Lindell, and as both chair of the APA Caucus on Religion, Spirituality, and Psychiatry, and a member of the Association of Professional Chaplains, I'm delighted to welcome you to the 2024 Oscar Pfister Award Lecture. First, just a bit about the award. Oscar Pfister, born in 1873, was a Protestant minister in Zurich, Switzerland, a man of many interests. By the time he was in his 30s, he was studying and writing psychological treatises, and had developed friendships with leading thinkers of the day in theology, medicine, and the social sciences. His friend Carl Jung introduced him to Sigmund Freud, and thus was born a 30-year correspondence between Pfister and Freud, for which Pfister is best remembered historically. In the spirit of the collaboration and friendship of Freud and other early psychoanalysts with Pfister, a clergyman who continued to serve his congregation even as he pursued understanding the mind and mental illness, in remembrance of that relationship, in 1983, the American Psychiatric Association and the Association of Professional Chaplains jointly established the Oscar Pfister Award to honor individuals who have made significant contributions to the interface of religion, spirituality, and psychiatry. Past recipients have been outstanding physicians, psychologists, religious professionals, and other scholars, including Jerome Frank, Victor Frankel, William Meisner, Robert Coles, James Fowler, Ana Marita Rizzuto, Irvin Yalom, Dan Blazer, George Valiant, the list goes on. It now includes over 40 individuals who have made outstanding contributions to the understanding of the relationships between religion, spirituality, and psychiatry. This year's Oscar Pfister Award recipient is Dr. Peter John Verhagen, an international fellow of the American Psychiatric Association based in the Netherlands. As both a psychiatrist and a qualified theologian credentialed to lead church services for the Protestant Church in the Netherlands, Dr. Verhagen has made tremendous contributions to the field of religion, spirituality, and psychiatry, not only in the Netherlands, but also internationally. He was the founding secretary and past chair of the World Psychiatric Association Section on Religion, Spirituality, and Psychiatry, and has been a co-editor of the section's newsletter for the past two decades. He has played a major role in promoting the field of psychiatry and religion, spirituality internationally, disseminating knowledge and translating it into clinical practice. He's a leading scholar, educator, and mentor for many interested in the field. He was the lead editor of the book Psychiatry and Religion Beyond Boundaries, an endeavor spearheaded by the World Psychiatric Association Section on Religion, Spirituality, and Psychiatry. It was published by Wiley Blackwell in 2010. The book is widely regarded as the leading text internationally in the field of psychiatry, religion, and spirituality. Dr. Verhagen was also a co-author of the 2016 WPA Position Statement on Spirituality, Religion, and Psychiatry, a document that has raised psychiatrist's appreciation globally about the clinical importance of spirituality and religion. Since 2020, he's been an associate editor of Mental Health, Religion, and Culture, a leading journal in the field. He's involved in numerous academic, religious, and service organizations and activities in his native country, the Netherlands. He's been equally comfortable sharing his many talents and insights in international, ecumenical organizations, including the Ecumenical Global Health Partners and the World Council of Churches. He will be adding the Oscar Pfister Award to many other honors, including an appointment entitled, and I really like this one, Extraordinary Professor at the Faculty of Theology and Religious Studies of KU Leuven, a top university in Belgium, and the Dr. P. Raghurami Reddy Oration Award from the Psychiatric Society of India. Certainly in the extensive outstanding contributions to the field of religion, spirituality, and psychiatry over several decades, Dr. Verhagen is most deserving of our recognition today. Sir, please accept our gratitude for your many contributions in the area of religion, spirituality, and psychiatry. Congratulations on receiving the 2024 Oscar Pfister Award, and welcome. Thank you. Well, good afternoon to you all. Dear Dr. Dell, dear representatives of the APA and the APA Foundation, dear members of the APA Caucus on Religion, Spirituality, and Psychiatry, dear members of the WPA Section on Religion and Spirituality in Psychiatry, dear colleagues, dear friends. You can probably imagine my immense surprise and joy when I received a letter congratulating me on being selected as the recipient of the 2024 Pfister Award. My colleagues shared my joy and sent me an Oscar statue to express their admiration. And of course, I began by explaining to them that the name Oscar Pfister is spelled with a K and not a C. And then I told them about this remarkable person and his lifelong admiration and friendship with Sigmund Freud and his family. Anna Freud, later on, remembered the joy when Pfister was at home with the family. Well, despite their differences, of course, but they admired each other's work and found in each other in this strange, at least according to Freud, strange alliance of psychiatry, psychoanalysis, and religion. Psychiatry and religion, as I have written before, as an alliance against nonsense and superstition. And in saying that, what we begin with will also be our provisional end point for today. This curious, controversial, sometimes questionable, and yet imaginative alliance between religion and psychiatry. I stand before you because in some miraculous twist of events, I am the 42nd recipient of the Oscar Pfister Award. There is a chair over here. You can... Oh, okay. Well, that's the seat of the photographer, but here... And of course, I reviewed the names of my predecessors in this position, and I was awed by the prestigious list and challenged to take up the mantle. And as a mark of honor, I selected photos of some of them and copied them into my PowerPoint presentation, as you will see. And another idea to value this award is to collect and publish a selection of evocative Pfister lectures, and I have already begun to make a selection, and I hope to interest the APA Foundation in this project. I particularly want to thank the representatives of the APA Foundation for allowing me to be honored like this, and I thank wholeheartedly Dr. Alan Fung, current chair of the WA section on religion and spirituality in psychiatry, for his warm support. And really, there are not enough words to express my gratitude and love for my wife, who is here with me today, despite her serious illness and the difficult times we are going through with my son and his partner. Without her, nothing would have been achieved as it has become. I have nothing to disclose. This is the title of the presentation, and this is roughly what I have in mind. Sorry. So what are we going to do about that? Well, there is a lot of mystery in the theme, that's sure, but what... The first one... Let's try again. So again, this is roughly what I have in mind first. I will talk a little bit... First, I'll tell you a little bit more about my background and about the Dutch and their spirituality. And then, of course, the main topic of my lecture will come up, the religiosity gap. I want to do two things. I want to show the stratification that there is more in it than just a difference in religious affiliation between professionals and healthcare users. And at the same time, I want to show some of the developments about the religiosity gap over the last, let's say, 40 years. That's about the span of my career and many of us in this field. And in this way, we will explore events and facts at different levels in different phases, connect them here and there, and eventually reframe them into a narrative. And here, of course, is one of the most famous winners of the Pfister Award, the famous Swiss theologian Hans Kuhn. And he really gave a provocative lecture in that time. He challenged APA psychiatry at that very moment to be aware of what was going on in the field of religion and spirituality. And I certainly hope that we can republish his lecture in the volume I announced. So here we are. This is our country. This is it. And it's from your perspective no more than a dot on the east side of the North Sea. But as you know, you should know, we settled here in the 17th century and called this place New Amsterdam. Many such things are less a source of pride today than they once were. Well, we live in a delta, largely below sea level. And this geography of a delta is not coincidentally perhaps a natural obvious image of the Dutch Reformed Protestantism. The Netherlands lies at the end of the delta of the Rhine, which originates in Switzerland. And Dutch Protestantism has its roots in Calvins, Geneva. The mainstream ended in our country in a delta with numerous branches. And the famous Swiss theologian Karl Barth once said, down there at the bottom of the Rhine, there is a corner where it always smokes, where it always smoulders. In his view, vapor evokes the image of Dutch. Today, we have far too much of it. But as we used to say about the Dutch Reformed, they are like Dutch. In a heap, they are a stink. But in sprinkling, they are a blessing. Today, it's the 4th of May. That means it's Memorial Day in our country. Memorial Day. And the theme for 4th of May, Memorial Day, and May 5, Day of Freedom, is freedom tells, prelude to 80 years of freedom. Freedom, a precarious gift, as we all know. On this very moment, in Amsterdam, is our national gathering. And there, we remember the fallen, including those from your country. And in a few minutes, led by the king, the country will observe two minutes of silence. And I wanted this to share with you on this very moment. As you see, at the left, we have our Bible belt, as in this country. Although, in our multicultural, secularized country, with its religious, spiritual, and humanistic diversity, church involvement has declined significantly. And let me tell you a little bit more what the Dutch think about spirituality. Berghuis and colleagues have described concepts of spirituality among the Dutch population. Well, the authors noted that spirituality has become an increasingly popular market of books and lectures and workshops and courses and spiritual tours and holidays. There is a remarkable spiritual supermarket at hand, where you can buy what you need or want to try. As a matter of fact, at the end of the 19th century, it was also recognized that there was a supermarket on spirituality. And the researchers asked themselves, would it be possible to find a single definition of spirituality? One that would cover all varieties. And should such a definition be as broad as possible, so that atheistic and agnostic spiritualities could be included? And the interesting part of this study, for this purpose, is that the participants were not asked to rate the characteristics of spirituality defined by the researchers. No, they were asked for their own descriptions of spirituality. Descriptions in their own words. So the question to the participants was, what do you understand by spirituality? Give your own description in no more than 50 words. And among other things, the researchers were curious whether some sort of overarching characterization would emerge or not. Well, I leave the details as they are. The researchers didn't find one overarching concept. They found no fewer than eight concepts. Eight concepts, and I'll add some examples of answers from the respondents. And these eight concepts are spirituality as a Christian way of life, and clearly visible in all dimensions of life. Spirituality as a responsibility towards others and nature. Spirituality, very remarkable or not. Spirituality as striving for mental health, well-being, contentment and balance, vitality, energy and inspiration. And practices that are meant to produce such feelings are a good external balance between yourself and life and a good internal balance between your feelings and your ratio. Spirituality, spirituality as a life attitude of inwardness. For example, spirituality is what you experience in your innermost self of being, of your innermost of your being. And again, remarkable, spirituality as the paranormal expressed in beliefs and practices. For example, spirituality makes me think of premonitions, soothsayers and mediums who can, for instance, make contact with dead people or predict the future. Sixth, spirituality as experiencing the transcendent and the non-perceptible. For example, something you cannot describe, see or comprehend if you don't believe in it. Spirituality as experiencing the imminent God. For example, spirituality is a way of life, it does not have to be related to belief in God. For instance, for me, spirituality is to believe in goodness and to do good, to live in the here and now, to take care of each other, to accept people as they are. And eighth, spirituality as the transcendent God. For example, for me, spirituality means that I have a personal relationship with God the Father, with Jesus and that his spirit lives inside me. Well, the highest scores have eight, the last one, and four, life of inwardness, and three, spirituality as striving for mental health. Underneath these concepts, there lies an enormous variety from connection with nature to experiences of the paranormal, which go far beyond the traditional ecclesiastical or spiritual boundaries. And as others also suggested, the authors concluded that there is no common understanding of the concept of spirituality. It depends on whom you ask. However, one could say that the eight concepts show a recognizable and even predictable kind of continuum of spiritualities, from purely secular on the one hand to established religion on the other. Furthermore, the repeated use of certain words stands out, words related to the transcendence and words related to the positive inner feelings. At the same time, this is the language, the way in which people express themselves when it comes to spirituality. So far, the Dutch. Well, how it started. It was 1980. The Dutch Association for Psychotherapy had invited a celebrant for its 50th anniversary. The co-author of the standard work on research into the outcome of psychotherapy. And everyone was ready to hear that psychotherapy was proven effective. That would only add to the festivities. However, Alan E. Bergen, you see his picture here, he was awarded in 1998. He was the invited guest speaker. And he began his impassionate plea to take religious values in psychotherapy seriously. But the Dutch were not waiting for that at all. The comfort report states that in retrospect the organizers did not know that they had brought in a Trojan horse with Bergen. And the audience was angry, amazed and saddened. There were murmurs in the hall and people spoke in outrage. The birthday party was spoiled. What was the religiosity gap about again? Well, it was Bergen who published several studies on religion, values and psychotherapy as early as 1980. His 1980 article on religious values and psychotherapy was groundbreaking. And in fact it was he who set the tone in 1983 with his first meta-analysis that showed a tentative positive correlation between religion and mental health. This is what he and Jensen wrote in 1990. Data from previous surveys indicated that therapists were less committed to traditional values, beliefs and religious affiliations than the normal population at large. And therefore it is also possible, they argued, that the psychotherapy that does take place is hindered by an unspoken religiosity gap. On the other hand, they were also convinced that there is apparently a blend of humanistic philosophy and spirituality that has not been well articulated and perhaps this spiritual humanism would add a value dimension to the therapeutic repertoire if it were not clearly expressed and overtly translated into practice. And in that sense they were not so negative at all. But it was certainly not a done deal, it was highly controversial. In the Netherlands, as I said, it had been received with reluctance. But it kept coming back there as well, in the Netherlands I mean. My first public appearance in this regard in 1991 was also marked by a highly critical and unwelcoming response. Although the chairman of the symposium was honest enough to remark that if there was indeed any evidence of the importance of religion and spirituality, then we should take note of it. Well, we will look at the religiosity gap from different levels of theoretical and practical perspectives. And this will extend from a gap in affiliation to an explanatory gap on the level of philosophy of life. In the context of ordinary everyday philosophical fieldwork, the term gaps refers to certain difficulties and challenges that may arise when trying to integrate discussions and practices into a broader historic and scientific understanding of a particular topic, such as religion and psychiatry. And of course it reminds us of the 19th century God of gaps concept introduced by Friedrich Nietzsche. But that is certainly not what we are after here today. It is my aim to construct, or perhaps more modestly, to tell a narrative as an account of events and practices that can and may be explored and connected. As an expression of the development of our field of interest that our field of interest has undergone. And this narrative is fascinating and unfolds in a series of stages and on multiple levels. So let me start with stages of development, or the developmental sequence using the approach of Bruce Tuckman, a researcher who carried out research in the theory of group dynamics, my other specialty, as I may say so. And I will use his approach as an analytic tool for the development of our field, particularly with regard to the religiosity gap. After all, with Bergen started, Scott Richard said, Bergen started a movement. Let's listen for a moment how Scott Richard remembered and honored Bergen. He wrote in his Remembering Alan Bergen in 2016, during the 80s and the 90s of the last century he, Bergen, risked his international reputation as an eminent psychotherapy researcher and scholar when he courageously confronted the entrenched anti-religious bias that has existed over 100 years in the psychology and psychotherapy fields. So it was not so easy. And it was even tricky. However, Scott Richard continues, Bergen's revolutionary article, the article from 1980, and rejoined or energized a powerful wide world movement to bring religious and spiritual perspectives into mainstream psychology and psychotherapy. And because of the eminence he had previously earned for his psychotherapy outcome research, the profession was compelled to pay attention to his new work. That's remarkable, isn't it? The Dutch apparently reacted counterproductively. And then Scott Richard concludes his words of praise to Bergen with, I quote, the movement Alan Bergen inspired, continues to advance today. It's now worldwide, ecumenical, and interdisciplinary in scope, and continues to enlighten behavioral scientists and healthcare professionals. His groundbreaking writings and research litigimized the study of religion and spirituality in psychological research and contributed to the development and proliferation of religiously sensitive spiritually oriented psychotherapies. Treatment approaches that demonstrate sensitivity to religious and spiritual diversity have been developed and are now widely used. Outcome research today provides evidence that spiritually oriented psychotherapies are effective and sometimes more effective than mainstream secular approaches. Efforts are now underway to mainstream spirituality oriented psychotherapies into the healthcare mainstream throughout worldwide collaborative research projects, end of quotation. Allow me to dwell for a moment on these last words, that partly because of Bergen, a movement was set in motion, also in the Netherlands. If we imagine that Freud and Pfister were the pioneers or representatives of the beginning, that is, the formative period, then Bergen is undoubtedly the starting point of the storming phase. Madness and religion have been considered throughout history, but the relationship between religion and psychiatry becomes an issue in the 19th century, thanks in part to the meteoric rise of science. And Freud and Pfister's friendship and discussion of religion is in some ways exemplary and certainly a temporary high point. With Bergen's input comes a new phase. In a sense, it is a conflictual period characterized by confrontational discussions, emotional charge, fear, resistance, and devaluing conflicts. It's the storm period. Madness caused unrest and provoked fierce criticism. As recently as 2008, an article, an editorial by Harald Koenig caused a stir in English psychiatry. But it is interesting now that the opponents in 2008, Chris Cook and Rob Paul, collaborated in an investigation into the issue of boundary violations and religion in psychiatric practice, and I'll come back to that in a moment. But that collaboration illustrates that we entered a new phase. After the storming, we started, we reached the norming period. After storming, the conflictual and the discussion, the norming period was and is a far more productive period. Interest groups arose. Your caucus, the caucus of the APA, is one of the oldest as the special interest group spirituality and psychiatry in Great Britain. India had already a special interest group, and other countries and their national psychiatric associations followed with the World Psychiatric Association Section on Religion and Spirituality in Psychiatry established in 2003. Brazil followed, Germany, and we even supported the Russian Society of Psychiatrists to organize a special interest group, and there is a special interest group, and how disappointing that collaboration seems ages ago now. So during this period, we saw an expansion of theory and an impressive improvement in empirical research, and we focused on the profanization beyond strict biomedical technical regimes, and protocols and guidelines and programs for residency training and continuing medical education were developed, and some of us had done this much earlier, of course, but sharing and greater coherence were developing. And yet, mainstream psychiatry remained more or less aloof, which remains frustrating. In the Netherlands, nowadays, psychiatry has been overtaken in this respect by the experts from experience and peer supporters and their relatives who have taken over the plea for meaning in psychiatry. How interesting. Well, I already mentioned the performing phase. Based on theory, research, and practice, things rolled out in practice guidelines and research programs, and in the Netherlands, we have recently published such a practice guidelines document, and we have adopted Rosemary's spirit in intervention to implement that program in Dutch emergency psychiatric care. And in Brazil, people are working on practice guidelines, and there is much more cooperation instead of confrontation, including cooperation with chaplaincy, spiritual caregivers, and religious and spiritual leaders, and recently, the WPA section on religion and spirituality in psychiatry has begun conversations with the World Council of Churches health representative. Well, I can only tell you briefly, but I find it extremely interesting, enlightening, and also inspiring to look back and forward in this way with this instrument, with this analytic tool of developmental periods, and it confirms, in fact, the words of Scott Richard in honor of Burgin. Now, I'll introduce my second analytic tool, a tool to organize knowledge and practice. When I meet a patient in the consulting room, that patient tells his or her story on an everyday life level of experience. That's the first level. That's the level of the story in which the patient talks about his or her complaints or symptoms, and in that way, it is a story determined by the cultural and religious or spiritual background of the person in question and his or her idiosyncratic experiences. And of course, in such a story, one finds constructs that the individual creates with regard to his or her identity, self, and self-image, how he or she explains or justifies his or her life experience and social phenomena concerning health, illness, and mental illness, including possible religious or spiritual explanations about the difficulties of that moment in life and expectations, of course, expectations with regard to therapy and recovery. For example, the patient I have in mind emotionally explains that in her view, it is the devil that is chasing her, but then something happens. Something is done to the story that is told. The mental health professional reconstructs the story into a clinical case, a diagnosis, a case formulation. That's the second level. The case formulation elaborates on the identified disorder, the patterns that are discerned in the story of the patient, the social context, and the clinician-patient relationship from a categorical description and classification to a personalized perspective, which furthermore leads to therapeutic action. But what happens to the patient's story about the devil chasing her? Probably, the clinician has tried to discern between a sign of psychopathology, psychosis, mood disorder, anxiety disorder, an anomalous experience, spirit possession, or another kind of authentic or pathological religious experience. After all, there is more between heaven and earth than we have dreamt of. Or the clinician has tried to discern between a symptom of a disorder and coping with the disorder or how the patient relates to the disorder. And one possible cause of events could be that the psychiatrist discovers inconsistencies in the patient's religious story about herself. And these inconsistencies could lead to inappropriate or harmful thoughts and or actions with respect to herself and others. These thoughts and actions could point to psychopathology, but not necessarily so. So what knowledge would a clinician need to have in order to be able to reach a conclusion, both about psychopathology and about possible harm? And this obviously raises a series of new questions. Is it either or, psychopathology or authentic religious experience? Or is it both and, psychopathology and authentic religious experience? Well, one of the questions could be a search for scientific evidence. What's known about the impact of possibly harmful beliefs on the incidence, occurrence, clinical picture and cause of psychiatric symptoms and syndromes? That is the third level. On this level, a clinical question or problem is formulated in a scientific or research language. And in the case of religion and psychiatry, disciplines like neuroscience, psychology of religion, sociology and theology are involved in the analysis of affective, cognitive, interpersonal and spiritual processes or dynamics. However, based on their experience with empirical research in medicine and psychiatry or in psychology of religion, psychiatrists are all acquainted with the difficulties in translating the clinical material into a scientific discourse. And back again to the everyday experience of the patient. A very interesting example of such an interdisciplinary analysis and dialogue on paranormal phenomenon is the case study by Lomax, Krippel and Pargament, 2011. Psychotherapist Lomax, historian of religion, Krippel, and a psychologist of religion, Pargament, discuss a special moment in a psychotherapy session. In a very moving way, the patient describes the meaning of a paranormal experience. And the experts discuss the experience on the basis of four key words. The paranormal, the sacred, the psychical and the therapeutic. And this is exactly what a multilevel, multidisciplinary dialogue could look like. Insights from history of religions, from psychotherapy research and from psychology of religion are brought together in a clarifying way, which ultimately benefits the therapy process in which the client is involved. And therefore, it is a pity that such case studies are rare, because the types of interdisciplinary dialogues and discussions that led to this article will expand the therapeutic repertoire of clinicians to the benefit of patients, and led to a more positive anticipation of psychotherapeutic help by the general public. The fourth level is the philosophical or meta-theoretical level. On this level, the basic premises of theoretical models, for instance, the biopsychosocial-spiritual model, the stress-vulnerability model in medicine and psychology, or the explanatory pluralism model for psychiatric illnesses. That's what we discuss about on this fourth level. And the same holds true for every scientific discipline, scientific theology, irrespective of religious tradition. For instance, in philosophical theology, propositions and concepts of religious doctrines are elucidated and extended by using standard philosophical means of analysis and argument. And it could be asked whether the sentence about the devil chasing somebody has meaning or not. This is a theological question. And another more philosophical question could be in what way psychiatry is able to integrate a view on evil, asking in what sense illness is related to evil or not. Or is it the other way around? Has psychiatry and its view on psychiatric disorder changed our view on evil? Or could it be argued that religion is a biological adaptation or by-product of adaptation from an evolutionary perspective? And that fear of supernatural beings makes us human? That would inevitably bring us to a discussion on the impact of cognitive study of religion and neuroscience. However, what kind of religion is that neurobiological religion? Is that still religion that is lived, spirituality that is experienced? There is a certain resemblance of what has happened to morality. The neuroscience of morality is altering what it seeks to study. It means that the application of cognitive science and studying religion is never a neutral act. The same applies to evidence-based psychiatry, as I will show. Of course, there is a neurobiological perspective on any human experience, but the historical and psychological perspectives are still alive and all these and other perspectives need to fulfill the criteria of internal and external consistency and coherence. That's what the fourth level is about. So let's have a closer look at the first level and the questions we ask. So we start from everyday language, the everyday language of the client. And we use acronyms like FICA and HOPE and FAITH. And of course, questions like these are important to orient whether the issue is relevant to diagnosis and therapy or not. But these type of questions already preempt to the clinical and institutional context of the assessment. Are these the most appropriate questions to ask? Are these questions, the questions we use in our psychiatric assessment, as in FICA and others, are these type of questions really linked to the human fragility and vulnerability of the human psyche that is expressed especially in grief, finitude, loss of control, despair, trauma, through poverty, prospect of death? There is another type of questions that we call slow questions. We call them slow questions for two reasons. They have accompanied humanity from the beginning of history and have not changed that much in the long course of development. And they cannot be addressed adequately with the use of fast technical questions. What type of questions do we ask in regular practice? Are these types of fast technical questions because we are running out of time? Are we running out of time? 30 minutes left. Or 30 minutes to talk for me. No, 30 minutes left. Then I'll have to skip some things. But let me finish this important point. So there is a difference. And again, these issues can't be addressed by fast technical questions. Fast questions often leave extensional and moral residues which cannot be absorbed by technical means. There is fast thinking, of course. It's automatic. It's unconscious with minimal effort. This seems like passive thinking because it happens beyond one's control. And there is slow thinking, deliberate, conscious, and with obvious effort. And because this conscious way of thinking has the person in control, it seems like a more intelligent way of thinking. In other words, if the right action has to be taken in the right place, one should also consider the right time. Reflection in action is not only about what is the best thing to do, but also about the right pace. Slow questions understood in this way confront us with the limits of the fast ones and the necessity of muddle through and to try to rewrite one's own life history to a certain extent. And envisage alternative ways of religious or spiritual meaning in life or of life. Mind you, there is a difference between meaning in life and meaning of life. Perhaps the word gap is too strong. But the subject of religion and spirituality itself calls attention to this difference in pace. And short-circuiting at this point could negatively affect the clinical relationship and leave the patient with these residues. I already announced the collaboration between Paul and Rob Paul and Christopher Cook. He was awarded with the Pfister Award in 2020. Let me tell you a few things about this very interesting study. Cook, of course, admired the editorial by Harold Kearney in 2008, but Rob Paul objected vehemently because of the possibility of boundary violations. So these two were the former opponents. In this study, no pre-established definitions of what constitutes professional boundary violations were used. Thus, the study mainly refers to opinions about boundary violations related to religion and spirituality in psychiatry. And the results are heterogeneous. Except that the comments show that proselytizing is a clear boundary. It's emphatically not allowed. But apparently, it's not just the rules such as the ban on proselytizing that play a role. But amazingly or not, there is also a certain pragmatism. If it helps, what's wrong with it? The researchers got even the impression that a pragmatic view is more likely to prevail than a principled one. But they argue that's pretty typical of medical practice anyway. The authors also note that there is certainly a high degree of uncertainty among professionals, given the contradictory arguments that professionals themselves use to explain their answers. The study found no evidence for or against the integration of religion and spirituality in psychiatric practice. Is there anything new in this study? Well, on the one hand, there isn't. Because this uncertainty was already known many years ago. But again, the advantage, the benefit of this study is of course the collaboration between the former opponents, including opponents within such a society as the British Royal College of Psychiatrists. So it illustrates that we arrived in another phase of doing our work. Not the storming, as I explained to you, but performing. That is really interesting to learn about. Well, I'll close with a brief view on the language of spirituality. Because we are talking about spirituality, and we use our clinical jargon when we approach spirituality. But what is spirituality then? And what does the spiritual language mean? Is spiritual language not a case of overly vague sayings, which in the end are useless? When does spirituality occur? Well, in difficult circumstances, in chaos, in struggles, stress, in case of illness are under excessive pressure, then it pops up. And Swinton and Patterson, Swinton is also a recipient of this award. He is a British practical theologian, wrote a lot about well-being, spirituality, and dementia, and so on. Very interesting work. Swinton and Patterson argued that spirituality in certain circumstances is emergent and responsive to certain needs in these circumstances. And even then, it is controversial. Because even then, it's not unambiguously clear cut. However, it is not at all surprising that vague or controversial words and terms turn up in difficult situations, namely in search of words, of course, in search of vocabulary in such circumstances. And therefore, Swinton and Patterson introduced the term limit language. Yes, it is vague. It is not concrete. But it indicates a limit beyond which is not at all clear what can be said and how it will be said. But again, that hesitation or hiccup, that search for words does not mean that it is out of place or meaningless. It says that there are limits to words in some life situations that are complicated for many reasons. And just because I'm not sure what I'm talking about doesn't mean that I might as well leave it as it is. That's not worth the effort, that it is nothing. Of course, there is this association with the concept of borderline situation, border situation as elaborated by the philosopher and former psychiatrist Karl Jaspers. In eloquent German. In proper English. Situation becomes a boundary situation when it awakens the subject to existence by radically shaking, shattering its existence. One step further, if spirituality is such a borderline word, border word, then one could also say that the term functions to name what is not there, the absence, rather than what is there, the presence. After all, that is what people in limit situations are confronted with. With what is not there anymore. So limit language as spirituality is vague, soft, but it is about meaning, hope, purpose, passion, love. And these are the words that pass in the definitions of spirituality, even in the concept of spirituality of the Dutch. But they are missing, are absent, are not available in the experience of the person concerned. And how does that work in the practice of mental health care, where people usually report in difficult circumstances with far reaching experiences in crisis. At the clinical level, in the practice of care and therapy, those words are simply missing. Simply missing. With a few exceptions. And with it, these fake words, soft words, suddenly take on a critical edge. Because why are these words missing? Is there not a deficiency in therapy? So these vague, soft words, this limit language, suddenly points to a gap between care practices and the experiences of the users of that care. In fact, this vague word thus becomes a protest word, which despite this vagueness and softness is powerful, powerful to change a practice. So it is indeed useful and meaningful to talk about spirituality. Well, I have to leave it here. I wanted to say a few things about the third level, and of course about the fourth level. I would like to tell you something about the soul and the self, and the way the self is placed in the center of our way of looking at life. That the self has become the place of the sacred. I would like to have told you a little bit about re-enchantment and mysticism, but I certainly hope to have the opportunity to write it down, and perhaps then you'll find the opportunity to read a little bit more about it. Thanks to the creative efforts of many, and their tenacious research around the world, we have been able to meet what the current complex era demands. And I'm quite sure that this demand not only comes from us, from within us, but also comes to us, calling and asking. I thank you for the honor of addressing you. Yeah, I'm just wondering, since all religions also talk about humanism, love your neighbor as thyself, and stuff like that, wouldn't it be better, and since we've gone beyond our galaxy and we haven't seen any evidence of heaven, hell, or earth, or whatever it is, gods, shouldn't it be a good idea for us to just accept that all this is happening in our brains, a network of neurons, and that we are just an advanced species of apes with higher frontal and prefrontal lobes, and that we should be focusing more on humanism, and seeing the common humanism like Buddha, you know, Guru Nanak, they brought away from God to humanism. It looks as if you are a bit worried about it. Well, I'm not worried about it. I think religion can be divisive, and lead to violence and wars, and it's happening even now in the earth, even in our United States, so I'm thinking the focus should be getting everybody to move towards humanism and common denominators, you know, that are also in all religions. Thank you very much for this, of course, very important question. I'm not sure whether it's really true that we would be better off if we leave it behind us based on what we learn from cognitive science of religion and neuroscience. It reminds me more or less, if you allow me, to the response Freud often gave to Pfister. Well, I'm quite sure that religion is not necessary. Concerning myself, I don't need it, and I think it would be better that nobody needs it anymore. But nevertheless, if there are a few who need it, okay, no problem, let's have it, and we'll see where it ends. That's the one end of the question, continuum, I would say. Of course, that is really based on a certain scientific stance and idea about human functioning, of course. On the other hand, there was, of course, the Pfister answer. In fact, as we know, Freud's small booklet on the future of an illusion was a critique of the thinking of Pfister. Pfister replied with an interesting paper, and especially the title of his paper is interesting, namely The Illusion of a Future. He turned it around, and he agreed with Freud that illusionary religion should be criticized because it's not functional, because it causes a lot of trouble, especially in the personal life of a lot of people. But there is something in religion, and we have continuously to look for that, to search for that, to find, to renew it, to re-find it after so many years again and again. That is really worthwhile, that we should be aware of, and in the words of Pfister, it was the idea of love. Pfister is famous, his work is famous, because this strong emphasis on love, psychoanalysis is not liberation by truth, as Freud suggested, it's liberation by love. And well, I'm not sure whether it is an appropriate saying here and now on this very moment, but in my view, if there is one thing that we miss, and that we don't find that easily in human endeavor, then it is this idea of love. So I still think that religious, spiritual traditions, with all their difficulties and terrible things, there is something they have to offer. And we are invited to take up the challenge and to renew our views. Well, that would be my answer for this moment. Thank you. Hi. I loved your talk. I'm Brent Menninger, I'm from Kansas. And you were talking about the woman with the devil after me. I thought, is it the real devil, or is it a metaphorical devil? And then I thought about my saying, I say, my patience, sugar is the devil. And by that I mean, it's so tempting. It's so seductive. And it is so evil. Sugar is evil. And it's a metaphor? It's true. I mean, it's evil. It really is evil, but it's not that bad. And in some ways, and then how do you get out of this thing? Because sugar is everywhere. I mean, sugar is... Anyway, so but the idea of self-love and self-care and self-respect and self-forgiveness and making peace with the banality of evil. And these are spiritual problems. And the slow questions, you know, it's a struggle. Slow questions are a long-term life struggle. Well, thank you. It's a perfect illustration of what could happen on the second level, isn't it? You illustrate and you explain to us how you would approach such a moment in such a conversation with the patient, isn't it? That's how I understand and appreciate your suggestion and idea about how to handle such a statement as, well, the devil is chasing me. Actually, in this case, it was a metaphorical use of language because the woman had not such a literal belief about sayings in her tradition. So it was a metaphorical expression. But that is something to discover with her, isn't it? Yes, of course. That's what metaphors are about. Okay, well, thank you. Yes, please. I hope I'm going to make sense. So religion is both wonderful and horrible. Religion is the area that inspires. You listed eight reasons. Moral code, inspiration, transcendence, and Iman and God. So having access to something that is intangible beyond more. But then religion is also organized religion. It's division, it's war, it's hatred, it's authoritarian ways of judging and eliminating. So it's that. Psychiatry is wonderful and psychiatry is horrible. Yeah. Right? Psychiatry tries to save and then psychiatry tries to diagnose saints. I just came from a talk where John of Ark would decide that she was an autistic child. So basically, we try to do good, but sometimes we fail. And right now we're looking at religion as inspiring psychiatry. Can psychiatry inspire religion in any way? Is there any work that we can do to maybe bring more unity in religious studies? Yes. Well, thank you. That's a very, very nice and important point to be aware of. It refers, if you allow me, to the seventh recommendation of the W position statement on religion and spirituality in psychiatry. Psychiatrists are invited or even are failing, so to say, if they do not inform the general public on the meaning of mental health issues, including mental health issues in connection with religion and spirituality. That's what we call health advocacy. And that's part of our job. That's part of what we have to do. That's part of our responsibility with regard to public health, including public mental health. So I think you are right, based on our knowledge. And we really know a lot about it. We do not know all about it, but we do know a lot about it. We know a lot about the adverse effects of religion and spirituality. No doubt about that. And it's up to us to inform the general public, policymakers, and whatsoever on that. And it might be that could help the general public or policymakers or whatsoever. So there are a few publications, for instance, by Van der Wele. He's an American psychiatrist. He does a lot of writing on this specific topic. And he wrote about, is human flourishing a public health issue? Is forgiveness typical intervention in spirituality integrated therapies? But the question is, is forgiveness a public mental health issue? And he makes it clear that it is. And that we have a responsibility as a group, as a discipline, to inform the public about it. So I agree on that with you. Thank you again.

Oscar Pfister Award

religion

spirituality

psychiatry

Dr. Peter John Verhagen

Netherlands

religiosity gap

Alan Bergen

therapeutic outcomes

spiritual language

organized religion

mental health