I. Last Fall, I was able to begin facilitating a class on the topic of Spirituality and Recovery. It is remarkable to me to have the opportunity to discuss spirituality in the context of recovery education and the feedback from students has been very positive. Because the class did not have an established curriculum, I have had to do a fair amount of consideration and research on the role of spirituality in recovery and how the topic might be best approached within a state-funded, recovery education center.
As it turns out, it’s not so complicated as the traditional clinical taboos on the topic of spirituality in mental health care might make it out to be.
I had done elective classes on subjects like positive psychology and The Four Agreements and so I had some experience doing inquiry-based education around concepts like gratitude, forgiveness, strengths, acceptance, perspective and values. We had, in WRAP class, talked specifically about spiritual practice as a wellness tool and we hold meditations several times a week at the recovery education center.
Still, a class explicitly on the subject of spirituality in recovery was new territory for me. I knew that I didn’t want any form of proselytization to take place, and that many people had experienced trauma through involvement with religious organizations. I understood that the worldview and self-view established by some bodies of belief can be harmful to people, supporting deep guilt, fear, and shame. Yet, for others, involvement in church communities had been life-saving. To accommodate all the different ways people experience and practice spirituality, the class is facilitated as a conscientious safe space in which people can share ideas and perspectives on what spirituality means to them and respectfully explore different aspects of spiritual awareness, such as discernment, faith, and love. Some students have told me that, for them, it is the most important class that is offered at the REC.
Across the country, there are initiatives that support spiritually-informed practice in mental health care. However, in spite of developing policies of best practice that affirm that a person’s spiritual health may significantly impact his or her recovery, it seems that many organizations do not have a clearly established ethos or practice that consistently supports spiritually conscientious mental health care. In traditional mental health settings, spirituality has long been a topic that is off limits to providers, due to the fear that supporting people in exploring spirituality may somehow breach the separation of church and state, compromise professional boundaries, or “foster delusions.” (Ashcroft, Anthony, & Mancuso, 2010)
Although the etymology of the word spirituality is rooted in conceptions of an actual spirit that “dwells” in people, modern usage has been expanded to refer in a more subjective and general sense to quality of life as defined by interconnectedness, sense of purpose, and meaningful self-worth. (Koenig, 2009; Ashcroft, 2010) Though spirituality and religion are not mutually exclusive, spirituality does not necessarily have anything to do with religion. In fact, for some, religion is actually counterintuitive to their understanding of spirituality, which can encompass everything from one’s connection to nature, to self-love, positive engagement in life activities, and simple joyfulness.
The current multidimensional view of spirituality is considered by some to be too closely related to measures of what is considered to be “good mental health,” and methodologically, if spirituality cannot be separated from good mental health, healthy spirituality indicates good mental health and vice versa. (Koenig, 2009) While this somewhat circuitous line of reasoning is criticized in formal literature, it aligns well with the conclusions drawn from many spiritual leaders and social theorists who have considered elements of spirituality to be part and parcel of human wellness. (Fromm, 1955; Dalai Lama XIV, 1999) However, what determines whether or not a person’s spirituality is “healthy” is very personal and highly variable.
What is “healthy” spirituality and what supports it? Is it our human right to question our spiritual orientations, to experience transcendence and dark nights of the soul? Is it not normal to go through strange and transforming processes in our becoming who we are? Is it not our right to have significant questions about God or to get bold ideas and big feelings about the world and our place in it?
These questions lead us to the spiritual rights of people who are considered to be psychotic, those who have most routinely been denied their spiritual rights in formal mental health settings. There is such a pervasive fear of mad spirituality that it is, in fact, included in the DSM criteria for schizophrenia, in the specific mention of delusions and hallucinations of a “religious” nature.
Beyond the range of normative Western expressions of spirituality is a rich array of tradition, myth, and self-world dynamo in the form of metaphysical inquiry, shamanism, and gnostic and mystic traditions. Due to the heightened availability of information and perspective that the internet affords us, many people are able to find ideas that resonate with them and their experiences. Without looking very hard, it is easy to see the similarities between what is considered to be madness and what are considered to be processes of spiritual exploration, transformation and intuitive resolution seeking.
Yet, it has been observed that, in formal settings, orientation to spiritually subcultural beliefs or engagement in practices that are thought to be atypical is often confused with “psychosis” or “delusions” and these manifestations of developing spirituality are dismissed as being “symptoms,” rather than being honored as deeply significant and meaningful spiritual realities.
In addition to the solid body of humanistic and transpersonal theory and analysis which suggests that the phenomenon of madness is deeply rooted in struggles with one’s self and consciousness, recent research affirms that themes in a person’s personal history and relational orientation to others and to the world in general tend to arise, in ways that suggest thematic coherence, in an individual’s experience of madness, and that conflicts within self and role may be integral to the madness process. (Sinnott 2010, O’Connor 2009, Lukoff 1988) It would seem then that an appropriate response to madness would accommodate the subjective reality of these struggles and recognize that the content of madness often has a great deal to do with unresolved questions of consciousness, self, and the world.
It is well-known that the typical responses to manifestations of spiritual crisis that meet diagnostic criteria for psychosis are chemical restraint and forceful and coercive discouragement of any further mention of those elements of experience which may suggest whisperings from God or any sense of divine calling that could be deemed grandiose. It is acceptable, of course, to engage in “healthy spirituality” such as church services and prayer groups. It is okay to be Christian, Jewish, Islamic, Buddhist… but, normative conceptions of what constitutes “healthy” spirituality seem to preclude one from being an unbound spiritualist who reads meaning in the happenstance of subway signs or a person who finds God in the wind outside of the confines of a metaphor in a poem written in a day treatment center.
Due to my interest in spirituality and recovery, when I saw that Dr. Nancy Kehoe, a popular NAMI speaker, would be conducting a local training on “Faith, Mental Illness, and the Journey to Wholeness,” I thought it might be interesting to see what a medical model perspective on the subject might be. I figured that I was prepared for the language of biopsychiatry and hopeless prognosis. However, I found that the training reignited a deep dissonance within me. I walked into the training with these questions in mind: “How can people of religious faith and/or a strong sense of spirituality invest in the beliefs of the medical model? How can the beliefs that “In God, all things are possible” and, more colloquially, that “God don’t make no junk” exist alongside the belief that difficulty in one’s human experience is due to a brain disease that one cannot fully recover from?
By the end of the day, I felt troubled, confused, and alienated, as I often do when I am forced to reckon with the strength of the disease model in shaping people’s view of the human condition. How is it that these pathological ideas can be so strong as to challenge the tenets of one’s most core beliefs in the purpose and potential of humanity?
“Why is it that people with severe mental illness often seem to be so spiritual?”
Dr. Kehoe nodded, and wrote down the question asked by a young clinician. After hours of hearing about the ways that “healthy spirituality” can be of great benefit to “the severely mentally ill,” the question was asked to the crowd of psychologists and social workers.
“What do you think?”
I had attended the training with the full intent of making my voice heard, as a peer and as a person whose emergent spirituality had led to experiences that were, erroneously, considered to be the products of a mental illness. However, by the afternoon, my voice was shaking as I spoke in answer to this question of why it is that “those considered to be mentally ill are often deeply spiritual.”
I disclosed my professional role and identified that I am a person with lived experiences of a severe and persistent nature. To my knowledge, I was one of the only peers in the room, though I know I wasn’t alone. Some of the clinicians, surely, had had their own dark nights of the soul. Dr. Kehoe herself had struggled after she heard a voice telling her to join the convent (Kehoe 2009).
The whole room, in fact, seemed to understand what I was saying when I said that if people have struggled to survive, when they have experienced great light and darkness with profound sensitivity… when people perhaps see and feel the world differently… that where there is raw humanity in life and death, there is great spirit, insight, and significance.
I felt my face rush to red as I spoke, and I heard my voice tremble, uncharacteristically stumbling over my words. I had to take a deep breath. I felt lightheaded, just like I used to feel when I would speak out from the back row of a lecture hall, or read something that meant something to me in front of a class. “There have always been people who have grappled with spirit… ”
People had the audacity to actually applaud, as if the “severely mentally ill” woman had been brave in speaking her piece. That night, after the training, I went home and I cried. For the past three weeks, I have been troubled by that day, by what I heard and by who I was in the context of the language used.
Throughout the day, I had been thinking about all the people who were sitting on locked wards, because they had, perhaps, gotten overwhelmed and confused about God or the devil or some combination thereof…about ghosts and the television…spirits in the pictures…telepathy with some big machine…a lifeforce relaying messages. How might their stories have been different if they’d had someone to talk with, someone to listen to them, to support them in figuring out what their thoughts and feelings meant to them in relation to what was in their hearts?
Part of my current spiritual practice is hoping that the people who are confined by chemical and court order because they stumbled into feelings and ideas that they did not have a context for will find some light in their day, that the fire in their hearts will not go out, and that they will feel somehow that they are loved… and that they will believe it.
I also thank God that I managed to narrowly escape such a fate as the one so often imposed by the medical model.
Ashcroft, L., Anthony, W. & Mancuso, L. (2010, June 30) Is spirituality essential for recovery? If spirituality supports resiliency, then it’s definitely part of our business. Behavioral Healthcare: The business of treatment and recovery. Retrieved from http://www.behavioral.net/article/spirituality-essential-recovery
Bstan-‘dzin-rgya-mtsho, Dalai Lama XIV (1999). Ethics for the new millennium. New York, NY: Riverhead Books.
Fromm, Erich. (1955) The Sane Society. New York: NY. Fawcett World Library.
Lukoff, D. (1988) Transpersonal perspectives on manic psychosis, creative, visionary, and mystical states. The Journal of Transpersonal Psychology. 20(2), 111-139.
O’Connor, K. (2009). Cognitive and Meta-cognitive Dimensions of Psychoses. Canadian Journal of Psychiatry, 54(3), 152-159.
Kehoe, N. (2009) Wrestling with our inner angels. San Francisco, CA: Jossey-Bass.
Koenig, H. G. (2009). Research on religion, spirituality, and mental health: a review. Canadian Journal of Psychiatry, 54(5), 283-291.
Sinnott, J. (2010). Coherent Themes: Individuals’ Relationships with God, Their Early Childhood Experiences, Their Bonds with Significant Others, and Their Relational Delusions During Psychotic Episodes All Have Similar Holistic, Existential, and Relational Themes. Journal of Adult Development, 17(4), 230-244. doi:10.1007/s10804-009-9090-y
Mad in America hosts blogs by a diverse group of writers. These posts are designed to serve as a public forum for a discussion—broadly speaking—of psychiatry and its treatments. The opinions expressed are the writers’ own.