Spiritual care in mental health in juvenile justice
In February 2009, the California Consensus Conference was held in the United States, where a representative sample of 40 leading figures from across the country—in the fields of Medicine, Nursing, Psychology, Social Work, Healthcare Management, and Spiritual Care—met with the goal of developing a definition of spirituality that was both functional and relevant to the healthcare setting. The agreed-upon definition was as follows: “Spirituality is the aspect of the human condition that relates to the way in which individuals seek and express meaning and purpose, as well as the way in which they express a state of connection with the present moment, with oneself , with others, with nature, and with what is significant or sacred” (Puchalski et al., 2011).
This definition of spirituality is largely consistent with that of the Hospitaller Order of Saint John of God: “The spiritual dimension (…) refers to the internal call of every person to orient (…) their life through permanent internal transformations, in the search for fullness, for happiness, in the fullest realization of their ideals (…) with others and with the Other, who can be God, or with any other name that is preferred to indicate the supernatural, which fills life with light and meaning” (2012, p. 37).
As can be observed, both handle identical semantic cores: spirituality constitutive of the human; search for fullness, meaning and purpose; connection and sacredness… These are, then, the principles that guide our clinical practice when attending to the spiritual dimension of the people we serve in our various facilities , principles that take on special significance in the Therapeutic Unit of the Els Til.lers-Parc Sanitari Sant Joan de Déu Educational Center , where adolescents with mental health problems who have committed transgressive behaviors requiring the intervention of the judicial system and are serving custodial sentences are treated.
Alek
Obviously, the profile of the young people admitted to this inpatient therapeutic unit is diverse, as diverse as the mental health of the general population. However, in most cases, certain constants emerge, stemming from their shared circumstance of being confined in a hospital facility located within a juvenile justice center. These constants are of particular importance with regard to spiritual care: the deprivation of liberty, the separation from their usual environment, youth as a period of exploration and forging of one's own identity, the looming threat of mental disorder, and the burden of guilt—acknowledged or not—for the crime committed. If spirituality is related to this three-way connection with oneself, with others, and with transcendence, how can it not be affected by this situation? When one cannot be at peace with oneself because one feels guilty. When one finds oneself distanced to varying degrees from significant relationships, families often overwhelmed by their educational responsibilities, sometimes even the first victims of their children. When one finds oneself bereft of great stories that help one integrate and hopefully transcend the extreme situation in which one finds oneself immersed.
How could it not?
And if spirituality also has to do with meaning and purpose, ultimately, with sense , how can it not be affected in these young people who seem to be left without a future as the triple stigma of psychiatric pathology, criminality and, sometimes, drug use gradually looms over them?
Again, why not?
Although they themselves often fail to recognize that aspect of the suffering caused by their situation as spiritual suffering—a tacit consequence of a society that attempts, in a reductionist way, to conceive of itself without reference to transcendence—this is their primary wound: they bleed at the fatal expectation of being left without a place in the world. A place worthy of the name, where experiences of belonging, recognition, and legacy are possible. These young people are prematurely confronted with many ultimate questions. Questions about their roots, perhaps challenged by public opinion. Questions about their present, conflicted, and conflicted identity. And, at the heart of it all, the great question of whether they can and deserve to aspire to a better future.
It is not common—though not impossible—for these young people to have any religious beliefs, which is why addressing their spiritual experience must be approached through other means, those already identified by the philosopher Ludwig Wittgenstein: aesthetics, ethics, and mysticism. In this sense, the intervention methodology developed specifically for these young people is organized through activities and workshops, and through personal, intimate, and unique accompaniment where the spiritual experience takes on its fullest meaning.
We refer to the accessible aesthetics of artistic exploration as a channel for expressing inner life. Workshops are held where creatives from different disciplines share their passion with participants and encourage them to experience the profound integrative potential of symbolism.
Spaces where these young people can experience themselves from new perspectives, far from the constant disapproval that their usual routines aroused, feeling firsthand the thrill of being not only recognized, but also praised and even applauded.
Painters, poets, actors, musicians, illustrators, dancers and flamenco dancers have led workshops in the Therapeutic Unit for them where making that possible and, through an intersection project between comics and theater, these same young people have been able to reflect one of the main maxims of Viktor Frankl, a pioneering psychiatrist in postulating the will to meaning that animates us as humans: there is in all of us an impregnable refuge of freedom from which we can position ourselves in the face of our circumstances and conditions.
UTeenagers Theatre Company
We're talking about the simple ethics of observing human behavior as a possibility for existential learning . Harnessing the power of narrative to empathize with the main characters in the stories discussed, individually or in groups, we try to understand these characters, learning to think critically based on their actions, and evaluating the moral soundness of their decisions. Comics, short films, movies, and novels allow these young people to see themselves indirectly, through the stories of others, learning from their successes and failures, and feeling alongside them that the drama of life, despite all its painful moments, still has meaning.
We appeal to the everyday mystique of connection, with oneself and with others. Often, the professional's human touch, their unconditional acceptance of the young person's inner self, act as catalysts for an intimate process through which the young person connects for the first time with their essential self and, very occasionally, with what we might call the divine within. Compassionate listening, believing in them, becoming mirrors of their most genuine facets, introducing them to generative meditation and connection with their own body, are paths along which these individuals, in their search for identity, learn to relate to themselves with affection—an essential requirement for navigating the path of restorative justice processes and, from there, for daring to fight for their future.
In a society that has abandoned exemplary conduct, bereft of role models, almost illiterate in the face of existential adversity, besieged by catastrophic socio-economic and ecological omens, our youth, and especially the young people served by our juvenile justice mental health facilities, remind us that human development is not possible without horizons of meaning that encourage us to give our best even in the worst circumstances, since without hope there can be no true freedom.
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