© Howard W. Whitaker, 1995. No other use without permission.
The healing of persons was the province of pastoral care long before the development of mental health services. The art of spiritual direction and discernment--many times with rituals of empowerment, inclusion, wholeness and healing--are recorded in the earliest records of most faith traditions.
Over the last century, practitioners of more clinical disciplines--psychiatry, psychology and social work--have risen to claim jurisdiction over matters of the mind. Increasingly, these disciplines are conceding that while they have much to offer, perhaps they have overreached. In 1994, the American Psychiatric Association elevated "religious and spiritual concerns" to a condition that could be addressed on Axis I under the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV). Other disciplines are requiring careful separation of faith issues from traditional value neutral therapies, while at the same time requiring that these issues be addressed as part of a client’s psycho-social history.
Mental health has both a clinical and a spiritual language. Increasingly, the language of psychology and psychiatry is the language of the insured middle class and the approved professionals who are providers. The language of the uninsured, unwelcome and chronic--especially the not easily categorized or cheaply treated--continues to be the language of faith and spirit. In an age of managed care, institutions of faith are frequently becoming the first line of comfort and advocacy for those who struggle with mental health.
Mental health has both clinical and spiritual dimensions as well. The line between psychosis and religious experience has always been permeable. Persons can hear voices, have physically manifest emotional symptoms, be subject to compulsions, see visions and experience ecstasy, out of body experiences or dissociation. Cultural milieu has determined whether these persons are interpreted as saintly or simply insane. It is well within the realm of possibility that our most revered mystics have been both.
Much ink has been spilled trying to separate religious practice from the presumably purer notions of the spirit. Many efforts to emancipate spirituality have developed their own forms, philosophies, rituals and directions which often look suspiciously like religious practice. (Have you ever tried to do something in the wrong order at a 12-step meeting?). These are noble attempts.
However, rather than pursue the ever popular, increasing vague term spirituality, many pastoral clinicians now follow the convention of speaking of Faith. Faith has far more developmental, primal, limbic roots that are nurtured or arrested in the course of our lives. Faith in this context is the product of the life process through which we make moral and existential meaning. It is from this meaning making process that we find hope. Hope, along with faith and love, are valuable, sacred commodities in the lives of those who struggle to preserve mental health.
The ideas we carry about love, marriage, family and child-rearing we learned in our family of origin. In the same way we "inherit" our understandings about God image, good and evil, right and wrong, sexuality, forgiveness, grace, power, truth and purposeful life. We may cherish these ideas, or we may know that they are not healthy for us. We may even think we reject their presence in our lives by studied non-practice.
An inventory and exploration of one’s faith heritage is almost always an invitation to spiritual growth. Like going through a closet during spring cleaning, we find some notions we have outgrown. There may be things that we thought we liked, but in reality never use. There are some things in which we are very comfortable. There are other things that may make us feel silly. There may be things that never belonged to us in the first place. Some things need to be kept, some altered and cleaned, and some--perhaps with fanfare and mourning--thrown away.
The gathering and interpretation of religious history is increasing being seen as a valuable adjunct to psychotherapy and mental health.
Persons trying to heal the wounds of trauma and abuse are often caught in a double bind when it comes to addressing faith issues. Abused persons typically come from religious backgrounds and their abusers frequently view themselves as "religious." Many studies show positive correlation between conservative religious practice and perpetrators of domestic abuse. Many survivors end up as adults in faith practices that replay the old abusive dynamics.
Yet, survivors sense there is a reason they have survived. Many seem to intuit a spiritual presence that transcends the religion of their childhood. Questions about judgment, contamination, guilt, forgiveness, anger, power and truth-telling are basically spiritual issues. These and the all pervasive question of "Why was this allowed to happen to me?" remains embedded in the therapeutic struggle of survivors of abuse.
Pastoral consultation as an adjunct to ongoing therapy has proven to be vital by offering a way to explore faith issues without undermining the clinical neutrality of the psychotherapy. Ego strength is supported by helping persons reconstruct a faith perspective that will uphold and celebrate their basic sacredness, dignity and worth. Every human being deserves an approach to the holy they can literally live with.
Issues of hopelessness, suicide, self-worth, cyclical life, stability in relationships, accountability and stewardship of resources are issues faced by all who wrestle with mood swings. The link between manic-depressive illness and creativity is often romanticized in literature classes. In real life, artistic temperament and "twisted brilliance" can take a terrible toll on one’s faith. A mood disorder is a fatal illness if left untreated and the host left unsupported.
Yet these are the prophets, artists, and visionaries who live at the edge of the abyss and report back to us what they experience. Often literally holding their lives in their hands, frequently participants in near death experience, they live closer to sacred mystery than most of us would ever wish. Most only ask the support of a non-anxious, holy companion along the way. This is a pastoral task.
Spiritual direction is the practice of welcoming the stranger and, together in concert, doing sacred listening. It has been described in antiquity as mid-wifery of the soul, that role that helps give birth to the part of us that is more than our body, that enables us to love, create, achieve intimacy and know the eternal.
There can be a coaching role to spiritual direction. There are very traditional resources of faith such as mantras, psalter, biblical passages, guided imagery, meditations and other elements that can be used to provide anxiety relief, ego strengthening, emotional articulation, affective identification, an awareness of holy presence and spiritual growth. There are ancient ways to use prayer as meditation and imaginative tools like journaling as prayer. Most are easily learned in good, mutually respectful relationship with a spiritual guide.
It should be assumed in spiritual direction that the client wishes to explore new understandings. It should also be assumed that the guide will be knowledgeable about and respect any parameters of religion set by the client. Spiritual direction is not the place for proselytizing, dogmatics or judgmentalism.
Although the word asylum has come to mean something very different in mental health, 19th century European reformers had in mind the cities of refuge set aside for those pursued by fear, hatred and despair. The idea is an old one preserved in both eastern and western religious writings and moral codes.
The world is not always a safe place. We all need a little asylum now and then. Many people from different traditions have found such asylum in pastoral care. Even people who are active in faith communities often prefer to have spiritual directors who are apart from that experience.
Persons looking for pastoral care and spiritual guidance are consumers of services and have the right to seek and expect an atmosphere of comfort, acceptance, respect and professional accountability. Several organizations certify pastoral counselors, chaplains and mental health clergy. Consumers should feel encouraged to inquire about certification, training and professional orientation to practice.
© Howard W. Whitaker, 1995. No other use without permission.