September 2023 – Glenn Myers

Mental health, then and now

Mental health demonstrates a wide bifurcation between Western and other worldviews.

The ancient Greeks, lending their day-to-day language to the writers of the New Testament, had simple terms that undergirded simple ideas. There were such things as ‘unclean spirits.’ People could be bothered by these unclean spirits and could thus be ‘demonized’.

When Jesus came along, he was able to wear this worldview effortlessly. He spoke on occasion to evil spirits within a person; they spoke to him, usually calling out curses; he cast them out; the patient recovered. It’s worth remembering that Jesus also ‘rebuked’ fevers and indeed ‘rebuked’ the wind and the waves. But as regards ‘unclean spirits’ he didn’t feel a need to update the ancient worldview; he operated successfully within it.

Western medicine has, I think, turfed out this worldview entirely, even though plenty of people still hear voices, voices that tell them to do evil things, and even though some people would self-diagnose as ‘demonized.’

Once I was on a conference call with a sick and very damaged person (he had been tortured). The leader of the call asked if anyone was in the room with him. The answer? No-one, he said, except the demon who watched him all the time and never left him.

Essentially, I think (and this is not my subject) quite a few Western-trained mental health workers would think the person self-diagnosing as ‘demonized’ was actually deluded and deceived and essentially, misdiagnosed. (I don’t want to downplay, though, the tenderness and skill with which some people within Western diagnostic traditions will nevertheless work with such a patient.)

There are plenty of fine reasons for this Western stance. Unfortunately (and I am very hestitant here because it really isn’t my subject), Western mental health is still in my view rather primitive. I wonder if it isn’t, in fact, roughly where Western physical medicine was about 300 years ago–dogmatic, authoritative, ineffective, its practice centred around humours, bleeding, and leeches.

How often are the mentally ill cured? I do not know. To what extent is mental illness itself a metaphor– in the sense that we sort-of know what physical illness is and (by way of metaphor), describe other things wrong with humans as ‘mental illness’? Are we medicalising something that isn’t an illness? For example the widely-cited Diagnostic and Statistical Manual of Mental Disorders (DSM-V) has a new entry called ‘Prolonged Grief Disorder’. This in effect medicalizes people who suffer bereavement for longer than might be considered normal. I don’t know enough to critique this properly, but at least on the face of it it seems odd to give a medical label to someone who’s taking a long time to move on. If you can’t pull your socks up in a decent amount of time, DSM-V seems to say, there must be something medically wrong with you and you need a psychiatrist. I am not entirely sure that I am happy with this, nor that it is right to use phrases like ‘mental health epidemic’ when more and more stuff like this is unearthed. ‘Mental health terminology epidemic’ might be equally fair. The wave of sadness and depression that is passing through the country, is, of course, not doubted, just (arguably) not properly diagnosed and even if the diagnosis is right, isn’t being ‘cured’. Or isn’t being cured all that much. People are still suffering and sad, which is the real scandal. People are still plagued with voices and terrors.

This circles back to the bifurcated worldview. It would be fine to disparage and move on from the ancient worldview if the modern worldview wasn’t, in itself, so frequently ineffective and disappointing.

Wouldn’t it?

History is slow, tidal, and made by unlikely people

I was enjoying spending time in Matthew’s gospel the other morning, the first chapter about the lineage of Christ. But keep reading. It’s subtle and clever, I think, even subversive.

Most people quote lineages to show the nobility of their birth. (Actually our pedigree Labrador did the same). Matthew does some of that, of course, but the subversive bit is that he only mentions four women – – five if you include the Virgin Mary – – and none of the four are what you’d call conventional, good Jewish girls. They span the range of scandal and tragedy, all females in a man-centred, sexually-objectifying world. Tamar, a sex worker, was impregnated by her father-in-law. Rahab, another sex-worker was a foreigner and an enemy. Ruth was a returning refugee. Bathsheba was seduced by King David when she was married to another man, and, stripping naked on her roof in sight of the palace, may have not been totally blameless in her conduct.

So the four women who were none of them conventional good Jewish girls (Ruth perhaps excepted) were highlighted by Matthew as blood relatives of the Messiah, part of his noble pedigree. Was Matthew gently reminding his Jewish readers that nobody’s excluded from having a part in Christ? That nobody’s history or reputation excludes them?

A second thing about Matthew’s genealogy was that surely he was making theological points rather than strictly historic ones. It reads to me like a stylized re-telling. Matthew was dealing in ‘who we are’ (truly) rather than ‘who we are’ (precisely). (There’s a lot of this in the Bible as everywhere. News reports, for example, are always stylized; they simplify to amplify.) In Matthew’s telling, then, there were fourteen generations from Abraham to David; fourteen generations from David to Babylon; fourteen generations from Babylon to Christ. Put this way it becomes a vignette of salvation history.

Fourteen generations from Abraham: the pioneers become a power. That is not just Israel’s story. It is the Muslim empire’s story, America’s story, the British Empire’s story, and on a wider canvas, the story of every world-dominating thing.

Then, over fourteen generations, the empire, corpulent and corrupt, is swept away, to Babylon. And it seems like the end; the bones scattered at the mouth of the grave.

But then fourteen generations from Babylon to Christ. Babylon to Christ! Matthew’s genealogy says, don’t be bogged down in the noise: learn to see the signal. History’s going somewhere, but it takes its time and has its seasons.

Postscript: A kind critic pointed out that it was not fair to call Tamar a sex worker. My friendly critic is completely right. Sorry for the careless writing. I find it impossible to entangle the rights and wrongs in Tamar’s actions, given her very limited choices and the distance of her culture from mine. But I suppose the general point still stands: Matthew seemed to alight on some unlikely women to name explicitly in his genealogy, and it’s a decent assumption that he was reminding us all of Jesus’ love and inclusion for those of who might doubt our insider credentials.

How to set up a social ministry that lasts

If you are a church group wanting to start some social ministry in your community, three principles stand out, I think:

Set well-recognized, high standards. Aim to be widely respected.
Don’t charge people for your services but trust that the money will come in somehow.
Go to where the Kingdom of God will have the most impact; start at the bottom of the barrel.

These are derived from Jesus’ instructions to his itinerant-healing-and-preaching disciples in Matthew 10:

Find the home of a local, well-respected worthy and lodge there. (This gives social accreditation of decent standards)
‘Freely you have have received, freely give’ but ‘workers deserve their wages’. The disciples’ stance was to serve for free, but to trust that they would be recompensed; God’s work, done God’s way, won’t lack God’s supply.
‘Go to the lost sheep of the house of Israel’. There are two ways to read this verse: assume that all the house of Israel are lost sheep; or perhaps the more straightforward one: the house of Israel has some sheep happily grazing, but others who are lost. Go to the lost.

This made me think of two charities that I know about or have recently learnt about. Romsey Mill in Cambridge works with families and youth, and has various specialities, such as groups for young fathers, or for young people with ASD. St Luke’s Advice Service in Brighton offers help to people with debt or disability, often navigating government bureaucracy on behalf of their clients. (I didn’t contact either charity before writing this, which is off my own bat.)

Each:

is widely respected in the community (St Luke’s has commendations from each of the area’s three Members of Parliament)
Offers services for free or for a notional contribution. The real funds come from fundraising; leveraging available Government funds; and calling on a volunteer workforce and local goodwill. Local churches and maybe other groups like businesses or charitable groups see each charity as a legitimate outlet for community service. The goodwill of churches was behind their founding and helps to sustain them without compromising their specific focus or standards. So their money mostly doesn’t come from their clients and their work is not for profit. There are no strings attached.
Is set up for the people who most need help.

What a vision: the churches of our country patching the holes in our social support networks, in that way finding a ready audience, and living out and demonstrating the Kingdom of God in the sight of all.

If it’s not ‘all in the mind’ quite a lot is.

Gavin Francis’ book Recovery — GP’s take on the neglected art of convalescence –:

has a brilliant example of what good, or harm, our minds can do as part of our well-being; worth quoting. Francis talks about two middle-aged men who ‘a few weeks apart both suffered a cardiac arrest and collapsed, ostensibly dead, but who were successfully resuscitated with electric shocks. Both were then fitted with portable electronic defibrillators …[that were] about the shape and size of a matchbox’. If either man collapsed again, ‘the portable defibrillator would sense the change and shock the heart back into a healthy rhythm.’

‘For one of the men, the intimate experience of the proximity of death, the fragility of life and his new reliance on the implanted defibrillator was utterly traumatic. He began to suffer panic attacks and fiddled ceaselessly with the swelling beneath his collarbone. He couldn’t find a way to stop fretting that it might fail. At the time of his cardiac arrest he had been working as an administrator but he found himself unable to go on working. He was afraid to be alone, and his nights became a torment of insomnia.

‘For the other man, the almost identical experience of collapse and then resurrection became an epiphany of gratitude. His new life was a gift, he said, for by rights he should now be dead, and all the tedious, niggling irritations that once troubled him seemed to dissolve. It was enough to be able to breathe this air, walk on this earth, see his grandchildren. He had always lived modestly, but now began to emjoy sumptuous meals, fine wine, and booked holidays to places he would never before have considered visiting.

‘He had died, but then he lived again, and that new life into which he was born seemed one of richness, tenderness and gratitude.’