Book Review - Spirituality and Psychiatry
Chris Cook, Andrew Powell and Andrew Sims (Editors)
Reviewed by Arthur A. Dole, Ph. D., ABPP
How do psychiatrists and other mental-health specialists justify the application of spirituality to patients in the United Kingdom? The contributors to this book maintain that spirituality is crucial to mental well-being and psychiatric care. Their evidence: international authorities, case studies, research, professional experience, official reports, and patients’ testimonies. (Incidentally, my review is based on the 300-page U.K edition, not the shorter U.S. version.)
The three editors—Chris Cook, a theologian; Andrew Powell, a psychotherapist; and Andrew Sims, a psychiatrist—state that spirituality has been defined in diverse ways. Their book, whose contributors included 17 psychiatrists, 1 social worker, and 1 psychotherapist, was supported by The Spirituality and Psychiatry Interest Group of the Royal College of Psychiatrists. Among aspects of spirituality identified in 14 chapters was, of course, religion, plus caring, empathy, mysticism, New Age practices, near-death experiences, life’s meaning, dreams, transpersonal perspectives, personal philosophy, and so on. And on. All these aspects, the contributors assert, can contribute to patient welfare within a mental-health team approach.
As an aside, Royal psychiatrists in the English National Health Service are by no means alone in expanding the meaning of spirituality, once pretty much confined to its religious aspect. Currently, Google provides 14 definitions, Wikipedia devotes to it 15 related topics, and the American Psychological Association lists 8 books and 5 videos on Spirituality and Religion in its 2010 Spring Book Catalog.
Chapter 13, Pathological Spirituality, by Nicki Crowley and Gillie Jenkinson, is of greatest relevance to readers of this journal. After a good review of the literature from Barker to Zimbardo and three case studies ("Compositions based on real clinical situations"), the authors conclude (p. 270):
Groups that use techniques such as ‘brainwashing’, ‘persuasive coercion’, ‘thought reform’, and ‘mind control’ may be damaging to individuals, their communities, and society at large. When such techniques are used, spiritual beliefs, practices, and experiences may become pathological.
Psychiatrists must be prepared to understand the potent effects of pathological spirituality, not only on the mindset of individuals, but also, from the cultic studies’ perspective, on the dynamics within groups. Only then can psychiatrists hope to recognize the signs and help those involved in the most effective way.
I wish that Crowley and Jenkinson had included brief comments on the names of the larger harmful cults in the U.K., and on efforts there at exit consultation, rehabilitation, and treatment of cult victims.
Each team of contributors ended their chapter with a brief conclusion, followed by References. I have summarized their conclusions to illustrate the flavors of the book. (My comments, if any, about their supporting evidence are indicated in parentheses.)
Spirituality, by Sims and Cook. The language of spirituality should permeate our relationships with our patients and colleagues.
Assessing Spiritual Needs, by Culliford and Eagger. Practitioners should take systematic and detailed histories to assess the patient's spirituality. (Eleven Useful Websites, such as AA 12 steps, supplement References.)
Psychosis, by Mitchell and Roberts. In caring for people with psychosis, the authors recommend practical spirituality that includes compassion, honesty, and humility. (References plus three case histories.)
Suicide, by Coghlan and Ali. Spiritual beliefs and practices, embedded in diverse religions, can have a positive impact on mental health and suicide prevention. (References are international in scope.)
Child and Adolescent Psychiatry, by Shooter. When 15-year-old Liam, dying of chronic renal cancer, refused further treatment, his parents, therapist, and the hospital staff were inspired by his spirituality. (References are diverse; they include Coles, Piaget, Dalai Lama, Erikson, Wilber, and Yeats.)
Psychotherapy, by Powell and MacKenna. When one is working in acute clinical services, the brief soul-centered approach to psychotherapy can be particularly helpful. The soul leads and science follows. (Four case histories. Among authorities cited are Frankl, Freud, Huxley, James, Jung, Einstein, Rogers, and Wilber.)
Intellectual Disability, by Raji. In the field of mental healthcare, spirituality extends beyond faith traditions to those with intellectual disabilities and to their personal and professional “carers.”
Substance Misuse, by Cook. Spirituality protects against substance abuse and may be helpful in treatment, as evidenced by qualitative and quantitative studies. (Three tables summarize 29 quantitative and qualitative studies.)
Neuroscience of the Spirit, by Fenwick. According to neuroscientific studies, spiritual methods change brain function and improve mental and physical health. (Publications cited range from physics, physiology, neuroscience, alternative medicine, and psychiatry to the Journal of the American Medical Association, etc.)
Spiritual Care in the NHS, by Eagger, Richmond, and Gilbert. Legislation and policy firmly support spiritual care (mindfulness) as a unifying aspect of the National Health Service. “Some 100 chaplains are employed by 40 of the 75 mental health trusts in England and Wales.” (References cite many official reports and are supplemented by a useful list of resources.)
The Transpersonal Perspective, by Read and Crowley. An expanded view of consciousness, and specifically of the transpersonal perspective, can contribute to a modern scientific theory of mental illness. (Five brief case studies. Jung, Assagioli, James, Laing, Lukoff, Maslow, and Wilber are among authorities cited.)
Religion and Religious Experience, by Salem and Foskett. As confirmed by research, religion, including Christianity, Bahaism, Judaism, Islam, Hinduism, Buddhism, Sikhism, Jainism, and folk religion, and cultural factors, when integrated with psychiatry and other health specialties, can promote mental well-being and alleviate mental distress.
Pathological Spirituality, by Crowley and Jenkinson. Psychiatrists must be prepared to understand the cultic studies perspective in order to help individuals damaged by groups who apply mind control. (Major literature from Barker to Zimbardo well reviewed, plus three case studies.)
Aging, by Head. As people age, their vulnerability increases to mental, emotional, spiritual, and physical factors. A multidimensional and holistic approach is therefore paramount in the teaching and training of old age psychiatrists.
Spirituality and Psychiatry makes a strong case for expanding the medical model by integrating religious and other related factors in the British National Health System. Some contributors used case histories skillfully and some relied on evidence from quantitative and qualitative research. They provided an impressive variety of material useful to psychiatrists and collaborating care givers, much of it relevant beyond the United Kingdom. The emphasis by many of these psychiatrists on a patient-centered approach, coupled with Beck's cognitive therapy, is commendable. The references at the end of each chapter and the index are helpful. Most contributors cite research, official reports, and the observations of medical authorities.
As is true of many edited books, this volume slips at times into redundancy. It fails to build an integrated theme from one contribution to the next. Authors tend to over-rely on secondary rather than primary sources in presenting research. Some draw more on psychiatric elders such as Freud, Jung, and Frankl rather than on contemporary theorists.
I was surprised that hypnotism was not mentioned both as a destructive method of cult covert social influence (cf. Hassan) and as a constructive therapeutic intervention.
As mentioned previously, the meaning of “spirituality” has expanded. I, for one, as a skeptical psychologist, winced at the inclusion of mysticism, New Age practices, and transpersonal perspective, for example.
The intended primary audiences for Spirituality and Psychiatry are British NHS psychiatrists, other physicians, chaplains, and mental-health specialists. However, I recommend it in whole or in part to English-speaking mental-health specialists around the world. Theologians will also find it informative. Among members of the International Cultic Studies Association, psychiatrists, social workers, psychologists, sociologists, lawyers, exit and pastoral counselors, and other specialists will find it valuable, especially when their travel plans include Scotland, Wales, or England.
International Journal of Cultic Studies ■ Vol. 1, No. 1, 2010