Having a belief system in common with a patient can be an asset or a
liability depending on what that belief system means to each and how they
handle it in the therapeutic setting.
John Peteet, M.D., is chair of APA's Corresponding Committee on
Religion, Spirituality, and Psychiatry.
Photo courtesy of John Peteet,
An Orangeburg, N.Y., psychiatrist who practices Buddhism teaches his
patients how to meditate and facilitates a group for like-minded clinicians on“
Spirituality and Psychotherapy.”
A Syrian-born Muslim psychiatrist in Boston keeps the door ajar, in
deference to Islamic sensitivities, when alone with a female Muslim patient in
the consulting room.
And an Orthodox Jewish clinician, who is also a neuroscientist, questions
her Orthodox patients about symptoms of obsessive-compulsive disorder (OCD)
that can arise in relation to rituals associated with washing, bathing, and
keeping a kosher kitchen.
Eighty years after Sigmund Freud, in The Future of an Illusion,
wrote that religious faith is an illusory reflection of “the oldest,
strongest, and most urgent wishes of mankind,” these clinicians have
opted to bring their distinct religious sensibilities into the consulting room
in the treatment of patients who share their religious beliefs.
They are part of a trend in “patient-centered” care and a new
emphasis on cultural sensitivity that has expanded to include the awareness
that a patient's beliefs—about the meaning and purpose of life and the
nature of the universe—are crucial to understanding a patient, and to a
patient's health and illness.
John Peteet, M.D., chair of APA's Corresponding Committee on Religion,
Spirituality, and Psychiatry, said recognition of the value of religious and
spiritual beliefs and practices in mental health treatment has grown in recent
years (see page 11). And he said many patients seek out like-believing
“I regularly hear from potential patients who are looking for a
Christian psychiatrist, and I first try to assess if this is something they
need, as opposed to something they can find better in a church or secular
mental health setting,” he said. “My faith informs the values and
vision that guide my view of people as created in God's image and therefore
valuable. It also informs my view of full health as relational and marked by
effectiveness in meeting existential life tasks, versus simply an absence of
William Greenberg, M.D.'s, interest in the practice of Zen Buddhism began
when he was a teenager, reading the works of Alan Watts, and has since grown
to be an integral part of his personal and professional life.
Today, in his small private practice he specializes in working with
patients who are also practicing Zen—many of whom also identify as Jews
or Christians. He is also director of the outpatient research program at the
Nathan Kline Institute for Psychiatric Research in Orangeburg, N.Y.; a member
of APA's Corresponding Committee on Religion, Spirituality, and Psychiatry;
and a priest in training at High Mountain Crystal Lake Zen Community in
Greenberg describes his early training and psychiatric practice as
conventional: he graduated from Albert Einstein School of Medicine in 1982 and
was director of residency training from 1988 to 2000 at Bergen Pines County
Hospital (now called Bergen Pines Regional Medical Center) in New Jersey.
But in 1997 he attended a week-long retreat in Key West, Fla., for mental
health clinicians led by Thich Nhat Hanh, a Vietnamese Buddhist teacher.
“It got me thinking that if I was really serious about Buddhism, why
was I not trying to integrate that with my understanding of human beings as a
clinician?” Greenberg told Psychiatric News.
Today, he teaches patients “mindfulness,” a meditation
technique in which one concentrates one's attention on some object or
phenomenon, typically the movement of one's breath. As the mind begins to
wander, the meditation practitioner in time learns to gently bring it back to
the focus of attention.
Greenberg believes it is an exercise that can help patients get“
unstuck” from the dysfunctional, ruminative thoughts and feelings
typically associated with depression, anxiety, and OCD symptoms. He said it
works especially well in conjunction with cognitive-behavioral therapy.
“Patients who meditate are more likely to be in touch with things
that bother them and better able to participate in psychotherapy,” he
said. “As things come up in meditation, you learn to acknowledge them,
accept them, and then gently let them go. That is what most patients who are
stuck have a hard time doing. And I think what is really healing is the
ability to let go. Once you learn that you can let go of something, it starts
to lose its force.”
Further, meditation can improve a therapist's clinical skills. “We
are better able to not let countertransference get in the way, better able to
hear other people, and better able to maintain a posture of evenly hovering
presence,” Greenberg observed.
“Meditation does change you,” he said. “It's not a matter
of simply sitting on cushions, but it carries over to inform the rest of your
“There is a big difference between the Islamic understanding of
mental illness and the way contemporary Muslims view mental health and
illness,” said Yousef Abou-Allaban, M.D., M.B.A.
In an interview with Psychiatric News, Abou-Allaban—an
Arabic-speaking Muslim psychiatrist with a group practice in suburban
Boston—said that psychiatric hospitals existed in Baghdad, Cairo, and
Damascus as early as 700-800 A.D.
He noted also that the Koran speaks of a variety of forms of mental
distress and offers prescriptions for them. He cited the Muslim physician ibn
Sina, born in 980 A.D., who wrote about melancholia and eating disorders.
Yet today, he said, the contemporary Muslim is likely to view mental
illness with a starker sense of stigma than does even the mainstream culture
and to ascribe mental illness to sin or the devil.
In a chapter he wrote on treating Muslim patients in the Handbook of
Spirituality and Worldview in Clinical Practice, Abou-Allaban ascribed
this disparity to the fragmentation of the Islamic civilization since its
golden era in the 9th through 13th centuries.
“In the 19th century, when Muslim lands were divided and colonized by
different Western countries, Muslim people were exposed to Western conceptions
of mental illness,” he wrote. “Those who established the new field
of psychiatry in Muslim countries were Western-trained psychiatrists who not
only carried the view that religion was a hindrance... to mental health, but
also attempted to apply Western methods in a very different cultural
“Through these periods of sociopolitical upheaval, many Muslims lost
hold of the guidance that their religious tradition offered them in coping
with mental health difficulties...,” Abou-Allaban wrote.
(The book was edited by Peteet and Allan Josephson, M.D., and was published
by APPI in 2004).
In his experience, Abou-Allaban said that contemporary Muslim patients are
receptive to the use of psychopharmacology, but far less receptive to the
notion of psychotherapy.
He also noted that the religious proscription against interaction between
unmarried men and women also influences clinical practice.
“If I have one female patient in the consulting room with me, I keep
the door open,” he said. “Muslim women feel very intimidated in a
room with a strange male by themselves while the door is closed. It's a pretty
At the same time, he said, it is not uncommon for Muslim patients to arrive
in the consulting room with the entire family in tow. “If the patient
has no family, he may bring a friend,” Abou-Allaban said. “The
issue of privacy and individuality is not as ingrained or as essential as it
is for non-Muslim Americans. There is a lot of family support.”
Predictably, much of what Abou-Allaban describes about practicing
psychiatry as a Muslim is colored by life in post-9/11 America.
He disavows violence and extremism and emphasizes that Islam is not
intrinsically hostile to America or to the Western world. “I enjoy
practicing Islam in the United States more than I enjoy practicing it anywhere
else in the world,” he said. “If you ask many Muslims, they would
say the same thing.
“People think all Muslims are like the Taliban, but although Islam is
one religion, it does not replace the local culture,” he said.“
When I talk to a Muslim from the Middle East, I can relate easily, but
it is very different with a Muslim from Pakistan or Russia. In each part of
the world, the culture has a major impact on how Muslims think and how they
understand mental illness and disease.”
Psychiatrist Elizabeth Sublette, M.D., Ph.D., is a clinician and
neuroscientist in the Department of Psychiatry at Columbia University College
of Physicians and Surgeons and the New York State Psychiatric Institute. An
Orthodox Jew, she treats a predominantly Orthodox patient population in New
“As an Orthodox Jew, I feel that I have a cultural familiarity with
what my patients experience and that I speak the same language,” she
told Psychiatric News. “It used to be that seeking psychiatric
help was completely stigmatized, and the Orthodox community was very wary of
it. That's changed, and in recent years there has been a tremendous
improvement of services available to the community and a growing number of
Orthodox practitioners who are going into this field.”
Certainly, there are aspects of treatment that are unique to the community.
In some Orthodox families, the protocols surrounding dating are exacting:
parents of someone of dating age may carefully research the backgrounds of
potential candidates, obtaining character references and a rabbi's approval
before the young couple can go out to dinner.
If there is a history of mental illness or a candidate is on medication, it
can prove a serious problem. “It's a real concern both because of
people's fears about genetic susceptibilities and about use of medication
during pregnancy in a community where people may have six to 12 kids,”
She said she typically asks her Orthodox patients with OCD about symptoms
that can arise in the context of ritual bathing or preparation of food. For
instance, she has known of patients with OCD who, in the process of keeping a
kosher kitchen, have thrown out hundreds of dollars' worth of food, or pots
and dishes, out of fear of contamination.
Then, too, there is a religious proscription against a man and woman being
alone in the same room, a rule that can turn therapy between a patient and
therapist of the opposite sex into a quandary.
In Sublette's case, the solution was a low-lying window into her
basement-floor office. “I asked a rabbi for a ruling on how I could
conduct therapy with a male patient,” she recalled. “The ruling
was that there had to be a window so that potentially someone could see in,
even if it was very unlikely.”
Peteet believes the sensitivity that like-believing therapists can bring to
their religious patients is clinically valuable.
“Sharing a belief system can be an asset or a liability depending on
what it means to the patient and clinician and how they handle it,” he
said. “Potential advantages include greater understanding, trust, and
the ability to draw on recognized and/or shared spiritual resources.
Fundamentalist patients may be able to trust themselves to a psychiatrist only
of the same faith or one they find through a trusted religious authority.
“Potential liabilities include negative reactions or struggles based
on prior experiences with religious authorities; collusion to focus on
religious or spiritual issues instead of on needed psychological work, some of
which might require confrontation; and unwarranted assumptions based on a
shared or similar identification,” he said. ▪