HISTORICAL TENSIONS between science and religion have been well documented, and have again been raised with regard to the practice of psychiatry, following the publication of a position statement by the Royal College of Psychiatrists (RCP) in London.
This area is complicated and the key question would seem to be whether spiritual matters should be dealt with in the consulting room. This might also concern psychologists, social workers and other professionals working in the broader mental health arena.
Concerns expressed in the literature and alluded to in the document include: the intrusiveness of spiritual assessment in the clinical process; the danger of boundary violations; concerns about psychiatrists praying with patients; and the lack of training or competence of psychiatrists to address spiritual or religious matters.
It matters little if your cardiac surgeon, mechanic or bus driver is a theist, agnostic or atheist if he or she gets the job done. However, given the intricacies of the therapeutic relationship between a patient/client and a mental-health professional, where the power differential generally favours the latter, immense caution must be advised.
The first of seven recommendations in the RCP document states that “a tactful and sensitive exploration of patients’ religious beliefs and spirituality should routinely be considered and will sometimes be an essential component of clinical assessment”, (my italics).
The second one suggests that “psychiatrists should be expected to be sensitive to the spiritual/religious beliefs and practices of their patients or to the lack of them and of the families and carers of their patients”. I agree, but fail to see how the routine exploration of a person’s religious beliefs is best practice.
Those attending for help usually do so because they have identified a problem and expect assistance in obtaining a solution which they have been unable to do on their own. Mental- health professionals are increasingly and appropriately presumed to work from an evidence-based approach and their particular assessments and interventions are guided by the nature of the problem.
Other recommendations warn against proselytising, undermining faith and emphasise maintaining boundaries around self-disclosure of their own religious beliefs; encourage development of policies that promote equality, respect and good practice in relation to spirituality and religion; emphasise a willingness to work with leaders and members of faith communities; encourage sensitivity to beliefs, or lack of them, among colleagues; and suggest that religion and spirituality and their relationship to the diagnosis and treatment of psychiatric disorders should be considered as essential components to training and continuing professional development. While some of this is reasonable, I would question whether mental-health services are an appropriate context in which to consider religious issues.
The US physicist Stephen Weinberg, in a 2008 article, outlines a number of general sources of tension between science and religion that are worthy of consideration. Religion gained much strength from the observation of mysterious phenomena later explained by science; the presumed special role of man has been eroded by Darwin and Wallace; and traditional religions rely on infallible authority and decry doubt and questioning, which are the cornerstones of a scientific approach. One might be reminded here of Brian D’Arcy and his colleagues.
While some scientists, such as Francis Collins, the renowned geneticist and leader of the human-genome project, have managed to maintain their religious and scientific positions, others have not. Stephen Jay Gould in his book Rocks of Ages tried to construct two “non-overlapping” magisteria to contain these conflicting world views. His attempt has been largely criticised.
Except in rare circumstances, religious beliefs and concerns are best left outside the offices of mental-health professionals. This is not intended to imply disrespect for patient or practitioner, but the emphasis on science in medicine and on evidence-based practice in general, does not lend well to honestly and openly considering issues that have their roots in the supernatural.
Paul O’Donoghue is a clinical psychologist and founder member of the Irish Skeptics Society
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