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‘Reflection takes a collective form through consultation.’

(Paul Lample in Revelation and Social Reality – page 212)

One evening, towards the end of last month, I gave a talk at Birmingham University, concerning a Bahá’í perspective on making sense of mental illness as derived from my own clinical experience. Even though I had two hours at my disposal, I still had more planned than I had time to say. This was partly because some of the comments and questions sparked a lengthier diversion than I had intended. Anyway, I thought I’d publish everything I intended to say on this blog.

The quote at the top defines what processes this sequence of posts will be exploring in more depth in terms of their positive impact upon helping people find meaning in their experiences when they are struggling to cope with psychotic phenomena.

But before we home in on those we need a helicopter view of the overall context of the problems and processes we’ll be examining here.

Trauma, Transliminality and Psychosis

Previous posts on this blog have explored the possible relationship between the factors captured by this diagram. The focus though right now will be on trauma and psychosis.

Hearing voices and strange but strongly held beliefs are two key supposedly correlated signs we will be looking at today. Thought disorder and extreme withdrawal from contact with other people are also taken to be signs. I don’t propose to delve into the validity of the label all too frequently attached when more two or more of these come together in distressing form. For anyone interested, see Mary Boyle’s Schizophrenia: a scientific delusion for a clear exposition of the sceptical case against the idea these form a real syndrome.

For an understanding of the evidence for a relationship between psychotic phenomena and trauma see Longden and Read’s The Role of Social Adversity in the Etiology of Psychosis. They deal extensively with this problem (pages 7-8):

Large-scale population studies have shown that associations between adversity and psychotic experience remain significant when controlling for possible confounders, including: family history of psychosis and other mental health problems (which negates the notion that psychosis only occurs in those genetically predisposed), age, sex, ethnicity, marital status, exposure to discrimination, other psychiatric diagnoses, education level, neuroticism, and substance use. Furthermore, the association has repeatedly demonstrated a dose-response relationship; that is, the likelihood of psychosis increases relative to the extent of adversity exposure.

Transliminality refers to the permeability of the filters surrounding our consciousness, whether that be from beneath (the brain’s subconscious) or above (some kind of transcendent level). Helpful analogies that illustrate the idea of such thresholds of access are our eye/brain system’s limited perception of light’s spectrum, a receiver such as a radio that only translates into intelligible sound the frequencies it is tuned into, or a transceiver such as a computer that can access and decode appropriate data stored in a cloud site as well on its own hard drive. Accessing outside those given ranges is taken to be impossible for the manmade devices. However whether the brain can access outside its normal range is a vex question. Good sources for evidence that this might be so can be found in Mario Beauregard’s The Spiritual Brain or in Irreducible Mind by the Kellys.

Ian’s Experiences of Psychosis

There are two people who were tormented by so-called psychotic phenomena from whom I learned a great deal more than they probably learned from me about what these are and how to deal with them. The lady in the poem above is one: Ian, whom I’ll consider in a moment, was another.

The lady had asked for help to deal with her childhood experiences of extreme abuse. Unlike with Ian, I do not have her permission to go into detail. However, what I can say to illustrate the depth of her problem is that the one-hour sessions dealing with her work on the abuse had to be divided into three roughly equal parts. The first part checked up on how things were going and that she wanted to continue the painful work. The second part looked at the abuse and her intensely painful memories of it, and the third part involved calming her down sufficiently after this to dispel the powerful and reactivated visual and auditory hallucinations of her father, the abuser.

I will look later in the sequence at one other indication of the painful and powerful hold the past abuse still had over her.

I can directly use Ian’s own words to convey the kinds of experiences he was grappling with. This is an extract from the transcript of a video interview which took place in late May 1993. Obviously P is me and I is Ian.

P. Could I ask you to describe at first how things were, say, a year ago before there was ever any question of our meeting and when things were not too good for you?

I.: Well, I’d got the voices nearly all the time. They used to wake me up at night, you know?

P.: Yeh. And can you say what kind of things they used to say, just as an example?

I.: `Get out of bed, you lazy bastard. Get up and wake up. Come flying with us. Go and jump in front of a train,’ you know?

P.: Right. And they were saying this to you constantly, were they?

I.: Constantly, yeh.

P.: Were they constant in the day?

I.: Yeh.

P.: Were they very loud?

I.: Yeh. They got loud when I was ill, you know, they got loud.

P.: Right. So, say last May, or last Spring, May, June, July, is this how it was with the voices . . .

I.: Yeh. They were pretty bad. They were loud, you know? They were right down in my ears. And – er – I was seeing things as well. I was seeing what I call the – the `Boss’, you know? He only come at night, yeh.

P.: Right. Where did you think these voices came from?

I.: The spirit world.

P.: So you thought they were ghosts of some kind, or . . .

I.: I thought they were spirits, come from the spirit world for me, you know? And that they wanted me to go with them. I didn’t think that I was going to hurt myself by killing myself, you see? But something inside me just wouldn’t let me do it, you know?

P.: Yeh. You held back?

I.: I think it was because I was afraid of hurting myself.

P.: Right. Because you did say at the time that unless you actually did it instantly it wouldn’t really count, would it?

I.: No.

P.: Right. So it was very important to you that you didn’t end up injured or in a worse state.

I.: Yeh. It was important not to get injured. It had to be a certain thing, you know? And the Express train looked the part.

P.: Right.

In an earlier exchange that month on audiotape, in response to my question as to whether his ‘experiences . . . were shutting [him] out from the world and shutting [him] out from the future,’ he replied, ‘Yeh. I was living in a dream world, you know.’ He also described it in the same interview as ‘brainwashing.’ He said:

They were so loud that I couldn’t hold a conversation, you know. And I couldn’t listen to the radio. They just blocked everything out. And I couldn’t think because they just sidetracked me, you know, saying the same thing over and over and over.

In an interview in September of the following year, he clarified further by saying that he no longer did what the voices told him to do, as he had in the beginning. He knew now they were not spirits but the products of his own head. Even so it was still hard work to keep them at bay.

In working with people experiencing psychotic phenomena, I found it important to distinguish the experience, with which I never sought to argue, from the explanation, which could be modified in helpful ways, for instance here in terms of the power of the voices. It is possible that this will lead, as in Ian’s case, to a recognition that the voices come from inside the person’s own head. This though is neither necessary nor inevitable. It is sufficient that a more benign explanation of the voices is arrived at that gives them far less power and, if possible, reduces any malignity.

Ian’s Life

For those interested in the full back ground to his psychotic experiences and how far back in his life traumatic events and situations began helping to shape his sensibility I have included at the end here a brief summary, which I helped him write, of his life up to the point I worked with him.  

By the time I was 14 months old my mother was dying of tuberculosis and I was failing to thrive. I was abandoned by my dad. My aunt rescued me and took me to live with her. She applied to the courts to adopt me. My dad, at the 11th hour, began to contest this. The proceedings dragged on until I’d started school. My situation with my aunt was not secure until I was six years old.

When I was seven my grandfather died suddenly. I was extremely close to him.  The pain of that still haunts me.

When I was nine I was walking to school through a farmyard, when I saw the farmer hanging in his barn. Shortly after that, the voices started, but they were nice and friendly, and kept me company as I walked the hills near home.

I went down the mines as soon as I left school. I wasn’t happy with that and joined the army. Within the first couple of years a bullying sergeant major triggered a psychotic episode. The voices turned nasty. I heard the voice of the sergeant major mocking and insulting me all the time. I faked my way out the army hospital by denying I was hearing voices any longer.

The army didn’t know what to do with me. As they reckoned people with schizophrenia were antisocial, they decided a solitary job within the army would be the best thing for me. They came up with what they felt was the ideal solution: they’d train me to be a sniper. You spend long periods alone and when anyone comes along to disturb you, you kill them – a great idea in their view. There’d be none of that stressful social contact!

At least two incidents in which I was involved in the army left me with strong feelings of guilt. The pain of the deaths I caused, I know now,underlay the later experiences of psychosis.

I was discharged from the army after I was seriously injured walking towards a bomb. I did this deliberately. It was part of a pattern. From time to time I felt I didn’t deserve to live so I put myself in danger. If I lived I felt I was meant to live and maybe I deserved to do so. When the feeling built up again, as it kept on doing even in civvy street because the guilt about the deaths never left me, I’d play the same kind of Russian Roulette.

Once out of the army I used to do this by lying down on a railway line in the early hours of the morning. If no train came within a certain period of time, I reckoned I deserved to continue living.

After leaving the army my marriage broke up and I ended up living with someone with a serious drink problem. I held down three jobs, working all hours, in order to make ends meet and finance her habit. Eventually, I got completely exhausted and depressed. I couldn’t cope any longer and threw her out.

That didn’t finish it though. I was so convinced that she would die on the streets, I felt like I’d killed her. I became tortured by guilt. I shut himself away in my room with my dog. I survived on frozen chips for six weeks, until my boss became so concerned he got the police to break in. They found me completely psychotic, they say. I think I was determined to die this way. They sectioned me. That began an eight year history of sections, medications, with long and frequent admissions, until I felt that life had nothing to offer me.

At the end of this eight year period our work together began. At the end of the first phase, the May 1993 video interview took place.

We are now at a point to move onto examining how far we were able to help Ian make sense of his psychotic experiences in terms of his life history. More of that next time.

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Suffering is life.

(Thomas Szasz quoted by James Davies in Cracked – page 276)

I threatened in an earlier post to republish this one. Here is it.

I was walking back from town one day when my phone pinged. It was a message telling me my book was ready for collection from Waterstones. I was puzzled to begin with then the penny dropped. Just before my birthday someone spotted that I had scribbled, in my list of books to buy, the title of Cracked by James Davies.

I turned round and headed back to town again. When I picked up the book, for some reason I wasn’t impressed by its cover. Maybe the words ‘Mail on Sunday’ put me off, though Wilf Self’s comment helped to redress the balance.

Anyhow, for whatever reason, I didn’t get round to reading it until after I’d finished Rovelli’s Reality is not What it Seems. I’ll be doing a short review of that later, possibly.

Once I started Davies’s book I was hooked.

I’ve already shared on this blog a review of Bentall’s book Doctoring the Mind, which brilliantly, for me at least, brings the more grandiose pretentions of psychiatry back to the earth with a bump. I quoted Salley Vickers’ verdict:

Bentall’s thesis is that, for all the apparent advances in understanding psychiatric disorders, psychiatric treatment has done little to improve human welfare, because the scientific research which has led to the favouring of mind-altering drugs is, as he puts it, “fatally flawed”. He cites some startling evidence from the World Health Organisation that suggests patients suffering psychotic episodes in developing countries recover “better” than those from the industrialised world and the aim of the book is broadly to suggest why this might be so. . . .

I summarised my own view by praising ‘its rigorous analysis of the misleading inadequacy of psychiatry’s diagnostic system, its powerful and carefully argued exposure of the myths surrounding psychotropic medications and their supposed efficacy, and its moving description of the critical importance of positive relationships to recovery.’

The Davies book also covers much of this same ground and is equally compelling. What needs to be acknowledged is that he also takes the argument to another level towards the end of his book. He is concerned that we are exporting our Western model with all its flaws to country after country and goes on to explore other implications as well.

In the chapter dealing with the export issue he first summarises his case up to that point (page 258 – square brackets pull in additional points he has made elsewhere):

Western psychiatry has just too many fissures in the system to warrant its wholesale exportation, not just because psychiatric diagnostic manuals are more products of culture than science (chapter 2) [and have labelled as disorders many normal responses to experience], or because the efficacy of our drugs is far from encouraging (Chapter 4), or because behind Western psychiatry lie a variety of cultural assumptions about human nature and the role of suffering of often questionable validity and utility (Chapter 9), or because pharmaceutical marketing can’t be relied on to report the facts unadulterated and unadorned [and its influence has helped consolidate the stranglehold of diagnosis and a simplistic psychiatric approach] (Chapter 10), or finally because our exported practices may undermine successful local ways of managing distress. If there is any conclusion to which the chapters of this book should point, it is that we must think twice before confidently imparting to unsuspecting people around the globe our particular brand of biological psychiatry, our wholly negative views of suffering, our medicalisation of everyday life, and our fearfulness of any emotion that may bring us down.

I can’t emphasise too strongly the value of reading through the details of his treatment of all these other aspects. I am of course aware that physical medicine, even though there are biological markers for diseases in this sphere unlike in mental health, has not been exempt from the disingenuous manipulation of data and unscrupulous marketing methods practiced by the pharmaceutical industry, as Malcolm Kendrick’s book Doctoring Data eloquently testifies, but the scale of that abuse is dwarfed in the arena of mental health – and I mean arena in the fullest sense of that word: the battle here is damaging more ‘patients’ and costing even more lives.

Davies’s examination of exactly how this exportation of the psychiatric perspective is coming about is also disturbing and compelling reading. He adduces for example how skilfully drug companies have learned to read the reality of cultures into which they want to make inroads with their products, how effectively they target key figures in the prescribing hierarchy of professionals, and how astutely they now reach out to the public themselves so they will go to their doctors and request what the drug company is selling – all this to detriment of the many ways the social cohesion of the receiving culture has often (though not always, of course) been supporting those who are suffering from some form of emotional distress.

Where he takes his case next, in Chapter 10, I found both compelling and resonant. He is in tune with Bentall in seeing the importance of supportive relationships but, I think, explores that aspect somewhat more deeply.

He repeats basic points, to begin with (page 266):

What the evidence shows… is that what matters most in mental health care is not diagnosing problems and prescribing medication, but developing meaningful relationships with sufferers with the aim of cultivating insight into their problems, so the right interventions can be individually tailored to their needs. Sometimes this means giving meds, but more often it does not.

He then quotes research done by a psychiatrist he interviewed (page 267). Using two existing MH teams, Dr Sami Timimi set up a study comparing the results from two groups, one diagnostic, the usual approach, and the other non-diagnostic, where medication was given only sparingly, diagnosis was hardly used at all, and individual treatment plans were tailored to the person’s unique needs.’

In the non-diagnostic group the psychiatrist spent far more time exploring with his clients the context of their problems.

The results were clear (page 269):

Only 9 per cent of patients treated by the non-diagnostic approach continued needing treatment after two years, compared with 34 per cent of patients who were being treated via the medical model. Furthermore, only one person from the non-diagnostic group ended up having to be hospitalised, whereas over 15 people in the medical-model team were referred for inpatient hospital treatment. Finally, the non-diagnostic approach led to more people being discharged more quickly, and to the lowest patient ‘no-show’ rate out of all the mental health teams in the county.

Davies also interviewed Dr Peter Breggin, a US psychiatrist who is critical of the medical model. Breggin explained his viewpoint (page 279):

Most problems are created by the contexts in which people live and therefore require contextual not chemical solutions. ‘People who are breaking down are often like canaries in a mineshafts,’ explained Breggin. ‘They are a signal of a severe family issue.’ .  . . . For Breggin, because the medical model fails to take context seriously – whether the family or the wider social context – it overlooks the importance of understanding and managing context to help the person in distress.

Davies quotes Dr Pat Bracken as singing from the same hymn sheet (page 273):

We should start turning the paradigm round, start seeing the non-medical approach as the real work of psychiatry, rather than as incidental to the main thrust of the job, which is about diagnosing people and then getting them on the right drugs.

It’s where he goes next that I found most unexpected but most welcome to my heart. He leads into it with an interview with Thomas Sasz just before his death at the age of 92 (page 276). He asks Szasz, ‘why do we believe as a culture that suffering must be removed chemically rather than understood in many cases as a natural human phenomenon, and possibly something from which we can learn and grow if worked through productively?’

Szasz’s response is fascinating:

Our age has replaced a religious point of view with a pseudo-scientific point of view. . .   Now everything is explained in terms of molecules and atoms and brain scans. It is a reduction of the human being to a biological machine. We don’t have existential or religious or mental suffering any more. Instead we have brain disorders.

Davies summarises Szasz’s position on psychiatry (page 277): ‘It had become deluded in its belief that its physical technologies, its ECT machines and laboratory-manufactured molecules, could solve the deeper dilemmas of the soul, society and self.

Bracken’s view on this brings in capitalism (page 278):

What complicates things more is that we also live in a capitalist society, where there is always going to be someone trying to sell you something… In fact, some people would argue that capitalism can only continue by constantly making us dissatisfied with our lives.… You know, if everybody said I am very happy with my television, my car and everything else I’ve got, and I’m perfectly content with my lifestyle, the whole economy would come shattering down around our ears.

He continues (page 279):

What we customarily call mental illness is not always illness in the medical sense. It’s often a natural outcome of struggling to make our way in a world where the traditional guides, props and understandings are rapidly disappearing… Not all mental strife is therefore due to an internal malfunction but often to the outcome of living in a malfunctioning world. The solution is not yet more medicalisation, but an overhaul of our cultural beliefs, a reinfusing of life with spiritual, religious or humanistic meaning with emphasis on the essential involvement of community, and with whatever helps bring us greater direction, understanding, courage and purpose.

Unfortunately psychiatry, as with economics according to the writers of Econocracy, is failing to train psychiatrists in the adoption of a critical perspective on their own practice. So, he concludes, the pressure to change perspective has to come from outside the psychiatric system. He quotes Timimi again (page 285):

The things that get powerful institutions to change don’t usually come from inside those institutions. They usually come from outside. So anything that can put pressure on psychiatry as an institution to critique its concepts and reform its ways must surely be a good thing.

So, it’s down to us then. For me, promoting this book is a start. We all need to think, though, what else could be done, whether as a patient, a volunteer, a friend, a family member, an MP, a clinician or simply a citizen.

Currently, help is often tied to diagnosis. One psychiatrist quoted in this book is concerned that if categories of mental disorder are not confirmed as diseases, services will never be funded at the required level, the level, say, at which cancer services are funded. Surely, though, if opinion shifts to a tipping point not only the greater humanity of non-diagnostic treatments but also their relative cost effectiveness must carry the day in the end. But opinion will only shift sufficiently if we all play our part.

I know! I’ve got it.

You all could start by reading these two books. How about that?

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One hour’s reflection is preferable to 70 years’ pious worship.’

(Hadith quoted by Bahá’u’lláh in the Kitáb-i-Íqán)

Central to the task of reconceptualizing the system of human relationships is the process that Bahá’u’lláh refers to as consultation. “In all things it is necessary to consult,” is His advice. “The maturity of the gift of understanding is made manifest through consultation.”

(The Prosperity of Humankind, Section III)

Reflection takes a collective form through consultation.

(Paul Lample in Revelation and Social Reality – page 212)

I explained last week that the talk I planned to give at the interfaith meeting in Holland House never happened. I gave a rather different one instead. These are the bare bones of what I said.

Introduction:

I began with a brief explanation of the core belief of the Bahá’í Faith: unity or oneness. This is rooted in our sense that there is only one God, the great world religions share the same spiritual core and the whole of humanity is basically one family.

In terms of the individual, unity extends from within each of us to what exists between us. Bahá’u’lláh explains this in these terms: ‘Since We have created you all from one same substance it is incumbent on you to be even as one soul, to walk with the same feet, eat with the same mouth and dwell in the same land, that from your inmost being, by your deeds and actions, the signs of oneness and the essence of detachment may be made manifest.’

My understanding of this includes the idea that we need to heal the divisions within us if we are to heal the divisions between us and vice versa. To contribute to the best of my ability to the creation of a supportive and united community I have to resolve the conflicts within me by bringing the ‘multiple identities that were born of passion and desire,’ as ‘Abdu’l-Bahá puts it, together in obedience to a higher and worthier power. Only in this way may ‘all souls become as one soul.’

Terraces on Mount Carmel

What does this mean in practice

We must all come to recognize the truth of what the Universal House of Justice conveyed to all those gathered on Mount Carmel to mark the completion of the project there on 24th May 2001:

Humanity’s crying need will not be met by a struggle among competing ambitions or by protest against one or another of the countless wrongs afflicting a desperate age. It calls, rather, for a fundamental change of consciousness, for a wholehearted embrace of Bahá’u’lláh’s teaching that the time has come when each human being on earth must learn to accept responsibility for the welfare of the entire human family.

They explain that a ‘commitment to this revolutionizing principle will increasingly empower’ us and enable us to awaken each other ‘to the latent spiritual and moral capacities that can change this world into another world.’

When we look at our local communities, which is where an active concern for the wellbeing of others starts, the Guardian of the Bahá’í Faith reinforces the message that we ‘must do [our] utmost to extend at all times the helping hand to the poor, the sick, the disabled, the orphan, the widow, irrespective of colour, caste and creed.’[1]

Within the Faith at local level the Bahá’í community and beyond often benefits, when the community is of sufficient size, from the guidance of a local Spiritual Assembly: at national level the National Assembly does the same. Even where a local community is too small to have an Assembly, all of its members, as far as humanly possible, should be actively safeguarding the wellbeing of everyone within that community, and beyond if within its capacity.

Two key components

There are two other key components about which I spoke briefly on the day. Without these two components community life would be that much the poorer.

I will deal as briefly with them here as I did on the day because I hope to return to them more deeply when I report on a recent talk I gave about the Bahá’í contribution to understanding mental illness. I’ve also explored them on this blog at some length in the past.

Reflection is the first, concerned as it is with the individual. Reflection is not just thinking more deeply about something outside ourselves: it also involves separating consciousness from its own contents. We come to realise our minds are like a mirror, and just as a mirror is not what is reflected in it, our minds are not what is reflected in them. We are not what we feel, think, imagine, sense, remember or plan. These change from moment to moment. We are the capacity to do all of those things. We are not even who we think or feel we are. We are the emotional and sensing thinker who lies beneath all thought.

The words reflection, contemplation and meditation are used in the Bahá’í Writings in closely related ways, and this is true of the talk ‘Abdu’l-Bahá gave at a Society of Friends’ meeting house in London in 1913. Amongst other things He is recorded as having said (Paris Talks – pages 174-176):

This faculty of meditation frees man from the animal nature, discerns the reality of things, puts man in touch with God. . . . The meditative faculty is akin to the mirror; if you put it before earthly objects it will reflect them. Therefore if the spirit of man is contemplating earthly subjects he will be informed of these. . . .’

Even if you find it hard to accept the existence of God, it still perhaps makes sense to see this process of reflection as putting us in touch with far deeper and wiser aspects of our being and as releasing us from the hold of shallower and more treacherous perceptions. His use of the image of the mirror is also significant in this context, and not just because of the possible pun in English on the word reflect.

For me, realising the power of reflection enables us to break out of our often divisive patterns of thought and become more in harmony with our deepest self, more united within. In that state of mind we can take better care of ourselves and others.

We become more able to compare notes with others in order to gain a clearer picture of reality and to formulate more effective plans for dealing with our problems. Reflection enables us to consult more effectively.

Paul Lample explains the exact benefits of consultation as follows (Revelation and Social Reality pages 199 & 215):

Consultation is the method of Bahá’í discourse that allows decisions to be made from the bottom up and enacted, to the extent possible, through rational, dispassionate, and just means, while minimising personal machinations, argumentation, or self-interested manipulation. . .

[C]onsultation is the tool that enables a collective investigation of reality in order to search for truth and achieve a consensus of understanding in order to determine the best practical course of action to follow.… [C]onsultation serves to assess needs, apply principles, and make judgements in a manner suited to a particular context.

It’s not difficult to see that in a community of any kind, whether Bahá’í or not, the exercise of these two skills will improve the wellbeing of all its members and enhance the quality of its community life.

The reciprocally potentiating combination of these two processes in this precise way is, as far as I know, unique to the Bahá’í Faith.

I hope to explain more about exactly how this might work in a therapeutic context at a later date.

Footnote:

[1] Shoghi Effendi Principles of Bahá’í Administration BPT UK 1976 Page 39.

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I ended the previous post with a quote concerning the influence of diet.

What has become abundantly clear is that what we eat affects many aspects of our health. A recent book[1] on psychobiotics explores one previously underestimated area to demonstrate the truth of this. A Guardian review pulls out the main points in detail including such statements as ‘Over the past decade, research has suggested the gut microbiome might potentially be as complex and influential as our genes when it comes to our health and happiness. As well as being implicated in mental health issues, it’s also thought the gut microbiome may influence our athleticism, weight, immune function, inflammation, allergies, metabolism and appetite.’

The inescapable conclusion, as all the researchers are keen to point out, is ‘that no matter how repetitive the advice, and difficult to achieve in the west, a varied diet rich in fresh vegetables and fermented foods such as sauerkraut, along with exercise and stress management, is the route to sustained gut (and general) health.’

Self-help

For reasons which modern medicine has made increasingly clear, Bahá’ís are prohibited from using alcohol and other mind altering substances: ‘Experience hath shown how greatly the renouncing of smoking, of intoxicating drink, and of opium, conduceth to health and vigour, to the expansion and keenness of the mind and to bodily strength.’[2]

We are also enjoined to take good care of our health ourselves in other simple ways, beyond just diet. ‘You should certainly safeguard your nerves,’ Shoghi Effendi says, ‘and force yourself to take time, and not only for prayer and meditation, but for real rest and relaxation….’ [3]

With great prescience he also emphasises the critical importance of sleep: ‘Regarding your question: there are very few people who can get along without eight hours sleep. If you are not one of those, you should protect your health by sleeping enough. The Guardian himself finds that it impairs his working capacity if he does not try and get a minimum of seven or eight hours.’[4]

It wasn’t until I recently read Matthew Walker’s Why We Sleep that I came to realise just how vitally important sleep is to our health. It pulls together evidence for the importance of sleep at every stage of life, and spells out in detail the damage lack of sleep causes not just to memory and concentration, but also to the health of body and brain in a multitude of ways: to name but a few, by raising the risk of Alzheimer’s, diabetes, stroke, heart attack, and cancer as well as by reducing the efficacy of the immune system. More of that in my next post.

Lucretia by Rembrandt

More Challenging Aspects

Other important points to bear in mind when helping those who are ill or whenever we are ill ourselves include the spiritual dimension of our being specifically, and not just prayer and meditation. ‘Abdu’l-Bahá explains that ‘The connection of the spirit with the body is like that of the sun with the mirror.’ The spirit or soul cannot be damaged by what damages the body nor helped by what cures it: ‘Briefly, the human spirit is in one condition. It neither becomes ill from the diseases of the body nor [is] cured by its health.’[5]

There are many reasons why factoring this in might enhance the way we treat others and the way we look at our own illness. Staff and relatives, if they believed in the soul, would find it even harder than they do to treat a comatose patient like an object rather than a human being. I also would find it easier, to some degree at least, to cope with a life impairing illness if I believed that I had a soul. These benefits do not, I know, amount to proof of the existence of a soul. I’ve dealt with that evidence at length elsewhere. What I believe this evidence strongly indicates is that, just as I cannot prove I have a soul, science cannot prove I don’t. To believe in a soul is as rational as not to believe in one: given the demonstrable benefits of belief to quality of life I know what side of this argument my money should be on, even if I didn’t already accept the reality of the soul.

An even more complex issue, which I have also dealt with at length elsewhere on this blog concerns pain and suffering. Shoghi Effendi gave this response to a question: ‘As to your question concerning the meaning of physical suffering and its relation to mental and spiritual healing: Physical pain is a necessary accompaniment of all human existence, and as such is unavoidable. As long as there will be life on earth, there will be also suffering, in various forms and degrees. But suffering, although an inescapable reality, can nevertheless be utilized as a means for the attainment of happiness. . . . Suffering is both a reminder and a guide. It stimulates us to better adapt ourselves to our environmental conditions, and thus leads the way to self-improvement. In every suffering one can find a meaning and a wisdom. But it is not always easy to find the secret of that wisdom. It is sometimes only when all our suffering has passed that we become aware of its usefulness.’[6]

The final tricky point concerns my previous professional vocation.

As I have explained elsewhere and will be republishing later, I am acutely aware that psychiatry has its limitations, which psychiatrists do not always recognise. Davies marshals a wealth of evidence in support of this contention.  If a mental health team acts as though all they really need to know is the diagnostic label, and what they suppose is the completely effective medication that goes with it, and all they have to do is make sure the patient swallows enough tablets, the outcome will be poor at best and potentially life-damaging at worst. If on the other hand, they take into account, not just the label and the tablets, but also the whole person and their context, working in consultation with the service user to create a recovery plan within the framework of a genuinely multi-disciplinary team, then the evidence suggests the outcome will be good and the recovery more stable.

This means that Shoghi Effendi’s cautious advocacy of psychiatry is music to my not necessarily objective ears: ‘Psychiatric treatment in general,’ he says, ‘is no doubt an important contribution to medicine, but we must believe it is still a growing rather than a perfected science. As Bahá’u’lláh has urged us to avail ourselves of the help of good physicians Bahá’ís are certainly not only free to turn to psychiatry for assistance but should, when advisable, do so. This does not mean psychiatrists are always wise or always right, it means we are free to avail ourselves of the best medicine has to offer us.’[7]

I’ll leave you to read my subsequent posts if you need to know more about my personal views on that one.

Hopefully this has been a reasonably clear helicopter view of the Bahá’í position on health and wellbeing. I think I’ve gone on long enough in any case. I’ll stop hear and catch my breath. I don’t want to precipitate a heart attack.

Footnotes:

[1] The Psychobiotic Revolution: Mood, Food and the New Science of the Gut-Brain Connection by Cryan, Dinan and Anderson.
[2] (Selections from the Writings of ‘Abdu’l-Bahá Sec. 129, page 150)
[3] 
(In a letter written on behalf of Shoghi Effendi, 23 November 1947 to an individual believer)
[4] 
(In a letter written on behalf of Shoghi Effendi, 15 September 1951 to two believers)
[5] (‘Abdu’l-Bahá, “Some Answered Questions”, pp. 228-29)
[6] 
(In a letter written on behalf of Shoghi Effendi, 29 May 1935 to an individual believer)
[7](In a letter written on behalf of Shoghi Effendi, 15 June 1950 to the National Spiritual Assembly of the British Isles)

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Holland House

Last Monday I was scheduled to give a short talk at Holland House, Cropthorne, to an interfaith group on the Bahá’í approach to health and well-being. It was an opportunity both to share the Bahá’í perspective on these matters and learn from other religions what their take on the matter is. I hope to deal with these other points of view in a separate post. This one is going to be long enough without them! It was another occasion when I had more to say than the time allowed and readers of this blog are paying the price!

More than that though, this time the talk I eventually gave was rather different from the one I planned, though it included some of the original points.

I was derailed by various things. No pun intended, but the train journey there was a nightmare. The four carriage train before mine had been cancelled when its brakes failed. The two carriage train I was on had to find space not just for us but for all the passengers from the first train who were still waiting. Sardine time! At every stop the wait got longer and longer as it became ever more difficult to squeeze more sardines into the tin. My chance of getting my connection faded gradually into Never Never Land.

I’d already begun to revise my talk when I got the final copy of the programme a few days before. It spelt out the topic of the day more clearly than the earlier version: ‘How does my faith community understand and support wholeness, wellbeing and health in individuals and communities?’ I’d started to rework it in the time available but needed to do more on the train.

That proved easier said than done. When I boarded the train I headed for a table with only one man sitting there. As soon as I started to sit down I realised I’d miscalculated. It was one man and his guide dog. No problem, I thought. I’ve done this before. These dogs are well-trained, quiet and docile. He readjusted his dog, and I did the same with my expectations as more passengers climbed on board and a lady joined us at the table. Still not a major problem as Milo, the brown-eyed labrador, still had room to lie down quietly. Until that is a second lady asked if she could sit at the window seat beside me.

From that point on, my revision of the talk was punctuated by unpredictable interactions with Milo who was clearly excited to be surrounded by so many people at close quarters. His harness was on the table. His owner explained that when Milo had his harness on he was in work mode. Without the harness it was playtime!

I arrived at the station for my connection with the train I planned to be on long gone. The next train was more than an hour away. Time for some lateral thinking. In the end, I bit the bullet and took a taxi to the venue. No way I could carry on revising my plan as we bounced along. I had to do that while the other speakers were doing their bit and before my turn came.

Anyway, I felt it might still be worth sharing in this sequence what I originally planned to say, before trying to type up what I actually said into a later post.

So, here it is.

The Basics

It’s probably best at the start to make two very basic points.

We need to use doctors when we are ill and Bahá’ís have no reservations about accepting medical best practice. ‘Abdu’l-Bahá is unequivocal: ‘the sick must refer to the doctor.’[1]

Also we have no Bahá’í healers as such, even if a Bahá’í feels they have healing powers. The Guardian of the Bahá’í Faith, Shoghi Effendi makes this crystal clear: ‘although there is no objection to your helping others to regain their health, he does not feel you should associate the name Bahá’í with your work, as it gives a wrong impression; we have no “Bahá’í healers” . . . You are a Bahá’í and a healer, and that is quite different.’[2]

We are free to use the material means at our disposal to help others in need: ‘There is nothing in the teachings which would forbid a Bahá’í to bequeath his eyes to another person or for a Hospital; on the contrary it seems a noble thing to do.’[3] and ‘There is nothing in the Teachings to prevent a Bahá’í from willing his body for medical research after death. However, it should be made clear that the remains must be buried eventually and not cremated, as this is according to Bahá’í law.’[4]

Complicating Factors

Now I’m going to complicate things a little.

Medicine is not the only option. ‘Abdu’l-Bahá explains: ‘There are two ways of healing sickness, material means and spiritual means. The first is by the treatment of physicians; the second consisteth in prayers offered by the spiritual ones to God and in turning to Him. Both means should be used and practised.’

He also adds an interesting rider to this: ‘Illnesses which occur by reason of physical causes should be treated by doctors with medical remedies; those which are due to spiritual causes disappear through spiritual means. Thus an illness caused by affliction, fear, nervous impressions, will be healed more effectively by spiritual rather than by physical treatment. Hence, both kinds of treatment should be followed; they are not contradictory.’[5]

This is not to say that spiritual means in some way trump material means. Shoghi Effendi wrote: ‘Healing through purely spiritual forces is undoubtedly as inadequate as that which materialist physicians and thinkers vainly seek to obtain by resorting entirely to mechanical devices and methods. The best result can be obtained by combining the two processes: spiritual and physical.’[6]

This sense of the complementary nature of the relationship between spiritual and material means is increasingly being endorsed by evidence such as that adduced in Goleman and Davidson’s excellent book on meditation where they explain that what matters most is our relationship to the pain we suffer from. Our experience, as the authors put it (page 148), is not based on the direct ‘apperception of what is happening, but to a great extent upon our expectations and projections.’ They add, ‘consciousness operates as an integrator, gluing together a vast amount of elementary mental processes, most of which we are oblivious to.’

In follow up studies they state (page 167) ‘no research so far has found that meditation produces clinical improvement in chronic pain by removing the biological cause of the pain – the relief comes in how people relate to that pain.’ And at the neurological level, the more you meditate, the lower are the levels of activation in the reactive areas of the brain. So, they are clear we don’t cure the pain by meditation: we maximize the efficacy of the way we deal with it and thus enhance our quality of life.

The value of human contact and support is endorsed by ‘Abdu’l-Bahá: ‘We should all visit the sick. When they are in sorrow and suffering, it is a real help and benefit to have a friend come. Happiness is a great healer to those who are ill. . . .You must always have this thought of love and affection when you visit the ailing and afflicted.[7]

It may even be legitimate at times to exploit the placebo effect: ‘…if a doctor consoles a sick man by saying, “Thank God you are better, and there is hope of your recovery,” though these words are contrary to the truth, yet they may become the consolation of the patient and the turning point of the illness. This is not blameworthy.’[8]

These points also strongly suggest that what we believe has an important role in recovery from illness, and, just as negative thoughts and feelings can impair our health, positive ones can enhance it.

The wealth of modern evidence pointing towards the power of the placebo reinforces this even when physical problems are involved. The nocebo effect, where our negativity undermines the benefits of interventions, points in the same direction in terms of the impact of our minds upon our bodies. It is also becoming increasingly recognised that the value of the medical approach can be augmented by adding psychological approaches into the mix, in terms, for example, of recovery from surgery.

Caveats

There are in addition some interesting and important caveats against blindly following medical advice.

First of all, Shoghi Effendi advises: ‘Before having any serious operation, you should consult more than one qualified physician.’[9]

Secondly, we should not become unnecessarily dependent upon medication: ‘Do not neglect medical treatment when it is necessary, but leave it off when health has been restored…. Treat disease through diet, by preference, refraining from the use of drugs; and if you find what is required in a single herb, do not resort to a compounded medicament. Abstain from drugs when the health is good, but administer them when necessary.[10]

This warning seems to apply to such situations as the abuse of antibiotics and the habituation and addiction to painkillers that escalates the dosage to dangerous levels over time.

Relevant aspects of diet include sugar, which ‘Abdu’l-Bahá consistently warns us is not good in excess, and possibly meat. ‘Abdu’l-Bahá goes as far as questioning its long-term value: ‘What will be the food of the future?’ he asks. ‘Fruit and grains,’ is his answer. ‘The time will come when meat will no longer be eaten. Medical science is only in its infancy, yet it has shown that our natural diet is that which grows out of the ground. The people will gradually develop up to the condition of this natural food.[11]

I must confess to a bias here. I am a vegetarian and have been for just over forty years. I must not though give the impression that the Faith prohibits the eating of meat. It does not. However, Shoghi Effendi states: ‘It is certain, however, that if man can live on a purely vegetarian diet and thus avoid killing animals, it would be much preferable. This is, however, a very controversial question and the Bahá’ís are free to express their views on it.’[12]

Next time I’ll be picking up on the importance of diet and exploring what else is said in the Bahá’í Writings about what we can do to improve our health.

Footnotes:

[1] From a Tablet – translated from the Persian.
[2] From a letter written on behalf of Shoghi Effendi, 13 December 1945 to an individual believer.
[3] From a letter written on behalf of Shoghi Effendi, 6 September 1946 to an individual believer.
[4] 
In a letter written on behalf of Shoghi Effendi, 26 June 1956 to the National Spiritual Assembly of Canada.
[5] Selections from the Writings of ‘Abdu’l-Bahá, Sec 133, pages 151-52.
[6] (In a letter written on behalf of Shoghi Effendi, 12 March 1934 to an individual believer)
[7] 
(The Promulgation of Universal Peace: Talks Delivered by ‘Abdu’l-Bahá during His Visit to the United States and Canada in 1912 2nd. ed. – Wilmette: Bahá’í Publishing Trust, 1982 – page 204).
[8] 
(‘Abdu’l-Bahá, “Some Answered Questions”, 1st pocket-sized ed. Wilmette: Bahá’í Publishing Trust, 1984), pp. 215-16)
[9] 
(In a letter written on behalf of Shoghi Effendi, 8 April 1954 to an individual believer)
[10] 
(Bahá’u’lláh, cited in J. E. Esslemont, “Bahá’u’lláh and the New Era”, 5th rev. ed. (Wilmette: Bahá’í Publishing Trust, 1987), p. 106)
[11] (‘Abdu’l-Bahá, cited in Julia M. Grundy. Ten Days in the Light of ‘Akka, rev. ed. – Wilmette: Bahá’í Publishing Trust – 1979, pages 8-9)
[12] 
(In a letter written on behalf of Shoghi Effendi, 9 July 1931 to an individual believer)

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At the end of October  published an excellent article in the Guardian which further reinforces the scepticism about psychiatric diagnosis that I have explored earlier on this blog. She succinctly makes what is a key point for me:

. . . the DSM [Diagnostic and Statistical Manual] only focuses on . . . “symptoms” and does not take into account the individual’s context. This in itself is a value judgment.

Below is a short extract. For the full post see link.

Psychiatric diagnosis must serve an ethical purpose: relieving certain forms of suffering and disease. Science alone can’t do that.

How do we decide what emotions, thoughts and behaviours are normal, abnormal or pathological?

This is essentially what a select group of psychiatrists decide each time they revise the Diagnostic and Statistical Manual of Mental Disorders (DSM), considered a “bible” for mental health professionals worldwide.

The DSM was first published by the American Psychiatric Association in 1952 to create a common language and standard criteria for the way we classify mental disorders. It’s now used around the world by clinicians, researchers, insurance and pharmaceutical companies, the legal system, health regulators and policy makers, to name a few.

Now in its fifth edition, revisions have gradually expanded the number of mental disorders, while also removing some as understanding or values change. Over the years many of these amendments have courted controversy.

These days, criticisms of the DSM are that it medicalises normal behaviour such as fidgetiness, noisiness and shyness.

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A DWP disability assessment questionnaire. Photograph: Alamy

In yesterday’s Guardian there was yet more evidence of the distressing and shameful  failure of our benefits system to understand the very real needs of those coping with mental health problems. Adam Jacques, the disabled husband of a claimant, writes movingly of his experience of his wife’s acute distress at being refused access to the personal independence payment system:

There’s nothing quite like witnessing your wife tumble through a gaping chasm, to see that there’s something rotten at the heart of a welfare assessment system. From what we experienced, the wrong people are doing the wrong assessments with the wrong tools, using incorrect assumptions. And it left me reeling: how could this happen to my wife? I discovered that her experience is just the calamitous tip of a PIP-denying iceberg.

Below is a short extract: for the full post see link.

My wife tried to kill herself in March. She took an overdose – while I was watching TV in the next room. Cue, in short succession: 30 minutes of heart-stopping panic, a nerve-jangling ambulance trip to A&E, an admission to a secure mental health unit, and a longer stay recovering in a crisis house.

Acute episodes such as this can be a recurring reality for someone with a longstanding mental health condition. From her battles with depression and struggles to get out of bed in the mornings, to anxiety so overpowering that a trip on a bus triggers a blind panic, for my wife (let’s call her Bea) life is a titanic battle to stay afloat. She experiences overwhelming feelings of worthlessness, guilt and impulsive urges to self-harm that can flood her mind and distort her thinking. Socialising with friends is hard, while work in the past year has been out of the question. But she’s also incredibly smart, funny, kind and brave.

Mental health is complex, but something simple triggered Bea’s overdose: a devastating letter from a “decision-maker” at the Department for Work and Pensions (DWP), informing her that her claim for personal independence payment, a disability benefit, had been unsuccessful. She’s not the first, and won’t be the last, to experience the dismissive treatment that people with severe mental health conditions can undergo when accessing the benefits system. And PIP, as the benefit is called, is one of the worst offenders.

PIP is supposed to offset some of the extra costs of a disability. Applicants are evaluated by health workers from the private firms Atos or Capita, who forward their assessments to a DWP decision-maker – who scores you on “daily living” and “mobility” (you need at least eight points for each to qualify). Currently nearly 3 million people claim some element of PIP, and my wife expected to be one of them. As did her benefits adviser, an NHS psychiatrist and a psychologist. So, armed with a dossier of supporting medical documentation, Bea applied. That was last November. I’ve seen glaciers move faster. . .

I discovered that her experience is just the calamitous tip of a PIP-denying iceberg. While the DWP claims it doesn’t operate quotas to save money, figures released in April, covering just six months of 2016, showed an enormous expansion in claimants receiving zero points, up to 83,000. That’s only 10,000 fewer than in the previous 12 months.

This raises huge concerns about the assessment process – especially given that, when rejected by the DWP, 65% of applicants who appeal to a tribunal get the ruling reversed. A panel of welfare experts told the work and pensions select committee earlier this year that the whole process was “inherently flawed”, with medical evidence often ignored by officials during the initial assessment.

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