BACKGROUND : Although religion and spirituality are increasingly recognised as important in the
understanding and treatment of patients, there are also concerns about their role in psychiatry.
The recommendation for the integration of spirituality in the approach to psychiatric practice
highlights the importance to further think about this practice.
OBJECTIVE : To contribute to the debate on the role of spirituality in psychiatry by considering
the opinions of two prominent thinkers in this field, the theologian Tillich, and the psychoanalyst
METHOD : The approach of Tillich and Symington to mental health problems are compared.
Narcissism is focussed on, since Symington describes narcissism as the core of all pathology
and states that the prime aim of psychoanalysis is the transformation of narcissism. The
contributions of Kohut and Kernberg are also briefly discussed.
RESULTS : In Symington’s opinion more than psychoanalysis is needed to help those in the grip
of narcissism. Tillich emphasises the difference between existential anxiety and anxiety due to
psychopathology. Psychotherapy can only heal the latter. Yet he also states that we are
incapable of change without self-acceptance. For this a larger experience of acceptance or grace
is needed, since we are incapable of offering ourselves this type of acceptance.
CONCLUSION : In the struggle to get a grip on narcissism, good nurturing experiences,
transformative selfobjects, a confrontation with the darker sides of the self and the message of
ultimate acceptance are needed. Religion and spirituality have an important contribution to
make to psychiatric or psychotherapeutic treatment.