Looking at Mental Illness from a Holistic Persepctive

by Cardinal Javier Lozano Barragan

Is the Mentally Ill Patient a Deformed Image of God?

I. Some Data on Mental Illnesses

1. Current Situation

According to the World Health Organization there are 450 million people in the world affected by neurological or behavioural mental disorders, of which 873,000 commit suicide each year. Mental illness is a true health and social emergency. 25% of countries do not have laws concerning mental health, 41% have no defined policy on the issue and in over 25% of health centres patients do not have access to basic psychiatric medication; among 70% of the world population there is less than one psychiatrist for every 100,000 people.

As to dealing with mental disorders, it maybe asserted that in the past 50 years great strides forward have been made, evidence of which are the technological advances in the field, of new psychotic and mental health medicines, which have considerably improved the quality of life of the mentally ill. Nevertheless, the conditions of assistance to mentally ill patients are quite deficient as a result of limited funding, the lack of understanding among authorities, the serious problem of the social stigma that the patients and their families have to face, all of which have serious repercussions on the social support networks in many countries that consequently deteriorate. The number of “homeless” mentally ill patients has considerably increased in wealthy countries. It is alarming to see how serious mental disorders are simply dealt with using bureaucratic and juridical or legal solutions without in the least taking into consideration the daily needs and the quality of life of patients and their families.[1]

Mental disorders affect more frequently those populations that are less fortunate economically culturally and intellectually. Millions of individuals have to bear on their body and mind the psychological consequences of malnutrition, armed conflicts or natural disasters with their heavy burden of morbidity and mortality.

2. The Action of the Catholic Church

On this occasion of the World Day of the Sick, celebrated here in Oceania, the Pontifical Council for the Health Pastoral Care made a survey on the pastoral care of mental health in 84 centres dedicated to mental patients in the Catholic community, in various countries across the five continents.

A questionnaire, carefully drafted by experts in the field was sent to 129 Bishops responsible for pastoral care in health, in various countries of the world. We received replies from 23 countries, of which 9 from Africa, 17 from the Americas, 6 from Asia, 51 from Europe and one from Oceania . The data collected from Africa came from Cameroon, Ghana, Senegal and South Africa; in the Americas from Bolivia, Canada, Chile, Colombia, Cuba, Ecuador, Mexico and Trinidad and Tobago; in Asia from China, Indonesia and Turkey; in Europe from Austria, Belgium, Ireland, Italy, Poland, Portugal and Spain; in Oceania from Australia .

The structures of interest were Mental Health Centres, Day Hospitals, Psychiatric Services, Residential and Semi-residential Centres, Centres of Co-operatives for Reintegration, Consulting Rooms and Clinics. 43% of the funding is from public sources, 33% from private and 23.3% from donations.

The personnel in the above centres is comprised of medical doctors, psychologists, psychiatrists, rehabilitation therapists, professional educators, social assistants, nurses, auxiliary technical staff, administrative staff, volunteer workers, chaplains, religious men and women, counselling experts and service staff. 75% of the centres reported that they have a just sufficient number of medical doctors; in general there is lack of adequate professional resources. These centres offer various services like consultation, rehabilitation, school medicine, family support, social services, work orientation, accompanying, home care and pharmacy.

The most significant mental disorders taken care of in these centres are: personality disorders, drug abuse-related disorders, psychosis, mood disorders, anxiety disorders, cognitive and dissociative disorders, eating disorders, sleep disorders, adaptation disorders, severe degenerative organic disorders, congenital mental insufficiency. The most frequently treated pathologies were personality disturbances, psychosis and mood disturbances. Personality disturbances mainly due to psychosis and drug abuse are more frequent in the age band of 17-25 years. Regarding the prevention of mental disorders, it is interesting to note that disorders hardly appear in age band of 0-16 years; hence, it is in this stage that prevention can be much more effective.

The approach in these centres is mainly characterised by teamwork, even though it is generally not systematic. Innovative therapies used are hypnotherapy, music therapy, game therapy, theatre and art laboratories.

At the level of prevention, a culture of welcoming people with problems of mental health is promoted, together with appropriate pastoral programs that give due attention to the psychological aspects of patients. When facing a full-blown disorder therapeutic interventions — some of which are systemic— are given for reducing disabling consequences for the patient, for screening, self-help groups, training of health professionals, family support, context analysis, on the content, reconstruction of the affective and relational fabric, pastoral programmes, collective prayers and assessment.

These centres are connected with universities, public hospitals, ministries of justice, education, labour, public relations and health. They also relate with local bodies, dioceses, parishes, police forces, employers, home neighbours, neighbourhood community, trade unions and charitable institutions.

Specific courses for training in pastoral care in mental health are organised. In these courses ethical questions related to drug abuse, coercive forms of treatments addressed and the way to approach a mental patient is discussed.

It is commonly believed that at the origin of mental disorders there is a strong cultural and religious influence fostered by a crisis of values of reference, hedonism and materialism, the technological culture and by the exasperation of desires and the search for the impossible, by the conflict of culture and religion, by the magical ritualism of some religious sects, the denial of the transcendent and by the ethical-religious relativism.

High risk situations include insecure means subsistence means, unemployment, poor education and training, lack of help networks, alienation of human rights, exclusion and marginalization, wars, terrorism, lack of education in sentimental life, the process of detachment from reality, influence of the environmental context, lack of social protection, corruption, imbalance in gender roles, lack of parental figures, separation and divorce, loss of the value of the institution of marriage, lack of communication, lack of time to spend together in the family, immaturity of parental figures, delegating responsibilities to third parties or institutions, weakness of the shared life project, inadequate preparation for married life, conflicts between parents and children, and aggressive or violent behaviour.[2]

II. Mental Disorder

By God’s grace, the work carried out by the Catholic Church in this area is indeed praiseworthy; it is work that has been done for centuries as testified by religious orders and congregations whose charisma consists mainly in taking care of mentally ill patients.

Considering how widespread this illness is — 450 million people as mentioned above— the bishops of Oceania have certainly made a timely decision to have the mentally ill person as the key issue for the discussions of this World Day of the Sick. This shall undoubtedly spur the Catholic Church to continue the work undertaken and it shall foster dialogue and cooperation with the institutions in charge of such duties in modern societies.

We shall now embark on a reflection on the mentally ill patient, starting from a Christian point of view. We shall begin from basic scientific information on mental disorder and then consider how the mental patient does not cease to be an image of God, and as such he or she deserves every respect. [3]

1. The Disorder

There is no doubt that the mentally ill patient —though still a human being— is someone who escapes classification as a normal person. In other words, he does not have the necessary equilibrium that enables one to define him as a person with full use of the human faculties. As an individual, he suffers from an alteration of the internal order and this is translated into an alteration of the external order that involves the whole universe.

Actually, the great thinkers of humanity have made happiness coincide with order, in its cosmic adjustment. In Oriental thought, we find Taoism, according to which the active masculine principle, Ying, must adjust to the flexibility of the feminine principle, Yang, which in the final analysis represents the order of the universe, even though this order is flexible only up to a certain point and changes according to the transformations of the universe. More or less the same idea was followed by several stoics of Greek culture, who sustained that one had to be in agreement with the whole cosmic dynamics, and that perfection actually consisted in being in syntony with the inexorable order. At the beginning of the Renaissance we find the organological thought of Theophrast Bombast Von Hohenheim and Paracelsus, who asserted that in a flower one could find the perfect and total order of the universe, a macrocosm in a microcosm. The entire universe is like a huge living organism to which we all belong and are its synthesis; the activity of each individual is sustained by a higher order to which one has to conform oneself, lest one runs the risk of becoming a cosmic anomaly. In a way this is close to the thought of Nicholas de Cusa with his ideal of the coincidence of opposites, as an order in the apparent disorder. Even in the concept of Redemption —especially under the influence of St. Anselm of Canterbury— in Western Theology, the work of Christ is classified as the restoration of the violated juridical order.

2. The Disorder of Neuronal Synapses

In the recent studies on neuronal activity, mental disorder is associated with the alteration in the order of the neurons. Actually, according to the description of the organic functions in Neurosciences, there is evidence of the complexity of communication between the neuronal cells sending and receiving messages. It is a network of very complex connections, which enable one to perceive and classify, to judge and put in action, along the route that extends from the external stimulus to the cerebral cortex and succeeds, so to say, in organizing the organism and attains equilibrium and harmony.

We know that the central nervous system collects and processes the information sent by our sensory organs, which it subsequently organises and acts accordingly. All these operations are the material underpinning the higher functions like thinking, memory and consciousness.

There are particularly two main instruments to follow the sensorial — neuronal — cerebral journey, namely: the propagation of the mechanism of action and the synapses, in other words the transmission of the electrical impulse of the neurons and the passage of a signal from one neuron to another. Each of the 100 billion of our nerve cells is connected via synapses to about 1000 to 10,000 other neurons. Learning and acquiring new skills by the human organism, requires changes in the synapses, known as “plastic changes”. In order to realise this change, all the synapses are involved and they will, in turn, change in every new connection. It is sustained that some human skills and abilities depend on the various patterns of connection present in every individual.

Connections take place thanks to the electric impulses, which neurons receive through the so-called ion channels, as a wave of positive electric charge propagating all along the cylindrical extension of the cell body, known as the axon. Such channels represent special permeability points present in each nervous cell. These points are special proteins that form pores in the cell membrane of the neuron, which open and close when they are appropriately stimulated, permitting the passage of external fluids. They through the ion channels transform the fluids into electrical impulses. The electrical impulses of the synapses are integrated into the neuronal dendrites, thus generating a potential action which is transmitted to other neurons. It is normally said that the basic model of the whole set of connections between neurons represents the material base of the memory, that is both of the so-called “declarative” or conscious, as well as the “procedural” memory (the portion which is used when performing tasks and governing unconscious reactions). Hence, the sensory information is processed progressively in consecutive layers of neurons.

With the aid of computational techniques (neuronal networks), the patterns of synapses of the networks of the different layers of neurons have been plotted. Nevertheless, though these techniques have worked well at a lower neuronal level, the real synapses of the cerebral operations in the whole complex of neuronal activity have not been fully understood, especially those concerning the higher mental functions of consciousness, thought, and emotion.[4]

3. Understanding the Neuronal Synapses

The mere comprehension of the action of neurons and the relative complexity of their connections is certainly very important for the understanding of cerebral activity, yet it is not sufficient for its complete and adequate understanding. On one hand, the brain operates simultaneously as one whole through large assemblies of neurons —and this whole action has not been fully penetrated yet; on the other hand, the merely biological-chemistry explanation is inadequate when it comes to the higher functions, especially the ones referring to abstraction and consciousness. As to the consciousness, we clearly ask ourselves, if it implies turning back into itself yet it is entirely made up of a mere biological element, is it possible that a quantitative element turns into itself. It would be and not be at the same time. Yet, this implies the absurd violation of the principle of contradiction.

Studies carried out in the scientific field, to which we have referred above, are certainly very useful, since, though a neuronal disorder alone does not explain the whole reality of mental illness, it is nevertheless an extremely important element leading to its explanation and therefore its treatment.

4. The Soul Factor

For a more complete understanding of the mentally ill patient, neuronal factors should be underpinned by the holistic understanding of the psyche. Already in ancient times it was understood that human life was necessarily made up of two fundamental aspects and that its relations for subsistence had to be directed to the care of those elements that we have classically defined as soul and body. When speaking about a mentally ill patient, in ancient Greece, Socrates preferred to consider only the soul, and he stated that the illness of the soul could only be resolved by means of maieutics —a technique leading to the knowledge of oneself by purifying the sick soul so that it may reveal its inner truth and is recovered by the knowledge and practice of virtues. Plato and Aristotle also dealt with the issue. Plato, with his dualistic mentality, believed that the major cause of mental illness was the body; mental illness is like the mud of the body that soils the soul of the mental patient, which could here be compared to a beautiful amphora lying on the sea—bed and becomes covered with mud and debris. Also Aristotle supports this view, though with a more balanced approach, when he asserts that it is the intellect which imposes harmony on the body; a harmonious soul will give life to suitable forms of the body, avoiding illness which is typically of the body, but at the same time basically arising from a disharmonious soul.

We could however affirm that the classical Greek thought is still present in the current way of conceiving the biochemical model of psychiatric disorders. Today the soul is identified with the biochemical energy of the neurochemical, neuroendocrine and neurovegetative systems of the cerebral cortex, the hypothalamus, the brain stem, the epiphysis, and the vegetative system. All these structures are linked to each other according to a plan aiming at self-equilibrium, for the prevention of possible irregularities. Mental disorders express an imbalance of this multi-system, diffused like a network throughout the whole body. The moment one of these systems is unbalanced, all the rest will be unbalanced.[5]

The mentally ill person suffers from this disorder, which varies depending on the type of psychic disorder that affects him. In all disorders there is an alteration of these connections, or parts of them, which produces an internal disorder that will lead to an external disorder that is relational in the social sphere.

Regarding the complexity and the seriousness of this disorder we should not forget the opinion of some psychiatrists, who assert that the instinct for life relates in an indissoluble way to the instinct for death. Both drives intertwine and psychiatry studies them complementing the “pleasure principle” with the “reality principle”— the pillars of psychotherapy— and considering the death instinct as an inner necessity of life.[6] The disorder affects both instincts and further complicates the state of mental illness.

On the other hand, when referring to the treatment of a mentally ill person, Psychiatry presents a wide grey area of uncertainties that clinical practice and scientific research help to identify under three different aspects: the precariousness of the theories on mental illnesses and therapeutic strategies, the high emotional involvement of the mental health care professional and the technology. Some scholars believe that the level of technology in Psychiatry is indeed low, in fact the therapy used is not technological but interpersonal.[7]

Nevertheless, in spite of all the difficulties of the studies of psychological sciences on the reality of mental illnesses, there is at least evidence of the fact that mental illness is due to a disorder in the reasoning, which is however not lost. It has been affirmed outside the Christian thought that man is made in the image of God because of his rational soul, or in classical terms, because man is a rational animal. Now, if this man loses his rationality, there would be no objection if he were treated as a being with human features but is no longer human.[8]

Obviously, this way of thinking is just a sophism, because the mentally ill patient has not lost his rationale, but, rather, it does not function as it should.

III. What can be done?

1. Mental Disorder in Christian Thought

In Christian thought it is said that these severe mental illnesses reduce man to sad conditions, like a deformed image of God, which is compared to the suffering servant of Isaiah (Is 53,1-7). Yet, apart from that deformation, or rather due to it, the mentally ill person resembles our Lord on the cross; and since the cross is the only way to the resurrection, the mentally ill person, has so to say a superior level, is worthier and reaches such a level of excellence because of the magnitude of his love and the suffering he endures.[9]

2. Is He a Deformed Image of God?

If the above holds true, I would like to move a step further and venture a statement that might shed light on the issue, from the point of view of Moral Theology. The statement is that: the mentally ill person is not a deformed image of God but, rather, a faithful image of God, our Lord.

Such a statement intuitively finds confirmation in the thought of our Lord when he says: “The Kingdom of God is within you” (Lk17, 21) and “what comes out of the mouth proceeds from the heart, and this defiles man” (Mt 15, 18). “For from within, out of the heart of man, come evil thoughts, fornication, theft, murder, adultery, coveting, wickedness, deceit, licentiousness, envy, slander, pride, foolishness. All these evil things come from within, and they defile a man” (Mk 7, 20).

The Kingdom of God, the existence of the Holy Trinity in each one of us, may be found in our heart, the heart seen as the ultimate source of decisions that give form to our whole existence; not only that which was previously defined as the fundamental option, but also the whole meaning of this option, with all the actions we perform to realize it. In other words, the heart represents all our dynamism at the service of the mission that God has entrusted to us.

The Kingdom of God enters into the loving knowledge and in the decision made in the deepest intimacy of our person, which are then realised by the power of the Holy Spirit, who leads us by the hand like Children of God, and by the total collaboration that give form to our existence, according to the Law of God. If we want to separate from the Kingdom of God, we can do so only with an evil heart, to which Christ our Lord refers, and from which all the sins come.

3. Faithful Image of God

Therefore, once the mental illness has caused such a disorder as to take away from the mentally ill patient any responsibility for his actions, qualifying them as separation from the divine will —as a sin— the mental patient cannot separate from God. In other words, the image of God in him cannot be distorted. In this case his knowledge or his volitive option are no longer sufficient to motivate any human action that separates him from God. His bodily and psychic conditions do not allow him to commit a grave sin, given that in his state of disequilibrium he does not have that full knowledge and ability of assent required to sin.

If we approach the argument from this point of view, whereby the mentally ill patient does not have the knowledge or the faculty of full consent required to commit a mortal sin, his is not a deformed image of God, since that image can only be deformed by sin. Certainly, it is the suffering image of God, but not a deformed image. He is a reflection of the mystery of the victorious Cross of the Lord. Inspired by the image of the Suffering Servant of Yahweh (Isaiah 53, 1-7) we are drawn to a conscious act of faith in the suffering Christ.

It is not by chance that in the old popular Mexican language, a mad person was called “bendito”, that is “blessed” not without the full use of reasoning, he was unable to commit sin and was, therefore, destined to eternal life.

It is true that the objective disorder of sin and its consequences are manifest in the mentally ill patient; however, at the same time, there is in him the historical equilibrium of the only possible order, the order and equilibrium of the Redemption.

This is not comprehensible to a secularized mentality; it is only understood within the context of Christian optimism, which stems from a reasoned faith that tells us how in such circumstances our obligations towards a mentally ill person, on one hand satisfy our duty to see the suffering Christ in the poor and less protected; and on the other hand the idea of seeing in the patient the love of God who has indicated him as his chosen one, in the sense that he shall not be separated from Him.

He is therefore a proof of the crucified love of God. Hence, the best thing we can do is to give them a treatment of love. Since the mentally ill patient is also the image of the resurrected Christ, we have the obligation of being the “Good Samaritan,” that is providing all that is necessary for his care. We need to think about a series of treatments that should be devised to pull these patients out of the prostration that is all the more painful the deeper the psychic suffering is. In fact these patients often lose the sense of human relations and feel persecuted by a hostile surrounding environment; or the subjectivity of the environment disappears and for them people become many objects, or are indifferent or even real threats to their security.

4. Treating the Mentally Ill

The treatment for a mentally ill patient should be a treatment of loving care, tenderness, and kindness, in order to help him cope with his imaginary world, perceived as an enemy, a world in which he often drowns. The treatment which should be personalised and of maximum quality, requires also maximum diligence in prescribing treatments and most appropriate medicines. It will draw from all the resources made available by science, be it from medical and technical arts or from the research that is always progressive looking for the most adequate medicaments from the psychosomatic point of view.

Practical Lines of Action

In this perspective, allow me to suggest some guidelines for practical interventions, which will help us offer a loving care to the mentally ill:

General Interventions:

• Establish, in the education systems, solid religious foundations that help one to work out clear and stable horizons, to be followed for a lifetime.
• Be aware of the system of values underpinning the whole human life and make reference to it, especially to avoid that mental illness is lived with anxiety, sadness and desperation.
• Fight against relativism, consumerism, pseudo—culture of instinctive desires and pansexualism.
• Promote the dignity of mentally ill patients.
• Foster a healthy development of the child, including his brain functions.
• Make awareness programs on mental illnesses for the society so that people may know about them and prevent them.
• Exhort religious Orders and Congregations, whose charisma it is to take care of these patients, not to waver in their commitment and to dedicate particular care to them, given the particular emergency that this illness presents.
• Support these patients with the administration of sacraments where this is possible.
• Enlighten and console the mentally ill with the Word of God, if their mental and physical condition allows it.
• Be aware of the fact that the rehabilitation of a mentally ill patient is a duty of the whole society together, within the context of solidarity that shows preference for those who are most in need.
• Promote a social and physical environment that favours human relations and for the mentally ill patients a sense of belonging to a concrete community.

National Interventions:

• Promote, at the national and international political level, appropriate laws to safeguard the rights of mentally ill patients.
• Urge the Health Ministries of various Nations to have a special attention for the mentally ill patients designing effective programs for them.
• Develop and integrate mental health services in all primary health units.
• Create appropriate institutions for a better broad- ranging care for the mentally ill patients.
• Allocate all the necessary funds to provide the necessary care to mentally ill patients.
• Provide hospitalization for the mentally ill patients who require it, as well as their stay in compliance with the recent advances in psychiatric medicine.
• Provide housing to the mentally ill who are homeless, roaming or cannot be kept in families.
• Institutionally support families in which there is a mentally ill patient with technical and scientific assistance as well as with understanding and respect.
• Promote research related to the different types of mental disorders and appropriate therapies for them.
• Humanize therapeutic programmes by means of continuous education for health care workers.
• Adjust psychiatric treatments to the diverse cultural patterns of patients.

Personal Initiatives:

• Educate within and from the Christian family providing everyone with solid life foundations in the acceptance of Christ —dead and risen— the reason of our existence.
• Intensify prevention of mental illness through effective action within families, especially in the first years of children’s lives.
• Strengthen the unity the families, giving the marriage institution all the power it deserves.
• Give more room to coexistence in the family, between spouses, parents and children and among siblings.
• Enhance bonds of affection and understanding in the nuclear as well as in the enlarged family.
• Let grandparents assume their proper roles.
• Offer your own children an appropriate maternal and paternal image.
• Treat children lovingly, offering them at the same time education with determination, clearness and vigour.
• Establish in the family solid relationships with teachers and other persons helping parents with their children, without entrusting them with duties that should never be delegated.
• Accept mental illness positively, fighting the stigma to which such patients are subjected.
• Understand both the physical and psychological needs underlying mental disturbances.
• Enhance individual potentials of every mental patient.
• Foster interpersonal communication between the patient and the people around him, especially within their own family.
• Free the patient from loneliness, isolation and abandonment.
• Teach the mentally ill the way to develop their own capabilities and the sense of self-determination.
• Teach the family members the proper behaviour in relating to a mentally ill member.
• Understand that science alone is not enough to treat a mental disorder, there is need for a holistic approach, including all its religious, philosophical and scientific aspects.
• Instil hope in the patients and their families.
• Intensify the therapy of loving care and kindness when treating the mentally ill.[10]

Conclusion

Remembering that sentence engraved on the lintel of a German hospital “Infirmis sicut Christo” — to the sick as to Christ— I would like to conclude my reflection insisting on this image of Christ suffering in the depth of his soul, full of pain and affliction, yet he succeeds in transforming this evil into a source of life, since his pain and suffering constitute the nucleus of his Resurrection, and therefore our salvation. Our way of approach to the mentally ill is a difficult test for our faith. Handling them effectively means professing our faith in the agonizing and suffering Christ, but at the same time victorious. This is the sense of today’s celebration of the World Day of the Sick, dedicated to the mentally ill patients.

Adelaide, Australia, 9 th February, 2006