Spirituality and Beliefs
Spirituality and Beliefs: Implications and Impact on Mental Illness and Psychiatric Disability IntroductionI wish to begin this paper by playing a short piece of music composed by Richard Einhorn and inspired by the life and writings of Joan of Arc. At the age of 13 in 1425 this shepherd girl from the village of Domremy in France began to hear voices. At sixteen these voices were telling her that she had been given a divine mission to reunite France. It is said that she heard the voice of God when the church bell rang. This piece is called ‘The Final Walk’ as she faces her execution. In 1920 nearly 500 years after her death at the hands of the church she was declared a saint.The basis of this paper have been the musings, conversations and reading over many years of a person who has been endeavoring to explain why it is that people who have been through the experience of a mental illness provide the potential of connection with deeper parts of who we are in a way that is not commonly found. I have welcomed the writings of consumers themselves to give light to this question, some studies, and the current resurgence of discussion about the nature and need for the spiritual dimension in life. It has been unfortunate that we have not recognized consumers as potential heroes of the journey of the ‘dark night of the soul’ but instead have negated the spiritual aspects of their psychic journeys. In so doing we have failed to listen to their desires that rehabilitation takes account of the meaning of where they have been and what they now understand as their own mental and spiritual well being. I acknowledge that my exploration of these issues is only a beginning.The place of the ‘soul’ in recoveryThere was a time, not that long ago when the connection of spirituality and mental illness would not have been a valid topic when talking about rehabilitation, mental health and treatment of the mentally ill. In fact religious concerns were often seen as a symptom or even cause of mental illness (Pinches 1996; Smith 1994), so persons responsible for the treatment of the mentally ill would endeavor to medicate, hospitalize in order to control, suppress or terminate such spiritual or religious experiences (Watson). This to me was an unfortunate outcome, and not because of any desire to promote religious ideas, but because the beginnings of the profession of psychology, using the Greek meanings of the words was concerning the soul.Psyche means soul and psychology is the study of the soul, psychologist is servant or attendant of the soul with psychopathology meaning ‘the suffering of the soul'(Elkins). Therefore if we as mental health professionals were to reclaim the roots of our profession, as many people are trying to do today, we could not consider approaching the rehabilitation of a person with a psychiatric disability without considering the place of ‘soul’ in their recovery. This by no means is a radical concept, but in an attempt to balance the more empirical nature of treatment, people in this profession are looking back and reclaiming the tradition which has always been there, but in practice often passed over or dismissed. Hillman wrote in 1975 ‘Where there is connection to soul, there is psychology; where not, what is taking place is better called statistics, physical anthropology, cultural journalism or animal breeding’ (Elkins). And Jung wrote in 1933 that of all his patients over the age of 35, not one was healed who did not develop a spiritual orientation to life (Elkins).Soul is a feminine concept with connotations of life and beauty. The soul is difficult to define, which gives us a clue about its nature. Soul reminds us that there is another world, far deeper, more meaningful than our logical processes. We encounter her when we feel stirred by another person, she is in the music that lifts us above ourselves, she is in the face of the child who helps us realise what is really important, she is the lump in the throat, the tear in the eye, the opening up when we face a stirring piece of art. The soul can be felt, touched but never defined. As David Elkins put it ‘She will slip through the net of every conceptual system and easily elude every scientific expedition that goes in search of her’.The reason I like and respond to what others have written about the soul, is that it helps me explain what it is about the relationships I have had over the years with people who have suffered from a mental illness. And I do not know why, and I have no proof or even a theory, but my connections with the people with whom I have worked has more often had a feeling or relation to soul, than what I have known in other situations and with other people. So my reason for reading, pondering and wanting to write these ideas has come from a desire to explain why the richness, and why the relationships seem to help me connect with my soul in the way that they do.Soul is associated with depth and unlike much of Western spirituality which is about overcoming, growing, ascending, transcending, soul means going down, descending into the valleys and experiencing the tragedies of life, of being in a place where the idea of climbing a mountain seems completely beyond reach. Soul is with us when everyone else has gone, when our ego is shattered, when alone in the night no one is interested in our pain and we wonder how we will survive until morning. And while no one would ever go looking for such pain or experiences, when it is past, and we look back, it is possible to be grateful for it, because it opens something within us, it gives us a depth, it makes us feel more human, and we know with some relief, that there is more to us than simply flesh and blood. Psychopathology is the most tragic cry of the soul, when a person is in deepest pain and confronted by death, meaningless, isolation and loneliness. If you know anything about the creative process, most musicians, writers, poets, artists have created their work, not from the mountain top, but from the place of the soul.For the last week our news bulletins have been full of the landslide at Thredbo. When the first survivor was pulled from under the rubble 66 hours after the collapse of the lodges, the word hero appeared as headlines. The rescuers were heroes and so was the first survivor. You can imagine the journalists breaking their necks to be the first to talk to that man. He potentially will be doing media interviews, be in the magazines and be writing his story of ‘My 3 days under the rubble and how I came through’, and he could make a lot of money out of it.I am not discounting the validity of his experience, but it is interesting who our society chooses as heroes. In symbolic terms his experience would not be unlike that of many people who have had a mental illness, in the dark for long periods of time, not knowing if human connection will ever be possible, not knowing if they will survive, being totally alone, unable to move, freedom being an illusion or a memory, facing everything that they have ever done and thought, alone. These are experiences of the soul or in mystical terms like the ‘journey of the dark night of the soul’. But do we make these people heroes? Do we acknowledge their value by placing bold medals on their chests as they march as survivors of an internal devastating war?Am I a saint or just mad?The Christian tradition has had a somewhat mixed response to people with a mental illness. The example of Jesus was not well sustained by the church. Jesus mixed with and healed many people ‘possessed with demons’ which was the way it was explained at that time. In fact the first person he ever commissioned to ‘tell his story of healing’ was a Gentile healed of a legion or 100 voices or personalities and the first witness to Jesus resurrection was a woman, Mary Magdalene who was also healed of ‘seven demons’ (York 1992). These two people given roles of the highest importance are examples from what was set out as the foundations of the Christian method of dealing with mental illness.It was unfortunate that following this many people who saw visions, heard the voice of God were often tortured, killed, burnt and sometimes were later made into saints. In 1484 Pope Innocent the 8th authorized the extermination of ‘witches’ who were considered demon possessed. The Malleus Maleficarum was published with its detailed descriptions of categories and symptoms of witches. Some academics who have studied this Latin document now say that it so closely runs parallel to the Diagnostic Statistical Manual (the clinical basis for diagnosing mental illness today) that any psychiatrist reading it would be able to identify the modern equivalents for the categories of witches(York).Of course you can say, we are well above the concept of witches and our diagnosis and treatment of people today. I feel however that we have not moved far enough. The ambivalence which the church has demonstrated is really another response by the wider community. This response can be interpreted as ‘people with a mental illness may be difficult to know what to do with, but on the other hand they seem to have access to experiences which we cannot altogether discount as being totally invalid’. As a result I feel that in modern times we have not even considered the possibility that the experience is a valid spiritual experience. So all voices are bad, all visions should be repressed, and the person themselves is also negated as having little value. In our fanatical obsession with reason I think we have negated the unexplained and seemingly irrational and in so doing socialised the seer and the hearer into the role of recipient rather than giver of truth. Perhaps like human history has often shown we may have to wait 500 years to see it.The denial of spirituality in the concept of treatment and cureSara Maitland wrote a lovely article in a recent OpenMind journal about the experience of hearing voices. The whole issue of hearing voices is a complex one. It is usually considered a definite sign that someone is experiencing a form of mental illness (Kirk 1992). The aim of treatment is to remove the voices. That is understandable given their potentially alienating, disturbing and even dangerous effects. Sara asks ‘Do all voice hearers want all their voices silenced at all times?’ She goes on to say that her voices are often companions, expressive and glorious and they give access to fascinating things about her, and that what she would like, would be skills to understand and decode the voices, not to repress them. “My voices seem to me to be very like having highly active and intelligent toddlers in the house: the exhaustion they cause does not mean you want them dead – it means you want them to behave better.” Sara also goes on to talk about how psychiatry has not taken much interest in the content of voices. At Joan of Arc’s trial she says that the content of Joan’s voices was the principle concern. And even though the outcome for Joan of Arc was not good, the Inquirers did take the time to ascertain the value of the content of her voices in relation to how she lived her life. Instead today to admit to voice hearing is enough to gain a label such as schizophrenia and so people deny hearing the voices as it means more medication or medical intervention or hospitalisation and the feeling that you are at risk. What Sara and other voice hearers are asking for is an exploration of what are the real meanings of their voices, and rather than a pathologizing and stigmatizing, a validation of their experience and some facilitation in being able to understand it (Maitland; Kirk).I have been grateful for the writings of other consumers who have spoken about the importance of their experiences as potential places of growth and validation, and the need for their experience to be understood from a spiritual framework (Cooper 1992).Some formal studies done on the benefits of the spiritual dimension in relation to a person’s recovery have shown that spirituality for some people is a real coping device, or it can be a source of social support, while for others it is a framework for understanding life events and providing meaning to what has happened (Sullivan 1993). Quoting Judith Miller’An impressive number of other clinicians and researchers have also suggested that for some individuals undergoing psychiatric episodes, the experience may actually be positive and reconstructive’ (Watson).Why then have we avoided this potentially positive side of the equation and repressed any spiritual connections of the experience of having a psychiatric illness? Sullivan proposes that we typically fear the discussion of the symbolic and mythic dimensions of the experience because it might encourage the person to become preoccupied with their inner life and consequently precipitate a relapse. But as he adds a person returning from such a journey with profound psychic experiences do not feel completely resolved until they have had the opportunity to put their experiences into words or art; to tell their stories. A person can emerge from a psychiatric episode with a belief like ‘Suffering is a punishment for something I did wrong’, ‘If I tried harder to be good, I could get well’ or ‘There must be some reason God has chosen me to suffer’ (Lindgren ; Coursey 1995) These belief systems provide a meaning to an illness whether we like them or not.I am sure you have come across such expressions from consumers. So what do we do with it? Firstly we assume that because of the religious belief this person has a very low self esteem and so the religion is a negative thing and perhaps even the cause. As workers it would often be avoided, and the discussion repressed or the belief of the person dismissed as invalid. How did this help the consumer resolve the huge existential question? It didn’t, but gave the consumer the idea not to talk to you about such matters anymore, and merely reinforced the belief that suffering was a way of life and no one was going to help understand it differently.It probably goes without saying that the ability to perform the role of spiritual facilitator following the psychic journey of the soul requires certain skills and attitudes. Thirty-seven percent of consumers in one study who were interested in issues of spirituality said they did not want to discuss spirituality with their support workers. The reasons for this were to do with being misunderstood and the worker having a different belief system. But without some means of discussion and communication, how can consumers begin the explore the implications of their beliefs and be able to identify experiences which are perhaps harmful if there is no forum to do so? It has been suggested that what consumers would like is a ‘soul mate’ who may be a friend, counselor or clergy person who is available and open to discuss these issues.Community implications of the separation of madness and spiritualityPeople with a mental illness are often aligned with the ills of modern society. They have become the scapegoats for when things go wrong. Newspaper headlines are a testament to how we look for madness as the reason for mass murders, murder suicides, genocide, extreme cruelty. Did the person responsible have schizophrenia is often the first question asked by journalists? What was the reason they did this terrible act? So then all people with a mental illness become associated with violence, unpredictable and cruel behavior. They have then by default become the scapegoats for the human acts which cannot be logically explained and which go wrong.The scapegoat is an ancient image, originally an image of healing the community. In Jungian terms it is a form of denying the shadow the part of ourselves we do not want to know about, the repressed anger, hatred, the impulses which call into question our validity to be called human. Hebrew religious tradition had a scapegoat ritual which ensured the ongoing health, safety and spiritual well being of the whole community. At the festival of Yom Kippur the priest would choose a goat and all the negative elements of the community, the sin, disease, violence, psychic sufferings were all placed on the head of the goat. The goat was then sent out into the dessert, away from the community and the community now being rid of its ills was once again whole.In the modern context this ritual has continued as individuals or groups, seen as the cause of the communities ills have been ostracised in this manner, sent away, put away, allowed to live in cardboard boxes, given no resources to develop or gain any status of value, out of sight and out of mind. However the ancient ritual had another dimension which has been overlooked. The dessert was symbolic of renewal. It was the place of spiritual renewal for prophets, it was the place the Hebrew people developed an identity, and while it was a lonely and threatening place, it was associated with the learning the depths of the soul. So the goat was sent to the place of spiritual renewal. And as long as the people knew the goat was in the dessert, their own healing was assured. The goat was not forgotten. The healing was reliant on the community remembering the goat in the dessert, the goat was bearing their ills and because the goat was there, they were free of their own potential destructive elements.Madness is not just about a definition in a clinical textbook. In order for me to be considered sane, I am aware than someone else has been called insane. And in order for that insane person to have the potential of recovery from her/his insanity, then I must also have the potential to embody the qualities of insanity. This isn’t just about dualism or cosmic balance, but about the continuum of life along which we move and change. The goat in the dessert is not different from the community. It is a symbol of one aspect of the community. R.D. Laing criticized the placing of all the responsibility on the consumer to make their realities understandable to others. He said ‘Both what you say and how I listen contribute to how close or far apart we are’ (Miller). The person diagnosed with schizophrenia or bipolar disorder or obsessive compulsive disorder, is representative of an aspect of the community of which we are all a part. The problem with the modern scapegoat and definitions of clinical diagnoses is that the scapegoat is profoundly alienated from the community, not only in ritual but in belief. We assume the scapegoat represents his/her own problems and that they have nothing to do with me. And in so doing not only have we cut off those people labelled with the mental illness, but we have cut off any potential of healing the community as a whole. We have denied our part of the scapegoat and we have denied them and we have castrated ourselves from hope and healing. People with a mental illness, in the dessert, on the collective boundaries and the isolation and disintegration of their madness, carry within them a part of the spiritual health of the community. And this we have negated, the goat is at risk of dying from disconnection and for this we have suffered a great loss (Bellingham, Cohen, Jones ; Spaniol, 1989).Symbols and their expression in psychosocial rehabilitationI believe that symbols are an important means of enabling the spiritual expression and development of people who have experienced a mental illness. There is a fantastic story of the closure of the psychiatric hospital in Trieste Italy. When the hospital was closing the whole community was involved in the preparation of it. The inpatients at the time decided on a symbol of their life being taken out into the community. Over time a story had developed among the patients around the large draft horse which worked for the hospital laundry. Each day the horse would leave the hospital laden with linen to be cleaned. This horse became a symbol of their freedom. So on the day that the hospital closed a parade was planned and the inpatients made a huge replica of the horse. Inside the horse was placed letters and poems of the inpatients expressing their hopes and dreams. Then as they pushed down the wire cages surrounding the hospital precincts, the patients pulled the horse out of the hospital grounds and into the streets of the community. You can still see the horse today in Trieste.When I started working at the Mission, there were some critics who felt that some parts of the programs such as art, craft, woodwork, music, drama and the association with the church were not really about rehabilitation. We were also meeting well meaning workers from other services referring participants who felt that learning to cook and budget was more important than art. This was perhaps why Cathy Harper and I presented a discussion at the Mental Health Conference on ‘There is more to life than learning to cook’. To me the devaluing of the creative and overtly spiritual aspects of programs was just another way of discounting the need for spirituality as an integral part of rehabilitation and negating the spiritual contribution that people with a mental illness make to the whole community.What I have spoken about today has not been about programs or models of service delivery but about something more fundamental, attitude and belief. Why are we here at this conference? Why do we work in this field? How do we really view people who have been through the experience of a mental illness? Yes we may believe in their underutilised potential. Yes we may consider the quality of the relationship with them as of prime importance. But if at the end of the day we are doing this simply because they need to receive what we can offer, then I feel we have missed the point, and I fear that one day history will merely label us with a more sophisticated form of paternalism.Alan Pinches a journalist and mental health consumer activitist concludes an inspiring article with these words; ‘With a breakdown, there is often a disintegration of personality and confusion in the thinking processes, in the early stages. All the ingredients of identity, meaning and purpose go back into the melting-pot, and a longer ‘ferment’ stage follows. In a long process much information and experiential learning grow into a new understanding of life. This understanding is often of a more fundamental nature:’I am human and I have unconditional worth’… Over time, a new synthesis can develop in us, a sense of true self can build up, wisdom can grow, and perhaps a realisation that the world’s priorities need not necessarily be ours. That we can be ourselves and pleased and proud at that. The seeker is then likely to justify his or her life’s quest with the argument that spiritual work is just as valid as any other form of work or vocation, and that society and the planet needs its thinkers, dreamers, poets, artists, writers and seers of visions'(Pinches 1996).For me, perhaps more than any other time, when the value of what we do and who we are is indicated by the dollar sign on a balance sheet, I think we need seers of visions, people who have journeyed into the depths and we need to hear what they have to say.Reference ListBellingham, R., Cohen, B. Jones, T. ; Spaniol, L. (1989). Connectedness: Some skills for spiritual health. 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(1996). Spirituality: the missing link in psychiatry. New Paradigm November 1996. pp. 8-11.Smith, W.J. (1994). The role of mental health in spiritual growth. Journal of Religion in Disability and Rehabilitation 1(2). pp.27-40.Sullivan, W.P. (1993). ‘It helps me to be a whole person’: The role of spirituality among the mentally challenged. Psychosocial Rehabilitation Journal 16(3). pp. 125-134.Watson, K.W. (1994). Spiritual emergency: Concepts and implications for psychotherapy. Journal of Humanistic Psychology 34(2). Pp. 22-45.York, R.L. (1992). Something discarded. The Journal of the California Alliance of the Mentally Ill 3(4). pp. 3-6.