Spirituality and psychiatry: conflicting values?

Larry Culliford's (2007) article stresses the subjective and uniquely personal character of spiritual experience. We agree. Psychiatry's tendency to privilege the objective over the subjective has been well documented and its neglect (indeed pathologisation) of spiritual experience is, we feel, related to this.

Tension between these 'two ways of knowing' in psychiatry has a long history. Despite a trend in recent years towards a flattening of this hierarchy, reflected, for example, in increasing interest in qualitative research, psychiatry continues to be underpinned by rationalist values.

This is the basis of its continuing tension with ‘spiritual values’. We endorse Culliford’s preference for the term ‘spirituality’ over ‘religion’. The term spirituality, in emphasising elements common to the religious traditions, avoids focus on dogma that often only obstructs dialogue. This term also helps to identify fundamental points of conflict between spiritual values and those of psychiatry, and it is these that we wish to discuss briefly.

In contrast to rational or objective knowledge, which concerns itself with the finite and the certain, spirituality is concerned with transcendence and therefore with the infinite and the unknown. In keeping with this, linguistic categorisations should be used tentatively and with due regard for the fact that language is itself located at the rational level of consciousness, as numerous authors have suggested (e.g. Watts, 1963; Danto, 1973). Conventional standards of proof, too, are very much an expression of psychiatry’s rational commitments, and spiritual discourse has traditionally acknowledged that prevailing notions of ‘proof’ are of limited relevance. This is illustrated, for example, by the Christian notion of fideism and in the Vedic distinction between higher knowledge vidya and lower knowledge avidya. The late Cambridge logician–mathematician turned theologian Alfred North Whitehead in much the same vein acknowledged the inverse relationship between that which is most amenable to measurement or quantification and that which is most meaningful or valuable to humans (Whitehead, 1929). Today, spiritual practices such as yoga struggle for validation other than in terms that recognise their ‘measurable utility’.

Psychiatry’s commitments to the rational domain are also expressed in its endorsement of the values of mass society. Maladaptive behaviour by society at large is relatively immune from characterisation as ‘pathological’ (following Erich Fromm). In addition, conformity to the values of society at large becomes a criterion for ‘sanity’ (however covertly). In contrast, conformity to the values of the material world is accorded a subordinate value in the Vedic and other spiritual traditions. Mental illness is therefore invariably viewed as falling short of an assumed standard. Conventional (rational) approaches leave little room for complementing interpretations of, say, depression, anxiety or psychosis with interpretations that recognise their potential in a uniquely personal way to facilitate spiritual growth.