Spirituality and Mental Health Care

Rediscovering a 'Forgotten' Dimension

John Swinton

• Publisher: Jessica Kingsley Publishers
• Year: 2001
• Print ISBN: 9781853028045
• eBook ISBN: 9781846422201
• Topic: Psychology
• Subtopic: Mental Health in Psychology
• Index: Psychology

A person's sense of spirituality informs his or her awareness of self and of the society around them, and is intrinsic to their mental well-being. In this balanced and thoughtful book John Swinton explores the connections between mental health or illness and spirituality and draws on these to provide practical guidance for people working in the mental health field. He analyses a range of models of mental health care provision that will enable carers to increase their awareness of aspects of spirituality in their caring strategies.

Using a critical evidence-based and interdisciplinary approach to contemporary mental health practice, Swinton explores the therapeutic significance of spirituality from the perspectives of both carers and service-users, looking at mental health problems such as psychotic disorder and depression, Alzheimer's disease and bipolar disorder. He also provides a critical review of existing literature in the field to place spirituality in contemporary theory and practice.

CHAPTER 1

What is Spirituality?

The Rise of Spirituality in Contemporary Western Cultures

Contrary to what might often appear to be the case, the latter part of the twentieth century has seen a major upsurge of interest in spirituality within the Western world. As Davie and Cobb observe (in Cobb and Robshaw 1998, p.89),

Despite a commonly held assumption – strongly bolstered by unrepresentative voices in the media – that secular attitudes prevail in modern Britain, the sociological evidence reveals that relatively few people in the population have opted out of religion altogether or out of some sort of belief; in other words, experiences of the sacred or spiritual remain widespread, notwithstanding a recognized and much talked about decline in religious practice.

It is true that institutionalized religion is becoming less popular. All of the major Christian denominations have seen a sharp decline in the post-war period, and this decline has carried on into the new millennium. However, whilst people may be becoming less religious, it would be a mistake to assume from that that they are necessarily becoming less spiritual, or that they are no longer searching for a sense of transcendence and spiritual fulfilment. What seems to have happened is that the spiritual beliefs and desires that were once located primarily within institutionalized religions have migrated across to other forms of spirituality. The spiritual quest continues, but in very different and much more diverse forms than those traditionally assumed to be normal.

This migration of spirituality from the ‘religious’ to the ‘secular’ has led to a change in the meaning of spirituality, as popularly conceived. Rather than being viewed as a specifically religious concept, spirituality has broadened in meaning into a more diffuse human need that can be met quite apart from institutionalized religious structures. This changing meaning of spirituality is reflected in the variety and diversity of definitions and understandings that are found in the literature on spirituality and mental health. The concept of spirituality is no longer confined to religion, nor is the practice of spiritual care necessarily located within any formal religious or spiritual tradition. Spirituality has become a wide and multi-vocal concept (i.e. it has many different meanings and interpretations), which is understood and interpreted in numerous different ways, from Christianity to Buddhism, to Islam, humanism and the New Age (Barnum 1998).

A slippery concept

Spirituality has therefore become a slippery concept within Western culture. As one works through the literature that explores the relationship between spirituality and mental health, it very soon becomes clear that whilst there may be a number of common themes such as God, meaning, purpose, value and hope, there does not appear to be a common definition that can fully encapsulate what spirituality is.

Positively, the disparate understandings of spirituality present within culture alert us to the need for thoughtfulness, imagination, creativity and flexibility when we are seeking to address the spiritual needs of people with mental health problems. A view of spirituality that does not look beyond institutional religion risks missing out on some of the very significant spiritual needs that are experienced by people with no formal religious interest, on a daily basis. Negatively, the very diffuseness of definitions and understandings makes it difficult to tie down precisely what spirituality is, and what its implications are for the process of caring. When spirituality is defined primarily in terms of a particular religious tradition or denomination, it is relatively straightforward to identify and meet spiritual needs through such avenues as prayer, scripture reading, meditation and so forth. However, when spirituality appears to mean all things to all people, it is more difficult to tie down specific strategies to deal with people’s spiritual needs. One of the tasks of this book will be to explore ways in which spirituality, in all of its divergent forms, can be identified, understood and worked with. For now the significant thing to bear in mind is that spirituality may well be highly significant to many people with mental health problems, even though they may not express an interest in or adherence to an established religious tradition.

Spirituality: a usable concept?

This does not mean however that spirituality is so diffuse as to be meaningless as a working concept. Irrespective of the diversity of its manifestations, it does contain identifiable components and experiences that can be understood, nurtured and cared for. However, in order to understand spirituality it will be necessary to let go of our positivistic desire for absolute certainty, neat definitions and universally applicable categories, in order that we can enter into an aspect of human experience which, in many respects, transcends final categorization. Alongside the cultural changes highlighted above, one of the main reasons for the lack of conceptual clarity surrounding spirituality relates to the difficulties of capturing, in words, dimensions of human experience that are essentially inexpressible. Experiences and feelings such as spirituality, love, meaning and hope are not easy to analyse and conceptualize in the language of science. Consequently writers find themselves stretching their language and concepts beyond the boundaries of the normal scientific discourse, as they attempt to express something of the inner depths of human experience. If we are to develop a therapeutic understanding of spirituality it will be necessary to learn to be comfortable with uncertainty and mystery. This is not to say that we need to become ‘unscientific’ in the sense that we refuse to seek empirical evidence for our claims. To adopt such an approach would be to exclude spirituality from participating in what is undoubtedly the dominant epistemological discourse within contemporary Western culture, and one which has been deeply influential on the development of mental health care practices. As we shall see, spirituality can in fact be studied scientifically, although our understandings of science may have to alter to accommodate for the new perspectives that spirituality brings to it.

What we do need to do, however, is to begin to expand our understandings of science and empirical evidence to include methods and ways of looking at the world which will not overlook the spiritual dimension of the person. This chapter will seek to wrestle with the tension between the inherent inexpressibility of the spiritual dimension, and the need to find ways of identifying and working with this important dimension of human experience. In working through these issues it will be possible to develop a working understanding of spirituality that will guide and inform the remainder of the book.

What is the Human Spirit?

In developing an understanding of spirituality, it is necessary to begin by reflecting on the nature of the human spirit. This starting point is not in itself uncontroversial. Within a cultural milieu that has come uncritically to accept the assumptions of science, empiricism and positivism, there might appear to be no justification for drawing upon such an ethereal and apparently unverifiable concept as ‘spirituality’. However, one of the continuing arguments of this book is that the way in which we currently view the world is only one possible construction of it. Certainly a narrowly conceived scientific perspective will not recognize or acknowledge the reality of the human spirit. Nevertheless, this study will aim to expand our view of science to include aspects of human experience that may be excluded from the present paradigm of ideas and worldview.

It is important to begin by noting that while the terms ‘spirit’ and ‘spirituality’ are closely connected, they are not synonymous. The human spirit is the essential life-force that undergirds, motivates and vitalizes human existence. Spirituality is the specific way in which individuals and communities respond to the experience of the spirit. This distinction is quite subtle, but very important.

The word ‘spirit’ is derived from the Latin spiritus meaning ‘breath’. An analogy would be human respiration, by which oxygen is taken in to sustain and maintain the existence of the person. The spirit provides a similar sustaining and maintaining role on a more ontological level. The spirit is the fundamental breath of life that is instilled into human beings and which animates them and brings them into life. An example drawn from the Judaeo-Christian tradition will help clarify this point.

The word [spirit] is etymologically related, in Hebrew (ruach) and Greek (pneuma), to the concept and picture of the stirring of air, breeze, breath and wind. In Hebrew anthropology, ruach was the enlivening force of a person – the breath of God which turned the prepared clay into a living soul. In the second creation story in the book of Genesis, Yahweh breathes into the prepared earth and the clay becomes a living nephesh. Thus the very being of the person is permeated by the ruach [spirit/spiritus] of God. (Lartey 1997, p.114)

The spirit energizes human existence and fills it with meaning and purpose. The source of the spirit is open to a number of understandings. It is variously described as God, Brahma or energy, and can be understood as an internal or interpersonal force of interconnectivity, or an external force that is given to people by some form of higher power. However it is perceived, it is ‘usually considered to be untouchable, indescribable and untestable by any physical science,’ (Pullen, Tuck and Mix 1996). Although ultimately mysterious and, to an extent, indefinable, the effects of the spirit can be described and understood.

Spirit as personal force

In contrast to the assumptions that the use of words such as ‘life-force’ and ‘energy’ might conjure up, the human spirit is not an impersonal, distant power that is unaffected by the experiences of the individual. As van Kaam in Goddard (1995, p.809) puts it, the human spirit is ‘the dynamic force that keeps a person growing and changing continuously involved in a process of emerging, becoming and transcending of self; it is through this gestalt process that life is imbued with meaning and a sense of purpose for existence.’ One of the dangers in using metaphors such as ‘energy’ to help us understand and describe the human spirit is that there is a temptation to forget about the metaphorical nature of our language, and to assume that spirituality is energy, rather than is like energy. The spirit is a unique force that has a quality of its own. We may be able to reach towards it using analogy and metaphor, but we must be careful to acknowledge these explanatory concepts for what they are.

A good example of this type of confusion between metaphor and reality is found in Goddard’s (1995) use of the term ‘integrative energy’ to describe the human spirit. She argues that ‘spirituality pervades, unites and directs all human dimensions and, therefore, constitutes the internal locus of natural health. Consequently, a definition of spirituality as integrative energy is hereby proposed’ (p.813).

However, as Dawson (1997, p.283) correctly observes, there is a

world of difference between agreeing to consider spirituality, for discursive purposes, as an integrative energy, and stating that spirituality is integrative energy. The first statement is metaphorical. As all metaphors do, it attempts to explain the unfamiliar (spirituality) by the familiar (energy). The second statement asserts an isomorphic relationship between spirituality and integrative energy; the two are deemed equivalent in every respect. In any context one can then replace the term spirituality with integrative energy and the meaning will be retained.

In order to understand any new thing it is necessary to begin by drawing it into our current frame of reference and exploring and describing it using that which is familiar to us. In this way we build up concepts and understandings that enable us to make sense of that which is alien. Terms such as ‘force’ and ‘energy’ are familiar concepts drawn from physics that enable us to approximate an understanding of some aspects of the way in which the spirit functions. These analogies and metaphors are helpful in enabling understanding. However, though the spirit may be like force and energy, that is not what it is. Energy is an impersonal force that functions according to fixed laws and principles. As such it is predictable and unchanging. The spirit is a personal force that responds to the life experience of human beings. Common expressions such as: ‘her spirits are high...

Table of contents

• Cover Page
• Other Books
• Title Page
• Copyright
• Contents
• Acknowledgements
• Introduction
• 1. What is Spirituality?
• 2. The Neglect of the Spiritual
• 3. Spirituality and Mental Health Care: Exploring the Literature (with Alyson Kettles)
• 4. Living with Meaninglessness: The Lived Experience of Spirituality in the Context of Depression
• 5. Enabling Spiritual Healing: Developing an Understanding of Spiritual Care
• Conclusion
• Appendix
• Bibliography
• Subject Index
• Author Index