Saturday 9 May 2009

Psychiatric Care

I had a nervous breakdown and was a day patient for 'counselling' in my local hospital. When I saw the psychiatrist I explained that I had been in a Pagan group where the High Priest had been a very bad influence and had us doing black magic. He said I was delusional and didn't believe a word. In fact I ran out of the hospital crying, I never went back.

In the past some clinicians believed that holding any degree of religious belief indicated delusion. Happily, that situation has reversed and spirituality has been recognised as being of benefit to psychiatrically ill people

  • Pagans are no more or less susceptible to psychiatric illness than non-Pagans. However, since Pagan beliefs are not widely understood it is important that carers are able to differentiate between real illness and Pagan belief.

Some Pagans will have trained to become clairaudient or clairvoyant and would not welcome any attempt to block these skills. Hearing or seeing things that others can’t is not necessarily a bad thing. However, if what the person hears frightens or compels them to do something they don’t want to, then they need help.

Pagans might tell you that they are a witch or a druid, must cast a circle and invoke a Goddess and you may see this as an aspect of their illness. There is indeed a fine line between demanding that staff allow us to dress in robes and wave a wand around, and searching for some inner peace via spirituality. Many Pagans are witches, casting a circle is to create a formal space in which to raise energy and importantly, contain it. Raising energy can make a person elated and if they are ill the effect of this may be unpredictable.

  • You may want to ask for help from the Spiritual Advisor or Pagan chaplain who will listen to everyone’s needs and suggest ways in which they can be fulfilled. They may be able to suggest alternatives to ritual work or work ritual with the sick person to control and direct their feelings.

Pagans understand the cycles of birth, death and rebirth which are as appropriate to psychiatric illness as they are to physical. We have myths and legends to help us through difficult times; Demeter and Persephone may be especially useful, using this archetypal experience as a mirror of our own experience. Many of us see mild psychiatric illness as a necessary part of growth. Shamanic Pagans work towards an experience of controlled stripping down to the soul in order to better understand themselves. This is usually achieved without psychoactive drugs.

  • Of course, if someone is a danger to themselves or others then they need swift help but unless particular idiosyncratic beliefs are proved to be dangerous – such as a god telling a patient to self-harm - they should be respected.

If nothing else Pagan practice may be a tool to aid recovery. Paganism does not believe that we are inherently sinful, hell isn’t part of our vocabulary and we don’t feel responsible for saving anyone. We are meant to take responsibility for our actions and whilst mental illness removes some or all of that ability it can be a useful touchstone.

Organ Donation and Reception


There are no formal teachings about organ donation or reception. Some of us believe that it is wrong to swap body parts, others that if donating a kidney or bone marrow will save a life then it is justified. Most of us are happy to receive blood products and donate it.

I if I were to be involved in organ donation I would like a chance to 'cleanse' the organ, or otherwise prepare it for entering a new body. I have read of people taking on aspects of the donor's personality or likes/dislikes etc and it makes perfect sense that the organ would carry energy that is suited to the donor. I don't know practically how it would work, but I can't see it needs to be a complicated ritual. Also, if it was the organ of a loved one who had died then I would like the chance to keep that person's energies intact for whatever they were going to do next.

Death

Death is a part of life, neither can exist without the other, it is natural and inevitable. Medicine is able to prolong life but this doesn’t mean that it always should. The individuals wishes should be of prime consideration and most Pagans will have written an Advance Directive, letting carers know what those wishes are.

Pagans will want to know when they are dying so they can consciously prepare for it. Some will want to choose their place and time of death; many will want to die at home.

When a Pagan is dying she will want to be in safe, familiar surroundings with her children, animals and friends around her and as close to nature as possible even if that simply means an open window. Some Pagans will want elaborate ceremonies performed, others will want simple but equally important words said.

When the spirit finally leaves the body we need a period of stillness and peace, the spirit can be confused after it leaves the body and the living can gently help it move on to wherever it’s going.

Sometimes we will remove flowers since they offer an easy pathway back to this world. Then if the living feel able they will perform final prayers and actions. Some will want to take the body home where they will prepare it for burial or cremation which is fully within the law: it is illegal to refuse to allow the body to leave the hospital unless you are a coroner or a doctor working on behalf of the coroner.

The majority of relatives and friends will welcome your help and guidance with final offices

Autopsy is generally disliked, being seen as an unnecessary invasion of the body.

The Pagan Book of Living and Dying




When my dad died in the A&E theatre they had been working on him for a long time. I breezed in and spontaneously went into an altered state, saw my dad on a staircase not knowing whether to go or come back to my mum and I knew that he had a choice, to come back and be brain damaged or to die. It felt as if I had the power to bring him back with me. I then had a vision of him being met by my biological father, Thomas, at a wall shaking hands and Thomas saying to my dad that he could wait for my mum there, it wouldn’t seem long to him but it would be about 20 years on this plane. Our dog Pax went to him and another small brown dog. I described the clothes he and Thomas were wearing to my mum, they were the clothes he used to wear when they first met in the 60s! The small brown dog turned out to be one he had as a youth according to my stepbrother. When I came to, all the crash team were just standing around the bed and me in a semi-circle silent, some crying. I went to talk to Hecate and ask her for release and his safe passage. As I was in the family room he visited me and just wafted my hair, I knew he was ok. I felt very empowered with the whole experience and the control of the situation made the passing easier.

Unconciousness


Many Pagans believe that the soul or parts of it can leave the body in times of physical or emotional stress. We believe that this is what happens when a person becomes unconscious, giving the body and mind time to rest and heal. But long-term unconsciousness is a serious matter. We have a way of dealing with this problem, called Singing the Soul Back Home (Appendix2) when a properly trained and experienced shaman can go looking for the missing parts of the ill persons soul and bring it back so that they can begin to return to this world. This ceremony has been performed in ICU’s before with good effect.

Complementary Therapies


Pagans tend to use complimentary therapies as a matter of course to treat acute and chronic conditions. This doesn’t mean that we reject allopathic medicine at all, but it may mean that we’ll allow an arnica tablet to dissolve under our tongue before surgery, which doesn’t affect gastro esophageal reflux risk. Patients are asked to hand over all medications so that they can be prescribed and monitored and sometimes there may be confusion over what constitutes ‘medication.’

General Illness

Pagans have very few specific rules about how we should live other than that we should take responsibility for our actions and understand the interconnectedness of all things. This freedom, however, doesn't mean that we live our beliefs casually. Individual Pagans will have examined their own ways of being through a personal (rather than hierarchical) understanding of our responsibility and interconnectedness.


Medication
The majority of us are opposed to animal testing and this may affect our acceptance of some medications, those containing gelatin or stearic acid and particularly animal-derived HRT and insulin.

Diet
Some of us will be vegetarian or vegan, but most have no religiously-determined dietary needs.

Jewellery and other religious objects
Hospitals are not the place to keep precious items and Pagans will understand that we can’t keep a multitude of objects on our bedside cabinet. We also know that we can’t burn candles or incense because of the fire risk and to avoid affecting other patients.

Some Pagans wear an item of jewellery that has religious significance, just as a Sikh wears the Kara.

The literature suggests that jewellery should be removed where possible but plain wedding rings could be taped to the patients’ finger if necessary. Ring taping is not for infection control purposes but to stop the rings being lost in the drapes. Ring removal can be very traumatic for patients, and Redfern suggests that rather than putting the patient through this distressful process, a thorough handwash prior to surgery would be an effective alternative. There is no evidence in the literature to guide advice on the management of rings or jewellery at other sites – nasal studs, navel rings, nipple rings etc., but there would seem to be no reason to remove these unless they are directly in the field of operation. In the absence of specific infection evidence, a consistent management policy should be developed related to preoperative preparation of the patient.

Recommendation:
There is no reason to continue the practice of removing the patients rings or other jewellery unless they are in the operative or anaesthetic field.



Behaviours and rituals in the operating theatre A Report from the Hospital Infection Society Working Party on Infection Control in Operating Theatres. Journal of Hospital Infection, Volume 51, Issue 4, Pages 241-255, 2001 A report from the Hospital Infection Society Working Group on Infection Control in the Operating Theatres

K Woodhead, EW Taylor, G Bannister,T Chesworth, P Hoffman, H Humphreys





And so we would request that you let us know that we are responsible for the loss of any jewellery and that you let us keep it. If we need neck surgery we’ll remove necklaces; hand surgery, we’ll remove rings from that hand. The literature on diathermy and electrical burns suggests that jewellery be removed from a distance of around 30cm from the operative site.

The issue here is one of control and power. Patients have very little power and health care staff have total power. Things that seem ordinary and of little importance to one group can have great ritual power to the other, including the rituals that build up around professional health care. If a patient feels respected they’re much more likely to volunteer to cooperate in the rituals that wards find useful.

Being in hospital over festivals
Most Pagans celebrate 8 festivals throughout the year, every 6 weeks or so, Some celebrate moon phases, particularly the full moon. Whatever the case, we’ll understand that it won’t be possible to mark the event as we would normally and will be quite content to modify our practice so that we can satisfy our spirituality without disturbing the rest of the ward.

Our festivals are an opportunity not just to honour our Deities but to join with our community, so if possible we’d like to be able to have our companions with us to mark the occasion. Simply pulling the curtains or screens around the bed will be enough to ensure our privacy and we can observe our festival quietly.

Discussing the needs of the ward and the needs of the patient, with the patient and the Pagan chaplain will help decide the timing of the celebration; whether it should take place during visiting hours or not; whether it might take place on the ward or in the multifaith room; a sensible number of people to have around the bed; and of course, the health needs of the patient herself.

Other Experiences
My only experience locally has been with the lady dying of a brain tumour who requested Pagan spiritual support and was told they didn't know of anyone who could minister to her. And then failing to process my application when I offered my services. A Pagan friend who had worked on the oncology ward said she wasn't surprised as the Chaplain wasn't Pagan-friendly.

I was invited to a couple of volunteers' meetings, I guessed it was to enable the other volunteers to check me out. I was purposely introduced to them as a Pagan, and they showed some curiosity about that. I was surprised to find that I was the youngest, and the only non-Christian in the group. The only activity of the volunteers seemed to be to ferry the patients to the chapel for the Sunday morning service. I'm sorry, but it wasn't my idea of spiritual service. My own intention to was to help people who were either Pagan, or not aligned with any particular faith, but were open to using techniques such as guided visualisation to find peace and comfort, or who just wanted to talk about fears or spiritual feelings without having God thrust at them. One of the volunteers did say that they had had a man in with alternative beliefs who refused to speak to any Christians, and just turned his back on them when they visited. The volunteer said he died without talking to anyone, but he did feel that he would at least have spoken to me. So I know from this that at our local hospital at least are failing Pagans spiritually.

I've now given up on the idea of hospital work (but sadly, don't know of any else locally who would do it) and volunteer instead with the local hospice, who are more open-minded. I took a very different approach with the hospice, and for the past 20 months have worked as a regular hospice volunteer - making tea/coffee, laying tables, acting as bingo caller or quiz master, or just chatting to patients. On my application form I did state my interests included meditation/relaxation etc, and in my covering letter I expressed an interest in working for the chaplaincy team, and explained a little about having written and conducted funeral services for people of our spiritual community (which I described as "alternative" and "nature-based" rather than Pagan!). I haven't followed that up since, preferring for people to get to know me as a person before judging me as a Pagan.

A year ago, I lost a friend to cancer. The hospice at home team became involved in the last week of his life, and so one of the senior nurses I work with knew the family and situation. When he died in hospital, I informed the hospice as they were not made aware. Then I explained that I'd only been notified of his death by his family almost immediately because they felt he wanted me to conduct his services. Following the services (crematorium service, followed by green burial), I did offer the nurse a script to read and she seemed quite impressed that it was written personally for A. Although we've never discussed my spirituality, I'm sure all the staff are aware that I'm not a Christian. I think they probably find me a bit eccentric, but reliable and caring and sensitive to the patients and their needs.

I don't talk to the patients about my personal spirituality either, although one was aware of the service I conducted at Birdsong - somewhere he has subsequently decided to be buried. Today he surprised me by asking in private if I would speak at his funeral service. I checked with the staff, and they say if I'm happy to do it, then there is no problem. So I've promised to take him some examples of the kind of things I usually say, just to see if it is really what he had in mind. He did talk about witches in Sussex, so I think he probably has me sussed!

As a result of declaring my experience and interest in meditation and relaxation techniques, pretty much since I started I've been leading guided relaxation sessions for the patients. It surprised me how much some of them gain from it in terms of pain relief. I've recently started training to be a hypnotherapist, hoping mainly to specialise in pain relief; helping to cope with issues surrounding treatment; and facing fears of death and dying. There is so much to learn though!

So, in a way, although it's a long and winding road, I am getting there. I don't suppose it really matters whether I ever make it to Chaplain status or not - I'm helping people, and that is the most important thing.

Childrens Illnesses



The children of Pagan families are not assumed to hold their parents’ beliefs but encouraged to make their own informed choices. However they will be familiar with Pagan imagery and belief from an early age and may find comfort in it when they are not at home or feeling unwell.

Pagan families try to ensure that their childrens wishes are taken seriously. We try not to patronise our children, we guide them, we make decisions for them and we aim to involve them in the choices we make for them. No child wants to experience painful treatment but we will help them face it with as many helpful tools as possible. This could mean involving the child in very simple relaxation exercises or, like any other parent, bringing in Teddy to share the experience, whatever is most helpful.

If a child is extremely ill and expresses the wish to die we will take this seriously. This doesn’t mean that we will remove our child from medical care but that we will listen and talk to staff, friends and the child and together make an educated ethical decision about treatment. With the child we may decide that they be allowed to die with as much medical backup as necessary or should go full steam ahead with treatment. We may want to bring them home with the support that community services can offer. The childs long-term interest are our main concern, as they are for the hospital team, but perhaps we may be less likely to hang onto any slender hope for recovery. The death of a child is terrible and tragic but Pagans believe in some form of reincarnation and a benevolent deity. This can perhaps make appalling decisions easier for us to reach.

The Beginnings of Life


Conception and Contraception
Pagans have no prohibitions around the use of contraception and in a world that is overwhelmed by humans we tend to use it wisely. We have no hard and fast rules about when life begins but we believe in the inherent importance of all living things, including the unborn.

Abortion
Some of us will get pregnant and not want to be. No woman would be condemned for having an abortion. She will be supported with some solemnity in her choice knowing the emotional cost to her is great.

  • Paganism is unique in having a ceremony where the pain of abortion and rape is recognised and dealt with. It is called the Reconsecration of the Womb (See Appendix 1) and is very useful in helping a person come to terms with these traumatic situations.
When I came into hospital for my termination the nurse I was under saw I was Pagan and I was treated with utter contempt. Also when I went for a scan to make sure of the age of the foetus, the Catholic nurse on the scanner tried to force me to see 'your lovely little baby' on the scanner. I found the whole thing quite disgusting.

I don't know what the climate is now but I find it an outrage to have these religious nutcases running around hospitals and shoving their own views on people who are very vulnerable at the time. Can you imagine if a Pagan nurse started trying to 'convert' a devout Muslim?



Pregnancy and Birth

Planned pregnancies are common in Paganism. Many of us choose a special time and place to conceive and because of the life changing and sacred nature of pregnancy and birth, and its uniqueness to the individual, we dislike being processed.

Pagan women make the same choices in maternity care as non-Pagan women but perhaps we’re more likely to opt for home and natural births.If the woman has or develops a condition that requires extra help i.e. diabetes or preeclampsia, then of course she will accept that help, but she will want to be informed and involved in her care.

You may find that Pagan women are less inhibited than the average woman in labour since we’re not ashamed of our bodies. Indeed, the whole reproductive system, female and male, is especially sacred.

In 1985 I was having my baby in Mayday hospital in Croydon. The midwife was very Pagan friendly and so were the entire staff. I was allowed to have the coven in to help me in the delivery room, there were 7 of us! The midwife chatted that the badge on her hat was St Juno the patron saint of midwives and that she knew she was a Roman Goddess. She also told me that sometimes there's an aura when the baby is born and that once she was delivering a baby when the whole room filled with a pink light coming from the baby. She gave me my placenta and umbilical cord in a bag for a ritual I had planned later. Nobody questioned my motives or made me feel weird for asking. So all in all a very positive experience.

A pregnant woman is a reflection of the goddess, she is creating new life and this is a miracle. A labouring woman is powerful and to be treated with respect and reverence. Labour is a force of nature, something that is not fully understood, that has evolved with us and so we trust it to work for us rather perceiving it as a life-threatening event.

Most Pagan women will want to be quietly supported to cope with labour in a very instinctive way. In this manner, a woman is less likely to require analgesia or intervention. However, analgesia is certainly an option is she wants it, as is intervention when research based evidence suggests it.

After delivery you may find that the woman is not very concerned about the childs weight or whether it’s covered in blood and vernix but will want to spend time getting to know this new life. You may also find that she will want to keep the placenta. My daughters’ placenta is buried beneath her namesake tree in Kew Gardens. Most Pagan women will breast feed, some will choose not to, and all will welcome your support.

I stopped breast feeding and developed Mastitis. I was rushed into hospital with a fever and was delerious. I put Pagan down as my religion on the booking-in form. Next minute as I was laying in bed delirious on Morphine, an evangelical Christian nurse came in and tried to convert me. She said I was a Jezabel and that I needed to embrace the Lord. It took all my strength to whisper...fuck off.


If things do not go to plan
If the pregnancy or delivery does not progress normally then everyone has to adapt for the wellbeing of the mother and child and parents will want you to do everything possible.

If the child is very ill baptism is absolutely out of the question, no matter what the midwife or anyone else believes. Some Pagan parents will chose to bring their sick child home and all will want their child to die in as little distress as possible surrounded by love and peace. Most will not agree to an autopsy unless the coroner insists after they have spoken with him, even if the problem is genetic.

  • Midwives are special within our faith; we hold the profession in high esteem. The term ‘Midwife’ comes from the old English meaning ‘With Woman’ or the Anglo Saxon ‘Wise Woman’ and the spirit of the word is enshrined in law today. When caring for a woman with a normal pregnancy midwives are free to make decisions based on their intuition and knowledge.

On Admission


Until recently many Pagans felt unable to be open about their religion because of the misunderstandings that could arise. Some nurses and doctors thought ‘Pagan’ meant ‘No religion’. Some became inappropriately curious. However, more Pagans are now happy to be open about their beliefs and more healthcare professionals are aware of Paganism as a distinct religion, not least because many healthcare professionals are also Pagan.

If your patient answers ‘Pagan’ when you ask what their religion is you may need to determine what they mean. You could ask, “Does that mean that you believe that the earth is sacred?” This will impress and reassure the genuine Pagan patient and will not offend someone who is not using the world incorrectly.

A growing number of Trusts have a Pagan chaplain working as part of the chaplaincy team but a number still don’t. Individual Pagans may give you the name and phone number of their Spiritual Adviser, someone intimate with their particular beliefs and practices who will support them while they’re with you, rather like a good parish priest. Please think about allowing Spiritual Advisors into the ward outside of visiting hours, just as you would a rabbi or priest, and feel free to approach them if you need advice on caring about Pagans.

The Needs of Pagans in Hospital


The needs of Pagans are in essence no different from any other persons. We want to be treated as individuals, our needs to be taken seriously, and to retain some control over what happens to us.

Some basic principals of Paganism are that:

  • The body is a wonderful gift to be respected and enjoyed.
  • We are part of the natural world and subject to the cycles of life, death and rebirth, just like every other living thing.
  • We are responsible for our behaviours, we don’t have a god or a devil that makes us do things or who will do terrible things to us.
  • We’re not above asking for help and respecting those people who offer it in good faith.