Religion, psychiatry and professional boundaries

Epilogue: Proposal for a World Psychiatric Association Consensus or Position Statement on Spirituality and Religion in Psychiatry

“…Amongst the objections to Koenig's editorial [6] raised by Poole et al [9], was an assertion that psychiatrists are 'essentially applied biopsychosocial scientists, who work within a clear set of humanitarian values and ethical principles in order to get alongside service users and facilitate their recovery from a mental illness'. In this context, dabbling in matters of spirituality and religion is seen as breaking 'the boundaries of our legitimate expertise'.…”

“…The implication may also be that spirituality and religion are either too private, or else not important enough, to be relevant to the role of the psychiatrist. Poole et al [9] refer also to the dangers of 'religious breaches of therapeutic boundaries' which, although not of a political nature, would appear similar to the dangers perceived by Eastern European psychiatrists who fear that asking questions about religion may present a potential threat to the therapeutic relationship.…”

“…However, the 'World Christian Database' on which he relies for these figures is seen by some as 'hardly an unbiased source of information' [8]. According to Koenig's opponents, the correct number lies somewhere between 15.5 and 36% [9], although we might note that the 15.5% figure actually represents those who identify with 'no religion' rather than those who are actually atheists, 2 and the 36% figure applies to those of age 18 to 34 years. 3 An interesting source for data, used by Lepping in his response, is the Religion Monitor (www.religionsmonitor.com) of the conservative German Bertelsmann Foundation [10].…”

“…What are the objections to these proposals? Poole et al [9] argue that a spiritual history can be considered 'intrusive and excessive' and lacking in respect for 'non-believers'. Hilton [11] mentions that there is too little experience in taking a spiritual history, as opposed to a religious history.…”

“…The process of supporting or challenging beliefs is also said to appeal too much to the norms and values of the physician, and to be incompatible with the 'therapeutic neutrality' that the clinician should adopt towards such matters. The introduction of prayer, a 'completely nonclinical' activity, into the clinical setting is said to represent a great danger of blurring boundaries and creating ambiguity around the therapeutic relationship [9].…”