Approaching the religious psychiatric patient in a secular country: Does “subalternalizing” religious patients mean they do not exist?

Abstract

This article presents the findings of an empirical research project on how psychiatrists in a secular country (Denmark) approach the religious patients, and how the individual worldview of the psychiatrist influences this approach. The study is based on 22 interviews with certified psychiatrists or physicians in psychiatric residency. The article presents the theoretical and methodical grounding and introduces the analytical construct “subalternalizing,” derived from subaltern studies. “Subalternalizing” designates a process where a trait in one worldview (patient) is marginalized as a consequence of another worldview’s (psychiatrist) “disinterest.” The analysis located four categories: (a) religion as a negative part of the patient story, (b) religion as a positive part of the patient story, (c) religion in relation to radicalization, and (d) there are no religious patients. The discussion shows that the approach is influenced by the psychiatrist worldview. Examples of “subalternalizing” are given and how this excludes “positive religious coping” and “existential and spiritual care” from treatment.

Approaching the religious patient in forensic psychiatry, with special focus on ethnic minority patients

“…The project is grounded in social constructivism (Berger & Luckmann, 1991;Nissen, Gildberg, & Hvidt, 2019) and employed a method of sequential semi-structured interviewing for data construction (Charmaz, 2006;Holstein & Gubrium, 2003). An open interview guide was constructed, informed by the following research question: What characterizes the approach of psychiatrists in Danish clinical practice regarding topics of a religious nature?…”

“…The 'first reading' of the interviews informed subsequent interviews in a dialectic process as the informants brought up topics or themes to be pursued, followed by an inductive segmentby-segment coding to establish themes while staying close to the data (Charmaz, 2006). An explorative/abductive analysis (Johannessen, 2018;Timmermans & Tavory, 2012) led to four categories characterizing the approach to religious patients: i) 'Religion as a negative part of the patient story', ii) 'Religion as a positive part of the patient story', iii) 'Radicalization', and iv) 'There are no religious patients' (Nissen, Gildberg, & Hvidt, 2019). During the analyses, an independent main theme emerged from the data from the forensic wards meriting further investigation: 'ethnic minority patients' (hereafter EMP).…”

“…Generally, the data show that religious EMP are approached the same as religious ethnic Dane patients (Nissen, Gildberg, & Hvidt, 2019). According to the data, the approach is to respect the religious worldview of the patient and to enquire about it as a conversational topic in relation to the therapeutic alliance, motivational support (Biglow, 2012;Griffith, 2008), and activities of daily life (ADL) (Mlinac & Feng, 2016) as aspects of patient empowerment and patientcentred care (Castro, Regenmortel, Vanhaecht, Sermeus, & Van Hecke, 2016;Dixon, Holoschitz, & Nossel, 2016).…”

“…International research has shown that failing to understand the cultural and religious background of patients of ethnic provenance other than the majority population leads to stereotyping, and within psychiatry, research has shown that psychiatrists in general are not trained to manoeuvre in cultural complexities, though it is becoming increasingly important in a multi-cultural world (Kirmayer, Rousseau, & Lashley, 2007;Tseng, Matthews, & Elwyn, 2016;Tzeferakos & Douzenis, 2017). In relation to religious patients of non-Danish ethnic backgrounds, the situation is further muddled by the highly secularized context of Danish society, where religion has become so private that it can be difficult for the patient to bring up their religiosity, and equally difficult for the psychiatrist to address the religiosity of their patients (Borras et al, 2010;Breemer, Casanova, & Wyller, 2014;Nissen, Gildberg, & Hvidt, 2019).…”

“…Cook et al (2011) argue that the secular is in itself biased against the religious. This, in turn, may lead to miscommunication and misunderstandings, disempowering individual resources (Nissen, Gildberg, & Hvidt, 2019), and may also obstruct de-escalation strategies and instead lead to conflict and the use of coercive measures (Campinha-Bacote, 2016;Kuivalainen et al, 2017). In relation to forensic psychiatry and ethnic minority patients the situation is even more complex, especially in the meeting between Islam and various culturally/religiously based understandings of mental health and forensic psychiatry that meet in a globalized world (Hassan, Tamizuddin, & Asmer, 2017;Geferakos, Lykouras, & Douzenis, 2014).…”