The Significance of Religious Uniforms when working with mentally ill

Photograph from Daily Mail. Click on it to read the article

For decades, if not for a longer period, there have been attempts from within the church to make changes to the tradition of wearing religious uniforms by clergy. The above photograph is of Peter Owen-Jones who has some dress sense when trying to break down the barriers in communications with the faith followers. The Church of England Synod will decide in February 2014 if they are prepared to put power first or their parishioners.

It is a very serious matter. Dress can have disastrous consequences. Sadly, for example, there is evidence that there were increased suicide rates in an area where a Catholic nun, social worker wearing her habit was appointed for about four years. 

   SIGNIFICANCE OF RELIGIOUS UNIFORM WORN BY MENTAL HEALTH   PROFESSIONALS

   

To whom is religious uniform significant	In what way is religious uniform significant
Mentally ill person	Barrier to communication It has already been established by scientific research that no uniforms should be worn in mental health setting.  Thus one finds that doctors, nurses, social workers and administrators in England have not worn any uniforms for at least thirty years. Uniforms are a barrier to communications as in “us and them”. With impaired communication there is a much decreased chance of effective diagnosis and treatment. The consequences of wearing uniform defeat the purpose of employment. Reminder of trauma Men raped by clergy as children experience flashbacks, panic attacks when reminders of trauma are presented to them. Diagnostic and Statistical Manual of Mental Disorders TR IV lists diagnostic criteria for mental illnesses. Under Post-traumatic disorder one is able to find that avoidance is one of the groups of symptoms. Avoidance means avoiding situations and people that act as reminders of the trauma. Talking about trauma is also a reminder. Even thinking about appointments with professionals when such traumatic events may be discussed can lead to anticipatory anxiety in patients with Post-traumatic Stress Disorder. Some patients have sleepless night(s) and even start vomiting when so anxious. There is no point in multiplying the barriers to communications with mentally ill people and wearing of religious uniforms does just that for many. Reminders of abuse by clergy include religious uniforms. The result can be severe panic attacks experienced by patients. Panic attacks are associated with higher mortality from myocardial infarction too. Therefore, religious uniforms represent health and safety risk in mental health setting that is preventable. Uniform symbolic of uniformity of values for the group wearing the same uniform It is would be recognized by most mentally ill people that uniform poses obligations on the wearer of uniform to conduct themselves consistent with the values of the institution it represents. This involves the sacrifice of individuality of the wearer. The issues of trust arise out of this situation. Person, who has given up their individuality and made considerable efforts at it, is unlikely to uphold another person’s right to his/her deviancy from norm (as in mental health issues) and especially so where the degree of deviance from the norm can be considerable (healthy or unhealthy). Health issues and stereotyping There may be health issues that patients would not disclose because of the fears of what religious person may think about them, for example, sexual issues, family planning, abortions, blood transfusions, epilepsy, mental Illness causing behavioural transgressions, hearing voices, feeling controlled by outside forces (as in some cases of schizophrenia) and so on. Reprisals Disclosing history of abuse by clergy to members of clergy has been very risky for victims. Now it is known that canon law requirement has been to keep the history of abuse secret from other people (including police) or risk excommunication. In communities where clergy have influenced even access to jobs fear of reprisals has been very real and not evidence of paranoia. Unemployment creates depression, and exacerbates mental illness. It can also lead to increased suicide risk. Threats of reprisals against the victims of abuse by clergy are some of the factors that prevented access to state justice system. Mental health is damaged by chronic injustice and this applies to victims, their families, and friends. It has been argued by some lawyers that aiding and abetting the crimes of child abuse happened at the top of religious hierarchy through the cannon law defects as well as lack of effective child protection measures following the disclosures of abuse. The offenders were allowed to work not just within the same religious organization but with children too while the risk of reoffending remained the same. As crimes were not reported to police there would be no Criminal Records Bureau check that would reveal anything. Authority and power v right to individuality Healthy attitude is to accept that each person is an individual. Religious uniforms represent authority and power in mental health setting as determined by state that permits it. Religious uniforms are misplaced in mental health setting as it actually ignores patients’ need to be considered as an individual who may actually hold very different beliefs and whose need at the time is his own health foremost and not to be preoccupied with what the needs of the religious person wearing religious uniform are. It is impossible to be faced with a person wearing religious uniforms and not notice it unless one is blind or has other rare perceptual disorders. This means that mentally ill person is expected to adjust themselves to the expectations of the religious mental health worker wearing the uniform irrespective of their desire, need or ability to do so. Equality issues through role modeling Mental health workers are like teachers in that they represent role models. It is unhealthy to act as a role model for values that are against equality for women, those of different ethnic groups, sexual orientation, different beliefs and so on. Religious uniforms stand for patriarchal values and outdated values which are not in keeping with the laws on equality. Anxiety Anxiety is common in many mentally ill people and introducing more anxiety by wearing of religious uniforms causes worry to patients and needless suffering which could be prevented. Putting patient in a situation where he/she has to deal with making of formal objections to wearing of religious uniforms also presents the task for mentally ill that they may not be able to do. It is unreasonable to expect mentally ill, vulnerable people to assert their rights and fight the system when even healthy professionals are scapegoated and destroyed (see example of Dr Helen Bright) when they attempt to do it. Provocation and Violence It can be said that religious uniforms can represent provocation to some patients who already may have problems with impulse control for various reasons such as high stress levels. Some patients can be paranoid and grandiose too which in itself can lead to poor impulse control and aggression towards those who are considered irritants (like those wearing uniforms). There are various cases of murders of nuns and priests by mentally ill who had a mixture of paranoid and religious delusions. The case of Mark Bechard is a well-known case and there are many others. He killed at least two nuns in the same day and wounded seriously more. Mental handicap/Learning Disability It is recognised that there are people who have severe cognitive handicaps, are very vulnerable and it can be accepted that they may be totally unable to object themselves to the wearing of religious uniforms or to even instruct anyone else to object on their behalf to the wearing of religious uniforms by mental health workers. There are sometimes large numbers of children with learning disabilities who suffered abuse in the some religious institutions. Reminders of trauma may not be verbalised but manifest themselves in behavioural deterioration which would be difficult for professionals to manage or even understand in patients with communications problems. Suicides a) Suicides can result from untreated mental illness. When barriers to communications exist as they do in human society and medical institutions for various reasons one finds increased suicide rates. Men have higher suicide rates and there is social expectation that men cannot be emotional, or sad. Gender inequality is reinforced by most major religions and for both sexes in a different manner. Sense of hopelessness may arise in patients when they see that mental health institution they want and need to trust upholds values detrimental to their health. Some religious people do not recognise manifestations of mental illness but see it as possession by evil spirits which is offensive in itself to mentally ill. We do know that medical regulator employs staff who have such beliefs. b)  In Dr Bright’s case, she had no suicides amongst her patients when working in a hospital where nun wearing her religious uniform was employed as a social worker. However, there appeared to be an increase in suicides following appointment of a nun wearing religious uniform and after Dr Bright’s dismissal for raising the issue  in the public domain. Inefficient use of Taxes It is now known that even as much as 50% of UK population would at some point in their life experience mental distress. In most case it would not come to the attention of psychiatrists. The majority of those people would be working most of their lives and paying taxes with which they would support the system that is not supporting them at all times. When wearing of religious uniforms in mental health is detrimental to patients it follows that using tax payers’ money for salaries of people wearing them is inappropriate and against the interest of the tax-payer too.
Doctors	Diagnosis and treatment a) When there is no communication or decreased or impaired communication between patient and doctor wrong diagnosis and wrong treatment may result. Wearing of religious uniforms impairs patient’ s communications with professional wearing it, and even with those not wearing the religious uniform that become associated with it in their minds. ”They are all the same” is what some say referring to all the staff after a disappointment. This occurs in depressed patients and is known as catastrophizing. The point here is that implications are wider than one might think at first. b) It is already established that not wearing uniforms is associated with better compliance with treatment, less absconding from wards, less self-harm, less violence from patients. See paper by Roger C. Rinn. Power a) Some doctors can be unfair and stigmatise mentally ill patients. This means that government policy of leaving mentally ill at the mercy of local NHS Trust policy making is misconceived when it comes to the wearing of religious uniforms by mental health professionals. There is already discrimination against mentally ill people and it is unlikely that all NHS Trust administrators would care about mentally ill or that the majority of doctors would care about mentally ill as much as about other patients assumed to be sane. b) Medical profession is self-regulated profession which means that it is possible to get rid of dissident voices over a period of time through sham peer review process using medical regulator such as the General Medical Council that has always been religiously biased. Raising the issue of religious uniforms has been a dissident voice which puts patients first and not doctors or other mental health professionals wearing religious uniforms. British Medical Association is conformist and it would support strike for doctors’ pensions for their members but unlikely to take actions on human rights for patients and especially not mentally ill. Medical ethics is that patients come first, but it does not happen in reality when religious uniforms are worn by mental healthcare workers. However, it looks very nice in print that patients come first. Values and beliefs Religious uniform may represent the values that mental health professional holds important and prefer to hold in isolation from other thoughts giving rise to cognitive dissonance such as thoughts how bad it is for the patients and staff as well as the community (public interest). Cognitive dissonance plays a role in many value judgments, decisions and evaluations. Becoming aware of how conflicting beliefs impact the decision-making process is a great way to improve ability to make faster and more accurate choices. This ideal awareness is not something that is likely to happen in medical institutions dominated by men (General Medical Council in over 150 years never had a woman President or Chief Executive) or where women are chosen for their adherence to the same values and biases as men already there have. All major religions are patriarchal and dear to some medical men for that very reason. But not all medical men are the same.
Politicians	Votes If it is accepted that religious people vote and that getting those votes could make one believe that by having religious bias at the expense of the mentally ill would lead one to have more power if elected. The assumption here is that religious people would prefer the rights of religious uniform to that of mentally ill persons. There is no evidence that in the setting of having the knowledge that uniforms (religious and non-religious) are harmful in mental health setting the majority of religious people would be unreasonable and demand special privileges to be given to those who wish to wear them. In fact, the latest statistics show that the majority of UK citizens have secular views. Power Most religions are patriarchal and that appeals to some politicians who may identify with such values. But many would not if representative of the population and if asked. Wilful Blindness Some politicians may have been well informed and knew that religious uniforms were, really, not such a good idea in mental health setting but avoided dealing with the issues by creating a good work wear policy because of cognitive dissonance and desire to eliminate it by extolling the virtues of religion because of all the previous personal investments made in religion.
Religious Institutions	Free Marketing When religious uniforms are seen in the setting where some good is done (health and social care) religious institutions get free marketing because religious uniforms are symbolic of religious institutions and their values. Doing the job of mental health professional while wearing the religious uniform is perceived by observer as the work of religious institution.
	Power Having the “right” to use religious uniforms when other mental health professionals are not allowed to do so places religious institutions in the positions of power and special privilege. In fact, there is no such right in law. It becomes impossible not to consider the needs of the religious person in all interactions between professionals and patients when religious uniforms are worn. Both professionals and patients have at all time to consider what to say and what not to say in fear of offending the religious and the institutions behind them. Like in dysfunctional families one is walking on egg shells. It is so very easy to offend the religious.
	Financial benefit Religious uniforms are also provocative and divisive. Firstly, scientifically minded professional is provoked to react to it. Similarly, person with sense of justice could do the same. Secondly, it is possible to eliminate competition from scientifically orientated professionals by claiming religious rights, establishing those rights as dominant rights and thereafter benefiting financially when scientific competition is firstly discredited and subsequently destroyed and eliminated from the workforce. In the case of Dr Bright, she was dismissed and erased from medical register while the nun was promoted and remains registered with Social Care Council. The rights of mentally ill have not been considered by anyone and how many died. This is breach of Article 9 of European Convention on Human Rights because religious rights are not absolute rights as well as breach of  Article 2.
General Public	Right to expression of religious belief While public recognize the right to religious beliefs public expects politicians to put their health first as well as the health of mentally ill. This would be in keeping with European Convention on Human Rights Article 9, having the proper balance of different rights.
Mental Health Institution	Image and values In UK so far the social and cultural background of institutional administrators determined preference for the religious uniforms while disregarding the needs of the mentally ill. No policies were created that eliminated the wearing of religious uniforms anywhere in UK while it has been acknowledged that no uniforms are worn in mental health setting normally. Power Where there is power there is potential for abuse of that power. Low social status of mentally ill people and low power of mentally ill enabled religious bias to dominate with fatal consequences. Religious uniforms may be symbolic of values to which some administrators aspire.
Justice system	High prevalence of abused males In a number of studies in penal settings in Europe and elsewhere it has been established that there is high prevalence of men who have suffered abuse as children including sexual. The incidence is about 70%. Considering the link of traumatic experiences to that of offending one would have to consider the impact of religious uniforms when visiting prisoners some of whom may have suffered abuse by clergy. There are men in UK prisons who have killed clergy members following experiences of abuse by them.
Military	Murders by religious psychiatrist wearing religious clothes 2009 USA Army base incident (Fort Hood mass shooting by Dr Nidal Malik Hassan who killed 13 people and wounded 29) is a good example of failures to assess the risk to army personnel. Here psychiatrist was seeing army personnel some of whom would have post-traumatic stress disorder as the result of the war in the country where predominant religion was Islam, the same as that of the psychiatrist who dressed in ethnic clothes identifying him as a Muslim. Patients with Post-traumatic stress disorder can be very irritable and provocative and religious uniform is provocative itself. The combination was fatal for many. This incident happened 10 years after Dr Bright warned about the wearing of religious uniforms in mental health setting in UK which was published worldwide.