Mary Nathan MSc
Reported by Dr. Gillian Broster
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Mary Nathan trained in general nursing, midwifery and in
mental health. She has nursed in Nigeria and served as a General
Nursing Council examiner. Currently she holds the post of Research
and Practice Development Nurse in the Ealing, Hammersmith and
Fulham Mental Health Trust. The study described here forms part of
what is to be a larger multi-centred study. Mary has a deep concern
with spiritual care in mental health practice.
Mary put forward the following list of possible barriers for
discussion.
- Inadequate educational preparation and lack of competence in
spiritual care.
- Emphasis may be placed only on biopsychosocial issues
- Spiritual care has been described as lacking a scientific base,
compounded by the associated problems of time constraints and
shortage of human resources
- Lack of clarity of the concept.
- Religion is taken to be synonymous with spirituality.
- There are conflicts in belief and value systems among mental
health professionals,
- Spiritual care can be personally challenging to most mental
health practitioners and the practice setting or institution may be
a barrier.
- There is an absence of the right kind of relationship between
the clients and the practitioners (it has been described as the 'it
and thou mentality'), reflecting a rigid model of care.
As to overcoming possible barriers to spiritual care, Mary
proposed the following:
- Promoting and utilising educational opportunities in spiritual
care and empathising with the whole person.
- Recognising the limitations of science and prioritising limited
resources.
- Working at what is known until the unknown is clarified.
- Recognising that religion and spirituality are not
synonymous.
- Addressing the challenges spiritual care poses to health care
practitioners and practising a holistic approach to care.
- Using positive attitudes towards self and others and
implementing care interventions that address the whole person.
Mary described a 'compassion scale' that she has devised for her
research. (This stimulated the group to think about the actions we
take as psychiatrists and whether they are to alleviate pain or
because it helps us feel better. Whose sense of safety and well
being comes first? There is a need for honesty. Do our actions
promote the quality of life for our patients or do they afford us a
position of power and control over that person? We could try asking
the question 'would I be happy to be treated in that way'?)
Mary then looked further at the question 'What is spiritual
care? It can be seen as providing the necessary resources to
address and support people's values and beliefs, provided these
values and beliefs place no individuals at risk. It is based on
treating each person with respect and dignity, promoting love,
hope, faith, and helping vulnerable people to find the strength to
cope at times of life crises when overcome by despair, grief and
confusion.
Discussion
What implicit attitudes are held by mental health professionals?
Are psychiatrists more sceptical of spirituality than the
population at large? Service users say how much their spiritual
beliefs have helped them cope with illness but feel unable to
discuss it with the psychiatrist. Yet if Jung's concept of the
wounded healer is to be taken into account, the mental health
professional is well qualified to support an attitude of spiritual
enquiry when the patient shows signs of wanting to explore
spiritual concerns.
Mary then proposed the following key aspects of spiritual
care:
- Acceptance: accepting people as they are.
- Help: helping people to be what they can be.
- Affirming: affirming people when they feel weak
- Giving: giving strength to set people free.
The point was raised that people enter the vocational
professions, including medicine, social work and teaching, because
they are spiritual beings but seem to have the spirituality knocked
out of them during training! It seems that neither the training,
nor the work environment, are supportive of the spiritual task. As
to psychiatry, the idea was mooted of establishing local networks,
to find ways to prevent burnout and disillusionment. Mary , in
summing up, made the point that in the final analysis, it is deeds
not words that count, as illustrated so powerfully in the parable
of the Good Samaritan.