Muhammad Saud KharalPhD in Social Science, Department of Sociology Faculty of Social and Political Sciences, Universitas Airlangga, Surabaya Indonesia. Email: muhhammad.saud@gmail.com

1. Spirituality and Mental HealthSpirituality and Mental Health
The Role of Religion andThe Role of Religion and
Spirituality in the Process ofSpirituality in the Process of
RecoveryRecovery
Muhammad Saud Kharal
PhD in Social Science,
Department of Sociology Faculty of Social and Political
Sciences, Universitas Airlangga, Surabaya Indonesia.
Email: muhhammad.saud@gmail.com

2. ““You need to know me and myYou need to know me and my
spirit--that I seek meaning inspirit--that I seek meaning in
suffering…some days I am ablesuffering…some days I am able
to make meaning of suffering.”to make meaning of suffering.”
Steven A. SchmidtSteven A. Schmidt

3. Jimmy’s storyJimmy’s story

4. Case study 1Case study 1
The year is 1927. A young woman is forcibly admitted toThe year is 1927. A young woman is forcibly admitted to
a psychiatric institution. Her diagnosis? ‘Moral insanity.’a psychiatric institution. Her diagnosis? ‘Moral insanity.’
Her ‘symptoms?’ Having an illegitimate child.Her ‘symptoms?’ Having an illegitimate child.
The year is 1968. A young man is admitted to aThe year is 1968. A young man is admitted to a
psychiatric hospital ward. His diagnosis?psychiatric hospital ward. His diagnosis?
Homosexuality.Homosexuality.
What do these vignettes tell us about the nature of mental health and illness?What do these vignettes tell us about the nature of mental health and illness?

5. What is mental health?What is mental health?

6. Case Study 3Case Study 3
A woman you encounter claims to haveA woman you encounter claims to have
seen a vision of Jesus, and to be inseen a vision of Jesus, and to be in
constant contact with him. That morningconstant contact with him. That morning
she spent half an hour on her knees inshe spent half an hour on her knees in
prayer – in the middle of theprayer – in the middle of the
supermarket.supermarket.
1.1. Does this woman have a mental health problem?Does this woman have a mental health problem?
2.2. If so why?If so why?
3.3. If not, why not?If not, why not?

7. Case Study 2Case Study 2
A young woman (with an intrinsic religiosity!)A young woman (with an intrinsic religiosity!)
who has quite recently been paralysed from thewho has quite recently been paralysed from the
neck downwards in a skiing accident, comesneck downwards in a skiing accident, comes
under pressure from her religious community,under pressure from her religious community,
to seek spiritual/miraculous healing. Sheto seek spiritual/miraculous healing. She
refuses: “My life could be no fuller than it is justrefuses: “My life could be no fuller than it is just
now. Why would I want to change anything?”now. Why would I want to change anything?”
Her friends say she is in denial.Her friends say she is in denial.
1.1. What do you think?What do you think?
2.2. What might she mean by a full life?What might she mean by a full life?

8. Mental HealthMental Health
ContextualContextual
Culturally BoundCulturally Bound
Socially constructedSocially constructed
ChangeableChangeable
Subject to power dynamicsSubject to power dynamics

9. What is a mental healthWhat is a mental health
problem?problem?

10. A clinical
experience
A social
experience
A lived
experience
A Spiritual
experience
Who am I and who says that
that is who I am!
Mental Illness is:Mental Illness is:

11. A Clinical ExperienceA Clinical Experience

12. The Neurobiology ofThe Neurobiology of
SchizophreniaSchizophrenia
Schizophrenia is a brain disease, now definitely known to
be such. It is a real scientific and biological entity as
clearly as diabetes, multiple sclerosis, and cancer are
scientific and biological entities. It exhibits symptoms of
a brain disease, symptoms which include impairment in
thinking, delusions, hallucinations, changes in emotions,
and changes in behaviour. And, like cancer, probably has
more than one cause.
E. Fuller Torrey Surviving Schizophrenia.

13. What is mental illness like?What is mental illness like?
Mental illness is aMental illness is a
physical condition justphysical condition just
like asthma or arthritis.like asthma or arthritis.
But still society believesBut still society believes
that a person who isthat a person who is
mentally ill needs tomentally ill needs to
show more willpower -show more willpower -
to be able to pullto be able to pull
themselves out it.themselves out it.

14. ……....It is also likeIt is also like
telling a persontelling a person
who has anwho has an
amputated leg toamputated leg to
run across therun across the
room.room.
But a person who has mental health issueBut a person who has mental health issue
has a “broken brain”.has a “broken brain”.

15. ““I cannot think of anything moreI cannot think of anything more
destructive of one’s sense of worth as adestructive of one’s sense of worth as a
human being than to believe that thehuman being than to believe that the
inner core of one’s being is sick – thatinner core of one’s being is sick – that
one’s thoughts, values, feelings, andone’s thoughts, values, feelings, and
beliefs are merely the meaninglessbeliefs are merely the meaningless
symptoms of a sick mind…”symptoms of a sick mind…”
John Modrow –John Modrow – How to become a schizophrenicHow to become a schizophrenic

16. ““What the concept of mental illnessWhat the concept of mental illness
offered me was scientific proof that I wasoffered me was scientific proof that I was
utterly worthless, and would always beutterly worthless, and would always be
worthless. It was just the nature of myworthless. It was just the nature of my
genes, chemistry and brain processes –genes, chemistry and brain processes –
something I could do nothing about.”something I could do nothing about.”
John Modrow –John Modrow – How to become a schizophrenicHow to become a schizophrenic

17. You can’t understand the clinicalYou can’t understand the clinical
experience without firstexperience without first
understanding the humanunderstanding the human
experience.experience.

18. ““The social power to define and categorizeThe social power to define and categorize
another person’s experience is not aanother person’s experience is not a
power to be ignored. … in order to supportpower to be ignored. … in order to support
persons who are trying to recover, wepersons who are trying to recover, we
must attend to the fullness of theirmust attend to the fullness of their
experiences, and not be distracted by theirexperiences, and not be distracted by their
medical diagnoses.”medical diagnoses.”
McGruder 2001McGruder 2001

19. A Social ExperienceA Social Experience

20. Mental Health Problems areMental Health Problems are
not like Measles!not like Measles!

21. Mental health problems areMental health problems are
social experiences that aresocial experiences that are
open to various forms ofopen to various forms of
interpretation, abuse andinterpretation, abuse and
manipulation.manipulation.

22. Schizophrenia as aSchizophrenia as a TotalizingTotalizing
ConditionCondition
Unlike measles, the flu or any other common
ailment, a person does not simply have
schizophrenia, the actually become
schizophrenia. Schizophrenia is an “I am”
illness – one that may overtake and redefine the
identity of the person.
Sue E Estroff ‘Self, identity, and subjective
expression of Schizophrenia: In search of the subject.’

23. Case Study 4Case Study 4
Derek is a committed Christian and has been forDerek is a committed Christian and has been for
many years. He believes strongly that he ismany years. He believes strongly that he is
called to be a minister, indeed he claims thatcalled to be a minister, indeed he claims that
God has spoken to him directly to confirm this.God has spoken to him directly to confirm this.
He attend the selection conference for ministers.He attend the selection conference for ministers.
During his interview it emerges that Derek hasDuring his interview it emerges that Derek has
had schizophrenia since he was 17 years old.had schizophrenia since he was 17 years old.
He is now 24. The interview finishes and theHe is now 24. The interview finishes and the
panel look at one another and smile…Derek ispanel look at one another and smile…Derek is
turned down.turned down.

24. 1.1. What strikes you as significant about thisWhat strikes you as significant about this
narrative?narrative?
2.2. What might be the given reasons forWhat might be the given reasons for
Derek’s refusal be?Derek’s refusal be?
3.3. How would you handle the situation?How would you handle the situation?

25. Images of madnessImages of madness
People evaluate mental illness negatively, reject
and discriminate against mental patients and base
their views on traditional stereotypes. Over all the
public image of a person suffering from mental
illness is considerably more gloomy than that of a
person suffering from physical illness and in
certain respects it appears to be closer to the public
image of a criminal.
Agnes Miles The Mentally Ill in Contemporary Society.

26. Images of MadnessImages of Madness
A lot of things you read in the papers and they’ve been
diagnosed as schizophrenic. These murderers – say Donald
Neilson, was he no schizophrenic? – The Yorkshire Ripper…
on Brookside that man who is the child-abuser and the wife-
beater – he looks like schizophrenic – he’s like a split-
personality, like two different people. First he gets like self-
pity and he brings flowers and works his way back into the
house and you could feel sorry for him, then he’s a child
abuser and a wife-beater. (Motherwell Group Interview)
Greg Philo Media and Mental Distress

27. Illness as MetaphorIllness as Metaphor

28. How then are we to understandHow then are we to understand
people with mental health problemspeople with mental health problems

29. DANGEROUS ?
DANGEROUS ?VIOLENT ?
VIOLENT ?
UNPREDICTABLE ?
UNPREDICTABLE ?
IRRESPONSIBLE ?
IRRESPONSIBLE ?
DISTRESSED ?DISTRESSED ?
FRIGHTENEDFRIGHTENED ?
CONFUSED ?CONFUSED ?
ANGRY ?ANGRY ?
POTENTIAL TO
POTENTIAL TO
GROW AND
GROW ANDCHANGE ?
CHANGE ?
WHAT DO YOU SEE?WHAT DO YOU SEE?
©Brandi Randell Canadian Mental Health Association, Manitoba Division

30. Presumed Incompetence!Presumed Incompetence!

31. Carole’s experienceCarole’s experience
What I think I am doing is notWhat I think I am doing is not
what you think I am doing! Butwhat you think I am doing! But
because you are powerful I havebecause you are powerful I have
to listen.to listen.

32. CultureCulture shapes theshapes the
experience of mental illnessexperience of mental illness
Depression in TaiwanDepression in Taiwan

33. Case Study 5Case Study 5
Jean is from Shetland and has enduringJean is from Shetland and has enduring
schizophrenia. She persistently complainsschizophrenia. She persistently complains
that she has a rabbit between her legs.that she has a rabbit between her legs.
You are asked to assess her mentalYou are asked to assess her mental
condition. You ask her how she is and shecondition. You ask her how she is and she
says, “I’m feeling fine thanks, but I have asays, “I’m feeling fine thanks, but I have a
horrible rabbit between me legs!” Howhorrible rabbit between me legs!” How
might you respond?might you respond?

34. GenderGender shapes theshapes the
experience of mental illnessexperience of mental illness
Depression in the Hebrides/Depression in the Hebrides/
Young west Indian men inYoung west Indian men in
inner city Londoninner city London

35. Gender and Race impacts mentalGender and Race impacts mental
health?health?
Research has shown an over-representation of ethnicResearch has shown an over-representation of ethnic
minorities, especially African Caribbeans in secure mentalminorities, especially African Caribbeans in secure mental
health settings.health settings.
African Caribbean patients are more likely than whiteAfrican Caribbean patients are more likely than white
patients to be detained and treated under the Mentalpatients to be detained and treated under the Mental
Health Act.Health Act.
There is evidence that the pathways into mental healthThere is evidence that the pathways into mental health
care are different for Black and ethnic minority patients andcare are different for Black and ethnic minority patients and
they may have different beliefs and explanations for theirthey may have different beliefs and explanations for their
illnesses.illnesses.
The specific needs of Black and ethnic minority patientsThe specific needs of Black and ethnic minority patients
may not be adequately met by mental health servicesmay not be adequately met by mental health services..
Ethnicity and Pathways into Forensic Mental Health Care Professor Dinesh Bhugra Professor Tom Fahy, MsEthnicity and Pathways into Forensic Mental Health Care Professor Dinesh Bhugra Professor Tom Fahy, Ms
Beenish Nafees, Dr Rajesh MohanBeenish Nafees, Dr Rajesh Mohan

36. SpiritualitySpirituality shapes theshapes the
experience of mental illnessexperience of mental illness

37. Case Study 6Case Study 6
David is deeply depressed. He has a history ofDavid is deeply depressed. He has a history of
depression, but his current mood is at an all timedepression, but his current mood is at an all time
low. He is convinced that God is punishing himlow. He is convinced that God is punishing him
for a sin that he has committed. He is not surefor a sin that he has committed. He is not sure
precisely which sin, but he knows it is there. Heprecisely which sin, but he knows it is there. He
is seriously contemplating suicide, but hisis seriously contemplating suicide, but his
religious beliefs mean that he believes that suchreligious beliefs mean that he believes that such
an act would send him to hell. “Why has Godan act would send him to hell. “Why has God
allowed this to happen!? Why won’t he healallowed this to happen!? Why won’t he heal
me!?”me!?”

38. His psychiatrist says to you, “this isHis psychiatrist says to you, “this is
precisely why religion is dangerous! Thereprecisely why religion is dangerous! There
are some who think that we should beare some who think that we should be
using religion in a clinical context, but thisusing religion in a clinical context, but this
just goes to show how ridiculous such ajust goes to show how ridiculous such a
suggestion is!suggestion is!
How do you respond?How do you respond?

39. Spirituality as the grammar ofSpirituality as the grammar of
human experiencehuman experience
A person’s spirituality provides people with the
language and grammar they use to understand and
interpret what is happening to them.

40. Spirituality matters!Spirituality matters!
It matters because MentalIt matters because Mental
health problems are first andhealth problems are first and
foremost meaningful, uniqueforemost meaningful, unique
and deeply personaland deeply personal
experiencesexperiences

41. It matters because it forces us toIt matters because it forces us to
remember that we need toremember that we need to
understand not justunderstand not just thatthat a persona person
is experiencing a mental healthis experiencing a mental health
problem, but alsoproblem, but also wherewhere andand howhow
they are experiencing it.they are experiencing it.

42. It mattes because itIt mattes because it
reminds us that there is noreminds us that there is no
such thing assuch thing as aa mentalmental
health problem!…Onlyhealth problem!…Only mymy
mental health problemmental health problem

43. We need to recognise thatWe need to recognise that
medicine and psychiatry aremedicine and psychiatry are
useful, but provide only oneuseful, but provide only one
perspective on the treatmentperspective on the treatment
and care of peopleand care of people
experiencing mental healthexperiencing mental health
problems.problems.

44. Drawing together the clinical andDrawing together the clinical and
the socialthe social

45. Disease and IllnessDisease and Illness
DiseaseDisease refers to the organic, viral, orrefers to the organic, viral, or
other physical basis of the condition. Cancer,other physical basis of the condition. Cancer,
influenza, and measles would constitute diseasesinfluenza, and measles would constitute diseases
and diseaseand disease processesprocesses..
IllnessIllness refers to the ways in which the sick personrefers to the ways in which the sick person
and the members of the family or wider socialand the members of the family or wider social
network perceive, live with, and respond tonetwork perceive, live with, and respond to
symptoms of disability.symptoms of disability.
Arthur Kleinman.Arthur Kleinman. The Illness Narratives: Suffering,The Illness Narratives: Suffering,
Healing & The Human ConditionHealing & The Human Condition..

46. The Role of Spirituality in theThe Role of Spirituality in the
Process ofProcess of RecoveryRecovery

47. Recovery means changing our lives…Recovery means changing our lives…
NOTNOT our biochemistry!our biochemistry!
Deegan (2004)Deegan (2004)
RecoveryRecovery

48. Schizophrenics Anonymous!Schizophrenics Anonymous!

49. RecoveryRecovery
In a recovery oriented approach, the focus is on theIn a recovery oriented approach, the focus is on the
person in the context of their life.person in the context of their life. The measure ofThe measure of
success is not simply an absence of symptomssuccess is not simply an absence of symptoms
or reduction in inpatient admissionsor reduction in inpatient admissions. In a. In a
recovery-oriented approach,recovery-oriented approach, success is alsosuccess is also
measured by how well we are able to pursuemeasured by how well we are able to pursue
the things that give our lives purpose andthe things that give our lives purpose and
meaning.meaning.
Deegan (2004)Deegan (2004)

50. ““in the simple and yet profound realization that people whoin the simple and yet profound realization that people who
have been diagnosed with mental illness are humanhave been diagnosed with mental illness are human
beings…”beings…”
““The goal is to become the unique, awesome, never to beThe goal is to become the unique, awesome, never to be
repeated human being that we are called to be.”repeated human being that we are called to be.”
““Those of us who have been labeled with mental illness areThose of us who have been labeled with mental illness are
not de facto excused from this fundamental task ofnot de facto excused from this fundamental task of
becoming human.”becoming human.”
Deegan, 1996Deegan, 1996
““The concept of recovery is rootedThe concept of recovery is rooted

51. ““In fact, because many of us haveIn fact, because many of us have
experienced our lives and dreamsexperienced our lives and dreams
shattered in the wake of mental illness,shattered in the wake of mental illness,
one of the mostone of the most essential challengesessential challenges
that face us is to ask who can I becomethat face us is to ask who can I become
and why should I say yes to lifeand why should I say yes to life.”.”

52. Recovery means finding ways ofRecovery means finding ways of
enabling people to answer thisenabling people to answer this
question:question:
Who can I become and whyWho can I become and why
should I say yes to lifeshould I say yes to life

53. Spirituality and RecoverySpirituality and Recovery

54. A focus on spirituality beginsA focus on spirituality begins
not with presumednot with presumed
inincompetence, but withcompetence, but with
assumed competenceassumed competence..

55. Spiritual CareSpiritual Care
Spiritual care is not a set of techniques orSpiritual care is not a set of techniques or
competencies.competencies.
Rather it has to do with the enabling ofRather it has to do with the enabling of
carers to do what they do already, but tocarers to do what they do already, but to
see differently.see differently.
toto listenlisten differentlydifferently and toand to look beyondlook beyond
that which is expected.that which is expected.

56. Spiritual care as ‘being with.’Spiritual care as ‘being with.’
You don’t have to believe what I believe to
give me spiritual care, but you have to have
empathy and the understanding that this
person requires this…its part of her…
A long term mental health service user

57. Looking and SeeingLooking and Seeing
DifferentlyDifferently

58. When weWhen we listenlisten differently anddifferently and
looklook beyondbeyond what is expected,what is expected,
we begin to practicewe begin to practice
differently.differently.

59. Spiritual NarrativesSpiritual Narratives
• May be expressed in the language of
religion, but in a spiritually diverse culture,
spiritual narratives may use different forms
of language.
• The expression of people’s experiences
relating to issues of meaning, purpose,
hope, value, relationship and the sense of
the Holy.

60. Narrative competencyNarrative competency
The assumption that a person has theThe assumption that a person has the
ability to tell their own story well.ability to tell their own story well.
The ability to listen and to hear beyond theThe ability to listen and to hear beyond the
obvious.obvious.
The ability to hear the spiritual in theThe ability to hear the spiritual in the
mundane.mundane.

61. David’s storyDavid’s story

62. The spiritual meaning ofThe spiritual meaning of
medicationmedication
Non compliance or the
reclaiming of citizenship and
one’s spiritual personhood
From Mental Patient to Person Peter Barham and Robert Hayward

63. The lived experience of depressionThe lived experience of depression

64. The abyss of depressionThe abyss of depression
When I’m in a phase that I am able to
believe that there is a God who gives
meaning to that universe, then I have hope.
But there have been spells when I haven’t
been able to believe that, and that has been
absolutely terrifying. That’s been falling into
the abyss. That is seriously nasty!

65. The logic of suicideThe logic of suicide
The idea of suicide is the most rational
thing in the world when you are going
through all that pain. It’s the people who
try to stop you that you think are off their
heads. Why would you want to go on
living if you felt like that?

66. The double bind of religionThe double bind of religion
““I want to kill myself but I can’tI want to kill myself but I can’t
because God won’t let me..Ibecause God won’t let me..I
am very angry with God aboutam very angry with God about
that!”that!”

67. Caplan GroupsCaplan Groups

68. Growing Old,Growing Old,
Keeping the FaithKeeping the Faith
Spirituality and dementiaSpirituality and dementia

69. Forgetting whose we areForgetting whose we are
Jean’s StoryJean’s Story

70. ReRementiamentia
Clear examples have been noted ofClear examples have been noted of
‘rementing,’ or measurable recovery of‘rementing,’ or measurable recovery of
powers that had apparently been lost; apowers that had apparently been lost; a
degree of cognitive decline often ensued,degree of cognitive decline often ensued,
but it was far slower than that which hadbut it was far slower than that which had
been typically expected when people withbeen typically expected when people with
dementia are in long term care.dementia are in long term care.

71. We are Persons-in-We are Persons-in-
RelationRelation

72. We relate therefore I am!We relate therefore I am!

73. Spiritual care with people who haveSpiritual care with people who have
dementia reminds us that we aredementia reminds us that we are
not our own.not our own.
To be me, I need you; to be youTo be me, I need you; to be you
you need me.you need me.

74. Jean’s storyJean’s story

75. Responding Differently,Responding Differently,
Responding SpirituallyResponding Spiritually

76. A question of meaningA question of meaning
““It is not as important whatIt is not as important what
happens to a person, as to thehappens to a person, as to the
meaning that the person gives tomeaning that the person gives to
what has happened.”what has happened.”

77. Man’s Search for MeaningMan’s Search for Meaning
Victor FranklVictor Frankl
Sometimes external circumstances in ourSometimes external circumstances in our
life situation are beyond our control.life situation are beyond our control.
Frankl maintains that the attitude weFrankl maintains that the attitude we
choose to take toward our life situation ischoose to take toward our life situation is
within our control.within our control.
The spiritual journey relates to our innerThe spiritual journey relates to our inner
struggle to shape our attitude towardstruggle to shape our attitude toward
illness and even death itself.illness and even death itself.

78. Meaning centred psychotherapyMeaning centred psychotherapy
interventionintervention
Meaning Centered Psychotherapy is based on the concepts of meaningMeaning Centered Psychotherapy is based on the concepts of meaning
as derived from the work of Viktor Frankl, M.D. and adapted for useas derived from the work of Viktor Frankl, M.D. and adapted for use
in cancer populations by William Breitbart at Memorial Sloan-in cancer populations by William Breitbart at Memorial Sloan-
Kettering Cancer Center, New York.Kettering Cancer Center, New York.
Breitbart noted that people asking for assisted suicide had commonBreitbart noted that people asking for assisted suicide had common
experiences: hopelessness, meaningless, feelings of being aexperiences: hopelessness, meaningless, feelings of being a
burden and so forth.burden and so forth.
Meaning centred psychotherapy is specifically designed to enable peopleMeaning centred psychotherapy is specifically designed to enable people
to overcome their sense of meaningless and hopelessness and thusto overcome their sense of meaningless and hopelessness and thus
the desire to take their own lives.the desire to take their own lives.
Two forms of Meaning Centered Psychotherapy have been developed:Two forms of Meaning Centered Psychotherapy have been developed:
Meaning Centered Group Psychotherapy (8 weekly 1 ½ hourMeaning Centered Group Psychotherapy (8 weekly 1 ½ hour
sessions) ; Individual Meaning Centered Psychotherapy (7 weekly 1sessions) ; Individual Meaning Centered Psychotherapy (7 weekly 1
hour sessions).hour sessions).
Breitbart W. Spirituality and meaning in supportive care:Breitbart W. Spirituality and meaning in supportive care: Spirituality- andSpirituality- and
meaning-centered group psychotherapy interventions in advanced cancermeaning-centered group psychotherapy interventions in advanced cancer Supportive Care in CancerSupportive Care in Cancer..
2002;10(4):272-2802002;10(4):272-280..

79. Participants become familiar with the concept ofParticipants become familiar with the concept of
spirituality as a construct composed of faith and/orspirituality as a construct composed of faith and/or
meaning.meaning.
Participants are helped to understand the importanceParticipants are helped to understand the importance
of meaning, as a component of spiritual well-being,of meaning, as a component of spiritual well-being,
and its relationship to depression, hopelessness andand its relationship to depression, hopelessness and
desire for death.desire for death.
Participants engage in a structured, didactic andParticipants engage in a structured, didactic and
experiential 8 session intervention for advancedexperiential 8 session intervention for advanced
cancer patients aimed at sustaining or enhancing acancer patients aimed at sustaining or enhancing a
sense of meaning in the face of terminal illness.sense of meaning in the face of terminal illness.

80. Care of the spirit stands against
systems and world-views which
militate against taking patient's
stories very seriously.
Care of the spiritCare of the spirit

81. Care of the spirit seeks to re-
member people whom both
society and those services
created to offer care and
support often dis-member.
Re-membering the PersonRe-membering the Person