Know Thyself: Should everyone be in therapy?

The answer to the question “Should everyone be in therapy” is answered with a resounding ‘yes’ in an article on QIdeas.

The authors base the answer on the premise of ‘knowing thyself‘ and the biblical concept of ‘self-examination’:

For centuries, self-examination was crucial for spiritual transformation. But, as David Benner convincingly argues in his Care of Souls, a post-Enlightenment church became mired in intellectual debates, losing its focus on soul care and spiritual direction. It was during this time the church abdicated its transformative role, trusting psychologists with the care once entrusted to priests, pastors and spiritual directors. And for the past 100 years, while a debate has raged on about the proper relationship between secular psychology and the church, it’s clear the original motive—know thyself— stands behind it all and remains crucial for the church’s mission. For the person best able to love God and neighbor is the person who knows the motives of her heart and is freed to live self-sacrificially.

The authors argue that as knowing thyself and knowing God are intimately connected, therapy should be curam animarum—the care of souls. They lament the ‘quick fix’ behavioral solution-based processes of modern therapy, but then posit this surprising twist:

But at the same time, I’m not convinced Christian therapists do this as well as secular therapists at times. Let me explain. Many settle for what Dietrich Bonhoeffer called “cheap grace,” a quick fix approach which stands in stark contrast to the “costly grace” of searching and knowing ourselves, through exploring our stories and examining our motives. This kind of care is, indeed, much more rare. Christian counseling which is reduced to mere Bible memorization, or repentance or a behavioral regimen misses the point. It is all law, and no grace—particularly costly grace. It is all behavior with no real, deep examination of one’s self. And so we often find among secular therapists the kind of “depth psychology” which takes seriously how deep the rabbit hole of human brokenness and sin go.

The authors conclude that we should all engage in counselling and judging by the link they give; specifically, Christian Counselling.

Now it must be borne in mind that QIdeas is based in the US and interestingly over on the Guardian today, Mark Vernon, writing in response to the ‘Spiritual but not religious mental illness study‘ comments:

This raises another question, though. Do religious organisations in the UK today take enough notice of the insights of psychology and, conversely, do schools of therapy treat spirituality seriously? As the Cambridge psychologist and priest Fraser Watts explored in a recent talk, American therapists, for example, seem to be far happier talking about their clients’ spiritual concerns than their British counterparts.

This is a vital question and one I explored via the book Spirituality and Psychiatry which was kindly sent to me by the Royal College of Psychiatrists:

Here are the opening words from the Foreward:

During my presidency I became more and more convinced of the importance of promoting mental health and well being, alongside the treatment of mental illness. But I see mental health as the responsibility of everyone, not just health and mental health professionals. The social care, criminal justice and education sectors and faith-0based organisations should all be involved in asserting the centrality of mental health in society, in contributing to the prevention of mental illness and in supporting individuals with mental disorders.

Sheila Hollins – Former President, Royal College of Psychiatrists

This to me is the crux, namely, the church must be at the forefront of supporting those with mental health issues, in partnership with other professionals.

Historically, much of the psychiatric care was provided within a religious context. There are shrines noted for their miraculous healing of folk with mental illness, the most famous of which is the shrine of St Dymphna, the Patron Saint of mental and nervous disorders. Priory’s also cared for the mentall ill.

The modern era has seen the development of psychiatry as a distinct discipline, which has sadly been characterised by an exclusion of spirituality and religiosity within mental healthcare.

The souring of relations between religion and psychiatry has been severe. Freud asserted that belief in God was delusional and that all religion was mass neurosis. Reductionism came to dominate in the mid 20th Century and consequently humans viewed as nothing more than cerebral, with behaviour as Pavlovian / Skinnerian conditioning.

There has been almost no teaching on spirituality in the context of mental heath in UK medical schools, or at post-graduate level in the training of psychiatrists, consequently, students and practitioners have had little or no training in how to enquire about an individual’s spirituality or religious faith. The word ‘religion’ has not featured in the indices of most psychiatric textbooks.

Christians have viewed psychiatry as in conflict with traditional religious values and many have associated psychiatry / psychology with atheism and antagonistic to religion in general, and perhaps with good reason, given the above.

However, encouraging attitude changes are taking place within psychiatry, concerning the importance of spirituality as a dimension of mental healthcare. This has been prompted in part by ‘service users’ asserting that spirituality is a vital dimension of their experiences that they wish to be able to discuss freely without being labelled in pathological terms. Surveys have indicated that up to half of patients turn to their religious and spiritual beliefs to help them get through a crisis, but they do not feel comfortable talking about such things with a psychiatrist.

Research in the area of mental illness and religious belief developed during the 1990′s from almost nothing to an accepted area of inquiry with research funding. Religion has been found to provide a protective factor from – and in – mental illness. Religion can also have negative effects, however, in general the beneficial effects considerably outweigh the adverse.

In 1991, the Patron of the Royal College of Psychiatrists, the Prince of Wales, urged an approach to mental healthcare that encompassed body, mind and spirit, and in 1997 the Archbishop of Canterbury addressed the annual meting.

The notion of linking spirituality with psychiatry developed largely in the 21st century and was preceded In 1999 with the formation of  the Spirituality and Psychiatry Special Interest group (SIG).  The SIG currently has a membership of some 1300 psychiatrists out of a College membership of 13000.

The Spirituality and Psychiatry book was originally conceived by the SIG and they have produced a ‘milestone’ leaflet entitled: Spirituality and Mental Health.

This is what the SIG say about themselves:

The Special Interest Group was founded in 1999 to provide a forum for psychiatrists to explore the influence of the major religions, which shape the cultural values and aspirations of psychiatrist and patient alike. The spiritual aspirations of persons not identifying with any one particular faith are held to be of no less importance, as well as the viewpoint of those who hold that spirituality is independent of religion. The meetings are designed to enable colleagues to investigate and share without fear of censure the relevance of spirituality to clinical practice. The Special Interest Group aims to contribute a framework of ideas of general interest to the College, stimulating discussion and promoting an integrative approach to mental healthcare. For patients, there is the need to help the service user feel supported in being able to bring spiritual concerns to the fore.

In contrast with the general population, only a minority of psychiatrists in Britain hold religious beliefs: 73% of psychiatrists reported no religious affiliation compared with 38% of their patients. Only 39% of female and 19% of male psychiatrists believe in God. However, 92% of psychiatrists in Britain believe that religion and mental illness are connected and that religious issues should be addressed in treatment; 42% considered that religiousness could lead to mental illness.

There is a need to overcome common prejudices within psychiatry such as ‘religion is usually harmful for patients’ and ‘religion is for the weak, vacillating and dependent’.

Overall, spirituality is increasingly being included as a component of psychiatric treatment, furthermore, a variety of faith-based organisations are providing care for folks with mental health problems.

The first chapter of the Spirituality and Psychiatry concludes with this:

Psychiatrists and other mental health professionals need to be bilingual, ‘fluent in….the language of psychiatry and psychology….and the language of spirituality that focuses on issues of meaning, hope, value, connectedness and transcendence’. It is probably fair to say that we have, for too long, neglected one of these languages to our own detriment and the detriment of our patients. That there is now renewed interest in learning the language of spirituality is very encouraging, but like all languages this one needs practice. Just as the language of psychiatry needs to be employed at every stage of assessment, diagnosis and treatment, as well as in all good research and training in mental healthcare, so the language of spirituality needs to permeate our relationships with our patients, colleagues and our whole understanding of the field of psychiatry.

I would advocate as forcefully, that Christians need to ‘learn the language’ of psychology and psychiatry in order that our churches may partner with mental healthcare providers. Faith-based organisations need to be part of the interdisciplinary and interprofessional team providing care to the vulnerable members of our community suffering from mental illness.

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