Spiritual Crisis as Transformation

by Lael Ewy

reBIRTH - hommage un partie  by jtravism

Just about every faith tradition has some kind of story of death and rebirth, from the familiar tales of Persephone in Hellenistic mythology to the execution and resurrection that is at the core of Christianity. This idea keeps coming up because it is at work all around us: as the high season of summer declines through autumn and the earth seems to die in the throes of winter, we look forward to the verdant rebirth that is the spring. As physical bodies die, their matter gets turned back into the stuff of life through the bodies of scavengers, bacteria, plants--the cycles of carbon, oxygen, nitrogen, and water.  

The arcs of our states of mind, too, undergo periods of waning and waxing: from zenith to azimuth, we all go through cycles of suffering and joy.

Such intimate connections between our physical universe and our inner states of being underscore the fundamentally spiritual nature of psychological distress as experienced by many people. In an excellent exploration of the subject, Jeff Foster argues that depressive breakdown can be "a call to awakening," that what we emerge into during an emergency is as important as the stressors that push us there to begin with.

The Strengths Model of mental health care suggests that risk is a necessary part of recovery. With so many mental health services still focused on stabilization and maintenance, how can we use times of crisis to refocus on what can be gained from the experience, on how a spiritual death can lead to a new appreciation of actual life? As people experiencing mental distress, how can we help our providers understand that some of what we are experiencing is a necessary part of our growth? As providers, how can we have the faith (all puns intended) and confidence in those we serve and our  relationships with them to know when these processes are running their natural course?

And above all, how can we all support each other in learning the lessons spiritual death and rebirth have to teach?           

Rebirth by Antonio David Fernández

Religious Freedom: Restraint as Opportunity

By Lael Ewy, MFA, CPS

US Constitution, Photo courtesy Mr T in DC

The most common issue we’ve encountered as we have explored spirituality and mental health recovery comes from service providers who are worried that they will run afoul of the 1^st Amendment’s “establishment clause” if they even approach the subject of a person’s spiritual life.

The actual clause reads thus: “Congress shall make no law respecting an establishment of religion, or prohibiting the free exercise thereof” (U.S. Const. Amend. I). Various interpretations of this amendment have set the bar fairly high: working within the framework of Medicaid services delivery, I am subject to a law Congress has made; therefore I ought to tread carefully so that I am not seen as promoting a faith or prohibiting others’ exercise of their own.  My own code of ethics as a Certified Peer Specialist states that I shall not “practice, condone, facilitate or collaborate in any form of discrimination,” including against any particular religion (State of Kansas, cited in WSU-CCSR, 2006, p. 5), an idea reinforced by the precept that I shall “at all times respect the rights and dignity of those [I] serve.”

A quick look at the American Psychological Association’s policy manual suggests similar guidelines, though they go on to note that the APA “encourages collaborative activities in pursuit of shared prosocial goals between psychologists and religious communities when such collaboration can be done in a mutually respectful manner that is consistent with psychologists’ professional and scientific roles” (APA, 2007, p. 4).

Those shared goals mentioned by the APA suggest a direction to go. And, with the usual caveats that I am not a lawyer and this is not legal advice, we can at least explore a few ideas about how to approach a person’s faith and spirituality as we move toward the shared goal of mental health recovery.

Defer To Agency Policy and Code of Ethics

First, and obviously, if you’re working for a mental health center or other organization that has a specific policy regarding discussions of religion and faith, defer to that. Defer, also, to your own professional code of ethics. 

Don’t Evangelize

This also ought to be obvious, but avoid trying to convert those you serve. That’s covered by the policies against “discrimination” above. You can discriminate against (“Your religion is bad”), and you can also discriminate in favor of (“My religion is good.”). Neither is kosher ethically, and both are unproductive. If we believe in self-determination, we are beholden to be aware that with the position of service provider comes power and authority, and to suggest to people how to believe in matters of faith is an abuse of that power.

Their Faith (or Lack Thereof) Is Their Own

Respect people’s right to practice (or not). That’s the second part of the establishment clause, and it’s important not just to the aforementioned notions of self-determination, but also because we each have different ways of believing, even within a given religious tradition. You might share a faith with someone you serve, but that does not necessarily mean that you experience that faith in the same way. You might view the bosom of your church as a place of solace and safety, but another might view it as a place of judgment and shame and may find recovery easier if she stops going. That’s okay; it’s her call. You can find out where she is on the subject by listening.

Listen

A big part of finding out when, if, and how a person wants to talk about spirituality is to listen to what she says about it. This may seem like a simple thing, but it’s sometimes hard to see through the cloud of our own ideas about how spirituality ought to work for people and see how it actually does. Our relationships with spirituality, particularly those of us who grew up inside specific faith traditions, are often as complex as the relationships we have with people—and often as deep. To try to sum up my relationship with my Mennonite background as good or bad, supportive or problematic, freeing or smothering, simply does not meet the charge. It has been all those things at various times, sometimes several all at once.

Ask

If by listening you pick up on the idea that a person’s spiritual life is important to him, or that it is important to his recovery, you have an indication that asking about it might be OK. Open-ended questions can help determine what the person’s relationship with his spiritual life is like and what he thinks it might do for (or against) him. At the right time, questions like “What does being a Methodist mean to you?” or “How could your mosque help support you in making this change?” could help a person get in touch with spiritual resources or determine how one’s spiritual life might be working at cross-purposes to his recovery.

Free Your Mind

Last, be open to the possibilities. Since everyone’s experience of spirituality is unique, being open to what is going on for a person spiritually and not pressing with interpretations of your own can lead someone to self-discovery. Many people experience what psychiatry would label symptoms as deep spiritual experiences. Even atheistic existentialists like Jean-Paul Sartre spoke of “angst” as not merely a matter of personal experience but as a result of a consciousness relating to the universe as a whole. One woman’s vision may be, to a mental health practitioner, hallucination. If so, they have little to discuss: the person having the experience may feel dismissed and misunderstood, and the practitioner, by reducing the woman’s experience to something that has no basis in reality, may be missing an important insight into how that woman sees the world.

Profoundly spiritual experiences may even be disturbing, but that does not necessarily mean they are unwelcome or bad to those going through them; the least appropriate response may be to try to “treat” them or medicate them away. Difficult spiritual experiences may be both deeply meaningful and an avenue to a whole new life, a whole new way of thinking. Just about all religious traditions have stories or rebirth through tribulation and trial, yet we are terrified that any setback or difficulty is a treatment failure, not an opportunity for growth. A respectful look through others’ spiritual lenses, even though they might not be the ones through which we look, can help create and maintain relationships of healing and of hope.

Following these points can turn what seem to be legal and ethical restrictions into assets for the service relationship, creating safe places in which people can express themselves freely without the fear of being told their faith is wrong or that their mental distress is a source of shame.

It is also far from an exhaustive list. Please contribute approaches that work for you in the comment box below. We’d love to hear from you!     

References

American Psychological Association. (2007). Resolution on religious, religion-based and/or religion-derived prejudice. In The Council Policy Manual. Retrieved from  http://www.apa.org/about/policy/religious-discrimination.pdf

U.S. Const. Amend. I

Wichita State University-Center for Community Support and Research. (2006). Code of ethics. Kansas Peer Specialist Basic Training Program for Certification: Facilitator’s Guide. Wichita, KS: WSU-CCSR.

Mindfulness Meditation and the Brain

by Priscilla Ridgway, PhD

Meditating in Union Station. Photo Credit: Wayne MacPhail

Many people interested in spirituality and recovery from serious mental health concerns may have felt like I did about brain imaging technology. I thought such research could contribute little or nothing to our understanding of the ineffable, because the transpersonal or spiritual dimension is “beyond measure.”  Imagine my surprise when I found brain imaging technology helps reveal the positive impact mindfulness meditation!

Yale post-traumatic stress researcher Steven N. Southwick (2012), reviews brain imaging studies of mindfulness meditation linked to cognitive reappraisal. These studies show heightened activation of parts of the brain that relate to more rapid rebound from, and quieting of anger, mistrust, and fear that are associated with improved resilience after trauma. The National Center for Complementary and Alternative Medicine recently spotlighted brain imaging studies that shows that mindfulness meditation increases brain connectivity (Kilpatrick, et al., 2011) and increases the volume of gray matter in the brain in areas associated with learning, memory, and emotional control (Holzel, et al., 2011).

The demonstrated improvements in brain volume and connectivity are in contrast to other research in which the onset of schizophrenia is associated with the loss of gray matter in parts of the brain (Tang, et al., 2012; Dazzan, 2011). Recent brain imaging studies at Yale University show stressful life events such as job loss and divorce are also associated with reductions in the gray matter in parts of the brain that regulate emotions and other physiological functions such as blood pressure and glucose levels, even in people who have no clinical symptoms (Hathaway, 2012). Early abuse has been found to reduce brain volume in adolescents that impact areas associated with motivation, working memory, emotion processing and control of aggression (Hart & Rubia, 2012). Another line of inquiry found that some psychiatric medications (such as the antipsychotic medication haloperidol) give rise to a structural remodeling of the brain that trims brain dendrites, thereby reducing gray matter volume (Science Daily, 2012). The impact of some drugs on brain structures has been replicated in animal studies by Dr. Shitij Kapur of King’s College, London, demonstrating a 6% loss in brain volume over what would be the equivalent of 5 years of medication usage in human subjects (Science Daily, 2012).

Mindfulness meditation has been shown to have other salutary effects besides improving connectivity and increasing brain volume. Some of these impacts were described by Holzel (no date) in a Harvard Medical School presentation, and include

• ·         Increased physiological and psychological relaxation

• ·         Improved mood

• ·         Increased ability to contend with challenging situations

• ·         Improved concentration and memory

• ·         Reduced blood pressure

• ·         Reduced cortisol levels

• ·         Improved immune function

Mindfulness meditation has become a common component of mind-body medicine. One study assessed women with newly diagnosed cancer. Those who participated in a short series of mindfulness meditation workshops showed improvements in mood, reductions in depression, improved energy levels and reductions in a variety of measures of stress (Speca, et al., 2000). Many mental health conditions are characterized as “stress vulnerability disorders,” so learning this effective stress reduction technique could prove to be a boon to some in their recovery process.

Such studies show that the brain has the capacity for plasticity and can literally restructure on a cellular level toward positive effects that  makes the individual more stress resistant and resilient.                         

                                                               

So what is mindfulness meditation?

The practice of mindfulness meditation has its roots in Buddhism and is thousands of years old. It is a process of relaxed but focused attention.  Recently mindfulness meditation techniques have been put to use in behavioral health programs, such as Dialectical Behavioral Therapy (DBT), in mind body clinics, in education and leadership training, and many more applications.

Want to try mindfulness meditation? 

The process is simple, but takes some time and focus to fully master. Here is how I have been taught to do this practice:

• ·         Sit comfortably upright in a chair, with your spine straight and your feet flat on the floor.

• ·         Place your hands, palms up, in your lap. You can touch your index finger and thumb together.

• ·         Place your gaze a few inches in front of your nose and close your eyes, or better yet, nearly close your eyes, until only soft fuzzy light is seen.

• ·         Begin to observe the interplay of thoughts and sensations in your mind and body for a few moments, then let those thoughts and feeling go, gently.

• ·         Begin focusing on your in-breath and out-breath, breathing in and out of your nose. If you like, you can tie the breath to a word of phrase of your choice, such as “calm” or “peace.”  Try to perceive the full sensation of the in-breath and the out-breath.

• ·         When thoughts or sensations arise, notice them gently and nonjudgmentally, and then bring your attention back to your breath and to the word or phrase you are using.

·         Practice mindfulness meditation for a few minutes, building up to ten or twenty minutes once or twice a day.

Recordings with guided practice are available to help in learning and practicing mindfulness meditation. Simple directions and free videos, lectures, e-books, and recording are available online:

http://www.mindfulnessmeditation.org

http://www.shambhalasun.com/index.php?option=content&task=view&id=2125

http://www.psychologytoday.com/blog/the-courage-be-present/201001/how-practice-mindfulness-meditation

How have you used meditation in your practice, or in your own mental health recovery? Please share your experiences and resources.

References

Dazzan, P., Soulsby, B., Mechelli, A., Wood, S.J., Velakoulis, D., Phillips, L.J., Yung, A.R., Chitnis, X., Lin, A., Murray, R.M., McGorry, P.D., McGuire, P.K., & Pantelis, C. (04/25/2012). Volumetric abnormalities predating the onset of schizophrenia and affective psychosis: An MRI study in subjects at ultrahigh risk of psychosis. Schizophrenia Bulletin. Advanced access downloaded from http://schizophreniabulletin.oxfordjournals.org on 09/24/2012.

Hart, H., & Rubia, K. (2011). Neuroimaging of child abuse: A critical review (2012). Frontiers in Human Neuroscience. 6(52): 1-24.

Hathaway, B. (1/09/2012). Even in the healthy, stress causes brain to shrink, Yale study shows. Yale News.

Holzel, B.K. (undated) Neural correlates of mindfulness practice. Power Point. Boston, MA: Harvard Medical School.

Holzel, B.K., Carmody, J., Vangel, M., Congleton, C., Yerrasetti, S.M. (2011). Mindfulness practice leads to increases in regional gray matter density. Psychiatric Research: Neuroimaging. 191: 36-43.

Kilpatrick, L.A., Suyenobu, B.Y., Smith, S.R., Bueller, J.A., Goodman, T., Creswell, J.D., Tillisch, K., 

Mayer, E.A.., & Naliboff, B.D. (2011). Impact of mindfulness-based stress reduction training on intrinsic brain connectivity. Neuroimage. 56(1): 290-298.

NCCAM (01/30/2012). Mindfulness meditation is associated with structural changes in the brain. U.S. Department of Health and Human Services. National Institute of Health. National Center for Complementary and Alternative Medicine.

NCCAM Clearinghouse (undated). Backgrounder. Meditation: An introduction. U.S. Department of Health and Human Services. National Institute of Health. National Center for Complementary and Alternative Medicine.

Schatz, C. (4/08/2011). Mindfulness meditation improves connections in the brain. Harvard Health. Accessed on the World Wide Web, 9/20/2012 at: http://health.harvard.edu/blog/mindfulness-meditation-improves-connections-in-the-brain.

Science Daily (05, 2012). Psychiatric medications’ effect on brain structure varies. Science Daily. Accessed  from the World Wide Web http://www.sciencedaily.com/release/2012/05/120508103915.html.

Southwick, S.M.  & Charney, D. (2012). Resilience: The science of mastering life’s greatest challenges. Cambridge University Press. See also ResilienceInUs.com.

Speca, M., Carlson, L.E., Goodey, E., & Angen, M. (2000). A randomized, wait-list controlled clinical trial: The effects of mindfulness meditation-based stress reduction program on mood and symptoms of stress in cancer outpatients. Psychosomatic Medicine. 62:613-622.

Tang, J., Liao, Y., Zhou, B., Tan, C., Liu, W., Wang, W., Liu, T., Hao, W., Tan, L., & Chen, X. (2012). Decrease in temporal gyrus gray matter volume in first-episode, early onset schizophrenia: An MRI study. PLoS ONE. 7(7): 1-6.

Bibliography on Spirituality and Mental Health

Below you'll find the bibliography on spirituality and mental health put together by Priscilla Rigdway, PhD for last spring's summit.

A stack of books awaits, courtesy photohacks.

Spirituality and Mental Health Recovery

A Brief Bibliography

Priscilla Ridgway, PhD

                                                                                               

Arnold, D., Calhoun, L.G., Tedeschi, R., Cann, A. (2005). Vicarious posttraumatic growth in psychotherapy. Journal of Humanistic Psychology. 45(2): 239-263.

Bassett, H., Lloyd, C.,& Tse, S. (2008). Approaching in the right spirit: Spirituality and hope in recovery from mental health problems. International Journal of Therapy and Rehabilitation. 15(6): 254-259.

Bussema, K.E. & Bussema, E.F. (2000). Is there a balm in Gilead? The implications of faith in coping with with a psychiatric disability. Psychiatric Rehabilitation Journal, 24(2), 117-124.

Calhoun, L.G., Cann, A., Tedeschi, R.G. (2000). A correlational test of the relationship between posttraumatic growth, religion, and Cognitive processing.

Calhoun, L.G. & Tedeschi, R.G. (1998). Beyond recovery from trauma: Implications for clinical practice and research. Journal of Social Issues. 54: 357-371.

Calhoun, L.G. & Tedeschi, R.G. (1999). Facilitating Posttraumatic Growth: A Clinician’s Guide. London: Ernbaum.

Calhoun, L.G. & Tedeschi, R.G. (2004). Posttraumatic Growth: Conceptual Foundations and Empirical Evidence. Psychological Inquiry. 15(1): 1-18.

Canda, E. R., & Furman, L. D. (1999). Spiritual diversity in social work practice: The heart of helping. New York: Free press.

Clarke, I. (Ed.) (2001). Psychosis and spirituality. London: Whurr Publishers.

                       

Corrigan, P., McCorkle, B., Schell, B., Kidder, K. (2003). Religion and spirituality in the lives of people with serious mental illness. Community Mental Health Journal. 39(6), 487-499.

Cornah, D. (n.d.). The impact of spirituality on mental Health: A review of the literature. The Mental Health Foundation.

Deegan (2006) Recovery journal: Spiritual lessons in recovery. Retrieved from website http://www.patdeegan.com/blog/archives/000011.php on 07/08/2009).

Derezotes, D. S. (2006). Spiritually oriented social work practice. Boston: Pearson.

Elkins, G., Rajab, M. H., and Marcus, J. (2005). Complementary and alternative medicine use by psychiatric inpatients. Psychological Reports 96 (1)Feb: 163-4.

Fallot, R. (Ed.) (1998). Spirituality and religion in recovery from mental illness. San Francisco, CA: Joseey-Bass Publishers.

Fallot, R. D. (1998). Recommendations for integrating spirituality into mental health. New Directions for Mental Health Services, 80, 97-100.

Fallot, R. D. (2001). Spirituality and religion in psychiatric rehabilitation and recovery from mental illness. International review of psychiatry. 13: 110-116.

                       

Fallot, R. D. (2007). Spirituality and religion in recovery: Some current issues. Psychiatric Rehabilitation Journal, 30(4), 261-270.

Fukuyama, M. A., & Sevig, T. D. (1999). Integrating spirituality into multicultural counseling. Thousand Oaks, Calif: Sage Publications.

Gilbert P.& Nicholls V. (2003) Inspiring Hope: Recognizing the Importance of Spirituality in a Whole Person Approach to Mental Health. London: National Institute for Mental Health in England.

Greg-Shroeder, Rev. Susan (N.D.). Mental Illness and Families of Faith: How Congregations can Respond. www.MentallHealthMinistries.net

Helmeke, K. & Sori C. (2006). The therapist’s notebook for integrating spirituality in counselling (Eds). NY: Haworth Press.

Koenig Harold, G. (2005) Faith and mental health: Religious resources for healing. Philadelphia: Templeton Foundation Press.

Levin, J. S. (2001). God, faith, and health: Exploring the spirituality-healing connection. New York: Wiley.

Leibrich, J. (2002) Making space: spirituality and mental health. Mental Health, Religion and Culture. 5(2): 143-162.

Lindgren, K., & Coursey, R. (1995). Spirituality and serious mental illness: A two part study. Psychosocial Rehabilitation Journal, 18(3), 93-111.

Lukoff, D. (2005). Spiritual and transpersonal approaches to psychotic disorders. In S. G. Mijares & G. S. Khalsa (Eds.), The psychospiritual clinician’s handbook. (pp. 233-257). New York: Haworth Press.

Lukoff David. “Spirituality in the Recovery from Persistent Mental Disorders.” Southern Medical Journal, 100 (6),June 2007.Available at: http://www.smajournalonline.com.

Mace, C. (2008). Mindfulness and mental health: Therapy, theory, and science. London: Routledge.

Metheany, J.-S. & Coholic, D. (n.d.). Exploring spirituality in mental health: Social worker and psychiatrist viewpoints. Retrieved from the Web at: http://uwinndsor.ca/criticalsocial work/exploring-spiritualty-in-mental-health. 3/27/12.

Mijares, S. G. & Khalsa G. S. (2005) The psychospiritual clinician’s handbook. New York: The Haworth Press.

Miller, W. R. (1999). Integrating spirituality into treatment: resources for practitioners. Washington, DC: American Psychological Association.

Moodley, R., & West, W. (2005). Integrating traditional healing practices into counseling and psychotherapy. Multicultural aspects of counselling and psychotherapy, v. 22. Thousand Oaks, Calif: Sage Publications.

Murphy, M. A. (2000). Coping with the spiritual meaning of psychosis. Psychiatric rehabilitation journal. 24(2): 179-183.

O’Rourke, C. (1997). Listening for the sacred: Addressing spiritual issues in the group treatment of adults with mental illness. Smith College Studies in Social Work, 67(2), 177-196.

Pargament, K. I. (2007). Spiritually integrated psychotherapy: understanding and addressing the sacred. New York: Guilford Press.

Phillips, R., Lakin, R., & Pargament, K. (2002). Brief report: Development and implementation of a spiritual issues psychoeducational group for those with serious mental illness. Community Mental Health Journal, 38, 487-495.

Pierre, J. M. (2001). Faith or delusion: At the crossroads of religion and psychosis. Journal of Psychiatric Practice. 7(3): 163-72.

Regers, G. M., and Rogers, S. A. (2002). Diagnostic differences in religious coping among individuals with persistent mental illness. Journal of Psychology and Christianity. 21(4): 341-48.

Russinova, Z., & Cash, D. (2007). Personal perspectives about the meaning of religion and spirituality among persons with serious mental illnesses. Psychiatric Rehabilitation Journal 30, 271-284.

Russinova, Z., Wewiorski, N. J., and Cash D (2002). Use of alternative health care practices by persons with serious mental illness: Perceived benefits. American Journal of Public Health. 92 (10): 1600-1603.

SAMHSA (2004). Building Bridges: Mental Health Consumers and Members of Faith-Based and Community Organizations in Dialogue. USDHHS. SAMHSA.  DHHS Publication No. (SMA) 04-3868.

Seybold, K. S. (2007). Explorations in neuroscience, psychology, and religion. Ashgate science and religion series. Aldershot, Hants, England: Ashgate Pub.

Smark, T. (2009). Spirituality and Mental Health. Australian Journal of Pastoral Care and Mental Health. 3(2):19-27.

Spaniol, L. (2002). Spirituality and Connectedness. Psychiatric Rehabilitation Journal. 25(4):321-322.

Sperry, L., & Shafranske, E. P. (2005). Spiritually oriented psychotherapy. Washington, DC: American Psychological Association.

Sullivan, W.P. (1992). Spirituality as a social support for individuals with mental illness. Spirituality and Social Work Journal. 3(1): 7-13.

Sullivan, W. P. (1993). “It helps me to be a whole person”: The role of spirituality among the mentally challenged. Psychosocial Rehabilitation Journal, 16(3): 125-134.

Sullivan, W.P. (2009). Spirituality: A road to mental health or mental illness. Journal of Religion and Spirituality in Social Work: Social Thought. 28(1), 84-98.

Swinton, J. (2001) Spirituality and mental health care. London: Jessica Kingsley Publishers.

Tedeschi, R.G. & Calhoun, L.G. (1996). The Posttraumatic Growth Inventory: Measuring the positive legacy of trauma. Journal of Traumatic Stress. 9(3): 455-470.

Tepper, L., Rogers, S. A., Coleman, E. M., & Malony, H. N. (2001). The prevalence of religious coping among persons with persistent mental illness. Psychiatric Services. 52(5): 660-665.

Wahas, S. and Kent, G. (1997). Coping with auditory hallucinations: a cross-cultural comparison between Western (British) and non-Western (Saudi Arabian) patients. Journal of Nervous and Mental Disease. 185: 664-68.

Whitney, E. (1998). Mania as spiritual emergency. Psychiatric Services. 49(12): 1547-1548.

Wong-McDonald, A. (2007). Spirituality and psychosocial rehabilitation: Empowering persons with psychiatric disabilities at an inner-city program. Psychiatric Rehabilitation Journal, 30(4), 295-300.

Woodward, C. & Joseph, S. (2003). Positive change processes and post-truamtic growth in people who have experienced childhood abuse: understanding vehicles of change. Psychology and Psychotherapy: Theory, Research, & Practice. 76:267-283.

Yangarber,-Hicks, N. I. (2003). Religious coping styles and recovery from serious mental illness. Dissertation Abstracts International: Section B: The Sciences and Engineering. 63(7-b): 348.