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Psychiatry, religion and spirituality: a way forward

Published online by Cambridge University Press:  02 January 2018

Rob Poole
Affiliation:
Glyndwr University, Wrexham, Wales, email: rob.poole@wales.nhs.uk
Robert Higgo
Affiliation:
Liverpool Assertive Outreach Team, Liverpool
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Abstract

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Creative Commons
Creative Common License - CCCreative Common License - BY
This is an Open Access article, distributed under the terms of the Creative Commons Attribution (CC-BY) license (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.
Copyright
Copyright © Royal College of Psychiatrists, 2010

Recent correspondence in The Psychiatrist suggests that there are conflicting, or perhaps polarised, opinions about the role of spirituality and religion in UK psychiatric practice. In their latest contribution to the debate, Cook et al Reference Cook, Dein, Powell and Eagger1 state that ‘it is important not to rely only on impressions derived from clinical experience but also to refer to evidence-based research and reviews. If we cannot eliminate bias in our interpretation of these findings, we can at least minimise it.’ We agree.

However, although rhetoric and the selective interpretation of evidence are an intrinsic part of scientific discourse, spirituality and religion cause particular problems. Most professionals have deep-seated views that are unlikely to be affected by evidence, no matter how compelling. For example, whereas Koenig's review of the literature Reference Koenig2 suggests ‘modest positive effects of religious faith’, we prefer Richard Sloan's review Reference Sloan3 of similar literature, the conclusions of which can be paraphrased thus: efforts to integrate religion into medical practice are based on bad science, bad medicine and bad religion. We find Sloan more convincing than Koenig, but we note that Sloan's conclusions resonate with our pre-existing attitudes and beliefs.

We have previously argued that psychiatry should only attempt to resolve problems that cannot be dealt with effectively by other means. Although mental health professionals have demonstrable skills in the relief of suffering caused by mental disorders, there is no evidence that we have any answers to problems of human happiness. There are other, non-clinical, routes to happiness. Thus, we agree with Sloan et al, Reference Sloan, Bagiella and Powell4 who have argued that even if the evidence shows that religious faith promotes well-being, it is still inappropriate for clinicians to actively promote religion or to unnecessarily interfere in spiritual matters.

These ideas are more closely related to modern medical values than to science. In any case there is no reliable evidence with regard to the consequences of integrating spirituality/ religion into routine psychiatric practice in the UK. Nonetheless, there is growing controversy on the subject. We believe that a number of statements, including the previous president's apparent support for Koenig's proposals (e.g. praying with patients or consultation with clergy) create a real and undesirable ambiguity as to the limits of generally acceptable clinical practice with respect to religion and spirituality. In a paper presently in press, Reference Poole and Higgo5 we argue that Koenig's proposals are in breach of General Medical Council guidance. It would be unrealistic to expect to resolve all of the current issues of dispute in the immediate future, but we would suggest that it would be possible to identify the boundaries of acceptable clinical practice with regard to the points of greatest controversy.

In 2006, the American Psychiatric Association published guidance on ‘religious/spiritual commitments and psychiatric practice’ (www.psych.org/Departments/EDU/Library/APAOfficialDocumentsandRelated/ResourceDocuments/200604.aspx). It would be timely for the Royal College of Psychiatrists to develop similar guidance. We call on the president to establish a working group to produce guidelines on broad principles and, in addition, to address a narrow range of specific issues.

  1. Is it acceptable to pray with patients? If so, under what circumstances and with what safeguards?

  2. Should a spiritual history be taken from all patients? Should this include atheists?

  3. Is it acceptable for psychiatrists to challenge unhealthy religious beliefs? How can this be assessed reliably? How can it be distinguished from proselytising?

  4. Should members of the College who write scientific papers for journals concerning religion or spirituality declare their religious aliation as a conflict of interest?

Given the depth of feeling expressed in recent correspondence, the task may appear daunting. However, this subject demands serious and immediate attention exactly because it is difficult and contentious. A carefully composed and well- chaired working group that had credibility with all shades of opinion could produce guidance that would allow us to move on from simply restating our disagreements. It would allow service users to know what to expect when they consult us.

References

1 Cook, CCH, Dein, S, Powell, A, Eagger, S. Research in spirituality and mental health. Psychiatrist 2010; 34: 304.CrossRefGoogle Scholar
2 Koenig, HG. Handbook of Religion and Mental Health. Academic Press, 1998.Google Scholar
3 Sloan, RP. Blind Faith: The Unholy Alliance of Religion and Medicine. St Martin's Griffin, 2008.Google Scholar
4 Sloan, R, Bagiella, E, Powell, T. Religion, spirituality and medicine. Lancet 1999; 353: 664–7.CrossRefGoogle Scholar
5 Poole, R, Higgo, R. Spirituality and the threat to therapeutic boundaries in psychiatric practice. Ment Health Relig Cult 2010, in press.Google Scholar
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