Spirituality and religion in psychiatry: in dialogue with the World Psychiatric Association Position Statement

Psychiatry and Religion: Consensus Reached! (Verhagen, 2017) The exclamation mark at the end of the title of my contribution to this special issue is apparently intended to give extra emphasis. Not wrongly, but some perspective is in place. What kind of consensus are we looking at? First of all, it is the task of the World Psychiatric Association (WPA) Sections to develop proposals on urgent or controversial topics for adoption such WPA consensus or position statements. What is then the difference between these two statements? The first one is a statement that is approved by the WPA and all its member organisations (the General Assembly). The second one is a statement approved by the Executive Committee of the WPA (World Psychiatric Association, 2007). The “consensus reached” is the second best, and therefore a position statement. By approving it, the Executive Committee declares willingness to take charge in a controversial area like spirituality and religion in psychiatry worldwide. Counterclockwise or clockwise, spirituality and religion in psychiatry still is a controversial issue, despite the work that has been done so far. That would be not so serious if it was not harmful to patients. And that is what it is all about. The exclamation mark therefore stresses the signal the Executive Committee has issued.

The editors of Mental Health, Religion & Culture, involved as they are in the topic (Dein, Lewis, & Loewenthal, 2011; Lewis, Dein, & Loewenthal, 2011), decided to acknowledge the exclamation mark by making a special issue dedicated to the position statement. I am very grateful to them that my contribution gave rise to this decision. Ten colleagues from around the world, all experts in the field, contributed to the ongoing discussion. Their contributions one by one show that spirituality and religion in psychiatry is not a more or less separate niche, but that it touches on the core of psychiatry, both conceptually and clinically. Meaning making, existential issues, including religion and spirituality, are always there, not only in the patients' lives, but also in the way the psychiatrist relates to his or her professional role! And again, that is what it is all about.

Let me introduce these eleven contributions very briefly. De Haan (2017) elaborates on the conceptual difficulties concerning the biopsychosocial-model and the extended variant including the spiritual dimension. The model in both forms is not very satisfying and the promising alternative is enactivisme. In his contribution Glas (2017) makes it very clear that religion and spirituality are not esoteric interests of certain religiously or spiritually oriented professionals, and do not belong to the so-called soft aspects in contrast with the hard core elements of clinical and scientific psychiatry. Religion and spirituality undeniably belong in the professional luggage of the psychiatrist and other mental health professionals. In order to make this point of view clear he introduces his ‘normative practice model’ for mental health care.

However, after decades of work it is still difficult to formulate sophisticated models that account for both positive and negative associations between religiosity, spirituality and well-being. An issue of concern despite the enormous improvements still are the weaknesses in empirical research, e.g., the western Christian bias. Abu-Raiya (2017) focuses on this particular point. Gray (2017) agrees with this and draws attention to the reductionism in quantitative research, on the one hand, and on the other hand, the gain that can be achieved through qualitative research. The meaning of religion and spirituality is not just a matter of feeling better! Indeed, a very important and constructive critique.

Not everything is mentioned explicitly, as Dein (2017) rightly states. Therefore his contribution on the impact religious experience as a special point of attention is a valuable commentary. An intriguing and thought provoking theme within this realm is known as what is called ‘creative psychopathology’: psychopathology that adds features that are in a certain way enriching. Huguelet (2017) broadens the scope of research. I fully agree with him that the whole topic of religion and spirituality is not just about religious or spiritual people. No, everybody confronted with a psychiatric disorder has to relate to that experience of psychic illness. Huguelet draws attention to the issue of coping with (loss of ) meaning and to the meaning-making process. And of special importance is the fact that he and his group have done a lot of research on patients suffering from schizophrenia, which is quite unique.

Declarations like the WPA position statement have been previously drafted and accepted, and are also followed. Peteet (2017) embraces the statement from a North American perspective. Braam (2017) concentrates on his endeavour to develop a multidisciplinairy guideline on religion and spirituality, which certainly is a new step that will bring the dialogue forward. He introduces the main chapters of such a guideline, also in relationship to other guidelines, especially those on spiritual care in palliative medicine. Cook (2017), who played an indispensable role in drafting the WPA and the British statements, highlights the potential and possible impact of the statement upon policy making. And it is therefore very important to follow as closely as possible the initiatives that are being carried out here and there and to study their impact on clinical practice, service developments and policy initiatives. Utsch (2017), co-author of the German position statement on religiosity and spirituality in psychiatry en psychotherapy, puts the finger at recognizable points with own accents. The line of thinking and of dialogue with the position statement is also supported by Herrman (2017), president of the WPA, in her contribution. She calls on to partnership with service users and family carers in whatever (sub) culture, which is fully in line with other WPA recommendations on best practices.

Looking at the near future, what are the risks, what are the challenges? I see two key uncertainties: the degree of awareness and of consensus. If the awareness of the importance of spirituality and religion in psychiatry remains low and consensus among professionals remains impracticable, attention to spirituality and religion will remain dependent on the interest of individual professionals and a few interested research groups, and the unmet need for data and their application will persist. On the other hand, in case of growing/high attention and growing/high consensus the available data will increasingly be appreciated both by the professional and by the patient, and data will be applied in clinical practice for the welfare of the patient. The most important conclusion is that we have to continue our work towards consensus and that dialogue on all levels is our most favourable instrument to reach out to it!