A Healing Take on Faith

Throughout much of human history, healing and spirituality have been nearly synonymous, the joint purview of medicine men, shamans, and aptly named "faith healers." In modern medicine, though, faith often seems an intruder in the clinic, the clunky out-of-town relative who means well but bumps into the equipment and wrecks the dietary plan with forbidden comfort food.

In psychological circles as well, spirituality and faith are viewed with great discomfort, despite being acknowledged as important facets of patients’ lives. I remember the excruciating moment when I revealed to fellow graduate students a cancer patient’s request that I pray with her during therapy ... and my assent. After a horrified silence, many of my colleagues made strong arguments for referring out such patients for pastoral care. They cited potential conflicts of ideas, boundary-crossing, transference and countertransference – legitimate concerns, all.

In the moment, though, it seemed to me that the patient’s deep yearning was for shared hope in the context of human connection. I did not, and do not, regret that I obliged and was moved by the experience.

What brought these thoughts to the fore was a thoughtful review article published in April by psychiatrist/philosopher John R. Peteet in the journal, Depression Research and Treatment (2012 [doi:10.1155/2012/124370]).

Dr. Peteet, whose thoughtful body of scientific writing has explored many dimensions of suffering, guilt, and forgiveness, as well as matters of the soul, typically drills to the core dilemmas facing clinicians as they seek, in the title of his article a "Spiritually Integrated Treatment of Depression."

His paper masterfully recapitulates the growing body of literature on the spiritual dimension of depression as an outgrowth of hopelessness, existential isolation, and the bleak belief by many sufferers that their darkness is retribution for spiritual weakness.

From those muddy waters – including a literature review that found 56 definitions in 156 papers addressing existential suffering in palliative care settings – Dr. Peteet offers a conceptual framework astonishing in its clarity, comprehensive philosophical scope, and clinical utility.

By summarizing patients’ concerns as emotional, existential, or spiritual, he identifies common belief statements (such as "I don’t know who I am," "There is nothing special about me," or "God is punishing/ignoring me") and offers insight about how each might allow for culturally respectful therapeutic interventions.

A depressed person grappling with meaninglessness, for example, might benefit from spiritually oriented approaches such as mindfulness, meditation, and other meaning-centered orientations, suggests Dr. Peteet, who serves as medical director of the Adult Psychosocial Oncology Program at Dana-Farber Cancer Institute and as a psychiatrist at Brigham and Women’s Hospital in Boston.

Another patient’s spiritual crisis may be guilt infused, and this patient may benefit from forgiveness-promoting positive psychology.

In Dr. Peteet’s conceptualization, there is room for humanistic psychology and the 12-step approach, cognitive behavioral therapy, and psychodynamic work.

He sees healing as coming through reconciliation and attunement, engagement and acceptance.

What does not appear in this very sensitive and contemplative review is the sense that the door between modern medicine and spirituality is one that needs to remain firmly and resolutely closed, best left to religious counselors and the dark solitude of a depressed person’s deepest questions of faith.

Betsy Bates Freed is a clinical psychologist in Santa Barbara, Calif., and a medical journalist.

Throughout much of human history, healing and spirituality have been nearly synonymous, the joint purview of medicine men, shamans, and aptly named "faith healers." In modern medicine, though, faith often seems an intruder in the clinic, the clunky out-of-town relative who means well but bumps into the equipment and wrecks the dietary plan with forbidden comfort food.

In psychological circles as well, spirituality and faith are viewed with great discomfort, despite being acknowledged as important facets of patients’ lives. I remember the excruciating moment when I revealed to fellow graduate students a cancer patient’s request that I pray with her during therapy ... and my assent. After a horrified silence, many of my colleagues made strong arguments for referring out such patients for pastoral care. They cited potential conflicts of ideas, boundary-crossing, transference and countertransference – legitimate concerns, all.

In the moment, though, it seemed to me that the patient’s deep yearning was for shared hope in the context of human connection. I did not, and do not, regret that I obliged and was moved by the experience.

What brought these thoughts to the fore was a thoughtful review article published in April by psychiatrist/philosopher John R. Peteet in the journal, Depression Research and Treatment (2012 [doi:10.1155/2012/124370]).

Dr. Peteet, whose thoughtful body of scientific writing has explored many dimensions of suffering, guilt, and forgiveness, as well as matters of the soul, typically drills to the core dilemmas facing clinicians as they seek, in the title of his article a "Spiritually Integrated Treatment of Depression."

His paper masterfully recapitulates the growing body of literature on the spiritual dimension of depression as an outgrowth of hopelessness, existential isolation, and the bleak belief by many sufferers that their darkness is retribution for spiritual weakness.

From those muddy waters – including a literature review that found 56 definitions in 156 papers addressing existential suffering in palliative care settings – Dr. Peteet offers a conceptual framework astonishing in its clarity, comprehensive philosophical scope, and clinical utility.

By summarizing patients’ concerns as emotional, existential, or spiritual, he identifies common belief statements (such as "I don’t know who I am," "There is nothing special about me," or "God is punishing/ignoring me") and offers insight about how each might allow for culturally respectful therapeutic interventions.

A depressed person grappling with meaninglessness, for example, might benefit from spiritually oriented approaches such as mindfulness, meditation, and other meaning-centered orientations, suggests Dr. Peteet, who serves as medical director of the Adult Psychosocial Oncology Program at Dana-Farber Cancer Institute and as a psychiatrist at Brigham and Women’s Hospital in Boston.

Another patient’s spiritual crisis may be guilt infused, and this patient may benefit from forgiveness-promoting positive psychology.

In Dr. Peteet’s conceptualization, there is room for humanistic psychology and the 12-step approach, cognitive behavioral therapy, and psychodynamic work.

He sees healing as coming through reconciliation and attunement, engagement and acceptance.

What does not appear in this very sensitive and contemplative review is the sense that the door between modern medicine and spirituality is one that needs to remain firmly and resolutely closed, best left to religious counselors and the dark solitude of a depressed person’s deepest questions of faith.

Betsy Bates Freed is a clinical psychologist in Santa Barbara, Calif., and a medical journalist.

Throughout much of human history, healing and spirituality have been nearly synonymous, the joint purview of medicine men, shamans, and aptly named "faith healers." In modern medicine, though, faith often seems an intruder in the clinic, the clunky out-of-town relative who means well but bumps into the equipment and wrecks the dietary plan with forbidden comfort food.

In psychological circles as well, spirituality and faith are viewed with great discomfort, despite being acknowledged as important facets of patients’ lives. I remember the excruciating moment when I revealed to fellow graduate students a cancer patient’s request that I pray with her during therapy ... and my assent. After a horrified silence, many of my colleagues made strong arguments for referring out such patients for pastoral care. They cited potential conflicts of ideas, boundary-crossing, transference and countertransference – legitimate concerns, all.

In the moment, though, it seemed to me that the patient’s deep yearning was for shared hope in the context of human connection. I did not, and do not, regret that I obliged and was moved by the experience.

What brought these thoughts to the fore was a thoughtful review article published in April by psychiatrist/philosopher John R. Peteet in the journal, Depression Research and Treatment (2012 [doi:10.1155/2012/124370]).

Dr. Peteet, whose thoughtful body of scientific writing has explored many dimensions of suffering, guilt, and forgiveness, as well as matters of the soul, typically drills to the core dilemmas facing clinicians as they seek, in the title of his article a "Spiritually Integrated Treatment of Depression."

His paper masterfully recapitulates the growing body of literature on the spiritual dimension of depression as an outgrowth of hopelessness, existential isolation, and the bleak belief by many sufferers that their darkness is retribution for spiritual weakness.

From those muddy waters – including a literature review that found 56 definitions in 156 papers addressing existential suffering in palliative care settings – Dr. Peteet offers a conceptual framework astonishing in its clarity, comprehensive philosophical scope, and clinical utility.

By summarizing patients’ concerns as emotional, existential, or spiritual, he identifies common belief statements (such as "I don’t know who I am," "There is nothing special about me," or "God is punishing/ignoring me") and offers insight about how each might allow for culturally respectful therapeutic interventions.

A depressed person grappling with meaninglessness, for example, might benefit from spiritually oriented approaches such as mindfulness, meditation, and other meaning-centered orientations, suggests Dr. Peteet, who serves as medical director of the Adult Psychosocial Oncology Program at Dana-Farber Cancer Institute and as a psychiatrist at Brigham and Women’s Hospital in Boston.

Another patient’s spiritual crisis may be guilt infused, and this patient may benefit from forgiveness-promoting positive psychology.

In Dr. Peteet’s conceptualization, there is room for humanistic psychology and the 12-step approach, cognitive behavioral therapy, and psychodynamic work.

He sees healing as coming through reconciliation and attunement, engagement and acceptance.

What does not appear in this very sensitive and contemplative review is the sense that the door between modern medicine and spirituality is one that needs to remain firmly and resolutely closed, best left to religious counselors and the dark solitude of a depressed person’s deepest questions of faith.

Betsy Bates Freed is a clinical psychologist in Santa Barbara, Calif., and a medical journalist.