Religion and Spirituality in Psychiatry

16 Samuel B. Thielmanresponsible for bringing psychiatrists out of thehospital and into the psychotherapy consultingroom. Freud was an unabashed atheist, andhis later works make very clear that he viewedreligion as a shared delusion, helpful for some,harmful for others, but ultimately something thatwas an indicator of psychological immaturity. Itwas a way through which humans came to termswith the fear of death and the concern aboutmeaninglessness.Freud’s thinking embodied the materialisticconception of medicine that continues to beinfluential and that, during Freud’s time, wastaught to him in London, Vienna, and Berlin.(37) In The Future of an Illusion (1927), Freudproposed that religion was a common but falsebelief and that God was a projection of internaldesires. In Civilization and Its Discontents(1929), he wrote that religion was a delusion ofthe masses that could relieve some anxieties, butthat fostered immaturity and restricted choice.Freud’s view of religion set the tone for the psychiatricview of religion in the West, particularlythe United States, during much of the twentiethcentury.But some analysts were uncomfortable withFreud’s hostility to religion (notably Carl Jung,but also Gregory Zilboorg) and, in fact, Freud’sthought could be adapted to the purposes ofreligionists. A number of American Protestantclergy, interested in applying the insights ofFreud to pastoral work, used psychoanalyticthought to enrich pastoral work. In 1906, theReverend Elwood Worcester (1862–1940) andthe Reverend Samuel McComb, both clergymen,set up an education and psychotherapy programthrough the Emmanuel Church in Boston andcollaborated with an early psychoanalyst, IsidorCoriat, as well as prominent Boston physiciansJoseph Pratt, James Jackson Putnam, and RichardCabot. This effort, which became known as theEmmanuel Movement, continued until 1929.The program was intended to counter the influenceof the new “healing cults” that were sweepingthe United States. However, as it developed,it foreshadowed the modern pastoral counselingmovement.(38–41)Psychiatry itself tended to relegate religion tothe province of hospital chaplains and clergy. Inthe United States, psychoanalytic thought andpsychoanalytic psychotherapy, usually somewhathostile to religiosity, became a major force in psychiatrythrough the 1960s.(42) Psychoanalysis,which in its early days had included practitionersfrom a range of disciplines, came to be comprisedlargely of psychiatrists, especially after 1938 whenthe American Psychoanalytic Association madepsychiatric training part of the requirementsfor membership.(25) (In Europe, psychoanalysiswas less influential, but more professionallyinclusive.)During the latter part of the twentieth century,the influence of psychoanalysis on clinicalpractice waned as psychiatry came to be influencedmuch more directly by the neuro sciencesand cognitive psychology. In addition, the spiritual,yet nonsectarian perspective of AlcoholicsAnonymous, which came to national prominencein the 1940s and 1950s, highlighted thepotential therapeutic benefits of spirituallyoriented programs.(43) With the lesseningphilosophical opposition to religion, somepsychiatrists and others interested in mentalhealth explored more fully the role of religionin mental health. In 1968, the Committee onPsychiatry and Religion of the Group for theAdvancement of Psychiatry published a reportnoting the positive as well as the negative influencesof religion on mental health.(44) In 1986,the American Journal of Psychiatry published aseminal review article by Larson and colleaguesdocumenting the lack of adequate literature onthe mental health effects of religion.(45) Duringthe 1990s and early 2000s, interest in religionand spirituality grew substantially and was evidentin many geographical regions. The RoyalCollege of Psychiatrists began the Spiritualityand Psychiatry Special Interest Group in 1999,the World Psychiatric Association recentlyestablished a Section on Religion, Spiritualityand Psychiatry, a journal of Muslim mentalhealth has been founded, and the number ofarticles on religion in peer-reviewed journalshas grown substantially.