Strangers At Bedside: A Learner’s Perspective on Psychiatry’s Spiritual Unease
Journal of Psychiatry Reform vol. 10 #10, September 2023
Mira K. Parekh
Fourth-Year Medical Student, University of California School of Medicine, Sacramento, California, USA. [email protected]
The human experience is arguably a spiritual one. Within our secularized social systems and institutions, we still rely on a guiding moral ethic, grounded in an altruism for life. Even atheism is a system of belief, operating on axioms and corollaries that allow individuals to make greater sense of their world. Those who do not identify with labels of religious or spiritual are still driven by the ineffable: belonging, inner peace, acceptance, to hang one’s life on the shingle of greater purpose. These are fundamentally existential and spiritual pursuits, anchoring us to beliefs of purpose and meaning. In psychiatry we label “ill” or “disordered,” patients who suffer crises of meaning, or whose actions and beliefs are incompatible with social mores. Yet as providers, we tread uneasily around the complex language of these human realities. In doing so, we risk estranging ourselves from the profound truths of human being.
The term psychiatry itself originates from the Greek psyche, “soul” and iatros, “healing.” But we deny any mention of the soul at bedside, coding patient narratives and interviews in medicalized language that fails to acknowledge the complex experiences— anguish, hope, disillusionment, transcendence— that are so often the bedfellows of crisis. Rather than foster an exploration of a patient’s natural history and worldview, we ask that patients parry and sanitize their own narrative to suit a script that can be coded, measured, and subsequently monetized.
Does our current approach deprive patients of their own sense of consequence? Journalist Krista Tippet explores this in “The Soul In Depression,” which includes interviews from several survivors of Major Depressive Disorder (MDD) who all sought medical treatment. Tippet interviews three prominent writers: the agnostic, multi-faith psychologist Anita Barrows, Quaker theologian Parker Palmer, and atheist journalist Andrew Solomon, all of whom survived severe MDD in their adult lives . Though the beliefs and ideologies of these individuals are diverse, their narratives converge on consequential and universal themes of darkness, self-estrangement, and the nature of the human soul.
Psychologist Barrows describes her own childhood experience, colored by her mother’s deep and crippling depression, as entering a permeable darkness. She states feeling compelled to “redeem the word depression from the medical and clinical,” which fails to capture its profound humanness, and the indelible mark it leaves on those it touches . Solomon who denies any religious identity, still called his depression the noonday demon. Despite using medication for his illness, he states that his descent into depression and subsequent re-emergence convinced him of the human soul.1 For devout Palmer, depression reimagined God and his faith, causing him to see the soul as that wild thing that could survive where body and mind were lost. Palmer did not view his pervasive suicidal ideation as simply a narrative of neurochemical imbalance, but rather a symptom of decades spent in denial his authentic self, and a critical part of his journey to self-actualization .
These expressions are beautiful ones. They remind us that the rich language of suffering is both universal and personal, and of what entire disciplines of the humanities—art, literature, poetry, theology, philosophy have made their canon. In withholding from our patients these explorations, at best we disempower them, at worst we implicitly negate their unique humanity. Palmer’s own spiritual perspectives towards his suffering were dismissed by his psychiatrists, which he found both disappointing and offensive .
This greater therapeutic disconnect is echoed in the article Mindfulness, Mysticism, and Narrative Medicine, where psychiatrist and philosopher Bradley Lewis explores medicine’s general unease with the language of mystical or spiritual experience . Mysticism, as has been examined in the medical humanities, can be defined as a significant state of consciousness that is positive to the experiencer, and often is accompanied with a sense of clarity, indescribability, and awe.4 It often centers around feelings of unity and peace and can occur separately from any spiritual or religious identity. While allopathic medicine has imported the language of mindfulness into its scope, it has also expunged any trace of the mystical that has traditionally been welcomed in such practices. This is especially significant considering the potential commonness of spontaneous mystical experience. Research by psychologist David Wulff has found that as many as 30 to 53 percent of a sampled population reported experiencing a mystical state; common triggers included medical experiences such as depression, childbirth, illness, and proximity to death . We work hard to remain strangers to our patient’s realities.
This should equally concern us from a bioethical perspective, which reinforces the patient as the primary stakeholder in their care. We should be critical of the potential harm done when we force patients to adopt (still incompletely understood) medical narratives of individual pathology while concurrently denying their important narratives of personal meaning. This is especially concerning in the historical context of a medical system that has done great collective, and even criminal, harm in its pathologizing of natural human modes of experience.
When we refuse to engage in cross-cultural and spiritual exploration, we perpetuate ongoing systematic ideologies that undermine our collective well-being. For example, the indigenous patient claiming to hear voices, who has suffered the generational harms of genocide, displacement, and the continued loss of sovereignty, should not be automatically medicalized with hegemonic definitions of psychosis. We owe to this (and any) patient an exploration of their culture and spiritual worldviews; their interpretation of their experience in the context of cultural and spiritual beliefs; the extent to which they connect their journey to a greater arc of meaning. This curiosity is the minimal therapeutic requirement, no matter how unfamiliar these themes may be to us personally. To truly care for any human is to support their rich sense of self, that necessarily includes possibilities of significant spiritual, cultural, and familial traditions. Else we risk perpetuating legacies of mistreatment and suffering already being borne. We cannot deny our patients in this way and claim to attend to them.
1. Tippett, K. (Host). (2021, Feb. 4). The Soul In Depression [Audio podcast episode]. In On Being. On Being Studios. URL: https://onbeing.org/programs/the-soul-in-depression/
2. Tippett, K. (Host). (2021, Feb. 4). Unedited Anita Barrows with Krista Tippett [Audio podcast episode]. In On Being. On Being Studios. URL: https://onbeing.org/programs/the-soul-in-depression/
3. Tippett, K. (Host). (2021, Feb. 4). Unedited Parker Palmer with Krista Tippett [Audio podcast episode]. In On Being. On Being Studios. URL: https://onbeing.org/programs/the-soul-in-depression/
4. Lewis, B. (2016). Mindfulness, Mysticism, and Narrative Medicine. Journal of Medical Humanities, 37(4), 401–417. https://doi.org/10.1007/s10912-016-9387-3
5. Wulff, D. (2013). Mystical Experience. In E. Cardena, S. J. Lynn, & S. Krippner (Eds.), Varieties of Anomalous Experience: Examining the Scientific Evidence (pp. 397–440). essay, American Psychological Association.