Religiosity and Spirituality in the Lives of African American Women with Severe Mental Illness: Evidence From a Life History Study

Findings from studies such as the National Survey of Black Americans indicate that African Americans underutilize professional mental health treatment, despite high rates of depression and anxiety. However, Blacks are more likely than Whites to seek out informal resources, such as religious clergy, friends, family, neighbors, and coworkers. The literature on treatment and recovery for people of color indicates that Black churches, irrespective of denomination, are instrumental in shaping many Black women’s experiences of mental illness. Yet less is known about the roles of spirituality and prayer, apart from religion, in recovery; the choice to not identify as religious or spiritual is similarly unexamined. This research examines ways that Black women living with severe mental illness describe experiences with religiosity, spirituality, prayer, or non-participation, and how these decisions shape their experiences of mental illness and help-seeking.

This phenomenological study centers on narrative analysis of in-depth interviews conducted with eight African American women living with Axis I mental illness. Participants were recruited through a local Community Mental Health agency and snowball sampling. Interviews were conducted using a semi-structured protocol, to facilitate the women’s describing their “life stories”— notable events that defined their experiences—and elicit thoughts, feelings, and interpretations of their experiences. The respondents were invited to talk for as long as they liked, up to eight hours in a first interview and four hours in a follow-up. The interviews averaged six hours; they were taped and transcribed. Field notes were summarized when recording was not feasible. The data were analyzed as texts for cross-cutting themes and the meanings the respondents ascribed to their experiences. The women’s interpretations were privileged; the researchers’ analyses provided context for how the respondents’ narratives related to existing literature, rather than imposing the researchers’ perspectives on the texts.

Analyses revealed a high incidence of familial and childhood religious affiliation, experiences with mental illness stigma at places of worship, evolving affiliations with religion and spirituality after awareness mental illness, and prayer as a coping mechanism. The responses ranged from experiences in churches where members suggested that mental illness is caused by distance from God; respondents who were no longer connected with churches but wished for a community, instead relied on individual spirituality; and prayer as both a negative and positive force. Reponses described prayer as recovery tool, in some cases of equal utility to medication and therapy.

The results of this research provide evidence of how the women’s interpretations of the ways that religion, spirituality, and prayer influenced their experiences, action toward and participation in treatment and recovery, to provide context for previous findings on the importance of these factors in Black women’s lives. This information can be used to inform culturally competent mental health services with a deeper understanding of how religion, spirituality, prayer, or the choice to not participate affect treatment and recovery, as well as the women’s relationships with families and community. The goal is to enhance frameworks for practice and future research on mental health care and community-level interventions to promote social recovery.