Patterns of religious affiliation among psychiatrists differ from those of
other physicians, and these contrasting religious beliefs may determine to
whom patients are referred for mental health care, according a study in the
September Psychiatric Services.
Researchers from the University of Chicago and Duke University mailed a
survey in 2003 to a sample of 2,000 U.S. physicians from the AMA Physician
Masterfile and received replies from 1,144 (63 percent), including 100
psychiatrists. The survey asked about their religious and spiritual
characteristics and also asked the nonpsychiatrist physicians to whom they
would refer a hypothetical patient with ambiguous psychiatric symptoms.
"Psychiatrists were less likely [than other physicians] to attend
religious services frequently, believe in God or the afterlife, or cope by
looking to God," reported Farr Curlin, M.D., an assistant professor of
general internal medicine at the Pritzker School of Medicine at the University
of Chicago, and colleagues. "In addition, psychiatrists were less likely
to classify themselves as religious and more likely to classify themselves as
spiritual but not religious."
Tension between psychiatrists and religious believers is not new. It may
have been exacerbated by Sigmund Freud, who had unpleasant things to say about
religion in his famous essay "Future of an Illusion." However, the
rift is probably not so unbridgeable today as it might once have been, Jeffrey
Boyd, M.Div., M.D., told Psychiatric News.
Boyd has seen both sides of this divide. He went to Harvard Divinity School
and was ordained as an Episcopal priest before entering medical school at Case
Western Reserve University. After residency at Yale in the late 1970s, he
worked at the National Institute of Mental Health in psychiatric epidemiology.
Since 1986 he has practiced at Waterbury Hospital in Connecticut, where he is
now chair of behavioral health.
"In my experience, people who are more religious see the mental
health field in general as hostile, so representation of psychiatrists among
those people is lower," speculated Boyd, who was not involved with
The researchers asked all the doctors about organizational or participatory
religiosity—how often they attended services and whether they believed
in God or an afterlife. They inquired about intrinsic
religiosity—"the extent to which an individual embraces his or her
religion as the 'master motive' that guides or gives meaning to his or her
life." They also asked about "spirituality," a term that
they concede is ambiguous but may cover both formal religion and feelings of a
connection with an entity greater than oneself that gives life meaning.
Responding psychiatrists, they found, were less likely to be Protestant or
Catholic and more likely to be Jewish or to declare no religion than were
other physician respondents. According to the survey report, 13 percent of the
U.S. population claim no religious affiliation, compared with 10 percent of
the responding physicians and 17 percent of psychiatrists. Protestants make up
55 percent of the U.S. population, but accounted for only 39 percent of the
respondents and just 27 percent of the psychiatrists. Catholics make up 27
percent of the population, but made up 22 percent of responding physicians and
10 percent of the psychiatrists, while Jews, who account for less than 2
percent of the population, made up 14 percent of physicians in the survey and
29 percent of the psychiatrists. Muslim and Hindu psychiatrists closely
matched the proportion of their other medical colleagues, but absolute numbers
were quite small.
In the hypothetical case, the patient was described as a man mourning
intensely two months after his wife's death.
"The religious characteristics of physicians determine to some extent
whether their patients receive evaluations from psychiatrists," wrote
the researchers. A religious nonpsychiatrist would be more likely to refer the
patient to a clergy member or other pastoral counselor rather than to a
psychiatrist or psychologist.
Protestant and Catholic physicians, for example, were less likely than
those with no religious affiliation to refer to psychiatrists or
psychologists, and more likely to refer patients to a clergy member or other
religious counselor. Jewish physicians were almost equally divided on the
"A lot could be explained by unfamiliarity, not antipathy,"
said John Raymond Peteet, M.D., an associate professor of psychiatry at
Harvard Medical School and chair of APA's Corresponding Committee on Religion,
Spirituality, and Psychiatry. "Conservative Muslims, Jews, and
Christians all want someone who understands them, and if their clergyperson
vets a psychiatrist, they will trust their values."
However, there is no wall separating believing nonpsychiatrist physicians
from their psychiatric colleagues, said Peteet in an interview. "Most
religious internists have psychiatrists they know and trust, regardless of
their religious orientation, but I have heard of cases of not referring to
secular specialists so as not to undermine the world view of patients, as in
cases that might lead to divorce."
In fact, the hypothetical case may be a little too simplistic to permit
drawing any valid conclusions, said Boyd. Perhaps differing views on the
nature of religion may underlie the aversion to psychiatry among
fundamentalist Protestants and devout Catholics, he said, citing Erich Fromm's
distinction between "humanistic" and "authoritarian"
religious belief systems. For instance, the Talmudic tradition in Judaism of
inquiry and argument—a very "psychological process," said
Boyd—contrasts with a desire among Christian believers to find
the authority for the answer.
Why religious physicians would choose not to refer to a psychiatrist is
open to speculation, said Curlin. Perhaps memories of Freud's antireligious
arguments or the "liberal political views of many influential
psychoanalysts of the 1950s and 1960s" still have their effect. In
contrast, Curlin also suggested that current emphasis on biological psychiatry
may equally alienate religious doctors.
Patients for whom religion is an important part of their lives have often
learned not to talk about religion to therapists for fear of being thought
poorly of, said Boyd. About seven years ago, he began wearing a small cross on
his collar as an outward indication of his faith, much as his observant Jewish
colleagues wear yarmulkes. He has found almost no negative reactions to that
move but has seen an increased willingness for religious Christians to be more
open when they see a sign of his religious background.
By whatever means, the worlds of religion and psychiatry may be slowly
moving to close the gap as both sides learn more about the other.
"In the last three decades, some form of counseling training has been
adopted in almost all seminaries in the Christian world, even in the most
conservative," said Boyd. "The pro-mental health rather than the
anti-mental health point of view has come out the winner."
Curlin and colleagues suggested that psychiatric training include more
cultural sensitivity to religious beliefs to help overcome any distrust.
Earlier studies found that psychiatry residents are less irreligious today, so
perhaps any current differences can be expected to moderate over time.
Another psychiatrist has suggested that clergy and psychiatrists can learn
from each other and that religious and biomedical forms of healing are not
"It is not just that religious professionals need to be educated
about mental illness, but also it is vital that psychiatrists understand
religious experience," wrote Simon Dein, M.B.B.S., M.R.C.Psych., Ph.D.,
a senior lecturer in psychiatry in the Division of Medicine at Royal Free and
University College Medical School, University College London, in a letter to
the British Journal of Psychiatry. Dein has studied the intersection
of mental health and religiosity among both Pentecostal Christians and
Orthodox Jews. "Mental health professionals need to be knowledgeable
about the circumstances in which referrals to religious professionals are
"Will there be a slow convergence of the mental health world and the
Christian religious world in my lifetime?" asked Boyd. "I think
it's moving in that direction."
"The Relationship Between Psychiatry and Religion Among U.S.
Physicians" is posted at<http://psychservices.psychiatryonline.org/cgi/content/abstract/58/9/1193>.▪