Spirituality is about the things that matter mostto all of us. For many patients it is a fundamental aspect of their experience of the human condition that they hope will not be neglected, but about which they may be hesitant to talk to their psychiatrist for fear of censure or misunderstanding. For some psychiatrists, spirituality is fundamental to their vocational calling and may influence their clinical practice (hopefully for goodbut potentially also for ill) in diverse visible or invisible ways. For others it is a cause for concern, perhaps even something that they would rather avoid. Spirituality appears in religious and non-religious forms. Even for the minority of people who self-identify as neither spiritual nor religious, their world view, their sense of meaning and purpose in life (or lack of it) and their experience of deeply important relationships with self, others and a wider universe all share many of the central concerns of spirituality. Spirituality is therefore relevant to the work of all psychiatrists.
Spirituality in Psychiatry: A Brief HistoryHistorically, much psychiatric care was provided within a religious context. The first specialist institution for the care of the mentally ill appears to have been established in Christian Byzantium in the fourth century. An Islamic facility was established in Fez in North Africa from at least as early as the seventh century (Zilboorg and Henry, 1941, p. 561). The shrine of St Dympna, at Gheel in Belgium, became a place of pilgrimage for people with mental health problems from around the seventh century, with reports of miraculous cures drawing large numbers of pilgrims and, in the thirteenth century, supported a church and a house for the treatment and confinement of the insane (Zilboorg and Henry, 1941, p. 562). In 1247 the hospital of St Mary of Bethlehem was founded in Bishopsgate in London. By the sixteenth century it had developed a special reputation for the care of the insane, and became known as 'Bedlam'. After two moves within London, it relocated to Kent in 1930 and merged with the Maudsley Hospital, in Southwark, in 1948(Shorter, 2005.More important than institutions, however, are the attitudes to care which they embody. The Spanish Renaissance philosopher, Juan Luis Vives (1493-1540), a contemporary of Erasmus and Thomas More, gave considerable attention to the humane treatment of the mentally ill, recognising them as suffering from illness and treating 1 I am pleased to acknowledge the contribution made to this chapter in the first edition of Spirituality and Psychiatry by my friend and colleague Andrew Sims. I have missed his partnership in writing for the second edition. Remnants of his writing will still be evident here, but much of the text is completely new and what remains has been extensively revised. 1