Canadian sociologist Charles Taylor (Taylor 2007
) asserts we are living in ‘a secular age’, marked by an increasing elimination of religions from public life in Western societies and their restriction to private life. On the other hand, there are also philosophers like Jürgen Habermas who speaks less of postmodern rather than postsecular societies (Habermas 2005
). In fact, Western societies are characterized by a new presence of a multiplicity of religious and spiritual (abbreviated ReS in this further context) groups and phenomena, also due to the many different political challenges like migration, globalization or terrorism. Actually, religions have not disappeared but are present in multiple forms and varieties. ReS needs, attitudes and practices seemingly continue to have considerable roles and impacts in the life of individuals and groups, albeit in new or different forms than in the past regarding their feeling, thinking and acting. It seems that, especially in moments of disease or suffering, people seem to activate or reactivate ReS needs and activities. In fact, religious people search for their God more often and pray more earnestly to cope with their illness. Such ReS needs are quite usual. Therefore, no one considers patients’ ReS needs as pathological ones, even in so-called secular societies. Without entering questions concerning the metaphysical truth of ReS beliefs, ReS behavior and subjective experience can become the object of empirical research with its scientific paradigm of epistemological “atheism” (Frick and Baumann 2017
). There is an exponentially growing body of research about the relationships of religions, spiritualities and health in general (Koenig et al. 2012
), also including mental health, psychiatry and psychotherapy (Huguelet and Koenig 2009
). This seems less so, however, in East Asia, e.g., South Korea.
The Republic of Korea (“South Korea”) is one of the highly industrialized countries, where religious liberties are assured, and the plurality of religions is generally accepted. It is also a country that can be considered strongly secular in Taylor’s sense. There is considerable immigration of workers from abroad (about 4% of the Korean Population) with various religious denominations and a complex presence of various religious groups. According to a Korean nationwide survey in 2015 (Statistics Korea 2016
), the percentage of non-believing persons was 56.1%. It was the first time that the atheist or agnostic persons’ percentage was higher than the one of believers. Most of the Korean people who confessed a religious denomination were Protestants, Buddhists or Catholics, many of whom are actively engaged in vital religious communities of their respective faiths.
While ReS needs of patients seem very acceptable for practitioners in somatic medicine and especially in life threatening diseases, we wondered about the situation in clinical psychiatry and psychotherapy in Korea. To our knowledge, after consulting academic information systems, e.g., RISS (Research Information Sharing Service
), there are no studies in this geographic context with this specific focus. If any study was conducted with this topic, i.e., religion and psychiatry in Korea, then it was focused on religion-related psychotic behaviors such as religious delusion or the relation between specific religions and mental well-being in Koreans who are not diagnosed with any mental disorder. Therefore, we intended to conduct a replication study with the design realized in a German study of staff in clinical psychiatry and psychotherapy (Lee et al. 2011
). In other words, we wanted to replicate these research questions and hypotheses in the (South) Korean context:
How religious or spiritual do psychiatric staff (psychiatrists, therapists, nurses, social workers) consider themselves?
How do they consider the Religiosity and/or Spirituality of patients when they encounter them in their clinical practice, and how do they consider the role of patients’ Religiosity and/or Spirituality in their disease and healing processes?
In addition, in both different cultural contexts including more or less ‘secularized’ societies and in personal attitudes, we hold it necessary to respect that respondents may feel so ‘distant’ from religious ideas and imaginations (Freud and Meng 1963, pp. 12f
) or ‘religiously unmusical’ (Habermas and Ratzinger 2006
); we hold it more adequate to offer a possible response apart, a response to the whole question as such, expressing one’s personal distance or overall foreignness from what might be meant by religious or spiritual terms or behaviors in their personal lives. This approach has also resulted in an adaption of the questionnaires used, and its implications will be commented on in the corresponding sections of this article (i.e., Method, Results, and Discussions).
With our results, we can give a first response to our question: How ReS do psychiatric staff consider themselves?
First, 56.7% answered that they are not believers. In a comparison with the numbers of the Korean non-believers (56.1%) according to a nationwide survey in 2015, there is no big difference. Generally speaking, according to our data, Korean psychiatric staff usually engage neither in organizational nor in non-organizational ReS acts. This is true even for believing persons. In contrast, according to a survey of Gallup Korea
), among believers, 44% claimed to go to a church, temple or similar places more than once a week. On the other hand, 3 of 10 persons on average go to such ReS places once a year at most or never. In comparison with German data, the percentage shows a distinct difference. In a German nationwide study of 2011, about 60% of psychiatric staff considered themselves believing persons. Among psychiatrists, more than 55% responded that they have a faith. Furthermore, the Korean psychiatric staff generally do not connect ReS aspects into their daily lives. The sum of the intrinsic religiosity was m
= 6.13, while, in the German study, the mean value was 7.01. A mean score of 6 (between 3 and 12) means that, as to items of intrinsic religiosity, the ‘mean’ response would be ‘tends to be not true’. Even if the separately offered response ‘unsure’ is put into the middle of an ordinal scale between ‘true of me/not true’ for (secondary) statistical purposes, thus including all 270 respondents, the results do not differ remarkably (M = 7.23, SD = ±3.31, of a scale between 3 and 15; see Appendix A
Interestingly, in the Survey of Gallup Korea
), about 52% of Koreans considered religions somewhat or very important in their lives, while about 48% answered rather not or even not at all meaningful. In this context, it seems that ReS issues are not noticeably less important for psychiatric professionals than for the Korean population in general. Further research and statistical comparisons need to explore, more specifically, if Korean psychiatric staff are less ReS than the Korean population in general or not and if there are meaningful subgroups that differ, e.g., according to religious denominations.
Secondly, we obtained valuable information about the question: How do they consider the Religiosity and/or Spirituality of patients, by extension, the role of patients’ Religiosity and/or Spirituality in their disease and healing process?
More than 80% of Korean psychiatric professionals stated that patients sometimes or even often mentioned ReS issues Occasionally, psychiatric staff observed that patients got supports, such as psychological stabilities or social support network, from the same ReS groups, and they could become more peaceful through ReS resources. In other words, health professionals confirmed that religiosity and/or spirituality can play a role as a positive coping resource (cf. Pargament et al. 2005
). However, together with this finding, our study also figured out that Korean psychiatric staff hardly regard ReS aspects as coping resources. It seems they still follow the mainstream legacy of Freud’s psychoanalysis which compared religions to obsessive-compulsive neuroses (Freud 1907
; cf. Baumann 2007
). They do not consider such ReS factors to be integrated into therapeutic processes. Many of the participants commented that religions as well as related issues should not be handled in clinical settings, as religions and such issues are just private; in addition, they commented that they encountered ReS phenomena in pathological contexts, such as religious delusions, from time to time.
These remarks of practitioners in mental health seem self-contradictory. For example, one psychiatrist mentioned, “I wonder with what kind of intention you do such a survey. I hope, please, there is not any intention to integrate religion into psychiatry.
” He added that religion could also be just unhealthy, and absolutely it should not be handled in psychiatric settings. While, based on our suspicion, there is a general refusal suspecting our research intentions in this remark, the second part is inconclusive and even self-contradictory: if religion can be “just unhealthy” for patients, why should it not be dealt with, even “absolutely” not, in psychiatric settings? If a patient´s religiosity is unhealthy and thus part of the patient´s psychopathology, it needs to be dealt with appropriately and professionally rather than be neglected (cf. Huguelet and Koenig 2009
Third, and also in consequence of the previous finding, we have to take note of the significant relations between psychiatric staff’s own intrinsic religiosity and their attitudes to patients’ religions-related aspects. There is a bias in mental health professionals which influences their dealing with patients and their ReS needs. According to our results, more highly ReS staff members pay more attention to ReS aspects of patients; in addition, they consider influences of ReS aspects more positively. The same is true vice versa: the less psychiatric staff is spiritually oriented, the more they tend to neglect ReS needs of their patients, and the more they tend to consider ReS aspects of their patients negatively.
Not only in our current survey, but also in other studies (Lee and Baumann 2013
; Lee et al. 2011
), professional neutrality is the strongest reason why psychiatric staff members say they will not deal with religions and related aspects in clinical settings. Our results give proof that clinicians are not neutral; significant moderate correlation shows that health professionals differ (unconsciously) according to their attitudes. The previously mentioned comment of a psychiatrist provides a lively illustration of this situation. This situation calls for improvement: we need to aim at transparent and reflected value-openness instead of (unrealistic) value-neutrality (Bergin et al. 1996
). If ReS and other ethical issues are treated differently depending on health professionals’ personal values, professionals should come to grips with their values and biases related with specific issues such as religions in a reflective, transparent and balanced way. Neglecting them can never be a professional solution. Rather, they call for more professional attention and self-reflective training. This has become even more important in “secular ages” and “post-secular societies”, which are characterized by a new presence of a multiplicity of ReS groups and phenomena. Actually, ReS needs, attitudes and practices continue to have considerable roles and impacts in the life of individuals and groups, albeit in new or different forms than in the past regarding their feeling, thinking and acting. In moments of disease or suffering, many people seem to activate or reactivate ReS needs and activities. It is part of psychiatric professional ethics (cf. Reiser 2018
) and ought to be part of professional practice that patients´ various dimensions and socio-cultural backgrounds are respected, including ReS like other personal attributes e.g., political views, sexual attitudes, or even private hobbies. Furthermore, personal attributes like gender, race, political views and religious orientations do affect psychiatric professional members in patients-staff’s clinical relationships (Cook 2011
In medicine and other health related sciences, there is an academic prevalence of a secular scientific paradigm which understands its epistemology as empirical and functionally atheistic. At the same time, health practitioners (physicians as well as nurses or other therapists) meet patients and their relatives, not only as bearers of syndromes but also as persons in the totality of their bodily, mental and social lives, including ReS dimensions. The patients and their relatives do so vice versa in meeting the health professionals.
In medicine and all health professions, therefore, the importance of holistic patient-centered care ought to be standard. In recent decades, bio-psycho-social dimensions have increasingly gained attention. Along with these, patients’ ReS needs should also be perceived and emphasized. The WHOQOL explicitly considers ReS and personal beliefs as relevant aspects of the quality of life of any individual (WHOQOL SRPB Group 2006
). These aspects presumably also influence the feelings, cognitions, behaviors and practices of all persons who interact in the health system.
We are aware that our study has several limitations
, which are considered along with the survey’s findings as well as discussions. First of all, this study was done in Daegu and its surroundings only. Therefore, the results are not representative of all Korean psychiatric professionals´ attitudes. Studies in other parts of Korea should follow. In addition, the questionnaire used in Korea was a translated version. Therefore, some linguistic differences might have occurred, even though all items used were at the end compared between English, German and Korean, whereupon no one revealed any difficulty with understanding items. More generally, however, we want to raise the issue once more if it is interculturally appropriate to put ‘unsure/I don’t know’ at the center of the ordinal scale in DUREL which is used to measure items of what we call intrinsic religiosity. In our understanding, the expression ‘unsure/I don’t know’ is not unequivocal interculturally and phenomenologically, as exemplified by Batson’s (Batson 1976
; Batson and Raynor-Prince 1983
) category of ‘Quest orientation’ on one side, and authors like Freud and Habermas on the other side who express their utmost distance to the “ReS world” in various ways.
In addition, we assume that quantitative questionnaires do not reach the same depth of understanding like qualitative in-depth-interviews, which, however, have their own shortcomings. In addition, this paper cannot discuss the possible impact of ReS aspects on patient psychopathology and on patient attitudes towards mental health professionals.
Finally, therefore, we underline the importance of studies dealing with ReS issues, particularly with professionals. In recent years, such themes have been increasingly researched. However, health care workers’ religious and other ethical values, their effects on medical practice and health care, as well as their interactions with patients and their families, have only been studied most recently. We are still at an early stage, esp. in psychiatry and psychotherapies on the one hand and in South Korea on the other hand. It is encouraging, however, that, even before finding significant results, a questionnaire itself can give professionals opportunities to think about religions and related professional behaviors. We therefore conclude with adding two quotations that one psychiatrist and one social worker appended to the end of our questionnaire: “Through filling out the questionnaire I got a chance to think about religious effects on therapies with patients, so I am wondering what kind of relations/influences [religions have].”, “It let me think about religious influences on taking care of patients. I want to know how big their relations/effects are.”