and fulfilment. For St Augustine and St Patrick and onwards, it is also a tool of the missionary for conversion. The form of words used, the rituals and the rites of prayer have an uncomfortable history of conflict and even the unstructured prayer within a nonconformist ‘free church’ comes with a history of struggle.

Within my own psychiatric service, I am happy to say that we can allow everyone the freedom to pray and express their religion as they wish, a right that has emerged from the religious history of the British Isles. I am fortunate in having a specialised team of professionals with decades of training and expertise in meeting and fulfilling the spirituality of our service users. I turn to their wisdom and guidance often when prayer and religious needs present with mental health problems. We call them the hospital chaplains. I don’t pray with the patients. They don’t give depot injections. It works.