Psychiatry and religion/spirituality (R/S) share an interest in human flourishing, leaving clinicians uncertain about how to approach ethical questions arising. Dec 10, It is not uncommon for patients to experience religious delusions such may never need to think about the relationship of spirituality to health. Mar 19, The challenges associated with treating extremely religious patients Ethical Issues in the Psychiatric Treatment of the Religious 'Fundamentalist' Patient Psychiatry's historical relationship with organized religion has been.
Our first concern is to listen to the patient. Physicians are autonomous agents who are free to hold their own beliefs and to follow their consciences. They may be atheists, agnostics, or believers. It is clear that religious beliefs are important to the lives of many physicians. Medicine is a secular vocation for some, while some physicians attest to a sense of being "called" by God to the profession of medicine.
For example, the opening line from the Oath of Maimonides, a scholar of Torah and a physician incorporates this concept: In a much earlier time in the history of the world, the priest and the medicine man were one and the same in most cultures, until the development of scientific medicine led to a division between the professions. After Descartes and the French Revolution it was said that the body belongs to the physician and the soul to the priest.
In our current culture of medicine, some physicians wonder whether, when and how to express themselves to patients regarding their own faith.
The general consensus is that physicians should take their cues from the patient, with care not to impose their own beliefs.
In one study reported in the Southern Medical Journal inphysicians from a variety of religious backgrounds reported they would be comfortable discussing their beliefs if asked about them by patients Olive, The study shows that physicians with spiritual beliefs that are important to them integrate their beliefs into their interactions with patients in a variety of ways.
These interactions were more likely in the face of a serious or life-threatening illness and religious discussions did not take place with the majority of their patients ibid. Obstacles to discussing Spirituality with Patients Some physicians find a number of reasons to avoid discussions revolving around the spiritual beliefs, needs and interests of their patients.
Reasons for not opening this subject include the scarcity of time in office visits, lack of familiarity with the subject matter of spirituality, or the lack of knowledge and experience with the varieties of religious expressions in our pluralistic culture. Many admit to having had no training in managing such discussions.
Others are wary of violating ethical and professional boundaries by appearing to impose their views on patients. Nonreligious physicians have expressed anxiety that a religious patient may ask them to pray. In such instances, one could invite the patient to speak the prayer while the physician joins in reverent silence. On the other hand, some physicians regularly incorporate spiritual history taking into the bio-psycho-social-spiritual interview, and others find opportunities where sharing their own beliefs or praying with a particular patient in special circumstances has a unique value to that patient.Religion, spirituality & ethics - Tariq Ramadan - TEDxSalford
These and a myriad of other questions have religious and spiritual significance for a wide spectrum of our society and deserve a sensitive dialogue with physicians who attend to patients facing these troubling issues. Often, such questions are initiated in doctor-patient discussions and may trigger a referral to the chaplain.
How can we approach spirituality in medicine with physicians-in-training? The UW School of Medicine was an early leader among medical schools in addressing the topic of patient-spirituality. In an elective course, originating in Spring,"Spirituality in Health Care," the range of topics goes beyond simply teaching spiritual history taking.
Students are encouraged to practice self-care in order to remain healthy as providers for others, and to give intentional consideration to their deep values and their own spirituality as components of their spiritual well-being. The purpose of this interdisciplinary course is to provide an opportunity for interactive learning about relationships between spirituality, ethics and health care.
Some of the goals of the class are as follows: To heighten student awareness of ways in which their own faith system provides resources for encounters with illness, suffering and death. To foster student understanding, respect and appreciation for the individuality and diversity of patients' beliefs, values, spirituality and culture regarding illness, its meaning, cause, treatment, and outcome. To strengthen students in their commitment to relationship-centered medicine that emphasizes care of the suffering person rather than attention simply to the pathophysiology of disease, and recognizes the physician as a dynamic component of that relationship.
To facilitate students in recognizing the role of the hospital chaplain and the patient's clergy as partners in the health care team in providing care for the patient. To encourage students in developing and maintaining a program of physical, emotional and spiritual self-care, which includes attention to the purpose and meaning of their lives and work. McCormick, Until recently, there were all too few medical schools that offered formal courses in spirituality in medicine for medical students and residents.
This situation is changing. InAAMC developed medical school objectives related to spirituality and cultural issues: Association of American Medical Colleges, Beyond the four years of medical school, residency programs, particularly those with a primary care focus and a palliative care focus, are incorporating education in spirituality training residents.
Doctor-Patient Relationship in Psychiatry
Christina Puchalski combined efforts as co-directors of this conference for several years. Patients facing serious illness, accident, or death often experience a crisis of meaning.
Some patients are profoundly comforted by their spiritual beliefs. Others may encounter religious struggle or negative ways of coping with illness. It is important for patients that their cultural, spiritual, and religious beliefs be recognized and integrated in the development of a plan of care and in decisions that are made concerning end-of-life care.
Respect for patient values and beliefs requires competent communication skills in health care professionals. Residency training programs and continuing medical education programs foster continued learning after medical school. However, there is room for improvement. New resources are available for educators such as those developed by the George Washington Institute for Spirituality and Health GWISHincluding on-line materials that are easily accessible to both students and faculty.
Health care professionals ought not to neglect their own psychological and spiritual well-being. Health care professionals work in an intense and stressful environment, frequently exposed to the suffering of others and to companying with the dying. Such work requires that we stay in touch with our own feelings and that which provides meaning and value within our own lives, while working in a profession dedicated to the care of others.
International Journal of Psychiatry in Medicine. Psychiatrists' viewpoints on religion and their services to religious institutions and the ministry. American Psychiatric Association, Anandarajah G, Hight E. Dependent personality expects miracles. Histrionic personalities have a tendency to exaggerate symptoms.
Antisocial personalities show a hostile attitude towards a therapist. Paranoids patients show lack of faith in the doctor and doubt every intention and guidance provided by the doctor. Many of the mental problems are considered a curse or mystical phenomenon.
Hence, relatives may approach a psychiatrist with little faith in the doctor's healing abilities. Economic factors, education, urbanisation: Affluent and educated families expect more time, more explanations and more flexibility from the treating doctor. They perceive doctor more as a friend and a guide. However, those who are not so educated and from non-affluent families expect a more authoritarian approach from the doctor; they treat the doctor as their saviour, and at times God.
Urbanisation has resulted in a more critical approach. This may be determined by psychodynamic conflicts. Factors pertaining to the treating physician A doctor's interaction with his patient depends on many factors: Especially with reference to objectivity, empathy, ethical and legal issues and his own expectations about his patient; His personality: Doctor with paranoid tendencies may feel threatened by the patient or his relatives. A therapist having a superiority complex may consider his patients as poorly educated and incapable of understanding the nuisances of therapy.
Especially about different types of patient and their socio-economic background. Also, a doctor may believe personality disorders as untreatable and hence his approach to the patient may be negative. Physical and material aspects: If a doctor feels he is not given fair remuneration for his abilities he may ignore the patient.
Society's expectations about doctor's behaviour: A doctor is supposed to be a saviour, ever available, non-commercial. The doctor may find it difficult to live up to this role. Approach towards the patient Approach towards the patient should be scientific and is discussed under the following headings: Non-judgmental approach with an open mind: Data from relatives are important, but that should not prejudice one's mind.
Similarly, educational qualifications, social background, financial conditions should not come in the way of making a sound scientific evidence-based diagnosis and treatment plan. Depending on the therapist's approach, both methods can serve the purpose well.
A combination of both and judicious mix is the best approach. Good empathy and sincere effort to understand patient's feelings: This is the crux of the approach and can never be over-emphasised. Involving relatives in an appropriate way: Relatives can offer valuable data and insights into the patient's condition while at times try to unduly influence therapy.
It is necessary to ensure the first while being aware the second does not happen. Especially in psychotherapy, and with all patients, there must be an assurance that their case histories will not be revealed without their consent.
Discussion about various treatment modalities: This can be discussed with the patient in case the doctor feels that he has insight into his condition and can understand the same. And Since Psychiatry has the Bio-chemical and Psycho-Social factors that can explain Mental Illness it were believed that there is no need for Religion or Spirituality to help Patients.
Was Mental Illness known in Ancient Civilizations?
In Ancient Egypt mental illness like any other illness was attributed to the wrath of Gods and the trend of treatment was focusing on bodily etiology in majority of illnesses and treatment involved Physical and Psychotherapy Okasha [ 4 ].
In Ancient Greece, Mental illness was also attributed to the wrath of Gods or punishment for bad actions treatment was seeking magical or paranormal remedies like going to the temple of the healing god Asclepius and spending the night there seeking treatment or at least seeking advice about what to do, although at that time Physicians and others challenged those beliefs and explained mental illness on Physiological basis. In the late 5th century BC some member of the school of Hippocrates wrote in a treatise On Sacred Disease that Sacred Illness like Epilepsy could be caused by Physiological rather than paranormal causes [ 5 ].
In the old Testament in the book of Daniel it was mentioned that the King of Babylon Nebuchadnezzar was punished for his vanity and was condemned to lose his mind and live like an animal for 7 years [ 6 ] Table 1. In the new testaments Jesus was accused of being Out of his mind or being possessed by demons [ 7 ], which leads us to a question: Did people in ancient times discriminate between mental illness and demonic possession?
Obviously they believed that both can happen due to God's wrath or punishment but could they tell which is which?! Moving back to modern times, before DSM IV there were examples of people with mental illness that happen to be religious as described by Larson et al.
Psychiatry and Religion, What Psychiatrists and Religion Professionals Can Do?
But over the last 30 years research pointed out by Koenig et al. Secular Psychiatric Ethics Fundamentalist Medical Ethics Based on ideas of the European Enlightenment reason, freedom, natural law, individual happiness. Based on scripture, tradition, religious law, religious authorities, statements or confessions of faith, rabbinical teachings, etc. Relative, consequentialist values eg, susceptible to modification on the basis of circumstances, and achieving patient-centered goals.
Absolute or categorical values eg, the Kantian principle that certain acts are always and absolutely wrong. Patient and physician are engaged in a relationship of trust and faithfulness in which the autonomy of both is limited and subordinated in obedience to God. Cognitive style tends toward "gray" responses to complicated dilemmas and tolerance of ambiguity in life choices. Cognitive style tends toward "black and white" answers to complex questions and intolerance of uncertainty in making life choices.
Goal of medical ethics is respect for patient preferences and wishes in the process of shared decision-making geared toward actualizing patient happiness and health in this world. Goal of medical ethics is to preserve the sanctity of human life and health so that individuals may fulfill God's plan for the salvation of humankind. Salient differences between psychiatric and fundamentalist ethics and orientation.
They are not held on demonstrably delusional grounds.