Tuesday, 29 November 2011

Have A Nice Day

People often complain about being 'ordered' to have a nice day by shop assistants or coffee shop workers or pretty much anyone American.

I'm no grammar nazi but here's the thing. 'Have a nice day' is not an imperative, an order. It's a subjunctive, expressing a hope or wish (it also has other uses).

Other examples of this use of the subjunctive are:

Get well soon
Long Live the King
Live long and prosper
Goodbye (god be with ye)
Hallowed be thy name
(Have a) Happy Birthday
(Have a) Happy Christmas
The old English 'Wassail', a contraction of 'Waes Hail' means 'be healthy', a kind of early version of 'have a nice day'. If/when the NHS falls apart we might want to revive it.

It's harder to spot a subjunctive in English because there is no special verb form to indicate it as there is in other languages. In French, for example, 'hallowed be thy name' is 'que ton nom soit sanctifié' and the soit gives it away.

This may not make it any less annoying the next time someone says 'have a nice day' and you know they don't give a toss but at least now you can be annoyed for the right reasons.

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?

Tuesday, 1 November 2011

White Poppies or Red on Remembrance Sunday?

In 1933 the Co-operative Women's Guild produced white poppies to be worn on Armistice Day - which became Remembrance Sunday. The Guild made it clear that the white poppy was not intended as an insult to the people who died in the Great War - a war in which many of the Guild women lost men - but a challenge to the continuing drive to war. In 1934 the secular Peace Pledge Union (PPU) was founded; it joined them in the distribution of the poppies and later took over the project.

Conscientious objectors were often treated very badly during times of war even though the Military Service Act of 1916 made it legal to object to fighting. Some went to war in non-combatant roles (for example, as stretcher bearers at the front, facing great danger - and they did not receive military pay) while others refused to have anything to do with the war effort. Objectors had to go before a tribunal, which was notoriously harsh and there was no shortage of people (often women) handing out white feathers to 'cowards'. Many objectors were religious - mostly Quakers - but not all.

Many of the "conchies" in the First World War were imprisoned in Richmond Castle, North Yorkshire. They were paraded through the town as a form of humiliation or threatened with execution. Life was also hard for their families, dealing with the 'shame' and the objectors often found it hard to get work afterwards. Given the harsh treatment of the men who would not fight, they were hardly cowards.

Ian Hislop made an excellent programme about them in 2008.

In World War II, there were nearly 60,000 objectors under the National Services (Armed Forces) Act of 1939. Treatment was less harsh but they were still stigmatised. In some countries today, objectors are still harshly treated. Forces Watch has issued recommendations on how the British Forces should deal with objectors within its ranks. It states that 'The procedure for registering a conscientious objection is not safeguarding the rights of those in the armed forces and, through lack of awareness, some could end up facing court martial and a criminal conviction'.

White poppies are still not without controversy. For example, the Royal Canadian Legion is staunchly opposed to them. In 2007, the BBC's Head of Editorial Policy said that TV presenters wearing anything other than the red poppy would 'undermine the trust of the audience'. The white poppy project is also accused of diverting funds from the British Legion who have been raising money for ex-service people since 1921. Some people see the pacifist ideals of the PPU as naive or misguided.

So what colour poppy will I be wearing? I am broadly a pacifist but not entirely; there are some justifiable wars. I don't think that we should have stayed out of World War II, for example. There are also morally justifiable interventions in other countries' wars. On the other hand, recent governments have been too quick to get involved in overseas wars for less than honourable reasons. And I support the right of anyone to be a conscientious objector.

Consequently, I have bought a white poppy and will also be wearing a red one. It might appear over-liberal to be a pacifist (or in my case, a semi-pacifist) but it's a genuinely-held and considered moral position. I'm aware that, as a woman, I would never have been conscripted and had to act on my beliefs.

It's important to recognise the bravery and sacrifice both of people who fought to defend us and the ones who went to war in non-combatant roles or who followed their conscience and didn't go at all. I will explain this to people who ask why I'm wearing one or who are hostile.

White poppies can be bought online from the PPU or from some outlets like the Quaker House on Euston Road in London.