Thursday, 3 November 2011

Save Our Souls - on the NHS

Should the National Health Service be tending to our spiritual health and if so, how far should it go?

This week, during a debate about an amendment to the Health and Social Care Bill, tabled by psychiatrist and crossbench peer Baroness Hollins, the Archbishop of York called for the words ‘spiritual health’ to be inserted into a clause about the duty of the secretary of state, the NHS Commissioning Board and clinical commissioning groups to improve the quality of services.

Spirituality is already covered in healthcare guidelines even though there is no evidence-base for it and even though its use is so broad as to be almost meaningless as I wrote about here. For example, going to football matches is considered a spiritual act by some healthcare providers, including the Royal College of Psychiatrists. Guidelines often assume that everyone is spiritual and has spiritual needs that the NHS must cater to. NHS Scotland’s past guidelines stated: ‘We are not human beings seeking spiritual experience. We are spiritual beings seeking what it means to be human’.

The NHS already forks out £29 million a year for hospital chaplains and again there is no evidence that they improve the patient care. In fact, many of the country’s best hospitals spent the lowest proportion of their expenditure on chaplaincy services.

The debate around the amendment wasn't just about some sort of wooly feel-good spirituality. The Archbishop of York’s idea of treating the spirit goes beyond what most people would consider the domain of doctors and nurses. During the debate, Dr John Sentamu told peers: "I am one of those who believe that human beings are psychosomatic spiritual entities."

He then explained how he freed the spirit of a girl who was terrified after seeing a goat sacrificed. Visits from a GP, psychiatrist and psychologist did little to help, he said, but then he said a prayer, anointed the girl and lit a candle on his visit. Shortly after, he received a phone call saying the girl was no longer terrified and was talking again. "That was not mental or physical illness; there was something in her spirit that needed to be set free," he told his peers.

This is a very particular interpretation of the word ‘spiritual’. A spokesman for the Archbishop said the case of the young girl just involved a standard prayer of healing. With candles and anointing to set her spirit free? Although Sentamu did not directly describe his actions as exorcism, they were very close to standard exorcist practice. He is not, by the way, a medical doctor. He is, however, someone who determines the laws and policy of this country along with all the other bishops in the Lords. Even so, as a lawyer he should know that one anecdote does not constitute evidence.

However, his statement isn't that outrageous when you know that the NHS has already been quietly working with exorcists to treat patients for at least 40 years.

Dr Rob Waller, a consultant psychiatrist and an honorary clinical lecturer at the University of Edinburgh was formerly part of a medical support group for the local Catholic exorcist at Bradford District Care Trust. It met monthly to discuss cases and whether they should be dealt with by the church or by a doctor. He said: “There was a similar set-up with local imams, and the Church of Scotland has links with psychiatrists and considers exorcism.” He also said that every consultant psychiatrist will see a “handful of patients” in their career requiring “some kind of deliverance ministry”.

It sounds so much more innocuous when you call it deliverance - although maybe not if you've seen the film of that name.

Professor Robin M. Murray, head of Psychiatric Research at Kings College’s Institute of Psychiatry, who this year was awarded a knighthood for his services to medicine, said: “Not all psychiatric problems respond to conventional treatments. So while I don’t know of any scientific evidence that exorcism works, I would have thought it reasonable for a [hospital] chaplain to carry this out.”

This is a scientist saying that a procedure with no evidence is reasonable.

However, Dr James Woolley, consultant psychiatrist at the Springfield Hospital in southwest London, doesn't believe in demonic possession or exorcism. There are many psychiatric syndromes characterised by a patient believing they are possessed and, for that reason alone, Woolley says, it would be “reckless and unprofessional” to recommend exorcism as an avenue of treatment. “The psychosis could get worse, and being in a highly paranoid state is associated with the risk of harm primarily to yourself and potentially to other people.”

Reckless and unprofessional. There is a possible placebo effect but the ethics of placebos are complex and still need evidence to justify their use.

In the mid-1970s, Archbishop of Canterbury Dr Donald Coggan laid down strict guidelines on exorcisms (deliverance) which were to be carried out only by an appointed diocesan exorcist after consultation with a doctor. The Church of England has 44 exorcists, one for every diocese, appointed by the Archbishop of Canterbury. Next time Rowan Williams is sounding off in the media, bear in mind that he is in charge of these men. The interview for appointment must be interesting.

There's a story in the Mail today about a nurse who asked Jesus to help when a baby was dying of a heart attack. While this is an extreme case, and she was struck off (and it is the Mail) the dangers of introducing any level of non-evidence-based behaviour into healthcare should not be treated lightly. The current trend for 'holistic' treatment opens the door to worse care, not better. At a time when the NHS is facing severe cuts, surely the most important thing is to treat patients and keep them alive long enough to worry about the state of their souls?

1 comment:

  1. 'Spirituality' has to be defined before any debate can happen. There are two tacitly accepted meanings, one being the religious floaty invisible immortal personality - and the other is the more nebulous hippy definition that is used by atheists/agnostics as by anyone else.

    If spirituality is being debated by religious people, then there is no debate outside of their own domain. If it is being debated by those who are not religious, then it has to be clearly defined, possibly even renamed in ways we can all understand. Religion is riddled with inpenetrable ideas that serve to confuse and browbeat the uninitiated, and this should not spill over into what should be rational debate in our own Parliament or society as a whole. :D