Worldviews in Practice
This book could not have appeared ten years ago – it is a tribute to progress in the field of spirituality and health that it appears now. The last decade has seen the foundation of the Spirituality and Psychiatry special interest group of the Royal College of Psychiatrists, the Transpersonal Section of the British Psychological Society and huge advance of spirituality and health courses in US medical schools – from 4 to over 90 of the 125 or so in existence. And the Royal College SIG has over 1,000 members. The four parts cover conceptual foundations, clinical foundations, patients and their traditions, and worldview and culture.

The preface notes the burgeoning literature on spirituality and health, and observes that all patients and clinicians have a world-view, whether they realise it or not; in other words, atheism and agnosticism are included. Although the editors say that it is important to gain an understanding of ‘our own and our patients’ worldviews’, in practice the focus is largely on the patient, while the conceptual foundations of Western medicine are not subjected to close scrutiny. However, it is true to say that the interaction of physician and patient implies an interaction of their worldviews. The introductory chapter concentrates on Freud, whose thought was very unsympathetic to spiritual worldviews, considering the implications of his worldview for his own clinical practice. Armand Nicoli concludes that ‘the patient’s worldview gives the clinician insight into the patient’s self-image, relationships, values, and identity, as well as how he or she confronts illness, suffering and death.’

The second part considers worldview in psychiatric assessment, in diagnosis and case formulation, and in terms of therapeutic implications. There is a useful discussion of an in-depth interview guide covering developmental history, community, God, belief, rituals and practices, and spiritual experience. Again the emphasis is on the patient, when it would surely be useful for each clinician to respond to the questions as an exercise in self-awareness. John Peteet then examines the overlap between existential and clinical concerns in terms of meaning and purpose attributed to life in general and hence to illness.

Part three – patients and their traditions – follows a common framework and covers Protestants, Catholics, Jews, Muslims, Hindus and Buddhists, atheists and agnostics. An introductory section is followed by a description of core beliefs and practices, clinical implications, variations of therapeutic encounters and collaboration with faith communities. It might make a considerable difference, for example, if a patient has a strong belief in original sin or the healing power of God. The case histories bring the concepts to life and show how worldviews shape the interpretation of symptoms.

The final part looks at the wider relationship between culture and worldview. Both situate an individual within a group with shared beliefs, but clearly many different worldviews can exist within the same culture. Overall, the volume should enable clinicians to adopt a more sympathetic approach their patients’ worldviews, especially if they differ from their own, but a greater self-awareness on the part of the physician is no less important.