CLINICAL HANDBOOK OF SCHIZOPHRENIA

58. Spirituality and Religion 599and create places where hospitality is extended beyond initial contacts, where activereaching out creates spaces for the whole person to be involved in ongoing communitylife. One woman reported that joining such an accepting church offered her a way to reestablishcontact with the larger society, convincing her that she was capable of meaningfulrelationships just when she had thought she “would never be able to be with peopleagain.”Religious communities, however, can be as rejecting and closed as they are acceptingand open. In fact, organized religious groups are not infrequently built around dynamicsthat emphasize certain qualifications for full membership and, equally important, characteristicsthat lead to disqualification and exclusion. For people with severe mental disorders,this can lead to painful feelings of rejection—because of the group’s expectationsabout ideas, behaviors, or dress that may be impossible for the individual to meet, becauseof implicit or explicit demands for financial support beyond the person’s means, orbecause of principles that rule out acceptance of the whole person. One woman reported,for example, that she was under tremendous pressure from her faith community tochange her sexual orientation. Though she had been accepted in many ways by thisgroup, their understanding of homosexuality made it impossible for them to include herin this area that was basic to her identity. Her painful dilemma was, on one hand, to leavethis church and relinquish its supports to be able to accept her own sexual orientation, oron the other hand, to remain in the church but try to relinquish her homosexuality. Bothalternatives involved difficult losses and threatened her recovery.Empowered Self and Devalued SelfSpirituality and religion often acknowledge the richness and complexity of human life,and place individuals in relationship to their own greatest potential. They frequently emphasizethe inherent goodness of humanity, or at least the possibility of its amelioration.Spiritual and religious practices can lead to a sense of empowerment, of not only havingcertain strengths but also of being invited to develop and use those strengths for selfimprovementand for the well-being of others. As with other aspects of spiritual reality,this kind of empowerment is rooted in ultimate or sacred contexts; the divine or transcendentor higher power is supportive of self-actualization (as this is understood in each tradition).This ultimate sense of being known by, important to, and valued by the divine ortranscendent supports recovery by creating a strong basis for self-valuing. For example,people who so often report a sense of their own diminished worth can find an effectivecountermessage in reminders that God loves them and sees their potential for full andmeaningful lives.In contrast, though, individuals with severe mental disorders sometimes draw on religiouslanguage that devalues the self. This is certainly evident in acute episodes of psychosisthat may incorporate images of the self as irredeemably sinful, damaged, or cursed.But even in recovery, individuals report that some religious convictions, frequently reinforcedby faith communities, contribute to self-denigration. One of the more commonthemes in this regard is a belief that symptoms of mental disorder or distress reflect anunderlying lack of personal faith or discipline. When people diagnosed with schizophreniaare told, and come to believe, that mental or emotional problems are primarily a resultof their spiritual deficiencies, religion becomes a one-sided obstacle to recovery.Whether by seeing the use of mental health services, especially psychotropic medication,as a sign of moral failure or by setting goals that are unattainable by spiritual meansalone (e.g., “simply” praying harder to lessen psychiatric symptoms), religion can underminean individual’s sense of self-esteem and reinforce images of deficiency.