Based largely on Sigmund Freud's views dismissing religion, psychiatrists and religious
leaders argued for most of the 20th century over how best to heal the human heart and soul. But for Mark
Servis, vice chair for education and residency training director for the UC Davis Department of Psychiatry
and Behavioral Sciences, that no-middle-ground debate didn't explain patients like David.
After many years of alcohol abuse and a party lifestyle, the middle-aged man was dying of cirrhosis.
David, a pseudonym to protect his privacy, also suffered from bipolar disorder and was receiving psychiatric
care as he awaited a liver transplant with at best a 50-50 prospect that an organ would be found in
time to save him. While medical treatment for David's bipolar symptoms was part of the answer, Servis
sensed a spiritual dimension to this patient that drugs and psychotherapy could not fully address.
In therapy, Servis learned that David's family had been active in a Christian church during his youth
But, like many young people, David dropped his religious practice in college as he embarked on a dark
journey through substance abuse, mental illness and a self-destructive lifestyle.
Stepping outside the conventional bounds of his psychiatric training, Servis suggested the man attempt
to renew his faith. The suggestion turned out to be a major turning point. Through his church, David found
powerful support that helped him get sober. He survived the transplant operation. While medication kept
his bipolar symptoms in check, continued religious practice helped him stay sober and leave behind his
He returned to college and advanced his career. "Without a combination of psychiatric treatment and religious
practice, it's hard to say how it would have turned out for this patient," said Servis. "While therapy
and medication helped manage his mental illness, religious practice was essential to helping him get sober
and stay sober and make other positive choices in his life."
New curriculum for new era
Because of the role of spirituality in healing patients like David, Servis has led the development of
an award-winning curriculum in religion and spirituality for psychiatry residents at UC Davis. Launched
in fall 2002, the curriculum places UC Davis at the fore- front of the movement to close the gap between
medicine and religion.
"We had been offering psychiatric residents a brief overview of religious issues since the early 1990s,
but in recent years our residents have consistently told us they need more background on religious faith
in order to better understand their patients," said Servis.
The curriculum has already won a major award the John Templeton Spirituality and Medicine Award. Sponsored
by the George Washington Institute for Spirituality and Health, this $15,000 prize supports the integration
of spirituality and medicine into medical school curricula.
Caught in the crossfire
In leading the curriculum development, Servis was able to draw upon challenging personal experiences
that occurred during his own training. As a psychiatric resident in the early 1980s with religious views,
he found himself caught in the crossfire between the conventional wisdom of his profession and his religious
"Medical residents who thought religion could be helpful to patients were treated with suspicion by our
peers and professors," said Servis. "Many left the profession or kept their views to themselves." At the
same time, he said his religious community struggled to accept his involvement with 'God-less science.'
Attitudes began to change in the 1990s as a variety of studies highlighted the health benefits of religious
Prozac or a pastor
The spirituality curriculum is tightly integrated within the psychiatry department's overall four-year
program. For example, residents typically rotate through consultation-liaison service, the inpatient unit
at the Sacramento County jail and substance abuse treatment. The spirituality and psychiatry curriculum
complements these experiences, including interdisciplinary conferences with chaplains and chaplain interns
at the medical center.
"Local clergy are typically on the front lines of mental health care in a community," said Servis. "When
people with religious beliefs experience a crisis, they typically turn first to their church, temple or
synagogue. The curriculum helps our residents work more effectively with these professionals to serve
For instance, the curriculum is designed to help residents diagnose patients who might be suffering from
mental illness that needs the attention of a psychiatrist, a spiritual crisis best addressed through religion,
or a combination of the two.
"These situations can be highly complex, and our curricu- lum helps students make good decisions about
when a patient needs Prozac, a good pastor or both," said Servis. "Every situation is different. Through
our curriculum, residents gain the skills they need to work with clergy to assess situations and make
good decisions for patients."
Addressing diversity of culture and religion
Residents also focus on undertanding the diverse religious beliefs they may encounter. Servis pointed
to a case in which a monk in an Eastern religion, a very revered older man, had chosen to undertake a
prolonged fast. Because of his advanced age and the severity of the fast, there were concerns that without
immediate intervention, he might die. Yet the monk refused to end the fast.
A psychiatrist was called in to assess whether the monk was mentally competent. Because the answer wasn't
clear, the psychiatrist consulted with other leaders in the religious order. Ultimately, the monk's peers
persuaded him that he had fulfilled the purpose of the fast and could end it.
"Because we approached the situation with respect to the man's cultural and religious practices while
tending to his medical needs, we were able to come up with a positive solution," said Servis.
The curriculum also helps residents understand the impact of religion on the complex interaction between
patient and therapist, said Servis, and broadens residents' knowledge about mystical experiences, direct
experience of the divine, near-death experiences as well as neuroscience, cults and new religious movements.
"If a patient is speaking in tongues, it does not necessarily mean he is suffering from mental illness,"
said Servis. "Given his cultural background and upbringing, this may be a beneficial practice for this
In assessing how to best help a patient in crisis of the mind or spirit, there are few black-and- white
answers, said Servis. Ultimately, the curriculum is designed to help residents better understand the strengths
and limitations of both psychiatry and religion, said Servis.
"As psychiatrists, we can be highly effective in treating depression, anxiety and other illnesses," said
Servis. "However, we are limited in our ability to answer existential questions, or help a patient find
meaning in tragedy. By working together, psychiatrists and clergy can provide patients with the best of