Wednesday, May 25, 2011

Essex Mind & Spirit Networking Lunch


That's the Spirit!

This lively title captured the mood of the twenty-five participants who met for a networking lunch at the Basildon Centre on 24th May and a presentation by Peter Goble and Reverend Fr Jo Delfgou on spiritual resilience and recovery in mental health, part of Essex Mind and Spirit's on-going programme of public engagement across the County. The event and the two presenters were introduced by Sidra Naeem, Hon. Secretary, who outlined the organisation's mission and structure, and invited participants to free membership, so as to be 'linked-in' to future developments and events.

Father Jo spoke movingly to participants from his experience as a mental health chaplain of spiritual journeying with people with serious mental health problems in secure environments. He made an impassioned plea to mental health staff to look beyond the stereotypes of religious delusion to the authentic spiritual struggles that patients undergo, to listen to their true voices, and – where possible - to advocate with colleagues about the spiritual dimension of recovery. Our religious language can betray our erroneous assumptions, he said, and convey the message that to others we don't want to meet them where they are, so we need to be sensitive, and listen with skill, patience and compassion to help tease out meaning in what is said. This instils the hope and confidence people need on the journey back to wholeness, and honours their autonomy. But spiritual care in mental health is full of complexity, and we need to carry on a continuing dialogue with each other – even those who may be hostile to our views - if we are to make sense of it.

Peter's approach was experiential, inviting participants to explore their own unique resilience to challenge, through a series of reflective and meditative exercises, drawn from his own spiritual tradition of Tibetan Buddhism, and his experience as a mental health nurse-practitioner and teacher. Participants were surprised and intrigued to be invited to “Stand Like A Tree” for up to ten minutes, in an exercise for which Peter claimed personal resilience-building benefit, by expanding and deepening awareness of bodily alignment with the earth, and the capacity for 'resting in attention'. Peter's guidance on unclenching the teeth, dropping the jaw, and dropping the belly caused some amusement, but by “standing like a tree” participants began to recognise how stress builds up unconsciously in the body, how bodily tension distorts alignment, perception, thinking and emotion, and how this reduces our capacity to respond skilfully to challenge.

Over a buffet lunch, participants were able to network, to meet new colleagues, exchange views and share experience. Many said that the event was worthwhile for this reason alone, apart from any other content. Most participants had been tasked to develop spiritual resources or to investigate spiritual approaches to care in their varied work, and all said that the event had furthered those objectives in one way or another. Peter, as chair of the South West Essex cluster group, invited participants to join him in growing the local cluster, through occasional meetings at the Basildon Centre or some other easily-accessed venue, to develop an agenda for local engagement in line with Essex Mind and Spirit's mission. Peter can be reached on 07951 869265, 01268 775521 or by email at, and will be delighted to hear from anyone interested in joining the cluster group.

Monday, May 16, 2011

Chaplaincy competencies

The 'competency framework' is a fairly new way of describing what used to be listed as the 'skills, knowledge and attitudes' expected of a professional worker. A good 'competency framework' has the virtue (perhaps) of helping the developing practitioner to visualise herself doing real-life things, so she can grow into the job in an organic way, rather than trying to bolt together bits of attitude, bits of practical know-how, and bits of theory when faced with an angry mum, a frightened child, or a patient vomiting blood.

Here's a list of chaplaincy competencies we were recently invited to dissect. I should stress that these were not proposed as THE competencies training was intended to develop in us; more a stepping-stone towards thinking through our own. I quote (and my musings are in italics):

"The chaplain can demonstrate.............."

Hang on a minute! Who is going to be watching this demonstration, and in what circumstances? Will the observer watch me over minutes or hours of performance, will I know I'm being watched, shall I have any warning or preparation, and how will the fact of my being observed affect what I do? More important, how may the observation affect my performance? Even more important, how may it affect the experience of anyone with whom I am transacting? By what criteria of competence will my performance be judged? Am I to know how they will be applied? And what assurances am I entitled to about the competency of anyone who judges me? Or am I just being my usual narky, paranoid and bloody-minded self? Some of these questions may be answered when we get to what it is I am supposed to be demonstrating competency in........

"1. Good grounding in one Buddhist tradition, with evidence of regular practice and doctrinal knowledge."

I wonder how one can demonstrate "good grounding" in a Buddhist tradition. Maybe one could ask a higher authority for a reference stating that "I hereby testify that So-and-so, whom I have known for what you will probably agree is a a respectable length of time, has a good grounding in the X tradition in which I am an accredited position-holder, as is suggested by my titles and honorifics, or you may just know by my name that I'm important enough not to have to declare them."

Evidence of doctrinal knowledge is another matter, although one may have written a book of doctrinal exegesis, or obtained a degree or other academic honour that fills the bill. Evidence of regular practice is a toughie, I would have thought. Leaving aside what constitutes practice, what are the acceptable criteria of regularity? This question has always perplexed nursing records, as it also vexes definitions of constipation.

Clinical evidence demonstrates that, although most individuals evacuate the large bowel regularly once or twice a day, for a sizeable minority a regular bowel-movement occurs once in every three or four days; and for a few, the call-to-stool prompts a trip to the lavatory weekly or at an even longer interval. As for height and formal intelligence, the normal range of regular evacuations is distributed on a Gaussian curve, rather like bell-jar. One might conjecture that regular practice (whatever practice means) shows a similar distribution. But does every observer of competency know that? Not many nurses are well-informed about bowel-movements. Some still expect everyone to "go every day" (or need an aperient).

"2. Knowledge and use of appropriate liturgy and ritual in healthcare settings".

Ah, ritual! Everyone knows that you have to squirt your hands with alcohol gel as soon as you walk into a hospital ward, and sometimes as soon as you get out of your car in the car-park, so that you don't carry germy MRSA into the clinical environment. Most people like doing this, as it helps to dispel the feeling of total uselessness that comes over us when we visit a hospital. There's something brisk and business-like about walking down the corridor rubbing your hands together, sniffing the un-germy smell of alcohol, feeling your hands cool and capable. One can almost imagine a junior nurse opening doors for one, holding out your surgeon's gown, passing the sterile scalpel, respectfully inclining her head and lowering her lovely gaze above the snowy mask.....

Of course, we'll get on to Buddhist ritual and liturgy on another occasion (to be continued).....

Monday, May 2, 2011

The language of compassion

We are all pioneers of a sort - rough frontiersmen and women. The so-called helping professions are at the beginning of an exciting journey that attempts to explore and enlarge human awareness and establish new disciplines - echoing some of the experiences of sixteenth-century physics. It is a fresh form of alchemy. There is the same sense of arrant nonsense and profound wisdom jostling side by side - often very difficult to tell which is which.
David Brandon (1941-2001)

Here's a vignette from a (very helpful) training exercise at a Buddhist Chaplaincy (Kalyana Mitra) study day, intended to develop competencies required for the chaplaincy task:

'Helen grew up in a small market town, trained as a teacher, and started a family. She had always been used to walking in the countryside as a way of ensuring that her career and family life didn't become too stressful for her.

Following the birth of her second child, however, Helen began to experience some unusual phenomena related to her walks in the country. She started seeing patterns in that nature which she hadn't perceived before; believed certain trees were speaking to her, and felt herself and her two children being drawn towards the lake.

These experiences reached such a pitch that she became very unwell; there were concerns about the safety of the children, and Helen was referred to the crisis resolution team.

Helen has no particular religious faith, but her spirituality is very much linked with her love of nature, and her love of children, especially her own children.'

To encourage reflection and discussion, the exercise poses the following question:

How can the chaplaincy service assist Helen to continue with a spiritual journey without aspects of it leading her on a path which might endanger her and her children?

For me, this vignette is characteristic of the 'mental health' mindset: it proceeds from genteel, middle class professional inferences (assumptions) about class, aspiration and lifestyle; it travels smoothly and without hesitation or doubt towards a further set of description of Helen's experiences. These seem to be a further set of inferences, couched in language that is at once tentative and non-attributable (the authorship is vague) and, at the same time, both authoritative and vaguely threatening.

Such language, it seems to me, is carefully crafted to combine a dual purpose: to convey a message of well-informed concern and benevolence on the one hand; on the other to imply a perilous or dangerous situation, a potentially malignant state of mind, a pressing need for urgent for intervention, and a presumptive right to do so. The language, at first reading, seems to be sympathetic, even empathic, full of well-judged concern: the language of compassion.

I also detect an unchallengeable conviction of the rightness of the view expressed; and an implied warning along these lines: "you would do well to consider that it might be imprudent, reckless even, not to accept this assessment of the situation, not to align your own opinion with this reasonable paradigm. Specifically would you want to risk the possibility of, and take responsibility for, serious harm to defenceless children at the hands of a hopelessly deluded mother?" None of this is stated so bluntly, of course.

How is this murderous intent, and the need to forestall an insane crime, implied in a few lines of anonymous reportage?

"Helen grew up in a small market town, trained as a teacher, and started a family". Helen, the writer seems to imply, is of archetypally wholesome and uncomplicated rural provenance, of modest intellectual capacity and ambition, heterosexual, and defined at least in part by her wish to become a mother within a conventional nuclear family. So far, so unexceptional; the sort of person, perhaps, who has known her family doctor since childhood, and whose parents live in the same town and happily babysit their grandchildren when invited.

"She has always been used to walking in the countryside as a way of making sure that her career and her family life didn't become too stressful for her." Note that reference to her "always" being used to country walks emphasises her rural origins, although presumably she has only "always" used these walks "as a way of making sure that her career and family life didn't become too stressful for her" since she had a career, and had a family.

One might imagine that Helen herself had volunteered this information about stress-management, but there is no evidence of this; indeed, none of the information about Helen is corroborated by actual statements she made, included in her own words. They might as well have been from third parties, or even made up. But the overall effect is to show concern for Helen, as a likeable young woman who organised her leisure responsibly, so as to maintain her personal and professional equilibrium: an example of good-housekeeping in every sense of the word.

Note that nothing is said or hinted at that might detract from or cast a shadow over the image offered the reader. No harbinger of a future sinister turn-for-the-worse. No hint at childhood trauma or a troubled adolescence; no problematic relationships; no major illnesses or accidents; no thwarted ambitions, no hidden fears, no repressed compulsions. There is an unsullied innocence about Helen, she is a clean slate. When she becomes "very unwell" we can derive some satisfaction from knowing that, because her life is otherwise so naturally wholesome, it should be possible to restore her quickly to health, to the bosom of her family, to the status quo ante of woodland walks, children busy in her classroom, primroses in a glass on the breakfast table.

After the birth of her second child, Helen "began to experience some unusual phenomena". It's at this point that the account begins to change style, and the clue is in the phrase given, which - rather than use Helen's own language to describe her experience, distances her experience from the narrative with the phrase "some unusual phenomena". The phrase is deliberately obscure and all-encompassing, and - if interrogated - could be (and almost always would be) re-expressed in terms that were incomprehensible to a layman: words such as "ideas of reference", "autochthonous delusions", or "thought insertion". These are psychiatric terms understandable to mental health professionals, but usually quite mysterious to lay-people.

Three examples are offered to give some substance to the unusual phenomena Helen is said to have experienced. First, "she started seeing patterns in nature which she hadn't seen before". Seeing new patterns in anything is not of itself problematic; indeed the opposite could be true, it might be a kind of awakening, a broadening and deepening of awareness. So what casts a shadow over it? Maybe it's the next phenomonen to be catalogued: Helen "believed that certain trees were speaking to her". We don't know whether Helen volunteered this as, "I believe that certain trees are speaking to me", or whether she used some other form of words.

It would be interesting, for example, to know whether she said that the trees spoke singly, in audible words, or together; and to hear from her what they said, in what tone or quality of voice. Did they utter cautions or commands, give advice or commentary, or offer reassurances? Did she recognise the voices in which they spoke? Or was Helen's use of "speaking to" a poetic metaphor? None of this seems to matter to whoever spoke with Helen; or if it did, Helen's possible meaning has been subordinated to the need to build a case against Helen's meaning, and in favour of a psychiatric diagnosis, within which meaning can be disregarded or set aside.

"And (Helen) felt herself and her two children being drawn towards the lake." It's a rhetorical device to combine three sentences or ideas to build emphasis, and this device seems to be used here to good, deliberately chilling, if understated, effect. Again, one would hope to find her own words on the page. Perhaps she said, "It would have been really nice to take the kids by the the lake, it was so pretty there with the trees and everything"; "I wanted to bring my kids down to the lake, I can't explain why really, but it seemed sort of important that I took them"; She might have said something like, "The way the trees seemed to lead down to the water, it was like an invitation, they were sort of pointing the way, and I thought of the girls, and that maybe the trees wanted us all to go down there together, where we could be peaceful and safe, and nothing bad could touch us...."

But one doesn't find this kind of personal statement in mental health reports, because it's too ambivalent, too open to interpretation, too full of idiosyncratic and contingent meaning, to close to the grain of human experience, in all its fury and its mire.