Religious Coping Styles and Recovery from Serious Mental Illnesses

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Despite the relative lack of empirical research on the role of spirituality in the lives of severely mentally ill individuals, personal accounts and qualitative studies have demonstrated the importance of religion in recovery from mental illnesses. Research on religious coping has shown faith to be a method individuals rely on to gain control in their lives. This study examined relations among religious coping styles, empowerment, level of adaptive functioning, and recovery activities. Findings indicated that the Collaborative approach to religious coping was related to greater involvement in recovery-enhancing activities and increased empowerment while the Deferring coping strategy was associated with improved quality of life. However, the Self-directing and Plead styles were linked with less positive psychosocial outcomes. This study provided preliminary support to the notion that reliance on religious faith and coping can be associated with active involvement in recovery and positive psychological adjustment among severely mentally ill individuals. Implications of these results and suggestions for future research were discussed.

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The idea that recovery from serious mental illnesses is a viable prospect has been promoted within the mental health field in the last decade contrasting sharply with the traditional view that they are chronic and intractable. The emergence of narratives written by individuals with severe mental illnesses describing their experiences of recovery and empirical research demonstrating the reality of positive outcomes in this population converged in the 1980s and gave birth to the recovery vision (Anthony, 2000). Anthony (1993) has defined recovery as a process of transformation, adaptation, and self-discovery involving changes in attitudes, values, and goals towards oneself and one's illness. Recovery does not refer to an end product, a linear process, or an absence of pain or setbacks. Relatedly, Deegan (1988) viewed recovery as the lived experience of individuals as they accept and overcome the challenge of their illness.

An integral part of recovery is empowerment, which involves consumers of mental health services taking responsibility and control over all aspects of their lives, including the treatment for their disorders (Corrigan, Faber, Rashid, & Leary, 1999). Traditionally, the mental health system has encouraged dependency and has restricted opportunities for choice and self-determination by regarding people who have mental illnesses as "passive recipients of treatment rather than as active agents in the recovery process" (Heinssen, Levendusky, & Hunter, 1995, p. 522). In contrast, Heinssen et al. (1995) have demonstrated that interventions are more effective when their recipients perceive choice, have a personal investment in the recovery process, and are treated as collaborators by mental health professionals. Additionally, activities, places, and people not related to the mental health system, such as lay social support networks, sports, clubs, and religious institutions, have been shown to be essential to many individuals' recovery (Anthony, 1993; Corrigan et al., 1999; Murnen & Smolak, 1994). Indeed, research has demonstrated that spiritual and religious involvement plays an important role in promoting and supporting recovery efforts (i.e., Fitchett, Burton, & Sivan, 1997; Koenig, Larson, & Weaver, 1998; Lindgren & Coursey, 1995; O'Rourke, 1997; Sullivan, 1999; Young & Ensing, 1999).

Even more neglected has been the study of the effects of religious beliefs and practices on the functioning of people who have serious mental illnesses (Crossley, 1995; Koenig, Larson, & Weaver, 1998). On the other hand, most personal accounts of recovery highlight spirituality. Religion and spirituality are seen as offering great help by providing coping and problem-solving strategies, a source of social support, and a sense of meaning in the midst of tragedy and confusion (Sullivan, 1999). Unfortunately, most of the current work on this matter is qualitative in nature and limited in scope.

The intersection of religion and coping has recently been identified as a rich area for scientific investigation (Pargament, 1997). One's method of religious coping has been found to relate to a number of psychosocial outcomes, such as the degree of adjustment to negative events and psychological resourcefulness. Pargament et al. (1988) identified three major approaches to religious coping with adversity: self-directing, deferring, and collaborative. The collaborative style reflects the joint responsibility for problem solving by God and the individual, while the deferring style implies placing all responsibility for problem solving on God while passively waiting to receive solutions. The self-directing approach emphasizes the individual's personal responsibility and active role in problem solving and excludes God from the process (Hathaway & Pargament, 1990).

Both self-directing and collaborative problem-solving styles have been linked to greater general psychological competence, while the deferring religious coping method has been related to lower levels of psychological resourcefulness (Hathaway & Pargament, 1990). However, in several studies the self-directing approach has also been associated with negative outcomes, such as anxiety and depression (Bickel et al., 1998; Schaefer & Gorsuch, 1991). Specifically, Bickel et al. (1998) found an increase in depressive affect under conditions of high stress with the reported use of the self-directing religious coping style. The use of the collaborative coping style, on the other hand, produced a decrease in depression under the same conditions.

Although generally not an effective problem-solving method, the deferring coping style has been found helpful in those situations where the individual has very little control over the stressful circumstances (Pargament, 1997). In these uncontrollable situations, delegating responsibility to what many view as a mighty and loving Being can be quite empowering, whereas assuming all responsibility for problem-solving may lead to great distress. Thus, a consistent pattern of positive outcomes emerges only for the collaborative coping style, while the other two styles yield mixed outcomes (Pargament, 1997). When applied to the recovery context, significant aspects of severe mental illness lend themselves to little control on the part of the person coping with it. Examples of this may include the presence of cognitive impairments, medication side effects, poverty, and discrimination.

Pargament and his colleagues (Pargament et al., 1990) also postulated the existence of an additional religious coping style, termed Plead, in which the individual petitions for God's miraculous intervention to bring about personally desirable outcomes, both refusing to accept the status quo and wishing for the world to change through God. In several studies, the use of pleading and bargaining for a miracle has been linked to greater distress and is generally considered a maladaptive religious style of coping (Pargament, Koenig, & Perez, 2000; Park & Cohen, 1993; Thompson & Vardaman, 1997).

Goals and Hypotheses

The major purpose of this project was to ascertain empirically the role of religion and religious coping in the process of recovery from serious mental illness. A more specific goal of this study was to increase our understanding of which religious methods of coping, if any, facilitate the recovery process most effectively. It was assumed that if certain approaches to religious problem-solving are indeed more efficacious in promoting individuals' psychosocial functioning, sense of empowerment, and recovery, mental health professionals and clergy working with these individuals would be in a better position to encourage the development and reliance upon these particular coping styles. …