Spirituality and mental health

While chatting to Dave Webster last weekend I came across the Royal College of Psychiatrists leaflet on mental health and spirituality. That in turn spurred me to look again at a set of guidelines on spirituality for staff in acute care services available for download from Social Care Online.

Now I do have some issues with the RCP leaflet:

"Although culture and beliefs can play a part in spirituality, every person has their own unique experience of spirituality - it can be a personal experience for anyone, with or without a religious belief. It's there for anyone. Spirituality also highlights how connected we are to the world and other people."

Of course one can be connected to the world and other people in a totally material way, no need to invoke the spiritual in order to feel a sense of belonging and connectedness.

"Spiritual practices

These span a wide range, from the religious to secular – which may not be obviously spiritual. You may:

• belong to a faith tradition and take part in services or other activities with other people
• take part in rituals, symbolic practices and other forms of worship
• go on pilgrimage and retreats
• spend time in meditation and prayer
• read scripture
• listen to singing and/or playing sacred music, including songs, hymns, psalms and devotional chants
• give of yourself in acts of compassion (including work, especially teamwork)
• engage in deep reflection (contemplation)
• follow traditions of yoga, Tai Chi and similar disciplined practices
• spend time enjoying nature
• spend time in contemplative reading (of literature, poetry, philosophy etc.)
• appreciate the arts
• be creative - in painting, sculpture, cookery, gardening etc.
• make and keep good family relationships
• make and keep friendships, especially those with trust and intimacy
• join in team sports or other activities that involve cooperation and trust."

Some of those practices are not obviously spiritual because they are not spiritual at all, and I do not see the need to invoke spirituality to explain why some of those practices are a good thing.

Finally;

"Spiritual skills include:

• being honest – and able to see yourself as others see you
• being able to stay focused in the present, to be alert, unhurried and attentive
• being able to rest, relax and create a still, peaceful state of mind
• developing a deeper sense of empathy for others
• being able to be with someone who is suffering, while still being hopeful
• learning better judgement, for example about when to speak or act, and  when to remain silent or do nothing
• learning how to give without feeling drained
• being able to grieve and let go."

Which I agree are a useful set of skills for anyone I don't particularly see the need to label them as spiritual skills.

However, despite some misgivings about the RCP's stance on spirituality it is clear from their position statement (link to pdf download) that the patient's right not to have spiritual beliefs is also respected. I do believe that for those people with religious or spiritual beliefs it is right that such beliefs are addressed especially when doing so may benefit them in clinical practice.

When I post on the Positive Psychology virtue of transcendence, with its associated character strength of spirituality I might show quite so much equanimity. Nor am I happy about the guidelines published by the Social Care Institute for Excellence.

These guidelines were drawn up by Peter Gilbert, Professor of Social Work and Spirituality, Staffordshire University, CSIP NIMHE National Lead on Spirituality and Mental Health.

My main objection is the sweeping over definition of spirituality.

"We all have something inside us which makes us tick: a spark of
motivation for why we get out of bed in the morning, and why we do the
things we do; a light which guides us when the going gets tough. This
spark is our Spirituality, which can be defined in many ways..." Gilbert, 2008, p3)

Most of us, most of the time, may have a spark of motivation (although we wouldn't have had before the 1904 when the term as an inner psychological state was introduced and it wasn't until the 1920s that the term came into general use). I do not, however, see the need to claim that as a uniquely spiritual rather than material state of affairs.

I am concerned that this publication doesn't include a case study of someone like me, a materialist who rejects the notion of spirituality. Although it does include someone who is spiritual but not religious, one case study where religious or spiritual beliefs is not mentioned, and five case studies involving religious and spiritual beliefs (seven cases in total).

I might react quite badly to someone insisting that I need to look after my 'spiritual dimension' and to those who insist on relabeling human activity as spiritual.

Positive Psychology, what's not to like

Imagine a psychology that can tell you how to live a happy fulfilled life, and to do this not on the basis of the received wisdom of religion or politics but to do it on the basis of science.

This is a psychology that would stand in contrast to negative psychology, the psychology of distress and illness, but rather it would be a psychology that would help to create scientific understanding and well founded interventions that would allow individuals, their families and communities to thrive.
The labeling of the rest of psychology as negative has been dropped, but the notion that positive psychology is something apart from the rest of the discipline has remained.  In order to replace the DSM positive psychology has come up with its own set of Character Strengths and Virtues (Peterson and Seligman, 2004).

I intend to look at these in some depth as time goes by, but right now I just want to get my  initial thoughts down, before I do too much reading of both Positive Psychology and the small body of critical work around it.

• Positive Psychology is as much a moral project as it is a scientific project
• Positive Psychology is deliberately ahistorical
• Positive Psychology mistakenly claims that the character strengths described are (or should be) universal

I will also look at each of the character strengths, probably starting with Transcendence as that is the one that contains Spirituality.

• Wisdom and Knowledge
• Courage
• Humanity
• Justice
• Temperance
• Transcendence

So at the moment this is just immediate reaction stuff.

I am a little perturbed by the claims that it is necessary to be spiritual to be authentically happy and thanks to David Webster I am more than a little skeptical of some of the claims made in the name of spirituality, http://dispirited.org/.


I dislike the trumpeting of positive psychology being some shiny new thing.

"For the last half century psychology has been consumed with a single topic only—mental illness—and has done fairly well with it” (Seligman, 2002 p. xi)

I don't think that claim will hold up, but the other thing that a move like this does is to deliberately underplay possible contributions from elsewhere in psychology.

Other authors, but particularly Held (2002) have pointed out the relationships between Positive Psychology and Humanistic Psychology. As far as I can tell, and it is too early to be really sure, it looks like Positive Psychology is doing to Humanistic Psychology what psychology as a whole has done to Freud. Rip off various appealing concepts, repackage them in a scientific framework, and then rule out the earlier contributions as none scientific nonsense that we are better off without.

Kurt Danziger (1997) writing about the attempt to create a psychology of motivation based on universal human needs suggested that:

"Elevating one set of historically contingent conventions to the status of universal human needs not only emphasized their importance for the society in which they originated but provided a rationale for proselytizing efforts elsewhere." (Danziger, 1997 p123).

Well that is enough for a Sunday evening.

References
Danziger, K. (1997). Naming the mind: How psychology found its language. London: Sage.
Held, B. (2005). The “Virtues” of Positive Psychology. Journal of Theoretical and Philosophical Psychology 25:1 p1-34
Peterson, C. & Seligman, M.E.P. (2004). Character Strengths and Virtues A Handbook and Classification. Washington, D.C.: APA Press and Oxford University Press.
Seligman, M. E. P. (2002). Authentic happiness: Using the new positive psychology to realize your potential for lasting fulfillment. NY: The Free Press.