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Spirituality SIG Chair Blog

What an exciting conference we had today! 130 people thinking together about Spirituality and Medicalisation. When do we decide low mood is a normal part of life, for example after a bereavement, or severe disappointment, and when is it pathological?


Prof Allan Horwitz gave us a clear description of Melancholia and how, through history, normal sadness was distinguished from illness by its intensity and symptoms and by its duration. Allan’s book “The Loss of Sadness: How Psychiatry Transformed Normal Sorrow Into Depressive Disorder” by Allan V. Prof. Horwitz and Jerome C. Dsw Wakefield | 1 Jun 2007 is a must read for any who find it strange that someone can be diagnosed under DSMV with major depressive disorder in the first month after their wife has died.


Research in several religious settings in Spain was presented by our next speaker, Dr Gloria Dura-Vila. She showed us how Spanish Roman Catholics interpreted some sadness as depression – needing medical treatment, and some as “The dark night of the soul” potentially leading to personality growth and deepening of faith.


Loneliness was the focus of the talk by Prof Gerard Leavey, highlighting the difference between loneliness and solitude, and acknowledging how communities of faith can be a major resource and source of social capital. He also made the important point that loneliness is a very individualised view of what is a community, social and political issue; how do we support those who don’t ‘fit in’.


After lunch we presented the essay prize and a £300 cheque to Daniel Hall, watch this space for his essay.

Prof Simon Dein shared the view of depression found in the branch of Judaism he has studied. Merirus – low mood and bitterness with a clear precipitant is contrasted with Atzvus which seemed to map well on to melancholia- depression without a cause.


There followed lively discussion in each of three workshops. I joined Prof Horwitz as we discussed: “What is normal, psychiatry’s unanswered question.” I think our conclusion was “well it depends…” I hear that the other two workshops on Vedic psychology led by Dr Chetna Kang, and Muslim approaches to sadness led by Dr Hashim Reza were well received.


I was impressed with the number of people who stayed and interacted with the speakers for the plenary session, and the high standard of thoughtful questions and comments. The sense of pressure to prescribe and the common lack of access to talking therapies was well described.


What did I learn today? Labelling all sadness presented to a psychiatrist as Major Depressive Disorder is problematic, but recognising the fact that our US colleagues have to use this classification for billing purposes explains the power of DSMV. All the cultures discussed recognise ordinary sadness and grief, and pathological sadness – depression, but may well set the boundary between the two at different places. We walk a tightrope between over and under diagnosis of depression, and there are risks to both; medicalisation is not a neutral phenomenon.


The next Spirituality and Psychiatry conference is 29th Nov which will be our 20th birthday celebrations. We will have talks from top experts including RCPsych past president Dame Sheila Hollins and Prof John Peteet from Harvard, and we will have cake!

Early bird booking will open soon for SIG members.


I look forward to seeing you all there

Alison J Gray
Chair Spirituality in Psychiatry SIG

5 April 2019

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