Spirituality, Religion and Psychopathology: Towards an integrative psychiatry

Abstract

The concepts of person-centred medicine and of psychiatry for the person offer, perhaps more than any other current biopsychosocial concept, the opportunity to develop a truly integrated approach to the psychiatric patient as a person suffering from mental turmoil. Within this approach to patients as people it is often necessary to give thorough attention to the patient’s spirituality, religious beliefs or worldview. Person centred psychiatry offers a well grounded reason for incorporating spirituality and religion into psychiatric assessment, diagnosis, case-formulation, therapy, and as a component of psychiatric training and continuous professional development. In this paper we consider the need for increased understanding of the nature of religious belief and of the variety of spiritual practice if a truly person centered psychiatry is to be practiced. Psychiatry sits on a three-legged stool of science, art and ethics [1]. Its provenance therefore includes understanding the spirit (soul) of patients, their Weltanschauung (View of the World) and the quality and meaning of their personal and professional relationships. The bio-psychosocial model of George Engel was based on general systems theory and yet successfully encouraged doctors to consider the social and psychological aspects of patient care in addition to biological parameters. The model however was considered primarily as a causal scientific framework, which could neglect its full potential to promote a humanistic person centered medicine. A biosocial/psychospiritual relationship based approach to health care provision is perhaps therefore closer to the essence of a Psychiatry of the person [2] as it is within this wider perspective that consideration of religious faith and spiritual practice optimally resides. Paul Tournier, pioneer of ‘medicine of the person’, encouraged crossing the boundaries of science, spirituality and psychology within the specific context of the doctor-patient relationship [3]. This bridging of disciplines is facilitated by new knowledge of the complexity of neuronal circuits, and recognition that religious belief has a partial origin in brain function and yet also determined by metaphysical events and transformational experiences. For Tournier, a Genevan family practitioner, there were no contradictions between his understanding of religious belief, the importance of spiritual practice (meditation), the dynamic of personal growth, and the scientific/biological exploration of illness for the optimal practice of medicine.