SACH
Scottish Journal of Healthcare Chaplaincy
Vol 7 No 2 October 2004
Editorial
CONFERENCE
REPORT
'MENTAL HEALTH, WELLBEING AND SPIRITUALITY'
Dundee.
12 -14 August 2004
I drove up to Dundee through intermittent rain, and under a louring
sky which spoke of yet more to come. At intervals, signs flashed a warning
that the A9 was closed north of Perth, and as I came within sight of
that city I looked down on a river Tay engorged with flood water. I
turned east, and my thoughts took me to the approaching conference.
It promised much; an international gathering, an array of distinguished
keynote speakers, and a diverse choice of workshops.
Mental Health, Wellbeing and Spirituality. In com-bination, they reflect so much that is currently creat-ing a buzz in the world of healthcare. This conference, hosted by NHS Tayside and supported by the Scottish Executive, had about it from the outset a palpable air of excitement, the sense of an op-portunity to explore movements and ideas whose time had come. It had attracted, among others, psy-chiatrists, psychologists and social workers; counsellors and nurses; those involved in advocacy work; academics and practitioners in various fields; chaplains and faith group representatives - and, most significantly, service users themselves, whose distinctive voice gave the gathering its particular intensity of focus.
It was no holiday. Meditation at 7.15am (absent: G Nelson); breakfast, and a bus at 9am sharp to take us to each morning's two keynote lectures. Back to West Park Conference centre for coffee, then straight into workshops till lunch, and again till dinner. Boot camp, but worth it. I have seldom spent a more invigorating, challenging and at times just plain bewildering two and a half days.
In the space of this editorial I can only provide a brief overview of what was on offer. Keynote speak-ers included Professor David Lukoff, whose central theme was the relationship between spiritual experience and psychotic illness; Professor James Griffith, who spoke about encountering the sacred in professional practice, and Professor David Fontana, who considered the growing body of evidence which warrants that spiritual and mystical experience be taken seriously. Dr. David Reilly offered a multi media presentation on 'Integrative Care: Creative Emergence', while proceedings were brought to a close by Professor John Swinton's thoughts on 'Remembering the Person. Thinking beyond illness to the possibility of a mental health care Service'. As for the workshops-they offered everything from 'meditation with children' to 'ageing and the spiri-tual journey'; from 'designing hospitals' to 'psycho-spiritual supervision'; from 'talking with people about their spiritual lives' to 'the art of living'.
Most thought provoking for me were the sessions led by psychologist David Lukoff, who explored the phenomenon which he called 'spiritual emergency'. He describes a spiritual emergency as a crisis related to a sudden spiritual awakening or breakthrough, an experience sometimes of seismic intensity. Such an event could be precipitated perhaps by over expo-sure to some ill-understood spiritual practice such as certain forms of yoga or meditation, and at its height could exhibit many of the symptoms normally asso-ciated with psychotic illness. His thesis is that men-tal health professionals need an awareness of the potential importance of the spiritual dimension in the lives of patients, and the discernment to distin-guish between a psychotic episode and a spiritual emergency. Such discernment, he argues, might mean the difference between being treated with anti psychotic medication, or being listened to carefully, contained within a safe environment, and assisted to integrate the experience and use it to begin to con-struct a 'creative personal mythology'. Drawing on both personal and professional experience, Dr Lu-koff advocates a hopeful prognosis; spiritual emer-gency, supported and not merely medicalized and suppressed, can lead to spiritual emergence, and on towards a life deepened and enriched by the whole episode. This is in contrast to the somewhat pessi-mistic stance adopted towards that which is deemed to be psychotic illness, with its expectation that the patient will be on medication for the rest of his days. He speaks of recovery in terms of a spiritual jour-ney, often towards greater integration of the person and an enhanced sense of connectedness to others, or to Another.
And so, Dr Lukoff advocates a re-visioning on the part of those of us who are steeped in western cultural attitudes and trained to employ a bio-medical model of understanding; that we should make room for other possibilities; that we should be less swift to dismiss the actual content of a patient's story, in favour of the form of a psychotic illness. To that end, Dr Lukoff and colleagues proposed a new diagnostic category to be included in the American edition of DSM-1V (1995). It deals with 'religious and spiritual problems' as the focus of clinical attention.
I hope that the above summary illustrates to some extent the fascination and challenge of the confer-ence as a whole. At one level, something fairly ob-vious is being promoted; that patients should be treated as human beings, their experience listened to with respect. At another level, the challenge is pro-found to those trained to regard as pathological any spiritual or mystical elements in a patient's presentation. Challenging also to the whole mental health-care establishment - that the care of those undergoing mental/spiritual turmoil should be truly therapeutic, and underpinned by hopefulness of a person's future potential. The challenge extends also to faith groups, that we should neither accept un-critically, nor dismiss out of hand as mental illness, the stories of those whose spiritual journeyings have the power to unsettle us so deeply.
I drove away from Dundee into unexpected glorious sunshine, with much food for thought and many shades of feeling. My mood arose in part from the elusive quality of this word 'spirituality' about which so many other words have been recently spun. John Swinton posed the question as to whether we need in fact to move on from using this word, with which so many meanings and so much vagueness are associated. (His own perceptive comment that spirituality is about living in the world of love, sto-ries and experiences speaks eloquently to some of us, but may run the risk of mystifying others. So it always seems to be when any attempt is made to capture the essence of what spirituality is.) I had heard many experiences described with sincerity, some involving the kind of free-wheeling, unfet-tered, extravagant imagery which is apt to unsettle a Presbyterian soul. So many 'spiritualities'- how to discriminate amongst them? Amid all the talk of auras and chakras, of alien encounters and out of body experiences, where does truth, or reality, lie? I found myself at times giving thanks for the rigour, the discrimination, the spiritual moderation of a mainstream religion, and for the quieter manifesta-tions of the spiritual life, nurtured within a commu-nity, nourished though struggle and prayer and the disciplines of daily living, and often issuing in lives of great compassion and self-forgetfulness. Yet, then again, I think of King David, embarrassing his wife by dancing and capering before the Lord. I remem-ber the eccentricities of an Ezekiel; I think of those scriptural hearers of heavenly voices; of Paul, speak-ing enigmatically of the man caught up into the third heaven; of Luther, even, chucking an inkwell at the Devil. And I think, hmmmm…
I am grateful
to Lynne MacMurchie for her summary of John Swinton's closing
remarks.
David Lukoff is Professor of psychology at Saybrook Graduate
School in San Francisco
James Griffith is Professor of Psychiatry and Neurology at the
George Washington University Medical Center in Washington DC
David Fontana is Distinguished Visiting Fellow at Cardiff University
and Visiting Professor of Trans-personal Psychology at Liverpool John
Moore's University
David Reilly is, among many other things, Consultant Physician
at The Centre for Integrative Care, Glasgow Homeopathic Hospital
John Swinton is Professor of Practical Theology and Pastoral
Care in the School of Divinity, Religious Studies and Philosophy at
the University of Aberdeen.
Diagnostic and Statistical Manual of Mental Disorders. 4th ed.(1995)
American Psychiatric Association. Washington DC
UNFIT
TO BE UNFIT?
A CHRISTIAN CONTRIBUTION TO THE HEALTHY LIFESTYLE DEBATE
Eric Stoddart
Pages 3-9
Abstract: Molly offers me a handful to sweets from her copious bed-side supply.
She is evidently over-weight and the complicity of her family offers
little hope that she will shed the tens of kilograms that are inhibiting
her recovery. Who am I to say 'no thanks' if that merely compounds my
inner disdain at her failure to make healthy choices?
This paper invites us to reflect on a Christian contribution to the
debate on healthy lifestyle choices that the Scottish Executive and
NHS Scotland are cur-rently promoting. How do we make a theologically-informed
response to those who make unhealthy lifestyle choices? Where does personal
responsibility and autonomy fit when our choices have fiscal implications
for the wider community? Can we legitimately stigmatise people who fail
to comply with others' model of health? To what extent does a Christian
perspective clash with the ultimate value that the healthy lifestyle
debate seems to place upon life? By exploring Christian ideas of humanity
and shared non-innocence we aim to identify key responses that might
enhance the contemporary practice of health promotion.
Key words: Christian, forgiveness, health, lifestyle, health promotion, sin
Eric
Stoddart is Lecturer in Practical Theology,
School of Divinity, Philosophy & History,
University of Aberdeen
THE
LOCATION AND IDENTITY OF CHAPLAINS:
A CONTEXTUAL MODEL
Mark Cobb
Page 10-15
Abstract: The place of chaplaincy in healthcare is endorsed by current guidance
in the NHS, but chaplains are also recognised as belonging to other
communities. This can be both advantageous and problematic for chaplains.
The identity of chaplains is intrinsically social and the communities
they are associated with are important sources of determining identity
and location. A contextual model pro-vides a way of understanding this
identity through three principal communities: the healthcare community,
the disciplinary community and the faith community. The model explains
why chaplains provide a valuable contribution to healthcare.
Key words: chaplaincy, social identity, community, social context
Mark Cobb is a Senior Chaplain and Clinical Director of Sheffield Teaching Hospitals NHS Trust, an Honorary Lecturer in the Faculty of Medicine at the University of Sheffield and an Honorary Research Fellow of the Lincoln Theological Institute at the University of Manchester.
WHO SHOULD EMPLOY THE CHAPLAIN?
Abstract:
The Church of Scotland is currently exploring the possibility that all
Healthcare Chaplains should be directly employed by the NHS. This is
in response to developments both within the NHS and within the Church
itself. This article contains reflections upon this issue, from four
different perspectives. We hear from the convenor of the relevant church
sub-committee, from a whole time chap-lain and head of department, from
a part time chaplain, and from a parish priest who reflects some of
the concerns of the Roman Catholic Church.
Key Words: healthcare chaplaincy; direct employment; spirituality;
Editorial
Introduction
Georgina Nelson
Page 16
Why transfer the employment of chaplains, and why now?
David Watson,
Convenor of the Church of Scotland,
Hospitals, Healthcare and Universities Chaplaincies Sub-Committee
Pages 17-18
Who employs the chaplain in NHS Tayside?
Gillian Munro
Head of Department of Spiritual Care
NHS Tayside
Pages 18-19
Playing
Cards with the Octopus.
Ken Coulter
Chaplain
Stobhill Hospital, Glasgow
Pages 19-20
A Roman Catholic Perspective on Direct Employment
Jim Duggan
St. Aidan's, Johnstone
Pages 20-22
WORLDS
APART?
A COMPARISON OF MENTAL HEALTH AND ACUTE HOSPITAL CHAPLAINCY
Iain Macritchie
Page 23-27
Abstract:Starting with a personal account of his own experience as a Hospital Chaplain, working in both the psychiatric and acute sectors of health care, Iain Macritchie makes observations, and draws some comparisons between these two areas of Chaplaincy. Healthcare Chaplaincy, in general, is seen as a dialogue between faith and suffering. The differences between acute and mental health Chaplaincy are highlighted by examining the nature of the theology and of the suffering in either case.
Keywords :Chaplaincy, acute,
healing, mental health ,suffering, theology,
Iain Macritchie is acting senior chaplain for NHS Highland.
RECOVERING
OUR LOST SAINTS:
A CURRENT THEORY OF LOSS AND ITS CHRISTIAN EXPRESSION
Tom Gordon
Page 28-33
Abstract: While faith and a spiritual perspective offer hope and reassurance in bereave-ment, not all Christians find that their faith gives them the framework they need in their loss and for some it may serve to slow down or disrupt the grief process. However, taking current grief theories, and applying them to a realistic theology, and in particular the concept of the communion of saints, has the potential to allow the Christian to grieve in a healthy way while continuing to hold to principles and beliefs informed by their faith.
Key Words: Bereavement, grief, loss, faith, Christian, spiritual
Tom Gordon is chaplain and co-facilitator of the bereavement service in the Marie Curie Hospice Edinburgh.
DAY
HOSPICE CARE:
PERCEPTIONS AND TABOOS IN PALLIATIVE CARE
Jacki Thomas
Page 34-38
Abstract: Stimulated by Downs(2003) article on Failure in Palliative Care the author reflects on the workings of a day hospice focusing on the difficult and challenging issues for patients and how the hospice setting can enable these issues to be raised and addressed. The issues are explored and illustrated using patient comments and experiences. Acknowledging a dearth of hospice day care research and literature the author seeks to motivate others and encourage a wider appreciation of day hospice and thereby influence future practice.
Keywords: day hospice, fullness of life, isolation, depersonalisation, taboo topics
Jacki Thomas is chaplain, Paul Bevan Day Hospice, Ascot.
THE
INTRODUCTION AND EVALUATION OF A SPIRITUAL ASSESS-MENT TOOL IN A PALLIATIVE
CARE UNIT.
Bruce Pierce
Page 39-43
Abstract: A study was undertaken to determine if individualised, formal spiritual assessment could impact on and optimise patient care within a Palliative Care Unit (PCU). The authors write on the benefits of formal spiritual assessment as undertaken by chaplaincy services. The Spiritual Assessment Tool (SAT) selected, introduced and evaluated for the PCU was the HOPE tool. The authors share the results of research into the effect and benefits that formal spiritual assessment had on members of the PCU's interdisciplinary team. The results highlight a posi-tive impact, of the SAT, upon the various team members. The article explores and expresses the staff's enhanced understanding of the nature and extent of spiritual and religious needs and resources.
Key words: Spiritual assessment tools; palliative care; chaplaincy; interdisciplinary team
Bruce Pierce is Palliative Care and Staff Chaplain at Princess Margaret Hospital and Toronto General Hospital, part of the University Health Network. Frederic Koning is Senior Chaplain and Teaching CPE Supervisor at Princess Margaret Hospital and Toronto General Hospital, part of the University Health Network
BOOK REVIEWS
Pages 44-45
Philosophy for Medicine: Applications
in a clini-cal context.
Martyn, E. Pekka, L. Puusstinen, R. (Eds.)
ISBN 1 85775 943 5
Radcliffe Medical Press
Teaching made easy: A manual for
health professionals (2nd edition)
Mohanna K., Wall D., and Chambers R.
ISBN 1-85775-871-4
Radcliffe Medical Press
Demonstrating your competence 1:
Healthcare teaching
Chambers R., Mohanna K., Wakely G, and Wall D.
ISBN 1-85775-607-X
Radcliffe Medical Press
THE ORERE SOURCE
Attribution: The creator of these pastoral abstracts is the Rev. W. Noel Brown, a retired Presbyterian minister, and hospital chaplain-supervisor. He was formerly chairman of the Standards Committee of A.C.P.E. and is a board-certified chaplain of the Association of Professional Chaplains.
he abstracts are held in the database of The Orere Source . It currently contains over 17,500 abstracts from the pastoral care literature and health-care literature which has implications for the continuing education of chaplains. Further information may be obtained from: < oreresource@rocketmail.com >
Pages 41-48