Steve: Thank you so much for joining me today to chat about faith and science. I think it’s really exciting because you are in a field that is a little different to some of the scientists that we’ve been speaking to in this series. Firstly, a big thank you for joining me. Tell us a bit about yourself. Also, what line of work are you in. What is your field of expertise?
Tswai: Yeah, so my name is Tswai. I’m currently a trainee psychiatrist in Scotland. I grew up in Scotland. My family are originally from Zambia, but Scotland’s home.
Psychiatry is often a field that people struggle to really get a full grasp on because people ask, “is it medicine? Is it psychology?” I’d originally trained as a doctor and then following my initial training in medicine, you then do extra training to qualify as a psychiatrist, and this involves learning about the brain in more detail, learning about psychology, learning about people’s development, and then trying to apply that to the treatment of mental illness. So, I’m currently training to be what’s called a neuropsychiatrist, and focussing on patients aged 16 to 65, and older adult psychiatry, which is patients 65 and over.
Steve: Can you explain more about neuropsychiatry for those of us who are not too familiar with what that is all about?
Tswai: Neuropsychiatry is an interesting field as it kind of straddles the line between neurology and psychiatry. You often find that a lot of illnesses that people view very much as part of one field bleed into the other. A good example is something like Huntington’s disease, Parkinson’s, and encephalitis – and also acquired brain injuries. To really get a good picture of neuropsychiatry there is a need to have a decent grasp of neurology but also a decent grasp of mental illness as the neuropsychiatric conditions are often picked up more because it doesn’t classically present like a pure neurological illness or a pure psychiatric illness.
So, understanding how both of them present normally kind of gives you a better picture of these conditions that in a way fall into the cracks.
Steve: That is fascinating! So, you decided to spend your time and career committed to this endeavour, but what led you to this of all things? It’s quite specific. It’s very challenging. What drew you to it?
Tswai: It’s quite an interesting story. Originally, I’d never wanted to be a doctor. It was actually towards the end of secondary school that I’d originally thought about becoming a dentist and I went on a dental work experience and the dentist did not inspire much enthusiasm for the job in me, unfortunately. So, my guidance teacher recommended that I go to another medical work experience. I went to that and saw a patient who actually just spoke to me and said, actually, doing medicine one day, you can make a difference in somebody’s life. That kind of stuck with me, so then I went into medical school. Originally, my thoughts around medicine were very much towards the more overtly scientific medical specialties. Things like haematology and rheumatology where there’s a lot of specific lab tests, and you can look at a slide and you know what’s going on. Later on I also started thinking about things like work-life balance and the fact that actually even when you see these conditions in rheumatology and in haematology a lot of these patients we treat but they don’t really get better and the idea of treating people who are broken and will remain broken actually kind stood out to me.
I did a placement in psychiatry in my final year of medicine and it really did just present quite a holistic picture and to me that really did pique my interest. Many people in my medical school days would joke that I was a humanities student dressed up as a medic.
So yeah, I know psychiatry kind of stood out for that. And thinking in particular about neuropsychiatry, I guess it has always been the fact that I’ve always been somebody who does like both the sciences and the humanities and neuropsychiatry, with conditions which are very established with an organic basis, yet still these individuals will have social issues, psychological problems, which impact their function and their recovery. That just really stood out for me. So that’s kind of how I got to where I am now.
Steve: If you had to pick one thing, what is that you love about it the most? What keeps you going every day?
Tswai: I think the thing I like most about neuropsychiatry is that everybody has a really interesting story, you know?
Like, you do not meet a neuropsychiatric patient who hasn’t got an interesting story. And you just get to journey with them quite a bit more, because even if somebody has a more acute neuropsychiatric condition, even after treatment the long-term management of the consequences of their illness do involve quite a bit of medical input. So, there is something about helping people for life, which I quite like about it.
And it also is just, in my opinion, one of the best vehicles to address the reality of mental illness to individuals who are quite sceptical about mental illness being biologically real. Being able to speak about Parkinson’s and say, actually, these people who have a loss of these dopamine producing cells in their brain, they talk slowly, they walk slowly, they think slowly. Somebody with depression who has lower level of these excitatory neurotransmitters like dopamine or at least sensitivity to them, also walks slowly, talks slowly, and thinks slowly. It really makes the biological reality of mental illness, I think, a bit clearer to many who are suspicious about it all.
And actually, I think that gives you a really good opportunity to have conversations about why mental illness matters.
Steve: That’s a great snapshot into the world you live in. Thanks. I’ve done a few years of pastoral work in the Church, and you mentioned there walking the road with people. That’s something I also really enjoy and find so fulfilling.
And so that kind of brings me to the next question. You’re a scientist, and also a person of faith. You’re a Christian. How did you come to be a Christian? And what does that look like for you today?
Tswai: Yeah, so I grew up in a Christian home. My parents raised us going to church, reading the Bible, praying. I would say for most of my life, before coming to faith, I had very much an intellectual acceptance of Christianity.
I would say, okay, well, the Bible says this. This seems, you know, like a valid enough story. And I can look at the world and say, yeah, humans aren’t great. So that kind of stuck with me. But I would say that the time where things really changed was when I went to boarding school.
It was the first time where actually thinking about my faith was something I had to do on my own. And ironically, the thing which most persuaded me about Christianity wasn’t really something I read in the Bible, but something I learned about history, which was the Reformation, and really just the idea of the word of God being so powerful that Europe changed, the world changed because people had access to this Word of God. And the deep truth that all of us are incredibly broken, all of us are unworthy! It just really rung true for me because I could see how unworthy I was and how broken I was in myself and in my own life. And just the way in which it’s changed lives. I would read about Scotland and that the birth of enlightenment thought within Scotland came from the Reformation.
In terms of public education, a good came because people can read, people must be able to read the Bible, and we can see the benefit that’s had for the nation of Scotland over time has clearly been quite significant. So ironically, history was one of the things that really persuaded me about faith.
Steve: That’s great. I also love reading about the historical impact of Christianity in the world throughout the ages. It’s often so overlooked, especially in our secular culture that likes to paint a picture that it’s the cause of all evils in the world – which is just nonsense!
So there’s the psychological point of view we have from the work that you do, and you’re a person of faith…so I have a couple of questions that I want to ask that are about the interaction, of faith and the psychological sciences.
First, have you ever encountered maybe tensions or misunderstandings from within the medical community or from your faith community about being both a psychiatrist and a Christian, and how have you navigated that?
Tswai: Starting from the medical side, I would say, on starting my training, I wasn’t shy about my Christian faith, and quite early into my training, a supervisor, began to just ask me questions about assisted suicide, questions about neuropsychiatric conditions and the associated impact on function and quality of life, and really those conversations about ‘is it just to keep death away from these people who are living in suffering’?
So that has been a bit of a challenge, and I would say especially more recently with the current debate about assisted dying legislation.
I would say what has been quite interesting is that some of the initial thoughts I had about my colleagues who are not of faith regarding their stances on assisted dying. It turns out some of them were actually sympathetic to the Christian worldview with regards to the sanctity of human life. And actually, the diminishing of the value of individuals with disability that is inherent in any legislation that would actually allow for assisted suicide.
I’m thinking again, and quite a common theme in mental illness is changes in religious belief, so in particular in a bipolar illness, some patients may become more religious than they had been and may even say that God is speaking to them, which has always led to quite interesting conversations with my colleagues. But sometimes colleagues would actually come to me and say, actually, Tswai, is this a normal Christian belief the person is showing, or is this actually illness presenting? And actually, it’s led to some quite good conversations and even just along those lines about faith and illness. There’s even been conversations we’ve had around how to support individuals with faith in a hospital setting.
And one thing is that I am very quick to make use of the hospital chaplaincy, which I think is a really good resource. We are quite limited as to how we can speak into faith issues in our work. However, we are actually encouraged to actually use our knowledge of faith with regards to what might be going on with one of our patients. But on the flip side, thinking about faith backgrounds and their thoughts about mental illness and psychiatry, I would say that historically there was quite a strong thought amongst Christians regarding psychiatry and psychology that it was a field that was inherently ‘worldly’, and to be avoided. I would say that that stance has somewhat softened.
I feel that by being a Bible-believing Christian who is a psychiatrist, I’m able to have those conversations with members of my church and sometimes even people who just happen to know that I’m a Christian psychiatrist. Sometimes they ask me what I might think about this or that issue? Or how can I best support someone? So, I would say attitudes are changing, which I think is a good thing. In fact, there is even a really good study which speaks about the impact of faith on individuals with mental illness. The broad strokes of the study are when individuals with a good faith background, in terms of a supportive faith background, go through mental health crisis, they will do better than individuals without a faith background. However, with an unsupportive faith background, they do worse than individuals without a faith background, which really kind of speaks to what I think is quite important in the current climate of mental illness: I think churches are in a place where we can support individuals who have difficulties with their mental health. I just think there needs to be good understanding of how we do that. But it’s definitely something I think we can and should be doing.
Steve: Very good. Those are some really interesting thoughts. Related to that, how does your Christian faith influence the way that you would understand mental health and the human person in terms of looking at things holistically in your psychiatric work? Because obviously you have a different lens when you come into this in comparison to someone who has no Christian worldview at all.
Tswai: Yeah – my Christian worldview really confirms a lot of things that are kind of taken for granted within the scientific framework. So currently the model that is commonly used to describe mental illness is the biopsychosocial model. And that really says that any person’s experience of mental illness or mental ill health is based on their physical health, that includes their genetics. It’s based on their past experiences, it’s also based on their social circumstances and their overall development in terms of relationships, potential abuse, and patterns of behaviour that they have learnt to help themselves cope with the world.
As Christians, we understand that humans have been made whole. We have souls, we have minds, we have bodies. These things are not as separate as many might put across and I would say that would be something that some of my colleagues within the medical field sometimes do struggle with, which is the connection between the mind and the body. Again, sin absolutely impacts our relationships our thoughts our attitudes and our behaviours and that will change the way in which we react to difficult situations or even enter difficult situations. Even coming back to the biological side, we live in a world that is broken by sin, so why wouldn’t our minds and our bodies be susceptible to sin in the context of mental illness in the same way that we are with physical illness. So, it actually fits quite nicely.
Steve: How would your faith then shape your understanding, especially when it comes to hope and the search for meaning and purpose that people experience? I’m sure you see this quite practically with those who you’d be interacting with especially in terms of their recovery journey and their struggle with mental illness?
Tswai: One of the key parts of recovery in mental illness is the instalment of hope. In our current world, a lot of people are coming to us hopeless, and in particular in the context of mental illness. Going back to what I said previously, this is often going to be lifelong with lifelong impact. And the need to provide for our patients or at least help our patients facilitate a view that actually their life is worth living. There are things that they can do to have meaning. This is a key part of the recovery process. As a Christian, it’s quite obvious to me that we as humans are quite directionless and without a true sense of who we are and what we are made to do, we are lost. That can lead to despair. I see that in plenty of my patients. But when it comes to my own personal practice, I do try and instill hope. But I do it, I believe, in quite an honest way, it’s not made up, because the Christian hope is based on something real!
So, I’m not trying to offer my patients something that’s unrealistic. Not just trying to give them a nice story, because a Christian story is nice. There’s als some brutality to it, and that includes facing who we are. And the fact that as much as the world is broken, we are part of that brokenness too. I think there’s something so genuine about it. And that’s because it is informed by the genuine truth that, yeah, our lives without meaning, without true meaning are directionless. And coming back to what I said about the chaplaincy, when I feel that somebody might be asking those questions, they’re a very good source to speak to about having that conversation. I almost view myself as if I can show someone truth, genuine love and care, give them realistic hope, that’s part of showing God’s love to them practically in my job.
Steve: That is very encouraging. And as Christians, we believe that there is one great hope, and that is the hope in the Gospel! The Good News that Jesus has stepped in to come find us and to offer a real legitimate hope, real restoration, and new life with him. And yet we are in this broken world, and I think that plays itself out in terms of the evil we see around us, but also the experience of mental illness, arising however it may.
One final question for you. What would you say off the back of that to a young person who is looking to go into the psychological sciences? What encouragement could you give them from your perspective, given the unique challenges that you face in your line of work?
Tswai: Yeah, I would say it is a field with challenges, but it’s a field where good people are needed. And as Christians we can provide what I think is a very important perspective. The psychological sciences and psychiatry do have some tools which are useful for the managing of the health and well-being of people in general, but the Christian worldview proves the impact of those tools in a really quite meaningful way. And I think the ability to communicate the Christian worldview, and the psychological and psychiatric interpretation of the world is really something that churches will benefit from too.
And it’s fascinating the number of times where you’ll look at a pattern of a defence mechanism and see actually how that’s steeped in a pattern that you read in the Bible of how sin manifests. It just never stops because the more you start to realize who humans are, the more the Bible just becomes more and more real.
Steve: Thank you so much. I have so many more questions I’d love to pick your brain on, but I think for time’s sake, we’ll have to stop there. Tswai, thank you again for chatting to me and for sharing the insights and the wisdom that you’ve have.
Tswai: Thank you for having me.
Tswai Mweemba is a resident doctor working in Scotland as joint General and Older adult Psychiatrist with a special interest in Neuropsychiatry. Outside of work his interests include rugby, board games, fantasy novels and helping with his local church plant.
