William:
There is a challenge that we may encounter when we are supporting or companioning someone on their journey of spiritual growth. And this challenge is often very confusing. At least, it is often confusing for me.
The confusion comes from distinguishing between the normal challenges of spiritual development and mental illness.
Having worked in this field now for many decades I expect everyone on the spiritual path to go through occasional times of confusion, depression, elation, delusion and insight. That’s normal – and we learn from them.
It is also normal for people to get over-attached to a particular belief or guru, and become fundamentalist, unable psychologically to accept and manage opposing ideas and perspectives.
The problem here and the source of my own confusion is that spiritual elation and fundamentalism look like, and may actually be, mental illness. They might, for example at worst, be presentations of psychosis or paranoid delusion.
My dad was a psychiatrist and when I took two years spiritual retreat, he was psychologically unable to process that his son had done this, and he told his friends that I had left the country on a tax dodge. Till the end of his life he was embarrassed by my engagement with spirituality; it looked to him like a personality disorder or mental illness.
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Spiritual companioning – supporting someone on their spiritual journey – also carries its own challenges. The person we are supporting might fall into patterns of projection, transference and dependence. As we become close to them, they start to process unresolved issues from childhood and we become players in their psychodrama. This too is normal.
But there can be worst case scenarios. The person we are supporting may go into an extreme crisis, unable to cope with daily life – depression, hyper, delusion – and at the same time they act out extreme dependency, projection and transference on to us. They need us, love us, hate us, and so on. In response, we of course want to support, be useful, compassionate and caring, but are now caught in the dynamics of their crisis. This can be overwhelming and exhausting. Worse than that, we are no longer of any use. (This may be when we realise that effective mental health care is best done in a team of family, carers and professionals.)
Over the years, my way of dealing with these crises and their dependencies has been to develop an intuitive sense that such a scenario is coming; and to slow down the process and relationship, by backing gently off and distancing myself. If there is what I call “a wave of grace” my gentle backing off can create the space for a new dynamic that helps my companion realise that they are going into crisis, and that they themselves need to slow down and self-manage. Several times, though, I have not handled it adequately and my companion has gone into crisis, and then both blamed me and wanted me to save them.
It is all very tricky and, as I wrote above, can be overwhelming.
More than that, in these situations I have to be very careful and acknowledge that my own training and capacity are limited, and I need to start a referral process. Of course, finding the right referral can itself be really difficult and usually requires the support of their family and general practitioner (UK NHS medical doctor.)
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What I do know, however, is this: the whole process and the dynamics of the relationship would have been eased if had known early on if my companion had a history of mental illness. If I had known early on that they had a history of mental illness, then I would have acted more carefully and with clearer boundaries.
This means though that, when supporting someone’s spiritual journey, it is actually good practice to ask if someone has a mental illness history; and that can feel awkward, intrusive and embarrassing. My experience though is this: if my heart is filled with care and compassion, and they can feel my empathic support, then it is a relief for them to tell me. They may be annoyed or defensive for a few minutes, but this subsides – and there can be a deeper and more meaningful connection.
Amy:
As I sit down to write my part of this blog, I instinctively feel myself tensing and my mind going blank. It is such a sensitive topic, partly because I struggled a lot with my mental health in my teens and early twenties, but also because how we deal with mental health can have such a positive or negative impact.
So before writing, I first wanted to ground myself in the practicalities. I looked, therefore, at the Spiritual Companions Trust’s Code of Conduct and our resource on Spirituality and Mental Health. I felt relieved. I don’t professionally or formally support people on their spiritual journey, but I do it all the time informally in my work at the local library and in my social and family life. The Spiritual Companions’ guidance applies whether we give support formally or informally.
In our guidance we suggest that we gently enquire about someone’s mental health history and maybe even those within their family. This can be difficult. I know I get prickly when people ask me what my mental health history is or, if I have disclosed already, they act differently because of it. So we risk potentially hurting a relationship we have formed with someone we are supporting if it’s not done in the right way.
My advice is as long as you are doing it with love, compassion and caring then its hard to go wrong; and if you do go wrong, use it as a way to explore with the person a better way of framing and exploring it with them. The key is not to completely avoid the conversation – delaying it is okay – but it needs to be had in order for you to safely work with and support someone else.
If someone is unwilling to go into this with you it might be that you need to skip ahead and advise them to speak to their doctor or mental health professional; you may also need to work with the family to do this. Whatever you do, always make a little note in your diary or similar so you know you’ve done it (or keep messages, emails, etc.).
Sometimes people may become very reliant on you or demanding. They might go the other way and reject you too. I think it is important to maintain your boundaries whilst demonstrating love and compassion. It’s okay to say that you need to stop supporting someone if it is outside of your remit, you are feeling overwhelmed or for any other reason. On the other hand, it’s also important to remember that its ok for the other person to struggle with you pulling away; it’s natural and expected, in fact. To help with this you can check that they have support from others and with kindness refer them to someone else better able to support them. Of course, also ensure you yourself have support, such as supervision with a wise friend or professional, or a peer group, to manage your own process and support your wellbeing.
Some First Aid Hints
There are also things that you can do to help someone if it looks like they are going into a crisis triggered by their spiritual journey.
- Encourage them in the first place to meet their basic needs – sleep, eat, drink, gentle movement and exercise.
- Tell them to slow down or temporarily stop their spiritual practice, because more spiritual connection and energy may make things worse.
- With the person’s permission, contact their friends or family, so that they know that their family member or friend has gone into temporary crisis; and can therefore relate with greater sensitivity,
- If relevant, enquire whether you can join or liaise with the person’s health care team. You can act as a pastoral champion representing the spiritual dimension in a multidisciplinary team.
- To ensure your own good practice, regularly have honest reflective conversations with trusted friends, Spiritual Companions, coaches, supervisors, caregivers, clinicians and therapists in your spiritual network
For more helpful information, see our diagram for a Mental Health Referral Pathway and our Spirituality & Mental Health booklet.
POST-PUBLICATION REFLECTION
Upon reflection and after some poignant feedback, we realised we had communicated clumsily so the blog could have been interpreted as ostracising those with mental health problems, or a history of them. Though this was far from our intention, we acknowledge that the blog could lead people to believe this. We apologise for our clumsiness.
We know that over one quarter of our population will have a mental health problem at any one time; and that probably the number of those with a history of mental health problems could be larger than this. We also know that there can be a cultural bias and that spiritual approaches and practices from other cultures can often be seen by others as a mental health problem. We also know that spiritual health is vital for your mental health, so those of us with mental health problems can be profoundly supported by appropriate spiritual care.
In the Spiritual Companions Trust, we want people to feel comfortable navigating this sensitive and sometimes confusing area where there can be a lot of blurred lines and no clear-cut answers. So, we want to add to our previous (clumsy) blog the following clarifiers:
- Everyone with mental health problems (or a past) can and should have access to spiritual support.
- Someone struggling with their mental health is not a warning sign to stop supporting someone spiritually.
- You can still support someone with spiritual care during a mental health crisis, but you may not have the skills or experience to help with the actual management and healing of their mental health challenge.
The reason I say that you may not be able to help them with their mental health crisis is because you may not be trained enough to give them the care that they need. If you are coaching or companioning someone (even informally) you have a duty of care to them and to ensure they get the best care and support possible.
Sometimes we will need to admit to ourselves, and the person we are supporting, that we are not the right person for the support that they need. This is normal good practice – knowing our limitations. We can do spiritual work with them, but they may also need to see a psychotherapist or other mental health professional. It is when suggesting that they see a mental health specialist that we may sometimes experience issues with the person we are supporting. And those are the circumstances that prompted our original advice. If we want to really help someone, sometimes we need to know when to back away – because our being there can stop them from finding the right person(s) to support them.
We will companion and support some amazing people, see them turn their lives around through various physical and mental health challenges. We may develop strong, long relationships with wonderful human beings. Some will have a diagnosable mental health problem, some won’t. Often no one will be able to tell the difference between the two!
But every now and then we might support someone that we, either temporarily or permanently, need to refer to someone else. Of course, we can keep that person in our prayers and carry on loving them, keeping an open heart to them. Time passes and there may be changes so that we support them again. But professionally and with intelligent compassion, setting a boundary and making a referral may be the most blessed and right action.