Coping with Pastoral Care
Mental Health, Mental Illness and the Church’s Pastoral Care
Of all the images Jesus chooses to use of himself the one we encounter in John chapter 10 is at one and the same time the gentlest, most caring, most loving, and one of the most challenging and thought provoking.
I am the good shepherd,” says Jesus. At once our minds go to the gentle words of the 23rd Psalm that have meant so much to people in times of illness, sadness and bereavement.
“I am the good shepherd, who is willing to die for the sheep.” What wonderful love Christ has for us that he is willing to go to his death for our sakes. It is through the dark valley of the shadow of his death that we come to life in all its fullness.
“I am the good shepherd.” Jesus went on to say, “As the Father knows me and I know the Father, in the same way I know my sheep and they know me. And I am willing to die for them.” Wait one moment. What Jesus goes on to say links him as the Good Shepherd with his Father. Is it just that Jesus wants us to think of shepherds in their gentle yet strong care of their sheep? Or is it that Jesus wants us to think of something more.
The clue lies in the opening words. There they are again. I am. Ego Eimi. I I am. Remember the name God disclosed to Moses in the burning bush? Say, ‘I am’ has sent you. Maybe Jesus had something more than the 23rd Psalm in mind.
Maybe he had in mind the words of the prophet Ezekiel in chapter 34:15-16
“I, the Sovereign LORD, tell you that I myself will look for my sheep
and take care of them in the same way as shepherds take care of their sheep ...
I myself will be the shepherd of my sheep, and I will find them a place to rest.
I, the Sovereign LORD, have spoken.
I will look for those that are lost, bring back those that wander off,
bandage those that are hurt, and heal those that are sick ...
In Jesus we encounter the LORD God who is our Father.
In Jesus we encounter the LORD God who as the Good Shepherd who looks for those who are lost, brings back those that wander off, bandages those that are hurt, and heals those that are sick ...
It is no coincidence that it is this image of the Shepherd that we bring into the caring ministry of our church life when we speak of it as Pastoral Care.
So in the next few minutes we are going to explore the practical way our pastoral care in church relates to people who experience mental illness.
Kate Blazey, who is one of our deacons and very much involved in our pastoral team is going to share some of her reflections on mental health, mental illness and the pastoral care we share in our church life together.
Mental Health Issues
Kate Blazey
I have approached this subject from a professional point of view as I spend half my week as a psychiatrist in Stroud, having trained originally trained as a medical doctor.
This may touch on some sensitive and personal issues. There are some ideas about how we can support each other later. I will also include some sources of help and information at the end.
What is mental health and ill health?
Mental health and ill health can be viewed as being on a spectrum, from things we all experience such as feeling low or detached, to less common things like believing your thoughts are being interfered with.
Common problems in working age adults include anxiety (with difficulties such as panic attacks and phobias), depression (with symptoms including feeling very low, problems with physical functioning and self worth) and substance misuse (abuse of drugs and alcohol).
Less commonly people experience bipolar disorder, with episodes of elevated mood and over activity with episodes of depression, and psychosis, for example in schizophrenia and severe depression. Psychosis can be seen as losing sight of what is real. People with psychosis can firmly believe things which seem bizarre. They may experience hearing or seeing something as clearly as you hear and see your television. They may also become paranoid and feel people are out to harm them.
In the elderly dementia and depression are common. Dementia has several causes and it leads to many problems with memory, behaviour and social functioning.
Children can experience conduct disorders (characterised by antisocial behaviour), emotional disorders like depression and anxiety, and hyperactivity.
Learning disability is not a mental illness but a disorder of mental development. People with a learning disability are, however, more vulnerable to mental illness.
Stigma – why does it occur?
Chambers 21st Dictionary defines “stigmatise” as “to describe, regard, single out etc. someone as being bad, shameful etc.”.
Stigma can arise from the artificial distinction between disorders of the body and the mind. Beliefs contributing to stigma include: people with mental illness are dangerous; it is a feigned or imaginary illness; it is a weakness of character; it is self-inflicted; there is a poor outcome and people with mental illness are difficult to communicate with. It can be difficult to understand and empathise with people with experiences so different to our own.
We need to examine our own attitudes. What do we base them on? We also need to increase our awareness and knowledge. It is important to realise that one in four of us will suffer with some form of mental illness in our lifetime. It is also important to recognise the effects of stigma. It can lead to distress and prevent people from disclosing their difficulties. It can affect treatment and recovery. We also need to brush up on our listening skills.
(Bolton, BMJ, 22 Feb 2003, s57-59)
(Dinos et al, British Journal of Psychiatry, 2004, 184, 176-181)
Why do people get problems?
It is usually due to a combination of factors. Family inheritance, or genetics, often plays a part. Early experiences can be important, trauma or insecurity in childhood for example. Life events and social difficulties (eg. poverty, loss and childbirth) can make people vulnerable. Physical illness and medication for physical illness may lead to mental health problems. There is a complex relationship between alcohol and drugs and mental illness. Alcohol can lead to, or worsen disorders like depression. Some drugs can precipitate problems with mood or psychosis. They can both arise independently, as a coincidence. People can use alcohol or drugs to alleviate their symptoms of mental illness.
Sometimes there is no particular main cause.
Treatments can be biological (medicines), psychological (different types of therapy) and social. Social treatment involves important areas such as activity, occupation, housing and support.
We will need patience and time when responding to people with mental health problems. Sensitivity and tact are important – people may not want to talk, or listen, they may just want to be with someone. In some situations we can approach it as we would a physical illness. It is also important to remember that people may tire easily and have a shorter concentration span. We should accept our limitations – not feel we must fix things. We can be honest if we are not sure what to do. Ask, “ What do you need?” It can be helpful to let someone know that we are there and ready to listen. Cards and letters can be useful for this. We can also take note of Jesus’ example of gentleness and non-judgemental acceptance.
Sources of further information