Well, folks, I never did get around to posting Working paper 4. It didn't flow well on its own, so I wrote it and immediately began integrating all the papers. Now, nearly two weeks later, I have the final draft here (well, it will be the final draft after my late-night final editing session). Hope any of you reading enjoy.
Arsenic demons whispering sins of the father. Blood spattering redemptions betrayal make me pay the sins of the father.
These incoherent words don’t make sense to the average reader, but to a person suffering from schizophrenia, they are a divine message, a prophecy.
Every year in America, around forty-four million people suffer from a mental illness, and some two million of those have been diagnosed with schizophrenia, the most devastating of the psychological disorders (NIMH). This disease steals an individual’s independence as it locks him within the prison of his own mind. It distorts his sense of the world around him, wiping away the line that separates reality from the dream world.
schizophrenic experience hallucinations, in which they senses things that do not exist and hear voices that are only in their minds, and delusions, either that they are specially chosen for a mission or that they are actually another person. Their thinking and behavior is disorganized and irrational. Almost all patients experience withdrawal, because hallucinations portray the people around them as enemies who want to harm them. Patients may exhibit a lack of emotion, or the inappropriate display of such, like laughing at the funeral of a loved one. Their motivation for daily events may decrease to the point that they stops caring for themselves.
Because of its nature, schizophrenia is difficult to treat. The illness is almost never discovered in its early stages because its onset it sudden and intense. A sufferer often has to be hospitalized to prevent him from harming himself and others. The severe psychosis that imprisons a schizophrenic makes him resistant to treatment. His hallucinations whisper that it is a plot to keep him from his mission. The doctors and hospital staff are the enemy’s spies, and the anti-psychotics are poisons.
Patients respond to the anti-psychotic medications eventually, but though the walls of the schizophrenic’s cell have begun to crumble, recovery does not end there. Although it is treatable, schizophrenia is incurable (NHMA). Even on a strong dose of medication, schizophrenics are often reluctant to let go of their false reality, and may suffer relapses, even years into treatment. The characters and voices they hallucinate, though they hiss messages of harm and worthlessness, are their companions, and without them, patients may become lonely. The delusions tell them they are specially chosen, and the knowledge of otherwise destroys the identity they had (Davis). Without intervention, these patients likely will not surrender their illness completely.
According to NIMH, many treatments beyond medication are available. Psychologists meet routinely with their patients, both during hospitalization and afterward, to evaluate, advise, and make necessary medication adjustments. Familial support is crucial as well, for after patients are released from hospitalization, they are generally cared for by their close family. Also, support groups of recovering patients are common and beneficial.
Until recently, when scientists began to realize it was missing, the area of spirituality has been absent from the treatment of schizophrenia.
The question of the correlation between spirituality and mental illness is a long-standing one. Until the study of psychology began to gain popularity in the late nineteenth century, most mental illnesses were considered the handiwork of evil spirits or demons. Scientists no longer “see a demon hiding behind every bush,” but religion still has some connections to mental illness (Sheafer).
As scientists are beginning to focus once again on the spiritual aspect of health, they are asking whether the treatment of mental illnesses, specifically schizophrenia, should incorporate the patient’s religious beliefs. Some studies support each side, and conclusions have not been made. Would a spiritually-integrated treatment program benefit patients or not?
Schizophrenics often either came religious backgrounds or became religious at the onset of illness. A study in Switzerland showed that about one-third of patients were religious (Huguelet, Mohr). Additionally, about thirty-six percent of schizophrenics in the US suffer from religious delusions, which may include the belief of a special calling from God; hallucinations of the supernatural, such as hearing or seeing angles and demons; or delusions of grandeur, which may cause the patient to believe he is God or another religious being. These religious delusions are often a sign of greater severity in illness, and patients experiencing such delusions are likely to have hallucinations longer (Huguelet, Mohr). These studies also point out that there seems to be a greater frequency of religious delusions among those that practice a religion than those that do not.
There is also a correlation between religious delusions, self-harm, and suicide. Schizophrenics with religious delusions are more likely to exhibit violent behavior toward themselves or others. About one in twenty-four homicides in the US each year is committed by a schizophrenic, a great majority of whom are suffering from religious delusions and claim religious motivations. These motivations might include the belief that the victim was an enemy of God, that God commanded the suspect to kill, or that the suspect believed it was his calling to sacrifice himself to appease God (Torrey).
Finally, religious delusions contribute to treatment resistance. Because of the way schizophrenia distorts reality, especially through religious delusions, patients’ symptoms are enforcers of delusions, and treatment programs are seen as elaborate conspiracies to thwart a patient’s special calling. Many patients continue to deny their disorder and refuse medication, for they believe they have a special bond with God rather than a mental illness. These patients usually have a poorer outcome in treatment.
Religion/spirituality also affects the way a healing patient copes with his mental illness. According to Natalia Yangarber-Hicks, there are four styles of coping with mental illness spiritually: self-directing, deferring, collaborating, and pleading. The self-directing style involves taking responsibility for coping and healing upon oneself alone, with little or no delegation to a Higher Power. Deferring is the exact opposite, laying all responsibility on God. Collaborating is the dual-responsibility mentality of “God helps those who help themselves.” Finally, the pleading style of coping entails praying for a miraculous healing, which, like deferring, places responsibility on a deity, and leaves little power in the patient’s hands. Of these styles, most studies argue that deferring and pleading are the most maladaptive.
Some researchers argue that religion does not always provide comfort to patients, but rather can be the catalyst for stressful situations. Practicing religion often places patients in a religious community of some sort, which is sometimes hostile, judgmental, and unsupportive. Such a situation can lead patients to believe the illness they are suffering from was “a punishment for [their] sins” (Mohr, Huguelet). For some patients, religion brings much more pain than it did help. One outpatient study participant remembered, ‘I had psychotic relapses, I felt guilty, having done bad things. It is in relationship with good and bad, it is there. If I read the Bible, it disrupts me, I believe I am evil, so I shouldn’t read the Bible” [sic] (Mohr, Huguelet).
Because these issues deal with patients’ core spirituality and how it leads them to cope with both life in general and their disorder, they are issues that cannot be handled casually. Dealing with a patient’s spiritual need and how it affects his illness is not as simple as dealing with other facets of treatment. Overcoming a stressor in the spiritual realm is not as simple as fixing other issues. If a medication is affecting a patient poorly, the psychiatrist makes a change, either in the dosage or in the medication itself— but how would one fix a spiritual problem? For these reasons, some mental health professionals argue that even if a spiritually-integrated treatment program is beneficial, the mental health sector is not prepared to deal with the monumental task of putting such a program into practice.
At the same time, though, it has been shown that patients’ religiosity can have a positive role in the healing process. A person’s religiosity can better the way he handles problems, including mental illness (Yangarber-Hicks), and many mental health officials believe that counselors should be trained to help their patients cope with their illness religiously (Hall, Dixon, Mauzey). For many patients, possibly because of familiarity, religion is a key factor in recovery and can offer answers that secular treatment cannot. About eighty percent of US patients claim to have dealt with their illness spiritually, and as outpatients, about half still claim to rely on religion for daily coping (Huguelet, Mohr). Religion gives recovering patients significance and purpose. It provides a meaningful routine of prayer and meditation as well as the support of a religious community.
These people assume that every human being has a basic spiritual need. With this assumption follows the argument that, as human beings, people with schizophrenia need some sort of spiritual input. Some researchers have even asked whether maybe patients with mental health issues have a greater spiritual need.
Consider again the four coping styles presented by Natalia Yangarber-Hicks. We remember that the coping styles of deferring and pleading were found to be the most often maladaptive, while self-directing and collaborating had the most positive effects in treatment. The same study, however, also showed that patients who were considered to be using the self-directing style experienced an increase in depression-like feelings and behaviors in stressful situations. Collaborative coping did not show the same results. This, perhaps, validates the theory that religiously-oriented coping provides a method for control and a base for consistency (“Spirituality and mental illness”).
In the area of comorbidity of drug abuse and suicide among patients with schizophrenia, religion appears to have some positive effects. Most religions look down upon, if not condemn, drug abuse. Likewise, most major religions, especially those with Judeo-Christian moral systems, are strongly against suicide. While religious delusions within schizophrenia sometimes lead to drug abuse, self-harm, and suicide, many patients, both with schizophrenia and other disorders, are deterred from these harmful behaviors by the core beliefs of their faith. One patient in a recent study stated, “Even in the lowest moments of my life, I forbid myself suicide because of my religious background” (Hall, Dixon, Mauzey 372). In fact, patients with some form of religious commitment have a lower rate of suicidal attempts and deaths (Hall, Dixon, Mauzey 372).
Religion can also add meaning, structure, and support systems to patients’ lives, says the Mental Health Foundation in a recent report (“Spirituality and Mental Illness”). Lack of routine can prove very stressful to mental health patients, especially to those with schizophrenia. Religion gets patients involved within a community, which can provide important support that a patient needs (but sometimes lacks) outside the medical sector. The activities and functions within the community give a person a sense of routine, belonging, and importance.
Within collaborative coping, prayer can also be extremely helpful, especially within a group or community. It allows patients to feel a meaningful connection to a Being they feel knows about and cares for them, and gives them a sense that while this Being may have ultimate control over their lives, which is often a relief, they do have some active part in their own healing.
Looking back at the epidemiology of schizophrenia and at the high occurrence of religious delusions, it can be argued that religiously integrated programs have been neglected for too long. Delusional patients cling to their religion fiercely, and the current trend seems to be to deal with this by either focusing completely on an aggressive pathological treatment or attempting to eradicate or invalidate the belief system behind the delusions. One might ask how much more positively patients might react to treatment if care professionals attempted merely to redirect their religious thinking, rather than completely remove it.
Few care professionals are currently practicing these methods, however. Many therapists feel unprepared to address spiritual issues with their patients, and current education programs for these psychologists, psychiatrists, and therapists do little to change this, often ignoring spirituality altogether (Hall, Dixon, Mauzey 506). Some of the justification in this is that religion has no place in the health care system itself, and should be confined to a religious counseling setting. Religion could, however, provide yet another bond from the patient to the therapist or physician, another base for treatment (“Spirituality and Mental Illness”). A survey done by Mohr and Huguelet showed that most patients were very at ease when discussing religion or spirituality with their therapist or physician. Yet care professionals often neglect the opportunity, leaving their patients feeling that their religious beliefs are insignificant or foolish. “Psychiatrists take a great power over us [. . .] I have the impression that the physician doesn’t agree for me to be religious [. . .]” (Mohr, Huguelet 374). Causing a patient to feel that his beliefs are insignificant or that they are only symptomatic of the disorder, alienates him and makes it even harder to treat him effectively (Modesty; Sheafer; Mohr, Huguelet).
Religion does, some insist, have a place in the direct treatment of patients with mental disorders. If used correctly, religion can have an impact upon even the pathological treatment of schizophrenia, and could allow for smaller doses of the current antipsychotic medication. Furthermore, recent research has shown that mental health patients who claim some sort of religious connection displayed remarkably better improvement, with shorter and less frequent hospitalizations (“Spirituality and Mental Illness”).
Physicians are beginning to believe that religious/spiritual counseling within treatment is important (Hall, Dixon, Mauzey 506). When coupled with current treatment methods, religion can be a powerful tool for treating a patient and helping him cope with daily living. For an illness that encompasses so many realms of life, should treatment not cover those same realms?
In light of these points, some therapists are calling for programs that incorporate religion. Others believe the idea has little, if any, merit. Would a religiously-integrated program be beneficial to patients, or would there be negative, unforeseen effects? Would the net results be good or bad?
Does God have a place in the un-twisting of the knotted minds of schizophrenics? The existing evidence says “yes.” Religion is already part of schizophrenia, whether the public likes it or not. Religious salience is one of the most common factors among patients with this disorder, and that common bond can be used for good (“Spirituality and Mental Illness”).
Coping with mental illnesses is a trial, and not one any patient should have to face on his own. Directing him to cope in a collaborative way with the Higher Power he believes in might be the greatest cognitive therapy the mental health care system can provide.
With the ethical issues surrounding medications and other pathological treatments, alternative methods are valuable. Patients seem more than willing to discuss their spirituality with their doctors, so why not take full advantage of that?
Religion gives patients a community support system and a chance to involve themselves in society again, which are a key parts in social and family therapy. It also provides a “home base” to fall back upon when changing situations cause stress that could eventually lead to a relapse.
Religion plays a key part in the resistance of comorbidity of drug abuse and suicide, a major factor for deaths even among outpatients. Religious therapy would enforce the importance of the patient’s beliefs, which factors into the resistance of these harmful behaviors. Patients with religious commitments are less likely to be involved in these self-harming incidents.
There are some issues to consider and research before putting an integrated program into place. One such matter is that of religious delusions. Since those who practice a religion are more likely to experience delusions, there is the concern that religious treatment could cause a relapse among residuals .
Another potential issue presents itself in the development of a deferring or pleading style of coping. Research has shown these two coping styles to be anything but beneficial, and fostering an association between religion and treatment might lead to this self-created helplessness.
Proselytism is another issue that should be addressed and dealt with before a program is put into practice. Patients should have the ability and freedom to choose which, if any, religious belief system they follow, without the coercion of their physician, who holds a great deal of power over them.
If all of these issues are taken into account, though, and measures are put in place to deal with them, there is no reason why a spiritually-integrated treatment program cannot be fully beneficial and revolutionary in helping to free people who are trapped by schizophrenia.
Drat. I have no idea how I would get my footnotes to work on here. Oh well. Pretend they're there. :p