Does psychiatry need religion and spirituality in its treatment approach? Narcissism as an example

BACKGROUND: Although religion and spirituality are increasingly recognised as important in the understanding and treatment of patients, there are also concerns about their role in psychiatry. The recommendation for the integration of spirituality in the approach to psychiatric practice highlights the importance to further think about this practice. OBJECTIVE: To contribute to the debate on the role of spirituality in psychiatry by considering the opinions of two prominent thinkers in this field, the theologian Tillich, and the psychoanalyst Symington. METHOD: The approach of Tillich and Symington to mental health problems are compared. Narcissism is focussed on, since Symington describes narcissism as the core of all pathology and states that the prime aim of psychoanalysis is the transformation of narcissism. The contributions of Kohut and Kernberg are also briefly discussed. RESULTS: In Symington’s opinion more than psychoanalysis is needed to help those in the grip of narcissism. Tillich emphasises the difference between existential anxiety and anxiety due to psychopathology. Psychotherapy can only heal the latter. Yet he also states that we are incapable of change without self-acceptance. For this a larger experience of acceptance or grace is needed, since we are incapable of offering ourselves this type of acceptance. CONCLUSION: In the struggle to get a grip on narcissism, good nurturing experiences, transformative selfobjects, a confrontation with the darker sides of the self and the message of ultimate acceptance are needed. Religion and spirituality have an important contribution to make to psychiatric or psychotherapeutic treatment.