Saturday, February 20, 2010

Religion and Psychiatry

"No longer can psychiatrists in a multi-faith, multi-cultural globalized world hide behind the dismissal of religious belief as pathological, or behind a biomedical scientism, as they are more frequently confronted by distressed patients for whom religious belief may determine their choice of symptoms and their compliance with treatment." So says the preface of the new book Religion and Psychiatry: Beyond Boundaries, edited by Dr. Peter Verhagen, Prof. Herman M. Van Praag, Prof. Juan Jos- L-pez-Ibor, Jr., Prof. John Cox and Prof. Driss Moussaoui. I haven't read it, but I saw this review that popped up on an RSS feed. I think most atheists and skeptics would have their hackles raised a tad by the wording here. On one hand, physicians don't, and should not, have the luxury of demanding that patients de-vert or treating only those whose beliefs align with their own. If you wait for a fully rational patient to walk in the door of your hospital or practice, regardless of whether you're a psychiatrist or any other specialty - well, you'll be waiting a while. Same goes for the healthcare providers, including yourself.

The practical upshot is that at times you'll be rhetorically framing medical information and education to patients in terms of religion. Speaking as a medical student, my ethical sense is that as a physician, should a patient press the issue ("Do you go to church doctor? Which one?"), I would not have a problem framing recommendations in religious terms if I thought they would be more effective ("What you need to know is that if your faith tells you to take care of your family, then you better quit smoking. Now.") But the preface seems to go beyond recognizing the importance of religion to a patient and how taking that into account can better help you care for them. The distinction that is blurred by overaccommodation is this: every patient has irrational beliefs about their health that physicians must navigate to care for them. But that doesn't mean - I hope - that even for a second the physician thinks that it's really the evil eye, rather than streptococcus, that's making his or her patient sick. To emphasize, I've only read the review I linked to and not the book, but it highlights an often-blurred ethical distinction in medicine which puts medical decision-making in peril.

(Note: I don't just post about psychiatry to bait Xenu-worshippers. But the bet offer still stands, guys.)


TGP said...

I wonder if my insurance covers an appointment with a witch doctor?

Michael Caton said...

It depends on what you call it. In some cases silliness does get covered. If the insurance company realizes that it can do something cheap (like reimbursing for sewing pins) and their customers are willing to settle for placebo effect, then there's a profit motive there. Fortunately that's not (usually) sustainable, although I have a link I'm going to post about this shortly.