Religion and Spirituality in Psychiatry

Self-Identity and Religion/Spirituality 171patient’s reference system, one must make surethat it favors the integration of all aspects ofidentity.14. MULTICULTURAL PERSPECTIVEFrom a multicultural perspective, the patient’sreference system – especially the conception ofthe self unique to this system – does not necessarilycoordinate well with the therapist’s modelof medical care and psychological health. Is therea risk of a conflict between two conceptions ofindividual identity? Under which circumstanceswould it be possible to establish a therapeuticalliance between the therapist and the patient’sreligious/spiritual (cultural) reference system? Itis the therapist’s responsibility to build this therapeuticalliance. In terms of roles, the therapeuticrelationship, in its basic structure, assigns themother’s role to the therapist. The therapist has tooffer the patient a protective vessel for his or hersuffering. This vessel refers back to a third party:the medical model of interpretation of psychologicaldisorders. When this medical model seemsincompatible with the patient’s reference system,it is up to the therapist to adjust the therapeuticrelationship to the patient’s reference system. Thefirst effort will be one of translation: an attempt tointerpret the functions, categories of a particularelement in the patient’s belief system, in terms ofthe medical system. First of all, this involves establishingthe foundation for the subject’s identitycohesion. Contrary to what seems evident to themodern Westerner and thus to Western medicine,individual identity does not rely on the constructionof a psychological core-self in every culture.In many cultures, the cohesion of the individualidentity, what protects the individual againstintrusions or mental breakdown, is collectivelyguaranteed by belonging to a group. The treatmentthen requires the therapist to take into considerationthis way of perceiving one’s relationshipwith oneself and to adapt the treatment by integrating,according to the specific case, the familyand cross- generational dimensions – sometimesincluding even relationships with ancestors andgods. It is not that the success of the therapeuticintervention depends on the therapist’s adherenceto the patient’s system of meaning. However, it isin the caregiver’s best interest to understand howthe patient interprets his or her actions and, if necessary,to suggest other interpretations. Medicaltreatment in a multicultural context requires theconstruction of a therapeutic framework basedon a conception of the self that is valid for thepatient. A proposal of therapeutic interventionthat compels the patient to completely forsake hisculture has little chance of success. Hence, it ismore about building an intervention frameworkthat draws support from the conception of the selfadhered to by the patients and that translates thepotential therapeutic course of action into termsof the patient’s identity construction. Such anapproach requires a lot of creativity. In the end, ifsuccessfully achieved, it will have brought abouta reorganization of the patient’s identity, integratingelements belonging to the patient’s cultureof origin and those originating in the therapist’smedical system.REFERENCES1. Ricoeur P . Soi-même comme un autre . Paris:Seuil ; 1990 .2 . Br an dt P Y . S e t rouve r d’ai l l e u rs c om m e p arsurprise. In: Mancini S , ed. La fabrication depsychisme: Pratiques rituelles au carrefour des sciencshumaines et des sciences de la vie . Paris: LaDécouverte ; 2006 :55–78.3 . Ste r n D . The Interpersonal World of the Infant:A View from Psychoanalysis and DevelopmentalPsychology . New York: Basic Books ; 1985 .4. Anzieu D . Le Moi-peau . Paris: Dunod ; 1995 .5. Ster n D . Le monde interpersonnel du nourisson:une perspective psychanalytique et développementale. Paris : PUF ; 1989 :21.6 . L apl an ch e J , Pont a l i s J B . Vocabulaire de la psychanalyse. Paris; PUF : 2002 (original ed. 1967).7. Cosnier J . Les vicissitudes de l’identité . In:A l le on AM , Mor v an O , L eb ov ic i S , e ds . Devenir« adulte » ? . Paris : PUF ; 1990 : 95 –111.8. Grom B . Religionspsychologie . München/Göttingen :Kösel/Vandenhoeck & Ruprecht ; 1992 .9. Bowlby J . Attachment and Loss (3 vol.) . Harmondsworth/Ringswood : Penguin Books ; 1991.10. Cyrulnik B . Un merveilleux malheur . Paris: OdileJacob ; 1999 .11. Tisseron S . La résilience . Paris: PUF ; 2007 .12. Abraham N , Torok M . L’écorce et le noyau . Paris:Flammarion ; 1987 .