Book Reviews from the SIG

List - SPSIG book reviews

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.

John Swinton. London; SCM Press.  2020. 320 pages £17.18 paperback. ISBN-13 : 978-0334059745

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.

Prof 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 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.

Prof Swinton 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 Prof 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, 

Chair RCPsych Spirituality and Psychiatry SIG.

Edited by Isabel Hamley,  and Chris Cook. London; SCM Press, 2020. 232 pages £25 paperback £20 Kindle. ISBN13: 978-0334059776

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 follows 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, and 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, 

Chair RCPsych Spirituality and Psychiatry SIG.

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”.

Luminous LifeThe 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

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