Is psychiatry a religion?

Rob Whitley

Dartmouth Psychiatric Research Center, 2Whipple Place, Suite 202, Lebanon NH 03766, USAE-mail: rob.whitley@dartmouth.edu

In the 19th century, Matthew Arnold famouslywroteofthe‘melancholylongwithdrawingroarofthe sea of faith’.

This referred to the decline ofChristian belief and the influence of Christianinstitutions in the day-to-day life of Europeansocieties. Such a decline was predicted by theenlightenment, which promised the triumph ofrational science over religious superstition.

Pre-dictions of the demise of religion have been some-what validated by the course of history. Fewerpeople are attending religious services, religiousinstitutions have lost much of their influence onthe masses, and religious views are frequentlymocked and vilified as archaic delusions moresuited to a dark and distant past.

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GK Chestertonfamously remarked that when people stop believ-ing in God, they start believing in anything. This begs a simple question – is there a lay replacementfor religion in contemporary societies? Is there anycomparable system of beliefs, behaviours and atti-tudes that stands as a binding doctrine held ‘true’ bythepopulaceatlarge?Isthereanysuchcompar-able system marked by a proselytizing zeal andenthusiasticsenseofmission?Inthisessay,Iarguethat psychiatry, and its handmaiden, clinical psy-chology, now constitutes an amorphous system of beliefs, behaviors and attitudes whose functionsanddoctrinesareunsettlinglysimilartothoseheld by conventional religions. Are psychiatrists thenew priests? Are clinics the new confessionals?Are pills the new prayer? Read on to learn thatnow may be the time to proudly add ‘psychiatry’to the pantheon of world religions.

Psychiatric proselytization

Mainstream religions have often demarcated thepopulace into two neatly distinct categories thatcould be crudely labeled as believers and non- believers. Much effort was expanded on ensuringthat believers are kept within the fold while non- believers are recruited into the faith’s welcomingarms. This involved mission work at home andabroad. Such activity is the fodder of Victoriannovels, perhaps best encapsulated in the risiblefigure of Dickens’s Mrs Jellyby.It could be argued that psychiatry and clinicalpsychology are characterized by a somewhat simi-lar Manichean attitude, as both endeavors involvelarge amounts of ‘outreach’ work to people notcurrently encompassed within its loving embrace.Like religious mission, this occurs at home andabroad.

This is often conceptualized in the lan-guage of ‘untreated illness’ or ‘unmet need’.

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Large campaigns are organized to make peopleaware that they or their loved ones may need toconsult psychiatrists.

Literature is distributed,advertisements are put in the media, seminars areheld.

Peoplemayevenbecontactedunannouncedand asked to discuss psychiatry, in the same man-ner that some of the oft-ridiculed religious mis-sionaries will ‘doorstep’ people to discuss matterstheological.

These efforts often attempt to per-suade the uninitiated heathen to believe in thecentral doctrines of psychiatry.Such activity is implicitly supported by largeepidemiological surveys suggesting that there arethousands (if not millions) of people who need tosee psychiatrists and psychologists.

Like themore zealous religions in times past, the idea thatsome of the uninitiated may actually be enjoyingquite satisfactory lives is rarely entertained. Thatsaid, one significant large-scale study roundlystated ‘the majority of those who receive no treat-mentfeltthattheydidnothaveanemotionalprob-lemrequiringtreatment’.

Thisraisesthequestionofwhose‘need’isbeingmetintalkof‘unmetneed’in psychiatry.Kleinman

arguedthatthereisnosuchthingasan untreated illness (though there are untreateddiseases) in that individuals and their social net-works respond to any suffering and distress withmultifariousaction,eveniftheydonotsee‘profes-sionals’. It has been argued that ardent adherentsof the medical model often disparage such ‘non-professional’ management of the suffering and

DECLARATIONS

Competing interests

None declared

Funding

None

Ethical approval

Not applicable

Guarantor

Contributorship

RW is the solecontributor

Acknowledgements

None

ESSAY

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distress inherent in the human condition.

This issimilar to the way that indigenous belief systemsintimespastweredisdainedand‘colonised’bythemore established religions. A corollary of this isthat some devotees to psychiatry/clinical psy-chology believe that only ‘real’ professionals in‘real’ clinics can conduct ‘real’ treatment. Such belief is somewhat similar to those who believe inthe ‘one true church’ (or variants thereof). Psychi-atric belief in ‘the one true system’ remains strong,and indeed may get stronger as the growing influ-ence of ‘evidence-based medicine’ leads to afocused distinction between what is ‘true’ andwhat is ‘false’.That said, it should be noted that psychiatry is a broad church (pun intended). Many who fallunder its crucible are skeptical of some of its rigiddoctrinal statements and more dogmatic precepts.Indeed ongoing struggles between social psy-chiatrists and biological psychiatrists may be con-sideredanalogoustostrugglesbetweenliberalandtraditional wings of established religions. Forexample,thetraditionalChristiantheologyoforig-inal sin posits that man is born defective and onlyGod’s grace can save him. More Pelagian pro-ponents of Christianity rail against this view asarchaic and dehumanizing. Popular psychiatrictheory posits that man is born defective (in thatgenetic factors are posited as strongly responsiblefor psychiatric illness) and only psychiatric inter-vention can help. Other psychiatrists inveighagainst such theories arguing that situational fac-tors determine suffering and distress, and thatchanging these circumstances will be of more benefit to the individual.It may sound bizarre to suggest that thoseworking in psychiatry are somewhat akin to mis-sionaries, but anyone with access to an Internetsearchenginewillsoondiscoverthatthisisindeeda common self-conceptualization. For example,prominent psychiatric journals, service providersand academic departments all have ‘mission state-ments’. Missions cannot occur without missionar-ies. Thus psychiatry (and clinical psychology), itcan be concluded, is ‘on a mission’.

Priests and psychiatrists

All mainstream religions make a distinction betweenthepriesthoodandlaity.Thepriesthoodleads, the laity follows. The priesthood goesthrough years of abstruse training; the laity doesnot.Thepriesthoodhasreservedesotericpowersincluding administering sacraments; the laitydoes not. Acting collectively, the priesthood can

ex-communicate internal dissidents; the laity isexpected to abide and support such decisions. Thepriesthood may be wedded to concepts such asCartesian dualism; the laity may not understandthese concepts but should unquestionably acceptthem. Does something sound familiar here? Cansuch a pattern be seen in the relationship betweenpsychiatry/clinicalpsychologyandthecontempo-rary public? Certainly, psychiatrists go througharcane training which sets them apart from thegeneralpublic.Psychiatristshavereservedpowersto administer medication and can even coercetreatment and compulsory detention. Like manyreligious denominations, loyalty and conformityare prized virtues within mainstream psychiatry.This can be witnessed in the peer treatment offigures who have deviated from the orthodoxy oftheir day, whether it be Ronnie Laing, ThomasSzasz, Peter Breggin and more latterly DavidHealy.

Job offers have been rescinded, bookshave been ignored, careers have been ruined. Psy-chiatry also operates on a presumption ofCartesian dualism and is very concerned (oftennot explicitly) with the ‘ghost in the machine’.

Indeed it could be argued that its topic matter, ‘themental’or‘themind’isasephemeralandnebulousas notions of ‘soul’, which underpin religion andtheological inquiry. Like priests, psychiatrists arestruggling with a topic matter that is often unfath-omable to the general public. One final point ofcomparison – priests generally consider it part oftheir vocation to offer care for those not already inthe flock, though contemporary mission is moreoften about community outreach work and devel-opment projects rather than ‘Bible bashing’. Like-wise, psychiatrists and psychologists oftenconsider those outside of their immediate care to be in need of their attention, which is manifested by the increasing penetration of self-help booksand media psychologists. Many postwar house-holds,from23RailwayCuttingstoRigsby’sdilapi-dated lodging house, used to fear the knock onthe door from the local vicar, who would usuallydescend upon them during rambunctiousmoments. Door-knocking may be passé, but thepublic can rest assured that almost every TV chan-nel, magazine, newspaper and the like, will haveits friendly mental health expert offering theirwords of wisdom on life’s travails.

Sacred texts

All religions have their canonical texts. The Koran,the Tanakh and the Christian Bible serve the threegreatmonotheisticreligions.Thesetextshavebeen

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inexistenceformillennia,servingasguidinglightsfor proponents and adherents of the said religion.They are used to determine appropriate attitudesand behaviours to the slings and arrows of outra-geous fortune. Psychiatry also has texts which areoften referred to in reverential and canonical tones– these are DSM-IV

and ICD-10, specifically thementalandbehavioraldisorderssectionV.

Thesetexts, in existence for decades, guide both psy-chiatrists, and to a lesser extent the lay public, inthought and deed. Like more overtly religioustexts, these are organized into chapter and verse(i.e. codes) that can be quoted and debated be-tween professionals and interested public.Sacred texts inspire priests and laity to writedevotional literature that interprets the greaterpower behind (and expressed in) the text in orderto help people face quotidian vicissitudes. Like-wise, psychiatry and psychology have spawnedmanybooks(oftenlabelledself-help)thatinterpretpsychiatric beliefs to the general public, helpingthem journey through this vale of tears. Indeed,most reputable bookstores now have shelvesdevoted to psychological self-help, often out-weighing those devoted to religious interpreta-tion. Where once stood CS Lewis, now stands DrPhil.

Weekly observances and sacredpractices

Most religions encourage attendance at a house ofworship at least once a week. Rituals and practicesoccur therein, which should be repeated in one’sown homes. This includes, for example, regularprayer, confession of sins and sacramental partici-pation. An aim of these practices is to maintain orrestorethesupplicant’sequanimityandwellbeing,allowingthemtobearthemortalcoilwithstrengthandcourage.Thoughthecontentmaybedifferent,in terms of form these hallmarks of religion aresomewhat shared in the clinical encounter with apsychiatrist/psychologist. As religious leaders en-courage weekly visits to their house of worship,some psychiatrists and psychologists encourageweekly visits from their patients. Therein, patientsare expected to reveal intimate details of their day-to-day life to the clinician. The clinician may refertotheirtextortrainingtodispenseadvicethatmay be behavioral and/or moral in nature. This adviceoften has unnerving similarities to religious ritual.For example, Christian ministers may advise asupplicanttoengageinHolyCommunion.Intheo-logical terms, this is a transformative experiencethat involves the sacred consumption of a smallwhite host, in whose substance God is deemed to be (symbolically or literally) present. Psychiatristsmay advise their patients to engage in anothersomewhat ritualistic behaviour, that is the con-sumption of a small white tablet in whose sub-stance efficacious agents of change are deemed to be present. Evidence supporting the intrinsic effi-cacy of both these behaviors is equivocal, thoughthe transformative value of their ritualistic aspectsshould not be overlooked.

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My comparison of Holy Communion with con-sumption of psychotropic medication may bequestioned, given that some psychiatric medica-tions have shown significant therapeutic effectsthrough randomized controlled trials (RCT),whereas religious attendance and sacramentalparticipation have not been subject to RCT. Thismay be true, and this evidence for efficacy shouldnot be lightly dismissed. That said, churches,synagogues and mosques (and the world-viewespoused therein) could be deemed efficacious interms of their enduring attraction to millions ofpeopleformillennia.Whatever,ifKarlMarxresur-faced today, he may be more circumspect in con-cluding that religion is the ‘opium of the people’.He may decide there is no need for clever meta-phorical poetics in describing the people’s pen-chant for diminishing the pain, distress andsuffering concomitant with the human condition.Today,psychiatry,anditspanoplyofpsychotropicmedication, may be the literal ‘opium of thepeople’.

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