Psychoanalysis,religion, philosophy and the possibility for dialogue: Freud,Binswanger and Pfister

Abstract

This article considers the longstanding disciplinary tensions between psychoanalysis, religion, and philosophy. It argues for a cross-disciplinary understanding of human experience by examining the relationship of Sigmund Freud to his two Swiss colleagues, Ludwig Binswanger and Oskar Pfister. In contrast to Freud's avowed atheism and pronounced ambivalence on philosophy, Binswanger and Pfister both professed a strong religious sensibility and philosophical outlook. The article juxtaposes their theoretical divergences on religion and philosophy with personal interactions and correspondence. The relationship of Freud to Binswanger and Pfister is instructive for understanding the historical and contemporary interaction of psychoanalytic theory and practice with other disciplines and diverse viewpoints. The dialogical spirit that connects the three protagonists constitutes a critical engagement with learning and is essential to psychoanalysis today.     

The spiritual dimension of cognitive therapy

There has been a quiet buildup of interest in spirituality within psychiatry. However, spirituality tends to be a vague and fuzzy concept to psychiatrists and probably to other psychotherapists. The field is surprisingly large, and there is space in this paper only to present a skeletal outline of the cognitive aspects of it. My observations come from spiritual issues discussion groups for inpatients and a religion and psychiatry clinic for outpatients at Butler Hospital.This paper is modified from one presented as part of a symposium in Spirituality and Psychotherapy at the Annual Convention of the American Psychiatric Association in New York City, May 14, 1990.     

The WPA position paper on spirituality and religion in psychiatry: a North American perspective

ABSTRACT

The WPA position statement is a clear challenge for psychiatrists to recognize how religion/spirituality (R/S) is relevant to their work. North American psychiatry has shown progress related to each principle articulated in the statement, especially in the areas of research and scholarship. However, most advances are yet to be widely implemented or coordinated, so that the statement offers valuable encouragement and direction in moving forward.     

Lived Religion and Family Therapy: What Does Spirituality Have to Do with It?

This review examines fundamental and methodological issues concerning the cross-disciplinary efforts of family therapists to involve spirituality in their clinical practice. Training requirements, challenges, and limitations are discussed. It is suggested that the construct lived religion is the best starting point for this work. Lived religion is a term that addresses the real, lived, experiential, and intimate dimensions of our religious life. It is also tied to a variety of academic disciplines that can guide and deepen thought. Significant problems and limitations are identified with the term spirituality. It is suggested that if clinicians continue to prefer spirituality as a construct, that it be seen as a form or expression of lived religion. This way the links to various discipliines are maintained and idiosyncratic efforts will be minimized. Methods that attempt to integrate spirituality and family therpay are also found to be lacking. For nearly a half century American divinity schools have developed various co-relational methods which foster more respectful and productive discourse calling for the goals and objectives of mental health and religion to be equally value and maintained. In this way the piftalls of reductionism, or oversimplification, and anti-institutional bias can be lessened.     

The existential dimension in psychiatry: an enactive framework

ABSTRACT

In his paper Psychiatry and religion: Consensus reached!, Verhagen advocates the relevance of spirituality and religion for the “origins, understanding, and treatment of psychiatric disorders”. In this comment, I argue for the broader claim that the existential dimension is important for understanding psychiatric disorders – of which religion can, but must not necessarily be, part. The existential dimension refers to our ability to relate to ourselves, our experiences, and our situation. This evaluative relation can play an important role in psychiatry: it can co-constitute the disorder, be affected by the disorder, and/or modulate the course of the disorder. Given this importance, it makes sense to explicitly recognize the existential dimension in our explanatory model of psychiatric disorders. The biopsychosocial model goes a long way in providing an integrative model, but there is room for improvement, especially when it comes to integration of its aspects, and acknowledging the existential aspect. I briefly introduce the research paradigm of enactivism, and suggest that an enactive framework is well-suited to incorporate this existential dimension – along with the traditional dimensions of the biopsychosocial model.     

Psychiatry and religion: a perspective on meaning

ABSTRACT

A Position Statement on Spirituality and Religion in Psychiatry was issued by the World Psychiatric Association in 2016. Among many recommendations, this statement underscores the need for research on both religion and spirituality in psychiatry, especially on their clinical applications. In this contribution we will put light on the issue of meaning and meaning-making, i.e., an important field for every human, Particularly for individuals suffering from severe mental disorders. After an introduction about meaning in its religious/spiritual dimension, we will describe what needs to be studied in order to get a better knowledge as to how patients cope with meaning, and how they process (in terms of meaning-making) the outburst of a severe mental disorder such as schizophrenia.     

Traumatic Stress and Religion: Is there a Relationship? A Review of Empirical Findings

Based on a history of close conceptual link, empirical studies are beginning to accumulate that investigate the relationship between trauma and religion. A review of empirical studies that examined the relationship between religion/spirituality and PTSD showed mixed findings (n = 11). Though the direction of association varied among studies, all but one study reported significant associations between the two. Factors that might have contributed to the mixed findings are discussed (e.g., measurements, research design). Overall, these results appear to be encouraging toward confirming the conceptual link between religion and trauma. Further research investigating the direction of causation and possible moderators of the association may contribute to a better understanding of the relationship between trauma and religion.Yung Chen, Ph.D. was a research fellow at Duke University Medical Center, and is now an Assistant Professor in the Department of Behavioral Sciences and Leadership at the United States Military Academy at West Point.Harold Koenig, M.D. is a Professor of Psychiatry and Behavioral Sciences at Duke University Medical Center.     

Christian Couple Counseling by Professional,Pastoral, and Lay Counselors from a Protestant Perspective: A Nationwide Survey

Couple counseling is widely practiced by Christian counselors, but there are almost no empirical data investigating it. The present study presents data from a national web-based survey of counselors from the American Association of Christian Counselors (AACC). We describe the nature of Christian couple counseling, as well as counselors' religiousness and their attitudes toward integrating religion and spirituality into couple counseling. Christian couple counselors were highly religious and their personal religiosity affected their attitude toward incorporating religion in counseling. There were differences between professional, pastoral, and lay counselors suggesting that each be treated separately rather than be lumped generically as Christian couple counseling.     

Spiritual But Not Religious? Evidence for Two Independent Dispositions

Some psychologists treat religious/spiritual beliefs as a unitary aspect of individual differences. But a distinction between mysticism and orthodox religion has been recognized by scholars as well as laypersons, and empirical studies of "ism" variables and of "spirituality" measures have yielded factors reflecting this distinction. Using a large sample of American adults, analyses demonstrate that subjective spirituality and tradition-oriented religiousness are empirically highly independent and have distinctly different correlates in the personality domain, suggesting that individuals with different dispositions tend toward different styles of religious/spiritual beliefs. These dimensions have low correlations with the lexical Big Five but high correlations with scales (e.g., Absorption, Traditionalism) on some omnibus personality inventories, indicating their relevance for studies of personality.     

Marriage and Family Therapy Graduate Students’ Satisfaction with Training Regarding Religion and Spirituality

Marriage and family therapists are likely to encounter religious or spiritual clients in their career and thus are encouraged to be aware of their clients’ religious and spirituality. This awareness is often fostered within graduate training programs. This study aims to examine graduate students’ incorporation of religion and spirituality in therapy and their satisfaction with the quality and amount of training programs’ adherence to religion and spirituality. A sample of 135 graduate students from American Association for Marriage and Family Therapy accredited programs completed the survey. Findings showed that graduate students with greater levels of religiosity and spirituality were more likely to perceive it important to address religion/spirituality in therapy and to perceive there is a need for religious/spiritual education. When controlling for religious and spiritual orientations, overall regression results revealed that not having a course on religion and spirituality and perceiving a need for religious/spirituality in education predicted lower satisfaction with the amount and quality of current training surrounding these dimensions. Implications demonstrate the need to address religious/spiritual concepts in the curriculum, supervision, and in marriage and family therapy training.     

Some reflections on spirituality,religion and mental health

For both religion and psychiatry context is becoming more important. Object relations theory, and especially the concept of a transitional object, may be a means of linking religious thinking and psychoanalysis together. The distinction between religion and spirituality is important, though not absolute. Two factors emerge from this engagement: 1) critical questioning at the boundary of each discipline; and 2) both spirituality and mental health are related to life in a specific society. The link between religion and irrational behaviour is important, religion being a primary means of acknowledging the irrational facets of everyday life. But delusion must not be confused with illusion: between these two imagination, art and religion flourish. Each of these is dangerous, since they connect the ‘normal’ with the ‘riskily marginal’. In a multicultural society behaviour which may be acceptable in one context may in another be regarded as a sign of illness. This is particularly true of religious behaviour. Three key issues are examined: 1) the social function of spirituality and religion; 2) the idea of personal wholeness; and 3) the link between external and internal validation of the individual's spirituality. The boundary between psychotic and religious behaviour is a difficult one to discern. Yet neither medical nor spiritual explanations alone seem sufficient. There is a complementary mapping of the complications of human experience.     

Spiritual But Not Religious? Beyond Binary Choices in the Study of Religion

“Spirituality” often has been framed in social science research as an alternative to organized “religion,” implicitly or explicitly extending theoretical arguments about the privatization of religion. This article uses in‐depth qualitative data from a religiously diverse U.S. sample to argue that this either/or distinction not only fails to capture the empirical reality of American religion, it does no justice to the complexity of spirituality. An inductive discursive analysis reveals four primary cultural “packages,” or ways in which people construct the meaning of spirituality in conversation: a Theistic Package tying spirituality to personal deities, an Extra‐Theistic Package locating spirituality in various naturalistic forms of transcendence, an Ethical Spirituality focusing on everyday compassion, and a contested Belief and Belonging Spirituality tied to cultural notions of religiosity. Spirituality, then, is neither a diffuse individualized phenomenon nor a single cultural alternative to “religion.” Analysis of the contested evaluations of Belief and Belonging Spirituality allows a window on the “moral boundary work” being done through identifying as “spiritual but not religious.” The empirical boundary between spirituality and religion is far more orous than is the moral and political one.     

A Model for the Role of Defined Spirituality in South African Specialist Psychiatric Practice and Training

The current bio-psycho-social approach in South African psychiatry refers to Engel’s extended model of health care. It forms the basis of the existing collaboration between medicine, nursing, psychology, occupational therapy and social work. Psychiatry also has to bridge the multi-cultural, multi-religious and spiritual diverse reality of everyday practice. It has become important to establish how, within accepted boundaries, spirituality should be incorporated into the model for practice. Referring to methods described for nursing theory development, a defined core concept was used to construct a model. It may contribute to the discourse on spirituality in local psychiatry, health and mental health.     

Examining Social Desirability in Measures of Religion and Spirituality Using the Bogus Pipeline

A primary concern in the psychology of religion is the distinct possibility that responses to empirical assessments of individuals’ degree and type of religiosity and spirituality are exaggerated owing to social desirability bias. In spite of increased secularization in American culture and a growing distrust of organized religion, religious involvement, personal religiosity, and spirituality are still viewed as highly desirable characteristics. This study estimates the extent of social desirability biases that affect self-reports of religion and spirituality by utilizing a bogus pipeline procedure. In this procedure, participants are convinced that experimenters can detect disingenuous responses to individual items on questionnaires through the use of physiological measures, although no physiological data are actually collected. If the self-reports of participants in the bogus pipeline condition indicate greater religiosity or spirituality than those in the control condition, self-report bias is indicated. The bogus pipeline procedure has been used in other areas of study to increase veracity of self-reports when social desirability effects are present (such as reporting sexual behaviors or prejudice). The results indicate that social desirability biases influence multiple constructs including religious orientations, religious coping, and daily spiritual experiences. Implications for future research relying on self-reports of religion and spirituality are discussed.     

Psychiatry and religion circa 1978: Analysis of a decade,part I

Prior tensions between science and religion have dissolved and coalesced into new alliances based on ideology and philosophy. This general cultural pattern is reflected in the realignment of interests and interactions between psychiatry and religion. There are increasing numbers of mental health professionals with devout religious commitments and involvement in religiously oriented mental health activities; while clergy have developed new organizational structures to reflect many diverse mental health interests, including pastoral counseling, community mental health chaplains, hospital chaplains, and expanded parish ministries. Clinical and research literature has continued to rapidly proliferate, while a unique genre of pastoral care and counseling literature has emerged. A decade ago there was hope for an amicable alliance between specialists in psychiatry and in religion. That irenic quest has shifted into overlapping goals and roles, with tensions between those engaged in universalistic norms and those seeking to develop particularistic norms.Dr. Pattison is Professor of Psychiatry and Human Behavior, Social Science, Social Ecology; Acting Chairman, Department of Psychiatry and Human Behavior, University of California, Irvine; Deputy Director, Training, Consultation, Education Division, Orange County Department of Mental Health. His address is UCI Medical Center, 101 So. The City Dr., Orange, Ca. 92668. Part II of this article will be published inPastoral Psychology, Volume 27, No. 2.     

Present at the Creation: The Clinical Pastoral Movement and the Origins of the Dialogue Between Religion and Psychiatry

The contemporary dialogue between religion and psychiatry has its roots in what is called the clinical pastoral movement. The early leaders of the clinical pastoral movement (Anton Boisen, Elwood Worcester, Helen Flanders Dunbar, and Richard Cabot) were individuals of talent, even genius, whose lives and work intersected one another in the early decades of the twentieth century. Their legacy endures in the persons they inspired and continue to inspire and in the professional organizations and academic programs that profit from their pioneering work. To understand them and the era of their greatest productivity is to understand some of what psychiatry and religion have to say to each other. Appreciating their legacy requires attention to the context of historical movements and forces current in America at the end of the nineteenth and the beginning of the twentieth century that shaped religious, psychiatric, and cultural discourse. This essay attempts to provide an introduction to this rich and fascinating material. This material was first presented as a Grand Rounds lecture at The New York Presbyterian Hospital, Payne Whitney Westchester in the Department of Psychiatry, Weill Cornell Medical College.     

When cognitive scientists become religious, science is in trouble: On neurotheology from a philosophy of science perspective

Since the 1990s medical technology has afforded exciting possibilities for studying the brain. Together with knowledge accrued through psychology and psychiatry, it has set the stage for pioneering research and stimulated disciplines such as Social Neuroscience, the Cognitive Science of Religion, Cognitive Anthropology, and Cognitive Archaeology. Another discipline has arisen, Neurotheology, which is interested in the brain and religious experience. Early proponents such as d'Aquili and Newberg had a religious agenda in their work. Others, such as members of Transcendental Meditation, have used experimental and brain studies to legitimate religious agendas. Experiential shamanists have embarked on a similar legitimation process. The differences between science and therapy and spirituality have been blurred or denied. Neurotheological attempts to discover areas of the brain responsible for religious experiences have led to untenable results. The fact that such research has passed the peer review process of leading psychological, psychiatric, and neurological journals is perhaps more indicative of the pervasiveness of religiosity throughout American society than of objective brain science. This essay argues that neurotheology is an example of the struggle between confessional and critical approaches to the study of religion. The main difference is that the battlefield of this struggle is the brain.     

Religious experience and mental health: anthropological and psychological approaches

ABSTRACT

Moreira-Almeida, Sharma, van Rensburg, Verhagen and Cook have written a very comprehensive position statement pertaining to religion and psychiatry. While presenting a good overview of studies of religion, spirituality and mental health it does not include the important area of the health implications of religious experience which is the focus of this piece. I begin by discussing definitions of religious experience before examining the work of William James. The second part of this paper focuses upon specific religious experiences and psychopathology with a focus on mysticism, hallucinations and culture.