CLINICAL HANDBOOK OF SCHIZOPHRENIA

598 VIII. SPECIAL TOPICSing with both. In response to withdrawal and constricted emotion, spirituality mayencourage hopefulness, enthusiasm, and even joy; it may enhance motivation for (re)involvementwith other people and the world at large. Beliefs that emphasize the possibilityof emotionally and spiritually “uplifting” moments and activities that provide direct experienceof such moments provide an illustration of such possibilities. For example, formany African American consumers, traditions of gospel singing and expressive worshipoffer avenues for vigorous and lively self-expression, a tangible antidote to wary socialwithdrawal.In dealing with positive symptoms, the capacity of spiritual and religious practices tocultivate a “calm mind” is particularly noteworthy. Meditating, focusing, grounding, centering,praying—all of these activities can offer stark alternatives to the often threateninginternal chaos that attends psychosis. Like relaxation more generally, this kind of calmnessis incompatible with anxiety. However, spiritual and religious practices often go beyondsimply facilitating a relaxation response. Sometimes the practice is embedded in alarger, purposeful discipline, so that it is not merely an “exercise” but a core expressionof spiritual devotion. Sometimes the practices involve content—images, holy words orphrases, sacred texts—that reflects unique meanings of a religious tradition, thus deepeningties to a faith community and its self-understanding. Sometimes the practice is consciouslyintended to bring the whole person to a particular state of well-being. In anycase, the peacefulness or calm that spiritual practices and beliefs may engender offers adistinct contrast to the intrusive and often threatening experiences characteristic of psychoticstates.Some Dilemmas of Religion and Spirituality in RecoveryHistorical bias against religion and spirituality is common in psychology and psychiatry,especially in certain psychodynamic traditions and other theoretical frameworks. As thepreceding discussion has indicated, it would be an error to allow such theoretical blindersto lead clinicians to minimize the importance of possible roles for religion and spiritualityin recovery from schizophrenia. Most people diagnosed with severe mental disorders reportthat spirituality has a valuable place in support of their recovery. On the other hand,it would be erroneous to permit enthusiasm for this potentially positive role of religion toobscure its difficulties. Spiritual and religious involvements are complex and can be relatedin correspondingly complex ways to recovery stories. Negative religious coping andexperiences of “religious strain” frequently carry negative outcomes in terms of mentalhealth: heightened depression, anxiety, and posttraumatic stress disorder (PTSD) symptoms,among others. It is helpful to consider some paradoxes related to spirituality andreligion, especially as these dilemmas may be experienced and described by people recoveringfrom diagnosed psychotic disorders.Inclusion and ExclusionIn recovery from schizophrenia and other severe mental disorders, experiences of stigmatizationand exclusion are common. Correspondingly, the importance of being included,being a part of, being accepted, or simply “let in” has been noted by many people in recoveryand by advocates as key values supporting recovery. On the positive side, spiritualgroups and religious communities may provide welcoming and caring havens in the midstof what can be a rejecting and indifferent society. Many individuals report the positiveimpact of being invited to join faith communities as full participants, without a focus ontheir deficits or problems. Such groups at their best can offer unconditional acceptance