Mental Health and Spirituality in Later Life

Elizabeth MacKinlay

• Publisher: Routledge
• Year: 2014
• ISBN:
  9781317787518
• Edition: 1
• Topic: Psicologia
• Subtopic: Salute mentale in psicologia

Explore pastoral strategies for dealing with mental health problems! Mental health is increasingly being recognized as an important issue in later life. This valuable book will help you examine this dimension of aging in the context of pastoral, spiritual, and cultural issues. It explores the relationship between mental health, spirituality, and religion in later life, including the search for meaning, cultural issues, spiritual issues, depression, dementia, and issues of suicide in older people. The first part of Mental Health and Spirituality in Later Life focuses on theology, ethics, and cultural issues in mental health and aging. The second part addresses issues of multidisciplinary practice, including a challenging chapter written by a woman with early onset dementia (Alzheimer's) and other chapters that present perspectives on the uses and meanings of ritual and symbolism in mental health and pastoral approaches to care. Part one of Mental Health and Spirituality in Later Life deals with issues of theology, culture, and mental health in later life, focusing on:

• the importance of a richly textured understanding of personhood as a prerequisite for constructing a picture of late-life mental health in the context of theology
• the relationship between culture, spirituality, and meaning for older immigrantsand their effects on mental health
• the adverse effects of a mental health system that reflects only the dominant culture of a society, leaving minority cultures vulnerable to misdiagnosis and inappropriate treatments that can do more harm than good
• a wholistic picture of aging that moves beyond the biomedical paradigm and demonstrates the power and potential of the human spirit in adjusting to and moving beyond suffering

Part two of this valuable book addresses issues of concern to practitioners in mental health and spirituality for the aging, including:

• disruptive behavior among nursing home residents and common practices that fail to identify its causes or address the problem
• how some staff/resident interactions can produce suffering for all concernedwith case study outlines that illustrate the point
• memory loss and its effect on spirituality, self-worth, and the faith community
• pastoral care for people suffering with dementiawith practical information on helping them to make use of the power of prayer and to deal with loneliness, fear, and disempowerment
• an insightful look at a recent major study of residents in aged care facilities in Australia that explores the link between depression and spirituality
• risk and protective factors associated with suicide in later life and the treatment of depression
• pastoral interventions for depression and dementia

Part 1: Theology, Culture and Mental Health in Later Life

Theological Perspectives on Ageing and Mental Health

Laurence J. McNamara, PhD

SUMMARY. “Theological Perspectives on Ageing and Mental Health” begins by setting the scene for discussion of the topic. An exploration of the variety of meanings attributed to mental health, ageing, spirituality and religion provide a framework for what follows. The paper argues that a richly textured understanding of human personhood is a prerequisite for any analysis of ageing and mental health. A brief historical and theological sketch is provided in support of this contention. From the foundation of the human person four characteristics of mental health or well-being, especially among the aged, are developed. [Article copies available for a fee from The Haworth Document Delivery Service: 1-800-HAWORTH. E-mail address: <[email protected]> Website: <http://www.HaworthPress.com> © 2002 by The Haworth Press, Inc. All rights reserved.]

KEYWORDS. Ageing, mental health, spirituality, person

Introduction

This presentation will proceed in three parts. In the first part, the meanings of mental health, ageing, spirituality and religion will be sketched so as to provide a sufficiently detailed context for the considerations that follow. The central section of the essay constructs a theology of the human person that is essential for the exploration of mental health and ageing that occupies the final part of the work.

I. Setting the Scene

Mental Health

What is mental health? What does it mean to be mentally healthy? As with physical health everyday thinking goes first to the opposite of health, namely, what is non-health. Explanations of non-health focus on objective realities (disease), on subjective states (illness) or socially recognised conditions (sickness). In this context, mental health is located within a continuum of mental functioning from illnesses such as depression or anxiety at one extreme, through normal or ordinary psychological health, to adaptive and robust mental health such as that found in successful aging (Koenig 1994, xxvi-xxvii). In fact it is difficult to define mental health in a clear and universally applicable way. Mental health is not synonymous with happiness, productivity, or intimacy, though it includes the capacity for all of these. While serious mental illnesses show significant similarities in different cultures, the definition of healthy beliefs, attitudes, and lifestyles shows great variability. Even within our own pluralist, secular culture there are substantial disagreements about the nature of the good and healthy life (Sullivan 1995, 1724).

Mental health is a term with complex clinical, social and ethical dimensions. If used conservatively the term denotes certain basic, adaptive, psychological and behavioural competencies that human beings require in order to function with reasonable effectiveness. Among these are the three primary functions of cognition, affectivity, and social bonding.¹ For a person to attain a satisfactory level of mental health sufficient neurological and general biological functioning is required in conjunction with a minimally adequate relational environment during the critical developmental years of an individual’s growth (Sider 1986, 379).

Bearing in mind the complexities associated with the notion of mental health this paper will view mental health more generally either in negative terms as the absence of mental illness (neuroses and psychoses) or positively as the presence of features said to be characteristic of mental health. It is the aim of this paper to sketch a number of the important features that contribute to mental health (Loewenthal 1995, 7-8).

Ageing

The experience of ageing in the developed countries of the West occurs in societies permeated with a fear of death. Social attitudes view ageing as a period of non-productivity. The priority given to all things technical considers ageing as a pathology, the incurable disease of living. Growth and development, the dominant paradigm of life in the modern world, are portrayed primarily in terms of an increasing independence. In this world, ageing is viewed as decline and a downward spiral into dependency. In reality, however, growth and development occur in an expanding system of obligations and dependencies. From this perspective ageing is but one of many stages in life in which everyone moves through one system of dependency to another (Thomasma 1981, 74-75).

At its core, ageing is fundamentally a mystery rather than a problem. If we fail to appreciate that ageing shares the dimension of mystery with life as a whole our inquiries into the meaning of ageing take unsatisfactory directions. This is well illustrated by a frequently quoted story about T.S. Eliot. At the close of a lecture on a serious ethical issue of the day an undergraduate rose to ask, “Mr. Eliot, what are we going to do about the problem you have discussed?” Eliot replied, “You have asked the wrong question in asking, ‘What are we going to do about it?’ Rather a different question should be asked, ‘How does one behave towards it?’” The question posed by the student requires a technical or pragmatic response. Eliot’s point of view, however, brings a deeper range of challenges to the fore, perennial issues which no particular policy, strategy or behaviour will dissolve (May 1986, 49).

Contemporary Anglo-American culture “appears to lack symbols of transcendence and rituals that would give meaning to the experience of growing old” (Kimble 1990). As a result the challenges of ageing have been reduced to a set of medical problems. From this perspective old age has become a pathological state and an avoidable affliction. Positive images and meanings of growing and being old are eroded. Too often ageing is portrayed either explicitly or implicitly in terms of what society can and should do for the elderly. There is an assumption here that the elderly have nothing to say or contribute to society at large (Curran 1982, 95-96). This crisis of meaning challenges ageing persons to accept the reality of their ageing, to appropriate it as a particular stage of life, to give it meaning and to integrate it into their sense of themselves as persons (Curran 1982, 105). Achieving these tasks ensures successful ageing.

Spirituality

Loss of soul and the need to recover an awareness of the sacred has increasing currency in developed nations today (Downey 1997, 6). The yearning for spirituality has a number of characteristics. Frequently a distinction is drawn between spirituality and religion. New Age concerns abound. Increasing interest in the thinking and guidance of religions and philosophies from the East coexists with aboriginal spiritual traditions that emphasise the sacredness of the earth or place. In all forms of current spiritual inquiry there is present an increased appreciation of the importance of psychological insights for the spiritual quest. This has resulted in a range of self-help movements and the emergence of gender related spiritualities. A quick trip to the local bookstore gives some idea of the range of spiritual concerns manifest in society today.

Whatever its form, contemporary spirituality attests to a widely spread awareness that there are levels of reality not immediately apparent, that there is more than meets the eye and that many of our citizens yearn for personal integration in the face of forces which seem to fragment and depersonalise contemporary living (Downey 1997, 4). Spirituality, therefore, points to the depth dimension of all human existence. In its widest sense it refers to “the experience of consciously striving to integrate one’s life in terms not of isolation and self-absorption but of self-transcendence toward the ultimate value one perceives” (Sandra Schneiders, quoted by Downey 1997, 15). The word “spirituality,” drawing as it does on the Hebrew ruach, refers to what animates the life of believers and urges them on to deepen and perfect what has at present only been begun (McGrath 1999, 2). At its core, Christian spirituality focuses on the living out of the individual’s encounter with Jesus Christ (McBrien 1994, 1058).²

Religion and Mental Health

During the nineteenth century, science increasingly assumed a preeminent role and in doing so displaced religion from its long held position of primacy. A person’s religion came to be seen less as a matter of adherence to the truth and more as a matter of subjective personal choice (Larson et al. 1995, 1704). In fact, for thinkers such as Freud, religion was symptomatic of a deeper illness. More recently, however, the relation between religion and mental health has been subject to a wide variety of interpretations. Some would argue that religion permits or even fosters mental illness particularly in the way it encourages guilt. For others religion is judged to control or even suppress mental illness since it fosters happiness in the individual. Another view emphasises the way religion protects the individual from stress or its effects while at the same time it contributes to self-esteem. Finally, religion is understood as exercising a therapeutic role in that it provides support and encouragement in the struggles of life (Loewenthal 1995, 2).

Considerable evidence has been gathered to show that religion contributes positively to both the mental and physical health of the individual (Larson et al. 1995, 1705f). In spite of this convincing evidence the professional psychiatric community has largely ignored these findings by continuing to view religion in a negative light or even as a pathological condition (Larson et al. 1995, 1706-1707).

Concluding Comments

The preceding sections attest to the wide range of understandings attributed to mental health, ageing, religion and spirituality. Mental health encompasses a wide range of conditions from clinical pathologies (psychoses and neuroses) at one extreme to ordinary, robust adaptive mental health at the other. So, too, with ageing which functions between the extremes of chronic and enfeebled ill health on the one hand and a lifestyle and state of health characterised as active and successful ageing on the other. The preoccupations of contemporary spirituality exist along a continuum. One extreme attests to the fractured human spirit obsessed with interior concerns. At the other extreme stands the integrated, outwardly directed individual who is wise in the ways of God and human existence.

II. The Human Person: A Central Concept

Historical Perspectives

It is the argument of this paper that a theological understanding of mental health and ageing requires a richly textured concept of the human person. Such an understanding provides the basis and context for evaluating issues of mental health in the lives of ageing persons. In elaborating this understanding attention must be given to the historical and theological factors influencing a Christian understanding of the human person.

For the ancients an undifferentiated view of the human person dominated their thinking. Life, health and illness applied equally to the individual human being as to society, animals and the universe. Magico-religious and moral codes provided interpretations for any physical or psychic states that diverged from the norm (Wallace 1995, 698). The body-psyche dualism that originated with Plato has exercised a significant and enduring influence down through the centuries. For Plato, the philosopher’s role was to be physician of the soul for those with disturbances of mind or body. Later, Aristotle was to emphasise the role that community play in proper human functioning. Medical practice in the Graeco-Roman world attended to both bodily states and the prayers and healing rites that contributed to human well-being.

Early Christianity incorporated prevailing Greek and Roman explanations of body, spirit and health. Influenced by Platonic dualism mental illness came to be viewed as a physical state. The immortal and immaterial soul is not subject to disease unlike the body and the brain. By the thirteenth century, Aquinas was to postulate that loss of free will accompanied the irrational thinking and behaviour of the mentally ill. In our own day bio-psycho-socially oriented approaches to mental health and illness give priority to the complex of interrelated spiritual, moral, medical/psychiatric and social factors (Wallace 1995, 1703). The various understandings of the human person throughout the history of the West have emphasised one or other elements in the mind-body, individual-social dichotomies.

In the context of this brief historical sketch, it is imperative that we be clear as to which view of the “person” dominates our thinking today on questions of mental health/illness and human ageing. Five criteria of human personhood are frequently highlighted in the literature: consciousness, rationality, agency, morality, and the capacity to form and hold relationships (Kitwood 1997, 9). This closely parallels recent bioethical notions of the person which emphasise in the functioning human the capacity for self-reflection, for entering into interpersonal relations and the capacity for autonomy and the exercise of choice. Functional approaches to personhood give a central role to moral agency in any consideration of the moral status of persons. A somewhat different emphasis is proposed by the philosopher Stephen Post when he argues that our understanding of what it means to be a person should be more strongly linked to feeling, emotion and the ability to live in relationship. This is particularly important for persons overwhelmed by dementia or Alzheimer’s disease. Post further argues that the fundamental moral commitment of “a good society is to protect all human beings, based not on their varied and unreliable capacities but on a radical human equality” (Post 1995, 16). Dementia in all its forms, I suggest, radically challenges contemporary understandings of the human person.

The Human Person As an Enspirited Body

From the Christian perspective, the life of each individual human being is a fundamental good underlying all other values. It is the gift of a creator God. Human reflection has struggled to maintain an integrated view of the living human person, one that views individual as uniquely body and spirit. Plato’s dualistic notions have strongly influenced both philosophical and theological thinking. Through the centuries an over-emphasis on human embodiment in relation to the spirit/soul or vice versa have undermined a sound notion of human personhood.

A unified view of the human person that appreciates human wellbeing in terms of homeostasis or equilibrium must necessarily attend to the physical and psychic/spiritual dimensions of the individual. Our human physical state (our embodiment) is the “stuff” or medium of our human activity. At the same time it is the conduit for God’s work in and through us. In theological terms the human person is rightly the icon of God. Catholic theology considers our embodied state as having a sacramental character since it is a necessary medium for God’s work in our world. In an ageing community the role of touch (at a time when bodily boundaries are increasingly problematic and hedged around with danger) and the physical care of ageing persons in imitation of the Good Samaritan witness to the sacramental dimension...

Table of contents

• Cover Page
• Half Title Page
• Title Page
• Copyright Page
• About The Editor
• Contents
• Foreword
• Preface
• part 1 Theology, Culture and Mental Health in Later Life
• part 2 The Possibilities for Mental Health and Spirituality in Later Life: Implications for Practice
• Index