Spirituality or Psychosis?

02.07.2018

What would you do if someone came to you and said that they were depressed, or experiencing major problems functioning in their life, but it became clear that the way that they were interpreting their faith or spirituality was a key component of their struggle?

It’s one of the tougher aspects of this line of work that I’m wrestling with now.

I have clients and I’ve studied and discussed case-studies where clients with psychosis or delusions have warped concepts of their faith or spirituality which make it nearly impossible for others to challenge their assumptions. Religion, which in the ideal exists as a system for living and a major support, instead becomes a fortified and seemingly impenetrable castle for the ego.

Psychosis presents itself through the lens of our own experiences. Naturally, a Christian experiencing psychosis may interpret his or her odd perceptions, hallucinations, or delusions using knowledge from the Bible. They may believe they are prophets. They may shun people who tell them otherwise. They engage in such a zealous fervor of religiosity that they become intolerable to most folks, isolating them from positive supports.

These things clearly and objectively identify impairment of psychosocial function. Such behaviors, formed by one’s spirituality or otherwise, and their consequences fall clearly within the scope of what defines disordered behavior.

I’m honestly not sure of the best way to then rectify these behaviors and perceptions when they go awry and harm clients. We talked about this predicament in classes in my graduate work, primarily in my diagnosis and multicultural classes. The best answer we seem to have come up with in terms of a strategy for approaching it in our field is the less-than-satisfying, “it depends.”

But lacking much official guidance, my own approach has been to follow the same path by which the problematic thinking entered the client’s schema, and challenge it from within; Trojan horse style. Build trust. Use their lingo. Summarize and draw attention to evidence of impairment. Then challenge, slowly and carefully. I am careful to pick my battles wisely, choosing problems for intervention which are largely external, and may subtly encourage reflection.

It’s not been easy, particularly with one of my clients, whose Biblical knowledge is more expansive than mine. But I’ve had some results, mainly in building trust with them; validating, acknowledging, and occasionally pushing back ever-so-slightly using their own lingo and arguments.

The adventure as I’ve found has been walking closely to that barely-perceptible line of too-far and not-far-enough, recovering with the client when my challenge hits an unexpected wall, and maintaining the all-important trust. I don’t have a perfect formula, but I find the work at once exhilarating and exhausting. I’m going to continue to explore it, and will post updates, (though perhaps vague and cryptic) as I find success and failure along the way.