CLINICAL HANDBOOK OF SCHIZOPHRENIA

602 VIII. SPECIAL TOPICSconsumer about the specifics of his or her spiritual life and choices. Clinicians also needto be knowledgeable about common religious and spiritual expressions among the peoplethey serve, so that they place individuals’ experience in appropriate cultural and socialcontexts. After individuals’ personal and cultural commitments are clear, the conversationcan meaningfully turn to ways in which mental health services can take more fullyinto account individuals’ spirituality.Some mental health agencies have begun to offer group or individual counseling andpsychoeducation that explicitly focuses on spirituality. Religious or spiritual discussiongroups that provide a safe place for people to explore the potentially positive and negativeroles of spirituality have become more common. Peer-led discussions frequently addressspirituality. Even in those programs that do not wish to offer such formal, spirituallyfocused services, clinicians can be aware of the larger community’s resources forresponding to the spiritual needs of consumers and include these resources appropriatelyin their discussion of recovery planning. Knowing, for example, those faith communitiesor spiritual groups that have been open to and supportive of people diagnosed with severemental disorders is key in helping consumers sort through their options for connectingtheir recovery with their spiritual lives.Spirituality and religion are frequently controversial topics, no less in mental healththan in the larger public contexts. Both positive and negative generalizations about therole of religious or spiritual involvements may become overstated and inaccurate.Though it is certainly true that the preponderance of evidence supports the potentiallysupportive role of spirituality and religion in recovery, there are also pitfalls in these domainsthat may make recovery more difficult. Clinicians do well to adopt a stance of empathiclistening and openness to understanding the complexity of spirituality as it may beexpressed at a specific time by a particular individual. By approaching spirituality in thesame kind of collaborative, conversational exploration that characterizes other topics ofinterest, clinicians create a space for meaningful discussion of the important and oftenminimized place of spirituality in the lives of people diagnosed with schizophrenia.KEY POINTS• Very substantial numbers of people diagnosed with schizophrenia report that spiritual andreligious resources are helpful to them in dealing with their mental health difficulties.• These supportive resources include a wide range of spiritual activities, as well as specificways of understanding the individual’s life circumstances.• Among the positive roles spirituality and religion may play in a person’s life are strengtheninga sense of meaning and purpose; enhancing personal identity; and bolstering emotionalwell-being.• On the other hand, certain kinds of spiritual or religious activities and beliefs (e.g., negativereligious coping) may undermine recovery.• Some key themes of religious and spiritual experience present both positive and negativepossibilities in relationship to recovery from schizophrenia: inclusion–exclusion, empoweredself–devalued self, expressive self–constricted self, autonomy–external control, and hopefulness–despair.• Clinicians should familiarize themselves with the religious and spiritual expressions, as wellas the personal and organizational spiritual resources, that are common among the peoplethey serve, with special attention to their social and cultural contexts.• Clinicians should have a culturally attuned, individualized conversation—a functional “spiritualassessment”—to understand the role of spirituality or religion in the person’s life.