Wednesday, 30 September 2015

Spiritual history-taking: worthy of consideration?

"Science and Charity", Pablo Picasso (1897)

It occurred to me just now that medical history-taking lacks an important component: the spiritual life. A proper spiritual history does not only ask about the patient's religion, but it seeks to answer these questions:
  • Does the patient use religion or spirituality to help cope with illness, or is it a stressor—and how?
  • Is the patient a member of a supportive spiritual community?
  • Does the patient have any troubling spiritual questions or concerns?
  • Does the patient have any spiritual beliefs that might influence medical care? 

I mean, why not? First, Indonesia is a [supposedly] religious country, so religion and spirituality are near and dear to the hearts of Indonesians. Secondly, a human being is both a physical creature and a spiritual creature. Religion is a human virtue born of a response to God's grace. Yes, of course this virtue is systematic, because virtue leads to order (i.e. orderly passions, orderly life, orderly worship and belief in God). Thirdly, I think we shouldn't make assumptions about a person's spiritual life based on his/her ID card religion. No two Muslims are the same, no two Christians are the same, no two Buddhists are the same, no two Hindus are the same. Consequently, two people holding the same faith might still define and approach their illnesses differently, and physicians should recognise this in order to give better care.

A spiritual history, however, requires a physician who is, at the very least, welcome to the notion of God, and who understands how important God is in many people's lives. Meaning, if the physician is an atheist, he must not dismiss the idea of a Higher Being as ridiculous or unfounded or counter-productive to treatment. In fact, he must use the patient's belief/religion/spirituality as an adjunct to treatment. I think, if used correctly, the spiritual history will add a fresh new dimension to the doctor-patient relationship and to medicine in general.

I'm not intending this post to be very long, so right now I'll just leave it there and think more about it.

Monday, 28 September 2015

Saints of Mental Health #1: St. Dymphna

The mentally ill are oft-forgotten children of God. In them, the wounds of Original Sin, especially the loss of integrity, manifest most insidiously and most destructively. As I'm proceeding through the humble first year of residency, I've come to realise the fact that mental illness is probably the darkest form of the darkness of ignorance. We need all helps we can get to aid this marginalised group.

St. Dymphna is the earliest known patron saint of the mentally afflicted. She was born in Ireland in the 7th century to a pagan king and his Christian wife. At the age of fourteen she took a vow of chastity, consecrating herself to Christ. At around the same time, her mother passed away.

Legend says that Damon, Dymphna's father, was so grieved that his mental health sharply deteriorated. He sent messengers throughout many lands to find some woman of noble birth, resembling his wife, who would be willing to marry him. When none could be found, his evil counsellors told him to marry his own daughter. Damon began to experience disordered desire for Dymphna, who was indeed just as beautiful as her mother.

When Dymphna learnt of her father's intentions, she fled the royal court together with St. Gerebran (or Gerebernus), her confessor priest and two other friends. From Ireland, they sailed toward the continent and landed in present-day Belgium. They took refuge in the town of Geel (or Gheel) and there built a hospice for the poor and sick.

King Damon successfully traced their whereabouts, due to Dymphna's usage of his father's material wealth for her service (Note: I don't understand the monetary system back then, but I imagine it must've been something like credit cards that can be traced, to make this story plausible). He ordered his men to cut off the priest's head and then he tried to persuade his daughter to return to Ireland with him. When she refused, he got furious so he drew his sword and struck off her head too. She was then only fifteen years of age.

In art, St. Dymphna is often portrayed with a sword, which is her instrument of martyrdom. Her feast is celebrated on 15 May.

Relationship with people with mental disorders

The narrative of St. Dymphna is largely based on legends, although at the town of Gheel two sarcophagi had indeed been discovered; one of them bore the name "DYMPNA", and the other was presumed to be that of Fr. Gerebran.

Invocation of the saint as a patroness of the mentally ill has existed from time immemorial. Ecclesiastical scholars noted that a colony of "lunatics" flocked at Gheel and were said to be miraculously cured. Even now there are sometimes as many as fifteen hundred whose relatives invoke St. Dymphna for their cure. At the site, the insane are treated in a peculiar manner: it is only in the beginning that they are placed in an institution for observation; later they are given shelter in the homes of the inhabitants, take part in their agricultural labours, and are treated very kindly. They are watched without being conscious of it. The treatment produces good results.

What does it mean for current psychiatric practice?

The "peculiar manner" described above sounds a lot like psychosocial rehabilitation, although not quite the same. The basic principle, however, stands true: the mentally ill have to be re-integrated into the society as early as possible, and as much as possible. For the modern eyes, the people at Gheel may be thoroughly foolish for accepting these people in their homes. But I'd say they just have great faith and great love.

"The beheading of Saint Dymphna", by Godfried Maes