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Role of Spirituality in Substance Abuse and Recovery

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Introduction

Separation of drug addicts from these substances during treatment has several implications on the general wellbeing of the same. It is because addicts' dependence on the drugs is very high and in most instances, they can hardly function without the influence of drugs. However, in order to function executively, independence from drugs and alcohol is of essence. The separation process is characterized by shame, rage, fear and many other factors that undermine the total recovery of the addicts. Studies conducted show that the process of mourning is fundamental because it enhances the release of the negative feelings that inhibit recovery. Indeed, mourning according to psychoanalysts enables the addicts to let go of the destructive relationships that they have with the drugs and establish constructive and productive viable relationships with human beings. In order to achieve this, it has been identified that spirituality plays a very fundamental role.

This concept means different things to different people but essentially, it has been contended that the influence of the Supreme Being enhances change in character. At this point in time, it is worth noting that change forms the background of the recovery process. Specifically, spirituality helps in the construction and reconstruction of personal narratives in the contexts of the purpose and meaning of the addicts' life. It is in this consideration that this literature review provides an in depth analysis of the role of spirituality in substance abuse and the recovery of drug addicts. To enhance effective coherence of in the review, it is organized in subsections that exhaustively evaluate particularistic aspects of the theoretical construct of the subject under review, psychodynamic perspectives on addiction, psychodynamic perspectives on mourning, psychodynamic perspectives on rage, the concept of spirituality and its role in the recovery process, how spirituality can be employed in the construction of narratives, the application of the multiple code theory on mourning and the impact of rage and shame on the mourning process and ultimate recovery of the addicts.

 

General theory of affect

Object relations theory

Over time, the objects relations theory has gained popularity because of the fact that its application plays a fundamental role in psychoanalysis. The theory explicitly explores the active course of mind development as an individual grows and the influence of the different 'real others' that are found in that particular environment (Masterson, 1998). The term 'object' in this regard refers to the physical others as well as the others that are imagined. All these are found in a person's holistic environment and influence growth in different ways. Ogden (1990) indicates that an individual's rapports with the various objects are often initiated during the childhood interactions that an infant has with a care giver, the mother or any other individual that the infant shares a close relation with. Studies conducted in this regard show that these early interactions can be modified and improved through time due to the different experiences that an individual goes through (Grostein (1981). However, despite the modification, Klein (1962) affirms that the early interactions have a permanent effect on a person's psychological wellbeing.

The infant usually interacts with and understands different objects differently in accordance with their functions and implications in its life. These are referred to by Ogden (1990) as part or whole objects. For example, he explains that the breast that provides milk and satisfies the infant when it is hungry is perceived as the good breast by the infant. However, one that does not contain milk and is of little help to the infant when it is hungry assumes a bad breast relationship. During this time, the infant is often subjective and sensitive to the different implications of the objects in its life. Moreover, it is from these relationships that the infant starts to internalize certain objects and develops a sense of imagination. As such it can fantasize about certain objects and develop an image of the same in the mind. According to Stephen (1997), these internal objects may be a direct representation of the real external ones, or may not. The presence of an ideal aiding environment results into the ultimate transformation of the part objects in to whole. To this end, the infant can then be able to accept the ambiguity and complexity of the whole objects (Gunstrip, 1995). For example, the infant will be in position to realize that both the bad and good breasts are part of the mother.

Fairbairn's contributes to this subject and contends that the parents are the first individuals that the infant develops a relationship with because of the personal relationship that the infant shares with them (Fairbairn, 1952). The various interactions with the parents lead to the development of a special bond which further strengthens the attachment between the parents and the infant. According to Fairbairn, the future emotional experiences of the child are highly influenced by the emotional relationship that the child enjoys with the parents during infancy. To this end, he asserts that the libidinal objects that the child develops at infancy determine later relationships with others.

With regard to the relationship with the internal objects, Fairbairn asserts that effective parenting results in to the development of holistic individuals that can maintain a good relationship with real others through interactions. On the other hand, defective parenting produces children whose interactions with real individuals are relatively superficial and therefore defective. In this respect, instead of valuing actual relationships with real people, these children fantasize private relationships with the internal objects and in most instances live in their imagined world. In order to nurture socially acceptable individuals, it is important that parents provide a good environment for holistic growth during infancy.

Fairbairn (1952) also argues that in cases where the parents are missing, the infant's mind internalizes the unresponsive (bad) aspects of its parents and visualizes the aspects as forming part of it due to the fact that the aspects are not actually available. He refers to this as the splitting ego effect. For instance, in cases where the mother of the infant is stressed but renounces this state, the child identifies with this state because s/he may be unable to establish a complete relationship with the mother during this period. As a result, the infant becomes stressed, not because of any external influence, but because of the fact that it can not effectively relate with the mother and the mother has denied the condition.

In his study, Winnicott shows that a child develops from an integrated condition to a distinct status from which s/he can be able to identify and relate with the objective world (Roadman, 2003). He asserts that the early environment, possibly provided by the mother provides an important basement upon which the future of the child is anchored. However, in order to attain a satisfactory level of development that is essential for survival, Winnicot argues that the child should be able to perceive the mother as neither a good nor bad object but rather an independent and complex individual who lives an independent life. This then helps the child to understand and acknowledge the contributions of the mother in his or her life. Generally, the propositions of Winnicott presented through his exploration of the development process create a good enough mother who is characterized by patience and tolerance. Thus in order to understand the patients well during therapy, he suggests that the medical practitioners should assume the ideal qualities of good enough mother and provide the best environment for the patient t recuperate.

The drive theory

This theory is based on the conception that human beings are born with certain structural expectations. Studies show that failure to fulfill these expectations results in to a state of anxiety which is basically destructive. Ogden (2005) explains that it is because anxiety leads to tensions that have adverse effects on the emotional wellbeing of human beings. However, when the expectations are met, the drive is then reduced and the being assumes a stable condition characterized by calm and relaxation. Proponents of this theory assert that drive often increases with time (Grostein, 1981).

With regard to psychoanalysis, the theoretical construct of drives is perceived to encompass different motivations and instincts which have distinct objects. Classic examples in this regard involve the drive in the direction or life (productivity and construction) and death (destruction). To this end, it is increasingly important that the therapists understand and appreciate the drives of their patients in order to derive the best approaches that they can utilize for effective recovery. For instance, by identifying the gaps and weaknesses in the provision of the expectations, timely interventions can be undertaken to avoid adverse effects.

The Inter-subjective theory of affect

This theory presumes than in order to address problems in an effective manner, there is need for an agreement between the differing parties (Carveth, 1994). A state of inter-subjectivity according to this theory is reached when the two or more differing parties agree on the same definition of a given condition even when they have different perceptions of the conflicting issue. Furthermore, the theory shows that inter-subjectivity plays a vital role in influencing our various ideas and relationships. To this end Atwood and Stolorow (1993) indicate that inter-subjectivity promotes peaceful conditions that are fundamental for human co-existence. Of particular importance according to them is the role of language in enhancing the state of inter-subjectivity. They assert that language enhances effective communication that enables the individuals to express themselves with ease and therefore reach a consensus quickly. According to this theory it is perceived public rather than private and is instrumental in initiating social relationships.

In light of modern psycho analysis, a study conducted by Carveth (1994) affirms that in order to attain inter subjectivity and enjoy its implications, it is important to forego the isolation that characterizes certain individuals. The myth of isolation to this end indicates that some individuals virtually exist on their own, independent of the world and other individuals. As such, they become vulnerable to the different forces and challenges that life presents. This vulnerability then culminates in to conditions of anxiety and anguish that in some instances becomes unbearable. It should be acknowledged that the state of anxiety highly inhibits effective emotional functioning of an individual.

To this effect, therapists recommend that patients are required to open up and involve third parties in making important decisions. In addition, when faced with any emotional and psychological problem, the patients should seek early interventions that can be readily provided by the persons that they are close to. This is instrumental in regulating the severity of the effect of mental problems to their wellbeing (Carveth, 1994). Basically, this theory shows that establishment of viable 'real' social relationships go a long way in avoiding psychological problems. It is because they give the patients a chance for relief during the early stages of their psychological anguish and relatively prevent situations of psychological breakdown and the associated mental difficulties.

The affect theory

Theorists in this regard contend that an affect refers to a sentiment or a feeling that is subjectively generated and is independent of any external influence. The affect theory is aimed at an organization of different affects in to distinct classes and provides a connection of each to a typical response. Often, the affect is internally felt but manifested externally through various expressions. Tomkins (1991) shows that all the affects can be easily recognized through different facial expressions that stem from a stimulus. For instance, the affect of pain or discontent can be easily identified through the act of frowning. On the other hand, the affect of happiness is revealed through smiling. The nine affects as identified by this theory include joy, excitement, rage, disgust, fear, distress, dissmell, humiliation and surprise (Tomkins, 1991).

With regard to modern psychoanalysis, the positive affects are always prescribed to the patients as opposed to the negative affects that are discouraged. During therapy, Kelly (1996) asserts that affects should be properly utilized to give the intended effect. Furthermore, it is argued that affects play a vital role in initiating and maintaining intimate relations that are fundamental in psychotherapy and mental health on the whole. It is because they emphasize positive relationships towards a particular goal and discourage the negative relationships. The employment of affects is also fundamental due to the fact that they encourage the members that are seeking mental health and recovery to express affects to each other in order to identify the extent of the progress and make prescriptions accordingly (Tomkins, 1991).

In addition affects can be very important in describing to the mental health patients the goals and objectives that are supposed to be achieved in the course of therapy. These are employed during narrative of different events that aid in therapy. Setting of goals provides an impetus fro the patients to employ individual effort and achieve the expected results within the set timeframe. Tomkins (1991) shows that not only does this help the patients to save time and resources that are used in therapy, but it also improves their productivity.

Furthermore, the affects are also associated with Christianity. To this effect, it can not be disputed that Christianity plays an important role in regulating feelings of violence, anger and suffering. On the contrary, it encourages feelings of love, peace and enjoyment. By optimizing the use of affects, therapists encourage the patients to embrace religion and spirituality. Studies conducted after its inception affirms that the theory plays a vital role in enhancing the process of therapy and positive results have been attained from its usability. Of particular reference is the employment of spiritual values and virtues during recovery. Kelly (1996) indicates that these values provide a framework for sustainable recovery.

 

Psychodynamic perspective on addiction

This perspective was initiated by Dr, Freud and it has been in use for almost a full century now (Mitchel & Black, 1995). Its contention is based on the presumption that there exist some complexities with regard to the extensive and expansive world of behavior. To this end, it is assumed that the unconscious forces that are found within the human being are key influences of why we behave the way we do and why we involve ourselves in addictive behavior. In this respect, Isaac (1958) shows that through the various modes of interpretation of the traumatic experiences that children often experience and the difficulties that they face during development, in future; they derive different meanings and relations with particular events, specific individuals and certain activities. At this juncture, it should be appreciated that the severe internal conflicts often originate from a persons childhood and if interventions are not made in a timely manner, studies show that this can result into mental illness at later stages of the child's life.

According to Martin and Marcel (2008), this situation can happen because of the fact that these childhood conflicts have the ability to inhibit the effective growth and maturity of three structures which make up the human psyche. In their study, they show that these encompass the ID that initiates the sexual and force related drives, the ego that is found in the brain and provides reference between reality and unconsciousness and the super ego which provides control over the stimuli of the Id and symbolizes ethical ideals. Freud suggests that their recovery from this trap is determined by the extent of their understanding, their disentangling and their exposition of these instinctive forces, convictions and meanings (Priestly et al., 1998). Over time, this perception has undergone various changes that incline the key concepts to special adaptation, efforts to provide self medication for painful and unbearable emotions, a compulsive behavior and need for this self medication and an ultimate reflection of an abnormality in self organization.

The mental psychologists strongly believe that various mental issues result from the psychodynamic conflicts that can not be effectively addressed using the defense mechanism. In their study, Lende and Smith (2002) argue that often, employment of defense mechanisms as a response to the different conflicts provides a temporal internal satisfaction. However, Ornsten (2008) indicates that at the levels of the super ego and the id, this approach is ineffective and it is largely blamed for adoption of maladaptive behavior, which in most instances is addictive.

Likewise, other theorists have made enormous contributions to this field using more specific aspects of addictions. To this end, the psycho analytic contributions made by Glover with regard to drug addiction can be considered very invaluable on this body of knowledge. Other compulsive behaviors explored by this author include the prostitution and sadism. Specifically, he classified the different mental disorders and explored the mind development process and its implications on addiction and other compulsive and persistent behaviors (Martin & Marcel, 2008).

In his study, Sando Rado coined the word compulsion that is presently used to describe addictive behavior. According to him the addicts experienced pleasurable moments by use of specific pleasure centers found in the addicts brain that are sexual in nature (Priestly et al., 1998). From these reviews, the word compulsion has been widely used in the addiction studies. Additionally, he suggested that psychopathology was likely to be a cause of addiction rather than its preconception as a result of addiction.

Simmel in his study made so many contributions to the field of psychoanalysis and addictions. He pointed out that gambling is indeed an addiction because according to him, it is virtually an expression pleasure although it is also characterized by tension and fear (Lende & Smith, 2002). During adulthood, this is used to restrict feelings of guilt and anger. Priestly et al. (1998) argues that it is related to the failure to comprehend the meaning of socialization. According to Simmel, unlike winnings that can be really ecstatic, loosing implies restriction of parental affection.

Leon Wumser is yet another psychoanalytic who made significant contribution to the field of addiction. He particularly explored drug addiction and contented that this is influenced by intense inner conflicts of a being, family diseases and disturbances that are faced in the course of development. He presumes that addiction to drugs occurs because usually, the user adopts them as a defense mechanism against what he terms as undesirable internal and external reality. In his study, he also explores the relationship between addiction and phobia and shows that the two, despite being compulsive, are parallel to each other. He also points out that according to his field research, most of the drug addicts were maltreated when still young (Martin & Marcel, 2008). They then suppressed these feelings at that particular time and find it difficult to face the feelings during later stages of their lives. This makes them to assume addiction as a temporal comfort zone for them, away from the fears of the urge to experience the painful childhood feelings.

Henry Krystal then explored the psychoanalysis of alcohol addiction with regard to the relationship of the addict and the object. To this end, he indicates that often, the drug addict wishes to reconnect with an ideal object and dreads it at the same time (Ornsten, 2008). As a result, he assumes fantasy and drama and can not be separated from the addictive substance. Thus particular functions that are meant for perpetuating nurturance are inhibited and instead reserved in order to act as a representative of the object. This knowledge shows that the role of therapy in this is to enable the patient to expand the conscious of self recognition to his entire self. According to Kystal, this frees him from the urge to use the drug which then enables the patient to have access to the parts and functions that were initially isolated.

Khantzian also explored the concepts of self, ego and opiate addiction and proposed that addictions often occur because the addict fails to asses his or her self and the different situations that s/he experiences. As such, the addict fails to caution and protect the self against the dangers by involving in dangerous activities. It is because of the fact that initially, he or she failed to differentiate between the destructive and constructive activities ad make efforts to putting place measures. To this end, he argues that the therapy should aim at effectively addressing the hidden psychopathology and other behavioral defects. In order to achieve this, Khantian suggests that the addict should gain full control over his or her feelings and destructive behavior. It is because the ability to effectively address this lies in the inner self of the patient. To this end, it can be argued that despite the fact that the therapist's help enhances recovery; the patient is the one to make the ultimate choice regarding the recovery from addiction.

Greenspan then develops a comprehensive model that fuses the developmental process and substance abuse in an effort to understand how each affects the other (Priestly, et al., 1998). In his study, he explores the different patterns of substance abuse and resultant addictions. He further argues that in order for the treatment to yield satisfactory results, it is important to understand the patterns and internalize the relationship between the inner and outer self of the addict and how the same contribute to the state of addiction. According to him, this is essential due to the fact that in most instances, addicts pretend and they may quit treatment before their internal problems are fully addressed.

Bernard Brickman argues that the traditional approaches to psychoanalysis did not effectively affect addictions. He supported this presumption using different studies and researches. He challenged the basic psychoanalysis assumptions with regard to psychoanalytic pathology (Lende & Smith, 2002). It is in this consideration that he proposed a holistic approach that is supported by various studies undertaken in other related disciplines like genetics and physiology amongst others. In general he recommended that abstinence should be the first intervention and should be taken during the early stages of addiction. According to him, this is a requirement for satisfactory analytic therapy. Additionally, he emphasizes that mutual help groups like alcohol anonymous play a critical role in the recovery of addicts.

Finally, Norman Zinberg contributes to this body of knowledge by highlighting that the physical and social environment of the addict also contributes in different ways to these conditions. His theory starts by acknowledging the fact that the attitude and overall personality of the user play primary roles in contributing to the condition. These propositions are very important during therapy in that the conditions in the hospital greatly differ from the home environment. According to him, these have different implications on the process of recovery. Generally, he contends that social factors including the social construct of the addictive practice contributes to different patterns regarding addiction. For instance, he indicates that in most societies, alcohol is associated with feasting and parties. To this end, frequent feasts and parties are likely to contribute to alcohol abuse.

Overall, he points out that therapy should adopt a multidimensional approach in order to realize optimal results (Martin & Marcel, 2008). He argues that despite the fact that behavioral change and drug administration play a vital role in the recovery process, external and independent aspects of the social and physical environment should also be given equal consideration.

The above reviews provide important insights about the psychological perception of addiction. To this effect, it can be ascertained that addiction is a multifaceted aspect and effective psychoanalysis is essential if effective treatment is to be given. Therapeutic efforts should also be complex in order to address all the aspects that impact upon the recovery process. Additionally, it is increasingly important for the psychological therapists to understand and appreciate the differing needs and requirements of their patients in order to provide customized services. Considering the fact that the patient's past has various implications on his or her present, practitioners should start by understanding the patient's past events and experiences. This forms the basement upon which successful psychotherapy is derived.

In addition, it should also be appreciated that the present society and life is characterized by stressful conditions and other forms of depressive events. It is in this consideration that this Ornsten (2008) suggests that the modern psychoanalysis should also put in to consideration the modern factors that lead to addictions. It is important that root causes of these factors that include economic, social and psychological difficulties are addressed in a timely and effective manner. This calls for integrated effort from all major stakeholders.

 

Psychodynamic perspectives of mourning

Mourning is a mental condition that is characterized by various processes and is triggered by a loss of an object that the individual has a great attachment to (Lerner, 1990). This takes some certain period of time that is depended upon the individual's capability to overcome it. The individual goes through various stages and when the process is over, s/he is completely separated from the lost object. The process is characterized by intense pain and denial of the reality but gradually, the individual attains a level of acceptance. Eventually, Field shows that the person succumbs to the changes, accepts the loss and initiates new relationships with other objects (1999).

The grief that occurs as a result of mourning has various emotional and psychological implications to the person that is mourning. Essentially, the different stages of the mourning process that contribute significantly to the theoretical framework of mourning were discussed in detail by Bowlby. These were based upon the observations made to the infants when the mother's presence was missing. The first phase according to this study includes numbing and is often characterized by painful feelings of distress (Berry, 2008). The feelings if not controlled may result in to psychological or mental breakdown. The individual may engage in certain activities that are physical in nature in an effort to express these feelings. Common activities include screaming, wailing and crying amongst others.

After this, the person that is mourning goes into a stage of yearning and looking for the missing individuals or objects. This happens because of the feelings of denial due to the fact that the loss could have been unexpected. The stage is still characterized by feelings of sadness and refusal of the loss. Usually, Lerner (1990) indicates that the individuals at this stage still hope that the lost object will at some time return to them. During this stage, the person is still susceptible to the external information about the lost object.

The third phase is then characterized by despair and lack of organization. This happens because of the inability of the lost object or person to return. It indicates the beginning of hopelessness and acceptance (Field, 1990). The fact that the lost object is not likely to return to the person makes the person confused and disorganized in various ways. In addition, the individuals' affirmation that he relationship shared with the lost person is also lost contributes to the disorganization.

Finally, the stage of increased or reduced reorganizations follows. This according to Bowlby is depended on the person's ability to appreciate the loss incurred. According to him, if the person fails to fully acknowledge the loss, s/he is unlikely to be organized during this stage. On the contrary, persons that perceive the loss as positive and part of the change process are often organized during this stage.

According to Bowlby, the time taken during the whole process and the sequence of the phases differ considerably from one individual to another. It is because various individuals posses different capabilities to deal with the loss and overcome it accordingly. In addition, the resources available during the mourning process also influence the period of time that an individual takes during mourning. In this respect, Berry (2008) argues that availability of resources such as therapy hastens the mourning process. Generally, the mourners' movement through the process as described by Bowlby is oscillatory- forward and backward movement.

This study was based upon the principles of psychodynamic analysis that highly utilizes the role of emotion in the recovery of mental health. To this end, Freud argued that grief was important because of the fact that it enabled the person mourning to dispel painful feelings and detach from the given loss. This is important because the person then has a chance to realize his or her potential with regard to psychological resources. To this end, it is suggested that longer periods of mourning are relatively beneficial to the emotional wellbeing of the individuals (Lerner, 1990). However, this contention has faced various changes with Field (1999) arguing that the propositions are not backed with empirical data. Field researches conducted by various psychologists in this regard show that the period of mourning has limited influence on the psychological wellbeing of different persons.

However, modern approach to the process of mourning appreciates the role of the child's environment. Additionally, the subjective reaction of the child to the process and the role of the third parties in enabling the child overcome the same are also acknowledged. While addressing the attachment theory, Boylby asserts that attachment as part of behavior mechanism that is fundamental for survival. Furthermore, with regard to grief and mourning, he indicates that these are disruptions that highly compromise the emotional stability of individuals. In addition, Field (1999) agues that disruptions in the relationships always occur due to insecurity as a result of lack of cooperation from parents. These complexities result in to depression and stress because of the feeling of failure experienced by the child. Further, the feelings are attributed to limited support from individuals who are supposed to offer the same.

Freud also did an extensive study regarding the psychodynamic aspects of mourning and ascertained that this state implied a real loss of person. He asserted that the process of mourning is part of melancholia and is pathological in nature. He showed that the feelings of accusations that are experienced during mourning are often directed towards the mourner, despite the fact that they are meant to be directed towards the lost person. To illustrate this, he gives the example of a loyal wife who rebukes herself after the loss of the husband on the pretext that she could have strayed in some way. According to Freud, this feeling should be directed towards the dead husband, who in this case is the cause of this, rather then the wife. At the end of the day, the wife is depressed by an imagined wrong.

Likewise, Klein's contribution to this course of study can also not be disregarded. She did extensive studies about depressive illness and suggested that in an ideal mourning situation, the initial stages are characterized be paranoid and suspicious anxieties. Their reactivation makes the mourner feel as though it is a punishment imposed on him or her. Because of immense pain, the mourner may loose some considerable level of emotional stability and goes in to a state that Klein refers to as depressive position. During this stage the person is not able to make personal decision and experiences extreme emotions that are either good or bad. To this effect, Klein argues that effective therapy usually targets providing a stable emotional condition that enables the mourner to make informed decisions and counter the pain experienced.

In his study, Winnicot takes a different approach by analyzing the implication of mourning to children. His findings were backed up by research carried out on thirty children whose pets died. To this end, the credibility of this study has been challenged by emergent researches that were carried out after Winnicots. The studies argued that the affection to the pets can not be compared by the affection that the children had on their parents. Generally, Winnicot contends that children do experience immense painful emotions when faced with any type of loss. He argues that this knowledge is essential as it shows the severity of the condition and enables the therapists to adopt most suitable and effective ways to address the same. Further, Winnicot asserts that loss leads to aggression of the mourner as a defense mechanism (Winnicot, 1974).

From the above review, the theorists affirm that the mourning process is a practice that individuals experience as a result of loss. It is characterized b various activities that in many ways enable the individuals to cope with the loss. As noted earlier, the ability to effectively overcome the loss is influences by various factors. In his study, Craib (1998) ascertains that various emergent studies have given the process an entirely new conception. Modern psychoanalysis in this regard shows that the mourning process is essential for healing and recovery. Hence psychotherapists should encourage the patients to boldly go through the process as failure to experience it has various adverse effects on the emotional wellbeing f the victims.

 

Psychodynamic perspectives on rage

Most studies undertaken in psychology affirm that rage can be very destructive and it should be avoided at all costs. It is because of the fact that it inhibits proper functioning of a person by initiating violence. Omstein (1999) indicates that extreme reactions of anger are caused by the numerous types of injuries done to the esteem of a person. It is also contributed to by disappointments from the people that are close to the person during childhood. These people in most cases have a significant degree of influence to the child's self esteem. They include the mothers, care takers and important others that relate with the child during the later stages of life.

In incidences where the injuries are traumatic or massive, Ormstein (1999) points out that the resultant anger is often intense and has destructive implications on the emotional and physical wellbeing of the individual. Psychoanalysis in this regard aims at addressing the root source of the anger. The psychologists adopt empathy as hey explore the enrage word of the patient rather than direct confrontation which in most cases only worsens the problem. These empathic approaches enable the therapists to address the particular causes of the problem as the patient opens up and shares his or her subjective experiences regarding rage.

Specifically, the therapists assume a neutral attitude and avoids being judgmental. Furthermore, in order to attain optimal results, the therapist is required to refrain from criticizing the patient in any way. In his study, Sehl (1994) shows that this makes the patient blame him or her self for the situation and undermine the process of recovery. To this end, psychological studies indicate that the therapist should be patient and explain to the clients the root sources of the anger and how the same can be countered. Ormstein (1999) affirms that this is likely to restore calm in the patients and ameliorate the vulnerabilities of the same.

Spontnitz made various contributions to the present day psychoanalysis of rage. According to him, most of the problems being experienced n the present society are as a result of the people continuously containing the destructive feelings of rage. He argued that the remedy in this lies in these individuals releasing the bottled up feelings that internally hurt the persons. To this end, he asserts that all children deserve comfort, understanding and emotional support in order to grow up in a healthy manner and become productive individuals of the society. He refers to this as a nurturing environment that is fundamental for growth and development. Despite this knowledge he shows that the present society has not taken much effort to address the concerns. To this end, he indicates that the present trends show that children are emotionally and physically abused in various ways. Many people according to statistic conducted in the recent past have in one way or the other undergone some sort of abuse and have been emotionally abandoned when they were young.

He further shows that in instances when a child is denied the basic needs for survival, a feeling and reaction of rage does occur. For instance, he indicates that when a child is frequently scolded for making mistakes, the child slowly withdraws from the social environment. This also makes the child to continuously attack itself and harbors feelings of inadequacy and worthlessness. Sehl (1994) asserts that these greatly inhibit the sustainable emotional development of the children. It is because the child feels that is does not deserve any form of love from any given source. These feelings have various implications on the overall development process and studies show that it even affects the academic performance of the child. It is because the child experiences confusion with thoughts and wastes much of its time n trying to clarify the expected experience instead of concentrating on achieving the goals set. Psychologists show that this pattern is likely to continue and even worsen in future.

In general Kohut (1971) indicates that rage is often meant for revenge. He asserts that it is manifested in so many ways and is attributable to the feelings of shame and failure. In his own perception, the patients and especially addicts often get enraged due to the fear to what would happen to them once their problem is addressed. This rage is usually unjust and is directed at individuals that the patients relate with in their daily lives (Wolf, 2001). This rage inhibits their cognitive capacity and results in to unfair judgments and actions against others. Enraged individuals often shout aimlessly and distort the facts while making various accusations at innocent individuals.

From the review, it is noted that rage is a form of psychological disorder that has negative implications on our thought process. The fact that it inhibits just decisions and encourages false accusations makes it undesirable. The root causes of rage lie within our society and are contributed to by the persons and events that we have conduct with. Hence, it is important that parents are made aware about their role with regard to growth and development of their children. They should assume the responsibility of cushioning their children against the societal ills by providing the bet holistic environment for effective growth.

 

Spirituality

This is also referred to as matters of ones spirit and is associated with existence of the deity or the Supreme Being. Matters related to spirituality are often beyond a person's physical wellbeing and energy. It is because it encompasses concerns that are well beyond an individual's time, physical senses and the general material world with which human beings interact with during heir existence (Anthony, 1993). To this end, studies conducted affirm that spirituality is characterized by a certain emotional connection to some being that is considered a reality yet it is beyond the physical world. These emotional experiences often entail some feeling of fear and veneration.

Furthermore, Bouma (2006) also contend that internal development and nurturing of spirituality requires an effort through practices that are often religious in nature. Special practices in this regard include prayer, meditation, searching for God, heavenly influence and information regarding life after death. These practices are unique to specific religions and differ considerably. However, they usually aim at upholding good practices and nurturing basic life virtues. Also, Culliford and Powell (2005) show that the perception and comprehension of spirituality differs from one person to the other and is basically subjective in nature.

Spirituality has various implications to the wellbeing of humans. Its practices such as prayer highly influence the individual's thoughts and actions too. To this end, it can be argued that it contributes a great deal in shaping a person's character and influencing the health of the same. To this effect, Chan et al. (2001) shows that spirituality influences a person's health because it dictates what a person eats, how the person dresses, activities that the person engages in and the relationships that the person initiates. It can be contended that all these contribute in various ways to a person's overall wellbeing. Despite the fact that this has not been scientifically proven, behavioral studies affirm that indeed, spirituality highly influences a person's wellbeing in different ways (Culliford and Powell, 2005).

To ascertain this contention, specialists in alcohol anonymous have indicated that the practice has been instrumental in enhancing the wellbeing of alcoholics. However, of particular importance is the presumption that spirituality is a source of true happiness and internal peace. It achieves this by preventing the feelings, emotions and thoughts that may prevent a condition of content and happiness. In his study, Anthony (1993) also shows that it does not necessarily involve religion, supernatural beings or religious beliefs rather it is based on a persons inner thoughts and aspirations. To this end, it can be appreciated that spirituality is pivotal in the recovery process of mental health and/or addictions. It is because of the fact that its central goal is to change the way of thinking of individuals and align the same to the basic virtues that influence healthy living. In this regard, Bouma (2006) indicates that spirituality challenges individuals to change their way of thinking to be in line with the virtues of religion and expectations of the deity.

In their consultative study, Culliford and Powel (2005) indicate that patients of serious mental disorders that include compulsive behavior always find spirituality a very important aspect during their recovery. A study conducted by Bouma (2006) in the US mental institutions affirmed spirituality provided strength for the patients to carry on during conditions of adversity. Furthermore, this study contended that spirituality provided the basic moral practices that helped the patients uphold an acceptable level of ethics and therefore recover steadily. These ethics were derived from the teachings and practices of spirituality that were conducted in the institution.

Also, the participants of the study pointed out that spirituality helped them change their way of thinking from pessimistic perceptions to positive perceptions. Thus they were able to initiate and uphold good behavior in hope that this would enable them to gain a state of health. Mental health practitioners contend that this positive change of attitude is instrumental in enhancing the healing process. Again, participants agreed that spirituality helped them to change their attitude and overall thoughts. As indicated earlier, it can be acknowledged that assimilation of positive attitude forms the core of the recovery process. Additionally, the participants affirmed that the teachings of spirituality gave them the strength that enabled them to face various daily challenges and overcome them accordingly.

According to the findings of this study, the participants also asserted that the teachings of spirituality enabled them to solve the problems that they faced amicably and expeditiously. They did this without anger and fear and promoted forgiveness. As such, they were able to co exist with each other in a peaceful manner and avoid external conflict which in most instances contributed to unnecessary tension. This led to the development of a serene living environment that is characterized by peace and tranquility. The environment then enabled them to engage in productive activities that boost their overall wellbeing and enhance their level of living. For instance, they were able to come up with a gospel musical and they recorded several Christian songs. Afterwards, with the help of the institution's administration, they sold these songs and the proceeds went towards enhancing their living conditions. Additionally, studies show that the tense situations that characterize conflicts only exacerbate the problem and by preventing it, spirituality and religion if very important (Culliford and Powell, 2005).

The participants also confirmed that the teachings of spirituality enabled them to initiate outreach programs and were able to interact in various ways with the communities. By organizing and participating in these programs, the community changed their attitude towards them and assimilation in the community on completion f treatment became faster. This assurance in itself hastened the recovery process of addicts. It is because initially, the community perceived them as a threat to their security and safety.

The inferences made from this study indicate that generally, spirituality enabled the mental health patients to adopt positive lifestyles that in return played a fundamental role in enhancing their recovery. They upheld good grooming and helped their peers to change their behavior ad attitude accordingly. In fact, the institution confirmed that they aided in recovery by encouraging other patients and setting the best examples. To this end, the study recommended that spirituality issues should be given equal priority by the therapists just like medication and other aspects. Without this, this study shows that the recovery process may not yield satisfactory results.

In his study, Anthony (1993) also shows that spirituality is very essential because it plays a pivotal role in avoiding substance abuse that can easily culminate in to addiction. It is because of the fact that most of the spiritual teachings condemn the destructive behavior that culminates from substance abuse. Additionally, the dependence nature that he substance abuse places an individual into is also discouraged by the spiritual teachings. According to them, the Supreme Being should be the sole source of our dependence. In Christian teachings for example, the Supreme Being, also referred to as God is considered the sole provider of all human needs. Dependence on other things according to this religion is considered idolatry, which is shunned within the religion.

A study carried out on fifty participants in a recovery period of twenty eight days in USA affirmed that spiritual practices are of great importance. To this end, the results of the study showed that prayer and self meditation had positive implications on the participants' wellbeing because they enable the patients engage in self discover. Particularly, the participants' abstinence from chemical use and abuse was influenced by these spiritual practices. Hence the findings of the study are important because they portray the positive relationship that exists between the employment of meditation, prayer and other spiritual practices and the recovery of patients that use or and are addicted to chemical substance abuse.

Another study about the relationship between spirituality and was carried out on a population that abused alcohol in south Asia. The inferences from this study also indicated that spirituality to this population meant there is a Supreme Being who has great power and whose directions and teachings were supposed to be upheld by the people. As such, the alcoholics changed their destructive behavior in accordance with the teachings and expectations of the Supreme Being. To this end, they were able to change their behavior and adopted positive mannerisms as prescribed by the teachings. In this regard, it can be ascertained that spirituality has a positive impact on the recovery process of alcoholics.

In general, it can be concluded that spirituality forms the basement upon which the recovery of compulsive behavior, mental health and addiction is based. Studies in this regard indicate that the recovery process is all spiritual due to the fact that it demands a significant degree of honesty, searching, finding and appreciating that there exists a Supreme Being that is more powerful than the human being and acknowledging that the recovery process can not be successful without the intervention of the higher power (Culliford and Powell, 2005; Bouma, 2006). In his study, Anthony (1993) shows that essentially, spirituality addresses the relationships that a being shares with the supreme power, with itself and with other beings. Thus he indicates that it is characterized by three dimensions. Further, it is indicated that all these relationships are intricately connected (Anthony, 1993).

To this effect, it is unlikely that an individual will genuinely treat the Supreme Being with absolute love and a fellow being with hate. It is because the teaching s emphasize that the Supreme Being is a direct representation of the humans with which we share different relationships with. As such, it implies that whatever is done to the fellow humans is actually done to the Supreme Being. This makes the humans review their activities and align them to the provisions of these spiritual teachings.

The therapists affirm that addicts seek treatment with an aim of evading painful repercussions that stem from the practice (Strupp, 1996). Often, the practices that they initially engage in have painful implications. According to the therapeutic measures undertaken, the ultimate role of the recovery process is to encourage the addicts and other diseased individuals to turn away from the destructive practices. In this respect, Bouma (2006) shows that therapy and recovery entails helping the patients to assume desirable social values and virtues that then help them achieve this desired goal. It is worth acknowledged that these virtues are derived from the teachings and practices of spirituality.

In his review, Strupp (1996) points out that some addicts that resort to treatment at certain stages often do not belief in any Supreme Being and lack any conscious relationship with the same. Therapists in this regard affirm that these people often fear establishing any type of relationship with the deity because of the expected changes and because of the assumption that they are already unworthy to share such relationships with the Supreme Being. According to Bouma (2006), the best approach to recovery in such instances is to come down to their level and initiate the recovery by starting with establishing the fundamental relationship with the deity. This can be achieved by the therapist informing the patient that s/he does not believe in a Supreme Being either. At this juncture Strupp (1996) affirms that this enables the patient and the therapists to collectively start by addressing the basics of spirituality. Additionally, this helps the patient to establish some level of confidence in the therapist and reduce the tension and fears that the patient might have prior to the initiation of the recovery process. Chan et al. (2001) shows that these initiations provide the best environment that enables the therapists to derive sustainable methods of effectively getting to the problem that the patient faces.

Another effective approach in this regard has been to help the patients be able to identify the connections and relationships that enhance holistic functionality of their being. This approach was considered because of the fact that the patients insisted on having no relations with nature and the Supreme Being as well. The issues that were important in enabling the patient change this perception were the recognition of for instance how the food they consume reaches their table as well as how the clothes they wear are made. For instance, the therapist would begin by explaining to the patients the interconnectedness that exists between the food consumed and the Supreme Being. To this end, particularistic examples would include telling the client that the weather is entirely controlled by the power of the deity. Thus He provides the rain, heat and other factors that enhance the growth and survival of food crops. To this end, Strupp shows that the patients are encouraged to think being themselves and appreciate the role of other independent and external factors in their wellbeing (1996).

To emphasize the importance and role of spirituality on the overall wellbeing of humans, Safran (1993) likens it to the heat that the sun generates and its role in maintaining life. He illustrates this by indicating that sitting in the sun during summer enables one to feel some warmth even though the source of the warmth can not be physically seen. Further, when a person temporarily moves in to a conditioned room, s/he is assured that the warmth is still there and it did not leave too.

Hence spirituality in the domains of psychological recovery implies that it is extremely important for the patient to let go of the negative and destructive thoughts, beliefs and practices amongst others and appreciate that the higher power and the colleagues are capable of reversing the trend. Chan, et al. (2001) asserts that acceptance of the Supreme control by the patients as a background to sustainable recovery. Ultimately, it enables them to not only stop the addictive practices but also gain intrinsic value of serenity, courage, respect and honesty amongst others that characterizes return to life.

From the above review, it can not be disputed that spirituality plays a vital role in the process of therapy and ultimate recovery of drug addicts and other mental health patients. Of particular importance are the teachings and practices of the same that seek to enhance change in attitude. At this point in time, it is worth acknowledging that positive change is essential in enhancing recovery. Spirituality, through its emphasis on vital values and social virtues plays a critical role in initiating this vital change in the lives of the patients with compulsive disorders that include drug addiction and alcohol abuse.

 

Spirituality and action

Culliford and Powell (2005) show that the teachings of spirituality often encourage the followers to undertake actions and make the teachings of the same practical. This is because of the need to practice and be able to develop a spiritually acceptable way of living. Without practicing what they are taught, Bouma (2006) shows that grasping the concept and inculcating it in their behavior and character can be very difficult. Safran (1993) affirms that human nature is characterized by a high level of forgetfulness that can only be effectively curbed through practice. Additionally, spiritual activities enable the followers to experiment and appreciate the outcomes of the theoretical teachings. Furthermore, these activities keep them busy and as such they hardly find time to engage in activities that are destructive and unhealthy. Above all, in his study, Strupp (1996) argues that these activities often enhance social cohesion because of the fact that they yield tangible results.

For instance, by reaching out to the community through activities like helping the poor and offering human services, the overall wellbeing of the society is enhanced. The psychological effect that accompanies such activities enhances co-existence through appreciation of each other. Additionally, as indicated earlier, when the drug addicts reach out to the communities, they are likely to alter the communities' perception of them as killers, rapists and violent people to positive perceptions. This also enhances social cohesion and reduces the conflicts that occur as a result of the initial destructive activities that the addicts once engaged in.

In his study, Hilton et al (2002) likens the concept of actions in spirituality to roots and fruits. He points out that true spirituality is represented by the roots which provide critical support for the tree to grow and bear fruits. In this regard, he argues that spirituality can be manifested through actions, just like the bearing of fruit by a tree indicates the strength and dedication of the roots by ensuring that the tree is well nourished. The people who perceive spirituality as to be related to religion often believe that true faith is manifested through actions. These actions are derived from the teachings about the specific religion.

Assuming that the same belief is held by addicts and other health patients, Hilton et al. (2002) indicates that it can be affirmed that the improvement of behavior of these people is highly influenced by the spiritual beliefs. For instance, when they are taught that the supreme demands that they do not kill, drug addicts are likely to refrain from substance abuse because it is the one that influences them to kill. In this respect, it can be contended that spirituality plays an important role in helping persons with compulsive behavior like drug addicts to modify their conduct. It should be appreciated that this forms part of the core goals and objectives of therapy.

 

Spirituality helping in constructing narrative

Use of narratives in psychotherapy has been employed in therapy since its inception during the onset of 1970s. In her study Mary (2003) affirms that its employment over time has produced relatively satisfactory outcomes. The therapists in this regard believe that the identity of individuals is completely shaped by the accounts of our lifestyles that are brought in to the limelight through their narrations and stories. Moore (1992) indicates that the role of the therapist is to help the patient in providing a detailed description of the comprehensive stories about their types of lives and the possibilities that are related to the same. As the patient gives this description, the therapist is often keen about investigating the person's relationships as well as influences. This enables the therapist to derive viable measures that are directed towards enhancing the recovery of the patients.

Full analysis of the problem is achieved during this process because of the fact that the therapists usually isolate the problem from the individual. This isolation not only enhances the relationships between the patient and the therapist because it enhances inculcation of objectivity in the same. As such, the therapist is able to treat the patient irrespective of the ills that are manifested through the problem. Additionally, the fundamental assumption made during this process is that the individual has the competency and ability to overcome the distanced problems that influence his or her life in various ways (Mary, 2003). To this end, objectivity ensures that the therapist capitalizes on this patient's capability in order to achieve maximum impact. Moore (1992) argues that the externalization of the problems makes the therapist to be able to evaluate them fully and come up with viable ways of how they can be addressed.

With regard to the role of spirituality in narrative construction, therapists can also employ the same procedure (Mary, 2003). This is achieved when the therapists externalize the values that are derived from spiritual practices. These are then evaluated and relationships made about how they can be employed in resistance of problems. Other ideals that can be explored in this regard include the patient's hopes, aspirations and commitments. These can be identified from the events narrated by the patient and then be incorporated in to the narration by the therapist during re-narrations. Moore (1992) affirms that when re-authored to take the position of helping the patient to resist problematic situations and practices, they are very effective in mending way ward behavior.

Further, considering that spiritual values are very influential, they can likewise be entrenched in to re-authoring conversations as a measure towards helping people to reclaim their lives. Also, the therapists can recommend the spiritual virtues to the patient at the end of the therapy and during the process of therapy. According to Hilton et al (2002), this helps the patient to perceive the same as part of their commitments and hopes and thereby steer the recovery process.

Additionally, considering the fact that the therapist has a broad array of questions to choose from during the process of therapy s/he can reframe the questions to address the extent to which the patient values spirituality. This then provides the basement information upon which the therapist can base the narration. To this effect, Bouma (2006) shows that the patients have various perceptions with regard to spirituality. Knowledge about this is important in order for the therapist to provide for the specific spiritual needs. In addition, it should be appreciated that spirituality is a sensitive matter that should be handled with great care and caution. Failure to put in to consideration the specific concerns of the patients according to Anthony (1993) inhibits the whole process and undermines the outcomes. For example, religious beliefs that are associated with spirituality differ from one religion to the other and in some instances, they are conflicting. Acknowledgement of these concerns is important in order to prevent contradicting the views of the patients.

Moore (1992) indicates that by insisting on the importance and role of spirituality during narration and construction of narratives, the desired effect can ultimately be achieved. In addition, before starting and finishing the process of therapy, the therapist can start by undertaking basic spiritual practices that may include prayer. It should be noted that this should be in line with the beliefs of the patient about the same. Additionally, Mary (2003) indicates that initially, the therapist should seek the consent of the patient before engaging in such practices. The practices can then be made more regular as therapy continues. By the end of the treatment, Safran (1993) shows that the patient is likely to attain spiritual fitness if this pattern is employed and enforced accordingly.

Spirituality as identified in the above discussion is very influential in the construction of customized narratives that meet the specific needs of the clients. The therapists can capitalize on this ability and construct their narratives in the sense that they address the specific needs and requirements of the clients. To this end, they should include the current issues that affect the psychological wellbeing of the clients as well as the spiritual beliefs that he patient associates with. It is worth acknowledging that the present world is characterized by complex issues that may contribute in several ways to psychological instability. Strupp (1996) contends that the present day psychological environment has pressurizes humans in several ways. This maximum effect has beneficial outcomes as then the therapy will be able to achieve


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