In "Spirituality and Mental Health Across Cultures," Alexander Moreira-Almeida and his co-editors assembled what might be the most comprehensive cross-cultural examination of the relationship between spiritual experience and mental health available in a single volume. The book brings together contributors from psychiatry, psychology, anthropology, and religious studies across multiple continents to address a deceptively simple question: how do different cultures understand the intersection of spirituality and mental health, and what can the mental health professions learn from this diversity? The answers turn out to be both fascinating and deeply challenging to Western clinical assumptions.

Moreira-Almeida is particularly well-positioned to lead this inquiry. As a Brazilian psychiatrist and researcher, he works at the intersection of cultures that hold very different relationships with spiritual experience. Brazil's mainstream psychiatric establishment operates within Western biomedical frameworks, while much of the population engages deeply with Spiritist, Afro-Brazilian, and indigenous spiritual practices that include mediumship, trance states, and communication with spirits—experiences that Western psychiatry would often categorize as pathological. This lived experience of cultural complexity infuses the book with a practical urgency that purely academic treatments of the subject often lack. The result is a work that doesn't just catalogue cultural differences but uses them to interrogate the hidden assumptions of Western mental health practice itself. For IMHU's community, this book provides essential evidence that what counts as "mental health" and "mental illness" is far more culturally constructed than most clinicians acknowledge, and that expanding our frameworks isn't just about cultural sensitivity—it's about clinical accuracy.

The book's central insight is both obvious and revolutionary: what gets classified as mental illness depends enormously on where you happen to be. Hearing voices, entering trance states, communicating with the dead, experiencing possession by spirits—these phenomena are pathologized in mainstream Western psychiatry but understood as normal or even valued in many other cultural contexts. A Brazilian Spiritist medium who channels deceased individuals during healing sessions is performing a respected social role. An American who reports the same experience in a clinical setting is likely to receive a diagnosis of psychotic disorder. The experience might be phenomenologically identical, but the cultural response—and therefore the outcome for the individual—is radically different.

Moreira-Almeida and his contributors don't use this observation to argue that mental illness isn't real or that all spiritual experiences are healthy. They use it to demonstrate that Western diagnostic categories embed cultural assumptions that are invisible to most clinicians trained within them. When the DSM describes "hallucinations" or "delusions," it assumes a particular model of consciousness and reality. Experiences that don't fit this model get categorized as symptoms of disorder, regardless of their meaning within the person's own cultural framework. The book makes a powerful case that this isn't just a matter of cultural insensitivity—it's a matter of diagnostic validity. A diagnostic system that can't distinguish between a psychotic episode and a culturally normative spiritual experience is a system with a significant accuracy problem, and that problem has real consequences for real people.

Several chapters examine specific spiritual practices—particularly mediumship and trance states—that pose direct challenges to Western psychiatric classification. The research on mediumship is particularly compelling. Studies of experienced mediums in multiple cultural contexts have found that the practice is generally not associated with psychopathology. Mediums tend to show normal or better-than-average psychological functioning, good social integration, and no higher rates of psychiatric disorder than the general population. Some research even suggests that regular mediumistic practice may be associated with better mental health outcomes.

This creates an awkward situation for Western psychiatry. If the experience of communicating with deceased persons is a symptom of psychosis, why don't mediums show the functional impairment, distress, and deterioration that characterize psychotic disorders? If it's not pathological, what is it? The book doesn't insist on any single answer, but it does insist that the question deserves serious engagement rather than dismissal. The contributors explore various frameworks: mediumship as a culturally structured dissociative capacity, as access to transpersonal dimensions of consciousness, as a form of enhanced empathic sensitivity, or as something that current scientific paradigms simply don't have the tools to explain. Whatever the mechanism, the empirical evidence suggests that these experiences can be integrated, functional, and meaningful—which means that automatically pathologizing them is not just culturally insensitive but scientifically unjustified.

One of the book's most practically valuable contributions is its guidance on how clinicians can assess spiritual experiences without defaulting to the assumptions of their own cultural training. The contributors propose assessment frameworks that consider multiple dimensions: the cultural context of the experience, its impact on the person's functioning, the degree of personal distress involved, the level of control the individual has over the experience, and whether the experience is consistent with the person's developmental trajectory and spiritual tradition.

This kind of culturally informed assessment requires clinicians to develop what the book calls "cultural humility"—a genuine recognition that their own clinical framework is one perspective among many rather than a neutral, objective standpoint. It means asking questions before making interpretations: What does this experience mean within the person's own tradition? Is this experience recognized and supported by their community? Does the person have elders, teachers, or spiritual guides who can help them navigate it? Are they distressed by the experience itself, or by the fear of being judged or pathologized? These questions can fundamentally change the clinical picture. An experience that looks like psychosis through a Western lens might look like a recognized spiritual development process through the person's own cultural lens—and the research suggests that the person's own framework often provides more accurate predictions about outcomes than the clinician's imported categories.

The book goes beyond arguing that spiritual experiences shouldn't be pathologized to make the positive case that spirituality and religious engagement often function as significant mental health resources. The research assembled here is substantial: religious and spiritual involvement is associated with lower rates of depression, substance abuse, and suicide across multiple populations and cultural contexts. Spiritual practices like prayer, meditation, communal worship, and pilgrimage provide coping resources, social support, sense of meaning, and frameworks for integrating suffering that complement and sometimes exceed what clinical interventions can offer.

This evidence challenges clinicians to reconsider their relationship with their clients' spiritual lives. Rather than treating spirituality as a private matter irrelevant to clinical work, or as a potential source of pathology to be monitored, clinicians might learn to recognize it as a therapeutic ally. A client's faith community might provide the sustained relational support that weekly therapy sessions can't. Their prayer practice might offer emotional regulation capacities that supplement clinical techniques. Their spiritual framework might provide meaning-making resources that help them integrate traumatic experiences more effectively than cognitive restructuring alone. None of this means spiritual resources should replace clinical care—but ignoring them means working with only part of the toolkit available for healing. The book advocates for a collaborative relationship between clinical and spiritual resources that serves the whole person rather than artificially separating domains of human experience that are, for most people, deeply intertwined.

The book's final and perhaps most far-reaching argument concerns the global mental health movement. As Western psychiatric models are exported worldwide through international organizations, training programs, and diagnostic systems, there's a real risk of cultural imperialism disguised as clinical standardization. The assumption that Western diagnostic categories and treatment approaches represent universal truths about human mental functioning—rather than culturally specific frameworks developed within a particular historical and philosophical context—leads to the systematic devaluation of indigenous and traditional approaches to mental health that have served communities effectively for centuries or millennia.

Moreira-Almeida and his contributors argue for a genuinely pluralistic approach to global mental health that takes local knowledge systems seriously as sources of clinical wisdom rather than merely obstacles to implementing "evidence-based" Western practices. This doesn't mean abandoning scientific rigor or accepting all traditional practices uncritically. It means expanding our definition of evidence to include the accumulated wisdom of diverse healing traditions, training clinicians to work across cultural frameworks rather than imposing their own, and building mental health systems that are genuinely responsive to the people they serve rather than to the assumptions of the cultures that designed them. For IMHU, this book provides the scholarly foundation for a claim the organization has been making all along: that the future of mental health lies not in the global spread of Western psychiatry but in the creation of something more capacious—a framework that can hold multiple ways of understanding consciousness, suffering, and healing without reducing any of them to the terms of any other.