Professional Documents
Culture Documents
20
CULTURAL CONSIDERATIONS IN
THE ASSESSMENT AND
TREATMENT OF RELIGIOUS AND
SPIRITUAL PROBLEMS
BACKGROUND
The religious and spiritual dimensions of life are among the most
important cultural factors structuring human experience, beliefs, values,
behavior, as well as illness patterns.v- 38 Yet mainstream psychiatry, in
its theory, research, and practice, as well as its diagnostic classification
system, has tended to either ignore or pathologize the religious and
spiritual issues that clients bring into treatment."
This tendency, representing a form of cultural insensitivity, can be
traced back to the roots of psychoanalysis as well as behaviorism and
cognitive therapy. Freud saw religion as "a universal obsessional
neurosis," Skinner largely ignored religious experience, and Ellis viewed
religion as equivalent to irrational thinking and emotional disturbance.
Similarly, spiritual experiences have been viewed as evidence of psycho-
pathology. Freud'" described the mystic perception of unity as a "regres-
sion to primary narcissism," and the 1976 report on mysticism by the
Group for the Advancement of Psychiatry" viewed it as a projection of
a "primitive infantile state." Even the limited references to religion and
From the Department of Psychology, Saybrook Institute (DL); the San Francisco Veterans
Administration Medical Center (DL); the Department of Psychiatry, University of
California, San Francisco (FGL, RT); and the Department of Psychiatry, San Francisco
General Hospital (FGL), San Francisco, California
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468 LUKOFF et al
and spiritual problems. 50, 51 The DSM-IV specifically notes that clinicians
assessing for schizophrenia in socioeconomic or cultural situations dif-
ferent from their own must take cultural differences into account:
THE ASSESSMENT AND TREATMENT OF RELIGIOUS AND SPIRITUAL PROBLEMS 471
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THE ASSESSMENT AND TREATMENT OF RELIGIOUS AND SPIRITUAL PROBLEMS 473
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474 LUKOFF et al