Category: Making things whole

Mental health, then and now

Photo by the blowup on Unsplash

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?

How to set up a social ministry that lasts

Mike Kenneally, Unsplash

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

  1. Set well-recognized, high standards. Aim to be widely respected.
  2. Don’t charge people for your services but trust that the money will come in somehow.
  3. 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:

  1. Find the home of a local, well-respected worthy and lodge there. (This gives social accreditation of decent standards)
  2. ‘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.
  3. ‘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.

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.

The Powers that Be (1)

In his striking and unusual book, the late theologian Walter Wink writes this:

This book is unashamedly about things spiritual. It assumes that spiritual reality is at the heart of everything, from photons to supernovas, from a Little League baseball team to Boeing Aircraft. It sees spirit– the capacity to be aware of and responsive to God –at the core of every institution, every city, every nation, every corporation, every place of worship … [It] celebrates a divine reality that pervades every part of our existence.

Walter Wink, The powers that be, 1998, Galilee Doubleday, p 13

Wink points out that ‘Latin American liberation theology made one of the first efforts to reinterpret the “principalities and powers” — which occur naturally in New Testament writing — ‘not as disembodied spirits inhabiting the air, but as institutions, structures and systems … Powers such as a lumberyard or a city government possess an outer, physical manifestation (buildings, personnel, trucks, fax machines) and an inner spirituality, corporate culture or collective personality. The Powers are simultaneously an outer, visible structure and an innner, spiritual reality’ (p24).

This is striking and unusual stuff. As Wink goes on to point out, when it comes to ‘Powers and principalities’, ‘fundamentalists treat the Powers as actual beings in the air … and secularists deny that this spiritual dimension even exists’ (p26).

The elegance of this outlook is that it roots the New Testament worldview into everyday structures of injustice and unrighteousness (or indeed structures of justice and righteouness). So by doing battle against, say, injustice, you are actually resisting spiritual powers, for which the gospel offers weapons and tools.

For example, Ephesians 6 says:

Finally, be strong in the Lord and in his mighty power. 11 Put on the full armour of God, so that you can take your stand against the devil’s schemes. 12 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 6:10-12 NIVUK

This scripture makes a lot of sense in contexts where spiritual forces are rife and obvious, where local industry manufactures charms and amulets, and where you can buy services like spells, curses, protection from the evil eye and love potions. I have worked with many missionaries who have spent time in those contexts and found New Testament-type solutions beneficial and fruitful.

It’s a lot harder though, in secular and materialist contexts, to know quite what to do with all these scriptures.

Wink offers a further insight. These powers, he claims, become fallen and demonic when they pursue ‘a vocation other than the one for which God created’ them (p29). So, calling an institution to be just and and upright and to fulfill the purpose God intends for it, is not just a matter of (for example) campaigning but is also a spiritual conflict requiring the kind of spiritual weaponry that the gospel offers. This is because the institution involved has a spiritual face as well as a material one.

This makes a lot of sense.

  • Ir explains why in the book of Revelation, letters are written to ‘the angel’ of each of the seven Asia Minor churches — not to the pastor, or the leadership team, or the congregation, but to the spiritual reality, the culture, that they together contribute to and embody.
  • It explains why in the same book, earthly realities are described withthe imaginative imagery of dragons, beasts and whores, a spiritual view of human institutions.
  • It helps make sense of the Beatitudes, which sees human attitudes and behaviours as having potency as spiritual weapons: Are you spiritually bankrupt? You’re blessed: yours is the reign of heaven (Matthew 5:3, my paraphrase).

Here’s his summary:

Evil is not just personal but structural and spiritual. It is not simply the result of human actions, but the consequences of huge systems over which no individual has full control. Only by confronting the spirituality of an institution and its physical manifestation can the total structure be transformed.

Wink, op.cit., p 31

There’s more to come.

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.)

We don’t know if we’re going, but we’re going

In which we try to understand History

Is there anything beyond the next banana? Photo by Giorgio Trovato on Unsplash

Are we going anywhere? Are we nearly there yet? The fun thing about blogging is that you can attempt subjects in which you are completely and entirely out of your depth.

This has all happened because I was listening to a set of lectures on St Augustine’s City of God, as I have written elsewhere.

The question is easy enough to pose: are we (as a species, or even as an entire created order) going anywhere?

  1. First let’s congratulate ourselves. No other beasts or plants are asking this question. Even our brother apes appear not to worry much about the tides of history; they are happy knowing where the next banana might come from.
  2. One possibility is that history isn’t going anywhere: it’s just random, pointless noise.
  3. A second, more popular I think, is that it is in some sense cyclic: the rivers pour into the sea, but the sea is never full; what comes around, goes around; no-one can ever say, ‘this is new’; that kind of thing.
  4. A third, beloved of Christians, Muslims, rationalists, communists and many cosmologists among others is that history has a direction, it’s going somewhere. Some science fiction too: ‘Space,’ said James T Kirk, ‘The final frontier’: the universe is a giant unploughed prairie, just awaiting the covered waggons, and that is our story and destiny. The idea of ‘Progress’ and ‘Progressive policies’ still resonate, and when we see the decline of poverty and the advance of medicine worldwide, we can sort-of believe it.
  5. It’s possible to argue that this idea of history having a direction, a start and an end, originated somewhere in the Judeo-Christian scheme.

Augustine saw history this way. For him, history had a direction and the big clue was the incarnation of Christ, when the beyond-time God hitched himself to the time-bounded creation. There was a time before this happened; there is a time afterward; there is a direction for the future.

It must be very bad form among proper historians, I imagine, to believe this. But I think it is Christian orthodoxy. History is about conception, resurrection, consummation, all around Christ, all about the timeless God involving himself with his creation and eventually filling it out with love and making it whole.

Surely this idea can be criticised all over the place. But it does give a point to each of our individual lives. The point: everything we are and do now that anticipates, outlines, foreshadows or even hastens that consummation has point and value. Everything that doesn’t, doesn’t. Not only does history have meaning and direction, our each individual moments have too–and they revolve around love.

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.

Populist bingo

After another heavy day on the Select Committee. Ashish Upadhyay on Unsplash.

And so Boris is gone, sulking, in a spray of adjectives and grievances.

In the USA, justice is chasing down President Trump, suspected of hiding documents in his toilet.

The populist First Minister of Scotland has fallen, with the cops sniffing around her house and looking for (among other things) a motorhome and a wheelbarrow. The suspicion (still unproven and hotly denied) is that the Caledonian Cabal made off with party funds to buy a wheelbarrow. This is a misuse of the misuse of funds. If you’re going to misuse funds, I mean, don’t do it at B & Q.

Over in Russia, let us hope, the authority of the president is pouring away like the water from a (former) Ukrainian dam.

Let us play populist bingo. Cross off the words when your favourite populist departs:

Witch-hunt

Kangaroo court

I did not lie

Not a shred of evidence

I am innocent

I was saying what I believed sincerely to be true

I take my responsibilities seriously

They have wilfully chosen to ignore the truth

I am now being forced out of Parliament by a tiny handful of people

A political hit job

I am bewildered and appalled that I can be forced out

Anti-democratically

Egregious bias

A phrase book for your convenience

I’m also providing a phrase book since language means a different thing on whatever planet the populists’ heads reside:

‘Tiny handful of people’ = A majority of the House of Commons, of the consituency, and of the whole country.

‘Egregrious bias’ = fact-based

‘Anti democratically’ = democratically

‘I am bewildered and appalled that I can be forced out’ = I am bewildered and appalled that I have to obey the rules

‘They have wilfully chosen to ignore the truth’ = They have wilfully chosen to follow the evidence

‘Not a shred of evidence’ = pants round ankles, hand in the cookie jar

And this should not be

This post doesn’t need a commentary really. I have an interest in youth justice and this landed in my in-box. 1 On April 26 2023, just a few weeks ago, the Chief Inspector of Prisons wrote this about His Majesty’s Youth Offender Institution at Cookham Wood:

An inspection of a HMYOI Cookham Wood in April 2023 found that a quarter of the boys were being held in solitary confinement for extended periods, including two for more than 100 days, as a means of managing conflict between children. Records showed that it was not unusual for these boys to not come out of their cells for days on end, with no meaningful human interaction, education or other intervention. At the time of the inspection, 90% of children were subjected to ‘keep aparts’ meaning they were not allowed to mix with some of their peers, and staff were managing 583 individual conflicts in a population of 77 children.

Children told inspectors they felt unsafe, and were increasingly resorting to carrying weapons, many of which were made from metal which boys had scavenged from equipment in their cells, including kettles, in a bid to protect themselves. More than 200 weapons had been recovered in the six months preceding the inspection, despite inadequate searching procedures.

Cookham Wood was in a poor overall condition, with dirty living units and broken equipment. Prison staff were exhausted, with significant shortfalls on wings, and, while many clearly cared about the children, they felt unsupported by senior managers and had given up hope that improvement was possible. Four-hundred-and-fifty staff were employed at Cookham Wood, including 44 directly employed managers, of whom 24 were senior leaders. The fact that such rich resources were delivering this unacceptable service for just 77 children indicated that much of it was currently wasted, underused or in need of reorganisation to improve outcomes at the site.

The findings of this inspection represented the culmination of a steady decline in standards documented in inspections since 2016 that cannot be allowed to continue.

I’m glad we have a Chief Inspector of Prisons, that their work is public, that (on government directions) they require immediate action from the government, and that we ordinary people can write about this stuff without people turning up in vans accusing me of ‘insubordination’ or ‘spreading instability’ as might happen in many countries. I’m glad there are caring people at Cookham Wood and others who will campaign and fight. I’m glad we don’t incarcerate that many children (fewer than 1000 in the whole country). But the good news stops somewhere there.

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