Compassion, empathy, and the ability to reflect deeply and thoughtfully are
the essentials of our profession, yet for many patients one often wonders how
to approach the spiritual dimension, that is, the crucial link with a higher
power. A recent patient of mine stimulated this discussion within myself, as I
struggled to help the teenager cope while he went through an arduous wait for
a cardiac transplant. We drew upon our inner beliefs, trying to explore
together the meaning of life and the implications of impending despair for
him.
When exploring the spiritual dimension with a patient, it is essential to
understand that every individual has a value system, and these spiritual
factors can become effective partners of science, bringing critical insight to
assessment and treatment of various psychiatric disorders.
The key questions that need to be addressed as a psychiatrist considering
the role of spirituality in a patient's life include how much does a
psychiatrist support the patient's spiritual and religious practices, and what
role does one's own spiritual belief play in therapy? The answers are not
clear, but as psychiatrists we must not assert the primacy of our own world
view, but rather should help the patient find a way to live in and with the
world.
Spirituality may help some individuals by raising energy levels, inducing
relaxation, and enhancing connectivity of an individual toward self, a higher
power, and healing. A correlation between spirituality and better health has
been suggested in prevention, coping, and recovery in a wide variety of
chronic physical conditions, including hypertension, cerebrovascular and
cardiac disease, increased survival time in AIDS patients, and improved coping
with cancer. It is, therefore, imperative that psychiatrists and mental health
professionals begin to understand the value that compassion, hope, faith, and
spirituality can play in the process of healing for their own patients.
While spirituality may not be missing in the personal lives of the
patients, their families, their psychiatrists, or the societal belief system,
it is largely unaddressed in the modern mental health delivery system.
Training in psychiatry provides limited guidance as to how to deal with
spiritual matters, and often, as the trainee feels unskilled, he or she tries
to evade or even dismiss these issues. Yet it is likely that many individuals
with mental illness turn to spiritual beliefs to help them cope with their
illness and move toward recovery.
During residency and as an early career psychiatrist, one should learn to
be comfortable with taking a spiritual history. This history should address
the patient's spiritual attitudes and value system, spiritual development, and
sense of meaning and purpose spirituality may play in the patient's life, as
well as acknowledge the role of spirituality in clinical decision making. At
the same time, residents and early career psychiatrists should be aware of
their own countertransference issues in response to such spiritual disclosures
while maintaining sensitivity to, and tolerance of, the patient's values. This
approach, along with the involvement of chaplains and pastoral care as
appropriate, could constitute an effective spiritual prescription.
While the patient I mentioned earlier was fortunate enough to undergo a
successful cardiac transplant, he said that the experiences he had as a
sufferer and then as a beneficiary completely changed his view of life and
strengthened his belief in humility, hope, faith, and compassion. As the
treating team, we were left watching spirituality in action and pondering what
Einstein had once so aptly said: "The most beautiful experience we can
have is the mysterious—the fundamental emotion which stands at the
cradle of true art and true science." ▪