Spirituality and Psychiatry

Member Dr Andrew Powell was the founding chair of the special interest group of the Royal College of Psychiatrists on spirituality and psychiatry as far back as 1999. Significantly - and surely this is the sign of the times - this SIG is now the largest in the College, with nearly 25% of the total membership. I remember discussions during the 1990s in the Network Council, of which Andrew was an active member, on whether we could risk using the ‘S-word’ – the ethos around the use of the term spirituality has been transformed, and sociologists of religion now employ the term SBNR – spiritual but not religious. This has been a process of ‘coming out’, which I am sure has been professionally facilitated for psychiatrists by the existence of the SPSIG. Just recently on a Galileo Commission Summit, a number of contributors were remarking that it is now much easier to speak about one’s spiritual experiences than it was at the beginning of their careers. I also remember Dr Jean-Marc Mantel speaking about spirituality and psychiatry at our second Beyond the Brain conference in 1997.

The first edition dates back to 2009, and the new one has been extensively revised, updated and expanded while continuing to advance an argument for the importance of spirituality in psychiatry, with respect to both research and clinical practice,. As such, it is designed primarily as a clinical handbook. There are completely new chapters on common mental disorders, forensics psychiatry, DSM-5, spiritual interventions and the patient perspective. Gaps still noted by the editor include eating and personality disorders. The editors argue that spirituality is every bit as important now, focusing attention as it does ‘on the things that matter most to people – relationships with self, others and our wider reality that provide motivation, meaning and purpose in life’. They note that there is still a lack of training in medical curricula. The emphasis on spirituality is surely even more important in relation to the continuing rise in mental health issues, although Lucy Johnstone in a recent webinar argued for a complete reframe with her Power Threat Meaning Framework, which is an ambitious attempt to outline a conceptual alternative to psychiatric diagnosis based not on mental illness but on meaning-based distress highlighting the centrality of narratives.

Andrew provides a personal reflection on the SPSIG in the context of his own career and developments in psychiatry more generally, which he covers in his article in this issue. During his training, patients were more often talked about than talked with, an observation also made by Dr Thomas Verny in my recent Imaginal Inspirations interview. Tom described how popular he was in his residency when it became known and that he was actually listening to and talking with patients! Andrew discovered the importance of spirituality on his own path, encouraging his patients to go within. He adds that ‘regardless of diagnostic labels, human distress needs to be met with sensitivity and psychological understanding’ within a framework of person-centred care, encouraging genuine dialogue and getting alongside patients.

The first 13 chapters cover a wide range of themes, beginning with spirituality and religion in psychiatry and spiritual assessment, then moving onto specific chapters on psychosis, suicide, child and adolescent psychiatry, the spiritual dimension of psychotherapy, intellectual disability, substance misuse and addiction, common mental disorders, forensic psychiatry, the neuroscience perspective on meditation, prayer and healing (co-author Peter Fenwick), religion and spirituality in the DSM and ICD, and finally spiritual care in NHS. The second part looks in more detail at spiritual and religious interventions including mindfulness, compassion-focused therapy, religiously integrated CBT, and forgiveness therapy. Then there are chapters on the patient perspective, religion and religious experience, pathological spirituality, and ageing. The new edition also contains an extensive cross-referenced glossary that includes such topics as past life regression therapy, possession state, soul, spirit release therapy and spiritual awakening. The editors are to be congratulated on producing such a hugely informative clinical handbook for their colleagues, which deserves to be widely read also by psychologists and psychotherapists in every English-speaking country.

It looks like the UK is well ahead of the US in this area, and a Google search is headed by The Mental Health and Faith Community Partnership, which is ‘a collaboration between psychiatrists and clergy aimed at fostering a dialogue between two fields, reducing stigma, and accounting for medical and spiritual dimensions as people seek care.’ There is no comparable professional forum in the American Psychiatric Association, although they have issued some ethical guidelines for professionals, and there is a Society for the Psychology of Religion and Spirituality as a division of the American Psychological Association. The British Psychological Society has two sections on transpersonal psychology and consciousness and experiential psychology, also founded by Network Members. One can only hope for the sake of patients that other national psychiatric institutions will follow the UK lead, and a first step would be for their presidents to read this handbook for themselves.