Article
Care
Culture
Mental Health
3 min read

Separating mind and body still stigmatises mental health

Our minds and bodies are meant to be inseparable.

Rachael is an author and theology of mental health specialist. 

 

 

Two bird sit on wires facing in opposite directions.
Eduardo Soares on Unsplash.

I recently had a somewhat surreal experience whilst trying to get two consultants to agree to some treatment I needed to have.  

One was a cardiologist, the other a psychiatrist - both consultants, working in the same geographical area - and I found, to my surprise, that there was no recourse for my physical health records to be viewed by the psychiatrist and vice versa.  

And as I went through the process of trying to mediate between these two professionals, it made me reflect that whilst in theory there is agreement that our minds and our bodies are one and that they cannot be treated wholly separately, the reality is something rather different.  

Mental and physical health problems are, in fact, treated as entirely separate entities, with different trusts and funding models in place to deliver care and treatment for mental illness and physical illness.  

Now, there is probably a bureaucratic reason for this, but I believe it uncovers a perhaps unconscious belief that our minds and bodies are distant relatives at best, and not only that, but our mental health is still the poorer relation - best ignored unless it’s particularly bothersome.  

I think this separation sits at the heart of the stigma that mental health problems still face - a stigma that persists even in the mental health system. It has ancient roots. Go back to ancient Greece and its philosophers. They held to a  doctrine where the body and soul were completely separate - our bodies are simply houses for our souls. In a way, the stigma that exists about mental health is the inverse of this- that our minds are less important than our physical bodies and that caring for mental health always comes second to caring for physical health. 

Yet, also in those ancient times, the Bible's treatment of humanity shows that we are creations of mind, body, and soul—all equal, beloved, and cared for by God. In Mark’s gospel, we read that the command to love God and one another is multi-faceted: “Love the Lord your God with all your heart and with all your soul and with all your mind and with all your strength.’ The second is this: ‘Love your neighbour as yourself.’ There is no commandment greater than these.” To love one another, then, means we need to care for one another’s mental health as well as physical health and strength, as we love with our minds and bodies. 

In truth, we cannot care well for ourselves or one another without considering both our mental and physical health. To ignore the mental strain of physical illnesses like cancer, and ignore the physical pains that mental illnesses cause, such as their effects on digestion and blood pressure, is to ignore significant parts of people's suffering.  

In the Old Testament of the Bible there is the story of Elijah, one of the great prophets who flees from a murderous ruler and, whilst spiritually and physically exhausted, begs God for death. “I have had enough, LORD,” he said. “Take my life; I am no better than my ancestors.” 

These are words of desperation that echo those who struggle with their mental health, and God’s reply to Elijah’s pain is to meet him with an encounter with an angel who urges him to sleep and eat, comforting him with the words “the journey is too much for you”. There is no reprimand for Elijah’s suffering, simply comfort for a tortured mind and provision for an exhausted body. 

The answer, then, is to treat ourselves and others as the embodied creations we are, with mind and body inseparable and interconnected in ways that even science cannot quite explain or articulate.  

The answer is to trust in the embodied hope of Christ, who chose to save us through not only his bodily crucifixion and resurrection, but through experiencing the breadth and depth of human emotions so that we may never again feel alone in them. 

Both our bodies and our minds matter to God, and we need to see that reflected in society, where we care not just for single ailments, but the whole person. We need not just an awareness of our minds, but an understanding of what it means to be mentally healthy, as well as a recognition of the horrors of mental illness. Only then, I believe, can we see a society which cares and serves those most in need not simply as isolated symptoms, but as valuable creations.  

Article
Assisted dying
Care
Comment
Politics
4 min read

Assisted dying is not a medical procedure; it is a social one

Another vote, and an age-related amendment, highlight the complex community of care.
Graffiti reads 'I miss me' with u crossed out under the 'mem'
Sidd Inban on Unsplash.

Scottish Parliament’s Assisted Dying bill will go to a stage one vote on Tuesday 13th May, with some amendments having been made in response to public and political consultation. This includes the age of eligibility, originally proposed as 16 years. In the new draft of the bill, those requesting assistance to die must be at least 18.  

MSPs have been given a free vote on this bill, which means they can follow their consciences. Clearly, amongst those who support it, there is a hope that raising the age threshold will calm the troubled consciences of some who are threatening to oppose. When asked if this age amendment was a response to weakening support, The Times reports that one “seasoned parliamentarian” (unnamed) agreed, and commented: 

“The age thing was always there to be traded, a tactical retreat.”  

The callousness of this language chills me. Whilst it is well known that politics is more of an art than a science, there are moments when our parliamentarians literally hold matters of life and death in their hands. How can someone speak of such matters as if they are bargaining chips or military manoeuvres? But my discomfort aside, there is a certain truth in what this unnamed strategist says.  

When Liam McArthur MSP was first proposed the bill, he already suggested that the age limit would be a point of debate, accepting that there were “persuasive” arguments for raising it to 18. Fortunately, McArthur’s language choices were more appropriate to the subject matter. “The rationale for opting for 16 was because of that being the age of capacity for making medical decisions,” he said, but at the same time he acknowledged that in other countries where similar assisted dying laws are already in operation, the age limit is typically 18.  

McArthur correctly observes that at 16 years old young people are considered legally competent to consent to medical procedures without needing the permission of a parent or guardian. But surely there is a difference, at a fundamental level, between consenting to a medical procedure that is designed to improve or extend one’s life and consenting to a medical procedure that will end it?  

Viewed philosophically, it would seem to me that Assisted Dying is actually not a medical procedure at all, but a social one. This claim is best illustrated by considering one of the key arguments given for protecting 16- and 17- year-olds from being allowed to make this decision, which is the risk of coercion. The adolescent brain is highly social; therefore, some argue, a young person might be particularly sensitive to the burden that their terminal illness is placing on loved ones. Or worse, socially motivated young people may be particularly vulnerable to pressure from exhausted care givers, applied subtly and behind closed doors.  

Whilst 16- and 17- year-olds are considered to have legal capacity, guidance for medical staff already indicates that under 18s should be strongly advised to seek parent or guardian advice before consenting to any decision that would have major consequences. Nothing gets more major than consenting to die, but sadly, some observe, we cannot be sure that a parent or guardian’s advice in that moment will be always in the young person’s best interests. All of this discussion implies that we know we are not asking young people to make just a medical decision that impacts their own body, but a social one that impacts multiple people in their wider networks.  

For me, this further raises the question of why 18 is even considered to be a suitable age threshold. If anything, the more ‘adult’ one gets, the more one realises one’s place in the world is part of a complex web of relationships with friends and family, in which one is not the centre. Typically, the more we grow up, the more we respect our parents, because we begin to learn that other people’s care of us has come at a cost to themselves. This is bound to affect how we feel about needing other people’s care in the case of disabling and degenerative illness. Could it even be argued that the risk of feeling socially pressured to end one’s life early actually increases with age? Indeed, there is as much concern about this bill leaving the elderly vulnerable to coercion as there is for young people, not to mention disabled adults. As MSP Pam Duncan-Glancey (a wheelchair-user) observes, “Many people with disabilities feel that they don’t get the right to live, never mind the right to die.” 

There is just a fundamental flawed logic to equating Assisted Dying with a medical procedure; one is about the mode of one’s existence in this world, but the other is about the very fact of it. The more we grow, the more we learn that we exist in communities – communities in which sometimes we are the care giver and sometimes we are the cared for. The legalisation of Assisted Dying will impact our communities in ways which cannot be undone, but none of that is accounted for if Assisted Dying is construed as nothing more than a medical choice.  

As our parliamentarians prepare to vote, I pray that they really will listen to their consciences. This is one of those moments when our elected leaders literally hold matters of life and death in their hands. Now is not the time for ‘tactical’ moves that might simply sweep the cared-for off of the table, like so many discarded bargaining chips. As MSPs consider making this very fundamental change to the way our communities in Scotland are constituted, they are not debating over the mode of the cared-for’s existence, they are debating their very right to it.