Finding Jesus in the Storm. John Swinton

Чтение книги онлайн.

СКАЧАТЬ THINNING OF SPIRITUALITY

      The final area of thin description emerges from a rather surprising source: the ongoing conversation around the role of spirituality in mental health care. If systems of categorization such as the DSM tend to create diagnoses that can have thinning and objectifying effects, and if biological approaches risk turning people into bodies without persons, then conversations around spirituality reveal that even in the realm of the apparently holistic and spiritual dimensions of care, thin descriptions abound and hold hidden dangers. This may at first sound rather odd. We’re tempted to say: “Surely, spirituality has to do with whole-person care and holistic ways of viewing people.” Well, one might be forgiven for thinking that. However, closer scrutiny of what is actually going on in the realm of the spiritual as it is articulated within mental health care reveals something quite different.

       Spirituality in Mental Health Care

I have been a part of the conversations around spirituality and mental health care for many years. In 2001, I wrote a book titled Spirituality and Mental Health Care: Rediscovering a “Forgotten” Dimension.46 Among other things, that book pointed out the lack of research and practical attention being paid to spirituality within mental health care. It suggested that the “forgotten dimension” of spirituality was in fact crucial for good mental health care and indicated ways in which mental health professionals could be encouraged to remember it and, in remembering, become people who care for the spirit as well as minds and bodies.

Since then, the situation has changed significantly. What appeared to have been “forgotten” in 2001 is well and truly remembered today! The literature emerging from the mental health-care professions reveals a burgeoning and vibrant interdisciplinary conversation that explores a variety of issues around spirituality, religion, and mental health. Religious spirituality has been positively associated with the alleviation of depression, anxiety, PTSD (post-traumatic stress disorder), schizophrenia, anorexia, and personality disorder.47 The more generic forms of spirituality are not so closely tied to measurable outcomes, but they are assumed to be fundamental to genuinely person-centered care.48 Some authors even suggest it is essential to our humanness.49 This latter claim is probably not very wise, because highlighting any capacity or desire as fundamental to what it means to be human inevitably means that those who do not have that capacity or share that desire can be viewed as less than human. Nevertheless, the universality of spirituality is certainly a frequently made claim.50 The presence of spirituality is recognized even at the level of policy, with governments insisting that all mental health professionals and indeed all health-care professionals take spirituality seriously.51

      At first glance, this seems to be very good news! We may not be clear on what mental disorders are, but we do know what human beings are and what human beings need: they need spiritual care. Alongside the necessary care for mind and body, we also need to care for people’s spirits. One might ask the question: “What could possibly be wrong with this?” Surely this puts things like religion and theology back on the map of professional credibility and offers important new possibilities for care. To an extent this is true, however, as useful as a focus on people’s spiritual dimensions is, there are significant problems with this approach.

       Spirituality as Self-Actualization

The basic understandings of spirituality in the relevant literature focus on the central features of what people assume spirituality to be: meaning, purpose, hope, value, respect, love, dignity, and (for some people) God.52 Few of these definitions offer a strong philosophical or theological rationale for what spirituality actually is, and why it should be understood in such ways. Instead, many researchers simply create their own definitions of spirituality, which tend to focus on those things the researcher assumes to be most valuable in and, importantly, most absent from current caring practices. Their general assumption is that the content of spirituality emerges from the personal choice of the individual. Some people choose to express their essential spirituality in terms of religion, but others choose different ways of engaging with their spirituality (through nature, art, relationships, sport, and so forth).

      Researchers think about spirituality in this way in order to ensure that it is inclusive. Put slightly differently, this is a spirituality designed to cater to people of “all faiths and none.” It is nondenominational, open to the religious and the secular, and above all, individualistic and personal. Spirituality is thus perceived to relate to a series of personal choices that everyone should be given the freedom to develop on their own terms and in their own image. Spirituality relates to my meaning, my purpose, my value, and my choice about whether I believe in God. Viewed in this way, spirituality becomes a mode of self-actualization, a way of meeting personal needs and goals quite apart from others or God. This mode of spirituality fits neatly within the goals of modernity and the expectations of a culture that is deeply individualistic and fundamentally oriented toward personal choice as the moral arbiter.

       Thin Spirituality

      What we end up with is a very thin mode of spirituality that is terrified of offending anyone. No longer do we have deep, thick descriptions of spirituality, richly narrated spiritual encounters with God, angels, or demons. We have prayer, worship, and sometimes a loose affiliation to religion, but involvement with what God is doing in the world is optional, if it is included at all. Instead, spirituality is thinned down and renarrated in terms of personal choices and practical psychological utility (does it make you feel better?). The efficacy and acceptance of spirituality are gauged by the effect of particular behaviors—prayer, meditation, church attendance—on a person’s well-being, with “well-being,” once again, being viewed primarily in relation to an individual’s hopes and desires. One can choose the God who created the universe and who flung the stars into space, or one can choose a walk in the park. Both are assumed to be pretty much the same thing in terms of spiritual worth.

      Practical utility is key. “Does it work?” “What benefits can it bring to people?” “How can it help us feel healthier?” This kind of spirituality is a spirituality from below—a spirituality that may include transcendence, but only as one option among many others. It makes little difference whether God is real. What matters is whether we choose God as a lifestyle option. Rather than introducing something that is radical and new, this mode of spirituality is designed to help certain culturally bound conceptions of spirituality fit in with current practices and assumptions. Instead of transforming mental health-care practices into something radically different from what is available currently, it is deeply shaped and formed by what is already going on in health-care institutions. It is a spirituality from below that takes its shape not from the urgings of the Spirit of God but from the nature and spirituality of health-care institutions.

       The Spirituality of the Institution

      An examination of the National Health Service (NHS) in the United Kingdom will illustrate this point. The NHS was launched in 1948. It is a system that assumes that good health care should be available to all people regardless of wealth. Health care is thus free at the point of use for all UK residents and is based on clinical need, not ability to pay.

      The СКАЧАТЬ