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| No | 44% | 287 votes | Total: 656 votes | |
| Yes | 56% | 369 votes |
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Add to FavoritesPsychiatry and spirituality begin with two fundamentally different perspectives: pathology versus belief. Psychiatry is fundamentally a discipline which proceeds on the presumption that a patient has a clinical illness which stems from one or another disorder of behavior (a cognitive pathology). Spirituality is fundamentally a perspective which proceeds on the belief that there is some metaphysical sentience. Psychiatry begins with the presumption that a patient needs treatment. Spirituality is about belief systems.
Patients with psychiatric illness already suffer not only from their illness but also from an insurance system which devalues their illness - as manifest in the routine disproportionate discounting of insurance payments for psychiatric services. While there are several reasons for this insurance behavior, one of them is the difficult of quantifying the processes of psychiatry. The patient's illness is commonly not quantifiable in rigidly measurable terms and the value of the service is commonly not quantifiable in rigidly measurable terms. Thus, it often becomes very difficult to talk solidly about an extent of illness and an extent of treatment response. Insurance companies therefore see psychiatry as an economic "black hole": a place which may suck down resources without any solid criteria for limitation. To combat this, they pay less for the services and hope that this will reduce consumption. (Of course, there are other reasons for psychiatric service discounting, but this isn't the place for a discourse on that.)
Patients with psychiatric illness are truly ill. In fact, since the brain runs all of human behavior it can be argued that the impact of psychiatric illness is commonly more pervasive and profound than that of most other illnesses. Certainly psychiatric illness is commonly lethal (via suicide, lethal consequences of drug abuse, or lethal consequences of other antisocial behaviors). At non-lethal levels psychiatric illness pervades and damages relationships, career and life satisfaction.
It is unquestionable that spirituality is a portion of behavior, and thus becomes a topic of discussion in the context of psychiatric illness. It is unquestionable that knowing "who you are" requires knowing what you believe. Yet,it is damaging to both psychiatry and spirituality to "link" these as if they are versions of the same discussion.
Those who believe in a spiritual side to life will not want to have this considered tantamount to psychiatric illness. And, those who have psychiatric illness will not want to have their illness further complicated by subjugating it to the disparate views of spirituality. All of behavior is...well...all of behavior. However, psychiatry is about illness and spirituality is about belief.
Learn more about this author, John Barbuto.
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Yes
Spirituality should be a part of any helping or healing profession. Whilst it will take a long time for what should happen to become what actually does happen, I think that there are slow movements in that direction.
I am talking about spirituality in its broadest sense: anything that brings a meaning and sense of purpose in a person's life. It would seem the most obvious thing in the world to expect a helping professional to look at their 'patient' as a whole person with their own important and relevant experience of life. It would seem obvious that the professional would need to acknowledge, respect and tap into what gives people's lives meaning and purpose. However, idiotically, this is very often not the case. Psychiatry has probably been criticised more than any other profession for failing to do this as a discipline and for producing professionals who fail to do this as individuals. It has also accumulated a history of dehumanising and abusive practice, which it has by no means shrugged off as yet.
If, instead of seeing a person, you see a 'disorder' or the lack of a 'disorder, you have already started off on the wrong foot if you actually want to have a positive effect on this person's life. This is presumably the idea of being in a healing or caring profession - to have a positive effect. If you look for 'symptoms' in the words and actions of the person, rather than aiming to empathise with what life is like for them and what is important to them, then you are really in danger of doing them more harm than good. At the end of being objectified and having their experience reduced in this way, many people will be left, not only with distressing 'symptoms' but also probably feeling violated, or at least further deflated. They will probably walk away with a decreased sense of self, a decreased self-esteem and a weaker grip on their sense of meaning and purpose.
Treating people as laboratory rats rather than as whole human beings with feelings has been a bad habit of all Western medical traditions, and particularly doctors, not just of psychiatrists. (I am not suggesting that laboratory rats should be treated that way either, by the way!). Treating people as 'matter' or 'machines' rather than spritual beings with meaningful subjective experience, feelings and dreams, is also a common criticism of the Western medical approach. There are movements towards more holistic ways of viewing health in general health care, and so there is every reason to assume that this is happening in psychiatry as well. It is certainly happening in mental health, and alternative therapies have straddled both fields and grown in influence in both.
The ones at the top of the tree in either field are the ones that are slowest to catch up with new trends, but even they can not resist forever. The bottom line is market demand, and it is the patients that have driven these changes and that will continue to drive them. Those at the top of the tree probably have the most to lose, and are the most reluctant to surrender their power and the power of the discipline as they know it. After all they have established themselves as respected and highly paid 'experts' in a field, and they are often absolute beginners or novices within the changing landscape, and the new filed that might emerge. People who go into 'scientific' disciplines are also likely to be people who want things to be predictable and controllable and easy to understand and 'know' in a cut and dried kind of way. Whilst the big thinkers, like Einstein, might not have fitted this mold, most 'followers' do. They are not comfortable with uncertainty.
The training that draws such people also tends to be pretty cut and dried in approach as well: "This is how it is. Memorise these facts and you will be an expert. Yes, have some 'bedside manner' as an add-on, but your main role is to use this expertise and administer 'treatment' accordingly." How much scarier it is to have to engage yourself and the patient deeply as human beings as a foundation of your practice and for things to be different every new patient,and harder to pin down. However, this is what it is like with people. Whilst there is a place for research, gathering 'facts' and categorising things in relation to humans, this can not be the dominant force forever and times are a changing. Those without people skills should not work with people. Neither should those who can not deal with ambiguity. They may be better redeployed in studying inanimate matter, rather than approaching humans as if they were just that, particularly when dealing with mental health. In the world of mental health, absolutists may be the dinosaurs, a dying breed in a world that must become more sophisticated and evolve.
There are psychiatrists who are forward-thinking and the discipline seems to be slowly grinding forward, inch by inch. However, it has a very long way to go, and it may need to transform its way out of existence. Personally, I am not sure that psychiatry is actually needed as a separate discipline at all, and I do wonder if it will eventually die out. In the U.K. psychiatrists tend to concentrate largely on doling out medication and trying to make sure that patients comply with taking the medication. They do not tend to offer talking therapy, which tends to be done by counsellors and therapists largely, and also some psychologists who are pretty thin on the ground. Psychiatrists are notorious for not respecting or understanding the value of talking therapies, or any intervention other than medication and draconian forms of control.
It strikes me that G.P.'s (General Practitioners - regular doctors)could just as easily prescribe medication, and that all doctors should be trained in mental health better than they are anyway. A huge proportion of people who visit their G.P.'s have mental health problems, after all. The money spent on psychiatrists could be better spent on talking therapists, for whom people are crying out and to whom people have very limited access in public health in the U.K. Psychologists, counsellors and other therapists, are already far ahead of the game compared to psychiatrists in terms of seeing the whole person and the meaning in their experience, and they are usually people who had a natural affinity for people from the start. At the moment these disciplines are underfunded and undervalued in public health, despite huge demand for the public. Surely this lack of response to demand can not go on forever, and spirituality, along with feelings and other aspects of experience, will find their proper place in mental health care.
Learn more about this author, Jules Cyber.
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