Psychiatry, religion & Pope Francis

13 Mar

Pope Francis 13 MAR 2013 (2)

This evening, the new pope, Pope Francis, stepped out onto the balcony overlooking crowds in St Peter’s Square in Rome, having just been elected by the cardinals’ conclave. I can’t claim to know what this means for Catholics, as I am not one. However, I imagine this is a sensitive time for Catholics: on the one hand, it must be a gloriously wonderful time to have a new head of the church; yet on the other it may well be an unsettling time full of hope and possibilities. Perhaps even some of the fundamental certainties people have used as a framework around which they have built their lives will change, with the new pope reportedly viewed as more of a reformer than the previous two. Inevitably there will be change.

Within moments of Pope Francis stepping onto the balcony, this glib comment by London psychiatrist Dr Chris Hilton popped up on twitter:

Extraordinary watching these old men faffing around, dressing up, in the cold, blessing “the entire world” and talking to invisible friend”

I responded:

I wonder if any of your patients who follow your tweets will feel they should keep quiet about their beliefs now.”

Dr Chris replied:

Perhaps – but I doubt it. I’m very open, including w pts, that I find religious faith a peculiar choice – but benefit to some.”

And then me:

“That’s what some patients may find concerning about mentioning faith to a psychiatrist: that it/they are considered peculiar.”

Take a look at this Storify story of our tweets – where we discuss science, religion, belief, choice, proof, male gynaecologists … and ballroom dancing!

There was one key point I didn’t develop in my discussion with Dr Hilton, though it was the reason I responded to his tweet. I couldn’t find the way to frame it within the context of a fast moving tweet conversation. The topic? The hidden coercion in psychiatry the extent of which is, I believe, largely unrecognised by your average jobbing psychiatrist; the treatment by psychiatry of religious belief as a possible symptom of mental illness; and the impact these two have on patients’ willingness to discuss religious beliefs – which can be a core part of someone’s personality, a driving force in their lives, and sometimes the cause of deep distress – with their psychiatrist. (See what I mean about trying to fit that into a tweet?)

I’m sure most psychiatrists view themselves as doctors and healers, as people using science and compassion to bring relief to the sick and suffering. In that context, it can perhaps be hard to see some of the nuances of what it’s like to be on the other side of the desk – to see the power imbalance.

On the other side of the desk, there’s always the power imbalance. There’s the usual power imbalance that occurs in every doctor/patient relationship: you want or need something from the doctor and they are the ones who can provide it to you – or not. The doctor is the one who says yes or no. The doctor is the one into whose sphere of expertise you have entered.

Added to that, in psychiatry, there is the fact that a psychiatrist can – if they believe you to be a danger to yourself or others – detain you against your will. A psychiatrist can – regardless of whether or not you have mental capacity – treat you against your will. That is the backdrop to psychiatry. That is a fact that’s always there. Unlike consulting other doctors, you can’t just go elsewhere if you don’t like what they say. You can be stopped. You can be detained. You can be treated by force. I have to say, that power imbalance is always at the back of my mind. I don’t think it’s there in the minds of psychiatrists – hence I term it hidden coercion.  Religion and psychiatry - Psychiatric Times

And, as psychiatrist Dr Simon Dein wrote in 2010:

“Religion has often been seen by mental health professionals in Western societies as irrational, outdated, and dependency forming and has been viewed to result in emotional instability.”

Or, as Dr Hilton tweeted, “peculiar”.

Religious belief can also be viewed as a symptom of mental disorder. When I was on ward, I found many people took strength from faith and religious beliefs. Perhaps it’s something to do with finding yourself at the bottom of the heap with nowhere else to turn. Talking about faith or religion, though, is going to be one of those things that gets noted down on the clipboard: “talking about religion – query delusional?”

Tonight’s coverage on Channel 4 of the new pope’s first speech demonstrated another point from my conversation with Dr Hilton: the effects of lack of understanding of the subject matter. Channel 4 had shipped their star reporter, Jon Snow, over to the Vatican. Snow reported the election of the new pope as if it were the appointment of a new chief executive taking over a large and ailing corporation. His commentary even talked over Pope Francis. How different would the reporting have been if a Catholic or someone with religious belief had delivered it instead? How much more insight would we have gained from someone with a better understanding?

A more subtle point, then, is that lack of knowledge around faith and religious belief can lead to a lack of understanding of the patient. If your psychiatrist views your religious beliefs as akin to a passion for ballroom dancing, will they really be able to understand how troubled you are by a religious matter, without seeing it as a symptom of mental illness? Would you feel able to raise it with your psychiatrist knowing he viewed religious belief as “peculiar”?

In the context of coercion, in the context of religious belief being seen as a possible symptom of mental illness or at best akin to believing in Father Christmas, how willing are psychiatric patients to raise such matters with their psychiatrists?  As I said to Dr Hilton at the start of our twitter conversation:

I wonder if any of your patients who follow your tweets will feel they should keep quiet about their beliefs now.”

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4 Responses to “Psychiatry, religion & Pope Francis”

  1. Emma 13 March 2013 at 11:58 pm #

    As someone with both religious faith and a mental illness, I have always been quite wary of mentioning my faith to psychiatrists, despite it playing a very central role in my life. Partly in case they think that I am delusional, or that religion is mentally unhealthy, or else that they treat me somehow as more ill, more “mad” than someone who has no faith; and partly because the sort of things that affect my illness that come from my faith, the way those two things play out together, are not really something that a psychiatrist can deal with.
    For instance, I – and many others – have had concerns about the cause of my mental illness – is it a punishment from God for sin? and about healing – if I had enough faith would my symptoms go away? which cannot really be addressed by medicine. I would be intensely wary of mentioning those concerns, and if they are affecting my depression, in case the psychiatrist either dismissed them or took them as evidence of some sort of destructive religiosity.
    It would be nice – and maybe it happens – if psychiatrists and faith leaders had some sort of contact, if more faith leaders had the medical tools (diagnoses, the way people are affected by illness, but especially how to spot if someone is displaying symptoms of delusional thinking, although I would hope they have some understanding already) and if psychiatrists had a little understanding of the theological/religious concerns that some patients may experience.
    It is a big subject, and I am aware that the RC of Psychiatrists has a spirituality and mental health aspect to it, although I do not know much about it.
    Sorry to go on so long, but the intersection of faith and mental illness is the subject of my blog, so these are things I think about. And I haven’t even looked much at the idea of demons – either here or on my blog, because that is a whole can of worms that I am not qualified to address!

    • Sectioned 14 March 2013 at 12:55 am #

      Thank you for your thoughtful comment. I’ve added your blog to the web links above 🙂

  2. diana brighouse (@dianabrighouse) 25 March 2013 at 2:17 pm #

    Really good commentary on the current position. I am shocked that Dr Hilton (whom I do not know) should tweet so carelessly about such a sensitive topic. As Emma says in her comment, the RCPsych has a very large special interest group (I think about 3,000 members) within the College looking at Spirituality. I recently went to one of their study days and was very impressed by the thoughtfulness and openness of the contributions, especially in the smaller workshops. What I thought was very telling though is that they have been trying for a number of years to get the topic included in the core curriculum for psychiatry trainees, but have as yet failed to do so. Perhaps the Dr Hiltons are in the majority in determining the curriculum, which is very sad.
    My own psychiatrist has always been very encouraging of me talking about my beliefs, and I haven’t ever felt that he has dismissed my ideas as symptomatic of my illness – indeed it is me who has questioned that (often). However my anxieties arise from a different angle – I don’t know, but suspect from discussion, that he has a fairly evangelical faith, and I do therefore feel wary about voicing things that I know would lead to clashes of opinion in that direction. I have heard of friends who have seen very evangelical Christian GPs who have been told how to help themselves in overtly Christian terms – despite them having no faith of any sort. I think that this is at least as much of a problem as the dismissal of religion.
    But of course you are right that the bottom line is that one can change one’s GP, but not one’s psychiatrist if s/he happens to think that your request for change is delusional. That doesn’t cross my mind when I am well and in dialogue with my psych, but it certainly does when I am unwell. I don’t know what the answer is, because unlike many who suffer with mental illness I do think that there is a need, very, very occasionally to be able to detain people for treatment against their will in order to keep them safe and instigate treatment. I know this is controversial, and I think the Mental Health Act is used way too often, but even if it were only to be used a dozen times a year the dynamic would still be there in the room for all of us when unwell.

    • Sectioned 25 March 2013 at 10:42 pm #

      Thank you for taking the time to leave your thoughtful and interesting comment. Much appreciated.

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