An exploration of meaning and role of spirituality in rehabilitation among people with schizophrenia

Abstract

Spirituality has received increased attention in the psychiatric literature; however, it remains underexplored on a global level, especially among Chinese population. Knowledge about spirituality of people with schizophrenia is often hindered by their psychotic symptoms. This view not only results in a discrepancy in the understanding of spirituality between clients, professionals and family caregivers, but also limits clients’ expression of spiritual needs and impedes the provision of high-quality holistic care. Therefore, the understanding of spirituality in Chinese individuals with schizophrenia, and the roles spirituality play in the recovery process from the perspectives of clients, mental-health professionals and family caregivers warrants in-depth exploration.

A qualitative design with semi-structured individual interviews was employed. The analysis was based on data collected from interviews with 19 clients diagnosed with schizophrenia, 19 mental-health professionals, and 11 family caregivers from public hospitals and mental-health community rehabilitation centres in Hong Kong. Data were collected and analyzed based on grounded theory principles.

Ten components of spirituality emerged from the data: 1) Beliefs, 2) State of mind, 3) Sense of self, 4) Transformation/Growth, 5) Meaning in life, 6) Human nature, 7) Connection with others, 8) Connection with higher power, 9) Apparitional experiences, and 10) Religion. They were classified into personal domain (component 1-6) and communal domain (component 7-10), and formed a conceptual model which indicated the trajectory of spiritual development in people with schizophrenia.

Three illness phases also emerged from clients’ illness experience: i) acute phase, ii) remission phase, and iii) stable phase. At different illness phases, components imposing the most prominent influences on clients’ recovery changed. The shift from one component to another indicated a change in the roles of spirituality in accordance with the degree of influences induced by the psychotic symptoms, as well as a change in clients’ spiritual pursuits throughout the process of recovery.

The findings provided insights and perhaps a roadmap for clinical practices and research investigations in schizophrenia. First of all, a more inclusive definition of spirituality (i.e., beyond the boundary of religion) should be adopted so as to embrace the diversity of views expressed in discussions of spirituality in clinical setting and prevent biased results in research. Second, clinical practices and research investigations need to be phase-specific in order to meet clients’ spiritual needs at different illness phases. Finally, the trajectory of spiritual development in people with schizophrenia illustrated in the conceptual model indicates the value and feasibility of conducting spiritual interventions for this population, with prioritized goals.