Distinguishing spiritual, psychological, and psychiatric issues in palliative care: Their overlap and differences

摘要

It is often difficult to discern whether the suffering of a medical patient should be regarded as a spiritual, psychological, or psychiatric problem. A further challenge is to determine whether consulting a chaplain, psychotherapist, or psychiatrist will best aid the patient. We present a four-step assessment for determining which perspective and which clinician may best aid a patient: (1) distinguish whether suffering is due to a normal syndrome of distress or to a psychiatric disorder; (2) assess the potential efficacy of spiritual care, psychotherapy, or psychopharmacology for relieving distress of this type; (3) determine probable effectiveness for spiritual care, psychotherapy, or psychopharmacology given limitations of clinician availability, clinicians' clinical competencies, and the treatment setting; and (4) learn whether the patient has a strong preference for a consultant with a secular (psychiatrist, psychotherapist) or religious (chaplain, clergy) professional identity. This assessment prioritizes patient preferences in its decision making, while evaluating the clinical problem, consultants' capabilities, and treatment setting so that recommendations hold promise for effectiveness. Spirituality, psychology, and psychiatry are each richly developed traditions of healing. The aim of care should be to provide the best from each towards reducing a patient's suffering.