Abstract
In premodern times, concerns regarding illness and healing were often encompassed within the wider domain of a religious worldview. In many cultures healing was a sacred art. Today, at least in the developed world, medicine, including psychiatry, is a secular discipline, basing its understanding on a scientific worldview. Psychiatry, in particular, claims a biopsychosocial basis for its understanding of life and illness but, as will be suggested in what follows, we operate from restricted notions of what this claim might entail.
To the degree that medicine has a scientific basis, it is a dynamic enterprise, its knowledge and practices open to revision, in light of new discoveries. Religious/spiritual institutions, and psychiatry/medicine, share a concern with illness and the alleviation of human suffering but as human enterprises they have little in the way of shared conceptual bases [1].
Religious bodies in many instances refer to the past for the foundations of their beliefs: such beliefs are generally not open to revision in the light of new evidence although there are exceptions to this (see below), and in this regard religious/spiritual traditions stand in radical contrast to science.
This paper is written in the belief that psychiatrists, particularly in the area of psychotherapy, may contribute to the generation of more hopeful and empowering stories, which once more bring together science and sacred awareness. The paper suggests possible lines of enquiry for such an enterprise.
Finally, it should be noted, that although the following has particular reference to the practice of the psychiatrist as psychotherapist, it also bears on a number of the conceptual presuppositions common to psychiatric practice and hence on the range of explanations available to both practitioner and patient.
The beginnings of this enquiry lie in the author's earlylife church experience where, in face of the preacher's assertions regarding God's presence, I sought in vain for objective validation (a hopeful early commitment to an empirical stance), finally deciding that the Almighty must be hidden behind the organ pipes that formed the backdrop to the pulpit. Since that day I have spent what must seem to those close to me, an inordinate amount of time searching. As the late Gregory Bateson asserted, the point of the probe is always in the heart of the researcher. To date I have come up not with answers but with what I believe to be a better set of questions. I am attempting to show that there are still areas in which we, as therapists, may consider the possibility of a sacred dimension in the understanding and treatment of human suffering.
To conclude this introduction, I must make a specific point, namely, that it is not the intention of the writer to criticize or derogate the religious/spiritual beliefs of any individual. As I hope to show, psychiatrists may need to be more mindful of this aspect of human being, and accord it appropriate respect.
Clinical concerns
In practical, day-to-day matters, it may well be asked what, if any part, do religious issues play in actual psychiatric practice. When Napoleon asked the mathematician Laplace what role God played in his scheme of things, Laplace is said to have replied ‘Sir, I have no need of that hypothesis!’ The same might be said of contemporary understanding in psychiatry. A clinician may consider the possible role of a patient's religious/spiritual beliefs as contributing to the expression of symptoms in any particular case. The conceptual bases of understanding in psychiatry, particularly in psychotherapy, and in religion, however, are held to belong in largely non-intersecting domains.
Aristotle gave a fourfold description of the concept of cause: material (e.g. the brass of a bowl); formal (a plan or form); efficient (the primary source of the change, which accords with our commonsense understanding of cause); and final (the purpose or end for which a thing is done). To paraphrase Aristotle, religious belief may be seen as a formal cause, the meaning which a particular patient may ascribe to his or her state of distress and hence to a possible source of relief, whereas for the psychiatrist biological and psychological factors comprise the efficient (real) cause of the patient's disorder.
From a patient's viewpoint, religious/spiritual factors may well be seen to be important in their own perception of their illness state. While this might have particular application in the area of transcultural psychiatry, there is evidence for the relevance of enquiry regarding a person's religious concerns, based on a domestic (Australian) population. In a pilot study conducted in a rural setting, D'souza [2] found that 79% of the patients ruled spirituality as very important and 82% thought their therapists should be aware of their spiritual beliefs and needs. It is now recognized that religious/spiritual beliefs may have a role in buffering against the adverse consequences of mental and physical illness [3]. In the US an anthology entitled Psychiatry and religion: the convergence of mind and spirit has recently been published by the American Psychiatric Press [4], a pointer to the more widespread incidence of religious belief in that country. Cognitive–behavioural techniques may enlist a patient's religious belief structure as an aid to therapy [5], but the person's religious belief system is not part of the essential structure of psychiatric understanding.
Development of ideas about the mind in Western thought
In order to give a clearer understanding of what follows it will be necessary to refer briefly to the history of Western thinking about the nature of mind.
Perhaps the oldest problem in philosophy is the question of what is real, and how can we know it. The answer given by Greek philosophers in antiquity was that we could know directly. Aristotle saw an identity between ideas in the mind and the essences of things in the world: we could know because our minds could directly grasp the essences of things in the world. There was no split between what there is, and what one could know, because the mind was in direct touch with the world [6].
Descartes (1596–1650) drew a fundamental distinction between the mind and the world, holding that they were not one but two different kinds of things. The body was of flesh and the world; the mind was not, and hence the mind could not be directly in touch with the world. Ideas (other than those assumed to be innate) became ‘internal representations of external reality’, forever distant from the world but somehow corresponding to it. This distinction, Cartesian dualism, served to emphasize the conception of disembodied, (i.e. transcendent) reason as that feature that distinguished humans from other species. However, ‘once the mind is taken to be disembodied, the gap between mind and world becomes unbridgeable’ [6].
In Western philosophy, from the time of Plato, a distinction was made between appearance and reality. That which was apprehended in ordinary perception was a transient manifestation in time expressive of a deeper, unseen reality, the domain of eternal, unchanging forms. In Christian tradition, particularly with St Augustine, such conceptions were assimilated to the idea of an eternal everlasting realm beyond this world of birth, decay and death and to a notion of interiority, (i.e. a shift of focus occurred). Human life was to be understood not only in terms of (external) cosmic forces but also in terms of an individual interior realm, associated with the idea of the individual soul. In this regard Augustine can be seen to be an important contributor to the rise of the modern idea of a private inner domain, a precursor to the later development of depth psychology [7].
The foregoing views, the idea of a transcendent realm together with the idea of a transcendent creator God, maker of Heaven and Earth, have become problematic for many in the modern West, as has the notion both of the soul and of transcendent disembodied reason. I will return to this area in discussing certain developments of cognitive science.
Psychotherapy and spiritual concerns
If in the twentieth century, religious/spiritual considerations have largely disappeared from psychiatry, one exception is to be found in the domain of psychoanalysis and related psychotherapies. Sigmund Freud [8] emphasized the neurotic and regressive structure of all religious beliefs, drawing parallels, for example, between the defensive function of obsessive–compulsive disorders and the performance of religious rituals. Later psychoanalytic writers have perhaps been less dismissive. Bion [9] wrote of faith as the ultimate response to the catastrophic origins of psychic life and in this work one may discern parallels with the Buddhist conception of Sunyata, the Void or emptiness at the heart of Being. Winnicott [10] rejected Freud's concept of the death instinct, and in contrast with Freud's bleak view of humanity, held to a more optimistic view. This is not to claim that Winnicott openly espoused a religious/spiritual viewpoint but rather that his views on psychological development, especially in the mother–infant interaction, allowed for a space in which religious/spiritual issues might be considered [11]. An article by the psychoanalyst Judith Issroff in a recent anthology [12] contains interesting reflections regarding psychoanalysis, God, the self and distinctions between the ideas of religion and mystical experience.
Kohut held that religion was one of three great cultural enterprises, the others being science and art [13]. Kohut believed that religion met human needs in three forms: idealizing needs (a concept of God), which reflected in part early mother–child relations; mirroring needs through what is usually called grace (a glimmer of the mother's gleam); and a third selfobject need that he called alter ego or twinship, which Kohut felt was especially satisfied in one's participation in a worshiping congregation.
Religious/spiritual concerns in therapy have appeared largely outside of psychiatry: few psychiatrists today study the works of Carl Jung. It is my impression that religious and spiritual issues find more place in clinical psychology than they do in psychiatry. However, in the field of counselling, particularly pastoral counselling, religious/spiritual concerns may achieve prominence.
Therapies that draw on ideas from mystery traditions, particularly those of Eastern origin, include Epstein [14] who describes parallels between Buddhist and psychoanalytic ideas and Karasu [15], who skilfully subsumes reflections on the Being of the practitioner, as contrasted with his or her skills or technique, within a broadly Vedantic conceptual universe.
The mind–body question, science and the self
Hume (1711–1776) challenged the notion of our belief in the existence of an enduring self, saying that when one attempted to grasp this, one discovered only a bundle of fleeting sense impressions (i.e. there was no substantial self to be found) [16]. Furthermore, Descartes ‘“I think, I am” simply leaves untouched the nature of the “I” that thinks.’ [17]
The rise of modern science including the publication of Darwin's Origins of species (1859), challenged the belief in a creator deity and the related idea of the existence of an individual soul. The decline in traditional religious and metaphysical ways of thinking challenged the notion of a transcendent mind associated with the belief in a transcendent God.
With the rise of modern science, which dealt only in objective, testable observations, the role of mind became problematic. In the development of psychology as an academic, empirical discipline, the study of mind was later left largely to philosophers, and to the emerging discipline of psychoanalysis. This persisting division between the study of mind as being the concern of an essentially subjective approach on the one hand, and on the other, the requirements of scientific enquiry calling for an objective approach, saw the emergence in psychology of behaviourism (i.e. the question of the nature of mind was largely excluded from the purview of science). The role and nature of the self remained problematic. More recently, Damasio [18] has given an account of the emergence of a sense of self, in neuroscientific terms.
Possibilities for further enquiry
In what follows reference is made to areas where issues of a religious or spiritual nature may be seen to intersect with scientific views that have relevance to psychiatry, giving rise to the possibility of collaborative development. Particular attention is given to emerging conceptual shifts in understanding arising from cognitive science and their relationship to certain beliefs and practices within religious/spiritual tradition.
Cognitive science: developments in the scientific study of mind
Cognitive science, the scientific study of mind, should not be confused with cognitive therapy, a specific mode of treatment.
Cognitive science is an interdisciplinary research enterprise that had its beginnings in 1943–1953 [17]. It seeks to account for intelligent activity, whether exhibited by living organisms (especially adult humans) or machines. Its core disciplines are cognitive psychology and studies in artificial intelligence: also included are neuroscience, linguistics, philosophy, anthropology and more recently, developmental studies. The emergence of cognitive science is inextricably linked to advances in technology, particularly the development of the digital computer.
Cognitive science models of mind have developed along three broad streams. Earlier schemas characterized the nervous system as essentially an informationprocessing device, a model suggested by the digital computer, the input coming from signals received from an independently existing external, (i.e. objective) world, expressed as symbolically encoded representations of this objective reality. However, if this were in some way illustrative of mental functioning in human beings, how is it that we not only seem to have pictures in the mind but there seems to be an observer of this inner screen [18]? The gap between our subjective experience and such computer models of mind has been parodied as the postulated existence of an inner theatre, the Cartesian theatre in which a little man surveys the screen and so derives or assigns meaning to these representations of the flow of external events. The obvious next question is: is there yet another even smaller man inside the little man's head who makes sense of his experience?
It has become apparent, both in this earlier model of mental functioning and in later developments, especially those in the field of artificial intelligence, that the naïve assumption of the existence of a central controller was problematic. Such findings seem to be in conflict with our subjective experience of an enduring, unitary self.
Another line of development in computer modelling of mental functioning was that of neural network or connectionist depictions. This postulates networks of simple neurone-like interconnected units. Activation of such systems yielded emergent states, the expression of global activity throughout the system. The network could be ‘trained’ by varying the weightings of connectivity between the nodes. Success was achieved in pattern recognition, in particular in speech recognition. Symbols play no part here. The postulated network structure had the merit of bearing some similarity to the structure of the biological brain.
One property of connectionist systems that has particular relevance to cognitive models of mind is that of selforganization. A self-organizing system is one in which some kind of higher-level pattern emerges from the interactions of multiple simple components, without the benefit of a leader, controller or organizer [19]. Brains consist of many networks that themselves are connected in various ways, a patchwork of networks. Minsky suggested the notion of a society of mind whose central feature is a patchwork architecture of cognition [17].
Both of the foregoing schemas are based on the idea that mental processes operate on the basis of representations of an independently existing external reality, an objective domain, mind as a mirror of nature. In such a depiction the role of the observer is not accounted for. It is as if the observer has been parachuted in to a preexisting world; no account was given which included the experiencing self.
Philosophical exploration of this subjective/objective split can be found in the works of Heidegger and Merleau-Ponty. In cognitive science, following particularly on from the work of the latter, focus has shifted from the functioning of the isolated individual (an agent-side viewpoint), to a more embracing view which includes biological, evolutionary and contextual considerations. The individual was seen to function in a cultural and biological context, and mind/body to be understood not in terms of mind/body operating in an independently existing world, but of brain, body and world in reciprocal mutual interaction. Mind in this understanding was not a thing, or place but an emergent expression of this ongoing, dynamic process.
Biological systems may be characterized as being autonomous systems. This means that their changes or transformations are reflective of the organizational structure of the system itself. Environmental factors serve as perturbations to the system, (i.e. they only serve to trigger changes in the system); the nature of these changes is a function of the system's organizational structure at that time. In biological systems this is continually changing. The system undergoes a sequence of transformations while its organizational structure is maintained. This account of the dynamic functioning of biological systems stands in contrast to the common notion of causal change as being of the billiard-ball (i.e. Newtonian) type.
Any account of the operations of such a system must also give an account of the context or environment in which the organism operates. Context (world) and organism exist in a relationship of mutual specification. This point can be illustrated by an understanding of evolutionary development. The emergence of many lifeforms depended on the evolutionary appearance of bluegreen algae whose metabolism released oxygen, leading to atmospheric change and the rise of new species, both of these changes resulting in changes to the earth's surface (hydrosphere and lithosphere), changes which in turn triggered further evolutionary changes in the biosphere. The process here is one of reciprocal mutual causality or mutual specification.
In artificial intelligence studies, mobile robots have been found to perform most successfully where there is no attempt to incorporate a central planner or model of the environment. Instead robots perform effectively on the basis of couplings between an array of relatively independent inboard devices (e.g. light sensors, and selected aspects of the environment) [19].
In cognitive studies, the foregoing principles are termed an enactive or embodied approach to the understanding of intelligent behaviour; from a philosophical perspective it is termed embodied realism. This approach entails the following:
Mind is inherently embodied [6]
Mind is not disembodied but arises from the nature of our brains, bodies and bodily experiences. Mind is not a skull or skin – encapsulated entity operating on an (objective) body in a given (objective) external world. Mind is conceived of as an interactive process involving brain, body and world, in reciprocal interactions of mutual causality. Mind is both embodied and embedded in this matrix of mutual causality, mind not as a mirror of nature but as a controller primarily evolved to make things happen. Biological mind is first an organ for controlling the biological body, to make things happen in local space in real time. ‘Mind is a leaky organ, for ever escaping its “natural” confines and mingling shamelessly with body and with world’ [19]. Perception is thus geared to tracking possibilities for action. Cognition is ‘not the representation of a pregiven world by a pregiven mind but is rather the enactment of a world and a mind on the basis of a history of the variety of actions that a being in the world performs’ [17].
Unconscious thought
Thought is mostly unconscious ‘not in the Freudian sense of being repressed, but in the sense that it operates beneath the level of cognitive awareness, inaccessible to consciousness and operating too quickly to be focused on’ [6].
Reason
Human capacities grow out of animal capacities. Reason is not disembodied but arises from our embodiment, in the context of evolution and builds on the same pre-existing neural and cognitive structures that allow us (and other animals) to perceive and move around. There is no abstract, transcendent reason. Reason is mostly unconscious [6] and necessarily involves emotion, ‘the passions’, formally assigned to our lower ‘animal’ nature [20].
Abstract thought
Abstract concepts are largely metaphorical and emerge as neurocognitive extensions of prior sensorimotor (i.e. bodily) experiences, to form conceptual metaphors [6]. Examples: to see what something means is a metaphoric extension of concrete sensorimotor experience in childhood, as is the notion of grasping an idea.
A decentralized vision of the overall neural economy
The brain is now understood to function by way of distributed internal representations. There is no Cartesian inner theatre [19] (see above).
Developmental aspects
As biological systems have evolved in a mutual shaping of organism and context, so too do individuals develop in reciprocal interaction with a context or environment which includes other individuals, all against a background of shared cultural understanding that includes language. Such interactions give rise to mutually specified, shared domains, creations that emerge as the consequence of dynamical, reciprocal, non-destructive interactions. (This of course is a grossly simplified account but it serves to illustrate the basic generative nature of such non-destructive interactions.)
Levels of intelligibility
In certain cognitive science depictions of mental processes, reference is made to levels of functioning that attempt to account for the empirical data. One such description is that of a phenomenal level, a neurocognitive level and a neurochemical level. It is important to note that an adequate account of functioning must give an account on each level.
Cognitive science and psychiatric custom
As clinicians, psychiatrists must have working models of mind and of human behaviour. For the most part these are implicit assumptions and hence not open to conscious revision. In an objectivist understanding of human development and functioning as portrayed in much contemporary science, there appears to be no credible space for inclusion of a religious/spiritual dimension that might be congruent with a broadly scientific understanding.
The foregoing points from cognitive science are, I suggest, of the first importance for the practice of psychiatry. First, I suspect that much psychiatric thinking is bedeviled by a latent Cartesianism. This is reflected in linguistic usages such as ‘psychogenic’ versus ‘organic’. The term psychosomatic articulates an implicit dualism, psyche (mind) and soma (body). Such dualisms then give rise to the (pseudo) question ‘how does the mind interact with the body?’ The title of the College history enshrines this dualism [21]. A related problem might be referred to as that of homuncular thinking [17]. In this mode, agency is ascribed to individual structures (‘the brain thinks…’) or to functions (‘the ego avoids…’) rather than to persons interacting in a physical/social/cultural environment.
Second, one conceptual viewpoint that arises from recent findings in cognitive science (i.e. embodied or interactive realism) question the older subjective/objective worldview and asserts that each of us in our interaction with others, if the interaction is characterized by mutual acceptance, brings forth a shared domain and this domain or world is value-laden.
For psychotherapy the process might be described as a process of co-construction; therapist and patient jointly bringing forth a change in the being of each participant. To make this claim is not to deny the tragic and contingent nature of human life but to add what may be an essential possibility, that of travelling hopefully.
The outcome of this process is substantially dependent on the range of beliefs, values and attitudes held by the therapist and if these are limited along the dimensions to which I am alluding, so too are the possibilities for transformation of the patient's life.
Religious/spiritual tradition, non-dualism and the embodied mind
The second and related area to which I wish to draw attention relates to some traditional religious beliefs. In certain variants of Eastern spiritual traditions and in some Christian mysticism, God or whatever unnameable entity the term suggests, is not wholly other but is rather the ground or void from which all arises. The essence of the self is to the boundless divine as a wave is to the ocean: our idea of cosmic isolation and separate selfhood is illusory. In the Vedantic tradition, Atman, the sacred foundation of each individual life is one with Braham, the universal source of all. Thus, the search for one's true identity is inward, and to experience a sense of such identity is the goal of life.
Two significant differences distinguish such searching from much contemporary psychotherapy: first, the searching occurs within a sacralized worldview; and second, this practice essentially involves the engagement of the actual body as, for example, in yoga and similar traditions. The contrast here is with much Western psychotherapy with its practical (and conceptual) separation of mind and body.
Aboriginal traditional belief presents a stark contrast to our Western notions of isolated individual identity. For Aboriginal persons, as I understand this complex issue, one's being arises as a part of a group or clan, itself situated within a sacred lineage which includes both ancestors and the sacred ancestral land. Western notions of isolated individual responsibility, the existential core of much of our personal therapy, finds little place in such a context. Moreover, our therapies do not include any essential consideration of the natural world and our place in it, as is the case in Aboriginal understanding [22].
Buddhist thinking refers to the absence of a substantial self; human suffering is held to arise from a striving after certainty in terms of an enduring self.
Varela and associates, paying tribute to the thinking of Merleau-Ponty, bring together ideas from cognitive science and Buddhist philosophy, in a work which describes our double sense of embodiment, mind in nature as described by cognitive science and mind in everyday lived experience: this later may be examined within the meditative tradition. Varela adds: ‘The possibilities for transformation of ordinary life need to be presented in a context that makes them available to science’ [17].
Three examples are offered from a Christian perspective. The first relates to a postmodern understanding; the second is reflective of the potentially generative nature of the embodied perspective; and the third of a wider, ecological understanding.
1 Cupitt, a contemporary thinker, in a work entitled After God: the future of religion [23], advances a postmodern view of the nature of religion. There are no gods, no Truth Domain. All mankind's religious and spiritual beliefs have their only existence in the domain of language. There is no way we can be outside the domain of language. Thus, he holds to a non-dualistic view of both the human being and the experienced world. In a later work, Cupitt [24] states: The deep reason for this [the changes in the understanding of religion that he describes] is the end of metaphysical realism – the end of Platonism, and the end of the appearance/reality distinction; the end therefore of the idea that the way things visibly appear to be is determined and is mediated to us by an invisible order… Faith is inner silence. Listening in silence, renouncing and dissolving the categories of thought which rule us, relinquishing our ego's claim to be self constituted and autonomous, we become open to the true awareness of things as they are… Faith is ‘Freedom from the Known’ (in Krishnamurti's phrase). The openness of faith or active release dissolves the carapace of habitual images and fixed circuits which we took to be the boundaries of the self. The objectified, materialized self opens into an experience of a provisional, contextual, ‘empty’ self. Who we are becomes immanent in the network of relations we are engaged in. For a moment, indeed, we seem to be constituted by those relations, determined wholly by our recognition of an ‘other’. Who we are becomes who we are with, as the word is with God. In that space of our relations we first come to be, and awaken. enjoins one to love for the sake of the other alone, to give ones self unconditionally, to empty oneself utterly; to go beyond oneself, out of ones self, so one becomes as it were ‘nothing’. It is to act as God acts, to love as God loves… According to this, it is what humans do that reveals God's presence, and is God's presence… God is not some thing; he does not do anything: he is the doing… in our activity we reveal him.
I believe that two elements offer the opportunity for a renewed relationship between medicine/psychiatry and the domain to which religion makes reference. First, our enhanced understanding of the evolutionary nature of our being and so of our essential embodiment as part of the natural world; and second, the possibilities for transformation suggested in certain religious traditions. Appropriately concerned as we are with the role of neurotransmitters and genetic predisposition, human behaviour cannot be explained without referring to the meaning and intentions we give to our acts and ideas.
There exists a parallel between many religious ideas of transcendent mind or spirit, and the current implicit belief that our minds are somehow separate from or distinct from our bodies. It is my impression that much of our psychotherapeutic understanding and, indeed, psychiatric conceptualization operates in a context of the Western rational intellectual tradition with its mind–body split and hence is heir to these presuppositions.
Psychiatry does indeed rely substantially on chemical means to relieve distress: my claim is that there exists a conceptual gap in psychiatric thinking, especially in relationship to biological psychiatry, where mind is somehow seen to be epiphenomenal. Psychodynamic practice focuses on issues of meaning but again there is an implicit separation, this time involving the rational reflective therapist and patient who may talk about the body but do so in a symbolically significant physical setting that isolates the actual body (i.e. the physical body of the patient has no active role in the process, being merely one locus of reflection for the rational exchange).
Summary
I have suggested that dualistic presuppositions characterize much of our thinking, both in psychiatry and in Western religious understanding. The decline of metaphysical realism in Western philosophy and the advent of modern science may appear to exclude, a priori, consideration of a religious/spiritual dimension as being integral to the scientific understanding of human behaviour.
From a naïve materialist viewpoint, the only real causes are physical in nature, which may result in a form of fundamentalism that sees psychological, social and cultural factors as being somehow epiphenomenal. However, much cognitive scientific modelling of mind, as stated, includes consideration of several levels of explanation, each having its relevance and each essential to an adequate account.
I have attempted to demonstrate by examples drawn from some aspects of recent cognitive science and from certain religious traditions, that to which the term religious/spiritual refers is neither an entity nor a place. It is, rather, a way of being in the world. In psychotherapy, or indeed in any transactions between psychiatrist and patient, it presents as a possibility.
The interaction between practitioner and patient occurs against a shared background of understanding. In their interactions a domain of consensual understanding is generated [27]. The extent of what is valid or relevant in this space is constrained by the practitioner's/psychiatrist's belief system. That which does not accord with the practitioner's presuppositions may not be heard, or will be discounted, thus limiting the range of possibilities for transformative change.
To focus on the psychotherapist/patient interaction: if the therapist has respect for the patient as an individual, and if the therapist is not unduly constricted by dogmatic theory, then the therapist may allow the patient his or her freedom to be creative [Symington N: Healing the mind: what is the healers task? Address given at RANZCP psychotherapy conference, 2002]. Therapist and patient may then, in the process of their reciprocal, mutually shaping interactions, bring about a change in the being of both participants. For the patient in particular, this may manifest as an expanded awareness, a softening of old rigidities, an enhanced appreciation of life, and the advent of feelings of gratefulness.
Thus seen, religion/spirituality is not expressive of a metaphysical reality but rather points to a way of living in the world, arising in the context of interactions in this world. It is not some secret compartment within a person or brain, it dwells with an individual as a disposition towards others, and towards the world, a disposition of respect, of gratitude for life, and a capacity for forgiveness, a way of being which enhances the freedom of others.
Transactions that are generative of such states, in the sense indicated, are not, of course, peculiar to good therapy only. Such attitudes form the very basis of civilized life and are daily reflected in innumerable acts of kindness, expressive of a selfless regard for others. What I am trying to show is that scientific understanding and religious/spiritual concerns do not necessarily refer to quite separate domains but merge as the very essence of the creative aspects of psychotherapy and, indeed, of all positive practitioner–patient relationships.
The generative possibilities described stand in contrast to certain formulations that reduce all understanding of human behaviour to issues of egoism and instinctual conflict. It would of course, be naïve, to attempt to explain all human behaviour in positive form, as a glance at any newspaper, television programme or a knowledge of history will demonstrate. Indeed, much of therapy is spent in addressing painful issues such as negativity, hostility, resentment, egoism, and violent feelings towards others and oneself, to name a few. Our theories of psychopathology have largely, and perhaps necessarily, addressed the negative aspects of human life. We have perhaps ignored the creative possibilities, especially those long associated with our religious traditions.
Conclusions
What I have been trying to show is that neither much of contemporary Western religion nor of mainstream psychotherapeutic practice address the crucial issue of our embodiment, essential to an adequate understanding of mind in and of the world. They operate rather in a transcendental realm that bypasses our actual, functioning, earth-bound bodies.
In the foregoing I have suggested that within psychiatry, as indeed in the wider culture, we psychiatrists have been operating within a limited understanding of what it is to be human in a participatory universe. Such limits accord with a secular humanist worldview but this may no longer be adequate to continued civil life [28]. As psychiatrists, our implicit understanding of human life necessarily shapes and limits our understanding, both of ourselves and of our patients, and hence our practice. This is in no way to suggest that all our understanding up to this time is suspect, but rather to suggest we should look to widen our understanding by exploring the possibilities for renewed dialogue that would encompass both scientific and religious/spiritual viewpoints.
In view of the conflicts and destructiveness of the last century, extending now into the present time and in view of the prominent role ascribed to religious differences in such conflicts, it may seem that to promote a further enquiry into the possible relationship between psychiatry and the religious/spiritual domain is a retrograde step. If, however, it appears to be the case that certain of our religious beliefs are no longer adequate to the world of today, we too, as psychiatrists, may be operating within a restricted view of human life and so we unconsciously restrict possibilities for transformation.
It seems now appropriate to review certain of our implicit assumptions in psychiatry and in the religious/spiritual domain in the hope of gaining a wider understanding of the nature of human being as an historically emergent species in an evolutionary earth process [26]. We can acknowledge the deep truths of the great wisdom traditions but we might also employ our privileged position to contribute to a renewed dialogue between religious/spiritual understanding, the macrocosm, and that microcosmic world of our daily concerns as clinicians, the relief of suffering and the sharing of more hopeful stories.
Footnote
It is suggested that psychiatrists consider the possibilities of a new direction in research. Psychiatry, as a medical discipline, stands in a unique position in regard to these matters, primarily concerned as it is with both mind and body issues (if they can be separated), and with the once sacred domains of the relief of suffering, and of healing. It should be noted that this proposal is not, in essence, a plea for psychiatrists to be more sensitive to the religious/spiritual beliefs of their patients, worthy an aim as that may be. Rather, it seeks to promote a renewed dialogue, a search for common themes shared by certain religious/spiritual traditions, and modern scientific understanding, as in the few examples referred to above. If in modern times religion has come down out of the sky, so too must psychiatric understanding move out beyond its skull-encapsulated, anthropocentric view of mind, to a broader understanding of human life. In a renewed dialogue between psychiatry and religious/spiritual tradition, each might be changed and we would have better stories both for ourselves and for our patients.
Footnotes
Acknowledgements
Thanks to Edwin Harari for his encouragement and support in preparation of this paper.