July 25, 2018 at 6:25 pm #3825
The intro says “The mental health professionals have been deeply affected by the influence of the medical model and the pathology-oriented world view that accompanies it. Consequently, it is often difficult to focus on issues of mental health that may not fit neatly within such an empiricist worldview.” I found this to be a very relevant thought. I immediately got to thinking about the stigma that still comes with having a mental health illness diagnosis, to me this fits very well with the idea of pathology. Yes it is helpful to have a frame work for some understanding but when the frame work becomes ridged walls that do not take into consideration other more fluid parts of a persons life – like spiritual orientation that can change with life experience – the framework becomes too narrowly focused. The rest of the intro I think explores this well as it talks about entering into another’s experience and looking with their eyes. I greatly appreciated it speaking to the fact that spirituality is common amongst all humans, this fits with my belief that we are all spiritual beings and as such we can not isolate issues of spirituality from the illness of the person. Where I find myself challenged is how to interact and provide appropriate intervention when it is clear that the way the persons spirituality is being experienced in the context of mental illness is doing more harm than good. How do we engage this tension in a way that does not deny the spirituality but yet addresses how it is not healthy. And on a secondary line, how do we even determine healthiness of a particular spiritual belief in conjunction with mental health issues.
Chapter one as it addresses what spirituality is, does a fairly decent job at engaging the issue of how hard it is to come to a common definition of what spirituality is. I appreciated how is works more from looking at common themes in spirituality than trying to come to a concise definition. I also appreciated it separating spirituality and religion. I believe this is even more important in our current context where connection to organized religion is decreasing, yet people are still finding spiritual connection. At one point it speaks to needing to be comfortable with uncertainty and mystery to work fully into a theraputic understanding of spirituality. I tend to lean into the more contemplative and mystical parts of my faith, that journey has taught me how to be comfortable in just what they are talking about, I have found that comfort level to help me sit in those challenging spaces of uncertainty with those who are in spiritual/mental health crisis. Chapter one is rich with a great deal, I appreciated it speaking to the need to come along side with science and empirical evidence to begin to work in to a healing approach that uses a both/and perspective.
I struggled a bit with Chapter 2 as I wondered if it’s perspective on the lack of presence and willingness to address spirituality by the mental health profession is still accurate. I know in the last 17 years as a chaplain I have witnessed a greater embracing of the importance of and integration of spirituality and spiritual care as part of the medical model. I did find it’s engagement of the topics of positivism and empiricism very helpful and I found myself gaining a greater understanding of just what those mean.
I found myself highlighting a great deal and making many notes. I shall stop here and use this as just and overview and bring along more of what has caught my attention from chapter one and two as we continue the conversation.
July 26, 2018 at 11:35 am #3826
Thank you for the thoughtful replies to the initial reading. I too found myself underlining and highlighting much of what I read. This always means that the concepts and discussion both resonates with my experience and provokes me to deeper thinking.
Here are few of my reflections that are similar to yours. At the end of the introduction, “The intention is therefore to provide an open, non-denominational framework within which people of varying spiritual persuasions can find direction and assistance in fulfilling what is a vital health care task. It is hoped that, irrespective of the carer’s particular spiritual perspective, the information supplied within this text will be usable and effective in enabling genuinely person-centred spiriutal care.”
I agree that this has been a much-needed goal for a long time. My training as a pastoral counselor required me to learn as much as I could about the psychotherapeutic models related to the medical model. I became a very proficient psychotherapist and was also challenged to integrate that learning and practice with theological reflections. Swinton seems to be calling us beyond that. In the process of learning psychotherapy from the psychiatrist, we often taught them as much about that theological integration as they did us about psychotherapeutic principles and technique. This broader approach suggested by Swinton would have been welcomed back then as a way to cross over and provide a common language.
I agree also that it is important as discussed in chapter one that more medical and mental health professionals are taking seriously spirituality as an important part of human development.
There is a huge challenge in helping people understand the difference between religion and spirituality. Even medical professionals tend to think they are synonymous.
The one concern that I have is that as spiritual caregivers attempt to include empirical research in the undergirding of the work that the mystery or contemplative aspects might get lost.
I will share more later. I hope our other friends will join in our discussion.
July 26, 2018 at 5:10 pm #3828
Rick, I resonate with your comment about finding a common language. I think this is still a fairly sizeable hurdle to get over. The conversations are happening as spiritual care begins to develop a common language with in ourselves, now the challenge it to translate that to the medical model and vis versa. This feeds into one thing I picked up on in chapter one where it discusses use of metaphor and analogy, early in the chapter (Location 240 on kindle). It speaks to the metaphorical nature of our language and how that can be helpful in reaching towards an understanding of spirituality. One thought I had about this is that we need to be careful with metaphor because the metaphor that makes sense to me may completely fall flat for someone else. It also led me to the question for people dealing with mental health issues particularly certain psychiatric diagnoses are metaphors even helpful or do they take us to uncertain territory of pitfalls of unhelpful or even dangerous metaphorical misinterpretation?
I also resonate with your comment about the challenge in differentiating between religion and spirituality. If I had a penny for every time I have used the phrase and educated on the concept of everyone is spiritual in some way, but not everyone is religious I would be well set for retirement. My own spiritual journey to connecting more deeply with contemplative and mystic Christianity as well as my training in Tai Chi leading to an understanding of my own personal and spiritual energy what is of called chi in the Tai Chi traditions has greatly influenced my understanding of the difference between the two.
Lastly I too share your concern about loosing the mystery and contemplative aspects of spirituality in the push for spiritual care to become more outcomes oriented and evidenced base. It is a fine balance and I am concerned that the pendulum may be swinging too far in the other direction. This is not to say we should not be about outcomes or evidence, that is needed to be in conversation with the medical model – we just need to be careful not to loose the other part of what makes being a spiritual journeyer with someone so powerful, our ability to embrace mystery and not feel the need to explain it away.
Enough for now.
July 30, 2018 at 3:10 pm #3831
Joy, Kathy, Lee, and Joan,
Here are some additional thoughts and questions in Chapter 2. I agree with Joy that some of this chapter is out of date. For example, I see a lot of research interest and best practice interest in the nursing literature. In fact, it seems that nursing researchers are leading the way in research into the impact of spirituality on patients’ lives. Has that been your experience?
I also find more and more research interest in psychiatry on this topic. I am fortunate to have a close working relationship with several psychiatrists and integrative medicine physicians who are very interested in this whole area. Wayne Oates had a tremendous influence in this regard with his psychiatrist colleagues at the University of Louisville Medical School during his tenure there.
Swinton argues for a change of paradigm to thinking of mental health caregivers as spiritual healers. What do you think of that as a challenge? Have you seen any evidence of that happening in your experience? I have to keep in mind that Swinton writes from a European perspective.
I have reached out to him to see if he has updates on these two perspectives in this chapter. Will let you know what he says.
Although Victor Frankl was only mentioned once, I found much of what Swinton was arguing for had already been laid out in Frankl’s work. As a pastoral counselor, pastor, former chaplain intern and resident, and human being who struggles with depression, I found his example about depression to be right on. In my experience, medicine, insight and expressive therapies can help alleviate depressive symptoms but the hard work is done around the issues of meaning.
What do you all think?
July 30, 2018 at 4:07 pm #3832
I too have noticed more research on spirituality in the nursing literature. Perhaps that is because they spend 12 hours a day at the bedside of their patients sometimes for more than one day at a time, they have a unique opportunity to engage conversation over a longer period and as patients get to trust them, open up more allowing them to perhaps be connecting the dots quicker. I think too, perhaps they are able to look at this from a more humanistic perspective than necessarily religious providing for something more broadly connective. However, this does not mean we as spiritual caregivers get off the hook on doing research ourselves, I think rather it creates a unique opportunity for partnership in research.
I can’t speak to the openness of psychiatry really. It is not an area that I connect to much. Our hospital has only one psychiatrist on staff and he is VERY busy. I do know he is greatly appreciative of our work as chaplains and has commented positively to me on what I am contributing to the outcome of patients that we are mutually seeing. If I am in the room when he is rounding he will defer to me if he is able. So there is a respect of what I bring to the table. I would say that generally I think there has been quite a bit of growth in recognition and research from the physician side of things to the importance of spirituality, particularly in the growth of the whole person model of treatment.
I am not super familiar with much of Frankl’s stuff, but from the general broad understanding I have I do agree the much of the hard work of any kind of crisis comes in the meaning making. It is messy, non-linear, and hard. In my experience there are lots of questions asked that do not have specific answers other than what the person doing the meaning making can create for themselves. It is the meaning making that I think spiritual caregivers are uniquely equipped to come along side with. Our skill set of being comfortable in the mess and ability to sit with the questions and not rush to answers and be journeyers with someone is invaluable.
Good thoughts Rick. Thank you.
July 30, 2018 at 4:57 pm #3833
First of all a little about myself. I’m Joan, a member of a religious order. I am a member of the Catholic Church. I grew up on a farm in IL. I have 2 brothers, one has already died. I also have a sister. Working in a small rural hospital has not exposed me to working with many people with a mental disease. When we have a patient who seems to have a mental disease a mental health case worker is called to work with that patient. If needed, then the patient is transferred to a larger hospital with a psych unit. So I have little experience in this regard, but will try to learn what I can from each of you.
Also, I’ll be as active as I can with this seminar. As of last week I handed in my resignation after 10 years of working in this hospital. So the moving boxes are slowly being filled, and other plans are in the making.
July 31, 2018 at 10:58 am #3834
I’m sorry I’ve been MIA. I have chosen an interesting week in which to take a Spiritual, Silent Retreat at the Abbey of Gethsemani just outside of Bardstown, KY. Interesting, because Chapters 1 and 2 resonates with my purpose for the retreat. It is difficult to hone in on the material from Swinton’s book; however, I’ll try and narrow my thoughts around two areas, one from each chapter.
Chapter one leads me to reflect on my being a body that carries a spirit. We recognize that we are flesh animated by Spirit. As the text points out “Spirit” in Hebrew is ruach and in Greek is pneuma. It does point out that a translation is “wind,” but the Greek/Hebrew goes further. Each word can also be translated as “spirit” and “breath.” Thus, this body that carries the spirit carries that which moves us, that which sustains us, and that which gives us a meaningful life. Thus, as Swinton says, “Sprituality is the outward expression of the inner workings of the human spirit.” When you “see me,” you may notice that I’m average height, my dark hair has lost it’s color, I am frightfully thin due to a recent ongoing medical condition, and that I have a deep Southern accent; however, when you move beyond the outward physical Lee Whitlock and become my friend, you may see me in terms of my philosophical, political, and spiritual Lee Whitlock. I thought of the lyrics of “Some Enchanted Evening” from “South Pacific”:
<div style=”text-align: center;”>Some enchanted evening you may see a stranger
You may see a stranger across a crowded room
And somehow you know, you know even then
That somewhere you’ll see her again and again</div>
<div>My romantic side says that you might see me and want to know me. On the other hand, when you move up close and through my outward shell, you may “see me” and find I’m too liberal, my theology is too humanistic, and find that my spirituality is a bit odd for your tastes. You may find the outward me attractive but the inward me unattractive. You could also see any of a couple of other of the combinations of the two.</div>
<div>One other point from Chapter 1, I found it interesting that Swinton also delved briefly into the ideas that are central to all humans: Where have I come from, and where am I going. I’m currently reading Dan Brown’s current (repeat) novel, Origin. In it, Langdon, his protagonist from his previous novels is in pursuit of some research that was developed by a former student of his. The research, according to his murdered student, promises to answer these two fundamental questions. The older I get, especially as I see my on mortality slipping away has me focusing more on the second question rather than the first.</div>
<div>Chapter 2 carries the ideas from chapter 1 in the same direction, but on a physical basis. I have a plethora of doctors at the present time: GP, Oncologist, Endocrinologist, Urologist, Psychologist, and O<span class=”st”>rthopedist. Six years ago, I was diagnosed with Multiple Myeloma, a form of cancer. Currently and thankfully, it is taking a great deal of tax dollars (Medicare), insurance dollars, and personal funds to keep me alive. Most of my doctors see me from a statistical basis. I find it interesting that of the five listed, I see four of them only after a nurse has come in and taken my “vitals”. Before entering the room, the doctors look at the physical data and make decisions about how to treat me. Two of the four, I feel, take time to listen to Me (i.e. spiritual) and adjust their diagnosis based on what I say. In particular, MM keeps me in a certain level of pain. Rather than just throw pain medicine at me, they engage me in conversations about sleep, mood, psychology (How are you handling the pain?), and one of the two, my GP, asks about my spiritual condition. We talk about my use of “meditation” rather than “medication”.
<div>As Swinton points out, most medical professionals see religion, the spiritual, as a further neurosis that may need to be medicated. He speaks of nurses, but he might as well have been speaking of most medical professionals: “Nurses are frequently unaware of their own spirituality and spiritual needs. Consequently, they are often unprepared to recognize and care for the spiritual needs of others. It is very difficult to give what one does not have oneself.” It seems that technology has replaced theology. I visited with a psychiatrist for a couple of sessions since she had been recommended as someone who specialized in how various medications interacted with others. Since I had doctors in at least five different areas, I was being medicated by five different medical/physical directions. Each doctor only had a passing knowledge of the other medications I was taking. I also went to Dr. Davis because she had studied under Dr. Wayne Oates when she was in the Medical School at the University of Louisville. Later, she took an internship at Harvard, and Dr. Davis told me, “I was surprised that none of the other doctors had been trained in the spiritual aspects of medicine!”</div>
<div>It has taken me longer than I expected to address my two major points, and I could continue on. I suspect, however, you are ready for me to relinquish the floor, so I yield the floor. If you’ve made it this far, thank you for your time.</div>
July 31, 2018 at 5:29 pm #3835
I greatly appreciate your candor about your current medical experience. I think it is enlightening on how in some ways we have moved a great deal from where we were when the book was written and yet it seems in many ways we have not moved so very much. It strikes me that just like patients personal spiritual background plays a key role in their mental health, it also seems that nurses and physicians openness to spirituality is correlated to their own personal spiritual experience and background.
I also picked up on the bit about pnuema and ruach. This continues to be a very powerful spiritual/physical concept that I find helpful. As an participant in martial arts, both Tae Kwon Do that has a much more martial or fighting focus and also Tai Chi that tends to be used in a more meditative focus, breath is key. Particularly in my tai chi practice I have found that when I can incorporate breath with the meditation and movement I find myself moving more deeply into connectivity to the divine and myself.
August 2, 2018 at 4:14 pm #3840
Thoughts on Chap. 1. After reading that chapter I realized that at least half of my life span centered around religion. Religion was focused on the intellectual level of memory, learning and keeping the rules. It was pretty straightforward and felt very safe. There was a definite separation of body and soul. Gradually, I listened to a variety of seminars, lectures, and personal conversations with people I trust that living was more than that. There was spirituality. Spirit is who I am and is expressed through my body, emotions, thoughts and concern for others. It feel freer and not so confining. As was stated on pa. 17 “Spirituality is seen as the outward manifestation of the longings inspired by their experiences of their spirit: the search for transcendence, meaning, value, hope and so forth.”
In cht. 2 I appreciated the explanation of positivism, empiricism and the power of the medical model. WJ;e in the past much focus has been in these areas, I hope there is a slowly paradigm shift which includes focusing on the whole person. When I hear a patient mention, “I know how I feel but the doctor didn’t listen. He left before I could ask any questions.” I feel sad. For the rest of the day the person is frustrated because concerns were not addressed. Their sickness was the cause of being admitted to the hospital. In that regard, I listen to their concerns and question if they have an advocate when the doctor arrives the next time.
August 2, 2018 at 4:28 pm #3841
I resonated with you comment about “how a person’s spirituality is experienced in the context of mental illness is doing more harm than good.” I had an acquaintance who lived with a low grade of depression most of her life. After a a suicide by drowning, her mother shared that her daughter was scrupulous most of her life. It was not apparent to most of us as she kept it and her depression under control, until it ruled her. Outwardly she was a serious but happy person. But rules were important to her and change most difficult. It was so sad to see her die in this manner.
August 2, 2018 at 6:05 pm #3842
Thank you for sharing this. It to me is a perfect example of what we see is not always what is true. This is something I try to remember in my own ministry and work.
August 19, 2018 at 1:38 pm #3893
To speak to the first question of spirituality that is unhealthy: I would introduce you to the concept of scrupulosity. It is OCD with a religious bent. I have a chaplain who just did a poster presentation on this at APC, I would be glad to send out his research with his permission. So, from a mental health perspective there is such a thing as toxic spirituality/scrupulosity. In scrupulosity specifically, the focus is on doing everything right or enough to the point of the thoughts becoming obsessive leading to a compulsion that somehow soothes the obsessive thought. So, if someone is afraid they are not praying correctly, they would recite a prayer over and over again trying to make sure they get it right. This could last for hours. Or some people will not read parts of the Bible they deem negative, because it makes their obsessions worse-thinking if they read a particular verse something bad will happen to them or someone they love, so they create compulsions to go to great lengths to never see anything about that particular verse. Think of the TV show “Monk” but about religious thoughts and activities specifically. With scrupulosity patients the worse thing we can do is the thing we want to do which is reassure them. Reassurance takes the anxiety away briefly, but it comes back with a vengeance. Their thoughts and questions have to be answered, and they have to learn that they can be exposed to their thoughts and fears and live through the anxiety. It’s an interesting ministry, one that is challenging for me.
August 19, 2018 at 1:48 pm #3894
In regards to chapter two and the engagement of mental health field around spirituality: I can only speak for my experience, but in my hospital (which is a Catholic health care system, grounded in faith-based values), it continues to be a difficult road in some areas to help staff see spiritual care as equally important as symptom management. There is more focus on mindfulness-deep breathing, meditation, grounding- but mainly in the context of symptom management. Where I am beginning to see a shift is in our focus on trauma-centered care. Trauma centered-care focuses on the root of the problems, rather than simply symptom management. It focuses of meaning-making, building resilience, learning and growing from our past and building on our inner resources to become more healthy. I see this as what we have been doing all along! I will say, that I have seen growth in the appreciation of spiritual care in our setting over the last 3 years as I have made it an expectation that we all be an active part of the interdisciplinary team staffings. This had not been happening regularly, but after doing this for 3 years, the staff across the hospital are referring more patients to us for individual sessions, and integrating us into a part of the care plans on a more regular basis. It is a slow movement, but a movement, nonetheless.
August 20, 2018 at 1:27 pm #3896
I really appreciated your two posts. Your first one on scrupulosity was particularly helpful for me. It helped me to understand a bit more how line between helpful spiritual practices and toxic spiritual practices might play out in a specific way. I would be very interested in seeing your chaplain’s research.
I am curious how your involvement in working with the trauma-centered-care looks. In my setting with shorter and shorter stays I often only see a patient once so I am having difficulty imagining how this might look if one does not have opportunity to develop a the relationship over more than one visit.
September 7, 2018 at 5:52 pm #3907
Sorry for taking so long to get back in touch. I’ve had kids starting senior year and college back the last two weeks, so my schedule with working and taking care of all that has been crazy. In response to seeing people only once: our programs tend to have patients here for 2-4 weeks at a time, except for the detox unit where patients are only there for 2-4 days. So, we do have a little more time to establish a relationship. However, after meeting with someone in spirituality group, we often get a glimpse into some pieces they are dealing with and are able to do a follow up based on that information.
Your question does remind me of my hospice work, though where we work as though we only have 1 day with the patient. In that work I tended to dive deep rather quickly and usually the circumstance and sense of urgency helped that along. I suppose it would depend on the patient and the situation they are facing as to how open/willing the person would be to having an in depth relationship in a short amount of time. Mostly, though, what people have said is that they work with the assumption that everyone is dealing with some form of trauma (whether primary or secondary or lived trauma that happens over a long period of time). So, maybe instead of trying to focus on the patient opening up quickly you change the way you frame your questions and the way you deliver care. The other important thing would be to make sure the patient is given a good referral for follow-up when they leave you.
August 21, 2018 at 9:07 am #3899
Cindy, I too found your comments on scrupulosity to be helpful. If I am reading it correctly, it mainly has to do with people who have a distorted view of religion. My thoughts went quickly to the use of religion to find and support a particular political stance. In fact, I think the political right has hijacked the beautiful term “Evangelical”. Instead of spreading “Good News,” I find that they most often spread discord and division. This can only be done if one is a OT Christian. They completely miss the teaching of Jesus and the later prophets. Jesus comes preaching, “You have heard it said of old….but I say unto you….” The so called “evangelicals” come spouting, “You have heard it said of old…and that’s the way it is.” One political leader when asked his favorite Bible verse replied, “Well, I like an eye for an eye particularly.”
My experience in the mental health field is limited to a year working at Our Lady of Peace Hospital in Louisville, my own pastoral counseling with others, and my own experience in being counseled by pastoral care professionals. I found this to be especially true since I have been diagnosed with Multiple Myeloma. When I was diagnosed, I very quickly went to “acceptance” toward the disease and not in a negative way. I knew that it was a power greater than me, but I also believed that God would help me deal with it appropriately. This is still my stance; however, at the insistence of one of my primary care physician who believed I was in “denial”, I began seeing a psychiatric nurse practitioner. What she has mainly helped me to do is deal with the family issues around this dis-ease. I recognized that in a real sense cancer is a family disease. I had been the primary problem solver in my small family, and suddenly, I found that I needed someone else to take over that role. The main burden fell to my daughters in the early stages of the disease. Others have also come on board as care givers. To paraphrase Blanche DuBois, “<span class=”ILfuVd yZ8quc”>”I have always depended on the kindness of friends.” This has never been more so for the past six years.
My experience with Pastoral Care in
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