Religion and Spirituality in Psychiatry

Teaching Religious and Spiritual Issues 3331.1.1. For the Mental Health FieldI will state this bluntly: Someday we are allgoing to die. If we do not teach our knowledgeto a new generation, it will die with us. The nextgeneration will lack the skills and knowledge wehave acquired. If we mental health professionalscannot provide care for religious-spiritual issues,our patients will go (and already are going) elsewhere.(2–4) Either we provide treatment relevantto our patients’ needs, or we die as a field.Training in this field, like training in other topics,will improve the competence of mental healthclinicians and will strengthen the healing powerof our professions. In fifteen years of teachingreligion-spirituality to psychiatry residentsand psychology interns,( 5) I have observed thattrainees exposed to religion-spirituality teachingare usually more well-rounded clinicians thanunexposed ones.1.1.2. For our PatientsPeople who seek mental health care are asreligiously oriented as the general populations inwhich they live. (6) Mental illness causes intensesuffering. People cope with suffering by seekingmeaning in their suffering, very often through religion,which provides a system of meaning. (7–9)Morally and professionally, we owe our patientsand clients the best possible care. That includescare for religious-spiritual issues, which patientsview as essential to their overall health. (8) If you,the reader, are a person for whom faith is essential,wouldn’t you want a therapist for yourselfor your family who was skillful in dealing withreligion-spirituality?1.1.3. For our Colleagues in TrainingThe World Psychiatric Association’s recommendedcurriculum for psychiatry residents worldwide(discussed below) explicitly recommendsteaching religion and spirituality (p. 10). (9) Thetraining requirements of psychiatrists in theUnited States and Canada require teaching of culturalissues such as religion.( 10 , 11 ) Standardsfor training of United Kingdom psychiatrists andAmerican psychologists refer to teaching culturalcompetence, which includes religion.( 12 , 13 ) Theethical guidelines for American psychologists andpsychiatrists (14–17) require competent treatmentof religious and spiritual issues in treatment. TheAmerican Psychological Association’s ethical code18 ( section 2.01b) explicitly states that “psychologistshave or obtain the training, experience, consultation,or supervision necessary to ensure thecompetence of their services” and expects them tobe competent in “factors associated with … religion… essential for effective implementation oftheir services.” Ethical requirements dictate thatwe educate our younger colleagues to meet competencyrequirements in religion-spirituality.We can ensure good care for the next generationof patients by providing skilled clinicians to helpthem with their religious-spiritual issues. Thoseclinicians are not going to absorb this knowledgeby osmosis. They have to be taught religion-spirituality,just as each of us had to be taught assessmentand psychotherapy techniques. If we don’teducate them about a topic as universal as religionspirituality,we have failed in our duty to give themthe best possible education. We wouldn’t dream ofneglecting to teach trainees about common andimportant conditions such as depression, anxiety,or psychosis. The same is true of religion-spirituality:It is a core human issue and is more prevalentin the population than all mental illnesses combined.We can’t be silent about it and pretend to beeducating fully competent colleagues.1.2. Why Focus on Students and Trainees?Given the reality that few practicing psychiatristsand psychologists were given adequate trainingin religion-spirituality, why focus on educationof students and clinical trainees? Surely we haveenough education to do with clinicians already inpractice. That’s true, but it’s short-sighted. First,it is far easier to initially teach someone a skillcorrectly than to struggle to reshape inadequateskills practiced for decades. Old dogs can learnnew tricks, but it’s much easier to teach the puppy.If we teach residents, interns, and students aboutreligion-spirituality, we can form their lifelongattitudes and practice skills toward competenttreatment of religion-spirituality.