A search for meaning

[00:00:01] Lucy: This podcast has conversations around different mental health experiences that may be distressing for some people. If that doesn't feel like something you want to explore today, you might want to visit another podcast and come back to us another time. [00:00:14] Rachel: discovery college acknowledges the traditional owners of country throughout Australia and recognises their continuing connection to lands, waters and community. We pay our respects to Aboriginal and Torres Strait Islander cultures and to the elders, past and present. They have never ceded sovereignty. [00:00:32] Lucy: In this podcast, we share stories that help us learn from each other, connect us and inspire growth. We want to acknowledge that this way of being, of coming together to share knowledge and stories, is a tradition that has already existed on this land for hundreds of thousands of years as a part of the culture of First Nations people. [00:00:51] Rachel: discovery college acknowledges the views shared in this podcast are about mental health experiences, but are not a substitute for professional mental health advice and support. The views in this podcast are not the views of Alfred Health, but are the views of the individuals we've had conversations with. [00:01:07] Lucy: The stories we share on this podcast aren't just stories, but memories of the people who have bravely shared their experiences with us. Remember to take care of yourself as you listen, as well as to take care of the stories that you hear. [00:01:33] Rachel: Extremely Human is a conversation about the profound experience of extreme states. When we speak about extreme states, we want to explore a more humanistic way to understand people's experiences that aren't always shared by others. [00:01:47] Lucy: Each extreme state holds different meaning for each person, including those related to psychosis, depression, grief and addiction. As we chat with a variety of humans, we explore the important question how can we respond to distress with greater compassion and humanity? [00:02:05] Rachel: In this episode, we talk with Elsa. Elsa talks us through her new role as the spiritual care lead and some of her hopes for the role. Elsa breaks down and simplifies what the word spirituality means, what it can look like in a modern world, and why it can be important in the context of mental health and healing. [00:02:35] Lucy: Thanks for joining us today, Elsa. Are you able to tell us a little bit about yourself for those who don't know who you are? [00:02:42] Elsa: Yeah, sure, I suppose in a work context. I work for the Alfred. I've been working on the inpatient unit at the Alfred Hospital for Mental Health and I just recently finished my role there as a allied health principal and I'm starting a new role in July as the mental health and spiritual well being worker. I'm also a mum of three teenagers, married and live locally, so that's a bit about my personal life. I also do some voluntary work with young people. So, yeah, that's a little bit about me. [00:03:29] Rachel: We've been asking everybody who, at the start of each episode, the same question. I wonder, Elsa, if you can think of a time you or someone you know have had a disproportionate reaction to. [00:03:41]Elsa: Yeah, well, yeah. The one I thought about was probably because I've been visiting family and I'd gone to Dublin, and because I knew I was going to see my family, I was going to surprise my mum and dad. I wanted to do something special. So I was like, I need to get something that's Irish. And so I bought a couple of presents for my parents. I got my dad, like, a peaked hat, sort of made in Ireland, like, it's authentic. And I tried to get something for my Mum that was equivalent, and I got her this scarf that was also made in Ireland. And it all seemed quite sort of legit and authentic, and I was just really excited about it. And I get quite excited about seeing people happy or probably over. I don't know, I just do a bit of, like, a bit of a dance and a bit of a. And I remember giving it to my parents, and my Mum's reaction to the scarf was like, oh, isn't it great? And I was just, like, making it, like, trying to sort of make it better than it was, I suppose. But for me, it was just so meaningful and stuff like that. And I was just like a child. I sometimes look at myself and reflect, and I go, why are you so excited over something so simple? And the reaction from someone is, like, a bit disappointing. And I think it's their reactions that kind of stop me or people's reactions to my sort of. [00:05:20] Lucy: We are here to talk about extreme states. That's the overarching theme of the podcast. We just wanted to ask you what that meant for you in your life or in your role, because it's a bit of a broad term and people interpret it in different ways. But when you think of extreme states, what comes to mind for you? [00:05:39] Elsa: If I had to define it, I'd say it can be unpredictable and it can surprise you. It's often, in my opinion, a response to something that is an event, or whether it's a sad event or exciting event that maybe lacks control sometimes. And I think sometimes extreme states can surprise us, and sometimes it can be a learning experience as well. When you go through that, is there a real definition about it? Sorry, I'm just interested. [00:06:16] Rachel: I think it's often used as an alternative to medicalised language around things like psychosis or other extreme states that are sometimes referred to as symptoms or explained through disorders. [00:06:34] Elsa: Yeah, I suppose things that aren't perceived as normal is an extreme state, I suppose. But I'd also question what is normal? [00:06:45] Rachel: I don't know if it's perceived as. I think maybe what we're trying, the use of a term like extreme states is trying to say they are normal. Their responses to experiences or things that happen for humans. So they're kind of extreme psychological distress, perhaps. So we're trying to actually mean they're quite human responses to different life events or different experiences or different experiences of ourself. [00:07:21] Elsa: Yeah, I think especially when working with others or talking to others. And when I think about sort of the conversations I've had, I don't know about you, but sometimes you think, oh, why is that person feeling so upset about that? Or like expressing that way and themselves in that way? And I think we do need to remember that there's so much that might be different and that we are different, we are individuals, we will respond differently. And that example I gave about me being excited and my family not being as excited or whatever, I think the problem is sometimes we make apology for feeling those ways. But maybe it's actually okay just for them to feel the way they did in terms of their response. And it's also okay for me to have felt excited about something that maybe they didn't feel as excited about. Because for me it was meaningful in a different way. Like, I spent a bit of time thinking about it and I went to quite a few shops and it took me a few days to decide on what I was going to do. I didn't give them that context, but that's why I was excited. Maybe that's why I was like, this is meaningful. But they didn't get that context. They just got me giving them a gift. And I think sometimes we sort of judge that response that what we experiencing but what we haven't understood is the meaning behind it or what's gone on for that person. And I think that is actually sort of quite relevant. And we don't always spend that time asking or understanding. And I think if we did, then maybe we'd be just as excited or just as upset or whatever. I think there is something about that sort of understanding or just being with that person and connecting with that person. That's what's so important. [00:09:28] Lucy: We're all just off in our little individual realities, our little bubbles. [00:09:33] Rachel: Individual realities. [00:09:33] Lucy: Sometimes they join in. [00:09:35] Rachel: Gosh, I like that. [00:09:37] Lucy: Yeah, but I'm also really interested to hear about your new role. I remember opening up the email saying that you'd gotten the role, and I think it was the first time I'd ever seen a role like that come up, ever, in mental health. [00:09:52] Elsa: Yeah. [00:09:53] Lucy: I was wondering if you could tell us a bit about it, how it came about. [00:09:58] Elsa: I suppose I'm just as excited as you, and I almost am in disbelief that it's actually happening. It's a role that requires you to be a mental health clinician or someone with sort of that professional background that is able to not only understand mental health concerns or whatever, but be able to sort of engage with someone exploring their spirituality. So the emphasis is more sort of being a clinician exploring spirituality. And I suppose it's important to start off with what is spirituality? And I can actually sort of just give you a definition. Spirituality refers to the human search for meaning, purpose and morally fulfilling relationship with oneself, other people, the universe, and of being, however that's understood. So I suppose when we talk about spirituality, we're talking about meaning and purpose, and the key is relationship. And I think that's the key around sort of seeking meaning and purpose. It is through relationship, as it says, with oneself and others. And that's what brings meaning and purpose. And how can we ignore that when it comes to mental health? And what I have found, as I've sort of worked for different services in the UK and here, is that it's not always considered or talked about. And also for the person that is sort of receiving mental health service, they often have said to me and others that they are afraid of talking about that because of fear of judgment and stigma, because of their belief. And also how that sort of sometimes conflicts, comes into conflict with things like hearing voices or psychosis, if you like. And I remember this one time working with somebody, and again, this was in my, she was a young person with a very strong christian belief, christian community, christian family, and she experienced and was diagnosed with schizophrenia, and she was experiencing a lot of psychosis. And she felt that in that experience of psychosis, that she was being quite sort of judged and people from her community did not understand or know how to deal with it. And some of it was actually quite dangerous in terms of what they were saying to her around that. And then in the care that she was getting from mental health, that sort of stigma around sort of like just her religious beliefs and sort of how that, like when she was saying that she prayed and heard from God, it was almost minimised or sort of seen as something that was psychotic. So she was having a lot of conflict around, sort of like what is truth and what isn't. And I remember having those discussions with her and it was such a good start to my career, in some ways, around really exploring that and trying to understand that more. I'm not saying that I get it, but I am saying we need to feel comfortable about helping people explore their spirituality, but also decipher what's real and what isn't and maybe just feel comfortable to have those conversations with us as clinicians. So I suppose when I look at this role, I think it's a good role to have, and I think it's important to understand different cultural beliefs, different religious beliefs, but also help people understand and decipher what's true and what isn't, because I think there is a lot of confusion. And when we avoid things, it means that we're not helping or enabling people to explore that aspect of their lives that bring meaning and purpose. And so that's where I think this role will be really significant. But I also think it's a role. Whilst it's new in Australia, it's been explored in other countries like Canada, America and UK, where they actually see it as part of their mental health care. I'm quite excited about having this opportunity. [00:14:50] Rachel: So how do you think it will work? What are your hopes for how the role will integrate across the mental health system? [00:15:01] Elsa: I wonder, like I said at the beginning, I feel like a lot of clinicians have felt probably not empowered or enabled to sort of really speak freely or explore freely with those within the mental health system. But even, like, when I talk to staff, a lot of staff withhold their beliefs and thoughts. I don't know if you found that as well, and that's actually quite sad. I do wonder whether it's about what's happened over the years around sort of like terrorism and extreme belief systems of certain sort of religions. And I think you come across every kind of belief that someone might have. There'll always be a spectrum, there'll always be those extremists that sort of like, believe things that aren't necessarily really true. And because of media, they just see the extreme. And I think there is something there that's really influenced people's thoughts and beliefs and their ability to explore with others. And I do wonder, is it fear? And I think whilst we don't talk about it, and whilst we don't allow those spaces to talk about things, then what it becomes is it becomes alienated, it becomes something that isn't explored. And how do we learn? We learn by questioning, being curious, exploring and conversation. And it's ironic. We just said spirituality refers to like, it's linked with relationship. Relationship is giving and receiving, isn't it? It's not just a one way thing. So in the same way, when it comes to spirituality and stuff, I think we do need to talk more about it. There's three components to the role, I think a part where I think I need to probably get staff on board to talk a bit more and to explore a bit more and educate and also learn together. But also I also think about group work, how that's a good space and maybe sort of looking at well being and including spirituality. So not just looking at the social, emotional, mental well being, but looking at spirituality. So bringing that as part of our package of care for consumers. So when we're working with them, when we're doing a wellness plan or whatever, that we're looking at that aspect, we explore and we're asking. And then there's the third aspect, the one to one work, helping people explore their spirituality and meaning and purpose through that one to one work. And especially those that are sort of having conflict, like I described earlier on with that young person. And I have had a couple of clinicians ring me up and say, look, I'm working with someone and they exploring their Spirituality, but I don't know how to talk to them or how to refer them on. And I think there is an aspect of sort of like, how do we as a service, ensure that what we support people with is safe. [00:18:36] Lucy: I love how you've sort of demystified spirituality by your definition as well. Because I think a lot of people steer away from the word spirituality because it sounds very airy, fairy, and not grounded in reality. But I would say the opposite is probably true. When you. [00:18:53] Elsa: True. [00:18:54] Lucy: Would you ever read that definition again? [00:18:56] Elsa: Yeah, sure. Spirituality refers to the human search for meaning, purpose, and morally fulfilling relationship with oneself, other people, the universe, and of being. However, that's understood. And it can also support, in times of suffering and loss that is experienced. And I think that is true because often when we work with people that are in crisis or people that are facing death in any way or extreme situations, often they're not looking to sort of what do they do? They look for relationship, they look for meaning. They look for purpose. Suddenly all those things, those materialistic things or those things that like work or whatever, doesn't mean anything anymore, but what they're looking for is something else. And I certainly can speak from my own experience when I suffered loss, but also those that I've worked with, whether they're friends or in a work capacity. It's interesting. That's something that often happens, I would say. [00:20:12] Lucy: Yeah, I feel like people probably in their everyday life, if you read out that definition, I don't think there's too many people who wouldn't relate to that in some way. I think we're all looking for meaning and purpose. [00:20:25] Rachel: Absolutely. [00:20:25] Lucy: And working on ourselves and relationship with ourselves and others. It's just how we frame that. And I think when you go into those heightened extreme states, it really amplifies what's important sometimes. [00:20:39] Elsa: Absolutely. I agree with you. [00:20:40] Lucy: Do you think that there is an overlap between spirituality and psychosis? [00:20:46] Elsa: Look, what I'm going to say is not founded in sort of, like, evidence, necessarily, but I actually do think there is. I find it interesting that when you sort of unpack things when someone's going through psychosis and stuff, often there's a lot of reference to sometimes religious beliefs and spirituality. Really? And I find it fascinating that as clinicians and I speak for myself sometimes, that we immediately kind of think, oh, not reality based, blah, blah, blah. But then when you sort of really unpack it with someone, there's an element or a thread of truth there. Like, I've often listened and thought, gosh, it's like you connected to something that's beyond here. And whilst they're in that extreme state, I wonder whether they are a bit lost. But you do wonder whether there's a thread of truth to some of what they experience. And I do think there is an overlap. And I do think it's interesting that a lot of psychosis makes reference to spirituality, whether it's evil spirits or not, whether it's God or whatever. And I think there is an overlap, and I find it fascinating. I'm like, why is that? Yeah, but it's just fascinating. [00:22:21] Lucy: It is fascinating. I've worked with a lot of people with psychosis and had psychosis myself. The one thing we all had in common, believing you’re Jesus, or feeling like you've got supernatural powers. And when you come out of that, you go, oh, no, I'm not Jesus. But at the time it feels like that, but it never gets explored at all. It's just immediate shutdown. And a lot of people feel, again in that book that we read, my beautiful psychosis, when she comes out of it, she feels like she's had a big spiritual awakening. And they go, no, that was just psychosis. Just like reduced to a meaningless experience. Shame. [00:23:00] Rachel: Yeah. I wonder why we're so reluctant as a system, if you like, or a world, to really explore what the belief systems are representing about the real life of someone. [00:23:15] Lucy: Yeah. [00:23:16] Rachel: What these psychotic expressions or experiences. What metaphorical meaning might that be playing to the real life of a person and their experience? But why do you think we are so reluctant to explore and be curious about the meaning of these beliefs and experiences that someone might have in an extreme state? [00:23:39] Elsa: Wonder if we're afraid. Like, I. It's like a lot of us are afraid of not being in control, I think. And maybe I'm just speaking for myself and sometimes going through a journey of sort of something like that, like psychosis, spiritual journey or whatever, there is that sense of part of you feeling like maybe a lack of control. And I wonder whether also I do blame media and things like that around, sort of like, what is portrayed around, like, as soon as someone, they're very quick to sort of say, someone's mentally unwell when something goes wrong and all that kind of stuff. So I do worry about that stigma and that concern, and I think I wonder whether that has impacted and influenced even clinicians and the work that they do and maybe also those that are experiencing it, that sort of sense of fear of being labeled or people making assumptions about them. So I do wonder whether there's a sense of fear. [00:25:03] Rachel: But there's this sort of reductionist kind of result of the human experience. I do a lot of work with or talk to a lot of people who are experiencing anorexia, and I often think this is happening for a really important reason, and this has a really important meaning. And how do we explore that? There's no explanation or opportunity to really make sense of what this very human experience means in someone's life. And I think the same happens with psychosis. You're hearing voices or you believe these things about yourself because you have psychosis. That's not an explanation, but it feels like a certainty in a way. It feels like we are really quick to label it as a symptom or something that's happening because you have a disease or something wrong with your brain. Rather than being able to sit with some sense making and exploration of what this means for someone and their life and their experience of the world. [00:26:15] Elsa: And I love what you just said about making sense. I think as humans, we do compartmentalise. We do try and make sense. We try and sort of say, this is what it is. And even when we label or diagnose, we kind of are trying to make sense and saying, this is what to expect and this is how to treat. But actually, sometimes the danger of that is just the individualism and treating that person as an individual. The reason why spirituality is so important is because it is about being and just almost being comfortable with the not knowing. And I think sometimes we struggle with that as humans because we try to sort of maybe control our emotions or just be okay in certain settings or sort of, like, meet with each other's expectations. But sometimes that sense of sort of spirituality or just being there is a sense of sort of freedom, and it brings hope, and that's what's so exciting. And I think that's the bit that probably we all struggle with, if we had to be honest. [00:27:21] Lucy: And it looks like different things for different people. I know Rachel has compared spirituality or religion to the football because it feels like you're part of something. [00:27:33] Rachel: I mean, it's a bit of tribalism, actually, but no, it does.This is a little bit embarrassing, actually. But it gives me a sense of having a shared belief system with people and a community in which I feel I belong to and I get to connect with others that I wouldn't otherwise meet in the world and develop relationships. And this sort of shared thing that's happening between our community. And that's something that I think is really kind of absent for many people in their lives in a very individualist culture where there's different parts of our community that offer us that, but not all of us have access to it. And I think religion and faith communities are big at offering that to individuals and people. And so is the football. [00:28:33] Elsa: Yeah, but it's because you feel like you belong to something bigger than yourself. And I think it's wonderful. And I think that's a little bit about, again, relationship, like with others, with yourself. The whole thing about spirituality, it is that sort of sense of belonging to something bigger than yourself, which is empowering, because when, you know, let's face it, it's lonely and hard to feel on your own facing life. And I think to feel like you belong to something or part of something is so important because it picks you up when you're feeling down and all that kind of stuff. [00:29:21] Rachel: Elsa, it's been so wonderful speaking with you today. We have one thing more we'd like to ask. Can you tell us about a time or an experience that you've seen or witnessed or had, where you've seen someone be supported who's experiencing an extreme state in a way that you think has been helpful? [00:29:45] Elsa: Sure. I can actually think of a lot of examples, I think, because of my work context, but I'm going to choose one that's probably simple and close to home in terms of just working with a young person who was quite distressed and visibly quite panicked and restless and expressed that they just didn't know what to do. And the reason why I'm going to share this is because I think sometimes we forget that people in those extreme states just need a bit of guidance and a bit of reassurance. I don't know about you, but sometimes you almost feel panicked. You're like, how am I going to help this person? And I just remember thinking, just giving simple sort of comments around, like, okay, breathe, and it's okay. And how quickly that person responded to those very sort of small phrases and prompts, and they were able to just sit in that space. And I remember taking them away from that environment as well and just sitting in a more calm environment. And it was just a reminder of sometimes that simplicity and those simple comments around, sort of like, noticing what's going on and helping them. Just that reassurance of, like, it's okay to feel the way you are and you will get through this and let's just sit here. And although you might be an experienced clinician or whatever, I think sometimes it's just reminding ourselves that simple guidance can make such a difference. [00:31:21] Lucy: That's such a beautiful example of just giving someone permission to arrive as they are. I love it. I could speak about this all day. It's been a lot of fun. Thank you so much for joining us. [00:31:34] Elsa: I've really enjoyed it as well. Thank you. You both are great. It's great to talk to you. So easy to talk to you. So thank you. [00:31:42] Rachel: Thanks, Elsa. [00:31:49] Lucy: What an incredible human Elsa is. [00:31:51] Rachel: Really right. [00:31:54] Lucy: I am so excited that there is a spiritual role in our service because I feel like there's not much room for conversations around spirituality in the context of mental health. I feel like when you say the word spirituality, people are like, oh, that's like woo woo, hippie crap kind of thing. I just feel like sometimes spirituality gets a real bad bit of a bad rep. [00:32:17] Rachel: and there's a lot of movement these days towards really kind of making sense of experiences. And this work that Elsa is going to do has got a great potential to really help people with that, really an opportunity to make meaning and be really responsive to people's kind of needs and preferences and belief systems. [00:32:42] Lucy: Yeah. So important. [00:32:44] Rachel: So important. [00:32:45] Lucy: And I love the way she provided us a definition with spirituality, because it just broke it down. It's so normalised. It's like, yeah, well, who wouldn't want that? It was just really nice to hear it summarised like that. [00:32:58] Rachel: Yeah, well, she's on a very important mission. [00:33:01] Lucy: She is. [00:33:02] Rachel: And I really wish her well, and I hope this new position really gets an opportunity to really cause some change. [00:33:11] Lucy: Yeah. Thanks for coming on, Elsa. We love the work you're doing. [00:33:28] Lucy Thank you for listening to our podcast. If you wanted to stay in touch or learn more about Discovery college, please head to our website, discovery college.