As it is in Heaven – a review for healthcare staff

(See what the International Movie Database says about As it is in Heaven)

Please note: This article may spoil your spontaneous enjoyment of the film. A number of significant events are revealed, so if you want to watch the film without preconceptions, we advise you to read the article after watching the film.

"As it is in Heaven" is about a successful international conductor who suddenly puts his career on hold and returns alone to his childhood village in Norrland.

By Dr Göran Björling, Specialist in general psychiatry

Truth and Community – Also On Earth?

After 18 years away from the limelight, the justifiably acclaimed “As it is in Heaven” is the return of Kay Pollak to feature films. The film deals with a different kind of return focusing on return and alienation, agreement and reconciliation, development and nostalgia. Anyone who has ever worked with people in crisis will know that within all these contrasts lie the difficult and simultaneously liberating experiences of change.

The film is set around the famous conductor Daniel Daréus, brilliantly played by Michael Nyqvist. After a personal failure he withdraws from the concert life to recharge his batteries and returns to his childhood village in Norrland in Northern Sweden. As a child he was bullied for his interest in music and suffered from isolation and loneliness. His childhood village is as introvert as ever and people there have difficulties seeing other perspectives than their own.

No-one recognises him as the village boy. With the help of the young shop assistant Lena (Frida Hallgren), the already reserved conductor becomes involved in the church choir in the village, and Daniel takes on the position as cantor for the congregation.

Daniel is advised by colleagues to work with the balance of the choir. Each member must find his or her own voice to make the choir work as a whole. It is not difficult to see that the issue is not only how a choir works, but also how a group or village works. Daniel entering the arena creates both delight and anxiety.

”It is not difficult to see that the issue is not only about how a choir works, but also how a group or village works.”

Many find this to be an eye-opener in terms of previously hidden needs and abilities. It turns out that the mentally disabled and marginalized Tore has a fantastic bass voice. Daniel helps him to find his voice, but development is not always welcome. The vicar’s jealousy flares up when his neglected wife finds her voice with the help of Daniel.

The film revolves around people with varying degrees of complicated relations and illustrates how Daniel and his work impact their lives. In particular, there is Lena, who is scorned by many of the villagers after a series of unsuccessful relationships. The relationship between Lena and Daniel grows deeper through the choir and cycling lessons they help each other develop. Lena falls in love with Daniel, something, which is not easy for her to bring up after the numerous men that have let her down.
Beneath the perfect surface of village life, a multitude of problems and conflicts lurk, but the will to help each other gradually emerges among the members of the choir.

By being able to speak openly with each other, the members of the choir develop solidarity, an ability to see each other as the individuals they in fact are. For some, however, the increasing openness becomes a direct threat. The vicar tells Daniel of his disappointment of losing his status in the village - he has become a nobody and suffers from breathing difficulties and panic attacks. When his established dominating position is disturbed by virtue of the liberation of people around him, his whole world starts to crumble.
Daniel and the choir travel to a choir contest in Austria, and here he meets his former agent who wonders whether Daniel has reached his goal. Daniel confirms that he has. The liberating and creative interaction has made both the members of the choir and him visible and accepted. On his way to the concert hall in Austria, Daniel suffers from chest pains. He finds his way to the men’s room, where he collapses. Through an air vent we hear the noise from the concert hall and the uncertainty brought about by Daniel’s absence leads the mentally disabled Tore to strike up a tune and others follow. In the end, the whole choir is singing and the audience joins in and perfect fellowship is created. Daniel’s goal is achieved: to create something completely different, something that no-one has ever heard before. Daniel dies with a smile on his face, where memories of the bullying during his childhood are replaced by reconciliation and fulfilment.

The film contains several different stories of change and development. A central theme is the introvert village, the confinement and its effect on people and their relationships. When human beings are afraid to express their emotions, they become incomprehensible to each other. Their lives and actions also become incomprehensible. Only when we dare to break these constrictions, can we act in accordance with what we really are, and thus give our lives meaning.

Comprehensibility, manageability, meaningfulness – the salutogenesis

Aaron Antonovsky

Aaron Antonovsky (1923 – 1994), American-born medical sociologist, who worked in Israel for many years, wrote in his classic book “Unravelling the Mystery of Health” about our need for the sense of coherence - SOC. According to Antonovsky, the sense of coherence has three hierarchically organised dimensions: comprehensibility, manageability, meaningfulness. The basis for Antonovsky’s work with these issues was his amazement concerning the fact that some people who survived the Nazis’ concentration camps to some degree succeeded in not being affected by psychological problems. Antonovsky’s originality is due to his focus on factors that may promote health – so called salutogenic factors – instead of looking at factors causing disease.

Antonovsky claims that the basis for maintaining mental health is that the surroundings are comprehensible to us like things that happen, why they happen, as well as the behaviour of others towards us such as their reactions and feelings. If we do not comprehend, we are thrown into a chaotic and confusing world.

Bullying makes those attacked subject to the terrible and confusing experience of not understanding why they are excluded or treated badly.Not understanding why is one of the hardest hitting aspects of bullying.

”Only when you dare to enter into conflict with the establishment and dare to stand up for your own opinions to help another human being will the picture change”

If we do comprehend our surroundings, our chance to cope with what happens may change a lot. Manageability may be made difficult in numerous ways. The power structure of a village (or a workplace, a group or a relationship) incorporates things, e.g. certain ways of behaviour or expressions which may be “forbidden” and such behaviour is ridiculed or mocked as a matter of course.

In such cases, some issues and problems will be very difficult to manage. One example from “As it is in Heaven” is the situation of the vicar’s wife before she dares to rebel against her husband. The situation does not become manageable before she rejects the established order of things which has been controlling her for so long.

Comprehensibility and manageability provide a decent basis for health. Meaningfulness is also required to obtain a stable basis, according to Antonovsky. Meaningfulness requires that we comprehend things happening around us and to us. It also requires that we take part in our lives, that we interfere in and influence our situation.

But to achieve meaningfulness, we must also perceive our lives as precious. The feeling that life is precious is invariably deeply personal, although it may be phrased in religious, political or ethical terms. Often people find it valuable to do something of significance for others. Rules and regulations does not give much meaning and when others demand that we follow rules for their sake, it becomes a threat to the meaningfulness of life.

“As it is in Heaven” provides numerous opportunities to contemplate the dimensions of SOC. In a mendacious world, where emotions are supplanted or forbidden a lot of what happens becomes less comprehensible.

So it is hardly strange that such an environment is perceived as not being very beneficial to health. In a rigid, authoritative society, it does not always help comprehending things that happen. There is still no chance of influencing the situation and how can life under such conditions feel meaningful? Only when you dare to enter a conflict with the establishment and dare to stand up for your own opinions to help another human being will the picture change. You will feel that you have done something that gives your life meaning. Pollak’s film also shows examples of this.

The SOC concept has sparked quite a lot of interest, but has only been integrated marginally in psycho-social treatment in Sweden which is regrettable in many ways. Antonovsky also constructed a SOC scale, which obviously gives a numeric value on how a person scores when it comes to his or her own sense of coherence. The scale has been used rather extensively within research on various psychiatric, psychological and psycho-social problems. But in practical clinical work, we see neither the term SOC nor salutogenesis. We will still much rather look for pathogenic than salutogenic factors.

We have far too little interest in the abilities and talents of our patients, even though, we know that people often experience happiness and acceptance when they are able to express their talents. We spend far too little energy finding out in which context this happens for our patients.

Albert Bandura

The term self-efficacy introduced by the legendary Canadian psychologist Albert Bandura resembles Antonovsky’s ideas. Self-efficacy concerns trust in our own ability to cope with different situations we meet in our life.

Bandura claims that we have much greater opportunity to help our patients find strategies to manage problems if our starting point is similar situations of success.

”We have far too little interest in the abilities and talents of our patients”

It is much easier to generalize behaviour already inherent in a patient than it is to accept suggestions from others concerning behavioural patterns which may feel new and uncomfortable. This type of ideas is used more and more in e.g. consultation in connection with risky behaviour (such as smoking, excessive alcohol consumption).

Bill Miller

A similar way of thinking is included in the Motivational Interview methodology developed by the American psychologist Bill Miller and his associates.

MI is a much more thoroughly tested method, which also includes techniques for meeting people’s ambivalence and resistance to change with respect. A basic rule for this method is that the motivation to change lies with the individual client/patient and is not something which is forced upon them from the outside world. The method is described in detail at www.motivationalinterview.org.
In Sweden, Motivational Interviewing is used in some areas within primary health care and substance abuse care, and regular training in this method has been available for a few years.
A similar working methods is the Marte Meo method, which means ”of one’s own strength”, developed by the Dutch special educationalist Maria Aarts. Marte Meo.

The method is distinctly salutogenic. If you for instance work with a dysfunctional family, the Marte Meo method entails that you help the family members identify the times when communication and interaction work well so that they may generalise based on these experiences.

Quite concretely, the procedure is as follows: Long sequences are recorded on videotape, and when the therapist watches the video with the family the therapist focuses only on the 15 seconds where it works well.

The Marte Meo method has become increasingly comprehensive and appreciated by the social services and psychiatric services for children and adolescents, especially as it will often provide better results than methods based on analysis of pathology. This does not at all entail that one method is better than the other, but the scope for salutogenic perspectives in the psycho-social treatment currently seems to be very extensive.

Choral Singing and Well-Being

Several researchers have pointed out that choral singing is useful, that practicing and participating in choirs creates well-being even after the practice sessions. The immune system gets a boost, the energy levels rise, the level of stress hormones is lowered, and there is balance between the sympathetic neural system (the accelerator) and the parasympathetic system (the breaks). Thöres Theorell, professor of psycho-social medicine at the Karolinska Institute, has said that when he sings in a choir, he feels like he is ”joining in something great and beautiful (where you) feel like a key on an organ”.

Participation in a choir can be viewed as a decrease of individuality. Taking part in teamwork entails among i.e. that no individual is more visible or audible than another. To achieve harmony through the unity, each individual must have his own voice, but also respect the requirements of the unity. The balance between individuality on the one hand and joint limitations and regulations on the other is characteristic of all group communities: a village, a workplace or an organization. These are fundamental dimensions of our existence, but they are not verbalized often. The lack of balance between the individual and the greater coherence is still an important reason for discord in life.

Gunnar Ekelöf

Individuality and Belonging to a Group

”In loneliness, you are nobody”, wrote the poet Gunnar Ekelöf. A depression is maybe one of the loneliest conditions in existence. Recovering from depression may be helped along with the aid of medicine or psychotherapy or it may happen totally spontaneously. Regardless of treatment methods, recovering from a depression is also about regaining your abilities, reclaiming bits of your life. We often talk about the significance of remission in the treatment of depression as a contrast to only reducing symptoms. Hence in recovery lies the opportunity of becoming yourself again both in your community and in your personal life.

How do we help our patients on the way to recovery? Sometimes the administered treatment is sufficient, but other times various efforts directed at the network or the patient’s situation may be required. In a fascinating and not always manageable way, problems of identity and individuality are intertwined and linked with issues of community and belonging.

”In a multi-facetted way, “As It Is In Heaven” sheds light on questions concerning the significance of individuality for the workings of the group”

In a multi-facetted way, “As it is in Heaven” sheds light on questions concerning the significance of individuality for the workings of the group, and the significance of the community for the self-esteem of each individual. As we all know, it is not always easy or conflict free to be yourself. In the community of the church choir, the persons are developed individually, both musically and emotionally. As members of the choir, they exist in coherence and may experience participation in a fellowship. You may be seen and accepted, but development may also be threatening. The film depicts both the emancipation and the threats in an expressive way and with all the complexity we recognise from clinical work.

Finally, it should be pointed out that “As it is in Heaven”also has very explicit Christian overtones, which may be tied to psychotherapeutic processes. Erland Svenungsson will write about this below.

By Pscychotherapist & priest Erland Svenungsson

Truth Shall Set You Free

I find the destructiveness in believing that you are always right both in thought and actions to be the fundamental theme of the film.

The vicar Arne does everything to control and organise the people of the village. They are weighed down by guilt and afraid to look ahead.

”They live out their emotions, their sensuality. They are all longing to be set free”

Their whole way of life is characterised by a fear of life, of each other and of themselves. They have developed into their own prison guards. Any step out of line or ahead results in feelings of guilt. Their fear becomes a cry from the unlived life, an expression of the undelivered passion of their lives. But beneath the surface, life exists as the life they try to keep away. Here everything is thriving from undelivered longing for love to rash violence.

In an intolerant, religious system the dominant villagers try to keep control for their own sake. Double standards abound. In the film, this is shown e.g. in the scene with the pornographic pictures in the vicarage. In his conflict with the representatives of double moral standards, and much to the consternation of his surroundings, Christ placed the kingdom of God inside each and every person. “The kingdom of God is inside you. Let therefore your inside determine what is right.”

Such an approach is the opposite of the rules and regulations imposed on people by the representatives of the oppressive religious systems – and which still exist within various religious traditions today. There, fear is often used as a means to keep the followers in line. If they step outside the boundaries, they risk punishment from the authoritative system.

In the rigid, narrow-minded world portrayed in the film, the conductor Daniel Daréus appears. During a relatively short time in the village, the exhausted conductor succeeds in “enticing” people there to take their own lives and the lives of other people seriously.

This is considered by the vicar to be seduction – the fact that everyone and even a mentally disabled person find their own voices and their own lives. This is the parallel in the film to the way Christ behaved towards people he met.

For those becoming part of such liberation, fear no longer exists. The new-found honesty towards oneself and other people is liberating and forgiving.

”Unless you become as little children you will never enter into the kingdom of God!” says Christ in the Bible. After Daniel’s intervention in their lives, the villagers find their inner child, their longing for emotion, and liberation. The vicar, being the symbol of the religious system, does not dare to step into that freedom. Instead he is prepared to offer everything for his fear and for order. But when he is personally confronted with Daniel in his own room, his pent-up religious walls start to crumble. He loses control and thus his humanity starts to emerge. Daniel must suffer a lot of frustration. He gets angry, desperate, resigned, but all the time, he keeps his vision of liberation of the villagers. In the beginning, they think he is strange. They are suspicious and curios all at the same time. They are not used to trust their own abilities and their own selves.

In the New Testament, the Messiah appears in an unexpected and “foolish” context: an unexpected desert spot and with an unexpected agenda. The similarities with Daniel’s arrival to the village are obvious and naturally all intentional. According to the story, Christ was sent by God to lead Man closer to a life in truth. The goal was not happiness, profit, health or beauty. Truth is the ultimate goal. According to my interpretation, this is the major message of the film. No-one is discarded. Everyone has a voice that matters.

The strong ones wait for the weak. All human beings has an innate longing for truth, insight and understanding. Christ – and in the film, Daniel – fascinates people through miraculous actions.

”According to the Bible, Christ was sent by God to lead Man closer to a life in truth”

Anything seems possible. In the film, this is shown in the final scene. The conductor lies dying some floors below in a men’s room, but he has achieved a change in the minds of people. His vision lives on and this is his goal.

With my theological background, each psycho therapeutic session becomes a “Messiah wandering”, where the goal is to get closer to the truth, an abandonment of shame, an outlet for longing.

It is based on a belief in people’s ability to make something of their lives, to be able to leave hostile patterns in their lives behind.

As the Bible says: “Unless a grain of wheat dies, it remains alone. But if it dies, it bears much fruit”. In this light, I also interpret the final scene of the film as follows: Daniel dies but is still there, and he does not leave his choir behind, just like Christ was forced to suffer and die for his cause so that others could live. Death is not the end. The choir will continue to sing all the way into the land of the blessed disorder.

By Choir master Kjell Lönnå

Community in Harmony

The first thing I experienced when I started in a mixed choir was community – community based on equality. People of all ages who enjoyed singing and had an interest in choral singing were in the choir. Various trades were represented, and there were people from different social backgrounds.

I was probably the youngest member. I believe I was 15 years old. I sat with the tenors and with a baker aged 50, but I felt that I was accepted by the other members. Age did matter, the singing voice did. Suddenly I belonged to a group of people who had one important thing in common: To be able to express oneself through singing and gradually be allowed to appear in front of an audience, be acknowledged and at most importantly appreciated.  Of course, I never regretted my decision to start singing in a choir which includes a social harmony and creation of musical harmony. It became a passion for me.

”In all of life's changes, song and music will sound to express comfort, happiness, and jubilation”

When something important happens in anyone’s life, singing is a way to celebrate. In all of life’s changes, song and music will sound to express comfort, happiness, and jubilation.

Some people will sometimes consider singing as superficial humming, a form of amusement to pass the time with no profound connection to life and person, which could not be more wrong. If we look closer, we find that singing helps at each significant occasion in life.

During the more than 50 years I worked with choral singing, I have discovered that there is more behind the sheet of music, behind the modulation, articulation and other musical grammar. Singing, both the spontaneous as well as the well prepared act, carries emotions touching a person’s inner being. No-one yet knows what happens in our minds and souls during singing. What we do know is that singing has a healing effect of unknown dimensions. Some surveys are said to show that choral singers are happier people.

It is important to respect the song, the simple as well as the elitist, complicated song, to use singing in all contexts, and that people dare to sing with their own voice. Sometimes simple humming can relieve a timid and rigid mind. A Bach fugue may transfer us to heavenly spheres, and the scrap books of our minds are opened when we hear singing and music. We leaf through events, associations and desires. Our longing starts wandering when we hear singing, when we join in the harmony of the choir.

Singing is more important than you think. A lot of people have realised this like in church there is more singing than speaking. Politicians have also grasped the power of singing and therefore their message is often sung, and in mass media almost every program is filled with some form of singing. Signing is extremely important. No wonder that 600,000 people are members in choirs in Sweden alone.

Choral singers say that they sometimes feel tired and maybe even depressed at the end of a long working day and therefore it takes a lot of effort to drag themselves to the two-hour choir practice that evening.

”Then the choir as a group and close-knit community has supported and strengthened the person in question”

Understandable, but the most frequent reaction after having completed the practice is: “Now I feel a lot better, and I have got new energy.” The characteristics of a good choir are that there is a social community bridging the gaps of age and social standing. Here everybody is equal, like organ pipes creating music. And the texts which are sung are often inspirational too.

Almost all choral music is music composed of poems. Poetry with perhaps subtle expressions, which modern and stressed people today do not come in contact with, but which is now allowed to flow in the souls and minds of the singers.
In my choirs, members have of course also been affected by personal problems. Then the choir as a group and close-knit community has supported and strengthened the person in question.

To be allowed to show grief and depression in such a close group as a choir will also provide the opportunity to receive comfort, support and strength to overcome the difficulties.

To be part of a group of people working to create harmony both musically and personally is extremely stimulating. In a choir, you are needed. The choir depends on all voices that create triads, chords and moods with each specific tone. I depend on the others, the others depend on me.

And then, as a member of this activity, to get to participate in concerts and rehearsals and perhaps even tours to other parts of Sweden and abroad stimulates each person’s needs to be accepted and to be seen.

I cannot think of a better way to find fellow human beings to disperse the loneliness than to find a choir and start expressing yourself by singing.

Bo Setterlind

Bo Setterlind wrote in connection with a concert I created: ”To sing in a choir, to build a world of song together with others, to be able to play with others despite seriousness in moods, sounds, a community of souls, dressed in beautiful tones, that is living, that is harmony”.