Spirituality and religion in psychiatric rehabilitation and recovery from mental illness

Mental health professionals frequently express concerns about the role of spirituality or religion in the lives of people diagnosed with severe mental illness—including schizophrenia, major depression, bipolar and schizoaffective disorders. These concerns flow from a number of sources: the not infrequent religious content of delusions and hallucinations; a sense that the metaphoric nature of spiritual ideation may have a negative impact on symptoms of disorganization and confusion; the involvement of religious language in self-injury (e.g. taking literally the injunction to pluck out the eye if it offends) or violence to others (e.g. killing demons seen in another person); and the perceived rigidity of religious beliefs and rituals, rigidity that may worsen symptoms and preclude acceptance of treatment recommendations. At the same time, there are increasing grounds for the acceptance of spirituality’s potentially positive role in rehabilitation and recovery from severe mental disorders: a growing recognition of the importance of religion in health and in coping with stress; greater emphasis on cultural competence in service provision; increased differentiation between spirituality and religion; more holistic approaches in many training programs; and increased attention to the voices of consumers and their understandings of recovery (Fallot, 1998c). This article will address three areas of special significance for rehabilitative work with people with severe mental illnesses: diagnosis; roles of spirituality in recovery; and the place of spirituality in rehabilitative services. I will use the terms spirituality and religion in ways that reflect both experience and institution. Experientially, spirituality and religion can be considered virtually synonymous. They both may involve a sense of ultimate purpose, meaning, and values; a sense of the holy or sacred; and/or a relationship with transcendent reality or higher power. Religion, in addition, involves a stronger institutional context; a shared set of beliefs, rituals, or practice; and a more or less identifiable community of believers. When spiritual group experience becomes formal and structured, then, it becomes increasingly difficult to distinguish from institutional religion. I will also use the term psychiatric or psychosocial rehabilitation in its broader sense to emphasize services provided to individuals with severe mental disorders, services that draw on community resources and consumer abilities to support people in meeting their chosen goals. Recovery will refer primarily to the experiences of consumers themselves and secondarily to a goal of rehabilitation.