COMMENTARY

Ethical Issues in the Psychiatric Treatment of the Religious 'Fundamentalist' Patient

Ronald W. Pies, MD; Cynthia Geppert, MD, PhD, MPH, MSBE

Disclosures

March 19, 2013

In This Article

Religion and Psychiatry: A Widening Gulf

Psychiatry's historical relationship with organized religion has been, at best, an ambivalent one -- and some might use the term "adversarial."[1] The cultural, more than clinical, influence of Freud's dismissive views of religion continue to shape the attitude of many psychiatrists -- often without self-awareness. For Freud, religion was at best a kind of neurotic compromise, and at worst a dark stage of human development that the enlightenment of psychoanalysis should eclipse.

Many cultural observers, at the height of psychiatry's prestige, cast the profession as a "new priesthood" with its own dogma and rituals to replace the historic faiths. The biological revolution, with its underlying materialist and positivist assumptions, has marginalized religion and reduced it to yet another brain region to be scanned -- often on the misguided premise that there is a neurobiological locus for the spiritual impulse.[2]

These historical trends signify the conceptual distance between religion and psychiatry. For those of deep religious convictions, and for most scholars of religion, the "pathologic" view of religion is at best an oversimplification, and at worst a deeply misleading caricature of the religious impulse. It is beyond the scope of this article to explore these theological issues. Suffice it to say that according to the work of Curlin and colleagues,[3]

Psychiatrists are less religious than other physicians, and religious physicians are less willing than nonreligious physicians to refer patients to psychiatrists. These findings suggest that historic tensions between religion and psychiatry continue to shape the care that patients receive for mental health concerns.

On the other hand, a minority of psychiatrists identify themselves as part of the "Christian psychiatry movement." In a 1991 survey of psychiatrist members of the Christian Medical and Dental Society, about one half said that they would discourage strongly religious patients from abortion, homosexual acts, or premarital sex, and about one third said they would discourage all patients from these activities.[4] This position also presents potential boundary problems, such as the imposition of the therapist's values, especially on nonreligious patients.

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