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Interview: Charlie Bell, psychiatrist

19 August 2022

‘Just because we know about psychology doesn’t mean we throw theology out’

For a long time, I was set on being an oncologist. Advances have been amazing, and I found it a privilege, being with people who were faced with agonising decisions, and trying to provide some hope.

But, in my first few years in medicine, I realised I was more interested in the way people think. We’re finally waking up to the fact that physical and mental health are very closely interlinked, and that the social, psychological, and spiritual — that which makes meaning — matters far more than we realised in treating mental illness.

Psychiatry’s a very challenging speciality, and you’re often viewed with suspicion by patients and families alike; but being a friendly face to someone in distress, and building trust, can itself do a huge amount.

“Recovery” and “resilience” have far too often been used as political tools in psychiatry. But “recovery” isn’t a bad term, provided we really focus on the individual patient. Good and bad mental health are not binaries, and I really favour a diagnostic system in which we focus on people’s symptoms and the effect on them rather than try to form discrete diagnoses.

My job at the Maudsley gave me the opportunity to do research alongside clinical work. I have a particular interest in people with personality disorders, particularly those who tend towards anti-social behaviour and criminality. It’s the non-trendy side of psychiatry, bringing me into contact with people who remain deeply disadvantaged and resented by wider society.

Where I work, in Brixton, there are many poor people, often already failed by society. Recently, I had to discharge two psychotic brothers back to a loud, aggressive house shared with eight people, with no support. You wonder what hope they have of recovery in those circumstances.

In recent years, psychiatrists have seen their roles much more in terms of social justice and societal change. In south London, it’s abundantly clear that socio-economic circumstances and societal prejudice — particularly racism — is at the core of poor mental health.

Culpability is a very interesting topic, especially with forensic patients. We know much more about the human brain and social conditioning. Theology has to engage with what we know, and not be frightened of learning empirically to refine theological doctrines and make them helpful. Just because we know about psychology doesn’t mean we throw theology out, but we start really grappling with problems, and have a better understanding of science.

Making the Church hold its doctrine’s feet up to the fire a bit is good. You can always learn a lot from people who have been marginalised, and the long courts of history show how the Church has needed to refine itself.

I wrote Queer Holiness to celebrate the gifts that LGBTQI people give to the Church. It’s amazing that they keep showing up: manning parishes as clergy and parishioners, being faithful, steadfast, willing — despite being told, at least at the institutional level, that they’re not equal, and their identity and relationships being reduced to sexual acts. There’s a 85-year-old guy in our church who has lived with his partner for 62 years. They are full members of the congregation, and we want to celebrate everything they are for us and for themselves, but we can’t marry them. That’s where the lived reality clashes with the institutional reality.

I also teach biochemistry to medical undergraduates at Girton. I love being part of a college, and learning from young people. And Girton’s a special place, because it’s a college founded for women who were originally excluded from Cambridge, and which continues its mission to promote diversity in all its forms in a university which can still feel old-fashioned.

Medical training in the UK is pretty good in the main, but I lead a commission of the Academy of Medical Royal Colleges called the Changing Face of Medicine, to help students prepare for the future better.

The role of the doctor is ever-changing, and we need to be more proactive. Patients are beginning to have better access to the information they need, and feel entitled to second opinions and different treatments. We must recognise that it’s a different doctor-patient relationship, although not every patient wants the same thing, and some need or want to have decisions made for them.

Also, the role of other health-care professionals is clearer: half of the stuff that makes people better or keeps people well isn’t provided by doctors.

Still, there are huge numbers of unfilled consultant posts, especially in psychiatry. We’re neither training nor retaining enough doctors. We continue to overload them, while many simply don’t feel fulfilled in their jobs, or face rotas where they can’t attend their sibling’s wedding, let alone go on pre-arranged holidays. We also need to free them up to be doctors rather than doing admin.

I was born into the United Reformed Church, but joined the Church of England when I was a chorister at Chichester Cathedral. My family were churchgoers, although I’m sure they all felt I was a bit over-devout as a youngster. My mum was a head teacher, and my dad worked for BT, and four of us children must have been quite a headache.

My parents were always hugely supportive of whatever we did, and when my father died, about ten years ago, it was a horrible wrench to us all. We all remain very close as a family, and I now have a wonderful partner, Piotr.

I’ve always had God there as a fact of life, even in my rebellious years. Chichester really taught me the value of sacramental life. I remember being terribly pious during one eucharist, and suddenly feeling something special was happening. It’s hard to put it into words, but the reality of God just felt very close.

The idea of the communion of saints has been something that infuses my spiritual life. The eucharist is the absolutely central act for me. At it, the presence of all creation, living and departed, becomes tangible.

I’ve never been able to separate the different parts of my life. I don’t have a secular and a religious side. For me, God is there throughout, and whether I’m in the clinic or in the pulpit, it’s all the same.

I finally told the vocations adviser, hoping she’d tell me to get lost. She didn’t — and here we are. I’ve always felt a strong calling to continue my medical work. Both complement each other, and something would be lost if I stopped my clinical job. Christians need to stop seeing the world as evil and the Church as good. We need to learn more from secular society, and being a priest in secular work is good.

Injustice makes me angry. Peace with justice is at the heart of our faith. It’s a gospel imperative to foster further and encourage justice — with mercy — wherever we can.

Watching Cavalleria Rusticana, or drinking a Campari on a beach in Italy — simple pleasures make me happy.

I adore the busy silence of the countryside — not total silence, but sounds that speak of normal life away from the noise of the city.

The Church has had some tough times. It’s focused on the externals rather than on the central tenets of the gospel; but, in the new generation of clergy, and throughout so many churches, this is beginning to change. The world’s full of terrible challenges, and it’s in desperate need of a Church that can not only be heard, but can be listened to. I see green shoots of that Church developing, and that gives me hope.

I pray most often for those places in the world where basic human dignity is trampled by prejudice and power. And I pray, too, for my wonderful congregation, and thank God for surprising me with being called to ordained ministry.

I’d like to be locked in a church with St Paul. I’d love to know which epistles he really wrote, and I’d love to have a conversation with him about how and why his words are still used to denigrate and dehumanise Christians.


The Revd Charlie Bell was talking to Terence Handley MacMath.

Queer Holiness (Books, 22 July) is published by DLT at £16.99 (CT Bookshop £14.99).

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