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         Mental Illness
                    & Spirituality

‘Out of the depths


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and developed by the Wood Family

in loving memory of

Mrs June Wood

Vale June Wood Details

One of the founding members of

A Nouwen Network.

A Nouwen Network is a ‘grassroots’ nonprofit outreach and receives no financial support from any organization. All activities are entirely voluntary.

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PASTORAL CARE AND MENTAL ILLNESS

Pastoral Care and Mental Health: An Anglican Minister’s Perspective          Ian Morrison


I HAD NEVER been to a psychiatric hospital until I began a ten-week term as chaplain to the acute psychiatric ward of a major metropolitan hospital. I did not know what to expect nor how I would be received by both staff and patients. I was aware that some psychiatrists considered religious beliefs to be a form of mental illness, and I also knew that mental illness sometimes evidenced itself in a patient’s religious delusions. I discovered patients who were trapped within themselves, unable to find the resources to survive, often unable to communicate effectively with others and thus unable to integrate with societal norms. They were therefore open to being labelled as a category of person to be avoided – the modern- day equivalent of biblical outcasts. But while the world may consider them different, the Christian response should be to include the mentally ill in the Christian community of hope. My experience was that some of my patients had a lot to teach me about what it means to be truly human.

Literature on pastoral care for the mentally ill generally speaks of ‘spiritual care’ as a distinct segment of a patient’s wellbeing, as if the patient’s needs for medical, pastoral and social help were separate, though related, forms of care. Psychiatric discourse is currently the most influential ideology in mental health. It sees the causes of mental illness as dysfunctional brain activity [1] and its treatments are pharmacological and behavioural, aimed at the amelioration of the symptoms. There is a tendency in the current literature and approach to mental health to compartmentalise ‘pastoral care’ as a distinct but separate element of patient care. Rather than capitulate in the medicalisation of this significant area of human experience, Christian spiritual tradition should apply its understanding of the emotional vicissitudes (resulting from the desires and frustrations experienced by human beings in their heartfelt pursuit of living in a creative relationship with God) by locating the manifestations of disturbance in mental health within the larger quest of the deeper regions of human experience.[2]

Spirituality and religion are sometimes used interchangeably in mental health literature but a distinction between them is often noted. Spirituality is seen as a person’s experience of, belief in, and relationship with, a power (some concept of transcendent reality, a deity) apart from their own existence, and/or an individual’s search for meaning. Religion is the organised outward practice of a system of spiritual beliefs, values, codes of conduct and rituals – a platform for the expression of spirituality. Religion has been identified as an important factor in community health. Spirituality infers a sense of well-being, and incorporating its use in inpatient mental health treatment is now seen as beneficial.

Spirituality, alone, is poorly defined and understood in relation to mental illness. Most empirical studies have involved identifiable religiosity in patients. Additionally, some mental health professionals have difficulty discerning between mental illness and spiritual experiences, [3] particularly where a spiritual crisis may occur at the same time as a psychotic episode.[4] There has been little critical dialogue within contemporary experience of mental health between psychiatry and religious tradition,[5] yet those who suffer mental health problems have been identified as the biblical poor and lepers of the modern age.[6]

Suffering in the context of mental health is uniquely formed of many layers and many levels, often challenging personal meaning systems.[7] It is here that lines of multiple social and individual deprivation intersect. Outside the criminal justice system, poor mental health is the major symbol of exclusion in our society. Being a whole person implies having physical, emotional, social and spiritual dimensions – undivided and interwoven so that the dimensions cannot be treated separately as the psychiatric discourse may seek to do. Ignoring any of these aspects of humanity may leave patients feeling incomplete and may even interfere with healing.[8] Competing with psychiatric discourse is the spiritual– theological discourse – the holistic ideology of personhood. This emphasises the human journey towards deeper integration with God: a quest for health, wholeness.

WHOLENESS

In the context of a psychiatric ward, I wondered what wholeness meant for the mentally ill. For many there will be no cure, no casting out of the demons and return to ‘normality’ (if such a state can be defined). Rather, their hope may be to reach some stability through medication which allows them some basic human functions and limited interaction with others. Yet I found that many of those I encountered, despite having difficulty with day-to day-interaction, had a belief system that provided life-sustaining meaning.[9] It has been suggested that mental illness may provide a ‘wake-up call’ to a spiritual life, in that spirituality becomes more important to patients when they become mentally ill.[10] Issues such as ‘What is my purpose in life?’ and ‘Why does God let bad things happen?’ come to the surface; it has been further suggested that the development of mental illness has prompted some patients to embark on a spiritual journey that was personally relevant and meaningful.[11]These issues, then, relate to potential interactions about God between patients and their carers. Many psychiatric inpatients have reported the importance of spiritual issues to them but do not have the opportunity to talk to anyone about those issues.[12] Some have expressed reservations about such a discussion, concerned that the mental health professionals may not accept their beliefs and experiences, or that these beliefs would be judged as symptoms of mental illness [13] and delusion. Some acknowledged that their spiritual beliefs did not disappear if they felt health workers would interpret them as psychosis: patients merely chose not to disclose the issue further.[14] One option is the provision of a pastoral carer or chaplain for inpatients, someone that patients associate with the allied health team rather than the medical team. . Those who are most comfortable with their own spirituality are also likely to be most comfortable with addressing the spirituality of their patients.[15]I was amazed at the openness of many patients to the need for prayer to assist them in their predicament. Patients openly asked for it, and literally queued up to see me as I was recognised as a person of prayer

The ‘simple act of turning one’s mind and heart to the sacred’ [16] is a powerful form of coping – a communication or conversation with a power that is recognised as divine.[17] Group prayer may be associated with greater well-being and happiness, solitary prayer with isolation and depression, although I found that most patients preferred individual prayer. I gave them an opportunity of saying what they would like to pray for and many stated afterwards that they felt better having had the opportunity to pray. This experience was church for these patients. Unable to interact socially in a social church setting, they were open to the interaction with God that prayer provides and were able to acknowledge the effect it had on them.

Collaborative relationships with patients’ clergy and chaplains can provide structured assistance with mental health problems in a balanced and holistic manner.[18] The engagement of a pastoral carer or chaplain for inpatients has already been suggested as a means of distancing the spiritual discussion from clinical diagnosis. The appropriate strategy is to convey to the patient a willingness to listen carefully to their beliefs without judgement and without the desire to insist that the patient’s beliefs be different from what they are[19] (so as not to be seen as imposing one’s views on the patient[20]).

Additionally, the use of discussion groups where non-acute psychotic patients can discuss spiritual issues of concern to them would also allow the expression of views in a non- threatening environment. This may be particularly important for adolescent patients [21] who are capable of abstract thought on existential and transcendent concepts and for whom exploration of these questions is an important part of identity formation and self-worth.[22] Some patients have indicated a desire to explore spiritual issues; spiritual frameworks formed through discussion may help them to make sense of the experience of becoming mentally unwell. Rather than insist that such spiritual experiences are symptoms of mental illness which should be treated so that they can be eradicated, it may be helpful to develop an understanding of these unusual experiences as part of the totality of human experience[23]–mindful always of any religious views which appear dangerous[24]. I conducted a weekly ‘Spirituality Discussion Group with Ian’. Most discussions centred around why bad things happen to people and how we might view God as a source of hope for the future through what Jesus Christ has done for us rather than seeing illness as some form of personal judgement against the patient. Understanding that the Triune God suffered on the Cross, that God does not leave them in this place but accompanies them as the true pastoral carer in a place which is not of their choosing, is the comfort and basis for hope in this dark place. As a pastoral carer, my role was to point to the one who does the pastoral care, the Triune God, who provides sustaining love and care through all those who tend to these patients.

PASTORAL CARE

Rather than seeing pastoral care as a separate need of mentally ill patients, I would prefer to embrace all care as pastoral – the journey to wholeness involving medical, social and personal aspects. In this sense, all carers are contributing to God’s desire to bring his creation to the fullness of its being. Spirituality should not be segmented as if it were a separate element. The whole of life is embraced in who God is and all carers are doing God’s work (whether conscious of it or not) by participating in the life which God gives us through Christ. Medical knowledge and resources are but one gift from God which enables us to be more human.


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