Category: Healing

Mental health and slow healing

Am enjoying a book called Dopamine Nation by Dr Anna Lembke. I also happened to come across a newspaper piece by author Rose Cartwright about mental health having predominantly environmental, rather than chemical causes. It’s fascinating. Since I suffer incurably from the journalists’ affliction of blogging about anything I’ve just discovered, without passing through the efforts required for actual expertise, here are a few things I’m learning:

  1. You can get excused from quite a lot of things these days by saying ‘it’s not good for my mental health’ (this is my wife’s insight). This is an upgrade on the excuse of Bartleby the scrivener, invented by Herman Melville, who avoided unpleasant tasks at work simply by saying ‘I’d rather not’. (I use Bartleby’s excuse a lot at church.)
  2. Sadly, perhaps the best way to raise the alarm about your difficulties in life is to use the language of mental health. If you do, at least someone will eventually come along to help.
  3. Mental ill-health itself, like white light passed through a prism, has a colourful spectrum of differing causes and cures. We need to think prismatically (as Rose Cartwright points out) rather than simplistically.
  4. The common practice of ascribing mental ill-health to a chemical imbalance in the brain, and then prescribing a drug to fix it, is rather less-well attested in the scientific literature (I think) whereas other causes, like poverty, trauma and deprivation have a rather stronger correlation. Rose Cartwright again: Evidence that exposure to environmental stress is the leading determinant of common mental health problems like anxiety, depression and OCD, seemed to be overwhelming, whereas evidence that organic brain dysfunction or genetics are the leading causes of such conditions seemed to be comparatively scant.
  5. Addressing one colour in the spectrum (the drug route) is arguably not going to entirely fix things in most cases.
  6. Academics generally know this. But academics don’t have ten-minute appointments with patients for which they are equipped only with a desperately scant toolbox.
  7. So doctors are left managing the problem and the result is a feedback loop involving doctors, drug companies, and mildly-sedated patients, few of whom are going anywhere except round and round again.
  8. I am reminded of a blog I wrote about the magazine Private Eye’s tame(ish) medic, Dr Phil Hammond. He wrote: Friendship and a feeling of belonging; an ability and curiosity to learn and adapt; purposeful physical and mental activity; observation and appreciation of the environment; compassion for others; food that is both delicious and nutritious; an ability to switch off and relax and regular, restorative sleep— collectively these daily joys of health are more powerful than any drug.
  9. Here’s a dream. Imagine a government that set up a proper study about the causes and cures of mental illness. Imagine it learnt that the issues to tackle are poverty, inequality, childhood trauma, struggling parents, discrimination, bad living conditions, food that isn’t food, the closing of recreational spaces and youth clubs, and (perhaps) the unlicencedness of smartphones, which (perhaps perhaps) are as dangerous and unregulated as cars in the 1920s. Imagine this enlightened government realized that investment and attention in those areas would reverse the tidal rise of ‘mental health problems’.
  10. Then imagine if they didn’t. Then further imagine what we non-career-politicians could do instead to make our corner of the world more congenial to the wellbeing of many: slow mission; patient revolution. No need to wait for politicians or blame them. Imagine.

Hope valley

Photo by Felix on Unsplash

Hope Valley is a place, in the English Peak District, where our men’s breakfast group held one of our annual walking weekends.

It’s also an emotional space, a rather life-saving one. So much about our world seems never to budge. The wrong people are in jail and the wrong people are in palaces. Lives are snuffed out at a dictator’s whim. Armies clash, soldiers die, loved ones mourn. Shells blow futures to smithereens. Praying people pray and pray and nothing happens.

‘God,’ said Desmond Tutu (I paraphrase), ‘we know you’re on the side of the right, but couldn’t you make it a little more obvious?”The arc of history is long, but it bends towards justice,’ famously quoted Martin Luther King.

Perhaps I could be allowed to add: sometimes this arc of history seems very long, longer than scurrying our little human lives can bear. Many lives aren’t long enough to see the good arrive.

Nor does the arc always bend in entirely pleasing ways. Mandela became president of South Africa, a happy geometry. Not long afterwards he was followed by a thief who plundered the country, rather than built it, and then by a good person, but who has, by some accounts, yet to get a grip. So a bad thing was followed by a different bad thing (plunder) and then by another different bad thing (unmended brokenness).

That arc of history has non-linear qualities. It wobbles. Sometimes it veers in the wrong direction.

Which is why you need hope, and why, for now, it’s a valley.

Thanks to hope we can know that the arc will be tamed someday, that symmetry will be restored.

That the arc will come to rest on a mountaintop.

Healing and the end of life

Not that I am personally planning on calling it quits any time soon, but I was wondering recently what ‘healing’ looks like in the context of the end of our lives.

Photo by SpaceX on Unsplash

We don’t know if this will be relevant for us, of course. Some friends of mine have been snuffed out without much time to do anything about it. Some apparently didn’t know it was going to happen. But most of my late friends and family had plenty of warning.

One part of healing near the end of life is, of course, that your life doesn’t end, you recover, and go on to see many good days.

But it occurred to me recently there is such thing as a ‘time to die’. However good or bad or complete has been our life, whether its conclusion will be bitterly painful or a blessed relief, our impact on the world is over, our days are winding down, this is it.

I wonder if ‘healing’ in this context isn’t about making peace with that fact; and going on to make peace with as much in your life as you can, and especially with God.

What’s fun about this idea is that it gives you back some agency. You’re in charge again. You have accepted the big fact (you’re mortal) and now you’re free again, to love and conclude things as you see fit, and as best you can.

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.’

The powers that be (2)

More about the teaching of Walter Wink, as mentioned last week, in his book The powers that be, which was a later summary of earlier work.

Wink teaches that every institution possesses an ‘outer, physical manifestation’ and ‘an inner spirituality, corporate culture or collective personality’ (p24) and combined they correspond to what the New Testament called ‘powers’, which were a tangible part of life back in New Testament times. Materialism has slanted our impression of them, but perhaps they have not gone away.

For our struggle is not against flesh and blood, but against the rulers, against the authorities, against the powers of this dark world and against the spiritual forces of evil in the heavenly realms (Ephesians 6:12).

For in him all things were created: things in heaven and on earth, visible and invisible, whether thrones or powers or rulers or authorities; all things have been created through him and for him (Colossians 1:12).

For I am convinced that neither death nor life, neither angels nor demons, neither the present nor the future, nor any powers … will be able to separate us from the love of God in Christ Jesus (Romans 8:38-39).

Are these ‘powers’ good or bad? It is customary in my part of the church to think of them (or at least the spiritual components) as ‘bad’, spiritual remnants perhaps of an original fall that led to the fall of some spirits into evil; the same worldview as can be found in the Bible and which John Milton used in Paradise Lost. And it is true that Jesus is never recorded as coming across an evil being that he wished to redeem. He apparently wished to expel all of them from his good creation.

In Wink’s view, however, the powers are:

  • Good
  • Fallen
  • Needing redemption.

He argues that:

These three statements must be held together, for each by itself is not only untrue but downright mischievous. We cannot affirm governments or universities or businesses as good unless we recognize at the same time that they are fallen. We cannot face their oppressiveness unless we remember that they are also a part of God’s good creation. And reflection on their creation and fall will seem to legitimate these Powers and blast any hope for change unless we assert, at the same time, that these Powers can and must be redeemed. But focus on their redemption will lead to utopian disillusionment unless we recognize that their transformation takes place within the limits of the fall.

Wink, op. cit., p 32

Whether or not the Powers can be redeemed (or merely expelled), the material, earthly institutions certainly are created, fallen, and can be redeemed. At the moment this is within the limits prescribed by our current fallen world; in the future it will be fully so, as part of New Creation.

This is eye-opening stuff:

  1. Institutions have a spiritual character as well as a material form.
  2. Institutions are good, fallen, and capable of a degree of redemption.
  3. They will be fully redeemed at the so-called eschaton, the full arrival of the New Creation.

How can the Powers be opposed? How can institutions be redeemed, or at least cleaned up a bit, capturing more of their divine vocation?

I have to skip over a large and brilliant part of his analysis here but the central understanding is that violent overthrow won’t do it. All violent overthrow does is replace one system of spirit-fueled domination with another. A revolution is rightly named: it’s just the turning of the same wheel. What do ‘work’ (and again I am oversimplifying) are the things Jesus taught so directly. Turn the other cheek. Hand over all your clothes if someone takes your cloak. Love your enemies. Do good to those who hurt you. Feed and water your enemies. You want to lead? Be a servant. You want to line up with God’s rule? Be a child. Jesus himself entered Jerusalem on a donkey, not a charger. He won the day by going to his death like a lamb to the slaughter.

The aim is not conquest, but relationship: humanizing the oppressor, so that oppressors are themselves liberated from being oppressed by their own oppressive behaviour: ‘today, salvation has come to this house.’ These same acts also restore dignity and agency to the victim.

That’s how we ‘win’. And the winning may not be seen in this life, or certainly only partly seen, but it is putting a foothold in eternity, it is filling up our storerooms in heaven, it is investing in the future.

Convalescence, the lost-ish art

Photo by Isaac Quick on Unsplash

Just finished an illuminating book called ‘Recovery’ by practicising GP Dr Gavin Francis. I am drawn back again to the idea of healing (I was in hospital when I wrote this) and really enjoyed how this book taught me things I’d previously groped towards. Some snippets:

Psycho-social

We fall ill in ways that our profoundly influenced by our past experiences and expectations, and the same can be said of our paths to recovery. (p8)

Green and growing

He talks of the difference Florence Nightingale made in the Crimea, how hospitals should have ‘the proper use of fresh air, light, warmth, cleanliness, quiet, and the proper selection and administration of diet’. (p 13, quoting Nightingale’s own 1859 Notes on Nursing). Windows should look out something green and growing. After her arrival in 1854, the rate of soldiers dying from their wounds fell from 1 in 2 or 1 in 3, to 1 in 50

Convalescence

But in changing times and with new drugs something has been lost:

It’s not possible for me now, as a GP, to admit a frail, elderly patient somewhere for nursing care and convalescence alone – the hospital gates don’t open unless there’s a medical diagnosis, and a plan in place that prioritises getting the patient out again as soon as possible (p15).

You might not find ‘convalescence’ or ‘recovery’ as a heading in the medical textbooks but you will find ‘post-viral fatigue’… Long-term symptoms from viral infections will be different for everyone, but can include varying amounts of breathlessness, difficulty concentrating, forgetfulness, mood changes, insomnia, weight-loss, exhaustion, muscle weakness, joint stiffness and flashbacks.

All these are to be considered normal – not evidence that recovery has stalled or is going (p20) into reverse.

Pacing

He suggests ‘pacing’ as the route forward – not the boom and bust cycle of activity and exhaustion, but steady efforts, frequent rests, small meals, not doing much for an hour after a meal, getting fresh air, sitting down a lot, avoiding exerting. With boom and bust, your world narrows; with careful pacing, it slowly widens.

Work aids recovery

He talks about the world of sick-notes, and that doctors are better coaches than judges. ‘Many of the patients I sign off from the obligation to find a job could undoubtedly work in some capacity, at something, if support were available to help them do it… Work aids recovery in all sorts of ways… If I could sign my patients up to a supportive back-to-work scheme, rather than simply signing them off sick, I would‘ (p27)

A misfortune whose cost should be shared

He notes Aneurin Bevin’s championing of the idea that illness is ‘neither an indulgence for which people have to pay nor an offence for which they should be penalised but a misfortune the cost of which should be shared by the community’ (p 29. Bevan was borrowing his ideas from T H Marshall, a sociologist.)

Healing: the future of the NHS

Photo by Daniel Chicchon on Unsplash. The photo is of San Francisco; note that bridge in the background.

I read a short article by Matthew Taylor, Chief Executive of the NHS federation, in the current Wired magazine (July-August 2023). This is an unashamed abridgement of that fine article.

Taylor points out that the human species is better at developing technology than thinking through its consequences. He sees these issue for the NHS:

  1. A revolution in diagnostics. This really good thing– catching disease early– depends a lot on how willing we are continuously to monitor our health. This is not so simple. Already there are harmless incursions in my life. Under my bed is a device that downloads my pacemaker data and sends it to my hospital in London. One time when I was developing symptoms, they asked for a download, then called me in, then re-timed the pacemaker and fixed the problem: really nice. On the other hand, when I was in hospital recently, nurses were taking observations several times a day. My observations are problematic and sometimes set alarms off. At least twice they sent a more senior nurse to redo the observations as they didn’t believe what a junior nurse had recorded. These constant readings do no good whatsoever to how I feel about myself. They are stressful and discouraging. Heaven forbid that I should have a thing on my wrist that did this to me all the time.
  2. The fact that diagnostics are usually probablistic, not black-and-white. In any case, diagnostics don’t help as much you’d like. If you might develop cancer, or might not, but will develop side effects to treatment, whaddya do?
  3. Inequality. Matthew Taylor points out that technology empowers people, but usually it is only some people, and inequality increases given that other people, already disadvantaged, don’t benefit. (This actually is a slightly curious argument when things are on average getting better, but let it pass.)

Finally he talks about care. He makes some fascinating observations: ‘Medicine is technocratic and scientific; care is human and relational‘. Medical expertise is sort-of expected by us patients; care is what makes the difference to how we feel about our treatment. That is very true in my experience.

Medicine is technocratic and scientific; care is human and relational

He points out this issue is especially important in end-of-life care. End of life treatment is usually the most expensive medical phase in a person’s life, but still ‘a lot of people don’t get the end of life care they want. They might receive expensive care, when they would rather have cheaper care that’s more humane, at home, with loved ones.‘ This is fascinating. Having watched friends die both in government hospitals and in our local (charitably run) hospice, I know which of the two I would choose. Give me the lovely hospice every time.

Perhaps a contribution that people of Christian faith can offer in their last days is choosing not to have every possible intervention to keep us hanging on, but to decide our time’s up, go home, or to a hospice, to face the end of life in peace? It is oddly the opposite of euthanasia, realizing our time has come and accepting it. Interesting.

Healing and social justice

One of our local miracle drugs

I’m struck (but then I’m a slow learner; it’s obvious when you think about it) how much health and social justice are linked. For churches, it’s fascinating how important this ‘pre-healing’ ministry is. And any church interested in ‘healing’ ought to be fascinated by the possibilities of pre-healing people before they ever get sick. The good we can do! The changes we can make! Look at this from the current Wired magazine 1, which finds its way to us among articles about virtual wards, remote robotic surgery, and unlocking the NHS’ troves of digital records.

… about one in five people live in poverty in the UK. Poverty has an awful impact on physical and mental health: it is associated with higher infant mortality, lower adult life expectancy, poorer mental health, asthma, diabetes, cardiovascular disease and obesity. It has been estimated that getting your daily calories from healthy foods costs three times more compared to buying poor quality food.

Housing is another big problem. According to the Health Foundation, one in three people reports a problem with the affordability, security, or the quality of their housing. Issues such as mold and damp can lead to respiratory problems and headaches…

Green spaces are another massive issue. There’s a lot of evidence now proving that exercise is like a miracle drug. There is also plenty of evidence that if you provide more open, free, green spaces to people, you end up with higher levels of physical activity in the population, and improved mental health. In 2020, the government itself estimated that if every citizen had access to green spaces, it could save the NHS billions of pounds a year.

… We need to realize that almost all policy has an impact on population health, and think more holistically about what our health priorities are for the longer term.

The healing before the healing

Photo by Ben Griffiths on Unsplash

The wonderful ‘MD’ from the magazine ‘Private Eye’ is cheaper and quicker than any number of inquiries into the National Health Service. One of his main points is that the NHS suffers when society suffers. It is free, like schools, the police, and even the prison service. Hospital doors are always open. So if people can’t get the help they really need, they seek out the hospital or the doctor.

Or to put it another way, there is a link between poverty, unstable homes, abuse, poor living conditions, poor nutrition, generally not being able to cope with being an adult; and ill-health. But ill-health is the easiest to address because all you have to do is troll up to the accident and emergency department.

With all the other things, if the state can fix them at all, there’s the problem of finding whom to ask, and then a process, delays, bureaucracy, forms to fill, queues to be at the end of, and if you reach the front of the queue they may not have what you need.

Schools are the same; they have to take the kids even if their lives elsewhere are crumbling. And prisons have to take whomever the courts send, so they find space for the mentally ill who, if other parts of the state were working effectively, wouldn’t be there at all.

An issue for politicians, then, and perhaps for the Christian community: the main way to fix the NHS, and schools at the same time, and with a side order of reducing the prison population, is to fix everything upstream that leads to people crowding towards the easily-accessed freebies. And the way to fix national budgets, perhaps, is to shift them towards the slow: stable, warm homes, good nutrition, fitness, and friendship and social support that stops people falling ill (and incidentally keeps them happier and more fruitful) in the first place.

Much easier, of course, said than done, not least because it is long-term and even if done well only addresses part of the ‘problem’ of the NHS. (Another part of its ‘problem’ is the Health Service’s ability to keep many of us alive, which requires a lot of maintenance, rather than dead, which doesn’t. The NHS’s successes poisons its own well.)

This affects healing in the Christian context too. A lot of the best healing ministry is, or perhaps should be, not healing at all but pre-healing: the network of love, the care, the personal disciplines, the pursuit of joy and vocation and indeed the pursuit of God himself, which save us from being ill. Real healing restores these; but really real healing prevents us from becoming sick in the first place, at least sometimes.

Of course all this is simplistic, obvious, easy to point out, hard to do, and is anyway only a temporary fix. The Second Law of Thermodynamics is coming for us. We will disassemble soon. The only permanent solution is the Christian hope. But I’m reminded how much healing should have a wide focus –the whole person in a loving network–not a narrow one — such as increasing the anti-depressant dose.

Healing, brokenness, and the mental health industrial complex

Photo by SIMON LEE on Unsplash

It’s interesting to watch — from the safe vantage point of vast ignorance — cracks in the gleaming exterior of Western mental health care. To say the least, it’s not like flying a plane, where highly trained people, following international standards of safety and expertise, successfully take people to places they want to go. Psychiatry and psychology are not like that. They may want to look like that, but they are not like that. 1 Here are some of the cracks:

  1. The standards aren’t, well, standard. The American Psychiatric Association publishes a thing called the DSM (the diagnostic and statistical manual of mental disorders), currently on its fifth edition, DSM-5. It’s widely referred and accepted and is the product of much scholarly endeavour. But it changes, and practice changes with it. After DSM-4 was published, ADHD diagnoses tripled, autism diagnoses increased 20-fold and bipolar diagnoses 40-fold. 2 This was not a sudden epidemic of mental illness, it was a consequence of widening the categories. So, beware, with the next edition of the book, your illness could become a variant of normalcy, or your normalcy be re-categorized as illness.
  2. It’s subjective, not objective. Physical medicine is at least a mixture of both, blood tests and MRI scans complementing the doctor’s own judgement. Mental illness appears not to be independently testable. This subjectivity on the part of mental health professionals has consequences: I have seen people bounced between diagnoses of Borderline Personality Disorder, PTSD, Bipolar, and schizophrenia in a process that seems a bit like different practitioners sticking random Post-It stickers on people’s heads. (Though it’s worth remembering that people who practice mental health care all are there to do something good for the broken and damaged people whom they meet every day and they want to help them thrive. They are not dabbling with words; getting it right matters. The bitterness of the debate is because everyone cares, not because no-one does.)
  3. Commercial interests are involved. As one kept alive by various drugs, I am very fond of big pharma, but I do acknowledge that they have a commercial interest in selling drugs for mental health, and that must influence their own influence in this subjective area. Certainly different groups of all stripes campaign to change the DSM in their favour, which must mean each DSM is a product of power struggles as well as pure evidence.
  4. It victimizes people. Telling my liver that it is abnormally swollen does not upset my liver too much; telling my head I have a personality disorder, and that, no, they haven’t really found a cure, affects my whole sense of who I am and what I am to do about it.
  5. It oversimplifies, or at least wrongly frames, the problem. Have mental health problems rocketed, powered by social media, relationship breakdown, unwise romantic choices, and covid-19 exclusions? Or have otherwise normal people across our communities been battered by exceptional stresses? Are they, at root, diseased or injured? That matters a great deal for how, and if, you can get well again.
  6. It’s not been great for children. Apparently (according to my source article again) as late as the 1990s it was ‘unusual to prescribe medication or give diagnostic labels to under-18s.’ That is no longer the case. It would be good to know what the evidence is for this change. I hope it’s solid. I can’t help thinking that diagnosing children -a subjective process and one that is inconsistent across practitioners- on the basis of the child’s own grasp of the problem, is a shaky place from which to start chemical intervention or medical labelling.
  7. Can it mean that problems are treated here in the West as primarily medical, rather than, say, primarily to do with relationships, poverty, trauma, abuse, poor choices, or just the kind of ennui that doesn’t know what to aim for or what to aspire to be, or what the point of living is; that we are attempting to treat medically a kind of lostness?
  8. Can it be that we are underplaying the social, the relational, the physical, and the spiritual and overemphasising the medical? This I find really intriguing because I think I have learnt that healing in any sphere is basically about shalom, peace and contentment; that’s the mark of the healed, even if those same healed ones limp around in broken bodies and perhaps with damaged minds. To thrive before God and people, in all circumstances, that’s healing.

So much to learn!