Patients' Cultural and Spiritual Beliefs Influence Their Diagnosis, Treatment, and Management -- From APA 2008: May 7, 2008

Andrew N. Wilner, MD


May 08, 2008

In This Article


Rounding out the fifth day of the American Psychiatric Association 2008 annual meeting in Washington, DC, Prof. Dan G. Blazer, MD, discussed the traditional role of psychiatrists in assisting patients; Prof. Wen-Shing Tseng, MD, President of the World Association of Cultural Psychiatry, MD, described how cultural beliefs affect diagnosis and treatment; and Prof. Charles B. Nemeroff, MD, emphasized the importance of spending adequate time with patients in order to consider multiple factors when assessing patient health.


Prozac and the Spiritual Self

The "self" isn't what it used to be, according to Dan Blazer, MD,[1] Professor of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina. "We live in a society that constantly challenges our concept of self. One of the challenges is psychopharmacology. We can restore a sense of well-being and perhaps can chemically change not only our bodies, but our very selves."

Dr. Blazer referred to the book by psychiatrist Peter Kramer, MD, Listening to Prozac, which suggested that not only can we escape emotional suffering, we can become different people through pharmacology.[2] Dr. Blazer explained that this transformation can be difficult for some people to integrate into their religious beliefs. For example, for those who believe that depression is a punishment from God, an antidepressant like Prozac which relieves the symptoms may not be a logical solution.

Dr. Blazer observed that modern society posits that the natural state of the self is happiness and fulfillment, not one of striving toward a goal (the spiritual journey) or suffering for a purpose. This concept has influenced what we expect from medications and has contributed to the fact that millions of people now take antidepressants.

"The idea that we can be sad has gotten lost. We feel that happiness is the normal state, and that puts a tremendous pressure on people in our society. This can be a tormenting thing for many individuals," stated Dr. Blazer.

Dr. Blazer explained that the traditional role of psychiatry has been to assist people in uncovering, formulating, and coming to grips with their "story" -- the details of their lives and the beliefs that contribute to their emotional state. Dr. Blazer recommended that even when prescribing Prozac or other antidepressants, psychiatrists should still talk with their patients about their sense of self and religious faith and discuss how pharmacologic treatment can contribute to improving their mental health within the context of their own personal "story."


Comments on Medscape are moderated and should be professional in tone and on topic. You must declare any conflicts of interest related to your comments and responses. Please see our Commenting Guide for further information. We reserve the right to remove posts at our sole discretion.