STAND BY ME
Peter Gilbert
Emeritus Professor of Social Work and Spirituality,
Staffordshire University
Visiting Professor University of Worcester
National Project Lead, National Forum
© P.Gilbert 2010
“SOMETHING WRONG FROM
THE CORE”
On Friday 20th November, 2009, Daul Kim, a South
Korean model was found hanging in her Paris
apartment. Posted on her blog on 15th October, the
model wrote:
“Freedom comes with such costs. But is it even
freedom? One could get numb living like this… decadent
nights to make up from losses. But this endless
loneliness. There must be something wrong from the
core”
Two weeks later the model wrote that she was:
“Mad depressed and overworked… the more I gain the
more lonely it is… I know I’m like a ghost”
BOATS WITHOUT ANCHOR?
“The individual life-projects find no stable ground
in which to lodge and anchor, and individual
identity-building efforts cannot rectify the
consequences of ‘disembedding’ and arrest the
floating and drifting self”
“The new individualism, the fading of human
bonds and the wilting of solidarity”
- Professor Zygmunt Bauman
BRINGING BACK THE SPIRIT
There seems to be a huge urge to bring back a
more spiritual dimension in mental health approaches
Peter’s pilgrimage of ‘empathic ignorance’!
Dissatisfaction with the reductionist approach in care –
“I am not my symptoms”
‘A revulsion from the soulless organisation’ and the
‘Dementor model’ cf J.K.Rowling of management
A huge yearning of the human heart
A feeling that there is ‘something there’ (David Hay)
Secularism – the European exception
BRINGING BACK THE SPIRIT (2)
Secularity is vital but not enough
“Every time you go into a book store, you find a lot of books written with
certainty – you find the atheists and you find the religious, and everybody
is acting like they know the answer. I think what a life in science really
teaches you is the vastness of our ignorance. We don’t really understand
most of what’s happening in the cosmos. Is there any afterlife? Who
knows. We don’t have any evidence for it. We don’t have any evidence
against it. The thing that has always surprised me is that people are
always acting as though they know the answer… There’s a meta-message
and that meta-message is that we don’t know” - David Eagleman, author
of Sum: Forty Tales ffom the Afterlives, 2009
Films and books e.g.. Avatar and The Lovely Bones. Angels are making
comeback! (For a considered view see David Albert Jones, Angels: A
History)
The Mid Stafford Hospital syndrome
Re-engineering ourselves to perfection undermines civic life. By replacing
chance with choice we diminish our ability to envisage a common fate with
the rest of mankind – philosopher Professor Michael Sandel, 2009 Reith
Lecturer
Our search for happiness – but what is it?
SPIRITUALITY AND MENTAL HEALTH PROJECT
From April 2009
Inspiring hope through encouraging person-centred
approaches
Presentations
Seminars
Conferences
list existing
published
resources on
website
(literature search
published 2006))
produce and
edit book of
diverse
perspectives
and other
publications
© Peter Gilbert, 2009
Producing
and sharing
resources
SP and MH
Forum
(registered
charity)
National
Project
Work with faith /
belief systems
Regional
Networks
LINKS
- consumer
groups
- faith
organisations
- professional
bodies
- universities
Pilot Sites /
Collaborative
- other
programme
areas
- journals and
publishers
Regional
Fora
- charities
- development
centres
- SCIE and SPN
National
Mental Health
Chaplains
Group
Staffordshire University
Centre for Spirituality + UK
Research Group - BASS
SO, WHAT IS IT ALL ABOUT?!
All philosophies and
religions speak of the
spirit (Divine / Human?)
as an “animating and
life giving force (O.E.D.)
SPIRITUALITY:
“Provides an expression
of an individual’s sense of
humanity, gives meaning
and direction” (MHF)
BODY
HEART
MIND
SPIRIT
Social / Cultural milieu
I AM HUMAN –
THE ETERNAL
QUESTIONS
YOU ARE HUMAN
BUT WHAT IS HUMANITY?
“Between the falling angel
and the rising ape”
The need for both
Individual and communal
expression
Paul Davies:
The Goldilocks Enigma Why does the Universe
exist as it does?
- Terry Pratchett (from Augustine)
• Where do we
come from?
• What are we
doing here?
• What is the
meaning in
suffering, if any?
• Where do we go
to when we die?
THE SEARCH FOR MEANING (Viktor Frankl)
© Peter Gilbert, 2009
WHAT DO SERVICE USERS
WANT FROM SERVICES?
Being seen as a Whole Person within their whole
environment.
Start where I am! Not where you think I am!
Empathy
Time (quality)
Attendance to emotional needs; culture, identity and
dignity
Working with, not doing to, to find solutions to
practical issues.
Being seen as having strengths as well as needs.
‘DAVINDER’S STORY’
- See Thurstine Bassett and Theo Stickley, Ed. (2010)
Voices of Experience, Oxford: Blackwell / Wiley
THE DOCTOR’S STORY
Dr Liz Miller was working in the highly competitive field of neurosurgery.
Gradually she became unwell, and a form of mania crept up on her.
She was sectioned and recalls that being a doctor didn’t help.
“The thing is, in medicine we live on this myth that illness is for other
people. Doctors don’t get ill. Illness is for the patient. And so I
swallowed it – the whole medical thing”
Miller came from a high-achieving family, “with enough doctors to start
a small hospital”. Giving up neurosurgery was both a public humiliation
and a personal wrench: “In the past, I prided myself on my brain. I
would get by on my wits. And suddenly your mind goes, and it actually
goes to the core of who you are. It says something about you as a
person. You ask yourself, ‘why me?’”
“Every time I was alone, I wept. The thing about mental illness is the
awful isolation. You think you are the only person there. And you are so
ashamed of it. There’s the external stigmatising behaviours from
society, but there’s also the internal shame… you can’t talk to anybody
about it”
See Mary O’Hara, Interview with Liz Miller, ‘Doctors Orders’, Society Guardian, 11th June 2008
VIEWS FROM THE ABYSS
Stigma and discrimination
Loss and crisis
Losing a sense of self
Making sense of the story
© V Nicholls 2010
© V Nicholls 2010
SPIKENARD AND JASMINE
and only when I’d lain in severing heat:
and only when I’d lain alone in binding ice:
and only when all life and love had lain eclipsed…
and only when I was made whole again:
and, by the river, unremembering,
I’d walked again, had walked among birdsong
and perfumed flowers,
had walked in the valley among spikenard and
jasmine:
only then, Lord, did I hear you call my name.’
From Spikenard and Jasmine by Angela Morton
© V Nicholls 2010
BREAKDOWN AND RECOVERY
Vulnerability and intimacy
Impact of childhood experiences
Re-emerging from fragmentation and chaos
Strengthening internal resources
Holding onto a sense of hope
© V Nicholls 2010
RESEARCH WITH SERVICE
USERS AND SURVIVORS
Knowing our own Minds / S4L
–
–
–
–
–
–
belonging to a helpful and supportive community
acceptance
flexible and sensitive response in crisis
compassion, understanding, non-judgmental attitudes
prayer when sought
a quiet space
Somerset Spirituality project
Spiritual practice day by day
– Spirituality as a feeling of being connected to something bigger can
provide a way of coping
– Some people’s experiences can be damaging or unhelpful these
need to be taken into account
© V Nicholls 2010
‘I walk to the gardens and sit on the grass. I
listen to the water fountain and close my
eyes. I imagine a peaceful place…’
‘I think it was a combination of my GP, the
medicine and my spiritual life. In some
incredible way they all came together and I
think it was the spiritual element that was
the glue that held it all together.’
© V Nicholls 2010
DRIVERS FOR SPIRITUAL CARE
Personalisation, through the White Paper: Our Health, Our Care,
Our Say (2006), the 2007 Commissioning Framework for Health
and Well-being, and Putting People First (December 2007), the
Government concordat to transform adult social care.
The need to create greater social cohesion and community wellbeing, as set forward in: Our Shared Future (2007).
The Equalities legislative and policy agenda.
The accent on promoting a healthier social and economic
community, as promoted by Lord Layard.
The need to meet the aspirations recorded by service users and
carers in surveys and through inspection reports.
The 2001 revised Patient’s Charter states that: “NHS staff will
respect your privacy and dignity. They will be sensitive to and
respect your religious, spiritual and cultural needs at all times”
(p29).
DRIVERS FOR SPIRITUAL CARE (2)
The clear evidence from research that membership of faith
communities can improve your physical and mental health.
The importance of ethnicity and of faith in individual and group
identity.
Increased cost benefit analysis achieved through working with the
motivations of individual service users, carers and community
groups.
The social inclusion agenda in which Spirituality has an important
role to play.
The need for Health and Social Care to be sensitive to user, carer
and staff belief systems [Religion or Belief: A practical guide for the
NHS, DH, January 2009]. Links across to Scottish guidance.
New Horizons, (DH, 2009) accent on prevention and early
intervention.
The NHS contract.
The March 2009 WHO Europe report by Dr Lynne Friedli,
emphasises the challenge of social inequality to the mental health
of the nation.
THE RESEARCH BASE
Most of the research has been done in the
USA and with homogeneous groups – mainly
Christians and Jews.
Work by people like Harold Koenig and others
demonstrates the benefits to people of a
religious faith across all aspects of health and
longevity.
The position in the more complex society of
the UK, is much less clear. The major empiric
(King et al, 2006) provides a very diffuse
picture.
Professor Andrew Sims, past President of the Royal College of
Psychiatrists, suggests three major benefits for belonging to faith
community:
Social benefits – a sense of belonging.
Trust in God and a ‘sense of rightness’ and the security this gives.
Internal levels of control e.g. the spirit of the divine and/or moral
purpose within me helps me to assert my own will to do better.
Professor John Swinton would add a number of other aspects e.g.:
The provision of social resources.
A positive self-perception.
Specific coping resources, not least through signs, symbols, rituals
and narratives – a framework for life.
The generation of positive emotions e.g. love and forgiveness
See Gilbert et al, 2010, Chapter 9
BIRMINGHAM AND SOLIHULL
MENTAL HEALTH FOUNDATION TRUST
RESEARCH PROGRAMME ON SPIRITUALITY
Development of a personal recovery scale. This is the first time that as
specific scale has been produced that focuses on a person’s spirituality
(sources of hope, meaning and purpose) that can effect their recovery.
Young people, psychosis and spiritual intervention. An attempt to consider
post-modern culture, which may have less dependence on traditional
meta-narratives. Some practical difficulties with keeping a group of ‘out
patients’ together.
Work with faith communities which has promoted much greater mutual
understanding and cooperative working between the faith communities
and the mental health trusts.
Professional attitudes to survey. The vast majority of staff surveyed
(across all professional and administrative groups, including social
workers who are not actually managed by the Trust) provided a
fascinating insight into the strong feeling that the spiritual dimension was
important, but an almost equally strong feeling that staff were not clear
how to work with service users and carers on this issue.
Occupational therapy and spiritual care.
Training programme across the Trust now agreed.
The effect of the integration of a spiritual care advisor in multi-disciplinary
teams.
‘SOUL LOSS’
“If we had a soul – and as a hard line materialist I do not
believe we do – a useful metaphor for depression could
be ‘soul loss’ due to extreme sadness. The body and
mind emptied of the soul lose interest in almost
everything except themselves. The idea of the wandering
soul is widely accepted across numerous cultures and
the adjective ‘empty’ is viewed across most cultures as
negative. The metaphor captures the way in which we
experience our own existence. Our ‘soul’ is our inner
essence, something distinctly different from the hard
material world in which we live. Lose it and we are
depressed, cut off and alone.”
- Professor Lewis Wolpert (2006, 3rd edition)
Malignant Sadness: The Anatomy of Depression, Faber and Faber