In this Q&A, Lloyd Sederer, MD, interviews Paul Summergrad, MD, Chair of Psychiatry at Tufts University Medical School and Past-President of the American Psychiatric Association (APA). Dr Summergrad will discuss spirituality and mental health at the 2019 APA Annual Meeting in San Francisco.
Dr Sederer is Adjunct Professor, Department of Epidemiology, Columbia University Mailman School of Public Health, Distinguished Psychiatrist Advisor to the New York State Office of Mental Health (OMH), and Director, Columbia Psychiatry Media. Dr Sederer’s most recent book, The Addiction Solution: Treating Our Dependence on Opioids and Other Drugs (Scribner, 2018), is now available in paperback.
Lloyd Sederer, MD: Faith, spirituality, even religion, seem an uncommon subject in the psychiatric office. I know you have thought about this matter a great deal. How do you understand their absence?
Paul Summergrad, MD: Including spiritual or religious information in medical training or exams is limited. It may appear in a perfunctory way in the review of systems, but since it is rarely an etiological factor in general medical practice, its role is limited. In that sense, psychiatry is not particularly unique. If there is a distinctive discomfort in psychiatry with spirituality it may derive, in part, as a vestige of the traditional psychoanalytic view of religion being almost a culturally sanctioned form of neurosis. Today, psychoanalysis does not have the power it once did, and it surely is no longer ubiquitous. Another challenge for psychiatry is more obscure: which is that in certain psychiatric disorders—mania and schizophrenia to name two—it is not uncommon to have delusions with religious or spiritual elements, phenomena which may make spirituality seem more suspect than other considerations.
Lloyd Sederer, MD: How do you define spirituality? How is it different from religion?
Paul Summergrad, MD: I am not sure that I have an exact distinction. In general, I would suggest that spirituality is linked to a sense of meaning, purpose, ineffability, or (potentially) experiences of unity with the world, even grace. While religious experiences may include all of these elements, religions are often viewed as a specific set of beliefs, often within a ritual or communal canon, including accompanying texts and an ordained clergy.
Lloyd Sederer, MD: Do you think psychiatry has an implicit bias about religion? Not just Freud and his followers. If so, what are we foreclosing from our clinical conversations with patients, given that religion (or faith) is so highly prevalent, especially in the US?
Paul Summergrad, MD: I don’t know if it is implicit. But it can be, at times, uncomfortable to discuss. First, it is not scientific per se, in that it doesn’t derive from experiment, clinical observation, human biology, or controlled clinical trials. The essence of religious experience is just that, namely experiential, and further refracted through individual consciousness. This seems especially so in the founding of religions. But eschewing religion in psychiatric practice does, I think, risk alienating psychiatrists and other mental health professionals from many patients and their families. Because of the great comfort or meaning they can derive from religious communities as well as the capacity to seek solace from pastors, priests, rabbis, Imams, and others.
Lloyd Sederer, MD: If a bias exists, how can we recognize it? What are we missing as a result?
Paul Summergrad, MD: It is a general principle of good care to meet people where they are. If they are medically ill, we may see them on a medical unit or an ICU. In communities, we may encounter patients in clinics or in outreach to underserved areas. Or it may be on college campuses. And in jails and prisons. Those patients who are religious, or members of their faith communities, are no different and should not be deprived of our or other physicians’ and clinicians’ expertise. Especially in the United States, where religious belief and the seeking of guidance from religious leaders is a more frequent event than in many other countries. It is, thus, essential that we have an effective means of communication with religious communities.
The author reports no conflicts of interest concerning the subject matter of this article.