A “complex” subject matter asks for a clear lead

Pargament and Lomax did the readers of World Psychiatry and the WPA community a splendid service with their comprehensive and well-ordered paper. They managed to clear the way for proper discussion and innovative study and action toward training, continuing medical education, and clinical practice. They clearly are not out to provoke or to tread on someone's corns. Their review is well-balanced, without finery, and therefore can and should be read closely. And indeed, the empirical data are self-evident.

Nevertheless, the subject matter is complex, as indicated with subtlety in the title of this Forum. Why is this the case? Are those data not as self-evident as I assume? Of course, as the authors explain briefly, the relationship between psychiatry and religion has a troubled history. However, the field is moving, they write, to “a more nuanced understanding of religion” with regard to the promising and damaging forces religious and spiritual beliefs can have.

It is often encouraging to be optimistic and to have positive expectations, as the authors seem to have, but I think the after effects of that troubled history remain a matter of concern. The issue of “psychiatry and religion” is still (and only?) emphasized by prominent scholars who are under suspicion of being strongly involved in faith or any spiritual tradition. In other words, it is supposed they have a conflict of interests, and therefore their contributions are essentially labeled as opinion based. Despite the evidence provided by research, the clinical relevance of data is still contested. Furthermore, the whole topic of “psychiatry and religion” is perceived as a threat to appropriate therapeutic boundaries in clinical practice 1,2.

Several colleagues do struggle with the double-sided face of religion. Hesitating as they are, they admit that religion and spirituality might be helpful for certain patients, but at the same time they tend to underscore the negative and harmful, guilt-inducing effects they have witnessed over the years.

Given this “complex” state of affairs, WPA could give a lead. According to the WPA Section on Religion, Spirituality and Psychiatry, it would be a major accomplishment if WPA would do so. In 2006, this WPA Section and the Psychiatry and Spirituality Special Interest Group of the UK Royal College of Psychiatrists started working on a statement that would delineate WPA's vision on “psychiatry and religion” in psychiatric practice, research, and training worldwide. A first version of this statement was published in a WPA volume 3. In the meantime, the Special Interest Group continued its work within the Royal College, and in August 2011 a position statement was approved 4.

Is the topic to be considered worthy of such attention? The WPA Section thinks it is according to WPA's own criteria. Pargament and Lomax's paper supports this view. In the first place, the topic is relevant to the further development of psychiatry around the world. The transformation of religion instead of its disappearance and the place spirituality occupies are significant to psychiatry. A renewed impulse is needed for empirical and conceptual research into the distinction between religious and spiritual experiences, on the one hand, and pathological phenomena on the other. Religiosity and spirituality can be corrupted, but cannot be regarded in themselves as morbid conditions 5. In addition, research is needed into the significance and effectiveness of religious and spiritual healing practices around the world. There are important differences in the way these practices are approached, interpreted, and evaluated, depending on cultural and subcultural contexts, values and sources. Second, the importance of the topic is supported by an overwhelming amount of empirical evidence, although mental health professionals, psychiatrists in particular, are often not aware of that evidence. Psychiatric training should be updated in order to get psychiatrists ready to readjust their attitude and to deepen their knowledge. Third, the topic is relevant to mental health as a political and public theme and is likely to get a high public visibility. Fourth, the topic is in line with the trend toward a more personalized clinical practice and the increasing attention to transcultural aspects of psychiatry. If it is true that the individual needs to be the focal point of clinical attention and has to be understood in his/her cultural context, then the dimension of religion and spirituality cannot be ignored. So, the absence of a statement on this issue may be detrimental to psychiatry and to psychiatric patients.

For all these reasons, the WPA Section on Religion, Spirituality and Psychiatry holds the view that the topic of psychiatry and religion concerns psychiatry worldwide and that consequently a statement deserves priority. We call upon WPA to take this lead.