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On Spirituality

Greenville, N.C.

I appreciate the positive mention by Dr. Christine Pulchalski in the June 18 article "Psychiatrists Urge More Direct Focus on Patients' Spirituality" about taking a spiritual history and using the acronym FICA (Faith, Importance, Community, and Address in Care) to gain some knowledge of patients' spiritual issues. However the religious, spiritual, and psychiatric often become entwined to the point that more than a simple spiritual history or spiritual screen is needed.

For example, patients who are obsessive compulsive and exhibit the dysfunction by ritually going "down front each week to rededicate their life in their church" will need more than a spiritual screen or history to get better. Or take dissociative patients, for example, who believe that they are God, Jesus, or the devil; they will also require more sophisticated and skilled pastoral or spiritual intervention.

Spiritual assessment contains at least 11 categories of spiritual issues: nature of the holy, actions of the holy, personal responsibility, rituals and practices, affective responses, vocation, community, grief, forgiveness, hope, and meaning.

These categories take time to understand and some practice to learn how to use them effectively in the treatment process. Fortunately, there are religiously trained professionals who work with these complicated patient issues, and they are called chaplains.

When a psychiatrist and chaplain work together to address the complexities of a patient's religious/spirtitual issues, the patient is better served, and treatment is optimized.

Footnotes

The writer is director of pastoral services at Pitt County Memorial Hospital, a part of the University Health System in Greenville, N.C., which includes the Brody School of Medicine of East Carolina University.

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