Of late, there have been two types of literature on the relationship of religion and mental health. The first has been a more philosophical approach to the subject and the other has been a more practical approach to dealing with religious issues when caring for patients. Psychiatry and Religion: The Convergence of Mind Body and Spirit, edited by James K. Boehnlein, MD, M.Sc., falls into the former category. This text is the first text on the subject the American Psychiatric Press has published on the subject in five years. It focuses on the current state of the relationship between the two similar, but historically opposed disciplines of psychiatry and clergy. This approach is a sharp contrast to Handbook of Psychotherapy and Religious Diversity, edited by P Scott Richards and Allen E. Bergin, published by the American Psychological Association, 2000. This text focuses on particular therapeutic issues that may arise in various religions in therapy and how best to approach them.

While laying out the state of the relationship, the text, as has the field, tiptoes around the issue of what to do when religious issues arise in the context of treatment. While there is a growing group that is becoming more vocal for better integration of spiritual issues and psychiatry (Francis Lu, MD, David Larson, MD, Harold Koenig, MD and others), the field has been slow to make the shift in paradigms.

To put numbers on the issue, Psychiatry and Religion quotes statistics from a study done by the Princeton Religious Center in 1994. “Nearly 95% of Americans report a belief in God, 57% report praying daily, and 42% report having attended church in the past week.” Also in another study quoted, “nearly two-thirds of patients used religious language during treatment to express their problems and conflicts.” The book makes is clear that religion and spirituality are important issues in patients’ lives. However, this is contrasted by the classical approach of psychoanalysis to the subject and how it has tried to resolve the issue. Quoting Dr. M.H. Spero from his text, Religious Objects as Psychological Structures: A Critical integration of Object Relations Theory, Psychotherapy and Judaism, University of Chicago Press, 1992: “To be clear, there is a difference between saying that God acts on human beings and that this action can have psychological effects, on the one hand, and saying that God’s action is an aspect of psychological process, on the other. The former preserves the integrity of the respective realms of discourse; the later overrides them, to the confusion of both.”

The point I make with these quotes is that part of the mental health field is recognizing and dealing with the real issue of spirituality and how to incorporate it into treatment while another part is still discussing whether or not spirituality and religion are valid concepts in psychological health. Thankfully, the “crusaders” I mentioned above have been fighting against mental health treatment as another separate and diametrically opposed philosophical entity and have working on the real life issue of religious and spiritual sensitivity as a tool to providing the best patient are possible. Whether a mental health professional endorses their patients religious beliefs or not, understanding a patient’s world-view, in all aspects, can only aid in a more positive treatment outcome.

Thomas Cobb, M.D. is currently a psychiatry resident at the University of Michigan. His interests include psychiatric resident education, neuropsychiatry, theology and religious history. He has reviewed psychiatric texts for other publishers and hopes to publish in the field soon. Future plans are in academic psychiatry with a focus on integrative approaches to the patient, from neurons to philosophy.

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