Religion and Spirituality in Psychiatry

338 Elizabeth S. Bowmanpsychiatry residencies have received awards. Farmore residencies have created curricula to applyfor these grants, but the number of unsuccessfulapplicants who teach their curricula withoutmonetary support is unknown. Standards forreceiving awards are high: Awardees must teachreligion and spirituality to nearly all years ofresidents, use a diverse array of teaching methods,and have visibility in the community. Theinfusion of monetary support into educationon religion-spirituality in psychiatry has greatlyaccelerated interest in teaching it to residents.But what proportion of American psychiatry residenciesdoes this represent?The Accreditation Council on GraduateMedical Education (ACGME) lists 181 accreditedpsychiatry residencies in the United Statesand Puerto Rico. (38) The fifty-one programs(forty-nine American; at least two Canadian)that have received Templeton awards account for27 percent of accredited American residencies. Ifeven half of the approximately fifty unsuccessfulapplicants for Templeton awards are teaching thecurricula they developed, seventy-six (42 percent)of accredited American psychiatry residencies areinvolved in teaching religion-spirituality to theirresidents. This is not a majority of American psychiatryresidencies, and we have no actual datathat more than 27 percent of residencies teachreligion-spirituality. The proportion of psychiatryprograms teaching religion- spirituality isquite similar in Canada and the United States,probably because of cultural similarities.A third factor that may have encouraged teachingof religion-spirituality in U.S. psychiatry residenciesis the availability of a 1997 curriculumspecifically for psychiatry residents. Funded bythe Templeton Foundation, the 105-page ModelCurriculum for Psychiatric Residency TrainingPrograms: Religion and Spirituality in Clinical Care.A Course Outline (19) (hereafter referred to as theModel Curriculum ) was developed as a guide forresidencies applying for the Templeton psychiatrycurricular awards. This ready-to-use curriculumis applicable to psychology or social worktraining programs in any English-speaking country,and for use in continuing medical education(CME) presentations. It contains three core modules(overview, assessment, and human development),eight accessory modules, discussion oflearning formats, and a sample evaluation form. Itis unknown how many residencies are using thiscurriculum.A fourth factor, the intense religiousness ofAmerican culture, may also contribute to thewillingness of American psychiatry residenciesto offer courses in religion-spirituality. Surveysof Americans consistently show high endorsementof religious belief and practice: 95 percentof Americans endorse belief in God (39) , 90 percentpray, and 50 percent pray daily.(40) Almostthree-quarters of Americans say their religiousfaith is the most important influence in their life.( 35 , 36 ) The religiousness of American society isnot necessarily shared by American psychiatrists,who are much more likely (21 percent) than thegeneral U.S. population (6 percent) to considerthemselves atheist or agnostic (36) and less likely(40–70 percent) than their patients to believe inGod. (14) However, Bergin and Jensen (35) foundpsychiatrists (40 percent) no less likely than thegeneral American public (42 percent) to regularlyattend religious services.(36 , 41 )3.2.3. Psychology Training: United Statesand CanadaPsychology is a mental health disciplinethat prides itself on its objective scientific base.Thus, we might expect psychology training to bedevoid of education on religion-spirituality andfew psychologists to be personally religious. Dodata support these predictions?The picture of religion-spirituality educationin North American psychology has not beenpretty. A quarter century ago, Bergin (42) notedthat “training in the clinical professions is almostbereft of content that would engender an appreciationof religious variables in psychological functioning.”In 1990, Shafranske and Maloney (43)reported that as few as 5 percent of American clinicalpsychologists reported having had religiousor spiritual issues addressed in their professionaltraining. The next year, Lannert (44) reportedthat no psychology internships offered education