Durham - Spiritual Health Victoria

explore the importance of spiritual wellbeing as a
protective factor for people who have a mental illness for
their mental health, wellbeing and recovery.’
Rosalind Cairns
Manager, Mental Health
[email protected]
5 participants in a community based programme.
All participants were women – aged 30-55 years
All participants had a diagnosis of depression
Some participants also experienced anxiety
One had an acquired brain injury
One lived with Asperger Syndrome
Unstructured, in-depth interviews participants were asked to
describe and reflect on:
• their lived experience of spirituality
• the positive benefits, if any, of attending to spirituality in
their treatment and care and in the recovery process
Participants were encouraged to use own language to describe
experiences & that there was no right or wrong answer.
Open questions were used & all interviews commenced
with the question “What is your understanding of
Some would say that spirituality is based on a belief in a personal
God and in that we find meaning for our existence. Spirituality
involves a personal quest to find meaning and purpose in life and a
relationship to the Mystery/God and the rest of the universe
(Ruffing Rahal 1984).
Spirituality is a quality that goes beyond religious affiliation that
strives for inspiration, reverence and awe, even in those who do not
believe in any God
(Murray and Zentner 1989).
Spirituality is the search for meaning through the inner journey
which is mediated through relationships; sometimes with each other,
sometimes with nature and sometimes with God
(Mowat 2006)
Drawing from these examples and for the purpose of this
study spirituality is defined as an experience and process,
not a religion; it is a quest for meaning and purpose, to be
connected through relationship and to encounter hope.
The universality of spirituality extends beyond doctrine,
beyond cultural difference, and at the same time is
uniquely individual.
Spiritual care includes and may seek to meet religious
Spirituality as connectedness through
 personal relationship with God/Higher power
 spiritual and religious practices
 relatedness with others
Recovery and Spirituality
Spirituality as a source of renewed meaning, purpose
and hope in the recovery process
 Mediated through meaningful activity
Spirituality from participants perspective
“Spirituality is about having a connection to something greater than
yourself and trusting in my life that things will work out.”
“My understanding of spirituality is that it is who we are. It is our
essence that is what it is. It has nothing to do with what we look like. It
is our essence. It is who we are.”
“Something that you believe in, faith gives you strength and it is all
positive. And for me also angel, I believe in angels.”
“My spirituality is important to me; it is a way of life. I receive strength
from my spirituality and it enables me to live each day.”
Whereas Debbie, was not really sure what spirituality was
nor did she believe that she had a spirituality, stating that
she took part in the study because
“…. nothing else had helped and maybe this could help me
deal with my obsessions.”
Perhaps Debbie’s search for what might help her cope with
the difficulties and “obsessions” was her spiritual journey at
this stage in her life.
Spirituality as connectedness through religious and spiritual
Perhaps our most basic human need is to enter into trusting, loving
and caring relationships to connect to someone or something
beyond the self. The experience of relationship with God and others
is for most people the most significant way that they express and
fulfil the spiritual needs (MacKinley 2006).
All participants acknowledged a belief in a god or higher power
although each person experienced and expressed this relationship
For some this connectedness was mediated through prayer and
meditation which provided a source of strength and hope.
“… I have two mentally ill sons too so if I did not pray, if I did not
believe then I would give up. I would think that there is no future,
nothing is going to change. It enables me to live each day, I know I
do not have to face the day alone and that I have God there.... I do
have a prayer partner who keeps in contact with me. A lot of
people have said that I have changed heaps in the last year and the
only thing that has changed is praying…my walk with God is
important to me.”
have gone to a Buddhist centre and done meditation and in my
own way pray.
I also like music, art and writing and I feel a real connection to
those sort of things.
do reiki healing. I go to this lady who moves my energy around, and
moves the bad energy out and tries to calm me. I literally feel the
energy move; it’s getting rid of the crap that we all accumulate by just
occasionally go to church. When I do get there just being with
other Christians to worship is important and I feel I belong.
I know this woman who does reiki healing and tarot card and I go
and see her. I take time out for me. People like her are helping me
to try and move on each day positively.”
Spirituality as connectedness through relatedness:
Relationships with self, God and others lies at the heart of
spirituality, and this may be expressed towards a God or higher
power or towards other human beings.
It is in and through relationships that an individual develops a sense
of identity, of who they are and their place in the world.
All participant indicated that their relationships with others was
something that they highly valued…
All indicated that relationship with family members was significant
in in their recovery and continued well being.
I have faith in the goodness of people. People are very important to me,
my family, my friends and my cat...support from my family really helps
me and support from my friends.”
Depression or depressive episodes drain the person of energy and
present a barrier for many to be or feel connected to others. Annie and
Carly elaborated on the impact of depression on relationships and
connectedness to others.
“I sometimes do feel disconnected to people because I do have periods
of depression. I feel more connected to people actually when I am not
“It has been a tough time. I take little steps; I don’t put a lot on my plate
anymore, because I know if I take too much it will drain me out. When
I think what I went through with that spiral effect of depression. People
use to say ‘snap out of it’ but it is not that easy”
The experience of being connected to others or at least one
other provides the person with a sense of meaning in life.
All participants expressed that it was relationships that
provided them with meaning in life.
Debbie was the most emphatic regarding the significant role her
relationship with her family had in her life and continued wellbeing,
indicating that it is the care and support of her family that keeps her
from further suicide attempts.
“The most important thing in my life is my mum and my entire family.
I would never want to lose my family. I only live for my family.”
The researcher followed this statement up with the question ‘Does
your life have meaning for your family?’ Her response: “Yes, they love
me very much” indicating mutuality in the relationship and that
Debbie was unconditionally loved and valued by them. Perhaps it is
this source of love that keeps her connected to life.
Effie and her ‘boys’, two young men in their early twenties.
“My kids, my boys are really important to me. I would say I live for
my kids, I know I shouldn’t but I do. My faith is important although
my kids come first. I do not want to lose my relationship with my
boys. This is in jeopardy at times with the way we are with each
Connectedness in the community.
“Sometimes it is rewarding like in the afternoons when some of the
mothers say hello and I will go over and chat with them.” Effie
The power of relationship, of loving and being loved has
the ability to sustain the person through tough times and
this is certain true for Betty.
“My spirit my essence sustains me especially in tough times,
but also all my babies. My four babies ranging in age from
19 to 26, but they are still my babies. I love them and they
know it and they love me.”
All participants valued the connectedness with others that
they felt at Karingal. Betty’s sentiment “I have good
company here” was echoed by each participant.
The quest for meaning provides the criteria for what
spirituality is and what the focus of spiritual care should be
(Burnard). Meaning is the foundation for the development
of mental health and well being. The primary motivating
force that impels the person towards mental health is the
quest for meaning and purpose (Frankl). Meaning provides
a sense of purpose and direction in life and hope for a
better future. Those who have experienced depression or
any form of mental illness need renewed meaning and
purpose in order to live with and combat the effects of the
illness as they engage in their journey of recovery.
Recovery through renewed meaning & purpose
Annie expressed this clearly when speaking about her
understanding of spirituality, she stated;
“I have often thought about what is the meaning of life or if
there is any meaning at all and what we are here for. What
is my purpose is and that sort of thing.”
“For me life is about searching for that meaning. I have got
glimpses of it, many glimpses and I just have to get hold of
it. I am still looking for that meaning and doing spiritual
work helps.”
Spirituality as mediated through meaningful activity:
Meaningful activity - activities that enable the person to grow in
connection, confidence, and contribution to society, education,
vocation and relationships.
Meaningful activity promotes wellbeing for all. Meaningful activity is
beneficial for the person recovering from mental illness in several ways.
• It provides a focus beyond self and affords the opportunity to give to
others, developing a sense of self worth in the person.
• Holds the possibility of breaking down the loneliness or isolation
bring the person into contact with others.
• Serves to give the person a sense of self worth and as being a valued
and contributing person in the community; enhancing the person’s
sense of self and identity as well as holding their integrity as a person.
has been really good in the programmes I come to, even the
little pot I am doing is making me feel really good because I have
created it, I have done it and I enjoyed doing it. I know I have help
from the council but this is different. They do for me whereas at
Karingal I do things. Things that I achieve.”
“I am now a school crossing supervisor. So that actually gets me out of
bed in the morning. I have to get out. I have to go and do the school
crossing. That gives me meaning too.”
Carly and Annie are involved in organising and participating in
client centred programmes through Karingal as a means of activity
and yet also as a means of giving back to the community that has
been part of their recovery journey.
When asked what has sustained her through difficult times Carly
“My sisters. Yes and when I work in this field. It is challenging
working with difficulty behaviours, but I enjoy it. I see just little
smiles, if they smile at me or acknowledge my name, that is an
improvement and I think, Oh that’s wonderful. It can be baby steps
and that’s all I need. I just love working in this field.”
Betty was not involved in any actual employment although
found meaning through her interest in and study of
“I do enjoy doing philosophy every week, and practical
philosophy which I love. Practical philosophy is where you
feel your feet on the floor, air on your face and the way you
hear. It is very, very calming. Every Tuesday I do that.”
Debbie indicated that participating in the programmes at
Karingal was helpful and enjoyable her hope for her future is
“that one day I work again.”
Recovery and hope.
Spiritual beliefs are a powerful source of hope for many people.
Having a sense of hope is the foundation for ongoing recovery from
mental illness. Hope provides that motivation that keeps a person
moving towards recovery and well being. at times of unwellness it may
be difficult for the person to hold and maintain hope, and it may mean
that for a time another carries that hope. The aim is always that the
person will develop and hold within them their own sense of hope.
Within the recovery process it is vital that the person encounter hope.
Hope is the belief in a positive outcome related to events and
circumstances in a person’s life. All participants held a sense of hope
although they acknowledged that it was more difficult to maintain this
hope at times of unwellness.
“I suffer from depression so there were a lot of times when
I haven’t felt much hope. However hope is believing,
believing that good things can happen, that I can get some
joy out of life; even when there are some difficult times
there are still simple things that I can enjoy.”
“One day I hope I will work again, one day I hope that the
obsessions will be gone. There is a lot to hope for.” Debbie
“I was going to say getting up in the morning but no the real
hope for me is seeing the world as a better place.” Betty
Concluding thoughts
• Spirituality as experienced through connectedness with God/higher
power was important (ABCE)
• For some participants spiritual practices provided that
• Spirituality was a motivator and means through which they viewed
the world and their place in life.
• All participants held the belief that life could be different thus their
spirituality provided a source of hope for the future and in the recovery
• Spirituality holds the potential to offer meaning beyond the
experience of mental illness, meaning that offers the person a deeper
and renewed sense of self and value as a contributing person in society.
•It also afforded the person a source of strength and courage in coping
with mental illness.
• Spirituality as mediated through relationships was vital for all
• For each participant the connectedness with family seemed to have
withstood the effects of mental illness on the person’s life.
• For Effie, Carly and Betty there was an element of guilt around the
impact that the mental illness had on their children.
• Participants spirituality is the means through which they embark
on the personal quest for meaning, hope, value and connection to a
higher power – not necessarily related to any institutional religion.
It is apparent that participants’ experience of spirituality very much
paralleled the view of Mowat who saw spirituality as a process and
search for meaning through the inner journey mediated through
relationship with self, other and God or a higher power. (Mowat
That attending to spirituality is an integral part of all
recovery based programmes.
 That spiritual assessment is part of recovery
(Pulchalski 2007, Culliford 2005).
One of the limitations of this study was the small number
of participants.
 That the study is replicated and analysis be compared
to this study
“The thing that I would never want to lose is my sense of self. Although
at times I feel I have lost in some ways. Like when I become unwell. I
don’t think I would ever lose it completely but it has been a bit scary
when that has happened. I am still finding myself and I believe that will
continue throughout my life as I discover more about myself and learn
and change perspective on things. I believe that there is a core self that
you keep always.”
This last comment of Annie is rather profound that the core self remain.
It may be battered, bruised and at times fragile yet even within the
experience of mental illness the core self remains. This sense of Annie’s
around her core self echoed the words of Patricia Deegan:
“You carry within you a precious flame, a spark of the divine. You were
born to love and be loved. That is your birthright. Mental illness cannot
take that away from you. Nobody can take that from you.”(Deegan)

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