The Revd. Dr. John Swinton
Senior Lecturer in Practical Theology, University of Aberdeen
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Introduction
I have been much heartened by recent developments within the
area of spirituality and mental health care. There is a growing
body of literature that shows clearly the positive correlation
between a person's spirituality and their mental health, even in
the context of severe mental health problems (Larson 2001). People
are starting to see this area of care as significant in terms of
research and practice and a number of positive spiritual strategies
are beginning to edge their way into mainstream caring strategies.
'Spirituality is good for your health' the slogan goes. And it is.
We are discovering that a healthy spirituality makes us happier,
protects us from depression, makes us more secure, provides us with
a stronger sense of self and, if our spirituality is manifested via
religion, roots us firmly within a supportive community, which in
turn has significant health benefits. All of this is exciting and
challenging, and opens up new and relatively unexplored channels
for caring and supporting people who are experiencing psychological
distress. It is becoming more and more clear that spirituality sits
at the heart of the enterprise of mental health care and that we
most certainly need to reflect critically and carefully on its
implications for our practice.
The rhetoric of love
At heart, spiritual care relates to the nurturing of that which
is good, wholesome and health bringing. It is an approach to mental
health and illness which is designed to enable carers to develop
strategies to see and to treat patients as whole persons; as
individual beings who require a sense of meaning, hope, purpose,
relationship with God, Self and others and who, above all, require
effective strategies which will enable them to love and accept
love. There is a meaningful sense in which at the heart of the
spiritual task of mental health carers lies the difficult objective
of re-introducing the rhetoric of love and connectedness to the
techno-scientific language of contemporary psychiatry.
The rhetoric of evil
Evil is the antipathy of love and goodness. A simple but not
indisputable understanding of evil is that it is the power, be it
internal or external, which seeks to destroy love in all of its
diverse forms. It is senseless, meaninglessness, hopeless, violent
and always results in the shattering of relationships. As such, one
might think it worthy of serious reflection in relation to
spiritual care within a mental health context. However, if we begin
to explore the literature on spirituality and spiritual care, we
will struggle to find any reference to the concept of evil.
Consequently, despite frequent encounters with actions and persons
often described as 'evil,' mental health carers are not presented
with any therapeutic strategies or perspectives that might enable
them to understand and deal constructively with evil. As we shall
see, they may recognise its existence, sometimes in quite
systematic ways, but there is no mechanism available which would
enable them to work constructively with evil.
Losing our religion
Part of the reason for the absence of evil from the rhetoric of
spirituality is that spirituality in its contemporary form is
frequently stripped of its religious roots. I don't want to give an
opinion on whether that is a good or a bad thing but it does leave
a gap in our conceptual thinking in relation to spirituality. Many
of the world's religious traditions acknowledge the reality of the
dark side of human beings. Within these traditions the nurturing of
a person's spiritual dimension is primarily aimed at moving them
away from their perceived propensity towards evil and into the
presence of 'the good' where they can find reconciliation,
acceptance and the possibility of transformation. To enable this
process, these traditions have rituals, rites of passage and
spiritual practices, which enable people to make this transition
and to sustain their lives in a way that emphasises good rather
than evil.
They also have specific mechanisms to enable those who encounter
evil to deal with it in constructive ways. For example, within the
Christian tradition the dictum 'perfect love drives out fear' as it
is embodied and worked out within the life of Christ, provides a
significant paradigm for dealing with evil in a way that is
compassionate and effective. Likewise such spiritual practices as
prayer, forgiveness and reconciliation are effective and often
therapeutic responses to evil and its consequences. When religions
speak about spiritual care, they are talking very specifically
about enabling people to live in ways that are considered good and
to avoid that which is evil.
Forgetting about evil
Much of the contemporary discourse that surrounds spirituality
and spiritual care has dissociated itself from any kind of formal
religious foundation. Instead it tends to locate itself primarily
within a very positive, humanistic worldview that focuses primarily
on that which is good within human beings and human living. On
reflection, it is clear that spiritual care and self-actualisation
are closely connected within current approaches to spirituality.
Spiritual care is designed to enable the actualisation of an
assumed latent good within human beings. Thus, for the most part,
spirituality is assumed to be immanent, emerging from
within human beings and intended to enable self-actualisation. As
there is no necessary transcendent dimension to spirituality, that
is, no external powers to encounter or wrestle with, there is
little need for the language of evil. Within this spiritual
paradigm the concept of evil is neither desired nor required. In a
real sense, evil is subsumed to the overwhelming quest for good and
consequently falls out of the therapeutic equation. As a result of
this, little reflection has gone into the possibility that an
understanding of evil may be clinically significant and that
developing effective strategies to counter evil within a
therapeutic context may in fact be an important dimension of the
care agenda.
What is evil?
To be able to see fellow human beings as wholly
evil...requires an imaginative capacity not found in other
species. (Storr 1991)
I now want to begin to develop a therapeutic perspective on evil
that will enable us to understand the potential clinical
significance of thinking about this area of care. I want to begin
by exploring some of the dynamics that lie behind the
creation of evil. Now I use the word 'creation' quite
deliberately.
For current purposes I want to avoid any deep philosophical or
theological arguments about the existence or otherwise of evil.
Personally, I am happy to acknowledge that evil may well have
ontological significance; there may well be an external force of
evil that impinges upon human beings irrespective of their desires.
However, I want to suggest that discussions over that possibility
form only a part of the debate. (I suspect that the reason evil is
easily discarded by many psychiatrists is because, when discussed
at this abstract level alone, the clinical significance of evil can
become confused and unclear). For current purposes I want to take
what we might describe as a pragmatic approach to evil. Such an
approach assumes the reality of evil within a mental
health context without necessarily arguing for its
existence. Let me explain what I mean by this.
Social constructionist thinkers have taught us that things don't
have to exist to be real (Berger 1966). Human beings are constantly
exploring and interpreting their worlds, creating understandings,
concepts, models, ideas which have no necessary ontological basis,
understandings which are not factual in a scientific sense but when
incorporated within our worldviews can be perceived in very real
and tangible ways. Irrespective of their ultimate empirical status,
these social constructions can impinge greatly on the way we
experience the world and act towards it. I want to suggest that
while evil may well have a supernatural dimension, it is
also a powerful social construction, an explanatory
framework that we use to grasp and make sense of that which appears
unexplainable. Evil is a powerful interpretative label which, when
ascribed to individuals, removes them from our therapeutic horizon
and leaves them stranded, alienated and vulnerable to forms of
treatment which are oppressive and dehumanising. When this happens,
it is not only a tragedy for the individuals who receive this
label, for in ascribing the label of evil and acting accordingly,
mental health carers can themselves become the perpetrators of
evil. The significance of this point will become clear as we
move on.
Creating evil and battling with monsters
Within a mental health context, we constantly encounter human
beings whose behaviours are bizarre, extreme and often
inexplicable. Particularly within a forensic context, we are
frequently faced with people who have committed acts that are
abhorrent, frightening and degrading. How do we deal with that
experience? When we encounter something we judge to be harmful or
evil, there are two ways in which we can respond. We can respond by
objectivizing and distancing ourselves from the
evil act, evil person or evil process. Here we set up strategies
either to battle against the evil, or to exclude it from our
presence either physically via prisons or special hospitals, or
psychologically through the process of labelling, distancing, and
scapegoating. When this happens we turn persons into
monsters and act accordingly.
When we consider the public profile of someone like Myra
Hindley, we can see this process clearly at work. Hindley bears the
label of 'the most evil woman in Britain' and there is a fresh
public outcry each time there is talk of her release. As Hilary
Brand correctly observes, despite the fact that her crimes took
place over thirty years ago, we are frequently exposed to that same
picture which freezes her in 1966 'a hollow-eyed, defiant 23
year-old, a sinister peroxide murderess. Its like we need her to be
a monster in order that we can understand and make sense of that
which is inexplicable'. But of course she is not a monster. 'She is
a dark-haired 58-year old with arthritis, angina and a degree in
humanities from the Open University' (Brand 2000).
Chilling as Hindley's crimes undoubtedly were, there is another
dimension to her story that, in a sense, is equally as chilling.
'Before those horrific two years in which she lured five
children to their deaths, she lived an exemplary life and was even
in demand as a babysitter. Throughout her imprisonment she has
shown no criminal tendencies, and experts are unanimous in the
opinion that she poses no threat to society. The detective who took
her confession in 1986 has no doubt. Had she not met Ian Brady and
fallen in love with him, she would have got married and had family
and been like any other member of the general public' (Brand
2000).
Could it be that the thing that frightens us most may be the
fact that despite the horrific nature of her crimes, in
uncomfortable ways, she is really just like us!
Implications for mental health care
Within a mental health context such a response to extreme
behaviours can have devastating consequences for the
personhood of people with mental health problems
and for psychiatrists and other mental health carers who
struggle to offer authentic spiritual care. An interesting example
of this is presented in the work of Dave Mercer, Tom Mason and Joel
Richman on the discourse of evil in a forensic context. They
carried out a fascinating piece of research at Ashworth hospital,
which sought to explore the significance of the discourse of evil
amongst forensic nurses (Richman 1999, Mercer 1999, Mercer 2000).
They uncovered evidence that raised the possibility that within a
forensic nursing context, the allocation of the label 'evil' could
have significant implications for nurse-patient relationships. They
noted that the term 'evil' is quite regularly used within the 'lay'
nursing discourse (i.e. the day-to-day language used by nurses as
opposed to the professional language of psychiatry or law).
Interestingly, while there was a good deal of tolerance for people
who were 'classically' mentally ill (psychotic, bipolar disorder
etc.) those with a diagnosis of 'psychopath' or 'personality
disorder' were frequently labelled evil and in significant ways
written off as fully human beings. Interestingly, the allocation of
the label 'evil' was neither random nor a purely pejorative act.
Rather it reflected what the researchers described as a
'formulation of a rule-structured taxonomic ordering' (Mercer:
16).
A Taxonomic Ordering of Evil in Nursing Discourse
Absence of medical descriptors
Evil was only
employed if there was no evidence of physical or psychiatric
symptoms.
Nature of the attack:
To qualify as evil, the nature of the attack or assault had to be
seen as deliberate, planned and purposeful.
Extinction of moral bonding:
Evil was linked to the transgression of practical and abstract
boundaries, implying free will, choice, intelligence, and
unrestrained 'instinct'.
Adjacent pairing of opposites:
Evil was associated with offences where there was a generational
gap between victim and perpetrator, for instance, rape of children
or the elderly.
Reality testing:
Acts were more likely to be described as evil if a pattern of
'deviant' behaviour had been established over time, and 'tested
out' in the world (Mercer 1999:15).
The label of evil was applied when the person was deemed to be
aware, reasonable and morally responsible for the particular
actions he or she participates in. Significantly, psychiatric
diagnosis appeared to 'expurgate the demons' and free the person
from the accusation of being evil. Thus, such language as 'an evil
no hoper', 'this one is beyond help', 'just rotten through and
through', 'evil, pure evil' and 'the only way out for this man is
in a box (coffin)', sat in uneasy tension with the expressed
clinical aims such as caring, developing self-esteem, and enabling
meaningful relationships (Mercer 1999:16).
The researchers end their report with this rather unsettling
statement: 'these perceptions conceptually move the patient beyond
the possibility of rehabilitation or, at least, beyond the ability
of psychiatry to effect a cure' (Mercer 1999:17). The perception is
that psychiatry can no longer help these 'evil creatures'. The evil
person is judged 'untreatable' and in a sense 'untouchable' and
particular strategies are employed to move him or her out of the
world of persons and therapeutic intervention and into the realm of
lepers, monsters and 'untreatability'. Such a discourse not only
degrades the patient, it also forces the mental health carer into a
position where the danger of inhumane practices becomes a real
possibility. You don't treat monsters as humans!
There is another dimension to this process that is equally as
crucial and must not be forgotten. If we take seriously Scott
Peck's definition of evil as "that force residing either inside
or outside of human beings that seeks to kill life and
liveliness (Peck 1988:43), 'creating monsters' in response to
evil acts not only destroys the liveliness of the patient, it also
destroys the liveliness of the carer and can become an evil in
itself; an insidious form of evil which in the long-term makes all
of us less than human. If that is the case, then the spiritual
stakes are high.
Battling with monsters and resurrecting persons: sitting with
evil in the hope of reconciliation
I have already suggested that one way of dealing with evil is
through confrontation and distancing. However, there is another way
that we can respond to the presence of evil. Christian psychiatrist
James Mathers (1979), in his exploration of the nature of evil,
highlights the life of Jesus as a paradigm for dealing with evil
within a therapeutic context. Whereas our natural tendency is to
adopt an aggressively exclusionist stance towards evil, Mathers
highlights the fact that that time and time again when confronted
with evil, Jesus took a different approach. Rather than isolating
or excluding evil, (although at times he certainly did adopt this
position) his overall tendency was to sit with those whom civil and
religious society deemed to be evil in the hope of reconciliation.
When he encountered demons, barbarians and madmen, Jesus sat with
them, ministered to them and in so doing resurrected their
personhood and destroyed the evil persona. This approach to evil
was costly, dangerous and ultimately fatal; it required integrity,
courage and love but it offered a response to evil that was
radically effective and which I believe is highly pertinent to the
contemporary practice of mental health care. I want to suggest that
this model of sitting with evil in the hope of reconciliation is a
helpful spiritual paradigm for addressing the types of problems
highlighted thus far.
A return to the virtues?
How then might we begin to learn to sit with evil in the hope of
reconciliation? I want to make a tentative suggestion that one way
in which we can counter the type of evil I have been describing is
by reflecting thoughtfully on the role of the virtues in
the practice of mental health care. While the virtues may not
command a great deal of attention within contemporary mental health
car practices, they nonetheless have the potential to add a
significant dimension to our caring practices when we are faced
with evil.
Aristotle described virtue as a state of excellence or
disposition whose aim is the highest good (Ross 1998). The term
'virtue' means that which causes a thing to perform its function
well (eye-seeing; knife-cutting edge; horse-running etc.) Human
virtue is that which causes us to fulfil our function in a way that
is appropriate for our status as human beings. Virtues such as
love, goodness, mercy, trust, courage and hope are not things that
are grasped and learned with the intellect alone. Rather, they are
habits that, when practiced regularly, result in a new and
virtuous way of being. Practicing the virtues leads to the
development of a form of character that will enable individuals to
act according to what is good within their particular encounters.
Virtues therefore aim to move a person towards the good, and away
from that which is bad or evil. As such, they would appear to be a
perfect counter to the types of negative social constructions of
evil that have been outlined thus far. Within the confines of this
paper is it not possible to develop this approach as fully as might
be required to make the case. Nevertheless, in order to offer some
pointer towards my thesis, I will highlight four virtues that are
of particular relevance to mental health professionals and reflect
briefly on how they might function in the overcoming of evil.
Respect and Honesty
The first stage in battling with evil relates to
re-conceptualising what it means to be human. In order to do this
we need to be totally honest about what human beings are.
I have already suggested that the current emphasis on spiritual
care tends to assume an inherent goodness within human beings.
There is much goodness in the human race. But history and common
experience tells us that human beings are a strange mixture of
touching goodness and terrifying badness. We live our lives in a
strange tension between the compassion of mother Teresa and the
horror of Auschwitz. On one level we are profoundly relational
creatures-persons-in-relationship, as John MacMurray (1995) puts
it. The priMary spiritual need that all of us have is for
relationship and reconciliation. From the cradle to the grave
we are dependant on love to survive. We become who we are not by
isolating ourselves from one another but by relating with one
another in a myriad of different ways. The very fabric of our Self
is relational. I cannot be a husband without a wife; I cannot be a
father without children; I cannot be a teacher without having
pupils and so forth. Paradoxically, this is what makes us
vulnerable to pain, hurt, suffering and forms of emotional damage
that can, to a greater or lesser extent, determine the trajectory
of our lives. Ironically, it is our need to love and to relate
which is one of the priMary causes of human suffering. These
inherent relational dynamics form the basis for our respect for one
another and our understandings of personhood. No matter how damaged
we may be, no matter how heinous our actions may be, we remain
persons-in-relationship and retain the need to be treated and
understood as fundamentally relational beings.
There is no doubt that human history is marked by tremendous
acts of love, compassion and altruism. And yet, there is another
side to being human which is much darker. For example, if we take
the Holocaust, which most of us would think of in terms of the
darkest form of evil, there is a dimension that is often
overlooked. William Styron, in his novel Sophie's Choice, makes a
simple but poignant observation.
Real evil, the suffocating evil of Auschwitz- gloomy,
monotonous, barren, boring was perpetrated almost exclusively by
civilians. Thus we find that the roles of the SS contained almost
no professional soldiers but were instead composed of a
cross-section of German society. They included waiters, bakers,
carpenters, restaurant owners, physicians, a bookkeeper, a nurse, a
fireman; the list goes on and on with these commonplace and
familiar citizens' pursuits. (Styron 1992:204)
There is ample evidence within the literature to suggest that
when 'ordinary' human beings for whatever reason become
disinhibited, they have a propensity to act in ways that can only
be described as evil. There is thus a strange tension between the
human propensity towards relationships and love and the tendency to
stumble into an abyss of darkness and evil. Those who cross the
line from light into darkness more obviously than the rest of us in
fact simply reflect in a concentrated form a darkness that abides,
all be it uncomfortably, in all of us. As we think about and
reflect on spiritual care and its implications for our practice, we
need to develop honesty with regard to the true state of
human beings. It is when we act dishonestly and pretend that the
evil embodied in certain individuals is radically other
than the evil encompassed within ourselves that problems begin
to emerge. Effective spiritual care that desires to deconstruct
monsters and resurrect persons only begins when we start to reflect
on the possibility that those who appear radically 'Other' may in
fact be persons like us.
Courage and Compassion
I was very much struck by an essay by Bob Johnson (2001) in the
recent Church of England Board of Social Responsibility report
Personality Disorder and Human worth. I have been
disturbed by some of the rhetoric surrounding the discussions about
recent legislation focussing on how we should deal with people who
are violent and have personality disorders. The rhetoric of evil
frequently appears in the political and social discourse around
this topic and much of what I have said thus far could equally be
applied to dimensions of that debate.
Johnson recognises the inherent forces of depersonalisation and
dehumanisation that are present in certain approaches to dangerous
and severe personality disorders. His paper is an attempt to draw
psychiatry back to its central focus on easing suffering and
enabling people to live meaningful and hopeful lives. He describes
people with dangerous or severe personality disorders as 'modern
day lepers'. With compassion he lays out a case supporting
the humanity of a group of people who are frequently assumed to be
less than human. As one reads Johnson's account, it becomes clear
that the label of 'untreatable' can function in a very similar way
to the label of evil as it has been described in this paper,
leaving a person isolated and alienated from the medical system and
with no hope of redemption through the standard psychiatric
avenues. If a person is considered 'untreatable', yet is still
suffering the effects of profound emotional trauma in their earlier
years, where do they go for help? Johnson reveals the way that the
label 'untreatable' assumes that the only legitimate treatment is
that which can be offered by current standard psychiatric
interventions. Yet the boundaries of treatment are narrowed in such
a way as to exclude a section of the population who are frequently
broken, vulnerable and in need of
persistentrelationships. Importantly, Johnson
calls mental health carers in general and psychiatrists in
particular to be courageous in their defence of the
humanity and spirituality of those who are dehumanised by the label
of untreatability. He draws on the analogy of lepers in the ancient
world to make his point.
'Six hundred years ago lepers were exiled, cut off from the
normal social intercourse in case they infected everyone else. A
few dedicated people worked with them, improved their standard of
living and long before anti-leprous drugs were available, enabled
them to live longer. The optimum treatment for this dread disease,
then as now, was human comfort. How can we do less to our own
mentally ill, merely because the current dominant section of the
psychiatric profession has determined that personality disorders
are as 'untreatable' as leprosy once was? Isn't it time to apply
other criteria?' (Johnson 2001:20)
Johnson calls for psychiatrists to be both courageous and
compassionate in their dealings with those whom others seek to
reject, stigmatise, alienate and marginalize. In defending those
who are assumed to be evil, the virtues of courage and compassion
are fundamental in deconstructing evil and resurrecting
persons.
The friendships of Jesus - sitting with evil in the hope of
reconciliation
How then might we embody these virtues? One way they can be
embodied is within another vital virtue, that of
friendship. Friendship is a priMary unit of human
relationship and as such is a major conduit for the development and
maintenance of spirituality. It is through our friends that we gain
value, meaning, purpose and transcendence, (the latter through our
friendship with God). More than that, friendship is an expression
of love. Friendship is the particular relationship that can be
utilised to sit with evil in the hope of reconciliation, one that
'treats' loneliness and hopelessness, and deconstructs evil. If we
return to the example of Jesus that I highlighted previously, it is
clear that the form of friendship that spiritual carers might find
most useful is very different from the cultural norm. Within
Western culture we tend to develop relationships based on two
principles: the principle of social exchange and the principle of
like attracts like.
The principle of social exchange presupposes that we gauge our
relationships according to what we can get from them. Thus I enter
into a relationship with another person with the hope that I will
get particular things back that will satisfy me and encourage me to
stay within the relationship. There is not inherent moral
obligation other than the quest for personal satisfaction.
Consequently, if I am not getting what I want from a relationship,
I will move on to one within which I can feel more fulfilled and
satisfied.
The principle of likeness assumes that friendships are
constructed between individuals who have particular things in
common. Thus our friendships tend to be based on the idea that like
attracts like. However, the friendships of Jesus are based on a
very different principle: the principle of love/grace (Swinton
2000). Jesus sat with those who were radically unlike him; tax
collectors, sinners, those considered religiously unclean and
women, and in so doing resurrected their personhood in and through
the relationship of friendship. His friendships were open,
unbounded by culture and particularly available to those whom
society marginalized, stigmatised and considered evil. It strikes
me that this model of friendship provides a useful corrective to
modernist ideas of health care as a distanced, objectified and
'non-committed' enterprise and draws us back to the reality that
all mental health care is profoundly personal and in one sense
deeply counter-cultural.
Of course, an immediate reaction to the suggestion that the
mental health carer has a role as the friend of the patient might
be to begin to highlight the dangers of losing boundaries, becoming
overly enmeshed, the importance of professional distance and other
such defences that the medical model has taught us to use to
protect ourselves from 'over-involvement.' As clinicians we are
trained to think clinically, detachedly and to be wary of so called
'non-therapeutic' relationships. Yet there is evidence to suggest
that friendship is a fundamental human requirement and a priMary
channel for the working out of human spirituality and mental
health, even in the context of profound mental illness (Swinton
2000). Friends accept one another for what they are and seek to
offer support and guidance in times of happiness and brokenness.
Friendship embodies community and acceptance and can provide a safe
space for growth and change. Friendship mediates love and perfect
love drives out all evil.
As Johnson quite correctly warns us, 'being sociable to
anti-social individuals carries a potential risk, just as
befriending lepers did in the middle ages'. But if we don't offer
it, who will? Whilst acknowledging the very real dangers of
over-involvement, manipulation, loss of security and the importance
of effective risk assessment, it is nonetheless vital that we do
not feel compelled to cloak our essential humanness in such a way
that we can no longer function towards patients as fellow human
beings. We must begin to think seriously about the implications of
incorporating friendship into our role as professionals and start
to utilise the spirituality and re-humanising power that is
inherent within the relationship of friendship. It may be that this
particular role, when developed and worked through within the
psychiatric context, could prove to be a priMary means of
re-humanisation which can take us beyond evil and onwards towards a
new way of looking at professional relationships and a revised
model of spiritual intervention.
Conclusion
Evil does not have to 'exist' to be real. It is alive, well and
being enacted and acted upon daily within our perceptions and
within our daily practices. The solution? Love. It is only perfect
love that can drive out fear and it is only love that can truly
conquer evil in all of its diverse forms. The values perpetuated by
the virtues are deeply spiritual and relate closely to the types of
spiritual understanding and care which are becoming prominent
within contemporary practice. Importantly, the virtues can be
taught and learned by being with someone who is virtuous. As such,
they hold the potential to offer a practical, therapeutic approach
to the type of evil that has been highlighted. When learned and
expressed, the virtues are one possible way of countering evil
within a clinical context. They enable us not simply to carry out
spiritual care that counters evil but more importantly, they allow
us to become the kind of people whose thoughts, actions and
influence are so profoundly impacted by love that evil cannot exist
in our presence. For now, the priMary task for mental health care
givers is to become the kind of people whose thoughts, words and
actions are imbued with love.
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© John Swinton 2002