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In That Most Secular of Rooms The Religious Patient in Secular Psychiatry

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In That Most Secular of Rooms The Religious Patient in Secular Psychiatry

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This thesis examines how psychiatrists in Danish secular psychiatry approach religious patients. This is done through a grounding in social constructivism and through a series of semi-structured interviews with psyciatrists.
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... The aim of was to deepen the understanding of physicians' experiences with patients' illness-related existential, spiritual, and religious needs, and how the physicians addressed these needs ). The aim of Nissen (2019) was to investigate what characterizes the approach of psychiatrists in Danish clinical practice regarding topics of a religious or spiritual nature (Nissen 2019). ...
... The aim of was to deepen the understanding of physicians' experiences with patients' illness-related existential, spiritual, and religious needs, and how the physicians addressed these needs ). The aim of Nissen (2019) was to investigate what characterizes the approach of psychiatrists in Danish clinical practice regarding topics of a religious or spiritual nature (Nissen 2019). ...
Article
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This article aims to understand why religion has proven difficult to address in secular healthcare, although existential communication is important for patients’ health and wellbeing. Two qualitative data samples exploring existential communication in secular healthcare were analyzed following Interpretative Phenomenological Analysis, leading to the development of the analytical constructs of ‘the secular’ and ‘the non-secular’. The differentiation of the secular and the non-secular as different spheres for the individual to be situated in offers a nuanced understanding of the physician–patient meeting, with implications for existential communication. We conceptualize the post-secular negotiation as the attempt to address the non-secular through secular activities in healthcare. Employment of the post-secular negotiation enables an approach to existential communication where the non-secular, including religion, can be addressed as part of the patients’ life without compromising the professional grounding in secular healthcare. The post-secular negotiation presents potential for further research, clinical practice, and for the benefit of patients.
Chapter
Spiritual care is an area of growing focus in healthcare internationally as research shows that existential, spiritual, and/or religious considerations and needs increase with life-threatening illness, and that quality of life increases when spiritual needs are addressed through spiritual care. This study presents an overview of spiritual assessment questionnaires as a way to approach the assessment of spiritual needs. Through the Catalogue of Spiritual Care Instruments, 22 questionnaires were located, representing a variety of geographical and healthcare contexts. The presentation of these questionnaires initiates a discussion of international relevance for the continuing development of spiritual care and international exchanges of best practices. The study concludes that spiritual assessment questionnaires are in focus in many cultural contexts and healthcare areas, but also that the bias of language makes it difficult to exchange best practice. In the end, a spiritual needs assessment is a matter between the individual patient and the healthcare professional (HCP) involved. It is an area of intimacy and privacy, not easily approached, demanding great empathy on behalf of the involved HCPs. A spiritual needs assessment questionnaire can be an appropriate way to approach this.
Article
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Spiritual care has been a growing focus in international healthcare research over the last decades. The approaches to spiritual care are many and derive from many different medical fields and different cultural contexts and often remain unknown across healthcare areas. This points to a potential knowledge gap between existing instruments and the knowledge and use of them cross-disciplinarily and cross-culturally, and thus best practice insights are not sufficiently shared. This article contributes to the growing field of spiritual care by providing an overview of the various approaches (henceforth instruments) to assess patients’ spiritual needs in view of improving spiritual care. This was done through a scoping review method. The results of the review were collected and catalogued and presented here as ‘The Catalogue of Spiritual Care Instruments’. The included instruments derive from a wide range of geographical contexts and healthcare areas and are aimed at patients and healthcare professionals alike, clearly showing that spiritual care is a focus in healthcare internationally. However, it also shows the difficulties of defining spiritual care, the importance of local contexts, and the difficulties of cross-cultural validity. The catalogue contains 182 entries and is available as an interactive platform for the further development of spiritual care internationally.
Article
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Delivering mental health services as patient-centered care has been an international priority for more than 50 years. Despite its longevity there is still not widespread agreement regarding how it should be defined or how it should guide the delivery of services. Generally, though, prioritizing the patient’s values and preferences seem to be at the core of this particular approach. It is not clear, however, that services attend to patient values and preferences as closely as they should. Terms such as “treatment resistant” and “noncompliant” seem to belie an attitude where the therapist’s opinion is privileged rather than the patients. To improve the effectiveness and efficiency of mental health services a move from patient-centered care to patient-perspective care is recommended. An attitude of patient-perspective care would require service providers recognizing that help can only ever be defined by the helpee rather than the helper. A patient-perspective service that was structured around the preferences and perspectives of patients might finally help to end the long-term suffering of many people who experience mental health problems.
Article
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Research to date has shown that health professionals often practice according to personal values, including values based on faith, and that these values impact medicine in multiple ways. While some influence of personal values are inevitable, awareness of values is important so as to sustain beneficial practice without conflicting with the values of the patient. Detecting when own personal values, whether based on a theistic or atheistic worldview, are at work, is a daily challenge in clinical practice. Simultaneously ethical guidelines of tone-setting medical associations like American Medical Association, the British General Medical Council and Australian Medical Association have been updated to encompass physicians’ right to practice medicine in accord with deeply held beliefs. Framed by this context, we discuss the concept of value-neutrality and value-based medical practice of physicians from both a cultural and ethical perspective, and reach the conclusion that the concept of a completely value-neutral physician, free from influence of personal values and filtering out value-laden information when talking to patients, is simply an unrealistic ideal in light of existing evidence. Still we have no reason to suspect that personal values, whether religious, spiritual, atheistic or agnostic, should hinder physicians from delivering professional and patient-centered care.
Article
Previous studies have shown the importance of focusing on the cultural background of migrant patients in the psychiatric assessment. The Cultural Formulation Interview (CFI) offers a patient-focused approach to foreground the cultural context of the patient in the clinical encounter. Our objective was to explore the acceptability and clinical utility of the CFI for physicians and its acceptability for migrant patients seen at a transcultural mental health clinic in Denmark. In this study, the CFI was used in a second session following the standard clinical assessment to explore what additional information was gained from the CFI. Data on the use of the CFI data were collected immediately after the interview with questionnaires for medical doctors (MDs) (N ¼ 12) and patients (N ¼ 71). The findings showed that the CFI, in addition to standard assessment, was useful to the MDs for planning the treatment (60.0%) and for exploring the patients' view on their cultural and social context (74.7%), but less so for the diagnostic process (9.9%). Patients reported high overall satisfaction with the CFI (93.0%) and viewed it as a welcome opportunity to tell their story. The findings add to existing knowledge on the CFI in terms of acceptability for patients of a primarily Middle Eastern origin and patients using an interpreter during the CFI session. Based on the findings of this study, the CFI is recommended to clinicians for treatment planning purposes and for exploring the cultural and social context of the patient.
Article
Ethnic minority patients are overrepresented in Danish forensic psychiatry and knowledge is needed on how these patients are approached in relation to religious and cultural issues. The aim of this study was to investigate how psychiatrists in Danish forensic psychiatry approach religious ethnic minority patients. The study revealed positive approach towards religious ethnic minority patients. However, unless religion features as part of the illness, the tendency is to not incorporate the patients’ religiosity in treatment. The study finds that the hospital chaplain is regarded by the psychiatrists as an important part of the ward and expressed the desire for a more formal cooperation with religious specialists to be developed. Finally, the study finds that religious practices such as Ramadan, common prayer, and Islamic edicts on food and unlawful touch are areas where more knowledge is needed, especially in relation to anxiety, potential stress, and conflict situations.
Article
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.
Book
This book is about the different philosophical paradigms and ideas that influence qualitative research. Its aim is to discuss and evaluate the ways that philosophical positions inform qualitative research as currently practiced. Unlike other contributions to the field, this book takes a historical perspective and shows how the philosophical ideas have evolved and influenced qualitative research in previous times and today. Today, qualitative researchers often report on their philosophical commitments (if they do so at all) in a separate section of their papers, but this book is written from the perspective that philosophical ideas influence everything in the research process from the first formulation of a research theme to the final reporting of the results. Therefore, it is preferable to highlight how this happens. Philosophy should thus not be thought of as a purely abstract discipline, disconnected from the practicalities of research, but rather as a concrete and pervasive aspect of all qualitative research practices. This book does not provide in-depth treatments of qualitative methods and techniques such as interviewing, document analysis, or participant observation, but rather aims to introduce and discuss the philosophical issues that are relevant regardless of the specific methods employed by qualitative researchers.
Chapter
This chapter provides a systematic review of research conducted prior to the year 2010, as well as more recent research, examining the relationship between religiosity and mental health in Muslims. Included here are studies examining depression, suicide, anxiety, substance use/abuse, psychotic symptoms, cognitive impairment, and well-being. This comprehensive review finds that reading and reciting the Qur’an, frequent engagement in prayer, holding devout Islamic beliefs, careful adherence to Qur’anic teachings, and a strong and close-knit family and community may help to neutralize feelings of stress and distress and enhance well-being and happiness. Islamic teachings set the bar high in terms of ethical values and behavioral expectations, promising dire consequences in the hereafter for those who fail to meet that bar. Nevertheless, Muslims who abide by those teachings appear to have better mental health than those who do not, at least during this life. Clinicians should be aware of these findings, particularly when encountering Muslim patients who are less religious (and those who are religious but may be misunderstanding or misinterpreting Islamic teachings).
Article
To reduce the use and duration of mechanical restraint in forensic settings and ensure evidence‐based patient care, we need more knowledge about patients’ subjective experiences and perceptions. The aim was to investigate forensic psychiatric patients’ perceptions of situations associated with the use of mechanical restraint and what they perceive as factors impacting the use and duration of mechanical restraint. Twenty participants were interviewed. Four themes were identified through a thematic analysis: ‘overt protest reactions’, ‘silent protest reactions’, ‘illness‐related behaviour’, and ‘genuinely calm’, which together characterize patients’ perceptions of their ways of acting and reacting during mechanical restraint episodes. These themes are linked together in two patterns in the process of mechanical restraint: ‘pattern of protest’ and ‘pattern of illness’. Further research is needed to illuminate the associations between patients’ perceptions of being subjected to mechanical restraint and ways of acting and reacting through the process of mechanical restraint.