John Swinton, Ph.D.
Christine Guth is discussing. Toggle Comments
Notes from discussion with John Swinton on mental health and mental illness
Tell me what mental health is?
absence of symptoms of mental illness
carrying out daily capacities
To feel balanced, with forward movement
ability to cope with stressors of everyday life. And to live well.
Well-being. What does it mean?
A continuum – good days and bad days, but getting through.
Life and all of its fullness. What is that fullness?
Mental health involves recognizing that person has an illness – when symptomatic
What does it mean to be healthy in the midst of profound mental illness
measures of mental health are done in universal scales, but mental health is always personal. What is healthy in one culture is not the same as another culture.
In relation to mental illness, who defines what it is?
DSM is “gold standard’ of medical diagnosis
Different subcultures define it differently.
Psychiatric diagnoses are sticky. You are ex-mental patient. You are schizophrenic, your culture holds onto that label.
What for pastoral theologians do you have to bring to the table that is unique?
Framework from Walter Brueggemann. Lament psalms reflect movements in the experience of the people of God. They move person from orientation to disorientation to reorientation.
Royal psalms talk about how wonderful the world is. A crisis hits. You get to process of disorientation. Everything changes. All the old maps change. Markers no longer enable you to make sense of the world. You become completely disoriented. From disorientation, psalm moves you to reorientation.
Psalms convey language to move you to reorientation. Reorientation is different. You have changed. You have a new way of seeing the world. This three-part structure gives a useful way of viewing mental illness. You can be reoriented positively or negatively.
Who determines the nature of the disorientation in mental illness? What is a diagnosis? When a mental health professional listens to the stories of a person’s experience. Mental health profession fits the stories into a particular diagnostic structure. Moves the person to reorientation. Mental health professionals MHP are there to move person. They focus on illness as problem. Their general ethos and goal is to identify and fix problem. Diagnosis is very useful for MHP. They are not designed for theologians. No reason theologian should start at same places as MHP. Diagnoses are created for a particular group. Pastoral theologians begin the journey in the wrong place. World began long before diagnoses were thought of.
Mental healthcare is participating in the journey. Where do we begin the journey. People go to mental health provider, get their stories back from mental health provider in different form. There is more to mental health than what can be diagnosed from perspective of problems. Looking at the fragility and problems of diagnosis. Book: Crazy Like Us. Says, DSM criteria function are highly contested. DSM looks scientific. Groups of psychiatrists differ. There is a mode of negotiation within western, American culture. Ethan Waters notices that US has been exporting its criteria and its solutions for mental health problems all over the world. Example: US sent counselors. But this was not culturally informed, not the usual way of dealing ways of trauma. Natural local ways of dealing with trauma were lost. Anorexia in Japan, schizophrenia in Africa, also examined in this book. Suggest that there is more than one voice. There are other dimensions of mental health that need to be considered.
Theologians coming to the situation have different voices. They can understand differently. WE can think about illness as having two stories, double narrative. First narrative: Biological narrative, the focus of current mental health professions. 2nd Narrative – personal , includes the spiritual. Western society takes the biological more seriously.
Story: friend of mine was preaching sermon on healing. God does not cause suffering. God is redeeming creating. It is not caused by sin. You will experience redemption. Two sisters were angry at sermon. Elder sister had breast cancer and had few months to live. Both thought it was important that God had done this to them. If God did it, there was possibility of meaning in it, possibility of redemption.
Pastoral theologians need to learn to see and narrate the second story well. Schizophrenia is one of the highly stigmatized illness. It has biological basis, and has social component. As soon as you have it you become it, and you can never cease being it. It is totalizing. A neurobiological condition that takes over whole life. Schizophrenia is a brain disease, scientific and biological entity. Probably has more than one cause. At one level, this is helpful. Draws schizophrenia into biomedical framework to destigmatize, compared with cancer or MS. Negative also. John Modrell writes: How to become a schizophrenic. To believe that the inner core of one is sick is devastating. Equates utterly worthless. Instead of having schizoprenia, you become it. No way to escape. Whole body is disturbed. People self-stigmatize. Have same thing through HIV.
Clearly another story that needs to be told. Biomedical teaches us to look in particular ways.
From Mental Patient to Person (Book) interviews with people with schizophrenia. One thing they point out is issue of noncompliance. Said to occur when person leaves institution and refuses to comply with drug regime. Authors asked why people did not take drugs. Mental patients take drugs. Citizens don’t take drug. To stop taking drugs meant you became a person. A reclaiming the sense of personhood, away from stigmatized condition.
In second story is where you find peace, relationship, hope value, purpose.
Pastoral theology begins:
1. it is not one of the mental health professions.
2. Theologically we have a different perspective on health and illness. Bible does not have a word for health. The nearest scripture has is shalom. more than peace. Core meaning is righteousness, holiness, and right relationship with God. Also friendship, community, and some version of health, justice and prosperity. But core meaning is right relationship with God. It has nothing to do with psychological health, but with spiritual condition. It means you can have health even in the midst of the wildest storms. But psychologists are among least spiritual of medical professions.
3. Mental illness is a psychiatric term. In scripture and we use modern categories, problems arise.
4. Recovery is learning to live well within the illness.
5. It works with a different set of narratives. Begins with creation.
Psychiatrists and psychologists tend to pathologize. They assume everything in person is due to illness. Religion superstitious and dangerous. Does religion cause pathology? no.
Spirituality informs you of who you are, why am I here, where am I going, and Why?
Spirituality gives you language to express these things. Provides a grammar to express your existential location in the world. If you are in turmoil of serious mental illness, what other language would you turn to – use that most powerful language available to you to express that. If spirituality is the grammar that people use to express pain and lostness, religion reflects, does not cause the pain and lostness.
Anthropologists talk about interpathy. Anthropologists enters into strange culture. looks around. When he takes the aspects of culture that seem bizarre seriously. Strange landscape becomes familiar. Understanding begins, becomes familiar. This is the place from which we interpret all experience.
Cultural broker accepts the skills of the culture, and interprets to the patient. A pastoral caregiver who can advocate the treatment to the patient in way she can accept. Pastoral caregiver moves empathically between these two worlds. We begin to see mental illness quite clearly. If cultural broker is present, possibility of finding new stories becomes a reality.
Psychiatrists and pastors created coupling groups. Would meet over case study. Pastor would bring case study to interdisciplinary group. Pastor was enabled to bring story, get professional perspectives. Provides a structure for mental health ministry within your church.
We need to reclaim certain practices. We need to reclaim lament. You notice quickly that we are taught how to suffer. Your culture tells you how to suffer, what is acceptable, what is unacceptable. Suffering has a shape. The lament psalms are designed to shape suffering. For small groups, where people had experienced profound suffering, were intended to give language to express that. To form suffering. Lament psalms have cathartic explosion of pain. Extreme violence. It all comes in prayer. For most of psalms there is a shift from rage, anger, distrust, you move to trust: despite it all I trust in you. Some stop dead. That is a place where you can find language for it.
Nella: all psalm hymnal, some have more than one version to be sung. New hymnal.
Moves beyond triumphalism into realism. To be able to express your lostness in a way that is faithful.
As a priest, how do I give hope and support to person who says he knew Jesus? Literature on delusion – for someone to say this, it is funny and bizarre. But also a sense of self-esteem. It is not just grandiosity, it is a place of safety and security as to who you are. You may want to think if they have a significant mental health issue, you may want to seek help. Still, he is saying something. You would not confront, you would seek assistance, but hold on to the fact that there are things that can’t be seen, not to believe that it is nothing but a delusion.
Friend name Neil who is schizophrenia, his church has told him to give up his pills. Has lost his job due to out of control anxiety. He is an adult who does not like how the pills make him different.
This is an unsustainable theological position – not scriptural. Many pastors will say in some contexts. I saw him with higher quality of life. Now the farther away he gets from the medicine, he can’t function.
He is an adult, he is not legally compelled to take meds. He must make decision by himself. Sometimes law compels. His choice has consequences. You can point out the consequences, accompany him through it.
Mental Health First Aid is used extensively in the UK. Designed to have congregations raised consciousness about mental health. Ties in with suicide prevention. It is functioning well. It is destigmatizing mental health. Opening up stories. Can develop a culture in which mental health problems become acceptable.
In my office lady attempted suicide in ladies bathroom. Shot gun. Not her first episode of complete breakdown. She was taken to hospital. Had isolated herself from friends. She was released from hospital prematurely. At first doctor’s appointment after hospital, she told doc that she had open cans of gasoline in her truck in church parking garage. People were deployed to check it out and found it was true. She had escalated the situation and would have created horror for others. When she was in the hospital the rector was overwhelmed she was banished from returning to church. Music department came to me saying He can’t kick her out of the church, this is her home, her community. We got creative — warden, choir master, they tweaked it. Vestry then invited her into a covenant of care and limited access. Trust had been broken. People were afraid of her. We had a pastorally worded covenant for her to follow her treatment regimen, is she ready to return with circle of care — accompanied but no one is placed at risk. Brought church to her in small groups – in coffee shop, park.
People are able to do better when they have a community. She needed a way of incremental steps for returning to community. Enables community to be flexible enough to not let her go.
What are specific issues you want to talk about?
What about dementia and Alzheimer’s who develop mental illnesses on top of developmental disability. There is not going to be healing or cure.
I think there can always be healing, though not cure. Joseph Pieper to love you say, it is good that you exist, I am glad that you are here. You have to make an effort to reach out. Difference between love and evil. To love, you need to reach out. To do evil, you don’t need to do anything. You slide into evil.
All of us need to willfully reach out and love for individuals. People with dementia are profoundly lonely. There is connection with loneliness and neurological deterioration. people with profound intellectual disabilities, the thing carers wanted for them was friendship. Beginning to develop strategies for befriending one another can be step toward healing. Accompanying people through their loneliness.
When dealing with developmental disability plus mental illness, the support is so important to be able to meet them. It is foundational.
Son with schizophrenia came dressed as a king to worship. People talked about it. King decided he would address his subjects in worship. Whenever he stood up and talked to him. Ushers would say, someone will listen to you in the pastors office. Someone listened to him, they took him out. He was treated with respect and disruption was minimized.
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