Psychiatry and Religion

       Breaking the Taboo

     John Young Foundation Annual Lecture

                                             given by

 Professor John Cox

16 October 2008

This year’s annual lecture was given by the eminent and world renowned psychiatrist, Professor John Cox. He gave a scholarly overview of the concept and practice of ‘medicine of the person’. He structured his presentation in three sections: firstly to outline the interface between religion and spirituality and how this impacts on the practice of psychiatry, secondly to highlight the life and work of Paul Tournier and ‘patient centred care’ and finally to look at the recent coming together of psychiatry and religion enabling the growth in the practice of integrative medicine or ‘medicine of the person’.  A summary of his talk is as follows:

Spirituality and psychiatry: ‘Spirituality’ as a terminology is of recent origin, which has developed over the last 20 years. Spirituality and religious beliefs and practices overlap to a great extent, but there is also a whole realm of spirituality that falls outside the domain of religion and religious people. Spirituality practised by secular humanists include search after ‘meaning’ and ‘truth’. Spirituality can be intra-personal (the quest for inner connectivity in one’s personal sphere), inter-personal (relationship between people and within communities) and trans-personal (reaching beyond self and others into transcendent experience). According to David Larson, spirituality is the yearning and search for the sacred, but extends to the non-sacred goals also, like ‘identity’, ‘belongingness’, ‘health’ and ‘wellness’. Spirituality thus is a source of values and luminous experience based on growth and development. Psychiatrists are meant to be healers of the soul. The term ‘psychiatry’ is after all derived from two words, incorporating psyche (meaning the spirit or the soul) and Iatros (meaning to heal). Spirituality comes into play when one enters into ‘value based’ practice. People do not always pause to think where do these ‘values’ come from. The relevance of these understanding of spirituality in the practice of psychiatry will depend on the socio cultural context of the dominant population and the spiritual and religious perspectives of the practitioner.

Paul Tournier and Person Centred Care: Tournier while practising as a General Practitioner in Geneva expounded the values of spirituality in the practice of medicine and established the International Medicine of the Person Group. For Tournier, there were few contradictions between the relevance of religious beliefs and spiritual practice, meditation, developmental psychology and scientific exploration. He was able to work within and interface with biblical theology, psychoanalytical way of thinking and into science and medical practice.

Turner had published some 20 books between 1939 and 1986 and had made seminal contribution to the concept of ‘holistic’ practice or medicine of the person. Professor Cox made a special reference to one of Tournier’s books ‘The violence within’, which describes how violence and aggression are handled from where they come from, within individuals and from society and how they can be contained and sublimated within a Christian context. Tournier held that the doctor has two tasks: a scientific task, aimed at diagnosis and treatment and a human task, aimed at the development of the patient as a person. The aim is to rediscover the very sources of medicine, as medicine concerns itself with ‘man’. Science is essentially ‘analytic’ and looks at people as ‘things’ or ‘mechanisms’. For Tournier, in a scientific approach the ‘whole’ was missing. If we are to discover the ‘whole’, we should enter into a personal relationship with a spiritual dimension. What is spiritual in man is his need for relationship, with his neighbour, with nature, with society and with god. This is the widest definition of the spiritual life.

Contemporary Issues: Spirituality is more than just religiosity. Our concept of spirituality is underpinned by theological, philosophical and cultural considerations. Role models like Paul Tournier, John Young, Andrew Sims and Frazer Watts have had an impact on psychiatrists during their learning and apprenticeship training experiences. At one time, the religiosity gap in the practice of medicine seemed to be huge, but is rapidly closing. There is unprecedented interest among mental health professionals, service users and carers alike, in spiritual matters as well as in the impact of religious beliefs in the treatment and recovery of mental disorders. These changes are driven by user and carer movement, whose emphasis is for a recovery combined with hope and positive well-being. Psychiatrists are both bio-psycho-social scientists as well as generic healers. Thus they are expected to explore the brain-mind interface. Brain and mind are two qualities, but one substance. The bio-psycho-social practice thus extends to incorporate a spiritual dimension to become a bio-psycho-social and spiritual approach.

There are implications for training. Psychiatry should be exposed to training in the relevance of religion and spirituality in the course of diagnosis and management of mental disorders as well as wider philosophical assumptions underlying mental health. Teaching in small groups will be particularly useful in which students describe their own ‘world view’. Yet there are mysteries here. There are leaps of faith and the motivation of hope and aspiration. With these developments, there is a possibility of a generic ‘spiritual view’ of man emerging, as predicted by Paul Tournier. There is also the unlocking of the religious brain. There is a longing among world psychiatrists and the structures to support this new approach are emerging that will span all world religions. Mental disorders and their cure will change to some extend with these changes so that treatment can be not only individualised, but also personalised. The therapy of the ‘healing relationship’ so deeply ingrained in the Christian tradition of ‘befriending’ will be retained. That is the true recovery of nerves and the breaking down of the artificial barriers between psychiatry and spirituality. That is the movement towards a truly integrative psychiatry and the ‘medicine of the person’.

Paul Srinivasan

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