This study measured distinctions made by a sample of clergy and mental health professionals in response to three categories of presenting problems with religious content: mental disorder, religious or spiritual problem, and "pure" religious problem. A national, random sample of rabbis (N = 111) and clinical psychologists (N = 90) provided evaluations of three vignettes: schizophrenia, mystical experience, and mourning. The participants evaluated the religious etiology, helpfulness of psychiatric medication, and seriousness of the presenting problems. The rabbis and psychologists distinguished between the three diverse categories of presenting problems and concurred in their distinctions. The results provide empirical evidence for the construct validity of the new DSM-IV category religious or spiritual problem (V62.89). Use of the V code allows for more subtle distinctions among the variety of problems that persons bring to clergy and mental health professionals. These distinctions may also provide a foundation for the initiation of co-professional consultation.
1 Intervention Research Center for Geriatric Mood Disorders, Department of Psychiatry, Weill Medical College of Cornell University, Box 194, 21 Bloomingdale Road, White Plains, New York 10605. Send reprint requests to Dr. Milstein.
2 Department of Counseling and Clinical Psychology, Teachers College, Columbia University, New York, New York.
3 Division of Epidemiology, Mailman School of Public Health, Columbia University and the New York State Psychiatric Institute, New York, New York.
This work is supported by grant T32 NRSA MH19132 from the National Institute of Mental Health. The study was assisted by a grant from the Lilly Endowment, and support was received from a fund established in The New York Community Trust by DeWitt Wallace. The results were presented in part at the 107th annual convention of the American Psychological Association, Boston, August 20-24, 1999. The authors thank Stephen Hurt, Ph.D., Tatsuyuki Kakuma, Ph.D., and Kenneth Levy, Ph.D., for their comments on an earlier draft of this manuscript. We thank Andrea Casson, M.A., for her superlative data management. We also thank the rabbis and psychologists who graciously agreed to participate in this study.