Eastern Religions, Spirituality, and Psychiatry: An Expansive Perspective on Mental Health and Illness

Eastern Religions, Spirituality, and Psychiatry: An Expansive Perspective on Mental Health and Illness

BOOK REVIEW

Eastern Religions, Spirituality, and Psychiatry: An Expansive Perspective on Mental Health and Illness

Edited by H. Steven Moffic, Rama Rao Gogineni, John R. Peteet, Neil K. Aggarwal, Narpinder K. Malhi, and Ahmed Hankir; Cham, Switzerland: Springer Nature Switzerland AG, 2024

354 pages • $159 (hardcover)

Reviewed by Renato D. Alarcón, MD, MPH

That a 4th volume on religions, mental health, and related ontological fields is published in 5 years by a distinguished editorial group, speaks not only of the tenacious commitment of these scholars but also about the inexhaustible nature of the topics and their pervasive fostering of reflections and challenges. To the previous studies on Islamophobia, anti-Semitism, and Christianity, this new publication adds descriptions and discussions on Eastern religions, effectively expanding their perspectives toward new fields of knowledge. Iterative questions, doubts, historical dilemmas, and socio-cultural connections consistently emerge, as happens with the reading of deeply stimulating books.

The first of the book’s 4 parts deals with general issues. Chapter 1 includes definitions of basic concepts (culture, religion, spirituality, etc) and introduces new and decisive factors such as increasing global migrations, training in cultural psychiatry, and the deprivations of minoritized ethnoracial groups. It also mentions the “evolution of attitudes” on the side of psychiatric schools, such as the polemic assessments of religion by the psychoanalytic “skepticism”. The distinctions between spirituality and religion, and their application to clinical and psychotherapeutic efforts, configure the mostly “didactic, manualized and inherently prescriptive” religious approach vis-a-vis a spiritual one that follows a dialectical model. A polemic statement emerges here (Chapter 2): the closing of asylums is called “unrealistic and impracticable”, and community care is labeled as “reductionistic”, that is, imposing new forms of constraint: manuals, guidelines, tick boxes, categorization. The choice is between prescriptive psychiatry and explorative psychotherapy, the author claiming that psychiatry is, mostly, “an art guided by science”. Many may wonder if that is so.

Beyond purely biological assertions, human development responds to various models (cognitive, psychosocial, religious, moral) tied to critical time periods. In Chapter 3, “epistemic humility” is postulated to confront this process without “abrupt conversions” while restoring important nature-based and “selective, experiential events impacting one’s religious/spiritual journey”. The influence of Eastern religions on parenting is explored in Chapter 4. Broadly classified as authoritarian, authoritative, permissive, and uninvolved, each of the Eastern religions seems to variously emphasize common and distinctive features; in short, the developmental trajectories conferred to parenting by Eastern religions and cultural traditions can be positive and negative, the latter (such as adult-centrism, intolerance, suppression of creativity, etc) deserving, in turn, observation and adequate management.

Learning about death and dying in Eastern traditions may emphasize an “omnipresent energy” coming from memories of the deceased, as well as a sort of warm, supportive preparation for death and the afterlife (Chapter 5). Along these lines, faith and practice norms (Chapter 6) are reflected in individual and family-based habits of support and solidarity, and the cultivation of harmony and statecraft by Buddhism, Confucianism, Taoism, and others. Chapter 7 is a vigorous documentation of spirituality as an essential component of health, a precious focus of scientific research (leading to the growing value of disciplines like positive psychiatry), a fruitful source of mental health care, and a significant contribution of Eastern models to Western clinical practices.

Part II deepens the information about the history and practice of Eastern religious and spiritual traditions. Its first 2 chapters describe Hinduism’s basic and clinical implications, and, more specifically, the relevance of its ancient scriptures in the conceptualization and management of anxiety disorders. Family and community concepts emerge and effectively reduce the partialized approaches of individual beliefs and behaviors; the method called Samvâda (Speaking Together) seems to align with the cultural formulation approach advocated by the most recent versions of DSM. The anatomy of a Hindu patient’s belief system, ie, their identity, encompasses 5 categories (spiritual, scriptural, cultural, ritualistic, and amalgamated) that substantiate a pragmatic, culturally humble approach through a variety of clinical or therapeutic postulates.

Buddhism is the subject of the next 3 chapters (10, 11, and 12) examining psychotherapeutic aspects, mental health and wellbeing concepts, and personal insights, respectively. Its close connections with modern mindfulness-based psychological interventions in the West are related to the ancient Four Noble Truths and the Noble Eightfold Path, conceived 2500 years ago; personal enlightenment and social engagement, cultivation of wisdom, compassion, empathy, and authentic humanism are therapeutic and existential objectives for Buddhist populations, including what some consider a distinct Western Buddhism. Attachment is considered the core of mindfulness meditation (MM) and mindfulness-based stress reduction (MBSR), Western-based techniques whose research results are generally presented as mixed, a conclusion explained by the unfortunate divorce of Western MM, “from its deep spiritual roots in Buddhism”.

Profound principles and meanings of spirituality and religion inspire the essence and actions of most, if not all, Eastern doctrines exposed by Chapters 13 to 18. It is evident that each of them manages to keep a sense of uniqueness. Such is the case of Sikhism’s proposals of lifelong spiritual learning that leads to giving up egocentrism and accepting humility. Taoism and its holistic self-acceptance, naturalness, a dynamic balance between opposing forces (Yin and Yang), and subsequent harmony. Zoroastrianism, an ancient Persian/Iranian religion, is 1 of the world’s oldest organized faiths and, arguably, the first monotheistic religion including a dualistic cosmology of good and evil, and a voluntary and collaborative relation between God, Zoroaster, and all the creatures; its clinical applications emphasize compassionate care and constructive collaboration between 2 people whose physical, relational, emotional and spiritual selves are viewed in unity. Despite its small sized demographics, Jainism entails a powerful cultivation of nonviolence, truthfulness, not stealing, chastity, and nonmaterialism, as well as the actions of an enlightened, self-centered human being. Interestingly, the original emblem of Jainism included the swastika (representing cycles of reincarnation), replaced in 1947 by the Om, symbol of the most significant Jain prayer.

Confucianism can be historically associated with mental health education, as its founder is widely considered to be the first private teacher in China, and his advocacy of “human becoming” is regarded as a crucially important pedagogical principle. In turn, the doctrine postulates 3 mental health models: individual, social, and state-centered, with physical-spiritual and moral-emotional makers of positive psychology. The author of Chapter 18 presents an original, updated Confucian model of mental health education centered on the Yin (Earth) and Yang (Heaven) movement, using “Confucianism’s multi-faceted discourse…. (and)….transforming the concern for the individual self into service and contributions to others.”

Part III discusses cultural humility, inspired, but also historically and scholarly elaborated, Western psychiatry’s perspectives on Eastern traditions. Its first chapter (19) presents a Christian view that emphasizes the Eastern origin of modern meditation, and the impact of Buddhist insights into paradox, freedom, compassion, contemplation, and mysticism, all typified as “paths to compatibility”. Similarities and differences between Muslim views and Eastern (Buddhist, Hindu, and Sikhist) traditions are examined next (Chapter 20); despite differences, a shared commitment to promote peace, compassion, and respect for all are significant bridges to reach “the other.” Jewish perspectives are examined in 3 chapters (21 to 23): the first consistently uncovers a Jewish-Buddhist complementarity based on the cultivation of meditation and its contribution to wisdom and wellbeing. Chapter 22 is a fascinating personal narration of the Jewish psychiatrist author’s development of profound interest in Asian topics. Chapter 23 integrates Judaic and Buddhist insights into psychotherapy and counseling, reinforcing the sharing of core values, the inseparability of spiritual and ethical principles, and the obstinate relevance of rational thinking. Chapter 24 conveys personal meditations about a psychiatric career as a route to enlightenment and professional competence. Similarly, Chapter 25 is an original exercise of self searching “through the faith of imagined others,” ie, the opus of illustrious thinkers (from Comte to Hesse, Husserl to Jaspers, or Korzybski), the exploration of the meaning of actions and events using religion, a generator of communities, and psychiatry, our beloved doing.

Part IV deals with social psychiatry perspectives on the overall topic. Esthetics, philosophy, psychoanalysis, or poetics inquire into the value of speaking (or writing) vis-à-vis the recognition of the imperative of silence (Chapter 26), culminating with “a redefinition of the sayable and the unsayable, ...the feeling of being at home or feeling estranged.” Kerala, an Indian city, home “to a rich tapestry of religious practices and traditions,” is the subject of Chapter 27; once again, syncretism materializes a religiously inspired harmonious diversity. In turn, the concept of caste, a heritable hierarchy much more complex than the typical socio-economic levels of Western sociology, seems to play an important role in mental health inequities across the globe (Chapter 28). Another risk factor is the use of spirituality as a “pretext” for sociopolitical control, a “fraudulent” exercise that generates a collective “cognitive dissonance” impacting communities through a model of authoritarian control (Chapter 29).

Thus, we arrive at the notion of Omnism (a term coined in the 1800s), “a religion for all… seeing the good in everything,” (Chapter 30) that attempts to link substantial meanings, purposes, and outcomes from the more than 4200 organized religions in the globe, traced back at least 11,000 years and grouped, under theism (or deism), in at least 4 categories: monotheism, polytheism, pantheism, and agnosticism. Omnism can be defined as close to spirituality since it does not have a fixed system of beliefs, holy book, or set of mandatory rituals, and does not demand any sort of institutional affiliation; the author feels “connected to something more than humanness.”

In addition to the new pieces of knowledge that the reading of this book provides, the challenges that it creates, such as questioning the medical model and the outreach of scientific processes, are outstanding. They foster a search for conceptual clarifications, ie between cure (didactic, individualistic) and healing (dialectic, transpersonal, and spiritual), and of the historic or epistemological origin of mindfulness and otherness in Eastern traditions. The externalizing Western clinical or psychotherapeutic procedures vs the internalizing Eastern approaches is a revelation that, nevertheless, does not erase the common elaboration of mysticism-related concepts. Thanks to these reflections, humility as a necessary condition for the honest use of wisdom and the genuine humanity of the clinical encounter are topics waiting for fresh, revealing routes.

As our reading advanced, more reflections, questions, and an increasing conviction about the need for further contacts and debates gained strength. The issue of diversity (intensified by repeated diasporas) and the possibility of integrative, syncretic efforts in search of a probably utopian Omnism are attractive goals. The study of the “anatomy of belief systems”, the reasons for “mixed findings” resulting from the use of Eastern and Western treatment modalities, and religion and spirituality as variables in these cultural psychiatry-inspired studies could be just 3 other joint research initiatives.

The teaching of these topics to future mental health professionals counts on a very rich list of resources, from Taoism-related quotes to closely connected works by Victor Hugo, Dickens, historians, poets, writers, and many other intellectual artists. The holistic nature of Eastern traditions makes it possible for psychotherapeutic models whose “goals, strategies and processes are equally constructed by 2 people, rather than controlled by asymmetrical measures.” Eastern religious and management strategies acknowledge the fluidity of personal identities and the multiple aspects of truth, attempting to reach physical-spiritual and moral-emotional balances, a consistent search for harmony that several chapters explore. Eastern inspired “human flourishing” becomes a predominant objective of religious and spiritual management practices of psychiatric conditions.

A final reflection on the overall approach of the volume has to do with the several times mentioned syncretism. As 1 of the contributors says, “Syncretism has been more the norm than the exception since the start of history. History is remade again and again by the creative misinterpretation of events and ideas from other times and other peoples.” Rationality in opposition to supernaturalism is the key message here: although a “complicated nexus”, the main topic of this book comes to be that of “shared core values, converging evolutions, psychological insights inseparable from spiritual and ethical values,” among different belief systems. Wisdom, universality, meditation, enlightenment, and disentanglement from wrong and or rigid notions, are management principles within “the metric of our humanity”. A “redefinition of the sayable” across generations can only be dictated by religious harmony and peaceful levels of consistency and tolerance. One has to fully agree with the statement that defines “incommensurability and intimacy in our relationships as complementary, not oppositional,” and with the reaffirmation that “the courage to listen is often as crucial as the courage to speak.”

Dr Alarcón is Distinguished Emeritus Professor of Psychiatry, Mayo Clinic School of Medicine, Rochester, MN; Honorio Delgado Chair, Universidad Peruana Cayetano Heredia, Lima, Perú; and Editorial Board Member of Psychiatric Times.