Healing Of The Soul: The Role Of Spirituality
 In Recovery From Mental Illness
 
Green, Joanne E.
Research Officer
St. Luke’s Anglicare and Department of Human Services
j.green@stlukes.org.au
 
Gardner, Fiona M.
 Senior Lecturer
Centre for Professional Development
 Latrobe University
PO Box 199, Bendigo
Victoria, Australia, 3552
Email:  f.gardner@latrobe.edu.au
 
Kippen, Sandra, A
Senior Lecturer
Public Health
Latrobe University
Email: s.kippen@latrobe.edu.au




Citation:
Green JE, Gardner FM & Sandra SA(2009). Healing Of The Soul: The Role Of Spirituality In Recovery From
 Mental Illness. International Journal of Psychosocial Rehabilitation. Vol 13(2).   65-75

 

Our recovery is marked by an ever-deepening acceptance of our limitations. But 

          now, rather than being an occasion for despair, we find that our personal
          limitations are the ground from which spring our unique possibilities.  This is the
          paradox of recovery, i.e. that in accepting what we cannot do or be we begin to
          discover who we can be and what we can do.
 

Researchers are taking great strides towards understanding recovery, but there still remains the need to further investigate and define this concept (Yanos, Primavera et al. 2001).   Gene Deegan (2003), for example, more specifically talks about recovery as a unique and complex path with recurring themes such as reclaiming hope and a positive self identity, not labeling oneself, managing symptoms, having good support systems and finding meaning and purpose in life. 

Although post–war studies influenced the mental health movement by generating interest in community care, it was the social and political ‘revolution’ of the 1960s that brought about a shift from treatment in large, bureaucratic, and hierarchical institutions, to community care programs.  The change was due in part to the use of psychotherapy, but more to the advent of greatly improved anti-psychotic medication.  During this period, the notion of anti-psychiatry emerged which, according to Goffman (1961), questioned the existence of institutions as a place and means of treatment for the mentally ill and instead looked in depth at the actual experience of psychosis. Szasz (1987) challenged mental illness as not a verifiable disease but simply legal fiction, a euphemism for problems in day-to-day living.  It was argued that institutionalisation, aside from the high cost involved, also exacerbated such negative symptoms as social withdrawal, poverty of speech and underactivity as well as loss of dignity, self-esteem and self-confidence (Watkins 1996).   The antipsychiatrists were sympathetic to the patient’s suffering and believed that psychosis, if left to evolve, could heal and transform the individual into an enlightened soul.  This belief had its limitations, however, and for many suffering mental illness, medication was the only relief from distressing symptoms and recovery, by any definition, was not seen as part of their future.

Mental Illness and Scientific Understanding
The Medieval Christian Church, which promoted a fearful and dogmatic belief in the power of God and the wrath towards those who sin, became less influential in the era of the domination of intellectual thought.  New theories based on reason and the material world became the predominant perspective for most philosophers. The Age of Enlightenment, during the eighteenth century, saw the rise of empiricism, the foundation of a new scientific and technological age (Kramnick 1995).

The central dogma of the scientific world was Naturalism. This belief, that there is no “God” or supernatural causes, enabled scientists to explain the happenings of the Universe as natural. With this theory there was no room for mystical or religious explanations of any kind.  Fundamentally it was believed that everything had a natural cause, nothing was left to chance. Furthermore, everything could be reduced to smaller parts and man and the universe worked like a machine.  Descartes believed, for example, that the body was separate from the mind, which was the seat of the soul (Hart 1985).   Matter was the only reality and whatever existed was physical.  Knowledge was limited to observable evidence and only sense experience could be regarded as the truth. Scientists were therefore regarded as objective observers who could verify facts and thus understand reality.  Although empiricism can lead to an explanation of the universe, it leaves no room for spiritual experiences that are often invisible and private and therefore cannot be empirically observed or replicated. 

The influence of these scientific beliefs on medicine has generally remained steadfast over the last hundred years with the biomedical model dominating the health care system.  Within the field of psychiatry, the medical model encourages the belief that a physiological problem, that is, a chemical imbalance in the brain, can explain why mental illness occurs.  As a result, mental illness can be diagnosed according to certain symptoms and the appropriate medication prescribed (Turner, 1987: 214). 

Both Western and Eastern world religions oppose the reductionist belief systems of the scientific world. These religions not only believe that there is a Supreme Being or Beings, but they also hold that we require this spiritual belief for our optimum fulfillment as human beings.  Some writers would now talk about spirituality more broadly. Dudley (2006:60) says “Spirituality, recognized as central to mental health from ancient times, has remained so in many non-Western and indigenous traditions, while this knowledge has been substantially lost in the West in recent centuries. Modern Western psychiatry is a secular discipline that applies scientific methodologies to clinical questions”.  Whilst relatively few psychologists or psychiatrists have integrated a spiritual perspective into their work,  Rumbold  (2002) suggests that “Spirituality is an emerging theme in the professional and academic literatures of business, education, and healthcare, as well as in the curricula of training institutions”.  

Certainly, there has been a continuing increase in interest in the place of spirituality in many professions including education (Fisher, 2007), nursing (Johns, 2005), pastoral care  (Lartey, 2003)  and social work  (Gale et al, 2006).  Speck  (2005) points out that one of the complexities of working in this are it the many definitions of spirituality used.  Tacey,  (2003:38)  talks about spirituality as the new umbrella term which "refers to our relationship with the sacredness of life, nature and the universe, and this relationship is no longer felt to be confined to formal devotional practice or to institutional places of workshop”.  He sees religion as part of this broad spiritual umbrella: some people continue to participate in religious traditions using particular symbols and rituals that are meaningful for them.   For others, Swinton (2001:20),  says  "Spirituality is the outward expression of the inner workings of the human spirit......intrapersonal in that it refers to the quest for inner connectivity...interpersonal in that it refers to the relationships between people and within communities...transpersonal in so far as it reaches beyond self and others into the transcendent realms of experience".   Spirituality in this sense might be expressed through meditation or prayer, as part of a religious tradition, but equally through valuing the spiritual in daily life through experiencing nature or music, for example.  Bouma (2005:xiv) suggests that what has changed is "the religious and spiritual have moved out from the control of both the state and such formal organisations as the church. No longer strictly controlled, the forms taken by the religious and spiritual become increasingly varied."

The aim of this paper is to discuss the role of spirituality in the process of recovery from mental illness from the perspective of consumers who have suffered and recovered from mental illness.  A broad understanding of spirituality was used which allowed the participants to define spirituality for themselves.   It demonstrates that recovery from mental illness often incorporates a strong spiritual component and argues that mental health workers who ignore this are working within a limited framework that discourages an holistic approach to management of mental illness.   It also demonstrates that what spirituality is will vary considerably for each individual: for some including connection to a religious tradition for others a variety of expressions of the human spirit.

 Methodology
The study was based on a qualitative phenomenological research design.    Through the exploration of human feelings, attitudes and experiences, as described by a small number of participants, this study was an investigative journey that reached into the personal realm of mental illness and discovered a deeper understanding of holistic well being and overall recovery.

The Participants
Six participants, (three men and three women), were selected for their extensive experience with mental illness and their recovery process.  They were contacted through their case managers, who made the details of the project available to appropriate clients, who could then notify the case manager if they wished to participate.  Three suffered from bi-polar disorder, one from schizophrenia, one from atypical psychosis and one from a varying number of different diagnoses. Each participant had been involved with psychiatric services over a period of a decade or longer. All six participants had, with varying degrees of success, traversed the hazardous highs and lows of mental illness on their very personal journey of recovery.

 Their ages ranged from 31 to 58 years and they resided in a large regional area in Australia.  It should be noted that three participants relapsed during the duration of the study and were hospitalized for short lengths of time.  Due to this, participants did not complete the third and final round of interviews until they felt emotionally stable and able to cope with requirements of the study.  Each was asked whether they wanted to continue with the interviews and all were positive.  The relapse was not an unusual situation given the unpredictable nature of mental illness.  The participants agreed, however, that although they suffered some setback, their overall recovery was still positive and they were moving forward with their lives.

Data Collection
The use of semi-structured, in-depth interviews enabled the collection of rich, perceptive and sensitive data. Each participant was interviewed three times, each interview focusing on a different aspect of recovery and culminating in a subjective description of their personal understanding of achieving recovery from mental illness.  Having three interviews allowed the participants time to reflect on previous interviews and to deepen and extend their responses if they so wished.  The interviews were conducted in the participant’s own home, in the interviewer’s home or in a private office at the university and lasted for one to two hours.

Data Analysis
 Interviews were transcribed verbatim and analysed according to the procedural steps described by Colaizzi (1978).  Data analysis began with the scrutiny of the descriptions contained in the transcribed data.  Significant statements, relevant to the phenomenon, were extracted from the main body of the data.  This gathering of statements was the first requirement of the analysis procedure described by Colaizzi. These were then grouped into aggregate areas of meaning and highlighted as such.  Each meaning was further reflected upon and a group of themes emerged. An exhaustive description of the investigated topic was extracted from the results so far, and the fundamental structure of recovery was articulated.  Once this analysis was complete, the six interviewees were presented with the themes for further discussion and any new information was worked into the final product of the research. A concept map assisted in visualizing and developing the themes that resulted from the research.  By working on an intuitive level and continually checking, the data was pulled apart and scrutinized to find the meaning behind the facts.  This interrogation of the data started by generalizing the facts into meanings then by working down towards a specific theme for each group of meanings,  a definition of the phenomenon, in this case ‘recovery’, was elicited. 

Reliability, Validity and Limitations of the Research Method
Prior to the interview, a practising psychiatrist was asked to check the structure of the interviews and make recommendations that would enhance the overall process of the research. Before the third interview took place, the general themes that had emerged in prior interviews were checked with the interviewees and with research supervisors.  The final round of interviews included questions based on the findings so far and the emergent themes.  These were used to validate the previously obtained data by comparing the interviewees’ final understanding with their previously expressed perceptions.   Due to the nature of the methodology used, this research is limited in its application to the general community.  This research is qualitative rather than quantitative and therefore reliability and validity are demonstrated through the richness of the data and the processes used to increase trustworthiness.

Findings
Participants explored a number of themes, including the journey of recovery, physical and material losses and gains, relationships with family, friends and health workers and self-help strategies for recovery.  This paper reports on one of these themes – the reflection of the participants on the role of spirituality in their recovery process.

Personal concepts of spirituality
All participants reported a degree of faith and a belief in a higher or Supreme Being, most often recognised as God.  Each discussed their own personal concept of spirituality and described God as all loving, powerful, forgiving and compassionate.  Participants ranged in their belief from practising and non-practising Christianity to a non-religious but personal spirituality.  In all cases this spirituality was perceived as a positive aspect of their current life, even though spiritual experiences related to their religious upbringing were, for the most part, negative. Some even held that prior religious experiences were at least partly responsible for their mental illness.  These views were in clear contrast with their current understanding of, and affinity with, their spirituality. Every participant agreed that they had developed a self-affirming, significant personal belief in spirituality that provided hope and a positive outcome from their suffering.  Some attributed their recovery to heightened spiritual awareness: 

In the second psychosis I actually gained through the help of my father…and his beliefs, I actually gained a sort of private spiritual belief of my own. 

It’s very strong [spiritual awareness]….I guess I could even say that without that I probably would still be quite unwell.

Relationship to religious experience

Several participants had had previous negative experience of religion, particularly in relation to making judgements about what behaviour was seen as immoral or leading to ‘guilt and sin’.  Two felt their religion had played a part in their illness. 

However, unlike their earlier experiences with religion, participants regarded their spiritual beliefs as now being free from guilt, shame, sin, judgment, and the church:

 I sort of gained this belief of a higher being as being God, even if it was a sort of a light in the sky as appeared, but someone up there…space, cosmos….sort of looking out for us and who loved us as his children but there wasn’t a guilt thing and it wasn’t a church thing, it was just a belief of a higher being.

Closely linked with the idea of spirituality was the notion of the soul and its relationship with mental illness.  Some described the soul as an earthly connection; the body being the tool through which soul and spirit were connected.  One participant  explained:

 … your body’s an earthly sort of a tool and that’s your earthly connection to the soul… your body’s your connection to the earth as an animal or a human being or a natural phenomenon…the body and soul are fairly integrated into the one being and so rather than being sort of separate, especially on earth anyway. 

Another described it similarly: 

I think the soul is more of your carnal nature, like your earthly sort of nature.

Other participants talked about the soul as being a measure of goodness, the very being or inner self and the emotional connection to the spiritual side of life:

 It’s something within…something that can be if the person wants to be conscious of it, develop it and do good with it. 

In relation to mental illness, participants saw the soul as being damaged by the emotional turmoil that accompanies psychosis.  They felt that the soul is closely linked with spirit, mind and body and those who experience its pain when damaged understand it to be the very essence of being. However, participants also described mental illness as a learning process from which they emerge a better person.  They had attained a ‘good’ soul through psychological and spiritual healing and, as a result, had developed a strengthened understanding of themselves and others. 

 Spirituality and developing sense of recovery
After having experienced the acute stages of their illness, participants often began the journey of recovery with renewed hope and determination for a brighter future.  During this period, they discovered new levels of compassion, understanding and empathy and were able to use it to benefit others who suffered similarly.  Participants talked about their true personality or self as emerging from the ruins of their mental illness; however, as one participant put it, “it came at a price”:

I have grown as a person…I am a more compassionate person, a more understanding person…but without sounding too bitter and twisted…my God it came at a price…it’s gonna be hanging over me until the day I die.

Perhaps the real transformation and healing of the soul occurs with the belief that life ultimately turns out for the better and hope and happiness are achievable regardless of the past.  This was expressed by one participant who said:

My character now gives hope to others, hope for them to start to create a vision and purpose and a quality of life…sometimes I pinch myself and think how come I’m so happy? … I’m grateful…everyday I thank God that I’m alive.

Perhaps the most positive aspect of spiritual awareness was that, during the dark hours of mental illness, for those participants with  belief in a higher power,  felt given the necessary hope that they could come through the suffering and achieve recovery:

It has helped me through just having that spiritual belief in God, mainly like God as a really loving, caring father, that’s helped me get through some of my episodes of mania particularly or depression.

I find that at my lowest points during an illness…I still have that sense that there’s some higher power that’s going to get me through it and I still bring that a bit into recovery.

For these participants, the hope that a better quality of life exists and that people suffering mental illness can achieve this, seems linked with a positive belief system and an ever increasing spiritual awareness.

What supported spirituality

Various creative and recreational strategies provided spiritual components that participants identified as being important to recovery.  For some, this was being in touch with nature:

I think it’s being in touch (with nature), I mean there’s never a day goes by without I’m sort of struck by the beauty of the land and that sort of feeling and oneness.

Quiet time when I’m walking by myself…the nature thing, that’s why I like living here, the nature thing helps.One participant found singing at church to be uplifting and peaceful:

Well now I attend church and I find I am singing at the church now and finding the words in those songs are quite uplifting, so when I’m practising I find that that sort of gives me that bit of peace.

An important practical aspect of every participant’s faith was the act of prayer or meditation which was used to express gratitude and  to make supplication on behalf of self or others.  One participant described use of praying and the scriptures to help relieve them of symptoms and prevent the return to old habits:  I don’t have that restlessness anymore, it gives me a peace.

Discussion
For most participants in this study, the experience of religion in their upbringing had been, overall, a negative one.  The pain, guilt and oppression caused by some organized religions can actually deepen and complicate the need for recovery (Fallot, 1998).  Instead of providing spiritual growth and expression, they can simply be repressive and limiting in their understanding and outlook on life (Fry, 1998; O’Reilly 2004). For some participants their experience led to a preoccupation or obsession with their beliefs that they felt may have ultimately caused delusional thoughts and irrational behavior (Sullivan, 1998).  There is some debate in the literature surrounding the possibility that some individuals may suffer a form of spiritual distress rather than the mental illness with which they are diagnosed.   The person may question their religious faith, resulting in spiritual pain, alienation, anxiety, guilt, anger, loss and despair.  Spiritual crisis may be similar to an existential crisis where the belief and value system of an individual are questioned (Thompson, 2002).

Although participants had experienced the pain, guilt and shame of dogmatic religious belief, they also came to understand a newfound positive spiritual awareness that transcended the negative impact of mental illness. “It is not necessary to hold formal religious beliefs or engage in religious practices, or belong ot an established faith tradition to experience the spiritual dimension (Culliford and Powell, 2005:1).  Spirituality was, to the participants, a source of hope, inspiration, love, joy, courage, comfort and guiding values or a moral code by which to live a complete and meaningful life; it also allowed them to ascribe meaning to their experience of mental illness.   Galanter (1997) defines spirituality as a search for existential or transcendent meaning. Participants  believed that the occurrence of a mental illness has a reason and poses a lesson in life, allows belief in a higher being and influences the way in which recovery is approached.The concept of soul was important to participants although they suggested it is difficult, yet important, to understand a definition of soul, particularly in practical terms.  It can be explained as that which evokes thought, memory, emotion, desire and action or simply self- consciousness or personal identity.    Participants felt that the soul was related to personal qualities such as compassion, understanding and insight, and that life experience such as mental illness, was a learning process from which one emerged a better person. The soul may be damaged when feelings are disregarded and important truths ignored, leaving a trail of pathological problems that are eventually vented through the symptoms of mental illness (Tacey, 2006). A soulful person is perhaps in touch with their feelings in a genuine day-to-day reality (Moore, 1992).  Thus healing of the soul is directly related to recovery and ongoing mental health.

The process of healing the soul eventually occurred when participants took responsibility for their illness and began to understand the depth and reasons for their despair. “Some view it as a journey forward; the emerging self is being both discovered and created along the way, incorporating many struggles as well as achievements in its composition” (Fallot, 1998: 41).

It is suggested by some authors that life with all its hardships, is simply a means of developing the soul, and that through these experiences we grow mentally and emotionally. Barnum (1996: 66) talks about individual life on earth:

“It is certainly interesting to contemplate whether, if all its traumas and tragedies were removed, earth would be an easier, but less efficient, learning environment for soul growth”.

Participants in this study agreed that through the experience of mental illness they were transformed into more compassionate, caring and soulful beings. On the one hand mental illness can be disruptive, damaging and disabling, whilst on the other it can be purposeful, non-judgmental and mindful.  Mental illness can teach people to live in the present, accept life’s challenges with dignity and maturity, and grow through hardship.  Participants agreed that it teaches people not to take their mental health, happiness or life for granted.  Above all it teaches individuals that life is all about how you think, feel and react to stressful situations and that with regular positive affirmations and an optimistic yet realistic outlook on life, circumstances can improve and life be worth living.

 
In the opinion of the participants, spirituality had a direct influence and positive impact on recovery from mental illness, giving them a sense of peace, fulfillment, value and particularly hope  similar to that described by Thompson (2002).  They suggested that therapeutic relationships between the patient and mental health practitioner can aid recovery or healing of the soul through a spiritual connection. 

               The attributes of spiritual relationships nourish the core of one’s being, which is

                the inner self or soul.  Spiritual relationships can be a source of love and foster

                the characteristics of inner strength, peace, a sense of meaning and purpose,

                self- reflection and interconnectedness (Fry, 1997: 30).

Where mental health workers do provide spiritual care, it was the quality of interpersonal care such as the expression of love and compassion towards patients that mattered most  (Greasley et al 2001). For example, the Israeli Psychiatric Nursing Program which is based on relapse, recovery and rehabilitation includes addressing the patient’s environmental factors, spiritual attitudes and behaviours and interpersonal relationships (Roe et al, 2004).  However, this aspect of recovery is rarely addressed by mental health workers.  In fact, the limits imposed on health care through the materialistic, mechanistic viewpoints of Western medicine and culture, have resulted in an increasing number of people turning their interest towards Eastern medicine and mysticism to gain a deeper understanding of life and an holistic belief in the interconnectedness of the mind, body and spirit (Miller, 1990).   Ideally, participants suggested they would be able to explore these issues with their workers.

 

Conclusion
Spirituality was described by participants in the reported study as providing strength through adversity, a moral code by which to live, and the desire to fill unhealthy voids with positive self- love and a new personal concept.  Personal faith also provided hope for the future and strength to get through the day.  It helped resolve fear and anger and promoted forgiveness.  From the results of this study, it may be inferred that participants consider a personal concept of spirituality is indeed important to recovery: gaining and maintaining mental health and a more positive lifestyle. The message for workers in the mental health system is that a failure to acknowledge spiritual issues in assisting clients to manage their mental illness may impact negatively on the clients’ recovery.

Australian Bureau of Statistics (2001). The National Mental Health Survey: Mental Health.

Australian Health Ministers (2003). National Mental Health Plan 2003-2008. Canberra, Australian Government.

Bouma, G. (2006) Australian Soul   Port Melbourne, Cambridge University Press

Bowden, J. (1998). "Recovery From Alcoholism: A Spiritual Journey." Issues in Mental Health Nursing 19: 337-352.

Chan, C., Ho, P.  et al. (2001). "A Body-Mind-Spirit Model in Health: An Eastern Approach." Social Work in Health Care 34 (3-4): 261-282.

Colaizzi (1973)  Reflection and Research in Psychology Dubuque, Kendall Hunt.

Colaizzi (1978). Psychology Research As The Phenomenologist Views It Existential -Phenomenological Alternatives For Psychology. New York, Oxford University Press.

Culliford, L. and Powell, A. (2005)  Mental Health Information: Spirituality and Mental Health Royal College of Psychiatrists, London.

Cutcliffe, J., Black, C. et al. (2001). "The Commonality and Synchronicity of Mental Health Nurses and Palliative Care Nurses: Closer than You Think ? Part One." Journal of Psychiatric and Mental Health Nursing 8: 53-59.

Deegan, G. (2003)  Discovering Recovery Psychiatric Rehabilitation Journal  26 (4) 368 - 378

Deegan, P. (1996). "Recovery as a Journey of the Heart." Psychiatric Rehabilitation Journal 19(3): 92-96.

Dudley, Michael  Mental Health and Young People in Gale, F, Bolzan, N. and McRae- McMahon  Spirited Practices  Spirituality and the Helping Professions Melbourne, Allen & Unwin

Fallot, R. (1998). "Spiritual and Religious Dimensions of Mental Illness Recovery Narratives." New  Directions For Mental Health Services 80: 35-44.

Fanker, S. (1996). "Biological psychiatry and mental health nursing." Australian and New Zealand Journal of Mental Health Nursing 5: 180-190.

Fisher, J. W. (2007) It's time to wake up and stem the decline in spiritual well-being in Victorian schools. International Journal of Children's Spirituality,  12 (2), 165-177

Frese III, F. J. (1998). "Advocacy, Recovery, and the Challenges of Consumerism For Schizophrenia." The Psychiatric Clinics of North America 21(1): 233-249.

Fry (1998). "Spirituality, Communication and Mental Health Nursing; The Tacit Interdiction." Australian and New Zealand Jounal of Mental Health Nursing 7: 25-32.

Gale, F., Bolzan, N. and McRae-McMahon (eds) (2007)  Spirited Practices Spirituality and the Helping Professions  Melbourne, Allen & Unwin

Goffman, E. (1961). Asylums. Harmondsworth, Middlesex, Penguin Books Ltd.

Gordon, J. (1990). "Holistic Medicine and Mental Health Practice: Toward a New Synthesis." American Journal of Orthospsychiatry 60(3): 357-364.

Greasley, P., Chiu, L.  et al. (2001). "The Concept of Spiritual Care in Mental Health Nursing." Journal of Advanced Nursing 33(5): 629-637.

Grof, S. (1988). The Adventure of Self- Discovery. Albany, State University of New York Press.

Hart, M. (1985). The Sociology of Health and Medicine. Ormskirk, Lancashire, Causeway Press Limited.

Hatfield, A. and Lefley, H.  (1993). Surviving Mental Illness. New York, The Guilford Press.

Hilton, C., Ghaznavi, F. et al. (2002). "Religious Beliefs and Practices in Acute Mental Health Patients." Nursing Standard 16(38): 33-36.

Jacobson, N. and Greenley, D.  (2001). "What Is Recovery? A Conceptual Model and Explication." Psychiatric Services 52(4): 482-485.

Johns, C. (2005) Balancing the winds. Reflective Practice, 6, 67 - 84.

Kidd, L. and Tusaie, K.  (2004). "Disconfirming Beliefs: The Use of Poetry to Know the Lived Experience of Student Nurses in Mental health Clinicals." Issues in Mental Health Nursing 25(4): 403-414.

Kramnick (1995). The Portable Enlightenment Reader. New York, Penguin Books.

Krebs, W. and Wilkes, G.  (1989). Collins Australian Pocket Dictionary of the English Language. Sydney, Harper Collins.

Kunz, D. (1995). Spiritual Healing. Wheaton, Theosophical Publishing House.

La Torre, M. (2000). "A  holistic view of psychotherapy: connecting mind, body and spirit." Perspectives 36(2): 67-68.

La Torre, M. (2001). "Therapeutic Approaches to Anxiety - A Holistic View." Perspectives in Psychiatric Care 37(1): 28-30.

La Torre, M. (2002). "Spirituality and Psychotherapy: An Important Combination." Perspectives in Psychiatric Care 38(3): 108-110.

Laing (1973). Laing and Anti-Psychiatry. Harmondsworth, Penguin Books.

Lartey, E. (2003) In Living Color An Intercultural Approach to Pastoral Care and Counseling    London, Philadelphia, Jessica Kingsley Publishers

Lefley, H. (1997). "The Consumer Recovery Vision: Will it Alleviate Family Burden?" American Journal of Orthopsychiatry 67(2): 210-219.

Lewis, L. (1993). continuity of care within the system of service delivery for people with. Department of Psychiatry. Melbourne, University of Melbourne.

Miller, J. (1990). "Mental Illness and Spiritual Crisis: Implications for Psychiatric Rehabilitation." Psychosocial Rehabilitation Journal 14(2): 29-47.

Moore, T. (1992). Care of the Soul. New York, Harper-Collins.

O'Reilly (2004). "Spirituality and Mental Health Clients." Journal of Psychosocial Nursing 42(7): 44-53.

Oldnall, A. (1995). "On the Absence of Spirituality in Nursing Theories and Models." Journal of Advanced Nursing 21(3): 417-418.

Pejlert, A., Asplund, K. et al. (1999). "Towards recovery: living in a home like setting after the move from a hospital ward." Journal of Clinical Nursing 8: 663-674.

Pettie, D. and Triolo, A.  (1999). "Illness as Evolution: The Search for Identity and Meaning In the Recovery Process." Psychiatric Rehabilitation Journal 223(3): 255-262.

Porter, R. (2002). Blood and Guts. London, Penguin Books.

Puckett, A. (1993). Community Mental Health. Marrickville, Harcourt Brace and Company.

Richards, P. and Bergin, A.  (1997). A Spiritual Strategy For Counseling and Psychotherapy. Washington, American Psychological Association.

Roe, D., Chopra, M., Wagner, B., Katz, G. and Rudnick, A. (2004)  The emerging self in conceptualizing and treating mental illness  Journal of Psychosocial Nursing 42 (2) 33 – 40

Rumbold, B. (Ed.) (2002) Spirituality and Palliative Care, Melbourne, Oxford University Press.

Scheff (1984). Being Mentally Ill: A Sociological Theory. New York, Aldine Publishing Company.

Spaniol, L., Koehler, M. et al. (1994). The Recovery Workbook. Boston, Center for Psychiatric Rehabilitation, Boston University.

Speck, B. (2005)  What is  Spirituality? New Directions in Teaching and Learning, Winter,  Wiley

Strong, S. (1997). "Meaningful Work in Supportive Environments: Experiences With the Recovery Process." The American Journal of Occupational Therapy 52(1): 31-38.

Swinton,  J.    (2001) Spirituality and Mental Health Care   London, Jessica Kingsley Publishers

Symmes, C. (1989). "An existential demonstration." Psychosocial Rehabilitation Journal 13(2): 9-17.

Szasz, T. (1987). Insanity: The idea and its consequenes. New York, Wiley.

Tacey, D. (2003)  The Spirituality Revolution  Sydney, Harper Collins

Tacey, D. (2006)  How to Read Jung London, Granta Publications

Thompson, I. (2002). "Mental Health and Spiritual Care." Nursing Standard 17(9): 33-38.

Turner, B. (1987). Medical Power and Social Knowledge. London, Sage Publications.

Valle, R. and Halling, S.  (1989). Existential Phenomenological Perspectives In Psychology. New York, Plenum Press.

Valle, R. and King, M. (1978). Existential Phenomenological Alternatives For Psychology. New York, Oxford University Press.

Van Manen, M. (1984). "Practicing Phenomenological Writing." Phenomenology and Pedagogy 2(1): 36-72.

Watkins, J. (1996). Living With Schizophrenia. Melbourne, Hill of Content Publishing Company.

Yanos, P. T., Primavera, L.H.  et al. (2001). "Consumer-Run Service Participation, Recovery of Social Functioning, and the Mediating Role of Psychological Factors." Psychiatric Services 52(4): 493-500.

Young, S. and Ensing, D.  (1999). "Exploring Recovery From the Perspective of People With Psychiatric Disabilities." Psychiatric Rehabilitation Journal 22(3): 219-231.