Historically, religion and mental health issues have had an uneasy relationship—and it goes both ways: people with mental illness have long faced stigma in religious communities, and mental health professionals have, for the most part, been suspicious of religion.
Mental health professionals are often trained to bracket out a patient’s religion in the name of professional boundaries, and have been encouraged to consider religion in the context of a medical model that can view spiritual beliefs as potential psychiatric symptoms. As psychologist David Lukoff explains:
This tendency, representing a form of cultural insensitivity, can be traced back to the roots of psychoanalysis as well as behaviorism and cognitive therapy. Freud saw religion as “a universal obsessional neurosis,” Skinner ignored religious experience, and Ellis viewed religion as equivalent to irrational thinking and emotional disturbance. Similarly, spiritual experiences have been viewed as evidence of psychopathology.
But the understanding of the role of religion and spirituality in mental health is changing. The California Mental Health and Spirituality Initiative (which grew out of a grassroots movement founded by activist and advocate Jay Mahler and other consumers, family members, and service providers) was established in June 2008 at the Center for Multicultural Development at the California Institute for Mental Health to advocate for the “inclusion of spirituality as a potential resource in mental health recovery and wellness.”
In advance of two upcoming California Conferences on Mental Health and Spirituality I had the opportunity to interview the initiative’s Director, the Rev. Laura Mancuso, along with Jay Mahler.
Why is a spirituality and mental health initiative important?
Laura Mancuso: Spirituality is an untapped resource for recovery from serious mental health issues. That’s the most important reason. We know that spirituality and religion can play a role in health and wellness for everyone. But the public mental health system has been hesitant to venture into this realm. With good reason, actually, because we don’t want to run afoul of the separation of church and state. But a lack of clear understanding has too often led practitioners to avoid the entire subject of spirituality and religion with their clients, which is a shame. The initiative is needed to provide clear information about how to venture into this territory, and how to do it effectively, legally, and ethically.
What are the goals of this initiative?
LM: We hope to transform the public/private mental health system in California to embrace spirituality as a potential resource in wellness and recovery. Notice that I said, “potential”—it’s not for everybody. This aspect of care should be client-driven, just like all of our services. We’re all about client choice. What we envision is a mental health system in which diverse forms of spirituality are respected and welcomed. Unfortunately, we’ve heard way too many personal accounts of clients whose spiritual experiences have been denigrated as just another symptom, or whose requests for spiritual referrals have been disregarded.
How would you define spirituality in relationship to individuals and communities mental health needs and concerns?
LM: I wouldn’t distinguish mental health from other health needs. As an individual who lives with chronic illness myself, I know that long-term illness can lead to a spiritual crisis, and that my own preferred spiritual practices go a long way in helping me cope with day-to-day situations. Why would it be any different for people with mental health conditions? In fact, I would say it’s even more important because when your mind and your emotions are affected, it can raise existential questions like, “Why me? Have I done something wrong to cause this to happen to me? Can I still rely on myself? What will the future hold for me?”
Can you briefly describe the historical relationship between mental illness and organized religion?
LM: Very complicated! Some religious groups have taken it upon themselves to provide compassionate care to people with mental illness. The Quakers initiated “moral treatment” of people who had been languishing in asylums as early as the 1700s. In modern times, Rev. Susan Gregg-Schroeder coordinates “Mental Health Ministries” within the California-Pacific Conference of the United Methodist Church; the fact that a major national religious group supports a full-time ministry dedicated to erasing the stigma of mental illness in faith communities is fantastic.
And NAMI, the national advocacy group for people with mental illness and their families, has established “FaithNet,” devoted to outreach to religious organizations. These programs are needed because people with serious mental health issues may be helped by religious organizations, but they may also face stigma and discrimination there. Most challenging is when they receive advice from their faith community that conflicts with what their health care providers tell them; for example, taking medications or engaging in psychotherapy, interventions that have been proven to speed up recovery. For the most part, though, organized religion in the United States reflects the views of the country as a whole, which typically includes significant misinformation about the prevalence, causes, and prognosis associated with having a mental illness.
It appears that spirituality is very important to people who have lived with mental illness. What role does it play in recovery and wellness?
Jay Mahler: The experience of “madness” can include a profound experience of connection and spirituality; oneness with nature; and the meaning and purpose of life. The mental health system has viewed this spiritual aspect of madness as delusional and as only a manifestation of the mental illness; denying the profound and potentially positive effects of this experience. The experience of madness can also lead to a painful and heightened awareness of the hand you were dealt in your life and the inequities of society. For many people with mental health issues, spirituality is key to understanding this experience. It is essential in their journey of recovery. Also faith communities have provided a sense of belonging and welcome to me, and to others who have been marginalized and experienced stigma and discrimination resulting from the public’s fear of persons with psychiatric diagnoses.
Is the Spirituality Initiative a California concern or is this a broader national phenomenon?
JM: Mental health consumers have long supported each other regarding the importance of spirituality but the role of spirituality in recovery has only emerged as a national and public dialogue in the last decade. In 1999 a conference of over 500 mental health clients developed a National Platform on Recovery through asking: “What are the most important supports for your recovery and life in the community?” The most frequent response was a relationship with “God,” with “friends” coming in a distant second. The Recovery Platform articulated principles that are now widely accepted in the mental health field as key elements in the rehabilitation and recovery of individuals who have been labeled as “mentally ill.” Hope and empowerment were the most important principles followed by spirituality and self-responsibility.
There are two conferences on spirituality and mental health scheduled for early next month, one in Oakland, and one in Los Angeles. What are the goals of these conferences, what do you hope will be achieved, and where to from there?
LM: The conferences have been designed for four audiences: people with mental health issues of all ages; their family members; mental health service providers; and individuals from faith communities (both lay people and clergy). Just the intermingling of these groups for two days, focusing on mental health and spirituality together, will be valuable in and of itself.
Other goals for the conferences include: exposing participants to a variety of innovative approaches to collaboration between mental health service providers and faith-based organizations from around the state; demonstrating how spirituality can be incorporated into mental health services in a way that is client-driven and respects the separation of church and state; and sharing information from research findings on the role of spirituality in trauma recovery and mental health.
We’ve worked hard to make the conferences interesting, unique, and experiential. In addition to inspirational speakers and representatives from diverse religious traditions, there will live music and sessions on meditation, tai chi, and yoga.
