wholeness not perfection: an interfaith framework for mental health

7/29/2019 Wholeness Not Perfection: An Interfaith Framework For Mental Health.

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Wholeness

An Interfaith Framework forMental Health

Texas Interfaith Center for Public PolicyJanuary 2013

Not

Perfection


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Wholeness, Not Perfection 2 Texas Interfaith Center for Public Policy

Mentaldisordershavebeenrecordedthroughouthumanhistory.Oneoftheworldsearliestmedicaldocuments,theEbersPapyrus(Egypt,circa1550B.C.E.)describesobservedbehaviorsandsymptomssimilartomoderndaydepressionordementia.Overthemillennia,peoplehavecraftedvarioustreatmentsformentalhealthconditionsfromdrillingholesinpatientsheads,tocastingoutevilspirits,totalktherapy.Whileknowledgeaboutmentalhealthandtreatmentmethodsfordisordershasexpandedsignicantly,thestigmasurroundingthemremains. Faithcommunitiesweresomeoftherstgroupstoprovidesystematiccaretothosewithmentaldisorders,andtheyarestillinvolvedwithmentalhealthcaretoday.Clergyareoftentherstsourceofhelpsoughtbysomeonewithamentalhealthdisorder.Assuch,religiouscommunitieshaveanimportantanduniqueroletoplayinmentalhealthcare. Inthispublication,weexplorethecalltoreligiouscommunitiestocarefortheneedsofindividualsandfamiliesaffectedbymentalillness,

takealookatthecurrentstateofmentalhealthcare,andofferideasaboutwhatyouandyourcongregationcandotohelp.Wehopetoinspireyoutoreectonwhatitmeanstobehealthyandwhole,andtoencourageyoutoexaminewhypeoplewithmentaldisordersoftenfeelunwelcomeinourcommunities.

Created in Relationship

It is not good that man should be alone; I will make him ahelper as his partner. Genesis 2:18

AccordingtotheHebrewScriptures,allpeoplewerecreatedbtzelemElohim,intheimageandlikenessofGod,andarethereforeworthyofdignityandrespect.CatholicsocialteachingsafrmthatpeoplewithmentalillnessalwaysbearGodsimageandlikeness;Godsimageisneither

Know all human beings to be repositories of Divine Light; Do not to inquire

about their caste; In the hereafter there are no castes.

Sikhism, Abi Grnth, Asa, M.1, p. 349

Let us bless the Source o lie in its infnite variety that creates all o us whole, none o us perect.

Judith Glass, Aterbirth


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An Interfaith Framework for Mental Health 3 January 2013

conditionalnorcircumstantial. TheQuransaysthatallpeoplewerecreatedfromthesamemotherandfatherandbelongtoonehumanfamily.BuddhistsandHindusalsoviewtheentireuniverseascomprisingonesinglefamily.Thissharedlineageconfersdignity

andrelationshipuponallhumanbeings. ThebookofGenesisdescribestherstpersonasbeingcreatedfromdustandbecomingalivingbeinguponreceivingthebreathoflifefromGod(2:7).ThenGodlooksathimandsays:Itisnotgoodthatthepersonshouldbealone;Iwill

Illness and CultureTheformthatillnesstakescanvarybetweenculturesorhistoricperiods.Culturecanbeillustratedasthebehaviorsandbeliefscharacteristicofaparticularsocial,ethnic,oragegroup.

Forexample,thereisanillness,amok,particulartoSoutheastAsiawhereamanhasanepisodeofmurderousragefollowedbyamnesiaandanillnesscalledzarintheMiddleEastexpressedindissociativeepisodesoflaughing,shouting,andsinging.InEuropeduringthelate1800s,doctorsdocumentedanillnesscharacterizedbymenwalkingforhundredsofmilesinastateofamnesia.Theseillnesseswererecognizedonlybytheirparticularcultureortimeperiod. Certainconstellationsofsymptoms

maybesharedbetweencultures,butmanifestthemselvesindierentways.TheWorldHealthOrganizationestimatesthat121millionpeopleworldwidehavedepressionandlistitasoneoftheleadingcausesofdisability.Symptomsofdepressiontypicallyincludesadness,hopelessness,andlackofenergy.InAsiancultures,however,depressionisoftenexpressedasaphysicalacheorpainthathasnoidentiablesource. TheWorldHealthOrganizationestimatesthat24millionpeopleworldwide

haveschizophrenia.Commonsymptomsincludeauditory,visualorsomatichallucinations,

delusions,atemotionality,andsignicantimpairmentsincognitivefunctioning Interestingly,thetypeofhallucinationandthecontentsofdelusionsthatindividualsreportseemtoberelatedtotheirculture.xxiForinstance,inJapan,acountrythatprizeshonorandsocialconformity,delusionsoftenrevolve

aroundslanderorthefearofbeinghumiliatedpublicly.InNigeria,wherementalillnessisbelievedtobecausedbyevilspirits,delusionsmaytaketheformofwitchesorancestralghosts. Sometimes,symptomstypicallyassociatedwithmentalillnessareinsteadassociatedwithreligiousexperience.PeoplefromvariousreligiousbackgroundsreporthearingthevoiceofGod,seeingvisions,andfeelingtouchedbysomeoneorsomethingtheycannotsee.Whilealloftheseexperiencesqualifyashallucinations,theyarenottypicallyinterpretedasevidence

ofillnessunlessaccompaniedbyseriousimpairmentstofunctioning. Cultureaectsnotonlythewaypeoplemanifestsymptomsofmentalillnessandwhattheyconsidertobeillness,butalsoaectstheirstyleofcoping,theirsupportsystem,[and]theirwillingnesstoseektreatment.ResearchhasshownthatAfricanAmericansareoftenreluctanttoseektreatmentformentalillnessforthemselvesorfamilymembers.Reasonsgivenincludeahistoryofoppressionandmistrustofthoseinpower,heightenedstigmaaboutmental

illnesswithinthecommunity,andalackofAfricanAmericanmentalhealthproviders.

Imagination, narrative, and other human meaning making activities have

an inescapable role in constructing the experience of someone who is ill.

--David B. Morris, Illness and Culture in the Postmodern Age

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alone.HumankindwascreatedinrelationshipwithGod,withthewholeofcreation,andwithotherpeople. TheshapethatGodsrelationshiptakeswithhumansintheHebrewScripturesisoneofcovenant.Intherstcovenant,Godinstructshumanstobefruitfulandmultiply,aboundonthe

Some philosophers and psychiatrists have suggested that we are investingour great wealth in researching and treating mental illness, medicalizing ever

larger swaths of human experience, because we have rather suddenly lost older

belief systems that once gave meaning and context to mental suffering.

--Ethan Watters, The Americanization of Mental Illness

Symptoms,thenareinrealitynothingbutthecryfromsufferingorgans.--JeanMartinCharcot,translatedfromFrench

The Medical Model

TheUnitedStatesandmuchoftheWesternworldembracesanunderstandingofmentalhealthbasedonthemedicalmodel.Underthemedicalmodel,adiseaseordisordercanbedenedasadeviationfromnormalbodyfunctionsthatcreatesnegativeconsequencesinanindividual.Ingeneral,themedicalmodelconsidersdiseaseasbeingwithintheconnesoftheindividualsbody,anddoesnothighlighttheinuenceofexternalforcesorconditions.Symptomsofdisease,suchasabnormal

behavior,pointtoanunderlyingphysicalabnormality.Mentalillnessesareviewedasdisordersofthebrainthathavephysiological,biochemical,orgeneticroots. AclassicationsystemhasbeendevelopedformentalhealthdisorderscalledtheDiagnosticandStatisticalManualofMentalDisorders(DSM).Amentaldisorder,asdenedintheDSMIV,doesnotrequireapurelyphysicalcause,butisconsideredamanifestationofabehavioral,psychological,orbiologicaldysfunctionintheindividual.xxvThisdenitionencompassesthemedicalmodelbutincorporatesothertheoriesonabnormalbehavior. Adiagnosabledisorderisconsideredseverewhenitresultsinseriousfunctionalimpairmentthatsubstantiallyinterfereswithanindividualsabilitytofunctioninhisorhercommunity,family,workplace,andothersocialsettings.xxviiDisordersthattendtobesevereandchronicincludeschizophrenia,bipolardisorder,majordepressivedisorder,panicdisorder,obsessive-compulsivedisorder,andpost-traumaticstressdisorder.Eachoftheseillnessesaltersapersonsthoughts,feelings,

and/orbehaviorsindistinctways.xxviiiIncontrast,somementaldisordersareacuteandtemporary,suchasanxietyormilddepression,oftenbroughtaboutbyintensestressinanindividualslife. Underthecurrentmedicalmodel,healthislargelyconsideredtheabsenceofdisease,andattaininghealthisfocusedoncuringdisease.Theprimarytreatmentmethodformentaldisordersismedication,whichtargetstheunderlyingneurologicalandbiochemicalcauses.Aftermedication,ifapersonssymptomsdonotsubsideorifthesymptomsintensify,themedicalmodeloerslittlehopeforareturntohealth. Today,mentalhealthprofessionalsincludingpsychiatrists,psychologists,andsocialworkersprovidetreatmentthatexpandsbeyondwhatthemedicalmodelcanoer.Someprovidersalsoincorporatespiritualityandreligionintotheirtreatment.Infact,theAmericanPsychologicalAssociationrequiresthattrainingprogramsincludeeducationinspiritualandreligiousconcepts.

makehimahelperashispartner,soGodcreatesanimalsandthentherstwoman(2:18).ThiscreationstoryillustratestwofundamentalreligiousbeliefssharedbytheAbrahamicfaithtraditionsofJudaism,Christianity,andIslam:one,thathumanlifeoriginatesfromandissustainedbyGod,andtwo,thatitisnotgoodforhumanbeingstobe

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earthandmultiplyinit,andGodpromisesthattherewillneveragainbeaoodthatdestroystheentireearth(Gen.9:7).Theinstructiontohumanstobefruitfulencompassesmorethanmerereproduction,andsuggeststheideaofhumanourishing.ThisideaisechoedintheChristianNewTestamentwhenJesussays,Icamethattheymayhavelife,andhaveitabundantly(John

10:10).Humanbeingsarenotcreatedmerelytoexist,buttobefruitfulandtoourish.InGenesis,Godafrmsthevalueoftheentirecreationbycallingitverygood(1:31). TheBuddhisttraditionbelievesthathumansarefundamentallygoodandcompassionatebeingsattheircore,andthatalllifeisconnected,suchthatIamyouandyouareme.FromtheBuddhistperspective,awakeningtotherealizationthatalllifeisintimatelyconnectedrevivesonescorenature.TheHindusystemofyogateachesthatoneoftheprimarycausesofsufferingisignoranceof

ourtruenatureandourrelationshipwithDivinity.Infact,thewordyogameansunion.

Broken Relationship

He was so terrible that he was no longer terrible, only

dehumanized. --F. Scott Fitzgerald, Tender Is the Night

Stigmaisapparentinthewaypeopletalkaboutmentalillnessandinthewaypeopleencounteroravoidthosewithmentaldisorders.Stigmaisacentralbarrierbetweenpeopleandtreatment. Thedictionarydenesstigmaasamarkofdisgraceorinfamy;astainorreproach,asononesreputation.Amedicallyorienteddenitionofstigmaisamentalorphysicalmarkthatischaracteristicofadefectordisease,asinthestigmaofleprosy.ThewordistakenfromtheLatinwhereitmeansatattooorbrandplacedonacriminal. Somestudieshaveshownthatidentifyingmentaldisordersasabnormalitiesofthebrain

hasresultedinincreasedstigmatizationofthosewithsuchdisorders.Symptomsofcertainmentaldisorders,suchasdisorderedthinkingorotherimpairmentsinfunctioning,directlyconfrontWesternnotionsofpersonhoodthatcenteraroundreason,rationality,andself-determination.Labelinganindividualwithadiagnosisofmentaldisordercanoverwhelmtheindividualsidentity


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Mental Health Care: A History Lesson

Overthecenturiesmentalhealthcarehasevolvedfromhidingindividualswithmentaldisordersinbasementsandtreatmentsofstarvationtousageofbehavioralhealthcenterswithpsychologicalcounselingandholistichealthtreatments.

Theearliestculturesunderstoodthecausationofmentaldisorderstobesupernaturalpowers,

metaphysicalentities,orwitchcraft;treatmentcenteredonreligiousrituals,herbsandointments,charmsandprayers,andacupuncture.SomeearlycommunitiesviewedmentaldisordersasadirectresultofaproblemwithanindividualsrelationshipwithGod,whileothersidentiedpositiveaspectsofmentaldisorderssuchasprophesyingandartisticinspiration.

IntheMiddleAges,thegrowthofIslambroughtnewideasandconceptsofmentaldisorders.Islamicteachingconnectedmentaldisorderstoalossofreason,andwritingscoveredlinksbetweenthebrain

anddisorders.Textsfromthisperiodcontaindiscussionsofmentaldisorderssuchasmaniaanddelusionsandproposedtreatments.TherstpsychiatrichospitalwasestablishedinBaghdadin705,andtheconstructionofinsaneasylumsfollowedintheearly8thcentury.Treatmentandprotectionofindividualswithmentaldisorderswas

humaneandfocusedontherapeutictechniquessuchasbaths,drugs,music,andactivities.

InEurope,ChristiantheologydominatedtheviewofmentaldisordersduringtheMiddleAges.Conceptsofmentaldisordersrevolvedaround

thedivine,demonicpossession,andmagic.Mentaldisorderswereviewedasamoralissue,eitherapunishmentforsinoratestoffaith.EarlyEuropeantreatmentsconsistedofpurges,bloodlettingandwhipping;fastingandprayerforthoseestrangedfromGod;andexorcismfordemonicpossession.TheinfamousBethlehemRoyalHospitalapsychiatrichospitalinLondonbetterknownasBedlamopenedduringtheMiddleAges.Bedlamremainsthehistoricalexemplarforinhumaneandbrutaltreatmentofindividualswithmentaldisorders,goingasfarastopromotepublicviewingsandmockeryofpatientsintheircells.

Bytheendofthe18thcenturythewidespreadviewofmadnessshiftedtotheconceptthatamentaldisorderwasanorganicphysicalphenomenon,notinvolvingthesoulormoralresponsibility.Newtreatmentoptionsfordisordersusingphysicalandpsychosocialtechniqueswereprevalent.Sometechniqueswereconsideredhumane,

Many cultures have shown a tendency to depersonalize those who have some formof serious disability, whether of a physical or a psychological kind. A consensus is

created, established in tradition and embedded in social practices, that those affected

are not real persons.

--Tom Kitwood, Dementia Reconsidered: the Person Comes First


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suchashiringsensitiveattendants,butmosttechniqueslikebloodlettingandforcedvomitingwerenot.Duetotheemergingclassicationsystemsofmedicineandbiology,scholarsandexpertsbegantodeviseschemestoclassifymentaldisorders.The19thcenturybroughtashiftinpublicperceptionsofindividualswithmentaldisordersandtheirtreatment,leadingtothementalhygienemovement,aimedatpreventingthediseaseofinsanitythroughpublichealthstrategiesandclinics.Thetermmentalhealtharosefromthisera,andtheprofessionsofpsychiatry,clinicalpsychologyandsocialworkdeveloped.TheSocietyofFriends(Quakers)providedastrongvoiceformorehumanetreatment

ofindividualswithmentaldisorders.TheQuakerspracticedamethodofcareknownasmoraltreatment,anapproachbasedonhumanecareandmoraldisciplinethathelpedtolaythefoundationformodernpsychiatricmedicineintheU.S.xxxvii

CongresspassedtheNationalMentalHealthActin1949,whichprovidedfederalfundingforpsychiatriceducationandresearch.ThisActledtothecreationoftheNationalInstituteofMentalHealth(NIMH)followedbytheCommunityMentalHealthActof1963.FurtheradvancementsintheeldoccurredwiththeenactmentofMedicaidandMedicare,enablinglow-incomeAmericanstoaccessmentalhealthservices.

Themid20thcenturyalsosawadvancesintreatmentoptions.Treatmentssuchaspsychotropicdrugtherapy,lobotomies,insulinshocktherapy,andelectroconvulsivetherapyhelpedtofacilitatethetransitionofthementalhealthcaresystemfromaninstitution-basedstateandnationalsystemtoalocal,community-basedsystem.Theensuingclosureofmany

statehospitalsresultedinthemovementofmanyseverelymentallyillpeopleintolocalcommunitiesthatoftenwereill-equippedtomeettheirneeds.

Theresultsofdeinstitutionalizationaremixed.Themovementofindividualswithmentaldisordersfromin-

patientfacilitiestocommunitycentersmeantincreaseddemandforcareandcoordinationofservicesthatmanylocalcommunitiescouldnotprovide.Individualswithunmetmentalhealthneedsbecameandremaindisproportionatelylikelytoenterthecriminaljustice

systemorbecomehomeless.Ontheotherhand,community-basedservicesinadditiontobeinglessexpensiveforthepublicallowindividualswithmentaldisorderstoremaininfamiliarsettingsneartheirfamiliesandothersystemsofsupport.

What sort of religion can it be without compassion? You need to showcompassion to all living beings. Compassion is the root of all religious faiths.

Hindu. Basavanna, Vacana 247.

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Healing is impossible in loneliness; it is the opposite of loneliness.

Conviviality is healing. To be healed we must come with all the other

creatures to the feast of Creation.

Wendell Berry, The Art of the Commonplace: The Agrarian Essays

callingthemschizophrenicratherthanaperson

withschizophrenia,forexampleleadingtofeelingsofworthlessorabandonmentbyGodandothers.Manypeoplewithmentaldisorderswrestlewithexcessiveguiltandshame,retreatingintoisolationratherthansharingtheirstrugglewithothers.Stigmahastheeffectofcompoundingthedistressthatpeopleexperience.Infact,shameandisolationmayhaveanevenstrongernegativeeffectonwellbeingthanapersonsunderlyingcondition. Mentalillnesscanbeunderstoodasthe

leprosyofthemodernera.Biblicalscriptures

onleprosyhelpilluminatethatconnection.TheTorahsaysthatthepersonwhohastheleprousdiseaseshallweartornclothesandletthehairofhisheadbedisheveled;andheshallcoverhisupperlipandcryout,Unclean,unclean.Heshallremainuncleanaslongashehasthedisease;heisunclean.Heshalllivealone;hisdwellingshallbeoutsidethecamp(Lev.13:45-46).Thescripturessaythatanyonewhotouchesaleperbecomesunclean(Num.22:4-5).

St. Francis and the Leper

FrancisofAssisiwaswalkingaloneonedayonaroadintotownwhenhesawamanwithleprosywalkingaheadofhim.Hehadalarge,festeringsoreabovehislips. Francis,feelingrepulsed,wantedtoturn

andwalkintheotherdirection,butGodledhimontowardtheman.Atrst,hegavethemanmoney,thinkingthatwouldhelphim.Themantookthemoney. Then,Francisnoticedthatthemanwasshivering,sohegavehimhiscoat.Still,Francisfeltthathehadnotreallymetthemansneed.HeprayedsilentlytoGodforguidance,andGodsanswersurprisedhim:kisstheleperonhislips! Francisembracedthemanforthecustomarygreetingbetweenfriends,and

whenhislipsfelluponthemans,themandisappeared.FrancisfeltinhisheartthathehadjustembracedGod.AsSaintFrancisdid,Christianfaithtraditionscallotherstocrossboundariesinordertoshowlove.s


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Today,manypeoplewithmentaldisordersreportpositiveexperienceswithfaithcommunities.However,therearestillthosewhohavenegativeexperiencessuchasfeelingjudgedorbeingexcluded.Separationfromfaithcommunities,pairedwiththefactthatsomeindividualswithseverementaldisordersbecomeincarceratedorhomeless,revealstousthatmanypeoplewith

mentaldisordersenduplivingoutsidethecamp.Sometimes,religiouscommunitiesgobeyondexcludingindividualswithmentalillnessandcauseharmtothementalhealthoftheircongregants.Justasinanyotherinstitutionorrelationship,thepowerandauthoritythatclergyandotherreligiousleadersholdinpeopleslivescreatesthepotentialforabuse.Religiousabusetakesplacewhena

The Gift of Being Human

Ismentalillnessagift?Somepeoplethinkso,andlinkshavebeendrawnbetweenmentaldisordersandcreativegeniussincethe4thcenturyB.C.E.Platobelievedthatmadness,provideditcomesasthegiftofheaven,isthechannelbywhichwereceivethegreatest

blessings....MadnesscomesfromGod,whereassobersenseismerelyhuman.Famousscientists,theologians,religiousleaders,athletes,writers,actors,politicians,musicians,andartistsallmakethelistofpeoplewithseriousmentaldisorders.Severalresearchstudieshavelinkedcreativityandmentalillnesstosimilar,underlyingstructuresinthebrain.Considerthatonecommonreasonthatpeoplegiveforavoidinguseofpsychotropicmedicationsisthatthesemedicationsalterbrainfunction,dullingcreativityand,thus,

personality.

The wound is the place where the Light enters you.

Rumi

Whilesomeconsidermentalillnessagift,othersfeelthatcallingitagiftminimizesthepainandsueringthatisexperiencedasaresultofsuchillness.Whatfaithcommunitiescanarmisthegiftednessofeachindividual,whethergiftednessisrelatedtomentalillnessornot.AJewishrabbi,theMaggidofZlathcov,saidthatitisthedutyofeverypersontoknowandconsiderthatheisuniqueintheworldinhisparticularcharacterandthattherehasneverbeenanyonelikehimintheworld.TheChristianapostle,Paul,saidtherearevarietiesofgifts,butthesameSpirit,(1Cor.12:4).Faith

communitiescanhelpeverymemberofthecommunityrealizehisorheruniquecharacterandgiftsforthegoodofthewhole.

Being human is difcult. Becoming human is a lifelong

process. To be truly human is a gift.

Rabbi Abraham Heschel

Ratherthancondemningmentalillnessasanaberrationoridealizingitasanacceptablecostofdivineinspiration,faithcommunitiescanoeramorenuancedapproach.WecanarmthatdiversityisapartofGodscreation,thatpeoplehavedierentwaysofexperiencingtheworld,thatthereisnonormal.Bysharingourdierentexperiences,wecancometounderstandthefulldepthandbreadthofwhatitmeanstobehuman.Wecanarmthatnoneofusareperfect,thatweneedoneanothertobewhole.TheologianStanleyHauerwassaid

thatwearecreatedforoneanotherandthatincompletenessmakespossibleourgifts.s


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personorinstitutionclaimstobespeakingfororactingasGodcommands,yetperpetuatesverbal,emotional,physicalorsexualabuseofothers.InBiblicaltimes,illnesseslikeleprosywerecommonlyunderstoodtobetheresultofsin,apunishmentfromGod.ThisisaviewthathasbeenexpressedbyalloftheAbrahamicreligions.TheIslamictraditionhasalsoviewedillnessordisease

asadivinetestofthelevelofpiety,devotion,andloyaltythatafollowerhastohisorherfaith.Today,manyfollowersofthesereligioustraditionsstillsharetheseviews,thoughthereareothersthatholdalternativeviews.SomebasetheirconceptionofillnessonthestoryofJobintheHebrewBible.Jobwasamanafictedwithleprosyandmuchmisfortunethroughnofaultofhisown. Onemoderntheologiandescribessinasprofoundestrangement.JamesB.Nelsonwrites,Itisrelationalbrokenness,separation

fromeverythingmeaningful.Itisalienationfromourselves,fromthosearoundus,andfromourenvironment.Itisseparationfromlifeitself.Fundamentally,itisestrangementfromGod,thesourceandgroundofallthatexists.Whenthefaithcommunitysfearsorpreconceptionsleadtotheexclusionordehumanizationofpeoplewithmentalhealthconditions,thenthiscanintensifya

personsexperienceofprofoundestrangement.Buddhiststeachthataboundarybetweenselfandothersisafalsedistinction,afalseconstructofthemind.TheBuddhistpracticeofmeditationcentersonraisingapersonsawarenessofhisownthoughtpatternofformingjudgmentsandseparatinghimselffromothers.Thefruitofmeditationistorealizethatindividualsmaybethoughtofaswaves,buttheyallpartofoneocean;that,infact,alllifeisinterconnected.

Illness and Religion

Whilemanyreligioustraditionsarmthatmentaldisordershaveabiologicalbasis,mostspeakofthehealthandhealingneededforindividualswhosuerfromsuchdisordersinadierentmanner.JewishandChristianscripturescontainnoexactwordforhealthalthoughtherearehealth-relatedconceptswithintheBiblelikeshalom.OnetheologiandescribesshalomasthewebbingtogetherofGod,humans,andallcreationinjustice,fulllment,anddelight....Wecallitpeacebutitmeansfarmorethanmerepeaceofmindoracease-rebetweenenemies.IntheBible,shalommeansuniversalourishing,whole-nessanddelightarichstateofaairsinwhichnaturalneedsaresatisedandnaturalgiftsfruitfullyemployed.xxixHealthasshalomspeakstothewholenessandourishingoftheentirecreation;itis

focusedonmorethantheindividual. Healing,fromareligiousviewpoint,representsatraditionsdeepesthopesandpromises....Itmaytaketheformofenlightenment,salvation,aplaceinHeaven,lifeinaWorldtoCome,Paradise,Nirvana,freedomfromcyclesofrebirth,immortality,sagehood,veneratedancestralstatus,remainingaliveinhu-manmemory.xxxTheseconceptsprovideindividualsandcommunitieswithanultimateframeofrefer-encewithinwhichtointerpretallotherexperiences,includingthemeaningofhealthinthislifetime.xxxiFromareligiousstandpoint,healingmayinvolvecuring,butitisconcernedmuchmorewiththeultimatemeaningandpurposeoflife. Religiousinterpretationsofillnessarediverse.Thereisparticularlywidevariabilityintheologi-calunderstandingsofmentalillnessbothwithinandbetweenreligioustraditions.Mentalillnessesareviewedasareectionofafallencreation,asaresultofindividualdisobedienceorcollectivesin,aspartofGodsdesign,astheresultofpossessionbyevilspirits,oraspartofthehumanconditionthateveryone

shares.Mentalillnessesareexperiencedasblessings,asameansofgrowth,ascurses,orasthecauseofimmensehumansuering.Attimesthroughouthistory,respectedrabbis,prophets,andtheologianshaveexhibitedbehaviorsmanywouldndsymptomaticofmentalillnesstoday. Peopleoffaithwrestlewithwhyandwhatforquestions.Theseareimportantanddicultquestions;howeveraskingwhowearecalledtobeandhowwearecalledtobeinrelationshipwithpeopleaectedbymentalillnessmayultimatelybemorevaluableandleadustowardgreatercommunityhealthandwholeness.


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Healing Relationship

Createdinandforrelationship,humanbeingsarenotmeanttobealone.ThebookofEcclesiastessays:Twoarebetterthanone,becausetheyhaveagoodrewardfortheirtoil.Foriftheyfall,onewilllifttheother;butwoetoonewhoisaloneandfallsanddoesnothaveanother

tohelp.Again,iftwolietogether,theykeepwarm;buthowcanonekeepwarmalone?(4:9-11).Peoplewithmentaldisorderscannotourishinisolation,alienatedfromothers.Theyneedcommunity,andthecommunityneedsthem.Buddhismdescribesfourkindsofgoodfriends:onewhohelps,onewhoisconstantingoodtimesandbad,onewhopointsoutwhatisgoodforyou,andonewhoissympathetic.ThereisaSikhsayingthatonlythosepersonsaremyfriendswhocanwalkalongwithme. Islamandmanyotherreligioustraditions

recognizethatthehealthofanindividualisrelatedtothehealthofthewholecommunity.InHinduthought,thewell-beingoftheindividualisconsideredfoundationalforthewell-beingofsociety.Karma,orthegoodorbademanationsresultingfromonesactions,iscollectiveaswellasindividual;anindividualsmanifestationofillnessmayreecttheenergiesofthegreatersociety.Jewishtraditionteachesthateachpersonissoimportant,thatsavingonepersonslifeislikesavinganentireworld.IntheNewTestament,theChristianapostle,Paulsays,Ifonemember[ofthe

church]suffers,allsuffertogetherwithit;ifonememberishonored,allrejoicetogetherwithit(1Cor.12:26).Similarly,theBuddhisttraditionsaysthatallpeoplesuffer,andallpeopleareatone.Iftheworldistoourish,thenallwhoareinitmustourish. Compassionandempathy,orlove,formthebasisforhealing,wholeness,andhumanourishinginmanyreligioustraditions.ThereisanIslamicsayingthatyoushallnotenterParadiseuntilyoubelieve;andyoushallnotbelieveuntilyouloveoneanother.BasedontheTorah,ChristiansteachthatGodsultimatecommandmentistolovetheLordyourGodwithallyourheart,

andwithallyoursoul,andwithallyourmind,and

toloveyourneighborasyourself(Matt.22:37-40). Jainismteaches:Havebenevolencetowardsalllivingbeings,joyatthesightofthevirtuous,compassionandsympathyfortheaficted,andtolerancetowardtheindolentandillbehaved.AnearlyChristianapostleinstructedmembersofhischurch:Donothingfromselshambitionorconceit,butinhumilityregardothersasbetterthanyourselves.Leteachofyoulooknottoyourowninterests,buttotheinterestsofothers(Phil.2:3-4).Thiskindofloveisfocusedon

boththeneedsandthevirtuespresentinothers.Itlooksforthebestinothers.Thiskindoflovecanonlytakeplacewhenpeoplespendtimetogetherandknowoneanother.Acommunitygroundedinmutuallovemakeshealingpossible.

What Can Congregations Do?

Faithcommunitiessometimesabdicatetheirroleinhealingtophysicians,psychiatrists,orotherhealthprofessionals.Mentalhealthprofessionalsofferaparticularkindofexpertise,focusingprimarilyonunderstandingandtreatingbiologicalandpsychologicaldisorders.Manynow

The Divine Presence dwells where there is love and peace generated

by friendship. --Rabbi Abraham Weinberg of Slonim


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Connecting the WholeCommunity

Congregationshaveauniqueroleinshapingtheentirecommunityinwhichtheyarelocated.Intherealmofmentalhealth,congregationsnotonlyhavetheopportunitytoeducateandestablishinclusionpracticeswithintheirreligiouscommunities;theyalsohavetheopportunitytobetterthementalhealthsystemasawhole. Faithleadersandcongregationscanbetterthesysteminamultitudeofways.Atthelocallevel,opportunitiesincludebecomingconnectedandworkingwithlocalmentalhealthcenters,participatinginlocalissue-forumsthatexploreboththechallengesandpositiveaspectsofthementalhealthsystem,partneringwithlocalhospitalstoprovideprogramsandsupportformentalhealthcommunitycenters,andjoininglocalboardsandfocusgroups. Alongsideconnectingwithmentalhealthprovidersandnetworks,congregationsandfaithleaderscanconnectwithhealthcaresystemdecision-makerslikelocalgovernmentofcials,stateagencyofcialsandlegislators.Whendiscussingissuesfacingthestate,faithleadersoftenprovideamuch-neededvoice,onewithexperienceandabackgroundthatisdifferentfromthatofthedecisionmakers.Whatfollowsisalistofsomeoftheprinciplesthat

canguidefaithcommunitiesintheareaofworkingwithindividualsandfamilieslivingwithmentalillness:

Learn.Faithleaderscanlearnaboutcommonmentaldisorders,symptoms,treatments,andstrategiestoworkwiththoseaffectedbythem.Theycanraiseawarenessaboutmentaldisordersthroughouttheircommunityduringtimesofprayer,worship,religiouseducation,orothercommunity-widegatheringsandthrough

recognizetheneedforspiritualcare,too.Religioustraditionshavesomethinguniquetocontributetothehealingprocess.Peopleoffaithareparticularlyequippedtohelpindividualsndmeaningandwholenessinthemidstoftheirillness. Religiousleaderscanhelpindividualsandfamiliesreframetheirexperienceinlightofthesacredwisdomofthetradition,encouraging

movementtowardpeace,forgiveness,andwholeness.Theycanhelpindividualsstrugglethroughtheprofoundspiritualquestionsthatmentaldisordersmayraise,theycanafrmthesacredworthofindividualswithmentaldisorders,andtheycanofferteachingsandprayerstohelppeoplemovetowardwholeness. Faithcommunitiescanprovidestoriesandmodelsthatgiveshapetopeoplessuffering.Forexample,thelamentsoftheHebrewBibleofferamodelforrelatingtoGodduringtimesofcrisisorgrief.ForChristians,JesusisGod-with-uswho

understandswhatitistosufferandbeabandonedbyGod.Faithcommunitiescanproviderituals,practice,prayerandmeditationthathelpprovidepeaceandstabilitytosomeonelivingwithamentaldisorder.Mostofall,congregationscanprovidefriendship,community,andacceptance. Therearesymptomsofmentaldisordersthatcan,attimes,bedisruptivetocommunitiesandwhilemostmentaldisordersdonotresultinviolentbehaviors,somedo.Itisappropriateforfaithcommunitiestosetboundariesaroundthekindsofbehaviorsthatareacceptableat

communitygatherings;however,behaviorsrelatedtomentaldisordersshouldnotbeusedasanexcusetoexcludeparticularindividuals.Faithcommunitiesareencouragedtomakeacommitmenttoremainopenandndcreativewaysofkeepingindividualswithmentaldisordersconnectedtothefaithcommunity.

There is no worship, no music, no love, if we take for granted the blessings

and defeats of living.

--Abraham Joshua Heschel


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Navigating The System

Thetermmentalhealthcareisusedinvariouscontextstocoverawidevarietyofservices,rangingfromfamilycounselingtotheprescriptionofanti-psychoticdrugsforschizophrenia.Thesystemafragmented

networkofprograms,services,andpaymentsthroughwhichindividualsaccesscare.Thementalhealthcaresystemisseparatedfromphysicalhealthcareandsubstanceabusecaresystems.Thisseparationoftenmakesitdiculttoknowwhereandhowtogetassistance. Therearefourcategoriesofmentalhealthproviders:highlytrainedspecialistssuchaspsychiatrists,psychologists,andpsychiatricnurses;providerswithtrainingingeneralhealthcaresuchasfamily

practitioners,pediatricians,andnursepractitioners;socialserviceproviderssuchasschool-basedcounselorsandcriminaljusticeworkers;andinformalvolunteers,suchaspeercounselors,thatgenerallyhaveneitherformaltrainingnoralicensetotreatmentalorphysicalhealthservices.Manyreligious-orientedprovidersaresocialserviceworkersorvolunteers. Thementalhealthcaresystemisintertwinednotonlywiththephysicalhealthcaresystem,butalsothecriminaljustice,

educational,andhousingservicessystems.Asaresult,mentalhealthprofessionals,individualswithmentaldisorders,andtheirfamiliesoftenrefertothementalhealthcaresystemasaconfusingmaze. Therststepforanindividualaccessingmentalhealthservicesisoftenareferralforamentalhealthassessment.Familymembers,emergencyroomattendees,schoolcounselors,primarycarephysicians,socialworkers,andavarietyofotherprofessionalsinvaryingcapacitiesmake

referralsforassessments.Forexample,ifachildisexperiencingsymptoms,acounseloratschoolmightrecommendanassessmentbyaprofessionalatacommunityhealthcenterorbythechildspediatrician.Apersonenteringthecorrectionalsystemmayhaveamentalhealthassessmentaspartoftheintakeprocess. Initialassessmentsareconductedbyanarrayofprofessionalswhothendiscuss

andanalyzebeforedecidingontreatmentoptionsandproviders.Onceassessedanddiagnosedbyaprofessional,anindividualwithamentaldisorderisquicktodiscoverthathealthinsuranceisaneededresourceforreceivingcare. Healthinsurancecoverageformentalillnessisoftenlesscomprehensivethanforphysicalillness.

Thisdisparityincludescompletenon-coverage,highercopayments,andlowertreatmentlimitsformentaldisorders.Lowerincomeindividualsturntonancingoptions,slidingscalepayments,andMedicaidandMedicareformentalhealthservicesandcoverage. Hospitalsoftenareovercrowdedandlackopenbeds,causinglongwaitinglistsforservices.Hospitalssometimesreferindividualstocommunitycenters,viewedbymanyexpertstobeidealforthetreatmentofmentaldisorders.Unfortunately,notallcommunitieshavetheresourcestoprovidealocal

mentalhealthcarefacility,andiftheydo,thereisfrequentlyalackofqualied,culturallycompetentemployeestostathecenter. Severementaldisordersandlackofavailableserviceshaveledtoanincreaseinpubliccostsrelatedtocrimeandcriminaljustice,homelessness,anduncompensatedhealthcare.Statebudgetcutsformentalhealthprogramshaveincreasedcostsforlocalgovernments.Thecombinationofdeinstitutionalization,inadequatecommunitymentalhealthprograms,andlimitsimposedbyprivateinsuranceplanshaveincreasedthelikelihoodthat

individualswithmentaldisorderswillendupinthecriminaljusticesystemorexperiencehomelessness.oday,thecriminaljusticesystemisthedefactoprovideroflastresortforindividualswithuntreatedmentaldisorders.Thefederalgovernmentestimatesthispopulationtomakeupabout16percentofthejailandprisonpopulation. Correctionalfacilities,mentalhealthprofessionals,hospitals,localprovidersandlawmakersencounterthesamemazeoffrustrationsthatindividualswithamentaldisorderencounter.Statementalhealthprofessionalsnotonlyassist

withtreatmentoptions,butalsoconnectindividualstobasicneedssuchashousingorincomeassistance.Often,mentalhealthprofessionalsatthestatelevelmaintainlongworkinghoursandamultitudeofpatientsorclients.Hospitalchallengescenteronalackofresources,beds,sta,andnances.Legislatorsmustmakedicultdecisionsaboutmentalhealth,fromtheallocationofresources,topoliciesinthecriminaljusticesystem,tomandatesrelatedtohealthinsurance.s


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supportfamiliesofpeoplewithmentaldisordersandestablishwellnessprogramsandworshipservicesfocusedonhealing.Therearealotofresourcesavailabletohelpinthisendeavor.Theextenttowhichaparticularfaithcommunitycanofferdirectservicesorprogramswilldependontheirsizeandbudget.

Partner.Mentalhealthprofessionals,stateagencies,communityhealthcenters,andnonprotorganizationscanoffervaluableinsightsinidentifyingsymptomsandworkingwithpeoplewithmentaldisorders.Theyoftenactasreferralsourceswhensomeoneneedshelpbeyondwhatthefaithcommunitycanoffer.Somementalhealthorganizationsarefaith-basedandprovidespiritualcarethatisintegratedwithmentalhealthcare.

Advocate.Faithcommunitiescanadvocateforpoliciesandprogramsthatprovidebetteraccess

toservicesforuninsuredindividualswithmentaldisorders.TheycanadvocateforsystematicimprovementtothesystemofmentalhealthcareinTexasandthenation,improvingthelivesofpeoplewithmentaldisorders.

Inlearningaboutsomeonedifferentthanourselves,wecometounderstandmorewhatit

meanstobehuman.Inchoosinglanguagethatafrms,ratherthanseparates,wemovetowardwholeness.Inconnectingwiththecommunityandmentalhealthsystemasawhole,welearnhowtobestassistthoseinneed.Inshowingcompassiontosomeonelivingwithmentalillness,webringmorepeace,love,andjoyintotheworld.

s

congregationalcommunications.Theycanlearnaboutthementalhealthcaresysteminordertohelppeoplewithdisordersgetassistance.

Afrm.Bysharingtheirtheologicalunderstandingofthesacredworthofallpeople,religiousleaderscandiffusethestigmasurroundingmentaldisordersandhelpindividualsreframetheir

identity.Peopleoffaithcanadoptperson-rstlanguagethatdoesnotidentifyapersonsolelybytheirdisorder.Peoplearenotthesumtotaloftheirmentaldisorder;theyareGod-breathedcreaturesthatGodcallsverygood.

Befriend.Perhapsoneofthemostvaluablethingsthatpeopleoffaithcandoislistenandbeafriendtopeoplestrugglingwithmentaldisorders,ortotheirfamilymembers.Friendshipinvolvesmutualunderstanding,acceptanceandsharedenjoyment.Itlooksforandcallsoutwhatisgoodinanother.

Itrequireseffort,commitment,andopennesstodifferentwaysofexperiencingtheworld.

Support.Faithcommunitiescancreateprogramsto

A believer who participates in human life, exposing himself to its torments

and suffering is worth more than the one who distances himself from its

suffering.

--Islamic Hadith of Ibn Majah


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SOURCES


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Justice FrameworksisapublicationseriesoftheTexasInterfaithCenterforPublicPolicy.BeeMoorhead,ExecutiveDirector.ThiseditionofJustice FrameworkswaswrittenbyEricaKniselyandAndreaEarl,andsupportedbytheHoggFoundationforMentalHealth(www.hogg.utexas.edu)andMethodistHealthcareMinistriesofSouthTexas,Inc.(www.mhm.org).TheopinionsexpressedinthisdocumentarethoseoftheInterfaithCenteranddonotnecessarilyreecttheviewsoftheHoggFoundationorMethodistHealthcareMinistries.SpecialthankstoTomFreeman,NelsonBurns,BarrySilverberg,BarbWatson,JackiePeck,andDr.PhilippaStrelitz.

The Texas Interfaith Center for Public Policy is a faith-based, 501(c)(3) non-prot organizationproviding theologically grounded public policy analysis to people of faith and other Texans. TheCenter is the research and education arm of Texas Impact, the states oldest and largest interfaith

legislative network. Texas Impact was established by Texas religious leaders in 1973 to be a voicein the Texas legislative process for the shared religious social concerns of Texas faith communities. Texas Impact is supportedby more than two dozen Christian, Jewish and Muslim denominational bodies, as well as hundreds of local congregations,ministerial alliances and interfaith networks, and thousands of people of faith throughout Texas.

TEXAS INTERFAITH

CENTER

for public policy

wholeness not perfection: an interfaith framework for mental health

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