levels of analysis, science and religion, philosophy of religion, religious/spiritual experience
In 2006, Two Dutch psychiatric residents and their residency training director reported on a small qualitative survey among 13 psychiatrists working in their mental health institution. The psychiatrists were interviewed about their attitude toward religion and spirituality. The interviewers were especially interested in the role religion plays according to the psychiatrists in the relationship between psychiatrists and patient (Fiselier et al. 2006). The theme is not new, and it still evokes a lot of controversy, considering the turmoil the well-known authority and opinion leader in this field of inquiry Koenig recently provoked with his editorial in Psychiatric Bulletin (Koenig 2008; Correspondence 2008). Reporting on countertransference, the interviewers quote a few, in their view, rather typical statements: “If one learns that a patient is a believer, that patient’s estimated IQ will actually be rated 20 IQ points lower” (p. 384). It seems that around half of these 13 psychiatrists attribute negative qualities to the religious patient. Nevertheless, these psychiatrists claim to be on the alert for their negative countertransference; a likely statement, indeed! In fact, the whole idea was to get more information about the basic assumptions as part of the self-view and professionalism of these psychiatrists, and the possible religious origin of their basic assumptions like trust, hope, relatedness, validation, and responsibility. Seventy-five percent said that the therapeutic relationship was partly founded on religious ideas and principles.
The question Koenig posed in the title of his editorial—“What Should Psychiatrists Do?”— should be preceded by another: “What should psychiatrists try to learn?” The contribution by Rushed to help forward the ongoing difficulties in the relationship between religion, religious experience, and psychiatry is an excellent example of what psychiatrists should try to learn and understand. I would like to mention (very briefly) three issues: four different levels of analysis, science and religion, the rehabilitation of religious experience.
Levels of Analysis
Rashed’s contribution shows very clearly that psychiatric thinking can be differentiated into levels of knowledge or degrees of abstraction, embedded in distinct practices and located on different places.
The first level is the level of daily experience, for example, the religious experience of Femi. It is the story the patient tells, including his or her idiosyncratic experiences and constructs with regard to self and self image, and how he or she explains or justifies his life experience, and so on. According to Rashed, the subject creates “a narrative that can accommodate those experiences, preferably in terms that are consistent with their personal biography. Biomedical language is only one possible language in this process,” (p. 199) and can in fact be used by the patient himself. It is already here that the problem starts. The so-called ‘hyponarrativity’ of the DSM tradition [End Page 209] forecloses more or less the opportunity to listen to this story, especially when not just the patient but above all the professional is too much bounded to his language. Rashed directs our attention to the second and third levels of analysis. On a clinical level, the professional reconstructs the story into a clinical case and case formulation. The case formulation elaborates on the identified disorder, the discerned patterns in the story of the patient, his sociocultural context, and the clinician–patient relationship from a categorical description and classification to a personalized perspective, which furthermore leads to taking therapeutic action. The difficult task here is to transpose the unique story and situation of this particular patient to general rules and concepts. In the case of Femi, the daily routine by which ‘criterion B’ and ‘cultural congruence’ as general rules are (not) practiced, falls short in the uniqueness of his story, and makes it almost impossible to ask questions like the author poses. His analysis on the third level, the scientific level, is illuminating. It is on this level that a clinical question or problem is formulated in terms of affective, cognitive, interpersonal, sociocultural, and spiritual processes. Fourth, on a meta-theoretical level we describe the premises of theoretical models. Psychiatrists need to be aware of this differentiation of levels of analysis to grasp and understand...