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[1] Shooter, M. (1999). "Proposal for a Special Interest Group in Spirituality and Psychiatry." Psychiatric Bulletin 23: 310.

In A History of the World in 100 Objects, by Neil McGregor, human artefacts are used as a way of telling the story of world history. This way of doing history invites imaginative interpretation, providing space for projection of subjective (psychospiritual) concerns onto tangible and objective realities. Objects, like people, have biographies which tell us about human meaning making. They make links across time and geography which tell the human story from different cultural and historical perspectives.

In reading McGregor’s book, I have been struck by just how many of the 100 objects have spiritual/religious significance. For example, the Maya Maize God Statue, from Honduras (715CE), reflects a tradition dating back several millennia, in which the fundamental concerns of human existence – food, water, sex – are closely linked to religion (rather than, as in our day, science or economics).

A Seated Buddha from Gandhara in Pakistan (100-300CE) originates in a period, a little less than 2000 years ago, when Christianity, Buddhism and Hinduism more or less simultaneously (and apparently independently) started representing Christ/the Buddha/the gods in human form. This has provided a powerful medium by way of which these religions have been able to communicate transcendent concerns in tangible (immanent) forms.

Conversely, the Gold coins of Abd al-Malik from Syria (696-7CE), issued around the time when the prophet Muhammed was moving from Mecca to Medina – and Islam was defining itself as a political as well as a religious system – show replacement of coins bearing the image of the human ruler with coins that bear only words. As other faiths were employing images to aid in the spiritual quest, Islam proscribed such representations as dangerously idolatrous.

Other gold coins in McGregor’s book, those of Kumaragupta I in India (415-450CE), reflect the rule of the king as endorsed by a Hindu deity, and also a desire for human connection with the divine, but simultaneously acknowledge the existence of religious plurality. Coins do a lot more than simply paying the bills!

A plate from Iran (309-379CE), showing Shapur II, portrays a hunting scene which acts as a metaphor for the king imposing divine order on demonic chaos. The Zoroastrian religion, in the context of which this plate was made, is the world’s oldest monotheistic tradition. Like most religions, it is concerned with allaying human anxieties associated with the disorder and dangers of the world in which we live.

Finally (at least insofar as my selection is concerned) the Holy Thorn reliquary (1350-1400CE, Paris) contains a single thorn, reputedly from the crown of thorns used to mock and torture Jesus Christ prior to his crucifixion (as related in the Christian Gospel narratives). Gifted by the French king to Jean duc de Berry in the late 14th century, it represented the most valuable gift a king could bestow at that time – not because of the gold and jewels of the reliquary, but because of the perceived supreme worth of the thorn. What was supremely valuable then would now be seen by many as worthless, and vice versa. In 14th century France, it was God’s presence amidst human suffering, as represented by this relic, that mattered more than gold or jewels.

In this way, objects from a museum tell us about the human search for security, meaning, and relationship to the transcendent. They express the fundamental spiritual concerns of human life. They tell us something about the human quest for the transcendent.

And so, this leads me to a question, “What are the objects that best represent the place of spirituality in psychiatry?”

As I have reflected on this, I recall an encounter early in my psychiatric training when I went to visit a patient with my consultant. In a bare room, with minimal furniture, this man had no possessions. Wearing only the hospital scrubs that the nurses had given him; he had been stripped of dignity and of any of the visible signs of identity or worth that clothing and possessions offer. I don’t recall the clinical signs or diagnosis, but I do recall that my consultant gave him a pen, so that he could write a letter. (This was long before the days of social media, text messages and e-mail!)

When we left the room, my consultant reflected on the transaction that I had just observed. Someone who had no possessions now owned something. Someone unable to communicate with significant others could now write a letter to them. The transaction was not about a pen, but about respect, identity, and human worth. For me, this was a lesson about the importance of the spiritual dimension to psychiatry. (Others might wish to replace the word 'spiritual' with another word – such as 'human' or 'compassionate').

I wonder, then what the object might be that you – my reader – would identify from your own career as saying something about the importance of spirituality in psychiatry? Please do let me know! I can be contacted by e-mail at c.c.h.cook@durham.ac.uk.

Professor Christopher C.H. Cook
Chair, SPSIG
December 2023

A lot has been happening in spirituality and psychiatry since my last blog in September 2022. The second edition of Spirituality and Psychiatry was published last year by Cambridge University Press and is now available. (College members are eligible for a 30% discount: login as a member on the RCPsych website, click on “My Content”, then on “My RCPsych”, and you’ll find the discount code at the bottom of that page.) It includes new chapters and a thorough updating throughout.

Like many other organisations, our regular pattern of meetings has been disrupted, first by a pandemic and more recently by other events. Sadly, we had to postpone our March 2023 day conference, “What’s God got to do with it?” - Is there a place for God in Psychiatry? due to rail strikes. This is now being rearranged for March 2024.

Patterns of working, education and communication are increasingly involving online engagement and not just hard copies of documents and publications, or face to face meetings in real space. Information is disseminated on the world wide web, in social media, and in a variety of virtual formats hardly imagined when our SIG was first constituted in 1999. People meet at work and in education in virtual space as much, perhaps even more, than they do in real space. It is not so easy to have a coffee together, or to chat over lunch, when working at home. It is easier than ever to meet with colleagues at the other end of the country, or even on the other side of the world.

This affects us as a SIG, given that spirituality is very much concerned with relationships. People now relate online in a variety of ways unimaginable when our SIG began, let alone when I began training in psychiatry. It is easy to feel unsettled by the pace of change. However, spirituality has always been concerned with the transcendent as well as the immanent, with the virtual as well as the real, and with awareness of that which is not present in bodily form.

In place of our autumn day conference, we are planning a webinar. More information to follow soon! This is a bit of an experiment for us, and we will welcome feedback on it. We are also thinking about whether, and how, we might contribute to the Dean’s online programme of “Grand Rounds”, or perhaps finding ways of enabling colleagues to have smaller, and more informal, meetings online to discuss spirituality in clinical practice. The president elect has established a number of new presidential leads, at least two of which directly relate to our interests in spirituality. One of our exec members, Russell Razzaque, will be standing down from the exec to take up appointment as Presidential Lead for Compassionate & Relational Care.

Our SIG exec will be undertaking an away day in November, to give space to thinking about our vision and strategy for the coming years. Please do feedback any thoughts that you may have on the direction you would like to see our SIG taking. Do also get in touch if you would like to consider joining the SIG exec, or perhaps supporting the SIG in other ways (for example, helping with conference planning, writing book reviews, comms and social media, or anything else). I am happy to receive e-mails at c.c.h.cook@durham.ac.uk

Warm good wishes to all
Chris

Professor Christopher CH Cook
Chair, SPSIG
May 2023

The Spirituality SIG members were recently surveyed online. Full details are in  this PDF of the survey results but in summary:

• Abroad spectrum of ages including many newer younger members and a good range of membership grades.
• This was consistent across all grades and all parts of the UK.
• Members were mainly from the General Adult Faculty but all areas of the College were represented.
• Most members never or rarely asked about spirituality in their work but a good percentage did more regularly and most were comfortable addressing it if it came up.
• Spirituality was not routinely covered in MRCPsych training. Around half had access to a Chaplain.
• SIG Events were very well received, with a preference for hybrid formats whatever their UK location.
• Usage of the SIG web pages was poor with most not accessing regularly, but there was interest in an online forum.

The executive committee have taken note of the findings of the survey and are keeping them in mind in planning future events.

We are sad to advise that two longstanding members of SPSIG have died recently:

Professor Andrew Sims (1938-2022) was Professor of Psychiatry in Leeds for over twenty years and College president from 1990 to 1993. One of the founding members of the SPSIG he was its chair from 2003 to 2005. Together with Chris Cook and Andrew Powell, he co-edited 'Spirituality and Psychiatry' (published in 2009 by RCPsych Press) and 'Spirituality and Narrative in Psychiatric Practice' (published in 2016, also by RCPsych Press).

His other books included 'Is Faith Delusion?' (published by Continuum in 2009) and 'Mad or God?' (published by IVP in 2018). Andrew did much to enhance the profile of spirituality and religion in psychiatry in the UK and around the world. A short obituary may be found on the College website and a tribute is expected to be published in Insight in the coming months.

Dr Alan Sanderson (1931-2022) was active in the Scientific and Medical Society and an early promotor of spirit release therapy and set up the Spirit Release Foundation. He was a very regular and faithful attendee of SPSIG meetings from its early days up until our most recent day conference in December 2022.

His recent book 'Psychiatry and the Spirit World' is due to be published in February by Inner Traditions and Park Street Press. For a tribute written by Andrew Powell, the Founding Chair of SPSIG, please see this document.

We have all been deeply saddened to hear news of the death of the Queen at Balmoral last week. Our thoughts and prayers are especially with the King, and with all members of the royal family, at this difficult and painful time. At the same time, as the news broadcasts remind us, we have so much to be thankful for. 

Our Queen lived her life to the full, in faithfulness to God and to her people, in service of the whole of the United Kingdom and the Commonwealth, and in deep humility. Her spirituality was, as with so many of her virtues, understated, but it was also deeply rooted in her Christian faith, and evident in her love and concern for all her subjects. She has given us a wonderful example of how spirituality impacts upon our relationships with ourselves, others, and a transcendent Reality, providing meaning and purpose in life, and underpinning all that we hold valuable and true.

Grief is deeply painful. It brings us face-to-face with our own mortality and causes us to think again about what matters most deeply to us. Elizabeth’s reign began amidst the grief at losing her father. This gave birth to a life of dedicated service to all her subjects, in which she showed respect for people of all faiths and none. As we face this time of national mourning, may we provide comfort to one another, to our patients, and to those whom we love, as we reflect on her life and give thanks. 

In sympathy,
Chris

Professor Christopher CH Cook
Chair, SPSIG
September 2022

It is now thirteen years since the publication of Spirituality and Psychiatry by RCPsych Press, a book that was conceived, written, and widely read within our SIG, as well as being influential in the wider world of psychiatry. We celebrated the book launch at our tenth-anniversary event at the College, in its old home in Belgrave Square, in 2009. Since then, a lot has happened in relation to spirituality and psychiatry around the world, A second book followed, Spirituality and Narrative in Psychiatric Practice, in 2016, also published by RCPsych Press. A position statement, Recommendations for Psychiatrists on Spirituality and Religion, has been published by the College, and policy statements on spirituality and psychiatry have been adopted around the world by the World Psychiatric Association, and by national psychiatric associations in Australia and New Zealand, Austria and Germany, Canada, and South Africa. Numerous other textbooks on spirituality and psychiatry have been written by other groups and authors, including a second edition of the influential Handbook on Religion and Health, edited by Harold Koenig and his colleagues in the USA.

Throughout this time, SPSIG has continued to deliver twice yearly day conferences and has kept the importance of spirituality at the forefront of debate in psychiatry in the UK and more widely. Whilst the evidence base for this has grown exponentially, and we have always sought to ensure that our approach is informed by research, SPSIG has also maintained its emphasis on clinical practice. Spirituality matters within psychiatry because it influences the way in which we practice, it influences the kind of psychiatrists we aspire to be, and because it matters to our patients. Important though the research literature is, it is not simply evidence to support an argument, it is there to help us to see that spirituality matters in assessment, in diagnosis, in treatment planning and in outcomes. 

The second edition of Spirituality and Psychiatry, much enlarged and thoroughly revised, is due for publication in October this year. Copies can be pre-ordered on the Cambridge University Press website. Don’t forget that College members are eligible for a 30% discount on the cover price! (Login as a member on the RCPsych website, click on “My Content”, then on “My RCPsych”, and you’ll then find the discount code at the bottom of that page). The book has retained its emphasis on clinical practice, but has broadened its international perspective and its multi-professional authorship, and addresses the latest developments in DSM-5 TR. It has been extensively revised and has several completely new chapters.

As editors, Andrew Powell and I hope that the second edition of Spirituality and Psychiatry will be read even more widely than the first edition but, much more importantly, that it will continue to have a positive impact upon clinical practice and thus, indirectly, upon the experiences that patients have of treatment by their psychiatrists. Only recently a patient told me how good his psychiatrist has been in so many ways, and yet how he was still not sure that he “got it” when it came to the question of why spirituality was so important to him. Hopefully, if you are reading this, you have “got it”, but we have much more work to do to ensure uniformity of good practice across our profession. I hope that the second edition of Spirituality and Psychiatry will play a part in this in the years to come. (Make sure you get it!)

Warm good wishes to all
Chris

Professor Christopher CH Cook
Chair, SPSIG
August 2022

I am writing this blog on my way home from our first face-to-face SPSIG day conference in over two years, held at the College on 5 May. It has been good to see members again in three dimensions – and not only in a small zoom window on a computer. Our theme for the conference – the 'Bigger Picture' – seems to sum up much of what spirituality is all about, seeing ourselves and others as a part of a bigger picture of life as meaningful, relational and multi-dimensional.

If spirituality is about something more than the merely material order, it is also still grounded in that physical reality. Being present to one another, physically and not just virtually, is an important part of spirituality. In the Christian tradition to which I belong we might refer to this as sacramental, but the immanence of the spiritual within the material order is an important part of many faiths and also the newer spiritualities that eschew religion.

At the conference, our bigger picture was informed by the twelve-step approach of Alcoholics Anonymous, the thinking behind the Power, Threat, Meaning framework, and the techniques of open dialogue, all of which provide radical ways of rethinking how we understand spirituality as an important and pervasive part of human wellbeing.

We are grateful to Sarah Eagger for organising this event, and to our speakers for an engaging and thought-provoking day. Perhaps equally important were the many discussions over coffee and lunch that enabled us to share our common interests in spirituality, and our mutual concerns for one another. (Many thanks also to the College Dean for dropping by at lunchtime and sharing that part of the day with us!)

In the plenary session of the conference, there was some discussion about what members would like to see in future SIG events. As a Special Interest Group, we are keen to know what you think and as a SIG member you should already have received an e-mail inviting you to take part in a survey of members’ views.

Please do respond to the survey and let us know what you think. The survey will close at the end of this month (May) so you still have time to respond if you have not done so already.

The Spirituality & Psychiatry SIG of the RCPsych is itself a part of a bigger picture of spirituality and psychiatry worldwide. The Ethics Committee of the APA has recently (2021) published a new Resource Document on the Interface of Religion, Spirituality, and Psychiatric Practice which helpfully affirms the importance of spirituality for both psychiatrists and their patients and offers some useful ethical guidance¹. The section on Religion and Spirituality at the World Psychiatric Association brings together psychiatrists from all member organisations (including RCPsych).

We express our sympathy to the colleagues, family and friends of its chair, Dr Avdesh Sharma, who died recently, as well as our support for its new chair, Dr Alun Fung. The bigger picture of spirituality and religion in psychiatry worldwide is one of increasing recognition of the importance of addressing the needs of the whole person: body, mind, and spirit. As members of the SPSIG we are all privileged to be a part of this and play our own part in taking this forward in our clinical work, professional development, and mutual support.

Warm good wishes to all
Chris

Professor Christopher CH Cook
Chair, SPSIG
May 2022

References

1. Resource Document on Ethics at the Interface of Religion, Spirituality, and Psychiatric Practice