Psychiatry and ethics: The problematics of respect for religious meanings

Abstract

Over the past two decades American psychiatrists have had to address the emergence of an increasingly fervent religious pluralism. Particularly in cases of socially controversial new religious movements (NRMs), distressed families have pressured psychiatrists to assess the mental state of recruits to such sects, often labeled "cults." At this inevitably acrimonious interface between family values and religious liberties, psychiatrists have for the most part resisted pressures to medicalize religious conversions. This article provides an historical review of American psychiatric response to NRMs with respect to nosology and practice. It introduces this response in the more general context of ethics and the problematics of respect for religious meanings.

Should Psychiatrists Serve as Gatekeepers for Physician-Assisted Suicide?

“…Psychiatry has had a troublesome role in a variety of controversial social behaviors including masturbation, 34 equal rights for women, 35 and religious “cults.” 36 American psychiatry first defined homosexuality as a mental disorder needing “treatment” and then, as the gay rights movement took hold, demedicalized homosexuality by a majority vote of the American Psychiatric Association 37 . Even the notorious political abuse of psychiatry in the Soviet Union has fainter echoes in our own country: during the 1964 presidential election, over 1,000 members of the American Psychiatric Association responded to a mailed survey declaring that Barry Goldwater was mentally unfit to serve as President of the United States 38…”

Levels of training to address religion in clincal practice.

“…Shafranske & Malony, 1990). Post (1993) recognized the risk when he stated: No one could deny that an incorrect clinical interpretation of a religious patient would be harmful if it leads to an incorrect or distorted picture of a persons' mental health. Certainly, a bias against religion would contribute to failing to recognize the religious patient in her or his fullest human dimension—a failure that can only compromise the therapeutic enterprise.…”

“…Post (1993) stated that a “strong scientific ideology and world view” may contribute to the failure among some clinicians to assess religious functioning or to “consider religion or other cultural aspects of patient experience with seriousness” (p. 364). Also, as Post observed, a historical analysis suggests that as the scientific framework emerged, it challenged existing “theologies” (p. 370), thereby planting a seed of suspicion toward religious persons within those trained as scientists.…”

“Spiritual Starvation” in a Holy Space—a Form of “Jerusalem Syndrome”

“…The glossary to the 1987 version of the Diagnostic and Statistical Manual of Mental Disorders (American Psychiatric Association, 1987) was replete with religious examples of psychotic symptoms (e.g., under glossary definitions of delusions, hallucinations, incoherence, magical thinking). However, these religious references were criticized for suggesting that religiosity in general was symptomatic of mental illness (Post, 1993), and most have therefore been removed from DSM-IV. As a result, religious beliefs are largely ignored altogether (Pierre, 2001).…”