The need for a category of ‘religious and spiritual problems’ in ICD-11

Normal or abnormal? 'Normative uncertainty' in psychiatric practice

The 'multicultural clinical interaction' presents itself as a dilemma for the mental health practitioner. Literature describes two problematic areas where this issues emerges--how to make an adequate distinction between religious rituals and the rituals that may be symptomatic of 'obsessive compulsive disorder' (OCD), and how to differentiate 'normative' religious or spiritual beliefs, behaviours, and experiences from 'psychotic' illnesses. When it comes to understanding service user's 'idioms of distress', beliefs about how culture influences behaviour can create considerable confusion and 'normative uncertainty' for mental health practitioners. In the absence of clear diagnostic and assessment criteria on distinguishing between 'culture' and 'psychopathology', practitioners have had to rely on their own intuition and seek out possible 'strategies' or 'procedures' from a contradictory and cross-disciplinary evidence base. Decontextualisation of service users' experiences may result in the pathologisation of culturally 'normative' phenomenon, 'category fallacy' errors, and poor health care experiences and outcomes for service users.This paper situates this dilemma within a wider debate that has concerned both the biomedical and social sciences, namely, the unresolved question of 'normality' or 'abnormality'. Indeed, issues that arise from dilemmas surrounding the question of 'culture' or 'psychopathology' are intimately tied to wider cultural ideas about what is considered 'normal'. The disciplines of psychiatry, psychology, and medical anthropology have struggled to establish workable criteria against which to judge behaviour as 'normal', 'abnormal', or 'pathological'. Three models for understanding mental 'abnormality' are evident in 'transcultural psychiatry' (what is now commonly known as 'cultural psychiatry'), and these models have corresponded closely to the interpretive models used by anthropologists attempting to make sense of the apparent diversity of human societies. The three models of 'absolutism', 'universalism' and 'cultural relativism' have not only important consequences for the nature and conduct of research enquiry, but also have implications for how the dilemma of 'culture' or 'psychopathology' is attended to in clinical practice.

Integration of Religion and Spirituality Into Trauma Psychotherapy: An Example in Sufism?

Bilateral stimulation (BLS) is of significant importance to eye movement desensitization and reprocessing (EMDR) therapy. Eye movements seem to be the most effective form of BLS in EMDR. A brief summary of the cultural applicability of EMDR is provided, and research which showed the value of incorporating religion and/or spirituality into psychotherapy is highlighted. Islamic Sufism, in common with other traditional religions, has long been known to have a psychotherapeutic perspective and has been used over time to help people to overcome trauma and stress. This article argues that the ritual movements associated with the Sufi Dhikr may involve a form of BLS and that this might underline some of the therapeutic effectiveness of Dhikr and Sufism. The authors recommend investigating if the Sufi Dhikr element could be incorporated into a modified EMDR protocol. We anticipate that this would give EMDR an even wider and more popular acceptance in the Middle East and the Muslim world.