Cultural considerations in the assessment and treatment of religious and spiritual problems

Scott Peck, a psychiatrist who has written several books on the spiritual dimensions of life, including the best-selling The Road Less Traveled, gave an invited address which drew a standing-room only audience at the 1992 Annual Meeting of the American Psychiatric Association. He pronounced that psychiatrists are "ill-equipped" to deal with either religious/spiritual pathology or health. Continuing to neglect religious/spiritual issues, he claimed, would perpetuate the predicaments that are related to psychiatry's traditional neglect of these issues: "occasional, devastating misdiagnosis; not infrequent mistreatment; an increasingly poor reputation; inadequate research and theory; and a limitation of psychiatrists' own personal development." In recent years, there have been a number of developments that have begun to redress psychiatry's cultural insensitivity to the religious and spiritual dimensions of life. In 1990, the APA Committee on Religion and Psychiatry initiated an APA Position Statement entitled "Guidelines Regarding Possible Conflict Between Psychiatrists' Religious Commitments and Psychiatric Practice." These guidelines emphasized that "psychiatrists should maintain respect for their patient's beliefs ... and not impose their own religious, antireligious, or ideologic systems of beliefs on their patients, nor should they substitute such beliefs or ritual for accepted diagnostic concepts or therapeutic practice." These guidelines reinforce the importance of acknowledging and respecting differences in religious/spiritual beliefs between clinicians and their patients. More recently, the Accreditation Council for Graduate Medical Education published the new "Special Requirements for Residency Training in Psychiatry," which incorporated several changes mandating instruction about gender, ethnicity, sexual orientation, and religious/spiritual beliefs. Finally, the inclusion of "religious or spiritual problem" as a diagnostic category for the first time in the DSM-IV acknowledges that religious and spiritual issues can be the focus of psychiatric consultation and treatment. John McIntyre, MD, former APA President, and Harold Pincus, Director of the APA's Office of Research, observed that this new entry in DSM-IV was "a sign of the profession's growing sensitivity not only to religion but to cultural diversity generally." It is hoped that these developments will increase the accuracy of diagnostic assessments, reduce iatrogenic harm from misdiagnosis, and increase the mental health professional's respect for individual beliefs and values.