CLINICAL HANDBOOK OF SCHIZOPHRENIA

58. Spirituality and Religion 601covering persons’ exploring their options fully and experiencing support for theirautonomous actions and chosen goals.Hopefulness and DespairPeople frequently find in spirituality deep reservoirs of hopefulness. Many spiritual andreligious settings and activities paint a hopeful vision of the future. In this kind of orientation,the future is more likely to be seen as open, and one’s valued place in it is more likelyto find affirmation. Spiritually speaking, hopefulness is built into the nature of reality,because there are forces for good, whether these are seen as divine or not, that are influentiallyactive in the world. Religious faith often carries the conviction that things—fromthe broadest perspective, at least—will work out for the best, and even more frequentlyexpresses the certainty that individuals have divine allies when striving to live faithfully.For people in recovery, the sense that there are real options in the future, that life canchange for the better, that healing and growth are both possible and supported by ultimatepowers, is a comforting set of convictions and provides energy for the recovery journey.Alternatively, of course, spirituality and religion can be sources of discouragementand despair. Especially when they emphasize guilt and sinfulness, and make the possibilityof redemption remote, faith communities can deepen depression and despair. Theologically,when they stress the tremendous difficulty of attaining salvation (or, inpsychosocial terms, health and well-being), they place additional obstacles in the way ofpeople who all too often experience themselves as broken and damaged. Even, perhapsespecially, for those who grew up with positive and hope-engendering contacts with afaith community or spirituality, discouraging messages can lead to demoralization. Particularlywhen these messages emphasize punishment and ostracism for “falling short,” orfor not fitting the mold of an idealized adherent, and when the community portrays theideal in a way the person in recovery is very unlikely to meet, hopelessness is not a surprisingoutcome.RECOMMENDATIONSClinicians often underestimate the importance of spirituality to the people they serve andmay be unaware of the ways in which religion and spirituality function in the lives ofconsumers. There are several implications of recognizing a more central role for spirituality.First, for those individuals who report that spirituality is important to their selfunderstandingor recovery, a functional spiritual assessment—attention to the role spiritualityplays for a particular individual at a particular time—is fundamental. Such anassessment is far more complex than simply noting a person’s religious affiliation (or lackthereof). It takes seriously the value of exploring the relationship between the individual’sspiritual practice or understanding and his or her overall functioning. Recognizing thecomplexity of religion’s role allows the clinician to listen carefully for ways in which spiritualitymay foster or hinder recovery.Second, if the consumer wishes to discuss the implications of spirituality for the serviceshe or she receives, clinicians can follow through on this assessment by discussingwith the consumer a range of options. A further conversation might usefully exploreways to enhance the role of spirituality that is primarily supportive of recovery, and to examinepossible alternatives to spiritual dynamics that undermine well-being. For theseconversations to be most helpful, though, clinicians need to be willing to learn from the