STAND BY ME Peter Gilbert Emeritus Professor of

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 20 th November, 2009, Daul Kim, a South Korean model was found hanging in her Paris apartment. Posted on her blog on 15 th 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

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, 11 th 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

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. ’ © V Nicholls 2010 From Spikenard and Jasmine by Angela Morton

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 / S 4 L – – – 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” (p 29).

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, 3 rd edition) Malignant Sadness: The Anatomy of Depression, Faber and Faber