New Program Explores the Intersection of Spirituality and Mental Health

Christopher Pittenger, MD, PhD: The inspiration starts from my conversations with psychiatrist Anna Yusim, a Yale School of Medicine graduate who had recently published a popular book for the lay audience, Fulfilled, on the role of spirituality in mental health. She approached the Department of Psychiatry with the idea of building up a program in spirituality and mental health here at Yale. I started having regular conversations with her around 2022. It’s been interesting—we come from very different perspectives. She’s deeply interested in all aspects of people’s spiritual experiences. I’m a neuroscientist—I tend to approach the mysterious from a perspective of open-minded curiosity, but also of careful skepticism.

It started out with just the two of us in conversation. Over time we brought in other colleagues across campus. Then, about two years ago, we launched a series of monthly events with the divinity school, in partnership with Bruce Gordon, who has been a great partner in expanding our circle and moving beyond interesting one-on-one conversations to these monthly events that are drawing more and more people in. That put us on the road to formalizing this as a program as opposed to just colleagues chatting.

Pittenger: Spiritual experience is an incredibly important part of people’s lives and often a source of resilience. It can also be a source of trauma, alienation, or strain. This is something that therapists take seriously all the time; this is particularly true in the treatment of substance abuse and end-of-life care. If you’re working closely with someone and trying to understand their lives and their struggles, spiritual issues come constantly.

But in academic psychiatry, it’s a little bit more fraught because no one quite knows how to talk about spiritual experiences. If you’re in a medical school and trying to keep things scientific, it’s hard to find the right language. As a result, sometimes spiritual experiences get excluded from the conversation. That’s something that I think is really problematic. If something is a part of people’s mental health and a source of both resilience and suffering, then we need to figure out a way to embrace and talk about it.

Pittenger: The short-term goal is community-building and figuring out a shared language. We are all coming from very different backgrounds—from psychiatry, neuroscience, and psychology, but also from religious studies and philosophy backgrounds—and we tend to use different words, or use the same words differently. Learning from one another and forming a space where we can communicate is the short-term goal.

The medium-term goal relates to scholarship and education. We want to train students to think fluidly across boundaries, and we want to create opportunities. We’ve talked about doing a symposium or writing together to try to build education and scholarship in this space.

The long-term goal would be to build our faculty—people who are explicitly working in this space. But that’s farther out in the future.

Pittenger: We’ve been holding monthly meetings. This year, every session has been a conversation between two people—one coming from the spiritual angle and the other from a more biomedical angle. In March, we had a meeting that was mostly about music. AZA Allsop, MD, PhD, an assistant professor in the psychiatry department who is very interested in how music affects the brain and how it can be used as a tool in mental health treatment, was in conversation with Braxton Shelley, PhD, George Washington Williams Professor of Music, Sacred Music, and Divinity, who’s interested in the role of music in ritual, particularly in the Black church. The conversation centered on what music means in our lives from those two perspectives, and how it relates to spiritual experience.

The February discussion was between myself and Carlos Eire, PhD, who’s in the Department of History as well as the divinity school. He’s written about historically documented accounts of impossible things happening, like meditators or saints levitating. Such events are richly documented, and the people at the time wholly believed that they were true; of course, a modern perspective tends to be more skeptical. That was a rich conversation about history from Eire’s perspective, but also about how we can honor the truth of people’s experiences in a way that’s still within the ambit of a scientific understanding of the world.

The one before that was a conversation between Bruce Gordon and Daniel Ibraheem, a medical student who is also pursuing studies at the divinity school, about the spiritual experiences of ascetic monks in the early church, mostly in Egypt, and the psychological experiences of asceticism and long isolation in a spiritual retreat setting. Much of this conversation was about concepts adjacent to depression, and how they have evolved over the years. Depression used to be conceptualized as a form of spiritual alienation. We explored these concepts historically and how they relate, or don’t relate, to the modern idea of depression.

Those are a few recent examples. Having just said that our medium-term goal is to do education and scholarship, each one of these topics could make an interesting paper. Bruce, Anna, Marc, and I are meeting in the coming weeks to think about what’s next. Taking the material that’s coming out of these curated discussions and putting it in writing could be part of the next phase.

Pittenger: In one-on-one therapy, it’s quite common for therapists to take the spiritual lives of their clients seriously and engage on that level. But in the inpatient setting, for example, we’ll sometimes ask questions about patients’ spirituality, but it’s often more of a formality. My sense is that psychiatrists often see these questions as bracketed. It’s something that we’re supposed to ask, but it’s not as important as what their symptoms are or what medications they’re taking.

We need to develop a vocabulary where we’re taking spirituality seriously and the patients recognize we’re doing so. If we don’t share a spiritual tradition with our patients, how do we nevertheless make them feel heard and that the spiritual aspect of their experience is just as meaningful and important to us as more transparently neurobiologically grounded aspects? That’s where I hope we can make care more integrated, and that will only be a good thing.

Pittenger: There are several different aspects to be excited about. For me personally, I love the intellectual discourse. I love seeing people from different intellectual backgrounds coming together, understanding each other better, and coming to new syntheses. As an intellectual, I’m excited to work across boundaries and traditions to come to a higher, integrated understanding than any of us would have on our own. As a clinician and clinical educator, I’m very excited about the ways we can bring discussion of patients’ spiritual lives more seamlessly into our conversations about mental and brain health.

It's a little bit difficult for psychiatrists to know how to engage with spiritual experience because it doesn’t fit into the language that we’re trained in to think about mental health. But the same could be true, and at times has been true, about other things that are very important parts of people’s experiences and yet aren’t visible or measurable, like pain, love, alienation, or a feeling of emptiness. These are important parts of experience that we do take seriously and try to integrate into our overall view of people’s wellbeing and needs.

Spiritual issues are a little bit harder to engage with because of the sense that doing so requires sharing a belief structure. But if we take these other invisible but critically important aspects of people’s experience seriously—pain and love and alienation—we ought to be able to figure out a language to do the same with spiritual experience, whether or not we share commitments on the fundamental structure of the universe.