IPA produced two superordinate themes. The first of these themes ‘Finding Certainty Amidst Confusion’ primarily relates to the first research question as it incorporates participants’ understandings of the relationship between faith and illness. The second superordinate theme ‘Struggle for Acceptance and Personhood’ relates more closely to the second research question, incorporating participants’ experiences of mental health treatment.
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2.5.1.2 Superordinate Theme 1: Finding Certainty Amidst Confusion
The first superordinate theme encapsulates a central conflict for participants between the profound confusion caused by psychosis and their attempts to re- establish a sense of stability and certainty. Participants experienced the onset of illness as deeply disruptive, often threatening their understanding of themselves and of reality, an experience Sullivan (2009) terms ‘existential anxiety’. This search to find certainty amidst confusion closely resembles the search for “meaning in ‘madness’” which was the central process identified by Macmin and Foskett’s grounded theory analysis of participants’ experiences (2004, p. 33).
This study found that for Christians with psychosis the confusion caused by psychotic illness had an additional layer of complexity caused by the blurring of faith experiences into experiences of psychosis. This appeared particularly problematic for participants who had experienced religious delusions, potentially having a significant long-term detrimental impact on both faith and illness. Similar experiences were reported in Drinnan and Lavender’s study (2006), in which most participants with religious delusions experienced uncertainty as to whether experiences were spiritual in nature.
Although faith contributed to the confusion experienced by Christians with psychosis, this study found that it was also a very important resource for
participants in coping with mental illness. Participants variously described their faith as providing certainty, stability, reassurance and a positive identity, enabling
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them to cope with the ravages of psychotic episodes and periods of hospitalisation. This mirrors the findings of previous studies of the experience of service users with spiritual beliefs (Drinnan & Lavender, 2006; Macmin & Foskett, 2004; Smith & Suto, 2012).
2.5.1.3 Superordinate Theme 2: Struggle for Acceptance and Personhood
The second superordinate theme identifies another central conflict for participants: the struggle to find acceptance and personhood when interactions with others often result in feeling devalued and isolated. This struggle can be seen as mirroring the intrapersonal conflict between confusion and certainty in interpersonal
interactions. Devaluing interactions with others contribute to a sense of confusion whereas finding acceptance and personhood are additional ways of re-establishing a sense of certainty.
2.5.1.3.1 Double Bind of Isolation
Participants’ accounts suggest that when they found acceptance at church or with mental health professionals, this could have a transformative effect on both their wellbeing and their faith. Yet more often this group of participants struggled to find acceptance from others. The experiences participants reported suggest that
Christians with psychosis may often experience a double-bind of alienation in which their psychotic illness is experienced as unacceptable at church and their faith is
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experienced as unacceptable in mental health services. This double bind was also apparent in the experiences of the predominantly Christian sample in Macmin and Foskett’s study (2004) and had a similar effect, causing alienation and threatening their sense of humanity. Taken together with Macmin and Foskett’s findings the present study suggests that Christians with mental health problems are a
marginalised group experiencing significant isolation. Given the stigma surrounding psychosis in society this issue may be particularly problematic for Christians with psychosis.
2.5.1.3.2 Spiritually Sensitive Care
A key finding of this study is the importance of faith being recognised and
supported within psychiatric treatment for Christians with psychosis. Participants’ narratives suggest that being able to talk about their faith was central to being treated as a person. Conversely not recognising a person’s faith was perceived as not recognising them as a whole person and frequently resulted in disengagement from services. The importance of supporting service users to talk about their spiritual needs as part of treatment was also a finding of Macmin and Foskett’s study (2004).
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Many participants described feeling that professionals pathologise spiritual experiences as psychotic and may also dismiss spirituality as irrelevant to care. Some participants described feeling that professionals dismissed their spiritual beliefs outright, causing strong feelings of disbelief, anger and personal offense. Incidents of professionals dismissing or pathologising spirituality have been
reported by participants in previous studies (Drinnan & Lavender, 2006; Macmin & Foskett, 2004; Mental Health Foundation, 2002). The present study suggests that this problem may not have improved in recent years. However some of the incidents described by participants in the present study were historical.
Previous research has suggested that frequent exposure to religious delusions and psychiatric working culture may predispose mental health professionals to
pathologise spiritual experiences (Eeles et al., 2003; Neeleman & Persaud, 1995). Yet in the present study participants more often attributed the pathologising or dismissing of their faith to professionals’ own spiritual beliefs. Such incidents suggest that for some professionals clients’ religious beliefs may stir-up strong negative counter-transferential feelings (Neeleman & Persaud, 1995), leading to lapses in professionalism as their personal feelings are expressed.
2.5.1.3.4 Response of The Church
Finally this study highlights the significance of the church’s response to psychosis and mental illness in general. When sensitive, accepting and supportive, church could play a central role in enabling participants to regain a sense of personhood
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amidst chronic and ongoing psychological distress, acting like a spiritual ‘home’. However participants reported frequently encountering a combination of stigma and attitudes they found unhelpful in church, some of which had arisen from narratives within the church. While the nature of psychotic illness might suggest that some of these perceived attitudes could have resulted from paranoia, the level of detail and consistency of the incidents participants described suggests otherwise. Moreover such narratives were recognised as contributing to harmful experiences of church in the Somerset studies (Macmin & Foskett, 2004; Mental Health
Foundation, 2002). The potential for churches and other spiritual groups to either support recovery or to cause harm has also been recognised in other studies (Drinnan & Lavender, 2006; Sullivan, 2009).
The present study identified several narratives that may contribute to stigma for Christians with mental illness. In particular the thorny issue of demon possession appears particularly problematic for Christians with psychosis. It would appear that psychotic symptoms such as auditory hallucinations may be interpreted as evidence of demonic possession by some Christians and church groups. Understandably such interpretations are deeply disturbing for the individual concerned.
2.5.2 Limitations
This study included several specific questions within the interview schedule relating to the confusion of faith and psychosis by professionals. It was considered
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conducting this study and built upon the findings of previous research (e.g. Drinnan & Lavender, 2006; Macmin & Foskett, 2004). Nevertheless, these questions may have led participants away from expressing their own opinions in their own terms (King & Horrocks, 2010; Smith & Osborn, 2008). This possibility was carefully considered during the analysis process.
The choice to recruit participants via mental health charities and service user organisations may also have influenced the findings of this study. This approach could have disproportionately recruited ‘activist service users’, whose experiences of treatment might have motivated them to become engaged in shaping services. This is suggested by the fact that several participants were involved in work within mental health.
While the majority of participants in this study had been treated for psychosis during the last year, participants typically had long histories of psychiatric
treatment, with an average of 18 years since their first inpatient admission. Thus, although many of the experiences participants reported had occurred in the past five years, others were more historic. Consequently this study provides limited evidence to determine whether spiritually-sensitive care is becoming more commonplace within the mental health system.