Religious People and Psychiatrists Don’t Trust Each Other

And that’s not good. But there is hope.

As an academic psychiatrist and a person of some faith, I live in two worlds that are generally regarded as competitive, if not incompatible. While my colleagues at Harvard wonder what I see in faith beyond coping mechanisms, my religious friends wonder how I can practice what seems to them a thoroughly secular, if not anti-religious, profession.

Many of my patients live in this tension: the survivor of childhood sexual abuse who—even after receiving sustained prayer—is still suicidal but does not want to be medicated; the depressed pastor who believes God is punishing him, and that taking an antidepressant would represent a lack of faith; the college student who came out to his family and had been sent for treatment by parents who want him to change; and the religious couple with a shaky marriage who want a therapist whose values they can trust.

I also often wonder how much a given patient needs medical assistance to be freed from their dependencies and how much they need to give themselves more fully to God. In order to help broker conversations around questions like these, two years ago I helped form the Caucus on Spirituality, Religion and Psychiatry at the American Psychiatric Association (APA). This group of around 50 psychiatrists was pleasantly surprised to learn that the APA was about to reach out to the faith community. What could this mean for the many people who suffer intertwined emotional and existential problems?

The statements the caucus has since put together note the fraught history between religion/spirituality (I’ll shorthand this to “R/S”) and psychiatry. Western medicine originated in an era when illness represented disfavor from the gods, healing involved gaining favor from the divine, and priests had unique roles as healers. During the Middle Ages, the first hospitals developed in monastic communities, and nuns served as nurses. But the Enlightenment brought major shifts in the Western view of the self and of the human condition. Freud’s militant atheism and the rise of neurobiology increased the divide between R/S and psychiatry.

And that’s where we are today. A prominent evangelical Christian, while acknowledging that psychiatry and psychology have made useful contributions, recently issued a warning that “much of those disciplines are built on a faulty worldview and must be (at least partly) rejected.” In a 2013 telephone survey of a representative sample of 1,001 Americans about mental illness, 35 percent of respondents (and 48 percent of evangelical, fundamentalist or born-again Christians) agreed with the statement, “With just Bible study and prayer, ALONE, people with serious mental illness like depression, bipolar disorder, and schizophrenia could overcome mental illness.” Meanwhile, most mental health professionals, who as a group are much less religious than the general public, suspect religion of being judgmental, masochistic, homophobic, misogynistic and monolithic.

So the two camps are not doing a great job of talking with each other.

But there is some good news! Twelve-step spirituality is widely valued in both camps. Psychoanalysts (such as Rizzuto) have revised Freud’s understanding of faith. Mindfulness has become mainstream. Palliative medicine includes spiritual care among its goals. Research into the effects of religion on and into the neurobiology of spiritual experience is growing. Most patients surveyed want R/S included in their therapy. Courses, papers, journals and books in this area have proliferated, many sponsored by interest groups within mental health organizations such as the American Psychological Association, the Royal College of Psychiatrists and the World Psychiatric Association. Seven doctoral programs in clinical psychology now exist within Christian universities. And while psychiatrists are less religious than other doctors, Curlin et al. found in a national survey that they increasingly advocate asking patients about spiritual concerns.

Those gains embolden me to look at the work yet to be done. On the one hand, the purpose of both psychiatry and R/S is to enhance human flourishing. And they share the understanding that this involves developing several key qualities:

  • adaptive capacities (like being reflective and regulating emotions)
  • a solid identity
  • realistic hopes
  • meaningful activities
  • authentic relationships
  • a mature moral life
  • and a balance between autonomy and respect for authority

Where they disagree is the relative importance and role of each of these categories. R/S places greater emphasis on growth and transformation toward full functioning than it does on critical thinking about the diagnosis and treatment of disorders. It places a greater emphasis on relationship to the transcendent and the community than it does on individual mastery.

Regular interaction between mental health and spiritual care professionals remains the exception rather than the rule. During one month, 60 percent of the oncology patients seen in psychiatric consultation at my institution were also known to a chaplain, but no documented communication took place between the chaplains and the psychiatrists. Relatively few seminaries or Clinical Pastoral Education curricula devote time to the care of major mental illness, despite the fact that clergy are often the first professionals approached by many individuals with mental health and family problems. And very few psychiatric residency programs include training in the clinical significance of R/S.

For all that, I have recently learned about a number of encouraging models of communication and collaboration: a mental health clinic in a Coptic church on Staten Island; a psychologist accepting regular referrals from Orthodox rabbis in New York; a list serve of Christian therapists used to facilitate referrals in greater Boston; a web-based course on mental health and substance abuse for South Asian pastors; and recent conferences for mental health and spiritual care professionals jointly sponsored by a mental health center in Vermont, the New Jersey Psychiatric Association, Saddleback Church in California and a consortium of entities in Toronto and Houston.

I also was encouraged recently when I attended a prominent APA gathering that brought together a diverse group of people committed to better serving the mentally ill—who often turn first to their faith communities for help. It was particularly moving to see the standing ovation given to former congressman Patrick Kennedy, co-sponsor of the Mental Health Parity and Addiction Equity Act, who described his own recovery from alcohol and substance abuse and the important role that spirituality played in that recovery. He concluded his speech by challenging the audience to follow the example of church leaders during the civil rights movement, calling for “another Bull Connor or lunch counter moment” to galvanize the conscience of the country on behalf of the mentally ill. Discussions in the workshops that followed acknowledged the need for “a movement, not just a moment,” pointed up exciting resources such as Pathways to Promise and sketched out some possible next steps toward continued dialogue to reduce the longstanding dissonance that so many of us feel.

I’m still in the trenches with these questions. I don’t know whether we care enough yet to catalyze a new Bull Connor or lunch counter moment. But gatherings like these and sites like Horatio do inspire me to keep trying.

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