Is spirituality essential for recovery?

Get ready to squirm in your seats because we need to have a talk with you about spirituality. Spirituality is a topic we behavioral health types have shied away from: Professionals are taught to avoid it in their practices, and organizations have concerns about the separation of church and state. Many of the people who use our services, however, tell us that some form of spirituality plays a key role in their recovery process. So, since we're all trying to create opportunities for people to recover, we'd better get over ourselves and figure out how to talk to people about this.

We've asked Rev. Laura Mancuso, a psychiatric rehabilitation counselor and interfaith minister, to help us discover ways of including spirituality in program planning and initiate conversations with people that will help them develop spiritual competence.

Laura worked in the public mental health field at the local, state, and national levels for 15 years before her own journey of health challenges and personal losses culminated in a calling to become ordained. As an interfaith minister, she strives to honor all faith traditions, as well as the beliefs and life philosophies of those who do not adhere to any religion.

Laura observes that “spirituality is highly personal, very central to a person's inner life, and oftentimes inseparable from one's cultural identity. It seems to me that if mental health programs can figure out how to respect and support the spirituality of the people we serve and the people we employ, we will have figured out how to respect and support their very essence as human beings. That's why spirituality should be included in programs that intend to be holistic, culturally competent, and recovery-oriented.”

The Joint Commission's Standards and Elements of Performance require healthcare organizations-including accredited behavioral health organizations-to assess how a person's spiritual outlook may affect his or her care, treatment, and services. The February 2005 issue of the Joint Commission's newsletter, The Source, states: “Spirituality can be defined as a complex and multidimensional part of the human experience-our inner belief system. It helps individuals search for the meaning and purpose of life, and it helps them experience hope, love, inner peace, comfort, and support.”1

Aren't those things we could all use more of?

Then why is it so hard for mental health programs to “go there”? There are many reasons. Although it's now shifting (see Milestones in the recognition of spirituality in mental health wellness and recovery), professional training programs warned students for decades not to discuss religion or spirituality with clients, as it was thought to foster delusions. Publicly-funded programs must be careful not to promote religion, or to favor one religion over another. Incidents of discrimination and violence on the basis of religious beliefs create more fear. The drive to improve the credibility of our interventions through scientific evidence causes us to turn away from concepts and processes that are more difficult to measure. Given these challenges, the most common response is to avoid the topic altogether.

The challenge before us is to wade into these murky waters with our eyes and hearts open, meet myths and misconceptions with facts, and listen to what service recipients have told us over and over: Spirituality is often a valuable resource in the recovery journey.

Here are a few things to avoid while wading in:

• Avoid proselytizing. Exploring one's spirituality is a very personal experience. Each of us needs to discover our own way of relating to spiritual issues.

• Programs should not favor one religion over another.

• Service eligibility should not be conditional on expressions of faith or participation in religious ritual.

• Humanists, agnostics, atheists, and other secularists should not be excluded-directly, indirectly, or even subtly.

These are basic premises of welcoming spirituality at non-discriminatory workplaces and service sites. Following these core practices still leaves a whole lot of room for dialogue about spirituality.

Now that we know what not to do, what can we do to help people develop spiritual strength that supports their recovery journey?

One approach is to talk about spirituality as one of the three parts of our basic makeup: body, mind, and spirit. Most of us know how to take care of our bodies, and in our business, we talk a lot about how to manage our minds. Since we've largely avoided conversations about spirit, we haven't given people much support to develop competencies in this area.

Next month we will wade deeper into this subject and explore more approaches to supporting this important aspect of recovery. In the meantime, here are some ideas that can create an opening for a supportive, recovery-based conversation about developing spiritual competencies:

• A good place to start is just listening to what people have to say about spiritual issues. As simple as this may sound, it's a step many of us haven't yet taken since we have not been open to having this conversation.

• We can ask how people understand the words “spirituality” and “religion,” and if they view them as distinct. Listen deeply to what they say.

• We can ask what gives their lives purpose and meaning. For example, the following questions were developed for use by physicians: “What do you hold on to during difficult times?” “What sustains you and keeps you going?” “What aspects of your spirituality or spiritual practices do you find most helpful to you personally?” “Is there anything I can do to help you access the resources that usually help you?”2

• If people express interest in gaining spiritual competencies, we can describe some practices that many others have found helpful, such as: prayer, meditation, contemplation, reading inspirational books, journal writing, spending time in nature, taking part in religious services, or volunteering services to others.

• We can show interest in and provide support for their spiritual findings and encourage them to stay with practices that support their recovery, and to let go of those that don't.

Spirituality is different from religion. It has less to do with organized approaches and is more individualized. But since there is a strong connection between the two, let's look at what the national polls reliably indicate about religion. They say that religion is an important facet in the lives of the vast majority of Americans. In 2009, Newsweek stated that polls since 1992 have consistently found 85 percent of Americans say religion is “very important” or “fairly important” in their lives.3 Research also indicates that faith, religion, and spirituality play important roles in coping with stress, trauma, and illness.4,5

Why would we assume that people with psychiatric conditions are any different? Anything that can support the resiliency of the people we serve should definitely be our business. We must move beyond our ambivalence about including spirituality in mental health programs if we intend to provide holistic, culturally competent, and recovery-oriented services.

Lori Ashcraft, PhD, directs the Recovery Opportunity Center at Recovery Innovations, Inc. in Phoenix. She is also a member of Behavioral Healthcare's editorial board. William A. Anthony, PhD, is director of the Center for Psychiatric Rehabilitation at Boston University. Rev. Laura L. Mancuso, MS, CRC, serves the mental health community in California as an interfaith chaplain, and was director of the California Mental Health and Spirituality Initiative from 2008-2010.

References

1. The Joint Commission. The Source ,February 2005, 3 (2),p. 7.
2. Anandarajah Gowri and Hight Ellen. “Spirituality and Medical Practice: Using the H.O.P.E. as a Practical Tool for Spiritual Assessment”. American Family Physician, 63 (1),January 2001 ,pp. 81-89.Available at: https://www.aafp.org/afp/2001/0101/p81.html.
3. Stone Daniel. “One Nation Under God?” Newsweek, September 20, 2009.Available at: https://www.newsweek.com/id/192915.
4. Lukoff David. “Spirituality in the Recovery from Persistent Mental Disorders.” Southern Medical Journal, 100 (6),June 2007.Available at: https://www.smajournalonline.com.
5. Peteet John “Selected Annotated Bibliography on Spirituality and Mental Health0.” Southern Medical Journal, 100. (6),June 2007.Available at: https://www.smajournalonline.com.

Behavioral Healthcare 2010 July-August;30(7):7-8