Electronic Letters to:
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eLetters: Electronic letters published:
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Partnerships between psychiatry and faith based organisations
- Simon Dein (10 August 2007)
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Interface of Psychiatry and Religion
- Dr.Sathish Masil (10 August 2007)
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Exorcising the devil: Partnerships between faith communities and mental health services
- Prathap Tharyan, Anna Tharyan, Sara Bhattacharji (15 August 2007)
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Re: Partnerships between psychiatry and faith based organisations
- Gerard Leavey (25 September 2007)
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Interface of Psychiatry and Religion
- Noel S McCune (12 October 2007)
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Spirituality and Psychiatry
- Prof K.A.L.A. Kuruppuarachchi MD,FRCPsych(UK) (18 October 2007)
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Religious agencies may promoting positive mental health: needs more research
- Om Prakash (27 February 2008)
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Simon Dein, Psychiatrist University College London
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s.dein{at}ucl.ac.uk Simon Dein
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S. Dein, Centre for Behavioural and Social Sciences in Medicine, University College London, Charles Bell House, 67 Riding House Street, London W1N 8AA Correspondence: E mail: s.dein@ucl.ac.uk Leavey and King (2007) provide a useful overview of the relationship between clergy and psychiatry. Although I wholeheartedly agree that there should be partnerships between psychiatry and religious sectors, I found the discussion to be one-sided. They say little about what religion can offer psychiatry. It is well recognised that religious states are often misdiagnosed as mental illness (Dein 2004). Religious professionals can play a pivotal role in teaching mental health professionals abut normative religious experiences and thus enable them to make better informed diagnoses. It is not just that religious professionals need to be educated about mental illness, but also, it is vital that psychiatrists understand religious experience. Of course ideas about mental illness reflecting sin still exist in some religious communities but in my own fieldwork among both Orthodox Jews and Pentecostal Christians, it is evident that rabbis and pastors increasingly recognise mental illness as a state independent of moral indiscretion. Even in communities where extreme religious experiences, such as hearing God’s voice, are prevalent, religious leaders are able to differentiate these experiences from the symptoms of severe mental disorder (Dein and Littlewood 2007). Similarly they are able to differentiate psychoses from states of spirit possession (which themselves require stringent criteria for their diagnosis within the religious context). Beyond this, there is emerging evidence that religion can play an important role in facilitating coping with life stressors (Pargament 1997). Mental health professionals need to be knowledgeable about the circumstances in which referrals to religious professionals are appropriate. They should be aware that for religious believers, prayer and ritual may play a central role in the healing process. Of course involvement in such activities may influence pathways to care but there is ample evidence that religious and biomedical forms of healing can work well together: biomedicine healing the body and religion healing the soul (Littlewood and Dein 1995). Finally I take issue with the statement that biomedical and spiritual models of illness are necessarily conflicting. Spirituality and biomedicine offer different types of explanations for the patients’ problems. The art of medicine should be to learn how to combine different treatments in order to provide more holistic care to patients. Declaration of interest REFERENCES Dein S (2004) Working with patients with religious beliefs. Advances in Psychiatric Treatment: 10, 287-295. Dein and Littlewood (2007) The Voice of God. Anthropology and Medicine 14(2), 213-228 Leavey G and King M (2007) The devil is in the detail: partnerships between psychiatry and faith based organisations. British Journal of Psychiatry 191, 97-98 Littlewood R and Dein S (1995) The effectiveness of words: Religion and healing among the Lubavitch of Stamford Hill. Culture, Medicine and Psychiatry 1,339-383. Pargament K (1997) The psychology of religion and coping: theory, research, practice. New York: Guildford Press. |
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Dr.Sathish Masil, SpR.Liaison Psychiatry Birmingham &Solihull Mental Health NHS Trust
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gmashil{at}yahoo.co.uk Dr.Sathish Masil
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Editorial The Devil is in the detail: Partnerships between psychiatry & faith based organisations: British Journal of Psychiatry- August 2007 (Vol 191). Letter to the Editor: It is an interesting point to note in the editorial about the difficulty in assessing the role of clergy and faith based organisations in promoting better mental health. Faith & other religious term are still not considered as an explicit language of psychiatry. Faith is a multi-layered phenomenon, involving a belief about things of which we are uncertain accompanied by an expectancy and/or conviction (David Clarke 2003). The bible defines faith as being sure of what people hope for and certain of what they do not see (NIV Heb 11:1). Faith is seen as a nebulous concept and its benefit is beyond objective scientific measurement. Despite this difficulty, WHO clearly stress the value of concepts like faith, hope and compassion in the healing process from any illness (WHO 1998).Religions based on strong faith and beliefs have evolved and persisted over centuries and people do turn to religion, when coping with life stressors (Pargament 1997). If this spiritual craving is to be capitalised, in promoting better mental health and holistic care, stronger collaboration is important between psychiatrists and religious professionals (Lorna H Rattray 2002,Simon Dein 2004)). It is encouraging to note despite the constant suspicion between psychiatry and religion (Bhugra 1997), the incorporation of religious principles based on faith into the treatment strategies especially in the psychotherapy and this should be welcomed. Christian principles in cognitive therapy has been effective and helps in improving the spiritual well being of clients (Lipsker et al 1990, Hawkins et al 1999) The third wave Cognitive Behaviour therapies like Dialectical Behaviour therapy, Acceptance and Commitment Therapy and Mindfulness based Cognitive therapy are closer to religious belief systems and practices. (Andersson and Asmundson 2006). Zen Buddhist ides have been woven into the fabric of Dialectical behaviour therapy process (Clive Robbins 2002). ACT connects with the Buddhist philosophy and practices in accepting the four noble truths and the eight fold noble path (Hayes 2002) The mindfulness based therapies have stronger association with Buddhism, its empirical database and its application for stress reduction, health promotion and improved personal functioning (Clive Robbins 2002). This gives an early hope that mainstream psychiatry and religion with strong faith and belief system can work together in collaboration in ameliorating the psychopathology and improving the well being of patients. References: Andersson & Asmundson (2006) CBT and religion-Editorial Cognitive Behavior Therapy 35(1), 1-2 Bhugra D (1997) Psychiatry and Religion: Context, Consensus and Controversies. Routledge Clive Robins (2002) Zen principles and mindfulness practice in DBT. Cognitive and Behavioural Practice 9,50-57 David Clarke (2003) Faith and Hope: religion and Spirituality. Australasian Psychiatry 11(2) 164-168 Hawkins et al (1999) Secular Vs Christian In-patient CBT Programs. Impact on depression and spiritual well being. Journal of psychology and Theology 27,309-331 Hayes S (2002) Buddhism and ACT. Cognitive and Behavioural practice 9,58-66 Lipsker Lee & Oordt Ruth M (1990) Treatment of depression in adolescents: A Christian Cognitive Behaviour therapy approach-Journal of Psychology and Christianity 9(4), 25-33. Lorna H Rattray (2002) Significance of the chaplain within the mental health care team. Psychiatric Bulletin 26,190-191 NIV-New International Version Bible (2002) International Bible Society. Hodder & Stoughton Religious. Pargament KI (1997) The psychology of religion and coping. New York. Guildford Press. Simon Dein (2004) Working with patients with religious beliefs. Advances in psychiatric Treatment 10,287-295 World Health Organisation (1998) WHOQOL and Spirituality, Religiousness and Personal Beliefs: Report on WHO Consultation. Geneva: WHO. Authors: Dr Sathish Masil SpR-Liaison Psychiatry. Birmingham Solihull Mental Health NHS Trust. New bridge House.130.Hobmoor Road, Small Health. Birmingham B10 9JH Email: gmashil@yahoo.co.uk ____________________________________________________________ |
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Prathap Tharyan, Doctor Professor of Psychiatry, Christian Medical College, Vellore, Anna Tharyan, Sara Bhattacharji
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prathap{at}cmcvellore.ac.in Prathap Tharyan, et al.
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The timely editorial by Leavey & King (1) coincides with efforts by some faith based communities to include Mental Health as a key issue in their mission(2). Though recognizing the traditional suspicions that have marked the relationship between psychiatry and religion, the editorial attempts to define the parameters of potential engagement; these echo the deliberations and conclusions of an international and ecumenical study consultation on 'The Global Health Situation and the Mission of the Church in the 21st Century' at the Christian-Jensen Kolleg, Breklum, Germany, from 25 September to 30 September, 2005. This consultation was organised by the World Council of Churches (WCC) mission study and health desks with the Northelbian Centre for World Mission and World Service (NMZ) and led to a set of suggestions whereby faith communities could partner the World Health Organization's Mental Health Global Action Programme (mhGAP,(3) an effort to implement the recommendations of the World Health Report, 'Mental Health: New Understanding; New Hope'.(4) These suggestions form the draft for a call to action that the WCC has endorsed, and are only representative of the many options that are available for faith communities to partner international efforts in reducing the burden of mental illness.(5) They cover examples of potential collaborative partnerships in training health service providers, clergy and congregations, education and stigma reduction, service provision in coordination with local health agencies, collaborative research, advocacy and funding. A copy of the full set of recommendations and related papers is available on request. While there are many instances where supernatural beliefs in mental illness causation and attempts at resolution through exorcism of demons, deliverance rituals and religious conversion have caused consternation and harm, there are many instances, of which many remain untold, where individually initiated spiritual solutions and community-initiated practical programmes have resulted in good. The heterogeneity of beliefs about suffering and healing found among mainstream faith-based organisations and of Pentecostal movements(1) are matched by the heterogeneity of beliefs about the causation and treatment of mental health problems among mental health professionals. Exorcising the Devil can only occur if faith communities and mental health service providers respect mutual positions, (irrespective of the levels of faith or evidence on which they are based) learn from each other and, ultimately, find a common platform to work with those who suffer- one in four of us and our families. References: 1.Leavey G, King M (2007) The devil is in the detail: partnerships between psychiatry and faith-based organisations. British Journal of Psychiatry, 191, 97-98. 2.Tharyan P, Braganza D, Jebaraj P (2006) Mental Health as a key issue in the future of global health developments International Review of Mission, 95, 36-49. 3.World Health Organization (2002). Mental Health Global Action Programme (mhGAP). Geneva, World Health Organization. 4.World Health Organization (2001) The World Health Report 2001. Mental Health: New Understanding, New Hope. Geneva, World Health Organization. 5.Breklum Consultation on the healing ministry (2006) Documentation1; Recommendation from Groups. International Review of Mission, 95, 166-178. Prathap Tharyan Professor of Psychiatry Anna Tharyan Professor of Psychiatry Sara Bhattacharji Professor of Community Health Christian Medical College Vellore 632002 Tamil Nadu India Declaration of interest: All authors are part of the WCC group working on Mental Health Issues |
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Gerard Leavey, Assistant Director R&D Barnet, Enfield and Haringey Mental Health Trust
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Gerard.Leavey{at}beh-mht.nhs.uk Gerard Leavey
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Dr Dein argues that our editorial (Leavey & King, 2007) on collaboration between psychiatry and religion is biased in that we failed to discuss what religion has to offer psychiatry. To be clear, we feel that many faith-based organisations and their clergy contribute much towards human welfare and healing and we would have been happy to discuss this in more detail. However, the focus of the paper was to highlight the barriers and dangers in partnerships between religion and psychiatry. Our own research with clergy has helped clarify some of these issues (Leavey, in press; Leavey, et al, 2007). Thus, clergy of all sorts find themselves perplexed by people with mental health problems and appear to be generally untrained and unsupported by both their own organisations and by mental health services. While some clergy are able to distinguish religious from psychiatric phenomena, others are not. On this matter, Dr Dein’s reference to his study of lay members of a white Pentecostal congregation seems barely relevant. Moreover, we never suggested that biomedical and spiritual models of illness necessarily conflict but in some instances, and among some religious groups, they do. To treat faith communities and their clergy as homogeneous entities is somewhat simplistic to say the least. While Dr. Dein advocates a more holistic approach in medical care, does he intend this to extend to exorcism and deliverance rituals? This question touches on the central concern of our editorial. It is easy to talk about inclusivity in psychiatry but it is likely to become rather more problematic should clinicians find themselves encouraged to engage with some of the more exotic aspects of spirituality and religion, that is, those that stray somewhat beyond prayers and visits from the local vicar. While we agree with Dr. Masil that religion and spirituality, or in his own terms, ‘faith’, should be of greater interest to psychiatric practice and research, we cannot agree that “its benefit is beyond objective scientific measurement”. Although problems of definition and measurement exist, many health studies of this kind have been undertaken, particularly in the USA where there is less hostility to research on spirituality and health than exists in the UK. Leavey, G. (in press) UK Clergy and People in mental distress: community and patterns of pastoral care. Transcultural Psychiatry. Leavey, G. & King, M. (2007) The devil is in the detail: partnerships between psychiatry and faith-based organisations. British Journal of Psychiatry, 191, 97 - 98. Leavey, G., Loewenthal, K. & King, M. (2007) Challenges to Sanctuary: the clergy as a resource for mental health care in the community Social Science and Medicine, 65, 548-559. |
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Noel S McCune, Consultant Child Psychiatrist Southern Health & Social Care Trust
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noel.mccune{at}southerntrust.hscni.net Noel S McCune
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Sir, Leavy and King's (2007) “persuasive and didactic role” for psychiatrists in dealing with contested normative values such as those related to sexuality runs the risk of control of belief. While people of conservative religious faith should be encouraged to understand progressive narratives and to examine how their values interact with those of progressive persuasions, it is just as important for progressives to understand conservative narratives and to examine how their values may affect their ability to provide culturally sensitive services to people of faith. Taking, for example, the psychological difficulties of religiously conflicted homosexually oriented individuals it is unhelpful to conceptualize these as exclusively due to internalized homo-negativity for which the prescription is education and persuasion for the individual and for society into an enlightened world-view. Religious convictions cannot just be airbrushed away because they are inconvenient to secular world- views. A helpful contribution, which attempted to address and to meet the needs of homosexual people who feel dissonance with their religious beliefs was described elsewhere. Haldeman (2004) a former chair of the American Psychological Association's Committee on Lesbian, Gay and Bisexual Concerns and Beckstead and Morrow ( 2004) Gay and Lesbian identifying Mormon psychologists reported on religious individuals who have, with varying outcomes, pursued so called “sexual reorientation” or reparative therapies. Their qualitative research documented the critical ways in which context, identity, and values intersect, sometimes clashing in painful ways. The research legitimised the idiosyncratic experiences of different individuals’ coming-out processes and attempted to build a model based on these experiences, rather than labelling them as exceptions to a presumed common healthy or adaptive outcome (i.e., coming out as gay). It showed how religious affiliation can serve as a central, organizing aspect of identity which the individual cannot relinquish, even at the price of sexual orientation. For some, described in the studies, who had chosen sexual reorientation therapy the potential losses of family, community, belief system, and core identity were so great that although attempting to change or manage sexual orientation was a steep price, it was one they chose to pay. The key issue for some was not so much about “coming out as gay” but rather working out how their experiences could become more or less consistent with deeply held belief systems. It is crucial therefore for mental health professionals to understand that the resolutions of conflicted identities are unique for every individual. Tyrer (2007) is right in pointing out that the same evidence can be interpreted in entirely different ways by different belief proponents and that belief will not go away just because apparently persuasive evidence is presented. There is a risk that persuasion can silence and as Hartman (1993) states “there is no better way to subjugate human beings than to silence them.” Leavey G. & King M. (2007) The devil is in the detail: partnerships between psychiatry and faith based organisations. British Journal of Psychiatry 191, 97-98. Haldeman D. (2004) When sexual and religious Orientation Collide: Considerations in working with conflicted same sex attracted males. The Counseling Psychologist 32, 691-715. Beckstead A. and Morrow S. (2004) Mormon Clients experiences of conversion therapy: the need for a new treatment approach. The Counseling Psychologist 32, 651-690. Tyrer P. (2007) From the Editor's desk. British Journal of Psychiatry 191, 188. Hartman, A. (1993) Out of the closet: Revolution and backlash. (Editorial) Social Work. 38, 245-246,360 Noel McCune Consultant Child Psychiatrist Child and Family Clinic, 2 Old Lurgan Road, Portadown. BT63 5 SG N.Ireland TEL 02838 392112 FAX 02838 361968 Declaration of Interest: None |
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Prof K.A.L.A. Kuruppuarachchi MD,FRCPsych(UK), Professor of Psychiatry Faculty of Medicine, University of Kelaniya,Ragama,Sri Lanka
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lalithkuruppu{at}lycos.com Prof K.A.L.A. Kuruppuarachchi MD,FRCPsych(UK)
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Gerard Leavy and Michael King (2007) highlighted an important aspect of psychiatric care in their recent editorial. The content of the article is relevant to most of the regions, particularly to developing countries as many seek help from religious and traditional healers in addition to western psychiatric care when they are mentally ill. The reasons may be related to the prolonged course of many mental illnesses , poor response to existing methods of treatment, cultural belief systems etc. It has been shown that psychiatry has failed to improve happiness and well being as a result of neglecting methods to improve positive emotions, character development, life satisfaction and spirituality (Cloninger, 2006). More attention has been focused on spirituality and psychiatry since of late. Though there were many drawbacks, rapprochement between religion and psychiatry has been commenced and this trend is unlikely to be reversed (Turbott, 2004). In developing countries, therapists are already incorporating religious beliefs in taking care of their patients (Kuruppuarachchi & Lawrence, 2006). Spiritually augmented cognitive behavioural therapy has been tried in Australia as well with positive results (D’souza & Rodrigo, 2004). Even though there are risks involved in incorporating religious activities in patient care, the patients and the relatives will continue to seek help from religious healers more often than what we expect. This is particularly true for eastern cultures. However one should not under estimate the magnitude of the problem in the west. Psychiatrists should be aware of this sensitive issue and take necessary steps to improve their patient management. References Gerard, L.& Michael,K.(2007) The devil is in the detail : partnership between psychiatry and faith-based organizations. British Journal of Psychiatry, 191, 97-98. Cloninger,C.R.,(2006) The science of well-being : an integrated approach to mental health and its disorders. World Psychiatry, 5 ;2: 71- 76. Turbott, J.(2004) Religion, spirituality and psychiatry: steps towards rapprochement. Australasian Psychiatry, 12;2: 145-147. Kuruppuarachchi, K.A.L.A. & Lawrence, T.S.(2006) Incorporating spiritual and religious beliefs in taking care of the elderly with psychiatric problems – Some personal experiences. Indian Journal of Geriatric Mental health, 2;1: 51-54. D’Souza, R.F. & Rodrigo, A.(2004) Spiritually augmented cognitive behavioural therapy. Australasian Psychiatry, 12;2: 148-152. |
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Om Prakash, Assistant Professor of Psychiatry National Institute of Mental Health And Neurosciences(NIMHANS), Bangalore-29, INDIA
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op{at}nimhans.kar.nic.in Om Prakash
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I would agree with the editorial (1) about the difficulty in assessing the role of clergy and faith based organizations in promoting better mental health. It is a common practice that psychiatrists ask clients to search the ways of relaxation either yoga, meditation or visit church/temple. It should be notable point that the most of neurotics not coming to psychiatrists because of these religious practices in their vicinity and probably getting benefits there. In my experience, some religious agencies (most notably, the Radha Soami sect based in northern India)(2) have also been promoting health promotion among substance abusers to organize themselves and to help each other in finding solutions to their substance abuse and rehabilitative problems. It is controversial topic and there is need to do enough research in this area. References: 1. Leavey G and King M. The devil is in the detail: partnerships between psychiatry and faith-based organisations. The British Journal of Psychiatry 2007; 191: 97-98. 2. Jhirwal OP, Basu D. Involvement of Alcoholics Anonymous and other self- help groups in professional treatment of substance abusers: an Indian perspective. J Subst Abuse Treat. 2005; 29(1):65. |
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