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Research in spirituality and mental health

  • Christopher C. H. Cook (a1), Simon Dein (a2), Andrew Powell (a3) and Sarah Eagger (a4)
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Abstract
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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.
References
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1 Crowley, N, Jenkinson, G. Pathological spirituality. In Spirituality and Psychiatry (eds Cook, CHC, Powell, A, Sims, A): 254–72. RCPsych Publications,, 2009.
2 Dein, S, Cook, CHC, Powell, A, Eagger, S. Religion, spirituality and mental health. Psychiatrist 2010; 34: 63–4.
3 Hansen, LK, Maguire, N. Divine intervention in mental health. Psychiatrist 2010; 34: 258–9.
4 Koenig, HG. Handbook of Religion and Mental Health. Academic Press, 1998.
5 Koenig, HG. Research on religion, spirituality, and mental health: a review. Can J Psychiatry 2009; 54: 283–91.
6 Blazer, DG. Religion, spirituality, and mental health: what we know and why this is a tough topic to research. Can J Psychiatry 2009; 54: 281–2.
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BJPsych Bulletin
  • ISSN: 1758-3209
  • EISSN: 1758-3217
  • URL: /core/journals/bjpsych-bulletin
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Research in spirituality and mental health

  • Christopher C. H. Cook (a1), Simon Dein (a2), Andrew Powell (a3) and Sarah Eagger (a4)
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eLetters

Psychiatry, religion and spirituality: a way forward

Rob Poole, Professor of Mental Health
22 July 2010

Recent correspondence in The Psychiatrist suggests that there are conflicting, or perhaps polarised, opinions about the role of spiritualityand religion in UK psychiatric practice (for example 1,2,3,4). In their latest contribution to the debate, Cook et al. 5 state that ‘it is important not to rely only on impressions derived from clinical experiencebut 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, whilst rhetoric and the selective interpretation of evidenceare 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, whilst Koenig’s review of the literature 6 suggests ‘modest positive effects of religious faith’ 5, we prefer Richard Sloan’s review 7of 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 thanKoenig, 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 8. Whilst mental health professionals have demonstrable skills in the relief of suffering due to mental disorders, there is no evidence than we have any answers to problems of human happiness. There are other, non-clinical,routes to happiness. Thus we agree with Sloan et al.9, 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 toscience. In any case there is no reliable evidence with regard to the consequences of integrating spirituality/religion into routine psychiatricpractice 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 10 for Koenig’s proposals 11, 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 12, we argue that Koenig’s proposals are in breach of GMC 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’ (http://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 toproduce guidelines on broad principles and, in addition, to address a narrow range of specific issues, such as:

•Is it acceptable to pray with patients? If so, under what circumstances and with what safe guards?•Should a spiritual history be taken from all patients? Should this include atheists?•Is it acceptable for psychiatrists to challenge unhealthy religious beliefs? How can this be assessed reliably? How can it be distinguished from proselytisation?•Should members of the College who write scientific papers for journals concerning religion or spirituality declare their religious affiliation asa 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.

Declaration of interests: RP is an atheist. RH is a Bhuddist.

1.Poole R, Higgo R, Strong G, Kennedy G, Ruben S, Barnes R, Lepping P, Mitchell P. Concerns over professional boundaries remain unresolved. The Psychiatrist (2010) 34: 211-212.2.Cook C, Dein S, Powell A, Eagger S. Spirituality and boundaries in psychiatry. The Psychiatrist (2010) 34: 257-2583.Mackin C. No religion or spirituality and mental health. The Psychiatrist (2010) 34: 3044.Zwi M. Declare, declare! The Psychiatrist (2010) 34: 304-3055.Cook C, Dein S, Powell A, Eagger S, Research in spirituality and mentalhealth, The Psychiatrist (2010) 34: 304.6.Koenig HG. Handbook of Religion and Mental Health. (1998) New York: Academic Press7.Sloan RP. Blind Faith: The unholy alliance of religion and medicine. (2008) New York: St Martin’s Griffin.8.Poole R, Higgo R. Clinical Skills in Psychiatric Treatment (2008) Cambridge: Cambridge University Press.9.Sloan R, Bagiella E, Powell T. Religion, spirituality and medicine. Lancet (1999) 353: 664-667.10.Hollins S. Understanding religious beliefs is our business. Invited commentary on... Religion and mental health. Psychiatric Bulletin (2008) 32: 20411.Koenig HG. Religion and mental health: what should psychiatrists do? Psychiatric Bulletin (2008) 32: 201-203.12.Poole R, Higgo R. Spirituality and the threat to therapeutic boundaries in psychiatric practice. Mental Health, Religion and Culture (2010) (in press).
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Conflict of interest: None Declared

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