Religious Beliefs and Psychiatric Beliefs: Worlds Apart and Perhaps Best Left That Way

“Religious Experience and Psychiatry: Analysis of the Conflict and Proposal for a Way Forward” is a compelling paper that challenges our moral intuitions—and self-perceptions—about the intersection of religious beliefs, culture, and psychiatric diagnosis. Rashed presents a case history of Femi, a 29-year-old British man of West African descent who had had an intense religious experience of being in direct contact with God. This spiritual revelation resulted in his social isolation, fasting, and purging of material possessions. Using Femi’s story, Rashed illustrates that, although we may want to think of ourselves as tolerant of a variety of cultural and religious belief systems, when these differences come up against mainstream social and medical belief systems, we may not be so generous. Rashed also makes the subtler point that even well-motivated attempts to care for patients sensitively, using devices such as the DSM-IV’s ‘cultural criterion,’ may result in harm to patients by stripping away the meaningfulness of specific experiences. Rashed argues that diagnosing Femi’s religious experience as an acute psychotic episode transformed a positive existential moment into one of shame and sickness. Rather than adopting medical language, and indeed a medical framework to approach patients, Rashed asks psychiatrists to find common ground with patients by negotiating linguistic, moral, and explanatory terrain to describe subjective experiences. In this regard, his proposal is a more substantive and demanding version of patient-centered practice.

Although Rashed is appropriately attuned to patients’ values, language, and epistemologies, one is left wondering where practitioners’ values, languages, and epistemologies fit in to his proposal for an “open-ended process of communication” with patients (2010, 185). The issue he is highlighting in the case history is that, “different languages and their associated values are adopted by the involved parties to attend to the problem” (Rashed 2010, 200). His proposal: “A way out of this crisis is for all parties to engage in a process of communication that involves an attempt to modify the language they use to talk about the problem” (Rashed 2010, 200). However, what he means is that practitioners ought to “adopt the patient’s own language, and frame the problem in terms that would meet her approval” (Rashed 2010, 200). Although patients’ values must dictate the choices about possible solutions to the presenting problem, it is unclear why prioritizing patients’ languages and epistemologies must occur. In describing the clinical course of Femi’s case, Rashed points out that, “The psychiatrist and the social worker who did the mental health act assessment on Femi simply did not believe him” (2010, 198). Do they have to believe him? If so, why?

Health care professionals come by their epistemologies and linguistic practices, at least in part, as a result of their training. A shared explanatory framework for the kinds of problems that each professional group tends to deal with is a fundamental part of the group’s identity. There is room for debate about epistemology, but participants in these debates are generally committed to one or the other version and such commitments inform their clinical work. For example, psychiatrists adopting a women’s mental health perspective may differ from colleagues adhering to standard psychiatric theory by arguing that women’s depression is more a result of their marginalized social position relative to men rather than defective neurophysiology. This explanatory difference may motivate feminist psychiatrists and psychotherapists to urge women to view their problems as resulting from systemic discrimination rather than individual conflicts and to work for social change. The commitment to the explanatory framework informs the clinical treatment and, as such, the commitment is essential to the clinical service being offered.

Epistemological commitments also inform clinical ethics. The interpretation and application of specific ethical principles and duties are tied to a profession’s epistemology. For example, in trying to execute the principle ‘do no harm,’ a practitioner is trying to offer patients medical care based on his/her best understanding of what is wrong (usually a pathophysiological explanation) and how it can be...