Religion and Spirituality in Psychiatry

156 Pierre-Yves Brandt and Laurence Borrasshaman. The efficacy of the intervention undertakenlargely depends on the extent to which thepossessed person, his family, and friends accept it.For the psychiatrist, the goal is the patient’spsychic autonomy. The complaint of possessionwill be interpreted as a paranoid delusion or as theexpression of the patient’s dependence on thoughtsof persecution. A therapeutic strategy could consistof reinforcing the “self” by helping the patientdevelop a rational stance toward the entities he feelspossessed by. The analysis could consist of demonstratingthat some of the patient’s ideas are incoherentor, in a more radical way, arguing against theexistence of the spiritual entities mentioned by thepatient and suggesting that he ignore these entitiesto show him that they only have the power that hegives them. This strategy can be effective, but it canalso be a complete failure because of the violentconfrontation involved between the demons or evilspirits and the authority of the psychiatrist. Evenworse, this strategy can lead to a conflict in thepatient’s loyalties that he cannot deal with, whenmedical compliance involves the humiliation of hisnative culture or religious faith.To avoid provoking a confrontation betweenantagonistic systems, the psychiatrist can chooseto occupy the position of someone who would liketo establish links between the two worlds of meanings.The aim is not for the psychiatrist to give uphis own system of reference. The challenge is toinclude the patient’s cultural perspective, the spiritualcounselor’s cultural perspective, and the clinician’spsychological viewpoint in the discussion. Atthe least, the patient must realize that the psychiatristis willing to take cognizance of the patient’s personalsystem of reference. Collaboration betweenthe psychiatrist and the patient’s religious system isnot always possible. For example, the patient mayseek the help of an exorcist who considers that hisintervention is incompatible with any psychiatricintervention. The aim would then be to help thepatient position himself so that he can accept thesupport of the medical system without necessarilybetraying his own system of reference. In any case,the psychiatrist should be aware that his domainof competence is based on a Western definitionof illness and suffering. Despite the difficulty hemay have in accepting that the patient attributes adifferent meaning to illness and suffering, the psychiatristwill benefit from taking a different pointof view into account. Understanding the role thepatient assigns him in his own system of referencecan only be helpful to the psychiatrist. To help thepatient view the therapeutic interventions of thehealers that belong to his system of reference froma critical angle, he must also develop an analyticalpoint of view toward the psychiatric interventionsrecommended within the context of the medicalsystem. Within the care setting, the aim is to providetherapeutic possibilities that help the patientmake choices leading to a higher level of psychicautonomy.9. ETHNOPSYCHIATRIC CONSULTATIONSAn “ethnopsychiatric consultation” (a term coinedby Georges Devereux who introduced the concept)can be helpful in this approach.(23) During such asession, a psychiatrist and co-therapists from differentcultural backgrounds meet with the patient todiscuss his symptoms and specific problems. Eachco-therapist can explain how these problems wouldbe interpreted by the system of reference that herepresents. In other words, the co- therapists playthe role of cultural mediator to facilitate the interpretationof one reference system through another.Possession can take on different meanings dependingon the patient’s system of reference. This specialsession can help him to more clearly formulatethe meaning of possession in his own system ofreference. As we saw in Barbara’s case, possessionis not always the result of cultural interpretationsoriginating outside the Western world. Thus, anethnopsychiatric consultation could also be usefulto patients coming from families with deep Westernroots. In this case, the participation of co-therapistswho can describe how the Catholic Church or differentprotestant and evangelical groups interpretpossession and exorcism would be important. Sucha session can help develop better communicationbetween the patient and the psychiatrist and facilitatethe construction of a common system of referenceincorporating the meanings of the patient’ssystem of reference as well as the meanings of the