CLINICAL HANDBOOK OF SCHIZOPHRENIA

600 VIII. SPECIAL TOPICSExpressive Self and Constricted SelfMany spiritual and religious practices facilitate self-expression and creativity. Via traditionallyexpressive means such as music, ritual, journaling, and art, spiritually based activitiescall for the enactment of basic beliefs and convictions about both self and world.These activities can be especially powerful for individuals whose emotional or social lifemay be otherwise narrowed and limited. Certain strains in the Christian tradition, for example,emphasize a core value of life being lived “to the full” or “abundantly,” understoodas a full expression of followers’ self-understanding as faithful disciples. For manyreligious communities, the ultimate “self-expression” involves this kind of authentic lifelived out in keeping with the most fundamental tenets of the faith. Each individual maydiscover a unique purpose for his or her life, a “vocation” or “calling” that brings togetherone’s own strengths and weaknesses, and orients the self toward meaningful goals.However, faith communities may be just as powerfully experienced as rigid sourcesof rules and regulations that more frequently limit self-expression than facilitate it. In recoveryfrom schizophrenia, some have reported the appeal of highly structured and clearexpectations and routines. At times of personal confusion, especially, there may be psychologicaland social advantages in relying on a community with very explicit behavioralguidelines. Even in less stressful or challenging periods, such clarity can be helpful in givingshape to a person’s life structure. The more negative impact of this dynamic becomesobvious in narrowly judgmental attitudes and practices often institutionalized in publiclyor privately humiliating sanctions. Individuals report that involvement in certain communitiesmay come to revolve around fear of being chastised by other members or of beingshamed by those more senior in the faith. For individuals struggling with interpersonalsensitivity to criticism and rejection, this process can deepen withdrawal and constriction.Autonomy and External ControlIn a related vein, consumers and advocates have often noted that autonomy is one of thecore principles of recovery. Rather than relying automatically or unnecessarily on professionalsor other supports, increasing autonomy for those in recovery involves making increasinglyindependent decisions and taking action to meet their own goals. Spiritualityand religion may offer both a rationale (genuineness, dignity, human rights, freedom ofconscience, and attendant responsibility for one’s own life) and specific resources (includingthe positive coping methods described earlier) for recovery. One survey reported thatpeople found spiritual or religious activities that they did by themselves to be especiallyvaluable in their recovery. One plausible explanation is that people have more controland choice over these activities than over those that involve others. Thus, self-determinationis supported in many religious traditions and in numerous spiritual practices.Just as a very strong emphasis on rules for living, especially when backed by shamingand humiliation, can lead to a constricted sense of self, so can these rules lead to a senseof external rather than internal control. The culture, beliefs, and rituals of virtually everyfaith community reflect elements of both individualism and belonging; indeed, this twosidedreality has been described as a fundamental tension in human life, as well as in faithcommunities. For people diagnosed with schizophrenia and other severe mental disorders,though, experiences with professionals and family are likely to stress their need to“comply” with treatment recommendations or to follow physicians’ “orders.” In short,traditional clinical approaches often overemphasize external control and minimize autonomy.When faith communities directly or indirectly similarly stress compliance at the expenseof individual choice and decision making, they may undermine the possibility of re-