Living As If: Belief Systems in Mental Health Practice

Living As If: Belief Systems in Mental Health Practice. By Sarah R. Taggart. San Francisco: Jossey-Bass, 1994. 208 pp. $25.95.

In examining the relationship between mental health and spiritual or religious beliefs, Sarah Taggart notes, as do other writers, the historical uneasiness between both domains (Popple & Leighninger,1990). Taggart perceives among mental health professionals a continuing embarrassment with, even hostility toward, their clients' issues of spirituality or religion. Pastoral counselors, to the extent that they participate in the mental health culture, also tend to bar the language of religion and spirituality from intruding upon their practice. Taggart joins other scholars in arguing that this segregation is unnecessary and limiting (Goldstein, 1987; Hermet, 1994; Kilpatrick & Holland, 1990; Sermabeikian, 1994; Sheridan, Bullis, Adcock, Berlin, & Miller, 1992). It impoverishes the practice and may render psychotherapy culturally insensitive and existentially meaningless. The author maps out regions of contact between mental health practice and spiritual traditions and invites the counseling professions to explore them.

Taggart points out that recent speculations about the nature of reality has allowed psychology's status as the only commonsensical view on the human condition to be reexamined. She argues that psychological theories are useful "as ifs," or convenient belief systems about an unknowable reality, and not different from spiritual beliefs. Neither one has a greater claim to truth than does the other. Moreover, the choice between and among them is beyond scientific scrutiny. Looking at psychological theories as "as if" systems grants them a more modest role in human life as well as a more modest status in relation to other "as ifs," including religious and spiritual ones. Psychology and religion are peer belief systems that function by regulating reality and reducing angst. Neither has the authority to characterize the other as false and, in order to be useful, both require our "suspension of disbelief." This is the first point of Taggart's argument.

A second point of her argument is that psychology focuses on a self-reflective being. Through what Taggart calls the subject-object split and Berger (1967) describes as the process of externalization-objectivation-internalization, humans build realities and worlds of meaning; they constantly re-create themselves, and mere observation changes them. Science alone cannot adequately contend with the inner life of human beings, which includes waking and sleeping dreams and, for many people, prayer. Prayer is grounded in a key concern of psychology, the relation of self to other (or the Wholly Other). Taggart asks why prayer is not given the same attention as dreams. She also asks why prayer is not considered among a client's object relations. She concludes that only a prejudicial attitude on the part of mental health professionals could explain that neglect.

A third point of Taggart's argument concerns the unity-versus-duality issue. Taggart argues for the existence of dualities, without which meaning is impossible. Dualities imply sets of opposites, including good and evil, which is difficult for professionals who tend to espouse radical moral relativism to accept. But because humans are morally aware beings, psychology cannot disregard the issue of good versus evil. According to Taggart, we relate to good and evil in two ways: via the existential experience of unity or through moral discernment. Religious and spiritual traditions offer myths and codes of behavior to help with moral discernment as well as age-tested techniques for achieving existential unity. She invites mental health professionals to honor those traditions that clients find meaningful.

Although Taggart discusses criteria for discernment of destructive belief systems, she also pleads for tolerance, for example, of clients' fundamentalist beliefs, noting that what appears to be rigid may sustain people whose life is in chaos. She alerts professionals that spiritual issues will eventually irrupt in counseling. She reminds them that in some settings (hospitals, hospices) and with some problems (chemical dependency, catastrophic events) existential questions become central to clients. Finally, she discusses spiritual practices that clinicians can add to their therapeutic armamentarium (meditation, journaling, dialogues, retreats) and the clinical possibilities afforded by myths, rituals, and metaphors.

Three major positions are held by mental health professionals about the inclusion of spiritual and religious dimension in therapy. One is noninclusion because religious beliefs can have a negative effect on people's lives, be clinically irrelevant, can threaten professional status, or generate confusion over standards of practice (Clark, 1994; Pittman, 1990; Sheridan, Wilmer, & Atcheson, 1994). Another is pragmatic inclusion for the sake of cultural sensitivity and the acknowledged religiosity of American people (Sheridan et al., 1994) as well as for pragmatic reasons (12-step programs, death and dying situations). The third is radical inclusion because spirituality permeates all of human existence and will emerge in therapy if just given the chance. Taggart endorses pragmatic inclusion as well as this last more daring position. Existing evidence, which is scarce, indicates that the noninclusion position, although it has many adherents, is the least popular and may be becoming less widely held (Sheridan et al., 1994). It is also the least tenable intellectually. Pragmatic inclusion is the most popular of the three (Sheridan et al., 1994). Taggart's argument in favor of a "suspension of disbelief" vis-a-vis clients' belief systems is consistent with the moderate position. It will resonate well with clinicians sensitive to diversity issues and those who appreciate spirituality even if it generally plays no role in their clinical practice. Her recommendation that practices derived from spiritual traditions be included in clinical healing should not be controversial because the practices are nonordeal and have for a long time served different and even opposing ideologies (Foucault, 1988). Equally noncontroversial is her argument that spirituality has a clinical role in hospital and hospice settings.

Taggart's most challenging argument favors the radical inclusion of spirituality and religiosity in therapy. The relationship of a client with the Wholly Other, prayer life, search for the sacred or for existential meaning, conversion and extraordinary experiences, all may be part of the psychotherapeutic encounter, according to Taggart. Although sociology and anthropology have often contested psychological theories, the conversation among those disciplines has always been conducted in a common epistemological language. Taggart's challenge is also more radical than simply questioning psychology's status as the custodian of mental health in that the array of professions, including psychology that now shares the field of mental well-being, all spring from a common knowledge base. Taggart's proposal implies not just a blurring of disciplines and authority, but a postmodern blurring of genres: all "as ifs" are of the same category. The mysterious, the alternative reality, the unverifiable, the unaccounted for are all legitimate content for the clinical gaze. They are not to be dissected or decoded (like dreams in psychoanalysis); rather, they are to be contemplated, listened to, wondered about, and witnessed.

Thus, Taggart ventures into a new frontier in clinical practice that needs to be explored. She raises some fundamental questions: What is psychotherapy? Is it an editing of life's "as ifs"? Who is their editor? Is the unfolding of psychotherapy a "reading" of an existing text or rather the creation of a new one? And last, but not least, what are the political and economic implications of redefining the mental health professions?

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