My one-time colleague and spiritual brother Rob Poole et al have expressed opinions which are to be respected (Psychiatric Bulletin, September 2008, 32, 356–357). However, they may be in error when claiming that Koenig's editorial (Psychiatric Bulletin, June 2008, 32, 201–203) is attempting ‘to shift the boundaries of psychiatry’. There are no such boundaries, only pseudo-boundaries. Although human experience can be thought of in terms of physical, biological, psychological, social and spiritual dimensions (Reference CullifordCulliford, 2002), there are no limits to or rigid cut-offs between them. They are indivisibly interconnected. Psychiatrists acknowledge continuous, fluid and potent interactions between the realms of biological brain and psychological mind, also between minds and society. Why not therefore recognise equally powerful, frequently healthy and therefore relevant movements of energy between minds and souls or whatever we experience as spiritual?

The eminent psychiatrist George Vaillant has recently, for example, written about the close relationship between spiritual experience and positive emotions like joy and hope (Reference VaillantVaillant, 2008). I have marshalled elsewhere (Reference CullifordCulliford, 2007a ) some arguments in favour of paying attention to the spiritual lives of psychiatric patients. To avoid doing so risks two important things: first, missing opportunities to improve rapport (‘getting alongside patients’ to use Poole et al's terminology) and patient adherence; and second, clinicians missing similar opportunities for additional personal growth through the reciprocal effects of compassionate intervention. Healthcare is a two-way process, and I have described in my book Love, Healing and Happiness (Reference CullifordCulliford, 2007b ) how this kind of growth comes about. Poole et al need not be too alarmed because none of this necessarily has anything to do with religion. In developing a non-denominational language of spirituality (using terms like ‘spiritual awareness’, ‘spiritual practices’, spiritual values’ and ‘spiritual skills’) members of the Spirituality and Psychiatry Special Interest Group have taken pains to avoid some of the risks they outline. I look forward to continuing the ‘serious debate’ for which they say ‘there is an urgent need’. To repeat, however, where boundaries do not exist, they cannot be blurred.

Declaration of interest

Larry Culliford is on the executive committee of the College's Spirituality and Psychiatry Special Interest Group. He has been paid to lecture on spirituality and mental healthcare, spirituality and healthcare, also spirituality and education. Until 2008, he taught a student-selected component to 3rd year medical students at Brighton and Sussex Medical School on spirituality and healthcare.