Religion and Spirituality in Psychiatry

280 Laurence Borras and Philippe Hugueletillness. Empirical evidence suggests that patientsare more satisfied when their psychiatrist sharestheir model of understanding distress and treatment.(72) It has also been shown that patientsare not less observant toward a clinician of adifferent culture.(73 , 74 ) The success of strategiesaimed at controlling the disease does notdepend as much on the efficiency of the medicalprescriptions (for example, medicines and traditionalremedies) as much as it depends on theway the prescriptions are being prescribed andon the meaning attributed by the patient to thetherapeutic process. (75) The clinician acts as amirror, being simultaneously the recipient of thelaments and the source of medical recommendations,of psychotherapeutic treatment and evenof rituals. The clinician is also a mirror to himselfbecause he has to ponder his own role as a specialistprescribing conduct and meaning, whilerealizing that his own sociocultural and religiousheritage affects the therapy he recommends. Theclinician must also take into account the therapeuticevolution of the patient, whose representationsof the disease and its treatment maychange, and along with them the patient’s choicesin terms of therapeutic solutions. Instead of callingthese oscillations a therapeutic mistake, theclinician should remain open to the patients andjoin them in trying to understand the new interpretationsdetermined by a set of complementarycircumstances and explanations. When the cliniciandeals with a patient of a different originor religion, it is interesting to have access to theelements specific to the patient’s culture such asthe representation of the disease, the body, andthe healing system of his or her tradition to beable to adopt the most appropriate strategy andthe best way to attend to the patient. It would beactually a good initiative to provide clinicianswith an introduction to the general aspects of theculture of the immigrants. Nevertheless, as usefulas this approach may seem in improving theunderstanding of differences, it cannot be generallyapplicable. In each country, there are culturaland religious variables between cities, regions,villages, regions, and ethnic groups. It is thereforehighly insufficient to take into account only theoriginal culture of the migrant, while denyinghis or her own individuality and historical background.If therapists are informed of some essentialaspects of their patients’ culture and religion,they will be able to identify better the thin linebetween the healthy and the psychopathologicalexpression of religious convictions to improvetheir approach to patients. However, the majorrecommendation for approaching patients in thebest way is to have available someone who willlisten. It is also true that, for our Western societies,listening is time-consuming and thereforeeconomically problematic. Things are completelydifferent in traditional allopathic medicine,which tends to promote a more deliberate andthorough approach to patients. In some cases,traditional allopathic medicine often takes intoaccount, along with clinical symptoms, aspectssuch as personality, character, or the physical andthe psychological environment, the living conditions,and the patients’ relationships, as well astheir moral issues and beliefs.Kleinman and Becker (14) recommended thata patient’s explanatory models of illness shouldbe elicited using an ethnographic approach thatexplored their concerns: “Why me?” “Why now?”“What is wrong?” “How long will it last?” “Howserious is it?” “Who can intervene or treat the condition?”Thus, the clinician would gather a betterunderstanding of the subjective experience of illnessand so promote collaboration and improveclinical outcomes and patient satisfaction.REFERENCES1 . d e B e au n e S A . C h am an i s m e e t pré h i s toi re.Un feuilleton à épisodes , L’Homme . 1998 ;38 : 203 –219.2. Sournia J-C. Histoire de la médecine et desmédecins . Paris : Ed. Larousse ; 1991 .3. Nic oud M. Éthique et pratiques médicales auxderniers siècles du Moyen Âge . Médiévales, n° 46,Paris, PUV; 2004 : 5 –10.4. Pichot P . Un siècle de Psychiatrie . Paris : Editionsles Empêcheurs de penser en rond ; 1983 .5. Mar ion M . Dictionnaire des institutions de laFrance au XVIIème et XVIIIème siècle . Paris : AyerPublishing; 1968 .