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Transcendence and delusion

05 January 2010

Psychiatry has issues,Gwen Adshead finds


Spirituality and Psychiatry
Chris Cook, Andrew Powell, and Andrew Sims, editors

THE editors of this book set them­selves an ambitious task: to explore the relationship between spirituality and psychiatry. They do this by inviting reflections from a variety of contributors, most of whom are members of a special-interest group on this topic. The Royal College of Psychiatrists wisely supports such groups, to amplify and enhance the quality of psychiatric practice; and this one has organised conferences, seminars, and now this book.

The editors make two important points in their introduction. First, they define spirituality as “the human experience of relationship, meaning, and purpose”, which in­cludes a transcendent dimension; and they point out the overlap with psychiatric practice, which also addresses these issues.

Second, they state that this is a clinical textbook, written with psy­chiatric trainees in mind; but note that, unlike a traditional textbook, it will ideally generate more questions than answers.

I have found this a hard book to review, perhaps because the twin focuses of spirituality and psychia­try are so large, diverse, and com­plex. I think it will indeed be useful for psychiatric trainees and others who work in the field of mental health or with distressed people generally. I particularly recommend the chapters on psychosis (by Susan Mitchell and Glenn Roberts) and ageing (by Robert Lawrence and Julia Head), both written with com­passion and intelligence.

The art, it seemed to me, was to explain how different types of psy­chiatric disorder (like other per­sonal disasters) challenge a person’s view of the world, and his or her place in it; and how a good psychia­trist uses diagnosis as a frame for thinking, not a vice.

What I missed, however, was a critical review of psychiatry as a materialist science, in thrall to an outdated positivist empiricism. I missed it specially because I had just read Karen Armstrong’s won­derful book The Case for God, in which she charts how man’s idea of God changed from the ineffable and immeasurable into a rigid entity, defined (and arguably con­fined) by a literal reading of reli­gious texts.

In the same way, I would argue, contemporary psychiatry has, to a great degree, abandoned the non-physical reality of the “psyche” in favour of a self that can be “measured” using self-report ques­tion­naires.

Although psychiatrists would be outraged if their own mental lives were treated so, patients’ experi-ences and relationships are often reduced to their most simplistic. It is not just that religious belief is sometimes assumed to be delu­sional: it is the theoretical assump­tion that there is a non-physical reality, delusion, which professionals can see but others cannot, and that this assumption is more “real” than the patient’s belief.

There is much more to say about this; and perhaps such challenges to orthodoxy have no place in a text­book. I hope that the editors may consider producing another volume that includes philosophers and theologians as well as psychiatrists, and which will generate even more searching questions, and deepen the discourse.

Dr Gwen Adshead is a forensic psychotherapist at Broadmoor Hospital in Berkshire.

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