Academic journal article American Journal of Psychotherapy

A Religious Psychiatrist's Ethnographic Self-Report

Academic journal article American Journal of Psychotherapy

A Religious Psychiatrist's Ethnographic Self-Report

Article excerpt

REFLECTIONS

The religious identity of psychiatric patients is deemed important as it may impact upon the understanding of patients' problems and the quality of the therapeutic relationship. It would seem important that the psychiatrist should also be sensitive to the role of his/her own religious identity and its effect on clinical work. Nevertheless, even in studies by and about psychiatrists who have religious roles within a community, this component has tended to he ignored. A series of self-observations are offered by a religious Jewish psychiatrist to describe the effect of religious identity on himself and his patients during clinical work in Israel. Three types of situations were apparent: when he was unsure about his religious identity, when he was unsure about his professional identity, and when he was dealing with essentially religious rather than psychiatric issues and having to differentiate between his own role and that of a rabbi. These observations support the need to be sensitive to the effect of one's religious identity on clinical work, while appreciating that, as Andrew Sims has stated, the psychiatrist's "attitude towards the patient who shares his faith is as a fellow believer and not as a priest."

INTRODUCTION

The concept of professional neutrality was applied particularly to psychotherapy, but is applicable to most areas of mental health work, symbolizing the presence of the therapist for the benefit of the patient as a detached professional, present to reflect and help analyze patients' difficulties without burdening them with the therapist's own crises and urges. It has become increasingly clear that such neutrality is more assumed than real and that many aspects of a therapist's identity are presented to a patient.

The age, sex, phase of life, height and weight, skin color, name, style of clothing, all convey aspects of a therapist's identity to patients. These are unavoidable and unchangeable aspects of therapists that one may or may not think about, and will have an effect on professional work. Each of these aspects of identity has an internal effect, influencing one's self-view and way of communicating and working with others. Above all, they impact upon patients.

All therapists also have a religious identity, whether atheist, agnostic or believer. This religious identity may or may not be visible. Religious values may well influence the behavior of mental health workers and therefore affect their patients, both directly and via their expectations from the therapeutic encounter. The aim of this account is to describe and evaluate the presentation of the religious identity of a modern orthodox Jewish psychiatrist in Israel as seen through his own eyes. If ethnography is a description of the attitudes and behaviors of a particular cultural group (1), then this may be seen as an ethnographic self-report. Ethnographic accounts are normally the work of anthropologists. Anthropology in the last decades has become more reflexive, looking in upon itself and noting the effects of being a viewer (2). So too, the psychiatrist has been used to view him/herself as an impartial evaluator. Only in the last years has an increasing awareness developed of the many aspects of the person in the psychiatrist's chair. This, then, will be such a reflexive view of one aspect of the psychiatrist's identity.

Religious identity has become an important component of mental health work for several reasons. Following Freud's pejorative references to religion as an illusion and a universal neurosis, the two subjects, psychiatry and religion, became adversaries. However, the general population continues to hold religious beliefs, in contrast to the predominantly nonbelieving culture of psychiatrists. A consequence of this gap was described by Kung (3) as "the last taboo" in that psychiatrists were avoiding discussing religious issues with their patients.

The developing role of psychiatry during the last century meant that it became the forum for discussing many of the life issues previously shared with the priest. …

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