When originally researching in South India for what was to become Basic Needs www.basicneeds.org.uk which celebrated its tenth anniversary last year, it became very apparent how many people labelled 'mentally ill' had very realistic, very rational abilities to assess their own condition.
Time and again you would meet people in the community centres/care homes we visited (primarily aimed at supporting 'middle class' Indians) who could give you very reasonable assessments of their condition and what, as a result, they could and could not entertain doing.
One man, I remember vividly, who happily introduced himself by saying, 'I am mad, you know' gave a very accurate and moving account of what he perceived as his limitations and opportunities for work within those limitations.
What equally struck home was the deep and necessary desire many people had for 'making a contribution'; that the ability to do work (paid or unpaid), to the limits of their known ability, was an important part of their perceived dignity and had an important part to play in their potential for recovery.
This desire (and its therapeutic and practical importance) was subsequently woven into Basic Needs' model of community based mental health care that has spread so successfully from its original inception in India to a range of other countries in Asia, Africa and now Latin America.
The notion of a sustainable livelihood was critical partly because when your are poor every penny does indeed count and the economic vulnerability of a poor family cannot sustain a mentally ill person, sometimes leading to abandonment but, more importantly, that work is a crucial aspect of identity and dignity. The ability to contribute in however small a measure helps make meaning for a person in a time when meanings are being deeply tested by the illness.
I was given cause to recall this last night when attending a talk on spirituality in mental health by one of the founders of the 'spirituality interest group' within the British College of Psychiatrists. It was a very interesting and sensitive talk about how to enable psychiatrists to be more aware of the spiritual/religious dimensions of the person when understanding their story (or 'case').
But it occurred to me as I listened that the functioning notion of 'spirituality' used here was very 'high' or 'vertical' - souls and spirits much to the fore - and that it might be possible and more productive to think more 'horizontally' as well: of the simple acts of inclusion that we fail to enact and recognizing the contribution that people can make when ill (as an aid to dignity and recovery). I remember visiting a 'tool hire business' in New Hampshire run by people all of whom had serious histories of mental illness that gave people significantly more than a job: a community of common interest and care.
The talk reminded, slightly unfairly, of a friend who told me of his neighbour, a writer, versed in books on spirituality (and 'spiritual intelligence') who persistently let their rubbish bins overflow to the invitation of rancid smells and the visitation of vermin, much to the misery of their neighbours!
In one of Meister Eckhart's sermons he attempts a daring inversion of the traditional pattern: he honours Martha over Mary. Mary may sit at the feet of her Lord rapt in contemplation but it is Martha who creates the conditions out of which such contemplation is possible: a swept floor, food on the table. It is in these enabling conditions of a caring, cared for life that people with mental illness both need and, critically, need to contribute too; and, it is often the second dimension of this sentence that lies neglected in which a sound spirituality might be discovered.