Christianity and psychiatry
This new work examines faith and tradition versus medical and scientific knowledge in the psychiatry-Christianity equation.
Christianity and psychiatry
Edited by John R. Peteet, MD; H. Steven Moffic, MD; Ahmed Hankir, MBChB, MRCPsych; and Harold G. Koenig, MD
311 pages; $119 (paperback)
Christianity and psychiatry is the third in a series of books focusing on several angles of the religion-psychiatry equation, published over the past 3 years and edited, virtually, by the same team of researchers. These characteristics confer a high academic quality and a homogeneous set of perspectives on the subject of Christianity and its many links with psychiatry throughout the centuries. The previous 2 volumes dealt with Islamophobia and anti-Semitism as human/behavioural/emotional attitudes. Christianity may not engender a similar breadth of negative responses, but, perhaps for the same reason, its ties to psychiatry present a wider variety of fronts.
This is the goal that the 4 editors – from Harvard Medical School, Medical College of Wisconsin, Duke Medical Center and King’s College London – have pursued by asking a total of 31 authors (23 from the United States , 3 from Canada, 3 from the UK, and 1 each from Scotland and 1 from the Netherlands) to contribute 21 chapters. As the foreword and introduction indicate, the book addresses different levels of faith and tradition in relation to medical and scientific knowledge, their antagonisms and controversies, and their integration and reciprocity.
A panoramic and detailed analysis of the content of the book led this reviewer to formulate a catalog of 5 areas explored over the chapters, areas sometimes clearly delimited, and other times inevitably mixed because of their complexity. It is not an isolating compartmentalization because the connections emerge almost spontaneously; nevertheless, I will describe and explore them as neatly as possible in an attempt to systematize the impressive wealth of reading material. The first 3 areas are history, clinical practice and education, while the last 2 examine implicit contradictions (not of or between the authors, but belonging to the subjects themselves) and certain conceptual or formal absences, but not necessarily formidable.
The historical emphasis touches many chapters with authority. Some readers may think the first, titled “The Heavy History of Psychiatry and Christianity,” would suffice with its impressive deployment of information from biblical sources to lucid insights into the Middle Ages and the accomplishments of legendary figures like Augustine d ‘Hippone, Baxter, Tuke, Brigham, Charcot, Janet and William James over the past 6 centuries.
The questioning of the divinely inspired behaviors of the heroes of the Old Testament as possible psychiatric syndromes also began a long time ago (chapter 3). It seems that the stigma of mental disorders (including self-stigma) has always existed (Chapters 2 and 14). We learn of the Christian origins of Alcoholics Anonymous (chapter 11) and the inclusion of “soul care” envisioned and clearly enunciated by Christian Reil (the originator of the name “psychiatry” for our field) in 1808 (chapter 16).
The controversies between conservative Christians (predominantly Protestant) and liberal Christians generated anger and confusion, but also channeled the first elements of the contemporary concept of liberation theology (chapter 19). Equally important, we learn about the protective attitude of the Prophet Muhammad towards Christians (chapter 19) and we consider the history of ideological and temperamental controversies between Freud (who could be described as an atheist Jew) and some of his early Christian disciples. notables (i.e. Jung), who occupy a crucial place in the doctrinal history of psychiatry and psychoanalysis (chapters 18 and 19).
Clinical practice encompasses diagnostic and treatment/care actions, all reflecting well-defined goals and positively oriented pragmatism. The historical detection of stigma, primarily among Christian (“charismatic”, authoritarian) communities and churches from ancient times, paved the way for the materialization of faith-inspired healing (Chapter 2). In turn, religion and God have become a source of resilience and adaptability, especially among young people (chapter 5). The distinction between psychotic symptoms and spiritual phenomena led to early conceptualizations of clinical processes later named spectra, an important contemporary nosological term that anticipated the great potential of mutually understanding collaboration among clinicians (Chapter 3). In the therapeutic realm, the progressive Christian view enabled the acceptance of “folk healing”, a strongly culturally-based approach to treatment that undoubtedly used elements of support, empathy, encouragement and inspiration in non-Christian or nominally Christian patients (Chapters 1, 18, and 19).
The above reiterates the hermeneutic closeness to “faith as treatment” (Chapter 5), which is also part of the spectrum of therapeutic resources that today’s well-trained and competent mental health professionals are learning to utilize. Spiritual care has a place in the list of therapeutic approaches to a variety of clinical conditions (Chapters 10-13 and 17). This is another way of saying that psychotherapy, as one of the most powerful resources for helping the mentally ill, follows an inclusive trajectory – a complete sequence in which the spiritual crowns a bio-psycho-socio-cultural path towards healing (chapters 8, 12, 14 and 16).
Medical/psychiatric education and training issues are an essential component of this volume. Virtually every chapter conveys valuable notions, ideas and themes that could or should—be incorporated into undergraduate and postgraduate curricula. Quite interesting angles are offered by the Christian evaluation of explanatory medical models of psychopathology (Chapters 2 and 4); comprehensive management of trauma (chapter 6) and psychoses (chapter 13); ‘integration debates’ as group educational activities (Chapter 12); characteristics of Christian psychiatric care delivery and clergy-clinician collaborations (Chapters 14 and 15); and the study of the results vis-à-vis different Christian psychotherapeutic interventions (chapter 18). Didactic principles are often conveyed through valuable biblical quotations (chapters 8 and 10). old terms such as acedia (or spiritual apathy; chapter 4) and theodicy (or human attempts to understand why God allows suffering; chapter 9) takes on renewed meaning and relevance.
It goes without saying that several of the ideas and concepts discussed so far, strongly reinforced by Christian perspectives, occupy a legitimate place in the educational arsenal provided by the book: resilience, stigmatization, “moral damage” helping to understand modern entities such as burnout (chapter 7), loneliness as a pathogen (“magnifying susceptibility to spiritual collapse”; chapter 16), etc. And, at the top, we can only mention, among many others, 3 vigorous contributions of Christian psychiatry:
1) His celebration of reconciliation as the driving force of emotional recovery and of life as a search for existential meaning – all of this predating the existentialism and logotherapy of Viktor Frankl (chapter 4)
2) Shared decision-making and values-based practice (Fulford’s legacy) that confers on psychiatry the role of a “normative practice approach” compatible with a community approach in social philosophy and ethics – the latter in the way of principles such as beneficence, mercy, charity, selflessness, hope and trust (chapter 12)
3) The study of relational phenomena which, beyond “leveling” and contextualization, relate to intersubjectivity and the existence of the “third party” outside the exclusively dyadic perspectives doctor-patient and teacher-public (chapter 16) – a wise anticipation of the “phenomenon of otherness that is so deeply relevant in today’s psychiatry and psychotherapy
A book of this nature must also examine ancient and current contradictions in the field of so-called Christian psychiatry to assert truth and objectivity. The controversies between Freudian discourses on religion in general – and Christianity and its churches, in particular – are repeatedly evoked, personalizing it in a way in their exchanges and Freud’s final break with Jung. Beyond that, the Christian vision reflects the numerous confrontations of yesterday and today between psychology and psychiatry (chapter 12). Differing interpretations of the same clinical phenomena, a frequent reality among clinicians, also occur among theologians discussing the religious/spiritual significance of psychopathological behaviors (Chapter 4). Last but not least, the contradictions are recognized and discussed within and between the Christian churches in their consideration of psychiatric symptoms, syndromes and illnesses, and – perhaps more profoundly – between the Jews (the first Christians in history) and black Christians (chapters 14 and 19).
Finally, a critic must point out the absences, omissions, or even excesses in the work read, of quasi-criticisms which may be quite personal or debatable. A broad and panoramic view of the religious/spiritual perspective as a strong component of ancient and contemporary cultural psychiatry seems to be lacking; some may say that the whole book is a sort of treatise on the subject, but an ontological clarification in the form of a brief chapter might have helped. The role of the family is mentioned many times, but lacks clear direction and meaning, again from a cultural (not just Christian) point of view. Theoretical speculation was sometimes unavoidable, and simplistic explanations (e.g., slow breathing triggering autonomic nervous system activation) were perhaps so likely due to space reasons.
In short, this volume is a fascinating foray into a field that everyone talks about, but few delve into. It offers excellent historical reviews, valuable clinical experiences, selected didactic pearls and, in its last 3 chapters, significant autobiographies of psychiatrists of different religious denominations sharing a common work rich in essentially human ingredients: psychiatry. As the final paragraphs point out, this perspective helps patients of all religious beliefs and viewpoints, encouraging them and their psychiatrists to integrate faith into the rest of their lives. This book will also help psychiatrists and other mental health professionals to “stay aware of (their) blind spots and their needs for both God and science”, reaching, in turn, “a grounded view of truth evidence-based, clinically relevant and informed”. by the wisdom of Christianity and its sister traditions.
Dr. Alarcon is emeritus professor emeritus of psychiatry at the Mayo Clinic School of Medicine in Rochester, Minnesota; Honorio Delgado Chair at Universidad Peruana Cayetano Heredia in Lima, Peru; and member of the editorial board of Psychiatric timeMT.