CLINICAL HANDBOOK OF SCHIZOPHRENIA

58. Spirituality and Religion 593in both assessment and service delivery. Spirituality is increasingly seen not as a domainseparate from the rest of consumers’ lives, but as an integral part of whole-person functioning.From this point of view, spirituality directly affects and is in turn affected byother life dimensions. In addition, the necessity and value of incorporating cultural competenceinto service models have led to calls for greater awareness of the important rolereligious expression plays in many cultures. Being attuned to a culture’s characteristicrange of religious views is essential to accurate assessment and to services that take intoaccount cultural dynamics and norms. In a related way, there has been renewed attentionto the significance and meaning of the subjective experiences of people diagnosed withschizophrenia. Alongside advances in biological psychiatry have stood studies of the waysin which individuals experience mental distress and disorganization, construct meaning,and renew a sense of self; these qualitative approaches have contributed substantially to amore comprehensive understanding of psychotic experience and of healing. Finally, led bymany consumers and advocacy groups, enhanced awareness of the possibility of recoveryfrom schizophrenia has grown into seeing recovery as a key, orienting value in manymental health service systems. Many individuals understand and describe their recoveryas most fundamentally a spiritual process or journey, one that relies heavily on a sense ofmeaning and purpose. Each of these clinically derived emphases—holism, cultural competence,subjective experience, and a recovery orientation—has contributed to a heightenedattentiveness to spirituality and religion in relationship to schizophrenia and othersevere mental disorders.The research literature has provided an additional set of reasons for attending to religionand spirituality. Focusing directly on numerous potential connections between religionand health—physical and social health, as well as mental health—these studies initiallyemphasized broad measures of religion (e.g., religious affiliation, organizationalinvolvement, religious or spiritual practices) and of well-being and illness. Numerous reviewsof this literature have noted a growing consensus that, on the whole, religiousnessis related positively to many measures of mental health and, conversely, to lower levels ofdistress. However, such findings are not at all unequivocal. In fact, other work has suggestedthat certain types of religious involvement or spiritual coping may be related topoorer mental health and lower levels of overall functioning. Recently, researchers havebegun to move into a second phase of more specific questions, asking, for example, abouthow specific aspects or styles of religiousness or spirituality may affect particular life domainsfor particular people at particular times. This line of research has also begun to addressquestions about the potential role of religion or spirituality in coping with symptomsof schizophrenia and in the process of recovery. Thus, from both clinical andresearch perspectives, spirituality and religion have emerged as increasingly important avenuesfor exploration in understanding the lives and experiences of people diagnosedwith schizophrenia.EXPRESSION OF RELIGION AND SPIRITUALITY IN PSYCHOSISPeople diagnosed with psychotic spectrum disorders frequently express religious contentin delusions or hallucinations. Two questions related to this observation are especiallyimportant for clinicians. The first concerns the relationship between religious delusionsand the cultural context. Both the frequency and the content of religious delusions seemto vary significantly from culture to culture. Not surprisingly, since religious/spiritual beliefsand practices may be understood as basic expressions of a culture’s meaning-givingstructure, the centrality and prevalence of religious practice in a given culture appear to