Book reviews from the Spirituality SIG
We publish book reviews for books on the topic of mental health and spirituality.
Please note, we are often asked to review books and reserve the right to choose which books are reviewed and which reviews are shown here.
In this published version of his PhD thesis, Brian Spittles challenges psychiatry on three fronts:
- That it should go beyond its “materialist assumptions” to bring “psychospiritual considerations within its epistemological remit” (p3)
- That psychosis should not be considered psychopathological and primarily biological in origin.
That psychotic experiences should not be considered fundamentally incomprehensible.
The term “psychospiritual” is used to denote a spectrum of phenomena and experiences, including the “spiritual”, “metaphysical”, “transpersonal”, and “mystical” (p7). It is used also to acknowledge the intimate connection between the spiritual and the psychological and is employed as a foundational term throughout the book. Whilst it is true that the spiritual cannot really be spoken about without reference to the psychological, it is not necessarily so the other way around and so I found this a bit confusing. However, it might well be argued that this is preferable to a biopsychosocial model which routinely fails to reference the spiritual, and it is this failure of psychiatry to address the spiritual which the book robustly criticises. The book further – and quite rightly in my view – criticises psychiatry for its history of generally either ignoring or pathologizing the psychospiritual, especially in relation to psychosis.
After introducing these challenges, and considering the nature of the psychospiritual domain, the book goes on to address the “psychosis-psychospiritual nexus” in four “focal settings”:
- The psychiatric view of psychosis
- A history of the psychospiritual within psychiatry
- A content analysis of attempts to distinguish the psychospiritual from the psychopathological
An argument that the psychospiritual and the psychopathological are indistinguishable
In Focal Setting One, close attention is given both to a historical perspective of the concept of psychosis within psychiatry, and a critique of the Diagnostic and Statistical Manual of the American Psychiatric Association (DSM). In Focal Setting Two, there is consideration of a range of ways in which psychiatry has dabbled with the psychospiritual, including the work of Richard M. Bucke on cosmic consciousness, the emergence of “metapsychiatry” in the USA in the 1970s, the 1976 Group for the Advancement of Psychiatry Report on mysticism, the field of neurotheology, and the introduction in DSM-IV of a V code for spiritual/religious problems. For members of the Spirituality and Psychiatry Special Interest Group (SPSIG) of the Royal College of Psychiatrists, things get particularly interesting in Chapter 7 where two pages are devoted to SPSIG. This is especially notable given the heavily North American focus of the rest of this focal setting, but it is also encouraging to read the author’s warm praise for our SIG. He writes:
Overall, the SPSIG exemplifies the capacity for mainstream psychiatry to seriously investigate psychospiritual matters in relation to psychopathology and psychosis. The robust example set by this mainstream psychiatric entity dispels the prevailing clinical view that psychospiritual matters are beyond the investigative remit of medical psychiatry. (p105)
Focal Setting Three undertakes a historical review, and then a content analysis, of ways in which the psychospiritual and psychopathological have been discerned to be distinguishable. The content analysis takes as its starting point the 2009 study by de Menezes and Moreira-Almeida in which nine criteria were developed as a basis for distinguishing spiritual from psychotic (and dissociative) experiences. Spittles goes on to identify 193 criteria, from 70 different texts, said to be indicative of psychotic rather than psychospiritual experiences. The top nine criteria are then examined in turn, each being found inadequate to the task. It is concluded, at the very end of Focal Setting Three that it is “seemingly impossible” to distinguish psychotic from psychospiritual experiences (p179).
In Focal Setting Four, Auditory verbal hallucinations and delusions are, in particular, called into question as diagnostic criteria for psychosis. Cross-cultural studies are used to argue that what is deemed psychotic in the west is deemed normal in other parts of the world. This contention is based on studies of traditional healers, shamans, and the phenomenon of spirit possession. A penultimate chapter on spirit possession and psychosis as understood within Tibetan Buddhist psychiatry (Chapter 13) is presented as providing an exemplary holistic understanding within which psychosis is found to be “essentially psychospiritual in nature and aetiology” (p231) Surprisingly, given the conclusions of Focal Setting Three, it is argued here that psychosis can be distinguished from (other) psychospiritual experiences after all, but only because of the open, heuristic and fundamentally psychospiritual approach that Tibetan Buddhist psychiatry adopts.
The fundamental argument within this book – that psychiatry needs to take spirituality more seriously – is one that I’m sure all members of SPSIG would resonate with. Buddhist psychiatrists might be especially interested in 13, although I find it hard to imagine how such a model could ever be applied in a health care setting such as that of the NHS. Culture is important, and Tibet and the UK are very different, culturally as well as religiously. For most members of SPSIG, there is a lot to like in this book, but also much that will be controversial and will not find universal agreement. For example, I share the author’s concerns about the idea of distinguishing between spiritual experiences and psychosis, but not for the same reasons. I would suggest that it is a form of epistemic injustice to propose that someone cannot be having a genuine spiritual experience just because they are suffering from a mental disorder, but that is a far cry from suggesting that all psychosis has psycho spiritual origins and does not (in my view) mean that psychosis should not be considered psychopathological.
As the authors of this book make clear in their introduction, belief in life after death is a feature of most of the world’s faith traditions and is widespread in the general population in most countries around the world. There is evidence that such beliefs are beneficial to mental wellbeing (Flannelly et al., 2012, Bradshaw and Ellison, 2010, Ellison et al., 2009). They may also be beneficial in terms of reducing despair during terminal illness, although this effect appears to have more to do with the underlying spirituality than with the belief in life after death per se (Mcclain-Jacobson et al., 2004). Belief in life after death is thus an important element of spirituality, and also something that psychiatrists and other health professionals should be interested in, but what is the evidence that such beliefs are well founded? Many scientists may either feel sceptical about this, or else assume that it is not a matter amenable to scientific investigation. After all, researchers cannot speak to people who have crossed over into the afterlife and returned to tell their story. Or can they? The authors of this book offer reviews of extensive empirical evidence from three lines of investigation: studies of mediumship, near death experiences (NDE), and reports of memories of a previous existence (referred to in the book as “cases of reincarnation type”, thus CORT).
Two examples of mediumship are considered in the book in some detail: Leonora Piper (1857-1950) and Chico Xavier (1910-2002). The authors offer some interesting details about each, including evidence that they were able to provide accurate information about deceased people with whom they claimed to have contact, which they could not have obtained other than through direct contact with the deceased individuals themselves. The possibility of fraud is considered and excluded. However, a quick search online reveals how controversial both of these cases were, and continue to be, especially that of Leonora Piper. More recent studies, including a meta-analysis of controlled quantitative research are considered, and other alternative explanations excluded. Arguably the more recent research provides better evidence. For me, however, the fundamental problem is that the most convincing studies provide evidence that mediums knew things that they could not have known by normal, or scientifically explicable, channels. This is not the same thing as proving that personal existence continues beyond death.
With the research on NDEs, the emphasis moves away from showing evidence of persisting memories, skills, and personality traits of a deceased person to arguing that the perception like experiences of the person having the NDE are veridical. Notably, this includes reports of out of body experiences (OBEs) in which details of procedures, or of environmental observations, are accurately recalled after the event, even though they could not have been physiologically perceived (due to lack of brain activity, or because they were not observable from the bodily location of the person concerned). Again, alternative explanations are considered and excluded. Given that these are “near” death experiences, rather than cases of confirmed death and resurrection, (and admittedly the distinction here might be subtle) it is difficult to know whether or not this evidence says anything about “life after death”, except in the very short-term post-mortem. It certainly seems to argue for the possibility of out of body experiences (OBEs), which are a slightly different, albeit related, phenomenon.
Finally, the now vast literature on CORT is summarised, admirably succinctly, in just 8 pages. As with previous sections, the possible alternative explanations are considered and excluded. I’m not sure that I can further condense the summary that the authors provide without losing something of the overall outline of the literature, but essentially there are many accounts of individuals (usually children) who claim to remember past lives. Moreover, investigation into the alleged memories reveals an historical basis for the existence of the allegedly reincarnated person, usually with evidence of veridical memories and persisting skills and personality traits that would support the contention that this is the same person, now reincarnated. In particular, rigorous research has been undertaken in the past by Ian Stevenson, himself a psychiatrist. Whilst belief in reincarnation is widespread worldwide and has had some limited support within Christianity and Islam, it is not generally believed in by Christians, Muslims or Jews. Whilst this is – potentially – the strongest evidence presented within the book the counterarguments are dismissed far too readily. (See, for example, (Edwards, 1996) for a general critique of this literature). The implications here for clinical psychiatry are especially important – for example where patients believe that they have suffered PTSD in a past life with symptoms that now impact upon present wellbeing.
The book is short and generally quite readable (although I found the philosophy sections somewhat over-condensed). I wish more had been said about comparative religious perspectives, theology, and clinical relevance, but this was clearly difficult within a book of this length. The book is very focussed on scientific evidence and the empirical scientific method is not the only way of knowing things. However, it fills an important gap in the literature and is a commendable achievement, notwithstanding these limitations of scope. It is always a good sign to get to the end of a book wanting to know more – which this reviewer certainly did!
Book review by Christopher CH Cook, Durham University
Edited by Alexander Moreira-Almeida, Marianna de Abreu Costa, Humberto Schubert Coelho. New York; Springer, 2022. 85pp. ISBN 978-3-031-06055-7
References
Bradshaw, M. & Ellison, C. G. (2010) Financial Hardship and Psychological Distress: Exploring the Buffering Effects of Religion. Social Science and Medicine, 7, 196-204.
Edwards, P. (1996) Reincarnation: A Critical Examination, Amherst, NY, Prometheus.
Ellison, C. G., Burdette, A. M. & Hill, T. D. (2009) Blessed Assurance: Religion, Anxiety, and Tranquility among Us Adults. Soc Sci Res, 38, 656-67.
Flannelly, K. J., Ellison, C. G., Galek, K. & Silton, N. R. (2012) Belief in Life-after-Death, Beliefs About the World, and Psychiatric Symptoms. Journal of Religion and Health, 51, 651-662.
Mcclain-Jacobson, C., Rosenfeld, B., Kosinski, A., Pessin, H., Cimino, J. E. & Breitbart, W. (2004) Belief in an Afterlife, Spiritual Well-Being and End-of-Life Despair in Patients with Advanced Cancer. Gen Hosp Psychiatry, 26 , 484-6.
Reverend Lorna Murray is an ordained minister of the Methodist Church UK who spent most of her years in ministry as a Mental Health Chaplain within the NHS. This book bears the fruits of her wealth of experience working in mental health chaplaincy, mostly in Scotland although she also brings experience of working in West Africa and India.
The author’s starting position is that human beings are relational beings and that God created us that way. We are created to be inter-dependent and so we cannot experience well-being in isolation from other people. The purpose of this book is to encourage people who identify with the Christian faith, to be more aware of how to support people going through a time of poor mental health or those with a diagnosis of a mental illness. The author’s hope is that in this way the church can be encouraged to become more involved in creating communities of well-being.
The concept of communities of well-being is central to the book. The author envisions such communities as ones in which people care for each other and all people are accepted not just for what they do, but primarily for who they are - their 'beingness'. Such acceptance needs to be backed up by the provision of adequate resources to support all people to live a life in its fullness. Although the author’s focus is psychosocial and spiritual, there is no doubting the political implications of her message.
One of the delights of this book is the many stories which the author uses as vignettes to illustrate key issues in supporting people who are suffering psychologically. Each chapter begins with such a story followed by a reflection, which then opens up a discussion of the issue addressed in the chapter. Based on her own experience, these vignettes also offer a window into the author’s way of offering pastoral work. What comes across is a mature thoughtful approach to mental suffering that is underpinned by her Christian faith. She realises that healing is not necessarily about improving symptoms, but also about making the person feel more accepted and welcome in a community. Among the issues addressed in this way are the importance of acceptance, social inclusion, sensitivity to cultural context, guilt and shame, and suicide.
From the perspective of a chaplain, she addresses a number of issues that have been the subject of debate in the Royal College of Psychiatrists’ Spirituality Interest Group such as when it might be helpful to bring in a Christian perspective (or the perspective of another faith) into a conversation without imposing one’s own view. She also addresses the issue of prayer in a particularly moving vignette about responding to a Muslim person’s request to pray together on a mental health ward. She emphasises the importance of allowing the other to initiate this so that one is praying with, as distinct to praying for someone.
Although the book is largely aimed at people who offer or might offer pastoral care to people affected by mental health problems, it offers a useful psychosocial-spiritual perspective for psychiatrists who have an interest in Christianity and mental health. It reminds us of the importance of spirituality to many service users and the valuable role that can be played by chaplains of all faith traditions in mental health services.
Introduction by Shimon Cowen, translations by Shimon Cowen and Liesl Kosma. Melbourne; Hybrid Publishers for Institute for Judaism and Civilization, 2020. 174 pages. £15.99 paperback £4.59 Kindle. ISBN13: 978195736656
Rabbi Dr Shimon Cowen’s invitation to review his book at once triggered in me both delight and dread. I have always come away delighted in our many conversions, learnt from his erudite talks and writings, felt honoured to be invited to contribute to his first volume of the Journal of Judaism and Civilization (1998). But there was also a sense of dread as I know that his ideas require close attention, intense concentration and sustained focus to keep up with his rapidly processing mind. To engage with Rabbi Cowen’s deep, layered understanding is an experience in self-discipline, to be sure, always worth the effort.
I wondered if I should have accepted the invitation as soon as I read Rabbi Cowen’s first page, quoting Frankl’s remarkable final sentence in “Ten Theses concerning the ‘Person’” (one of the five translated pieces from Frankl in the second part). That sentence which threw me off my track was:
The true discovery of the human, the inventio hominis, occurs in the imitatio Dei [imitation of G-d].
In response to Freud’s curiosity wanting to know what kind scholarly discipline Chassidus was,
‘My father replied: The discipline of Chassidus [Chassidic mystical theology] requires that the head explain the heart what the person should want, and the heart implement in the person’s life that which the head understands.’
The conversation continued …and another account has Freud’s explanation for the Rebbe’s apparent suffering from low spirits as,
‘The Professor stated that his [the Rebbe’s] suffering was a deep inward [one], which is [found] only in profound, committed thinkers. The heart desires more than the head can grasp, and the head understands more than the heart can come to.’ (p. 59)
Dr George Halasz, Adjunct Senior Lecture in Psychological Medicine, Monash University.
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[1] A brief explanatory note added by Shimon Cowen. This table shows how, in the light of a great Renaissance Jewish theologian, the Maharal of Prague, both a physical and spiritual ancestor of Frankl, whom Frankl claimed as the forerunner of his own “dimensional ontology” of personality, Frankl and Freud’s diverse theories can be related to one another and to the fundamental code of universal values, known as the Noahide laws (in and through which, according to religious tradition, the imitation of the Divine consists). Frankl who believed in moral absolutes, developed a layered model of personality, in which these layers with their sub-departments are correlated with harmonizing universal values. Freud’s own pantheon of instincts paradoxically also connects – as illuminated also in the work of the Maharal of Prague – with these universal values as their negative or inverse expressions. In other words, the Freudian instincts, the raw “bad” self, once tamed and transformed, “reinvert” into the same set of universal values, embodied in the Noahide laws. Understanding this requires some close study, but the five chapters of the Introduction provide it: they explain the connection between Frankl’s model of human personality as the imitation of the Divine and connect the same with a transformed and reclaimed Freudian theory.
Edited by Sarajane Aris (SMN), Hilary Garraway and Hannah Gilbert. Shoreham-by-Sea; Pavilion 2021. 344 pages £35 paperback. ISBN: 978-1-914010-62-0
This handbook is essential reading for health and social care professionals, service users and carers, as indicated in its subtitle. It is a revised and extended edition, following up on Spirituality and Mental Health edited by Peter Gilbert in 2011 and incorporating a new emphasis on mental health and wellbeing. Spirituality is increasingly recognised, as the foreword notes, ‘as an integral part of wellbeing and psychological health.’ The pandemic along with the effects of social media have exacerbated mental health issues across the life cycle, but especially among young people. The introduction asks where we are now, giving an overview of the current context and including chapters on integrating spirituality into mental-health services, African psychology and finding meaning and purpose. The editors propose that spirituality may well become 'The heart of and foundation for our mental health and well-being.’ I found the article on African psychology of special interest, in the light of colonisation as a global system of white supremacy, resulting in an evacuation of an all-pervasive spirit entailing interconnectedness and communal group connection, which we urgently need to rediscover.
The 28 chapters are arranged in four parts, including spirituality across the life-cycle, therapeutic practice and 14 themes and journeys covering a huge range of topics embracing spiritual crises, faith, psychotherapy, research, spiritual competencies, visions, compassionate leadership, caring, spiritual training, burnout, spiritual care, eco-spirituality, new spiritualities and the transpersonal. Many well-known authors are featured, and the book will surely put spirituality and spiritual care firmly on the agenda. Some authors propose spiritual reflections, and there are comprehensive references at the end of each article. In the final chapter, the editors summarise key themes and threads such as connectedness and the collective, the language of spirituality, diversity and inclusion, compassion and the whole person. They call for a process of reclaiming our inner knowing, transcending separateness and celebrating our shared humanity. They also highlight a few areas not covered in detail, such as bodywork and multiple faith perspectives. They conclude with some questions and reflections to explore on an individual and collective level, including expanding our awareness into more subtle realms so as to become part of the necessary spiritual transformation. As a whole, the book represents the depth dimension of life and healing, and deserves the widest possible readership.
Revd. David Lorimer, Programme Director, Editor, Paradigm Explorer.
This book comes from the Christian faith community, written by leading experts, with a foreword by the Archbishop of Canterbury. The volume is arranged in three segments, considering the underlying theology, specific case studies from the bible and then the practical application of this learning.
The first chapters give us an overview of the Christian story and our individual need for meaning-making, and then we turn to an overview of the Hebrew bible view of wholeness, “Wholeness in Old Testament perspective is not perfection…it inhabits the space between reality and the hoped-for perfection of all things.” P31
In a provocative chapter Joanna Colicutt points out the times in the New Testament narrative when Jesus' family come to intervene since he was thought to be ‘beside himself’. She asks: was Jesus divinely mad, or simply clinically insane? If you, like me, react instinctively against the idea that Jesus could possibly have ever had a psychotic episode, what does that say about how we value those living with psychosis and their spiritual experiences?
There follow two chapters on St Paul, highlighting the Hebrew worldview which Paul and Jesus would have shared, that an individual is an indivisible whole, not separable parts of body, mind and spirit. It is impossible to directly correlate our modern views of mind with any single term in Paul’s writings.
The second section of the book looks at various biblical resources and considers what we can learn from them in our responses to mental ill-health. From Job we broaden our pastoral responses to suffering. In the book of psalms, we find a rich and deep resource for faithfully expressing anxiety distress and lament. Jeremiah’s sufferings help us better understand sustained suffering. Jesus sermon on the mount gives us an image of healthy living, and Jesus healing of the Gerasene demoniac, “is a story about finding new life through the power of Jesus to set people free from spiritual, mental and social forces that enslave, exclude and condemn.” p153
In the third section, practicalities are addressed. John Swinton summarises his approach to mental health care and the bible, (for more details see his book, reviewed below). He sees health as being not the absence of difficulty but the presence of Jesus Christ with us in the storms of life. He lays out how the bible can be helpful to those struggling with e.g. depression, and how a hermeneutic of suicide can make bible study risky in severe depression. The Church as a promoter of recovery for those living with mental illness is the focus of the end of Swinton’s piece and the next chapter. We are then invited to look at the bible through the lens of trauma and resilience. We discover that the bible books are robust, that we are not alone in suffering, that the bible gives us a language for lament, and promotes our resilience.
Scholarly and yet accessible, this excellent book speaks with a diversity of voices about mental health and illness, the lifelong challenge of finding our stories in God's big story, and the centrality of Scripture in this process. It will be a useful resource for those involved in Christian pastoral work, as well as those seeking to integrate their faith with their life experiences as someone living with, or alongside those with, mental illness.
Revd. Dr Alison J Gray, FRCPsych
Committee Member, RCPsych Spirituality and Psychiatry SIG
Book: London; SCM Press, 2020. 232 pages £25 paperback £20 Kindle [2020 prices]. ISBN13: 978-0334059776
This is a timely book written by Jan Alcoe and Sarah Eagger and published by the Janki Foundation. The Janki Foundation is a UK charity promoting the integration of spirituality into healthcare. Jan and Sarah have both been involved with this organisation for many years – Jan as a publishing and training adviser and Sarah as the current chair. She is also past chair of the Spirituality Special Interest Group and continues to be involved with this.
The book is timely because it is published at a time when we are in the midst of two deep global crises - a pandemic and a climate crisis. Together these crises have contributed to a growing fear and uncertainty amongst many people. The book is a self-help guide which, as the authors explain, “is for all who wish to live a fulfilling and contented life in an uncertain world. The tools it offers help us to weather the storms around us by digging inner foundations of calm. In this way, however strongly the weather rages, we can stand firm and act resourcefully, staying true to ourselves, rather than being blown around in a maelstrom of fear”.
As a self-help guide, the book is aimed at anyone who recognises a need for calming the mind and is interested in a spiritual approach, including those who experience mild anxiety and worry. The authors make clear that this is not a substitute for appropriate professional help for more serious psychological problems, although the tools may be used as an adjunct to professional treatment.
One of the features of the book is that it blends together sound science with practical spirituality and presents this in a highly accessible way. An example of this is the easy-to-understand introductory guide to the three different systems of the brain – the primitive threat/defence system which produces the adrenalin-mediated fight or flight response, the motivational drive system mediated by dopamine pathways, and the soothing system with a response mediated by endorphins and oxytocin.
The seven tools described are all ways of stimulating the soothing system of our mind and body. A chapter is devoted to each of the tools which are:
- Creating inner safety
- Being present
- Loving myself
- Stepping back and accepting
- Empowering myself
- Connecting
- Discovering inner peace and wholeness
Each chapter has a similar format. It begins with the rationale for the tool and introduces key relevant concepts. The main aspects of the tool are then described. Practical encouragement and tips are offered to help the reader experience the tool in practice. A major feature of the book is the reference to a library of audiotapes on the Janki Foundation’s website.
These are high quality guided practice recordings that can be used to help develop the reader’s use of the tools. Each chapter also includes a few so-called “rescue remedies” to be used as quick ways to recover calm in difficult situations. There are helpful quotes from people who have used the tools - many of them referring to how the practices have helped them during the pandemic. Each chapter ends with appropriate positive affirmations.
The final chapter encourages us to continue to use these tools beyond the duration of a particular storm. Not only does this better prepare us for facing future difficulties, but the practices also encourage the growth of something more profound within us – our deep sense of interconnectedness with all life.
The spirituality that underpins the book is inclusive and practical and, as such, the guide will be of help to people from different faith backgrounds, as well as those who do not feel a connection with any particular faith tradition.
Overall, the book is full of warmth. It is presented with clarity and heart. It has a beautiful simplicity which is a hallmark of deep wisdom.
Andrew Clark
Book review editor for the Spirituality and Psychiatry Special Interest Group at the Royal College of Psychiatrists.
This book digs a little deeper into the specific theological and pastoral issues which are raised by three major mental illnesses categories, Major Depressive Disorder, Psychosis and Schizophrenia, and Bipolar disorder. It is based on repeated interviews with Christian service users over 2 years, and the authors experience as mental health nurse, chaplain and now researcher.
Professor Swinton begins by drawing out the difference between a thin, fast and superficial description of someone’s condition such as is found in the DSM and ICD manuals, and a deeper richer more complete ‘thick description’ which encompasses more of the persons' specificity and individuality and captures more of the complexity.
Spiritual reductionism and Biological reductionism are equally wrong; It is equally false to view all Major Depressive Disorder (MDD) as being caused by the individual spiritual disorder, such as lack of faith and obedience, as to view MDD as being entirely and utterly biological.
The author highlights the need for Christians to be honest about the challenges and the dark side of life, to avoid the risk of depressed Christians living inauthentically, pretending to be happy rather than seeking to live honestly and joyfully. Joy is “being able to celebrate the goodness of Jesus even during horrendous struggles…” p80. Medication taking can be a spiritual practice, when it relieves psychological pain such that one is able to engage fully with oneself, other people and God once again.
ProfessorSwinton highlights the ‘hermeneutical injustice’ of not accepting and valuing the lived experiences of those with severe mental illness, recognising that there can be a complex interplay between illness and healthy spirituality. He argues convincingly that demon possession has a completely different presentation to mental illness including, what is for me the key point, that mental illnesses fit into recognisable categories and respond to medication, which demons don’t.
“If we find ourself thinking that people hear voices because they are demon-possessed rather than because they have been treated terribly in the past, we need to expand our intellectual and spiritual knowledge and become more aware of the significance of our hearts”. P 212
In the final section we are shown different aspects of healing, where health is defined as the presence of God, not the absence of difficulties. The healing support offered by the church community at its best, enables people to recover and live well with their ongoing challenges, even when they are not cured of their mental illness. Most helpfully Professor Swinton introduces the concept of ‘retrospective spiritual discernment’, seeing where Jesus was with the individual as they went through the storm of major mental illness, and how this can help them face the future.
This accessible book will be of particular interest to chaplains, Christian ministers and psychiatrists, and to all who wish to learn more about a distinctively Christian, bible-based and professionally informed, approach to severe mental illness.
Revd. Dr Alison J Gray, FRCPsych
Committee Member, RCPsych Spirituality and Psychiatry SIG
Book Details: London; SCM Press. 2020. 320 pages £17.18 in 2020. Paperback. ISBN-13: 978-0334059745
Horatio Clare is a lecturer, journalist and travel writer, he here provides us with a vivid description of his journey through manic breakdown into recovery, both from the inside and through the observations of friends and family. The first part begins as an adventure story; on a family holiday in Italy he realises that he is part of a great conspiracy, everywhere he looks he sees hidden communications and secret signs. Aliens have landed, humans will have to work together, he has an important role to play. Back home he frightens his family and alienates his friends. His psychotherapist says he needs a psychiatrist. Clare hears noises and interprets these as spies using hidden access tunnels to complete their secret missions. He is reviewed by mental health services and manages to talk his way out of going to hospital. He begins to literally tear down the walls and ceiling of the flat. Eventually he is sectioned.
Clare spends a month in hospital, describing the characters there, all of whom seem to have been triggered into illness by cannabis. He finds visits to the local art gallery to be healing. After this he is then discharged to his flat in town and ongoing therapy.
Gradually he repairs his relationship with his family. Then he decides to stop taking his medication, but without telling his wife. She has made it clear that stopping his meds would mean the end of their relationship. He remains stable, and after a year it becomes apparent that he is off the meds, and his wife accepts this, the gamble seems to have paid off.
In the second part of the book Clare considers the impact of big pharma on psychiatric decision making, and looks at alternatives to the current system; I felt there was a tinge of grandiosity in his writing style here. He speaks to friends and revisits some of the people with whom he interacted whilst he was unwell, one of the ward support workers, the social worker who sectioned him. He begins to understand their point of view better.
Horatio Clare argues that sectioning people is often the right thing to do, that families should not hesitate to go this route when necessary, and that it should be easier to get people the care they most desperately need. At the same time he is highlighting the damage done by cannabis, and questioning the prevailing view of long term medication being appropriate in bipolar disorder. He learns about describing, and Open Dialogue and advocates for these approaches.
This book should become a classic, it is very readable, well written and contains clear descriptions of the way Clare’s mind was working and how he was able to interpret every experience as further evidence for his delusions. He does not shy away
from describing the ensuing damage to his relationships, and his flat.
Mental Health professionals can learn from his story how an educated, articulate person can be completely caught up in a delusionary system and behaving in a very disturbed manner, and yet argue their way out of mental health detention. The author crashed his car into a dam, stripped naked and was found wandering by police, and yet still avoided being sectioned.
Alison J Gray, FRCPsych.
Andrew Powell was the founding chair of the Spirituality in Psychiatry Special Interest Group of the Royal College of Psychiatrists, which is celebrating the 20th anniversary of its founding this year. Over those years it has provided a deeply valued forum for those psychiatrists with an interest in spirituality. This book is a collection of 17 papers and talks given by Andrew between 2006 and 2017, several of them given at conferences organised by the Spirituality in Psychiatry group. It is a welcome sequel to “Ways of the Soul” which included papers from the previous decade. Both collections draw richly on Andrew’s experience of working clinically as a psychiatrist and psychotherapist, as well as his understanding of psychoanalytic and Jungian psychology, quantum physics, anthropology and comparative religion.
Each paper is complete in itself and although many of them were originally addressed to clinical audiences, they are refreshingly jargon-free and so are accessible to anyone interested in the subject matter.
The overall focus of the book is the question of what it means to be human and the challenges we all face both on a personal and collective level. Indeed one of the chapters is the transcript of a dialogue addressing this very question. Andrew brings a broad bio-psycho-social-spiritual perspective to his reflections on being human. He sees our bodies as providing a vehicle and opportunity for an evolving partnership between the ego and the soul. The ego helps individuals to grow and survive in the physical world. The soul co-habits with the ego for the purpose of gaining experience and so must share in the ego’s experience of pain. The soul is seen as the particular manifestation of the all-encompassing Spirit (which may be called “God” or “Supreme Consciousness”) in an individual form. Both ego and soul need each other and when working in partnership can become the perfect instrument for creating heaven on earth. However, the ego’s innate tendency to separate and divide and see the world through its own lens, means that it is often unaware of and disconnected from the soul.
At an individual level, Andrew sees the disconnection between ego and soul as a key factor in mental health problems. At a collective level this disconnection has led to a profound sense of alienation and has led to untold destruction of our fellow human beings and Nature. Helping individuals and groups to re-establish a healthy connection between ego and soul has been Andrew’s life work.
The more clinically orientated chapters describe ways of helping others listen to and converse with their soul. With the help of remarkable anecdotes and case stories, Andrew provides glimpses both of his own journey and those of the patients he has supported. He offers examples of ways in which a clinician can invite the patient to go deeper, such as using a question like: “What would your heart say if it could speak?” He also devotes significant passages to the importance of forgiveness, which is ultimately seen as a quality of the soul which balances the ego’s tendency to retaliation. From this perspective, forgiveness does not need to be forced or pushed. Helping someone connect with their soul brings forth the quality of forgiveness naturally.
The chapters examining our collective human situation give a particular emphasis on how, over the last 300 years, especially in so-called Western culture, humanity has become increasingly enthralled by scientism. This is an ideology which particularly appeals to the ego with its explanatory and technological power. Whilst science has brought extraordinary benefits to humanity, scientism has led to a narrow materialistic worldview with little room or respect for spiritual perspectives. Consequently, many in today’s world have a deep prejudice towards matters of the soul. Inevitably, modern mental health care has been shaped by a similar prejudice. Andrew draws on some of the findings of quantum physics and transpersonal psychology to address this narrow worldview and to show that it is no longer in step with modern scientific and psychological research. Fittingly, the final chapter of the book is entitled: “Prejudice – can we live without it?” The chapter and book ends with Andrew’s answer to his own question which is “yes, we must, if there is to be a future for humanity.”
My overall response to this book is one of warmth and hope. Having worked in the same field, I was struck by the courage in Andrew’s professional work which comes through in these papers. He was exploring ways to help people connect with their soul which would have been frowned upon by some colleagues. He was exploring a pathway to healing that not many psychiatrists had trodden. It is worth remembering that the origin of the word “courage” is from the French word for heart “coeur” and this book does indeed have plenty of heart. This heart-centredness is blended with clarity of thought which many readers will value, whether or not they are clinicians.
The book is also a timely exposition of the centrality of love and its importance in any situation in which one is in a position to help another human being. Andrew reminds us that in the face of inevitable suffering we always have at our disposal “the best medicine known to humankind – the healing power of love”.
The title of this book derives from an ancient Indian philosophical concept: “Atmadeepo Bhava” which literally means “Be your own Light”. It is the culmination of the author’s
many years of working in mental health services in India and UK.
It describes a model of humanistic psychotherapy based on the author’s clinical experience of trying to help people with a wide range of mental health problems. It is described as a “Self-therapy” which, although particularly influenced by the work of Victor Frankl, Abraham Maslow, Narayana Surya and Carl Rogers, is also personal and distinctive.
The therapeutic model is presented in a self-help format and is clearly addressed to those wanting help, rather than to professionals. The language is relatively jargon-free, practical and refers to theory lightly.
The focus is on what each individual (and those close to them) can do in the here and now to help ameliorate the individual’s psychological suffering. To this end, a range of practical exercises are suggested, not in a prescriptive manner, but rather as tools for each individual to try out for themselves. The approach is underpinned by a deeply spiritual worldview drawing on the author’s own spiritual practice and ancient Indian sacred texts.
Seven major modules
The book describes seven major modules, which the reader is encouraged to work through in whatever order suits them. These modules cover Health, Forgiveness, Self, Connections, Will-power, Relationships and Living with Family. Four additional short modules are presented exploring Time, Negotiation, Creativity and Connecting with the “Common Person”.
A quarter of the text is devoted to the module on Health. The author likens health to a cube or room with six sides: physical, mental, cultural, social, material and spiritual. Interestingly, he also adds a section on philosophical health which he likens to the atmosphere within the room. He addresses each of these areas, with a particular emphasis on personal responsibility.
The module on forgiveness considers both forgiveness of self and other. It offers practical advice on how to deal with painful memories and persistent feelings of anger and guilt.
The module on Self considers the distinction between Self and Other and the importance of balancing the needs of both. It emphasises the intimate relationship between loving self and loving other. There is an interesting section on the pro-self and anti-self tendencies in all of us, which are part of the human experience.
Neither group of tendencies can be completely eliminated. The author notes that the anti-self tendencies have been alluded to in various cultural and religious texts. He refers to the idea of the “Six Enemies” described in ancient Indian texts as obstacles faced by any person on the spiritual path. These are lust, anger, greed, attachment, pride and envy. In the author’s view, the root problem underlying each of these is greed and practical suggestions are offered to control greed.
The module on will-power identifies this quality as the real power behind all our projects, large and small. The practical suggestions advocated to strengthen will-power include self-generated “deprivation exercises”, which may raise eyebrows amongst some readers.
The remaining three major modules focus on nurturing connections with fellow human beings (especially those close to us), to Nature and also to things that serve us well in our homes and workplaces.
In the final section of the book, the author widens his already broad lens and considers how we may all contribute to creating a healthier civilisation characterised by respect for Nature, a true balance of masculine and feminine roles, multiculturalism, a more spiritual and less materialistic approach to life and care for each other.
Conclusion
In summing up, the author again draws on ancient Indian sacred texts in which the three major manifestations of the Supreme Being are described: Satyam – Truth, Shivam – Welfare (sometimes translated as Goodness) and Sundaram – Beauty. Our task as human beings is to strive to manifest these qualities in our lives. For the author, it is striving for welfare of self and other, through service, which is the key for us. “You, I and other fellow beings will therefore achieve our respective places under the Sun if we continue to walk the path of ‘Love Self and Love Others.’”
The book could be a useful tool in working with patients who are looking for a self-help guide and perhaps particularly with those who have an interest in spirituality. It reflects the warmth, humanity and care of the author. I was left feeling that those patients, past and present, who worked with the author were fortunate to work with him.
Dr Partha Choudhury is happy to share his contact details in case any one wish to contact him: choudhp@yahoo.com & telephone +44 (0) 7435425926
Previous book reviews
- A Spirituality of Survival: Enabling a Response to Trauma and Abuse by Barbara Glasson, reviewed by Catherine Beaumont
- The Philokalia and the Inner Life: on Passions and Prayer by Christopher CH Cook, reviewed by Professor Andrew Sims
- Our Sound is Our Wound: Contemplative Listening to a Noisy World by Lucy Winkett, reviewed by Dr Christopher Findlay
- Mental Wellness: A Spiritual Journey – Finding Your Own Way to Healing from Depression, Anxiety and Addictions by Hamdy El-Rayes, reviewed by Dr Mlindelwa (Bokani) Vundhla
- Spirituality and Health Research: Methods, Measurement, Statistics and Resources by Harold G Koenig, reviewed by Professor Andrew Sims
- Positive Spirituality in Health Care: Nine practical approaches to pursuing wholeness for Clinicians, Patients and Health Care Organizations by Frederic C Craigie, reviewed by Dr Alison Gray
- Handbook of Religion and Health 2nd Ed, 2012 by H. G. Koenig, Dana E. King and Verna Brenner Carlson, reviewed by Dr Alison Gray
- Encountering Depression: Frequently asked questions answered for Christians by Andrew and Elizabeth Procter, reviewed by Irene Poiner
- Dazzling darkness: Gender, sexuality, illness and God by Rachel Mann, reviewed by Dr Alison Gray
- Dementia: Living in the memories of God by John Swinton, reviewed by Dr Alison Gray
- The Essential Guide to Religious Traditions for Spirituality and Health Care Professionals by Jeffers SL, Nelson ME, Barnet V, Brannigan MC., reviewed by Dr Rob Waller
- Crossing the River: the contribution of spirituality to humanity and its future by Hawes A, Bano B. (eds), reviewed by Dr Alison Gray
- Breaking Down is waking up: Can Psychological Suffering be a Spiritual Gateway? by Russell Razzaque, reviewed by Tony Dargan
- Walking Shadows. Archetype and Psyche in Crisis and Growth by Tim Read, reviewed by Paramabandhu Groves
- Walking Shadows. Archetype and Psyche in Crisis and Growth by Tim Read, reviewed by Claire Davis
- Rediscovering a Ministry of Health; Parish Nursing as a mission of the local church by Helen Wordsworth, reviewed by Richard Henderson-Smith
- Sanctuary: the discovery of wonder by Julie Leibrich, reviewed by Rev. Liz Bryson
- The Handbook of Spiritual Care in Mental Illness by Jo Barber and Carol Wilson, reviewed by Dr Stephen Turner
- Much Ado About Something: A Vision of Christian Maturity by Larry Culliford, reviewed by Jenny Kartupelis
- Spirituality and Narrative in Psychiatric Practice: Stories of Mind and Soul by Cook, C.H., Powell, A., Sims, A., reviewed by Larry Culliford
- Mindful Emotion: A Short Course in Kindness by Paramabandhu Groves and Dr Jed Shamel, reviewed by Dr Andrew Clark
- Sadness, Depression and the Dark Night of the Soul: Transcending the Medicalisation of Sadness by Dr Gloria Dura-Vila, reviewed by Dr Andrew Clark
- The Ways of the Soul: A Psychiatrist Reflects – Essays on Life, Death and Beyond by Andrew Powell, reviewed by Dr Andrew Clark
- Conversations with the Soul A Psychiatrist Reflects: Essays on Life, Death and Beyond by Andrew Powell, reviewed by Dr Andrew Clark
- Sitting in the Stillness by Martin Wells, reviewed by Andrew Clark
- The Big Book of Wisdom by Larry Culliford, reviewed by Andrew Clark