About Mercy Ministries
Ministries is a national non profit organisation dedicated to providing
homes and care, free of charge, for young women suffering the effects
of eating disorders, self harm, abuse, depression, unplanned
pregnancies and other life controlling issues.
Mercy Ministries provides a 6 month structured residential based programme that includes life-skills training, Equine Assisted Therapy and professional counseling based on Christian principles.
We provide a holistic programme that addresses all aspects of a young womans well being; physical, spiritual and emotional. Our goal is to have each young woman not only complete the programme but also discover the purpose for her life and bring value to her community as a productive citizen.
Who we help
Mercy Ministries UK helps young women between the ages of 16-28, who display a sincere desire to change. Young women come to Mercy Ministries suffering the effects of eating disorders, self harm, abuse, depression, unplanned pregnancies and other life controlling issues.
Why we existA recent national inquiry into self-harm reported that 1 in 15 young people self harm and that the UK has the highest rate of self harm in Europe. Eating disorders, depression and attempted suicides are all on the increase in our nation. There is a desperate need for organisations like Mercy Ministries UK to help provide the kind of support that tackles the root causes of these issues, rather than merely medicating the symptoms. We seek to help break the cycle of destruction by helping one young woman at a time find freedom and restoration in a safe home-like environment; this in turn will positively affect the generation she will parent and drastically reduce the chances of history repeating itself. We believe that this way freedom for one can bring freedom for many.
December 23, 2007 at 09:24:25
By James Callner, MA, AFOCD President. James Callner is an award winning writer, filmmaker and speaker on mental illness.
Note: Use of the word "spiritual" is not meant as a reference to any organized religion; instead, "spiritual" is meant to be understood as one's spirit that needs to be mended or reclaimed.
Who Knew? A phrase my Jewish relatives instilled in me decades ago. Who knew, that spiritually would be the strongest, most lasting, medicine for my Mental Illness? Who knew, that reclaiming and cultivating the damaged spirit within me would calm the trauma of Anxiety, Panic and Depression? In 1982, at age 29, I had a devastating nervous breakdown and was hospitalized in a psychiatric ward for six weeks.
Over twenty five years later I still dont know why they call it a nervous breakdown? My nerves didnt breakdown. I certainly had tactile feelings. I could touch my own arm and feel the sensation. So what nerves broke down? I have come to learn that it wasn't my nerves but my emotional defenses, my emotional guard; my perception of who I am that became confused and full of fear. I became fearful of living. Sounds scary? It was beyond scary.
I had an extremely severe case of (OCD) Obsessive Compulsive Disorder, a disorder that I experienced as a child and throughout adolescents without knowing it. When my full onset hit in 1982, my symptoms were classic OCD such as, Washing, Checking, Counting, Obsessions about harming others, etc The primary symptom was the phobia of Germs and Contamination. I would let no one touch me for fear of passing or receiving germs. The touch example will give you a basis of how OCD Germ and Contamination phobia works. If you touch me I develop anxiety, questioning what germs are on your hands. Then I would start obsessing if those magical germs may harm me? The magical thinking or obsessing exacerbates.
My fearful inner dialogue continues: "You touched my hand. I now have your germs. If I touch someone, those germs may get on some one else and harm them. They may get sick or die, simply because I wasnt careful, and its my entire fault! Sound irrational? It was. However, OCD is not a psychotic disorder, its a neurotic disorder. Its a Worrying state of being. It is a progression of obsessions (worrying thoughts) and compulsions (behaviors to try to control the worrying thoughts) all expressed from fear. It develops into anxiety and panic.
However, at the same time the OCD mind is frustrated and confused. I used to say to myself, this is ridiculous, how can this be happening? I dont really believe all these obsessions, but why cant I stop? OCD is a neurological disorder. It is a progressive disorder if not treated. In 1982, there was little or no OCD medication that would help. Anxiety reducing medication and ERPT, Exposure-Response-Prevention-Therapy worked the best for me; Ill talk more about that later. I became much worse before I started my journey to recovery. Washing hands nine hours a day, bathroom rituals taking up to four hours per day, two hours to take a shower, checking and counting with scrupulosity. I was obsessed with fear of virtually all my surroundings.
I had lost my job, my relationship, my apartment, and my life. I remember my Psychiatrist sending me the message that this would be the greatest journey of my life. My question was; when does it end? When does this great journey find peace? When will it all stop? I was willing to do any thing to make it stop! Recovery began with anti-anxiety medication so I could begin the long process of Exposure Response Prevention Therapy (ERPT). This was a process of exposing myself to fears and phobias and then not responding with rituals. Example: Using ERPT with a phobia of public bathrooms and germs. Heres how it worked for me. I would get cognitive support from my psychiatrist to work up a head of emotional muscle to take the risk of using a public bathroom. Then I went to a local hotel lobby. I used the bathroom. Now, the trick was not to ritualize the fears away by washing my hands for hours. I washed my hands twice and walked out the door. I then had a wave of anxiety that I was instructed to feel the feelings. Not go back and wash or do any other ritual to take care of that feeling. Just sit with it and let it dissipate. It worked!
I have been doing ERPT since 1982. I had a tool that with much practice would be a solid treatment. However, now that I could lean on ERPT to help my symptoms what was there to help balance my emotional life? What was there to bring serenity and peace back in to a life of stress, control and fear? What I found was some thing that I would never have thought of approaching. This nice liberal Jewish boy from Wisconsin was about to enter the realm of Spirituality. The Spirituality I am talking about is not religious in nature. It does not come from any religious denomination or sect. It is a spirituality that is about reclaiming ones broken damaged spirit. Mine needed extreme mending! It all started when my psychiatrist suggested I be around like-people. He recommended going to a 12 Step group. I am not advertising or promoting any 12 Step program. Its not for every one. You have to decide for yourself. I am simply describing my experience and how it guided me to an extremely strong medicine called, Spirituality.
At that time, Obsessive Compulsive Anonymous was virtually nonexistent in my area. My Psychiatrist suggested I go to Al-Anon. I said to him: "Now wait a minute, I dont think so. Theres nobody in my family that is an alcoholic, why are you suggesting Al-Anon? I have OCD." He sat back in his chair with a gentle smile and said; "The first step of all 12 step programs reads the same except for one word. For instance, in Alcoholics Anonymous it will read; We admitted we were powerless over alcohol -that our lives had become unmanageable. In Codependent Anonymous it will read; We admitted we were powerless over others-that our lives had become unmanageable. In Emotions Anonymous it will read; We admitted we were powerless over emotions-that our life's had become unmanageable". Then he looked at me with his soft nonjudgmental eyes and asked; "Jim, what are you powerless over at this time in your life? I replied; My fears, my OCD". He agreed and continued to ask me these bottom line questions. "At any level, has your life become unmanageable or out of control"? I thought for a few seconds. Bang! It all made sense. I had no control over my fears from OCD and my life was a mess because of it. He then asked the crucial question, "Jim, in that first step, do you think you could replace that single word with fears"?
So, on a Wednesday night, I went to my first 12 step meeting. In the beginning I found myself internally fighting with the program. For example: fighting with the principals, fighting with the ideas, fighting with the common sense simplicity of it all. All these slogans that made absolutely no sense to me. Let go, let God. My brain screamed silently; what the hell was that suppose to mean? It was clear that the program was not a religious program. The words, God and Higher Power were used only in the context of choice. A Higher Power of your choosing. It could be the Universe, it could be the group, it could be anything outside of yourself. I went back to my psychiatrist, and asked; "What the hell does Let go and let God' mean?" He replied with words that I carry to this day. He said plainly; All it means is Stop Trying to Figure It Out." For the first time in my life I got very very quiet and literally stopped talking. The committee in my mind, stopped arguing. Something finally made sense. I had been figuring out life for decades rather than living it. Then my brain snapped back into judgment mode. It sounded just too simple for a person so phobic and fearful. I said to him in a defending voice, Stop trying to figure it out? And then what"? He replied with another life changing spiritual concept; "and then, let go of controlling all your feelings and fears. Have them. Own them. Feel them. Life is about feeling all feelings, including fear and not controlling them. Jim, live life on lifes terms not your terms". Ouch, that made sense! I couldnt remember when I just let myself feel fear or anxiety and let it pass through me. I always tried to control it with rituals or obsessions. Spirituality is about rebuilding and reclaiming a damaged spirit. Children, whom have not experienced abuse, judgment or disorders, are children that are full of spirit. They play, they laugh, they explore. When children or adults have any dysfunction, come into their life, their spirit or life force diminishes. The goal of Spirituality is to bring back your spirit with new tools. Tools you may have forgotten. Tools that were always with you, but because of the dysfunction, have faded. For myself, I wanted spirit back. I wanted to let go of control and live in a place of serenity not fear. Control is my issue. There is a very strange paradox about control that you learn when you get in to spiritual work, whether it is through 12 Step programs, Course in Miracles, a large amount of books and tapes on spirituality from authors like Melody Beattie to Wayne Dyer to Deepak Chopra. The paradox is this, When you let go of control and stop trying to figure it out you get control. Let me repeat that. WHEN YOU LET GO OF CONTROL, YOU GET CONTROL. Isn't that strange? I found it unbelievable, but I tried it and it works every time. In rebuilding my spirit I found I was a tremendous people-pleaser, judger and controller. However, I learned a spiritual truth that I use to this day. I don't have control over what other people say, do, act or behave. I can influence other people, but I have no control over them. I have no control your feelings. I have no control over how you are perceiving this information you're reading right now. I do have control over my own thinking. A good example of this was in my beginning years of recovery using spirituality. One Wednesday night I was sitting in a 12 step meeting. In this particular meeting there was an elderly lady sitting in the corner knitting. She never spoke she just listened. She looked a little like Aunt Bea from Mayberry who was a sweet, kind, elderly lady, knitting in the corner of the room. She sat in the same chair, the same place, every meeting, every week. That night I was talking about how bad my day was. I was filled with anxiety, rituals and obsessions. I was exhausted from it all. Mad, frustrated and damn angry! The elderly lady put up her hand for the first time in months. She was chosen to speak. What came out of Aunt Beas mouth was the most profound thing I had ever heard. She quietly said; "You know, you can start your day anytime you want." The room went quiet, very quiet, for a few moments. Then, my thoughts started to judge her statement, as I had been judging her silence for months. How can you start your day anytime you want? I didn't understand. I asked myself. If I have an anxious day from 7am in the morning till 11 at night and I go to bed at 12 midnight, between 11pm and 12 midnight I should start your day!? She quietly expressed; "Exactly, and then went back to knitting. Aunt Bea wasnt Aunt Bea anymore. She was my Guru! That was the day I started to understand gratitude. I had a horrible day but I could make the conscience decision to start the day over no matter what time it was, and be grateful to the Universe or God that I had an hour of a good day. I could then build on that gratitude. Maybe next time I would have two or three hours, just because I changed my attitude in to gratitude.
Start my day over at any given moment, what a concept. Rebuild my spirit at any given moment, what a gift. Take back my power and decide to feel the feelings of anxiety and let them pass, at any given moment. I stopped judging this woman and began coming to meetings hoping she would speak. Adding Spirituality, in all its many forms, to my treatment and recovery from Obsessive Compulsive Disorder has changed my life completely.
I believe that it is the missing treatment modality that many of us need. It has given me life tools to work with. I wish I had a Spiritual Compassion class in the 3rd grade. For the majority of us, we were never taught spirituality without religion attached to it. Relearning how to look at my life from the inside out has been the most powerful medicine I have experienced. On my road to recovery, I continue treatment through cognitive therapy, medicine, exposure-response-prevention therapy, risking, 12 Step programs and spiritual books and tapes. All have helped me get back my life.
The spiritual component has been the strongest. At first, spirituality seemed New Age. Its actually Old Age, based on philosophies centuries old, and now made understandable for us slow learners. Belief was one of the strongest dynamics to change my biology. My heart is now open to all the possibilities of life. My favorite spiritual saying; When the student is ready, the teachers will appear. When I became willing to heal, all new spiritual concepts arrived, and I got better.
Spirituality; who knew?
Mr. Callner started his teaching and professional filmmaking career in his early twenties. He has earned over 35 national and international awards and critical acclaim for writing and directing films about physically and emotionally challenged individuals. In 1982, Mr. Callner himself was afflicted with the devastating anxiety disorder Obsessive Compulsive Disorder (OCD). After over two decades of cognitive, behavioral, spiritual, medical and alternative therapies and treatments, James Callner has emerged as a personal coach, public speaker and educator on moving though the fears and anxieties of life and into self confidence, self esteem and hope.
Christianity and mental health
Mind and Soul have been helping a number of groups around the country to network locally: mental health professionals, pastors or counsellors with an interest in mental health, and also with their own story to tell, says one of the directors, Dr Rob Waller, in the Christians at work newsletter, Networking.
Many mental health professionals say they have found the groups very empowering and a great encouragement to share their faith in relevant ways at work. Mind and Soul has a special section encouraging mental health professionals and articles aimed at the general public. It also produces audio and video resources and a monthly podcast.
"Blessed is he who
preferreth his brother
"Hurt not others in
that you yourself would
As you wish that men
would do to you, do so
"Do not unto others
what you would not have
them do unto you."
"Do naught unto others
which would cause you
pain if done to you."
"No one of you is a
believer until he desires
for his brother that which
he desires for himself."
"That which is hateful
unto you, do not impose
--Talmud, Shabbat 31a
"As thou deemest thyself,
so deem others."
"Regard your neighbour's
gain as your own gain
and your neighbour's
loss as your loss."
--T'ai Shang Kan Ying P'ien
"An ye harm none,
do what ye will."
"That nature alone is
good which refrains
from doing unto another
whatsoever is not good
Spirituality Influences Health, Most U.S. Doctors SayBy Steven Reinberg
TUESDAY, April 10 (HealthDay News) -- The majority of American doctors think that religion and spirituality play an important role in influencing patients' health, a new review found.
And the more religious a doctor was, the more likely he or she was to have a positive view of the impact of religion and spirituality on health, according to the study by researchers at the University of Chicago.
"This study helps explain the phenomenon that, despite many studies that examine the relationship between religion and health, there is an entrenched debate and disagreement about whether there is any such relationship," said lead author Dr. Farr A. Curlin, an assistant professor of medicine.
"A big reason why this debate won't go away is because the debate is not just about the data, it's about the frames of mind people bring to the data," Curlin said.
The majority of U.S. doctors -- 56 percent -- believes that religion and spirituality influence patient's health, Curlin said. "The influence mostly helps patients cope with illness and gives them a positive state of mind," he added.
A minority of doctors -- 7 percent -- believes that religion and spirituality can have a negative influence, Curlin said. "Sometimes, these beliefs can lead patients to refuse or not go along with medically recommended therapies," he said.
Curlin noted that "most doctors don't believe that religion has an influence on hard medical outcomes -- like heart attacks, infections, etcetera. The influence is more on helping get through and cope with an illness."
In the study, published in the April 9 issue of the Archives of Internal Medicine, Curlin and his colleagues sent a survey to 1,820 doctors, and 1,144 -- 63 percent -- of them responded. Included in the survey were questions about the doctors' religious beliefs and attitudes about the positive and negative influence of religion and spirituality.
The researchers found that two-thirds of the doctors believed that illness often or always increases patients' awareness of religion and spirituality. In addition, 56 percent thought religion and spirituality had a significant influence on health. Also, 54 percent believed that, sometimes, a supernatural being intervenes in care.
Most doctors -- 85 percent -- thought that religion and spirituality was generally a positive influence, but only 6 percent thought that religion and spirituality changed medical outcomes, Curlin's team found.
Curlin's group also found that 76 percent of doctors thought religion and spirituality helped patients cope, 74 percent thought that it gave patients a positive state of mind, and 55 percent thought it gave emotional and practical support through religious community.
Only 7 percent thought religion and spirituality caused negative emotions such as guilt and anxiety, and 2 percent thought it lead patients to decline medical therapy.
In addition, Curlin said that how doctors viewed the contribution of religion and spirituality depended on their own religious beliefs. "Doctors who are not religious say that their patients don't bring up religious or spiritual issues and think that religion impacts in negative ways," he said.
"Doctors who are more religious say their patients do bring up religious issues and that religion has a positive influence," Curlin said.
Dr. Harold G. Koenig is co-director of the Center for Spirituality, Theology and Health at Duke University Medical Center. He said most doctors don't really understand the positive effects that religion can have on patient outcomes.
"There is a misconception or lack of knowledge by many physicians about the effects of religious involvement on hard outcomes, and the under-appreciation of the patients' ability to cope and patients' positive state of mind have on their physical health," Koenig said.
Physical and emotional health are connected, Koenig said. For example, stress can have effects at the cellular level, he noted. "Women under stress have their cells age about a decade faster than women not under stress," he said. "There is evidence of the effect of stress and anxiety on heart attack, on survival, stroke and high blood pressure. If nothing else, it affects patients' motivation toward recovery."
Koenig thinks doctors should be aware of a patient's spirituality. "We don't want doctors to be addressing spiritual issues with patients," he said. "But they've got to know about them and if they make a difference in their coping and in their medical decisions."
James A, Wells A.
Bolton, Salford and Trafford Mental Health Partnership, Bolton, UK.
PURPOSE: Religion is frequently ignored within the clinical domain. Yet when examined, empirical evidence indicates that specific aspects of religiosity are correlated with mental health. The established associations between religious dimensions and mental health could be mediated by cognitive-behavioural mechanisms. This paper proposes a preliminary conceptual framework in which two types of cognitive and behavioural mechanisms are described, (1). generic mental models that provide a basis for guiding appraisals of life events and (2). self-regulation of thinking processes (metacognitive control). METHOD: A critical analysis of extant literature was employed to examine support for each of the mechanisms. DISCUSSION: Evidence supports the idea that a religious framework can serve as a generic mental model that influences appraisals and affects well-being. The benefits derived depend on the salience of the framework, level of certainty with which attributions can be accepted, and the content of the information. Evidence for the self-regulation mechanism is weaker. Although consistent with this supposition, it requires further empirical evaluation. CONCLUSION: The relationships between religious variables and mental health may depend on cognitive-behavioural mechanisms. Developments in this area might encourage clinicians to consider further the ways in which religious variables might be utilized and assessed in therapy. However, there is a need for further efforts to incorporate religious and spiritual factors in the clinical arena.
Religion in Mental Health
Staff writer for the Health and Science section of Islamonline
According to the World Health Organization this year, depressive disorders are the fourth leading cause of ill health and disability amongst adults worldwide. By 2020, it is expected that mental health disorders will represent the worlds largest health problem (Duckworth p.2). The spread of urbanization has been viewed as a major contributory factor to this as although it does increase opportunities for many, it also increases the pace of living and individualism.
The pressure to assimilate can be a daunting factor for immigrants even though waves of immigration over decades have enriched life in the United Kingdom; a culture that increasingly fails to provide a valid meaning for life. In the process it is not only many members of the immigrant population that become vulnerable to mental ill health, but also many indigenous people as well.
Their unique contributions, no matter how small, become devalued and sidelined while the crisis of modern day living becomes greater than they and those around them can handle. Where religion once offered order in home life and the outer world in addition to an opportunity towards self-understanding and growth, the calls of the outer world seem to promise offers of instant rewards whereby one can easily follow the piper that plays the sweetest tune. For those who have worked in the booming British mental health industry another story is told; a story that highlights the inadequacies of modern psychiatry for both the indigenous and non-indigenous alike.
When British journalist Magnus Linklater read A Memoir of Moods and Madness by psychologist and manic depressive Kay Jamison, he discovered that she had confronted a disease that has defied many including the experts - remaining unreflected in the rhetoric of last years governmental White Paper on Reforming the Mental Health Act in England. In fact the gory details of the history of the British mental health industry up until today has done little to explore the minds of the mentally unbalanced, still strapped by fear of the unknown and embarrassed by the minds that are losing their own. Control has been the order of the day repressed by drugs, other forms of treatment and the judicial system. As in some parts of Africa today, once under the Muslim Turks in medieval Anatolia the hospital villages of the Seljuk Empire viewed the mentally ill as people not to be feared and tortured as in the West but as ill people who had the choice to be admitted into the community under protection to be treated free of charge exempt from income tax on any income they would make (Songar p.3).
In todays National Health System in Britain, Archies height was found to be intimidating to his fellow students thus attracting defensive aggression caused by the insecurity complexes of the mentally well.
His manic depression began at school and he was eventually unable to cope with school life.
Archie's response to his arrival at a mental hospital was, to say the least, aggressive, being dragged inside kicking and screaming. From North to South he has resided in many hospitals and escaped many times. He has been exposed to a torrent of treatments but it was his inner recognition of his rights, character and will that survived the dilemma (Linklater 1-3). It is these characters I have found that are most likely to survive and end up the least handicapped, but for others the story is not the same especially where culture is involved as an additional fear to be reckoned with.
Ethnic Minorities Imprisoned in their own Minds
Both users and providers of the system have reflected concerns in many specialized British publications. The British mental health system has shown over-representation by certain groups, including Muslims.
Research has found that ethnic minorities are more likely to be admitted to hospitals under compulsory sectioning of the Mental Health Act (1983) requiring urgent treatment and thus placed in locked-up wards. They are likely to be diagnosed as schizophrenic not recognizing the reaction to how they are being treated (Hussein p.1) Sometimes incarceration is in a prison cell. Once at the mercy of this end of the mental health system, it is difficult to get out. If you were not a schizophrenic when you entered, the likely-hood of becoming one once on the inside is great due to the high doses of neuroleptic drugs given in preference to non-drug based treatments such as therapy. In a society that up until recently doesnt equate religion as a way of life and is insensitive and ignorant towards any cultural and religious practices other than its own a process of imprisoning of the mind occurs among some groups increasing reactions of depression and anger as a result of the way they are perceived and treated.
Many writers have highlighted that this stems from a racial stereotyping and cultural imperialism adopted by mental health professionals amongst a people who have become increasingly emotionally disabled due to the sterile environment. (Hussein p.1). This in reality is not surprising, as modern psychology has largely been dependent on a tradition that divorces the importance of the soul from the social being. No attempt is made to develop any detailed understanding of how the religious beliefs of Muslims influence their relationship to themselves and their environment. It has been the experience of family members and some supportive communities that have challenged the machinations of the mental health system seeking accountability and change. From this has arisen community-based support agencies and professionals often under-resourced and undermined. It was these resources that were found useful in response to the backlash of September 11th. The Association of Muslim Schools enlisted consultants to advise teachers on how to handle the situation. Many teachers, however, have preferred to take a personal approach to each pupil. Some Islamic schools have used prayer as a means of achieving calm, whilst others have held discussion workshops. One pupil from an Islamic School experienced recurrent nightmares about the events. She feared that Islamic schools, as gathering points for Muslims, might be bombed and she also held anxiety for her relatives in Pakistan. When Afghanistan first began getting bombed, my mum was so scared for my safety, she didnt want me to go to school. I was scared too but she read some verses from the Quran and I felt better after that (Akbar p.8).
In a report in the Journal of General Internal Medicine in 2000 there was a call to improve guidelines for the treatment and detection of depression and to ascertain the characteristics of a physician that might contribute to the under-detection of depression in minorities (Reuters Health p.1). This is probably due to the stereotype of what constitutes the symptoms of depression. Undetected, it can vent itself in the form of aggression or withdrawal.
Mental Health and Spirituality Go Hand-In-Hand
Islamic teachings encourage patience, prayer and turning to Allah (swt) in times of need and for guidance, but when one is struggling to survive in society and when discerning what is important isnt easy, one can easily lose ones way. This happens even in some Islamic countries undergoing fast urbanization whereby the states desire to catch up with the rest of the world has had a marked effect.
These emotional stresses communicate themselves through somatic or physical complaints. That is because they believe, then disbelieve, so a seal is set upon their hearts so that they do not understand (Surat ul Munafiqun 63:3). And there we are, separated from our hearts the seat of emotion, awareness and wisdom amongst physicians whose trade is not guided and informed by these notions. It is only recently, that there has been increased recognition through person-centered medicine of the major role of psychosocial factors in the patients well being and illness. Studies fail to address the question of why physicians may be less religious and why they appear to resist discussing religion in the clinic (Chibnall p.1). Over the last 30 years, hundreds of services claim to use psychosocial rehabilitation, however there is unfortunately great confusion as to what this means and entails (SDG p.2). Mental Health Social Worker Abul Hussein argues that religion or spirituality can act as a part of the holistic healing process the center of balance that gives calmness and peace so vital to recovery (Hussein p.4).The awareness of what resources we have at our disposal when applied creatively can achieve a lot. It is not only for us to develop it further, but for modern mental health to realize that the process of returning to a state of balance can best be addressed by recognizing and assimilating the inner wealth already in possession of the patient spiritually, psychologically and culturally. Only then will modern mental health be equipped with the resources it needs to facilitate its original objective.
Religious Beliefs and Practices Are Associated With Better Mental Health in Family Caregivers of Patients With Dementia: Findings From the REACH StudyRandy S. Hebert M.D., M.P.H., Qianyu Dang, Ph.D., and Richard Schulz, Ph.D.
From the Division of General Internal Medicine, Section of Palliative Care and Medical Ethics (RSH), the Division of General Internal Medicine, Center for Research on Health Care (QD), and the Departments of Psychiatry, Psychology, and Sociology (RS), University of Pittsburgh, Pittsburgh, PA.
Objective: Providing care to a loved one with dementia and the death of that loved one are generally considered two of the most stressful human experiences. Each puts family caregivers at risk of psychologic morbidity. Although research has suggested that religious beliefs and practices are associated with better mental health, little is known about whether religion is associated with better mental health in family caregivers. Our objective, then, is to explore the relationship between religion and mental health in active and bereaved dementia caregivers
Methods: A total of 1,229 caregivers of persons with moderate to severe dementia were recruited from six geographically diverse sites in the United States and followed prospectively for up to 18 months. Three measures of religion: 1) the frequency of attendance at religious services, meetings, and/or activities; 2) the frequency of prayer or meditation; and 3) the importance of religious faith/spirituality were collected. Mental health outcomes were caregiver depression (Center for Epidemiological StudiesDepression [CES-D] scale) and complicated grief (Inventory of Complicated Grief [ICG]).
Results: Religious beliefs and practices were important to the majority of caregivers. After controlling for significant covariates, the three measures of religion were associated with less depressive symptoms in current caregivers. Frequent attendance was also associated with less depression and complicated grief in the bereaved.
Conclusions: Religious beliefs and practices, and religious attendance in particular, are associated with better mental health in family caregivers of persons with dementia.
Key Words: Caregivers bereavement religion mental health
Comment: Soul searching
Posted: 12 October 2006
Medicine is not enough for Laura Lea who has mental illness, but she has an idea of what she does need
It has been impossible to tell my family about the experience of being mentally ill. No one apart from my ex-husband knows about my diagnosis, nor do they know what its like inside my head. Once I was asked by a church minister to describe it and I told him to think about the worst thing that happened to him, his worst hour, and then it just keeps going on without relenting. This is the nearest to what its like.
There is a lot to say about my illness, my decision not to tell my family and how I feel about it all but so little opportunity to say these things where its safe and useful. Recently I was at a conference on spirituality, religion and mental health for social workers, nurses, service users and carers. I spoke about the danger and pain in mental distress by reading out some words Id written.
Id spent two years as a member of a strategy group talking to senior managers and others in West Sussex about how to bring spirituality into a holistic approach to mental health care. Lots of workers seem unsure about spirituality, how it is relevant and whether there is time or space to make it part of their practice. But without hope, without addressing all aspects of my world, my practical needs and my hurting heart and head, recovery would be difficult.
I told the conference that in the light my thoughts start to race and pain tightens in my stomach. Panic stalks me. I have to be careful. If I allow the panic, fear will have me. I am possessed, like a bird that sees its own reflection in the house window and, mistaking itself, flies at its own image.
It isnt enough to decide that I want to refrain, to begin the painstaking work of understanding when I am becoming trapped by my mind and to then find a different way. How can I do this work without a reason or only because of the forgotten dream of living in an ordinary way, with ordinary human misery and ordinary human joy?
I need healing, I need a reason to try, I need an anchor to keep me steady in the storm. Alone in the light I forget. Forget that someone taught me to read and a doctor gave me medicine, that sometimes people smile.
When I look up at the sky on a night when the stars are out and there is a full moon, I sometimes think mad moon.
But then I start again and I see the stars, not the memories or the thoughts that stars bring. I look beyond and I see some mystery. That with the chaos there is also order. And the word faith occurs to me. Perhaps a fleeting and hard-won faith found from the darkness, a possibility of a belief, that there is a deep thread of hope that works for wholeness, running mysteriously and quietly, sometimes silently though our lives. No, medicine is not enough. If I cannot find a reason, or an anchor to hold me while I fight the giants of mental distress, psychiatry will fail. It is my soul that matters.
Laura Lea uses mental health services
|Unpaid help covering up poor service|
While there are no official records to indicate how long BMCs have been working with statutory services, it is increasingly apparent that this unpaid source of culturally appropriate support, is effectively plugging a critical care gap in failing mental health services.
Medication is still the primary option offered to black patients. The recently published Count-Me- In census has confirmed the worst fears of health campaigners by revealing that black patients are more likely than any other ethnic group to be detained on medium and high secure psychiatric wards.
They are more likely to receive coercive treatment on wards with high occupancy rates where inadequate staffing is the norm. Counselling, talking therapies and prayer offered by BMCs is primarily the only alternative source of care to this group.
Faith in God is almost the norm within the black community particularly in London, Rev Paul Grey, consultant at the Sainsbury Centre for Mental Health, told Black Britain. He added: For many people their faith determines how they govern their lives and so it isnt possible to communicate in any meaningful way without factoring this in, God goes to the very core of who they are.
Initial findings from the from the English Church Census, a large scale survey undertaken by the Independent Christian Research Organisation indicate that 75% of black people in the UK attend church on an regular basis compared to 5% of white British people. These figures make it clear that mental health services need to work with BMCs to stem the rising tide of the sectioning of black people.
Matthew Ashimolowo, is pastor of the Kingsway International Christian Centre in Hackney, the largest church in Europe. He has spoken out publicly about the crisis in BME mental health and is aware a significant proportion of his 12,000 strong congregation who attend his church in East London every Sunday will be affected by this issue.
In the past Ashimolowo said: The Government should engage with black communities and support initiatives that help to improve the lives and mental health of black people. The Church is one of the greatest sources of strength within the black community, yet there has been no cogent attempt to work with us.
There have been a number of studies in this area - as early as 1999, the government- funded Health Education Authority published a report: The Courage to Bare our Souls. This study concluded that spiritual belief can play a significant role in protecting people from mental health problems and called for health professionals not to dismiss peoples religious convictions as part of their illness.
How prayer helps those with mental health problems
At the moment there is a lot of spiritual abuse of those in the system because of the lack of understanding and acknowledgement of the significance of this in many peoples lives, David Robertson, Chair of Brent Black African and Caribbean Mental Health Consortium said. Robertson added:
Faith is just one part of the picture, but for people who believe, it is an important part of who they are and it does them a disservice to dismiss this.
Desmond Hall, Chair of Christian Together in Brent and Pastor at the Pentecostal City Mission in East Acton, West London told Black Britain that the churches presence in the wards have shortened the recovery rate of patients.
Hall, along with leaders of other BMCs in Brent was approached by Middlesex Hospital for volunteers to befriend and counsel in-patients in their psychiatric wards. He said:
The hospital is situated in one of the most diverse boroughs in London and the patients are, for the most part, from African Caribbean backgrounds and so we believe it is a positive thing that they saw the role Churches have to play. It is after all what we do, care for the sick and needy.
Hall has seen first hand the benefit their presence has made to patients in the way that they are able to share their concerns with people they see as neutral. He told Black Britain: There is a need for them to talk and just have someone listen to them the element of God helps people to relate and we find after the short services we hold people stream out so many of their concerns over tea and biscuits.
Hall has found that the continuing care BMCs provide once people have left hospital is as important as showing compassion for people when they are on the hospital ward. He said: It is important that contact with those whom we have helped recover does not abruptly end, so we continue to support people and provide social care, if needed, once people leave hospital.
If you talk to God, you are praying;
If God talks to you, you have schizophrenia.
If the dead talk to you, you are a spiritualist;
If God talks to you, you are a schizophrenic.
Thomas S. Szasz,
Praying 'aids mental health'
People who pray frequently are less likely to suffer from depression and anxiety, according to a study.
Much research has recently focused on the relationship between mental health and religion - with conflicting results.
A study by psychologists from Sheffield Hallam University looks into what aspects of religious observance are particularly likely to influence mental well-being.
They found that personal prayer was much more likely to have a positive effect than going to church for social reasons.
They studied 251 men and 223 women aged between 18 and 29, and measured their reasons for having a religious belief, the frequency with which they attended church and their tendency to depression.
Women were more likely to be religious than men, but for both the frequency with which they prayed was strongly associated with fewer symptoms of depression and anxiety.
And although people who saw religion as being present in every aspect of their lives were less likely to be mentally ill than others, only those who also prayed frequently had noticeably higher self-esteem.
Those who attended church for social reasons were likely to be more depressed and the mental health of those who were religious, but constantly questioned their beliefs was unaffected by their beliefs and practices.
The researchers, led by Dr John Maltby, say their findings suggest that the relationship between mental health and religion is linked to the way people use prayer to deal with stress.
Writing in the British Journal of Health Psychologiy, they said: "This finding would apper to support the view that a religious coping model is integral to the understanding of the relationship between religiosity and psychological well-being."
A spokeswoman for the Mental Health Foundation, which recently published a book on religion and mental health, said it had also found that those with a personal spirituality and life philosophy were more likely to be able to cope with stress.
"People who are religious on a personal level rather than adopting an organised religion, who perceive reasons for things and their role within a wider universe, appear less likely to suffer mental ill health," she said.
"They seem to be calmer and have a sense of order and a personal perspective which makes them feel more in control instead of passing responsibility to someone or something else."
The foundation runs a strategies for living programme which looks at what people find helpful in coping with everyday stresses.
It suggests health professionals should take a holistic approach to mental health, rather than just dealing with a person's symptoms.
The spokeswoman said it appeared spirituality in its widest sense had a positive effect on mental health.
"It may be as simple as having personal time and space and prayer may give people that," she said.
"Not having enough time to focus on yourself can contribute to mental distress."
However, the National Secular Society dismissed the idea that prayer helps mental health as "absolute rubbish".
It said research also showed bingo helped mental health.
"It is nothing to do with prayer," said a spokesman. "It is to do with community and togetherness."
New York, USA -- Harold G. Koenig, M.D., internationally recognized for his groundbreaking research on how religious involvement is associated with better physical health, opens a window on mental health in a new book, just released by Templeton Foundation Press.
In "Faith and Mental Health: Religious Resources for Healing" ($29.95), he provides an unprecedented source of practical information about the relationship between religion and mental health. Using scientific methodology, he explores how religious beliefs and practices are related to coping and positive emotions, as well as the use of religion for psychiatric disorders, substance abuse disorders, and severe mental illness. Based on this research, he offers an evaluation of whether religious faith represents a resource or a liability in terms of mental health.
Dr. Koenig begins by examining the evolution of the relationship between religion and mental health through the centuries. Historically, major religious traditions have related to the mentally ill and emotionally vulnerable in ways that range from positive to fearful to violent. Today there is a growing consensus that religious factors influence the mental health and wellbeing of persons with mental illness. Drawing on hundreds of research studies and clinical trials that examine the effectiveness of religious psychotherapies from Christian, Muslim, and Buddhist perspectives, Dr. Koenig describes the ways that religious faith can contribute to mental health.
He focuses on the role of clergy, religious organizations, and faith communities in caring for those with emotional problems and severe mental illness. He describes five categories of faith-based organizations (FBOs) that deliver mental health services and provides details on their organization and mission, along with examples that illustrate their functions.
Even as faith-based groups strive to support the delivery of mental health services, barriers remain to both research and implementation. Dr. Koenig outlines these obstacles that stand in the way of scientific research on the relationship between religion and mental health: methodological, focus/priority, funding, and attitudinal. He examines ways of overcoming these barriers, suggesting and detailing possible solutions that will require the cooperation between government agencies and private and faith-based groups.
A unique combination of both the history and the current research of mental health and religion, along with a thorough examination of faith-based organizations operating in the field, "Faith and Mental Health" is a resource for the healthcare community, including medical school professionals and caregivers; for religious professionals from pastoral counselors to chaplains; and for everyone concerned with the future of mental health care.
Dr. Koenig completed his undergraduate education at Stanford University, his medical school training at the University of California at San Francisco, and his geriatric medicine, psychiatry, and biostatistics training at Duke University Medical Center. Board certified in general psychiatry, geriatric psychiatry, and geriatric medicine, he is professor of psychiatry and behavioral sciences and associate professor of medicine at Duke University Medical Center. He is director and founder of Duke's Center for the Study of Religion/Spirituality and Health; editor of the International Journal of Psychiatry in Medicine, a medical research journal; and editor-in-chief of Science and Theology News, a monthly international newspaper. He has published extensively in the fields of mental health, geriatrics, and religion.
Contact: Diane Glynn
Publicity Email: Contact via http://www.marketwire.com/mw/emailprcntct?id=B109E936ABB3E1B5
SOURCE: Templeton Foundation Press
A religious faith can ward off mental illness
Religious and spiritual belief can play a significant role in protecting people from mental health problems, according to the body responsible for health promotion in the UK.
|The BBC's Emily Buchanan: "The reports calls for churches to do more for sufferers"|
Health professionals are also urged not to dismiss people's religious convictions as part of their illness, even if they encompass belief in controversial practices such as exorcism.
The HEA has produced a guide in collaboration with Christian and Jewish groups and the National Schizophrenia Fellowship that gives advice on ways of supporting people with mental health problems.
Lynne Friedli, manager of the HEA's Mental Health Programme, said: "Religious belief and faith have a central place in many people's lives and this initiative will raise awareness of the important role that faith has in protecting people from mental ill health and helping them to deal better with problems when they do occur."
The guide covers a number of areas, including:
- The type of help and support that can be offered by religious communities and ways of tackling stigma
- The relationship between mental health professionals and their clients with religious beliefs
- How faith can offer comfort, reassurance, guidance, support, a sense of belonging and can help to integrate people who have been ill into the community
- Scriptural references, prayers, ideas for worship around mental health themes and a directory of where to obtain information, advice and training on mental health issues
|Dr Lynne Friedli: "We're trying to encourage more partnerships between mental health professionals and spirtual leaders"|
In addition, many voluntary agencies with a strong religious base provide mental health care and support.
'Stigma must be challenged'
Ms Friedli said: "Religious leaders have a duty to challenge stigma. As people with mental health problems are so often excluded from the workplace and other environments, it is important that churches, synagogues and other places of worship open their doors to everyone in the community.
|Muslims: All faiths have been urged to act|
Martin Aaron, chairman of the Jewish Association for the Mentally Ill (JAMI) and a member of the working party that produced the guidance, said clergy of all faiths needed training in what services were available to help mentally ill people.
He said: "Unfortunately, in the past, many clergy - whether they be a rabbi or a parish priest - when approached by people with a problem have not been very well equipped to deal with it.
"Not dealing with a problem with knowledge and training can have a detrimental effect."
Mr Aaron said in most cases clergy would be encouraged to adopt a twin-track approach, offering spiritual guidance and support, and referring on to a medical specialist.
A book, The Courage to Bare our Souls, is published at the same time as the guide. Produced by the Mental Health Foundation and written by mental health service users, it tells of the positive and negative impact that religion and spirituality has had on their lives.
Why Psychiatry Needs Spirituality
The suggestion that psychiatry might need spirituality is an unusual one for two reasons i.It is clear that psychiatrists as a professional group are not particularly religiously inclined ii. Neeleman and Persaud suggest that somewhere in the region of 67% of British psychiatrists do not believe in God iii. Other studies have confirmed a similar lack of interest in the spiritual dimension iv. The reasons for this omission are complex v. Suffice here to say that in terms of self-identity, training and practice, spirituality does not have a high profile within psychiatry.
The suggestion that psychiatry needs spirituality also appears dissonant in relation to the current decline in religion within the UK and Europe. It is clear that traditional religions are in a sharp decline and have been since the late 1950s. Surely this would indicate that spirituality is becoming less rather than more important? Why would psychiatry need spirituality within a context that is obviously in spiritual decline.
The increasing interest in spirituality
However, a closer examination of the spiritual landscape within the United Kingdom throws up some interesting observations. In line with much of Western Europe vi there is a significant decrease in adherence to traditional, formal institutional religion. The decreasing number of people regularly attending places of worship evidences this. vii However, whilst traditional religion appears to be in decline, (a closer examination shows that Europe is an exceptional case viii and even within that context there is wide variation ix), there is a corresponding increase in the number of people expressing the importance of spirituality for their lives and claiming to have spiritual experiences and beliefs. Spirituality appears to have migrated from the overtly religious towards a more individualistic and subjective quest that has no necessity for formal structures.x People now want to believe in things spiritual, but no longer wish to belong to traditional religious institutions.xi Spirituality remains of importance to large numbers of people.
What do we mean by spirituality?
In assessing the significance of the spirituality, it is important to distinguish between religiosity and spirituality. Religiosity is defined as participation in the particular beliefs, rituals, and activities of traditional religion. It can serve as a nurturer or channel for spirituality, but is not synonymous with it. Spirituality is more basic than religiosity. It is a subjective experience that exists both within and outside of traditional religious systems.
Spirituality relates to the way in which people understand and live their lives in view of their sense of ultimate meaning and value. It includes the need to find satisfactory answers to ultimate questions about the meaning of life, illness and death. It can be seen as comprising elements of meaning, purpose, value, hope, love and for some people, a connection to a higher power or something greater than self. Perceived in this way, spirituality is not simply found in religious patients, but may be present in all patients.
Why God wont go away
This raises an interesting question: in a secularised, materialistic culture, why is it that people seem determined to retain spirituality and give importance to it in their lives? Andrew Newberg and his colleagues in their book Why God Wont Go Away xii investigates this question from his perspective as a neurologist. Newberg engages in a series of neurological investigations into the impact of meditation on Buddhist monks and Franciscan nuns. Newbergs findings indicate that human beings are hard wired for religious and spiritual experience for evolutionary purposes. He argues that there is a specific area of the brain which is designed to receive religious and spiritual experiences, in the same way as there is an area of the brain designed to receive sound, vision and so forth. The field has come to be known as Neurotheology and the area of the brain identified as the spiritual powerhouse has popularly come to be known as the G spot! The God spot.
Newbergs method was to link the monks and nuns to a SPECT camera (single photon emission computed tomography), and observe what changes occurred in the function of the brain when the person entered into a meditative state. Newberg and his colleagues noted that when a person entered into a deep meditative trance, a small lump of grey matter in the top rear section of the brain (the posterior superior parietal lobe) began to show unusual activity. This part of the brain functions to orient an individual in physical space. It keeps track of which end is up, helps us judge angles and distances, and allows us to negotiate safely the dangerous physical landscape around us. To perform this crucial function, it must generate a clear, consistent cognition of the physical limitations of the self. xiii The PSPL is the part of the brain that maps out and distinguishes what is me from what is not me. What Newberg discovered was that within a meditative trance this part of the brain began to close down. Consequently the meditator experiences feelings of merging with the world around them as the boundaries between me and not me broke down. For the Buddhists this was experienced as a general merging with the universe; for the nuns it was reported as a feeling of closeness to and merging with God. From this Newberg develops a theory that spirituality is a biological, inbuilt dimension of human beings which has been retained for evolutionary purposes.
Now, one might argue that this perspective is reductionistic; the danger being that people assume that God, religion and spirituality are nothing but the products of neurology. But this need not be the case. Depending on your starting position you might interpret Newbergs findings accordingly. If you dont believe in God you will be comfortable with the evolutionary explanation for the retention of spirituality within human development. If you are religious, then it will be clear that (whatever its developmental origins), the neurological receptor of spirituality is God-given; another way of communicating with God comparable with other areas of the brain that relate to communication with the Divine. (reason, intellect, the ability to read Scriptures etc.) These twointerpretations need not be exclusive. My colleague David Hay has pointed out that even the evolutionary explanation does not rule out the reality of God. xiv Within evolutionary theory things happen for a reason. We have ears because there is something to hear, eyes because there is something to see and a structure relating to spiritual experience because there is something to experience.
Spirituality as a human universal: Relational consciousness
In line with some of Newbergs thinking, but differing significantly from it, is David Hays work on the biology of God. In his 1966 Gifford Lectures given in Aberdeen University, biologist Alister Hardy put forward the thesis that religious or spiritual awareness has evolved in the human species because it is necessary for survival. Over many years Hay has developed Hardys work and has put forward some convincing evidence for there being a biological basis for spiritual experience. xv Here we will examine one dimension of Hays thinking as it relates to the spirituality of children. In his book The Spirit of the Child, Hay presents some research that he did on the spirituality of children. He proposes that children are naturally spiritual; that they have an inherent sense of awe, wonder and acceptance of things beyond their understanding. This inherent awareness he describes as relational consciousness. Relational consciousness is a form of consciousness characterised by the fact that it is always relational: self/other people, self/environment, self/God. It is what makes spirituality possible and in a certain sense is spirituality. Phenomenologically it is experienced as the shortening of the psychological distance between self and the rest of reality; a dissolving of the boundaries, that at the limit becomes the loss of distinction between self and other of the mystic. xvi From Hays perspective this is the source of the experiential basis of religion, seen as a social construction in response to spiritual experience.
However, whilst spirituality is relational and naturally inherent within theexperiences of children, when they enter the educational system they are de-spiritualised. They are taught to think logically and rationally and to downgrade or even exclude the pre-school spiritual experiences that were so formative of their early perceptions of the world. Hay identifies this spiritual repression with certain forms of frustration and aggression encountered by children in their teens.
If we accept Newberg, Hardy and Hays hypotheses, then two important things emerge. Firstly, in opposition to post-Enlightenment ideas of the social construction of religion (cf. Feuerbach and the subsequent development of his ideas by Marx and Freud), if these researchers are correct, it is actually secularisation that is socially constructed in opposition to the natural human experience of spirituality. xvii Whilst people who suggest the significance of spirituality for mental health care are often accused of imposing alien values on vulnerable people, if the evidence presented thus far is correct, then not to address the spiritual dimensions of patients experiences is to risk imposing false, secular values on vulnerable people.
Secondly, if this mode of thinking is correct, then it is not only overtly religious patients that will be experiencing spirituality and spiritual issues, but all of the patients whom psychiatrists encounter. If this is so, psychiatrists at least need to be open to the possibility that spirituality may be significant for certain patients and that that significance may have clinical utilility.
Religion and health the known research
A final dimension of the growing evidence base that suggests psychiatrists should take spirituality seriously relates to the developing research base which indicates a positive correlation between spirituality and mental health. In the light of the discussion on the biological roots of spirituality it is probably not surprising that we can discover some interesting correlations between spirituality and mental health xviii. The extensive research work of people such as Harold Koenig xix and David Larson xx is indicative of there being a positive association between religion, spirituality and mental health xxi. xxii The data from this field of research is suggestive (although not conclusive) that there may be certain positive associations between religious and spiritual observance and mental and physical well-being. Religion and spirituality have been shown to be beneficial on a number of levels and in relation to a wide variety of conditions. Health benefits include:
Extended life expectancy.
Lower blood pressure.
Lower rates of death from coronary artery disease.
Reduction in myocardial infarction.
Increased success in heart transplants.
Reduced serum cholesterol levels.
Reduced levels of pain in cancer sufferers.
Reduced mortality among those who attend church and worship services.
Increased longevity among the elderly.
Protection against depression and anxiety.
Reduced mortality after cardiac surgery. xxiii
Of particular interest from the perspective of psychiatry is the ability of spirituality to reframe mental health problems, at least potentially, in positive ways. On the basis of current knowledge we might consider that religious and spiritual beliefs may affect patients well being in the following ways:
Enhances coping by offering such things as hope, value, meaning and purpose.
Facilitates social integration and support by linking religious patients with specific forms of caring communities.
Provides systems of meaning and existential coherence.
Establishes a perceived relationship with a divine other, i.e. persons can extend their circle of social support by drawing in religious and spiritual figures.
Promotes participation in specific patterns of religious organisation and lifestyle which may offer support and protection from, for example, anxiety and depression. 0
This reframing is not always positive, but it is certainly not always negative.
Understanding the experience of mental illness
It is easy to forget that mental illness is a deeply personal and meaningful event within a persons life before it becomes a diagnosis.
Diagnoses give a formal structure to personal experience but they do not (or should not) define the nature of that experience. Mental illness brings about changes in peoples lives; events which often challenge people to think about certain aspects of their lives quite differently. Sometimes these changes are pathological, at other times they are transformative and deeply spiritual xxiv. The danger is that if psychiatrists are not aware of the spiritual dimensions of mental health problems, the transformative can easily become subsumed to the pathological with detrimental effects on patient care. When this happens we run the risk of creating despiritualising institutions and modes of care in line with Hays criticism of the despiritualising influence of our educational system.
Spirituality is important in that it provides belief structures and modes of coping within which people can make sense of their lives, explain and cope with their illness experiences and find and maintain a sense of hope, inner harmony and peacefulness in the midst of the existential challenges illness inevitably brings. Current research indicates that this type of reframing may have clinical utility. To practice in ways that assume such experiences to be unimportant, inevitably pathological or somehow secondary within the process of mental healthcare is to misunderstand in a quite fundamental way the nature and experience of mental illness and the significance of the person-as-person as opposed to the person-as-diagnosis.
The occlusion of spirituality
In the light of the evidence put forward in the first half of this paper, one might wonder why it is that spirituality has such a low profile within the practice and philosophy of psychiatry. An immediate response might be to point out the dangers of pathological spirituality arguing that it is far too dangerous to take spirituality into the clinical process as it opens up patients to powerful ideologies that may be dangerous. This position of course contains truth. Any powerful belief system has the potential for good and bad. However, to paternalistically decide that spirituality is bad for people without firm empirical evidence and without taking into consideration the fact that patients might disagree xxv, is to close down a potential source of healing without taking seriously its implications for good practice. The connection between religion, spirituality and pathology is not at all clear. It is certainly the case that people encountering severe mental health problems may utilise religious language and concepts to express their pain. However, if, as I have suggested, spirituality relates to the values, beliefs and understandings which are core and fundamental to a persons perception of the world and themselves within it, it is not at all surprising that they will use that same language and those same concepts to express the experiences they are going through. Expressing pathology through religious language does not necessarily indicate a causal connection xxvi. Avoiding religious and spiritual language does not necessarily bring healing and offer respect for the clients well-being. Indeed, as I have suggested, a lack of a willingness to engage with spirituality might end up being detrimental to care. Despite the potential problematic issues that may arise, the evidence would suggest that psychiatrists, at least, need to be aware of the potential significance of this dimension of patients experience even when it is manifested in the context of severe mental health problems.
Why does psychiatry struggle to see the significance of spirituality?
Yet, despite the growing evidence base, there remains a good deal of resistance even to explore the types of issues we have looked at in this paper.
Why might this be? In order to begin to answer this question we need to think about the significance of worldviews. Our worldviews make up our perspective on and understanding of the world. They contain and define the structures of normality and the general assumptions about the nature of that which we assume to be reality. Importantly, worldviews shape and place boundaries on what we see in the world. Worldviews are not real in a strictly ontological sense, they are things that cultures create. Nevertheless, they are real for those who accept them. Worldviews are temporary and are constantly changing. We no longer, for example, believe that the earth is flat or that the sun revolves around the earth. But we did at a particular moment in history; then, it was considered to be a scientific fact. Presumably much of the knowledge we currently have now will also be shown to be false or at least different from our current understanding at some point in the future.
Worldviews are thus temporary and transient, but nonetheless tremendouslypowerful in terms of their ability to shape the world. At any given point there are particular dominant ideas that shape worldviews and the thinking and understandings of those who accept them as reality. Within our own culture, biomedicine and its accompanying ideology has become a powerful shaper of our worldview and the ways in which we assume we should respond to health, disease and healing. For most of us it is within the worldview created by biomedicine that our interpretations of mental illness take place. Colin Samson argues that our current way of doing medicine emerged as a result of the developments that emerged during the Enlightenment.
Enlightenment medicine reflected a confidence in scientific methods of observation and experimentation to control nature and intervene to correct ailments that seemed to cut short life The approach to sickness advocated by the medical profession has now become almost a monopoly by virtue of its legitimisation by the state in all
Western countries as well as other societies xxvii. The concurrent movement towards prioritisng science and the scientific method within our interpretations of mental illness has resulted in a redefinition of the issues that once preoccupied philosophers. The questions:
What is human nature?
How is happiness achieved?
What is a good life? have been restated as
What is normal?
How can it be measured?
What conclusions are generalisable ?
Xxviii Within this scientistic worldview the unique and particular aspects of human beings become secondary to the generalisable and universal aspects. Spiritual interpretations of illness experience sits easily within the first set of questions, but becomes most uncomfortable when faced with the second.
What is interesting about the approach of the medical model is that, in principle at least, there is no need for the presence of a person. The individual as a meaningful interpretative being with goals, dreams, expectations and hopes is substituted for an understanding of persons as machines or at least as machine like. Within this understanding, good healers are perceived as effective mechanics able to utilise scientific technology to bring the body back to a state of health and well-being. So powerful is this way of perceiving and responding to health and illness that it is almost impossible to think of mental health without thinking about psychiatry and pathology. And yet, as our exploration of spirituality has shown, there is much more to mental illness than diagnosis and pathology. The point is not that biomedicine is wrong or that we should somehow do away with it. The problem being highlighted here is the way in which biomedicine has colonized our healthcare worldview and shaped our expectations in such a way as to blind us to other hidden and very important aspects of the experience of being ill; other interpretations which are equally true and which may be crucial to the practice of spiritually oriented mental health care. What is required is not a rejection of science, but an expanded science which includes issues of value, meaning and transcendence. The problem is that, for the most part we only see what our worldview and our assumptions allow us to see. If we use the example of this well-known optical illusion the point will become clearer.
Do you see an old woman or a young woman? Psychologists inform us that if we have a propensity towards older women that is what you will see. Similarly, if we have a propensity towards younger women, that is what we will see! Eventually we will see both, but most people dont until the second one is pointed out to them. People in general tend to see what they expect to see or at least, what they are primed to see. I want to suggest that the same principle is at work in the ways in which we understand health and healing. Because the medicalised perspective is so powerful within our culture it is almost impossible for us to see disease and healing in any other way until it is pointed out to us. When it is pointed out to us we begin to see things differently. When we see things differently we begin to act differently.
Rediscovering the forgotten dimension
One way of beginning to open our worldviews to an expanded science is by focusing on the area of spirituality. The biomedical view informs us that science is the only story that can be told about source health and illness. A focus on a spiritual perspective reminds us that much of the knowledge we gain and live by is not scientific, insofar as it is not generalisable or replicable but unique and non-repeatable. Many of our patients most profound and important illness experiences are not related to the assumed boundaries of their diagnosis. In closing let me offer an example which will help to illustrate the point.
In his book The Man Who Mistook His Wife for a Hat xxix, neurologist Oliver Sacks relates the story of a man, Jimmy, whose memory had been destroyed by Korsakovs syndrome. Korsakov's syndrome is a specific form of dementia which is the product of long-term alcohol abuse. It leads to irreversible degeneration of the brain. One of its central features is profound memory loss. The loss is so profound that sufferers become people without a past or a future, interminably trapped in an eternal present and bound permanently within one period of time. People with this form of mental health problem are in a very real sense lost and unable to establish roots. Sacks, from his position as a neurologist, assumed the truth of the medical narrative within which the Korsokovs was presumed to have de-souled Jimmy. However, while Sacks conceived of Jimmy as being in a sense absent from mainstream humanity, those close to Jimmy saw something else. Sacks recalls how one of the nurses drew his attention to a dimension of Jimmys experience which had been hidden from Sacks medical gaze. Watch Jimmy in chapel and judge for yourself said one of the nurses.
I did, and I was moved, profoundly moved and impressed, because I saw here an intensity and steadfastness of attention and concentration that I had never seen before in him or conceived him capable of. Fully, intensely, quietly, in the quietude of absolute concentration and attention, he entered and partook of the Holy Communion. He was wholly held, absorbed, by a feeling. There was no forgetting, no
Korsakovs then, nor did it seem possible or imaginable that there should be - clearly Jimmy found himself, found continuity and reality, in the absoluteness of spiritual attention and act.
From Sacks position as a neurologist, Jimmys was a narrative of pathology, lost personhood and presumed hopelessness. Yet, when he was forced to listen to the second narrative and to explore Jimmys lived spiritual experience, his perspective was transformed. His revised understanding, resurrected the person behind Jimmys condition and opened up new possibilities for care and understanding that reached beyond the boundaries of the biomedical model and into the mystery which is human life.
For Jimmy, his spiritual encounter with the Holy provided him with an anchor and a sense of self that was otherwise missing from his life. His experience seemed to locate him within a narrative that gave him meaning, purpose and a sense of self which transcended the limitations of his fading personal narrative. In the realm of the spiritual, Jimmy seemed to function in ways that moved beyond the expectations of the medical professions and offered him relief and purpose in the midst of a world of profound meaninglessness.
This story provides a useful example of the type of the way in which an acknowledgement of the significance of spirituality can radically reframe a situation. Sacks professional worldview primed him to see only pathology in Jimmy. The person was not part of the equation. When he and Jimmy came together within a professional context, there was a vital aspect missing from Sacks interpretation of what was going on which prevented Sacks from seeing the whole of the situation. That missing dimension was Jimmys spirituality. It was impossible for Sacks to accurately interpret the situations until he recognized the significance of spirituality for Jimmys horizon xxx.
In conclusion, it would appear that psychiatry needs spirituality if it is to provide a service which is person centred and meaningfully holistic. Not everyone will agree with the arguments presented in this article. That is as it should be. However, the fact that many readers will be experienced practitioners and will never have been exposed to this way of thinking about spirituality is indicative of a lack in the ways in which psychiatrists are trained and the types of information that is currently being made available to them. Psychiatry needs to wrestle carefully and thoughtfully with the issues raised by spirituality and in the process of doing this, begin to recognise that patients may expect them to know and to understand more than they assume they should.
i This paper was originally presented to the Royal College of Psychiatrists AGM in Edinburgh 22/6/05. It appears here in a slightly revised form.
ii Crossley, David. (1995) Religious experience within mental illness: opening the door on research. British Journal of Psychiatry. 166(3) March:284286.
iii Neeleman, J. and Persaud, R. (1995) Why do psychiatrists neglect religion? British Journal of Medical Psychology. 68: 169-178.
iv Neeleman J., and King., M. B. (1993). Psychiatrists religious attitudes in relation to their clinical practice: a survey of 231 psychiatrists. Acta Psychiatrica Scandinavica. 88:420-424. Toone., B. K., Murray., R., Clare, A., Creed, F. & Smith, A. (1979). Psychiatrists' models of mental illness and their personal backgrounds. Psychological Medicine 9:165-178.
v Swinton, J. (2001) Spirituality and Mental Health Care: Rediscovering a forgotten dimension London: Jessica Kingsley Publishers
vi Davie, G. (1994)., Religion in Britain since 1945: believing without belonging, Oxford; Cambridge, Mass: Blackwell
vii Scottish Church Census 2002 http://www.scottishchristian.com/features/0305census01.shtml It should be pointed out that it is only certain forms of traditional religion that are in decline. Evangelical Christianity, for example, seems to be on the increase rather than in decline. Likewise other traditional religions such as Islam are also increasing. It would appear to be the form rather than the context of traditional religion that is failing to resonate with contemporary postmodern society.
viii Davie, G. (2002). Europe: the Exceptional Case, London: Darton, Longman & Todd.
ix Casanova, J. (1994). Public Religions in the Modern World, Chicago and London: Chicago University Press; also, Borowik, I. & Tomka, M. (eds.). (2001).Religion and Social Change in Post-Communist Europe, Krakow: Zaklad Wydowniczy
x Heelas, P. & Woodhead, L. (2005) The Spiritual Revolution. Why Religion is Giving Way to Spirituality Oxford, UK and Malden, USA: Blackwell,
xi Davie, op. cit.
xii Newberg, A., dAquili, E. & Rause, V. (2001). Why God Wont Go Away: Brain Science and the Biology of Belief, New York: Ballantine Books.
xiii Ibid, pp. 4 -5
xiv See for example, 'The biological basis of spiritual awareness', in Ursula King (ed.) Spirituality and Society in the New Millennium , Sussex Academic Press, 2001, 124-135
xv See, for example, Exploring Inner Space: Scientists and Religious Experience, London: Penguin Books, 1982; 'The biology of God': What is the current status of Hardy's hypothesis?' International Journal for the Psychology of Religion, 4(1), 1994, 1-23; The Spirit of the Child, London: HarperCollins, 1998; Something There: the Biology of the Human Spirit, Darton, Longman & Todd (forthcoming).
xvi Hay, personal communication.
xvii See, The Spirit of the Child,op. cit. Chapter 2, The social destruction of spirituality.
xviii Swinton ibid.
xix Koenig, Harold G. (ed) (1998) Handbook of Religion and Mental Health. San Diego, Academic P.
xx Larson D. B., Pattison, E. M., Blazer, D. G., Omran, A. R., and Kaplan, B. H. (1986) A Systematic analysis of research on religious variables in four major psychiatric journals 1978-1982. American Journal of Psychiatry. 143:329-334.Larson, D. B., Sherrill, K. A., Lyons, J .S., Craigie, F .C., Thielman, S. B. Greenwood, M. A., and Larson, S .S. (1992) Associations Between Dimensions of Religious Commitment and Mental Health Reported in the American Journal of Mental Health and Archives of General Psychiatry: 1078-1989. American Journal of Psychiatry. 149, 4. April:557-559.
xxi Koenig H McCullough M Larson D (2001) Handbook of Religion and Health Oxford University Press
xxii Larson D B Swyers J P McCullough M (1997) Scientific Research on Spirituality and Health: a consensus report. National Institute for Healthcare research
xxivLuckoff D., Lu, F., and Turner, R. (1998). From spiritual emergency to spiritual problem: the transpersonal roots of the new DSM IV category. Journal of Humanistic Psychology, 38(2), 21-51.
xxvNicholls, Vicki. (Ed) Taken Seriously: The Somerset Spirituality Project. London:Mental Health Foundation.
xxviWilliams, Richard., and Faulconer, James E. (1994) religion and mental health: a hermeneutical reconsideration. Review of Religious Research. 35, 4. June:335349.
xxviiSamson, C. (1999) Health Studies: A Multidisciplinary Reader London: Blackwell
xxviiiNolan P. Crawford P. (1997) Towards a rhetoric of spirituality in mental health care. Journal of Advanced Nursing. 26(2) Aug:289-94.
xxixSacks, Oliver. (1968) The Man Who Mistook His Wife For A Hat. Harper Collins.
xxx The case of dementia of course offers some interesting challenges to the theories of Newberg and Hay. If spirituality has a neurological root, what happens if that piece of the brain is damaged or destroyed by dementia or other forms of neurological damage? Does this mean that a person ceases to be a spiritual being?
© John Swinton 2005