Psychosis and Spirituality: Exploring the New Frontier

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In total, 18 CFAs were done 9 four factor and 9 five factor , using data for the combined samples first, followed by separate analyses for each country sample. The standardized regression weights along with a variety of fit statistics for the combined sample analysis can be found in Table The overall model fit statistics for the analyses for each country separately can be found in Tables 11 through In all analyses for both four and five factor models, inspection of parameter estimates indicated that all regression weights i.

Alternatively, examination of covariances i. For instance, all covariances emerged significant with the total combined sample in both four and five factor models. However for the Canadian sample, the four-factor model produced nonsignificant estimates for all covariances involving EWB and in the five-factor model, five covariances were nonsignificant i.

For the American sample, two covariances were nonsignificant in the four-factor model i. For the four-factor model for the Polish sample, one covariance estimate was nonsignificant i. In the Slovakian sample, four emerged nonsignificant in the four-factor model i. In the Ugandan sample, two covariance estimates were not significant i. In the Korean sample, two covariances were found to be nonsignificant i. Lastly, for the Japanese sample, two covariance estimates were not significant in the four-factor model i.

When comparing the overall model fit statistics between four and five factor models for the total combined sample and for each country sample, the correlated five factor model emerged superior as reflected in significant reduction in chi-square values i. Based on this, the five factor model became the focus of our remaining analyses. Notwithstanding the findings supporting the five-factor model, closer examination of the fit indices suggests that overall model fit was not wholly satisfactory across all analyses.

On the positive side, fit statistics for the combined total sample, Canadians, Americans, and Indians provide reasonably good support for model fit e. The fit statistics for the Ugandan sample, while not as compelling, also appear to be at least somewhat adequate.


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On the other hand, for the remaining samples, all of which used translated versions of the ESI, fit statistics are less consistently supportive of good fit of the five factor model. To identify possible causes for the poorer model fit i. While a number of modification indices were generated, none of them indicated that any part of the model for these four samples could be respecified in a manner that made rational sense. For instance, there was nothing pointing to correlated error variances suggesting possible systematic measurement error due to unintended overlap in item content [ 45 ].

Similarly, there were no modification indices which strongly supported the re-assignment of an ESI-R item from one dimension to another in a way that would be defendable from a conceptual point of view or would generalize beyond a single country sample. Finally, to determine the extent to which parameter estimates for the five-factor model are stable and generalizable beyond the current samples, maximum likelihood bootstrap analyses were completed for the total combined sample and each country sample.

Confidence intervals for nonsignificant covariances as reported above, conversely, were found to include zero. As the most rigorous test of the ESI-R, we completed a series of CFA analyses wherein a freely estimated five factor model was compared to a model with parameter estimates constrained to equality and the change in goodness of fit evaluated simultaneously across each country sample.

Based upon the previous CFAs done for each country separately, it was decided that we would test a model with only the factor loadings constrained as factor inter-correlations varied across samples and appeared likely to contribute to poor model fit. Table 15 presents the freely estimated standardized regression weights for the country samples along with essential fit statistics. Table 16 provides an overview of the model invariance testing analyses that were done. For the first analysis, the baseline model i. For the constrained model, chi-square remained significant and the CFI value falls below.

Comparison of the change in chi-square across the two models indicates that the constrained model reflects a significantly poorer fit suggesting non-invariance.

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While Byrne [ 42 ] recommends systematically modifying and testing the constraints in a model to identify elements that are invariant versus non-invariant across samples, we reasoned that such an approach was not practical in the case of our study as there are simply too many comparisons to be made with a 30 item test across eight samples. Instead, we adopted the approach of examining the same constrained model with different sets of country samples as we saw this as being more consistent with our hypotheses. In this vein, we evaluated our baseline model to a constrained model using the four samples which completed the ESI-R in English i.

We next used just the American, Canadian, and Indian samples with the same result i. We did the same analyses comparing just Americans and Canadians, Americans and Indians, and Canadians and Indians, respectively. In all cases, the same pattern of findings were obtained; the baseline model and constrained model showed adequate CFI and RMSEA values but the change of chi-square came out significant with the constrained model always demonstrating poorer fit.

We then completed analyses comparing the Polish and Slovakian samples, and the Korean and Japanese samples, respectively. Regardless, in both instances, the constrained model was found to produce a significantly poorer fit. To further evaluate whether or not the findings reported thus far were the product of the type of test used and by association the type of item and test development strategy , exploratory principal component analyses were used to examine the internal structure of the SAL with the American, Indian, and Ugandan samples.

In all cases, the analyses were set to extract and orthogonally varimax rotate five components.

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To ascertain their association to the ESI dimensions, regression based component scores were calculated and used in a correlational analysis. The rotated component loading coefficients can be found in Table Examination of Table 17 reveals that for all three country samples, all five components house elevated loadings i.

Also, while there appear to be a large number of differences in the pattern of item loadings across the three countries, there are also some points of similarity which find corroboration in the correlations with the ESI-R as per Table All of these items concern positive self-evaluation e. The content of these items revolve around putative religious beliefs and behavior e. All four of these items have content which has obvious ties to paranormal beliefs e.

Components 3 and 4 from all three solutions show much less similarity to each other in terms of the pattern of high item loadings and their correlations with the ESI-R dimensions. In terms of the correlations, for the Indian and Ugandan samples, though some statistically significant coefficients were obtained, the correlations are generally of small magnitude. For the American sample, no significant correlations were obtained between component four and any ESI-R dimension but, unlike the other samples, the correlations with component three were statistically significant and of medium magnitude between four of the five ESI-R dimensions i.

Taken as a whole, these findings suggest that three of the ESI-R dimensions i. In consideration of these results, we elected to create three subscales with the SAL items common to all three country samples so as to see if they function adequately in terms of reliability and if they produce a similar array of associations as found with the ESI-R.

Analyses show a pattern of findings that are generally consistent with what was found for the ESI-R though some deviations are noted. Post-hoc analyses Scheffe test showed that all country samples were significantly different from one another for all three SAL subscales. Second, reliability analyses indicate that the three SAL subscales produce mostly satisfactory inter-item consistency coefficients and good corrected item-to-scale total correlations.

Third, in terms of associations with demographic variables, akin to the ESI-R, the SAL subscales produce a pattern of small correlations with age. With sex, SAL Religiousness produced significant and moderately sized correlations in all three country samples while the remaining two SAL subscales generated small coefficients.

Fourth, for all three country samples, the SAL subscales produced correlations with the ESI-R dimensions supportive of convergent validity e. This investigation offers a wealth of information that has substantive ramifications for the cross-cultural study of spirituality. Related to our research expectations, results provide generally satisfactory support for the first three hypotheses, no support for our fourth expectation and mixed support for our fifth.

As per the second hypothesis, the ESI-R was found to produce satisfactory reliability coefficients and corrected item-to-scale correlations for the pooled sample and mostly adequate alphas and correlations for the country samples separately. A noteworthy and unexpected trend, however, was observed with the samples that had the lowest representations of Christians i. Lastly, correlations of the ESI-R dimensions with demographic variables show similar trends across most country samples; with the exception of the Koreans, coefficients were of generally low magnitude and in the direction where age and females showed associations with higher scores especially with COS and REL.

In the case of the Korean sample, correlations tended to be of more moderate size with both age and sex. Third, evidence of factor replicability, configural invariance, and superiority of a five factor over a four factor model was provided by the EFAs and CFAs with the pooled sample and with the CFAs done for each country separately. With the former analyses, ESI-R items loaded in a manner very similar to MacDonald [ 12 ] both with and without the Canadian sample included in the analysis.

In the CFAs, while loadings were significant for all items in both the four and five factor models, the five factor model displayed a significantly better fit to the data as reflected in both the change in chi-square and virtually all other fit indices. For CFAs involving the country samples, item loadings were ubiquitously significant for all models tested, but the five factor model consistently demonstrated better goodness-of-fit.

With that stated, inspection of numerous fit indices for the five factor model for each country separately suggests that the model demonstrates elements of misfit for the Korean, Japanese, Polish, Slovakian, and Ugandan samples. Nevertheless, modification indices were examined and there were no indications of how the model could be meaningfully respecified in a congruent manner across all samples, so the five factor model appears to be the most defendable.

The fourth hypothesis which predicted that the ESI-R would demonstrate measurement invariance was not corroborated by our findings. Tests comparing an equality constrained model to a freely estimated correlated five factor model consistently revealed that the constrained model had significantly poorer fit. Also, significant differences were found at the item and dimension level as a function of country as per ANOVA findings. ESI-R Cognitive Orientation toward Spirituality was also observed to generate notable associations with the same factor as Religiousness, a result which seems copasetic with what we found with each and every country sample in this study.

In addition, when three subscales were created for the SAL, they demonstrated a pattern of findings in terms of reliability, and correlations with demographic variables mostly similar to what was seen for the ESI-R. With the SAL, Religiousness was found to produce significant and moderately sized coefficients with both Paranormal Beliefs and Existential Well-Being for all three country samples.

Such associations were not found with the ESI-R. All the same, many of the findings with the SAL seem to be fall in line with our expectations. So what do all of these findings tell us? In general, it appears that when defined and assessed quantitatively, spirituality may be viewed as a viable concept which empirically behaves in a similar manner across cultures. It also seems that spirituality is best treated as a multidimensional construct made up of related but unique components. While the number of these components was found to vary as a function of the inclusiveness item content seen in measures employed in the present study, based upon the results using the Expressions of Spirituality Inventory-Revised, it may be argued that spirituality is comprised of at least five dimensions.

Rather, it seems the opposite holds true; the specific meaning ascribed to spirituality appears to be intrinsically bound by culture and cannot be fully understood without consideration given to cultural factors. That is, while there are similarities, spirituality is not the same across cultures.

The significance of our results seem quite apparent—nomothetic approaches to the study of spirituality are at best incomplete and at worst run the risk of misrepresenting the construct and any associations claimed to exist between it and other aspects of functioning. Accordingly, a concrete recommendation for future research is for investigators to be mindful of the role and influence of culture and to augment quantitative methods based solely on self-report questionnaires with other hard quantitative procedures e.

We offer this suggestion not just for research using samples drawn from different nation states but also for studies using samples of different ethnicities obtained within more pluralistic societies e. As well, we strongly suggest that any and all empirical findings generated with samples obtained from one culture be tested and replicated with samples taken from several other cultures prior to making any claims regarding generalizable scientific knowledge. In this vein, we encourage investigators throughout the world to challenge and expand upon our findings using samples from the same and different cultures.

The manner in which we report our results in this paper e. Our findings hold other important implications. First, while not demonstrating measurement invariance, the five dimensional model of MacDonald [ 12 ] did receive support for its configural invariance and its pattern of associations with the SAL were similar across cultures.

Given that the dimensions have been found to be differentially related to psychological functioning [ 91 ], it seems reasonable to conjecture that such results may also be manifested in studies with different cultures. Though this is an empirical question which would be best answered by future cross-cultural research, when considering the current state of the science, it seems necessary if not prudent at the present time to discourage investigators and practitioners from characterizing the association of spirituality to functioning in solely positive terms [ 98 ] as it appears likely that any link found may be a product of how spirituality is defined and measured [ 99 ].

Future studies need to either be more inclusive in terms of what they are considering to be spirituality or acknowledge up front that they are only focusing on specific facets of the construct domain. A second notable implication concerns the results involving the demographic variables. In particular, age and sex were found to be significantly correlated with at least one dimension or scale from both the ESI-R and the SAL for every cultural sample.

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Considering past research which has uncovered such associations with the original ESI and other measures [ 18 , , ], it seems reasonable to argue that spirituality may not only differ in precise meaning across cultures but also across age and sex and as a function of the interaction of all three of these variables however, see [ 17 ]. Clearly, more studies are needed to fully substantiate this interpretative possibility. Nevertheless, it appears as though our findings further challenge assertions regarding the universality of spirituality and call attention to the need to better account for its diversity of experience and expression in research and application as a function of individual differences [ ].

There is one other aspect of our results which deserves mention and it concerns Existential Well-Being. Though many operationalizations of spirituality have been criticized on the grounds that they are confounded with well-being [ 14 ] and available evidence suggests that ESI-R Existential Well-Being EWB may be best treated as something separate from spirituality [ 15 ], results in the present study give some reason to reflect more on the issue.

In particular, while we observed that ESI-R EWB was modestly associated to the other ESI-R dimensions for all cultures, our findings with the SAL indicate that something akin to existential well-being comprises a replicable component which correlates moderately with other elements of spirituality, most notably Religiousness and Cognitive Orientation toward Spirituality.

Since the SAL was developed based upon written narratives describing a spiritual person provided by a sample of Canadian university students and the data we analyzed came from three differing cultural samples i. If understood in this light, then the place of existential well-being within the content domain of spirituality may be reframed in terms of a directional relationship with the other dimensions. In fact, this is something that has already been proposed. Notwithstanding the many key findings, the present study may be seen to suffer from a variety of limitations that need to be kept in mind when critically considering the meaning and generalizability of the results.

First, all participants across all cultures were university students. While it may be argued that the consistent use of students served as a basis to make more apt comparisons across samples e. Resultingly, there is a strong need for research to be done across cultures with samples drawn from more diverse adult populations. Second, unevenness of sample sizes may be viewed as having a deleterious effect on the stability of our results, especially for those samples that are relatively small i.

Future investigations replicating and extending our findings with larger samples are needed. Third, even though we included two measures of spirituality developed via different means in an effort to see if test construction strategy and test content had an impact on our results, both instruments are descriptive and not theory based. As well, our study lacked additional criterion measures that could have been used to better determine if the ESI-R and SAL produce similar patterns of associations across cultures.

While we attempted to ensure that translations were done adequately in terms of preservation of essential content and meaning of the items, we could have done more to better evaluate linguistic equivalence and cultural adaptedness prior to data gathering e. As a result, we cannot conclude with certainty that the relatively poorer fit of observed with non-English language samples was due to inadequacies with the translations or to bonafide cultural differences.

Spirituality is an area of human functioning that has garnered greater attention and legitimatization and will undoubtedly continue to be the focus of research for many years to come. Nevertheless, the philosophical and methodological challenges it presents to science are substantial and should not be ignored.

The present study serves to elevate our awareness of these complexities by highlighting the importance of culture and language in how spirituality is conceptualized, operationalized and measured. It is our sincere hope that the findings from this investigation contribute to more sensitive and socioculturally contextualized approach to theory development and inquiry. Paravati, Ms. Parimala, Stanislaw Urbanski, and Malgorzata Wroblewska.

Analyzed the data: DAM. Browse Subject Areas? Click through the PLOS taxonomy to find articles in your field. Funding: The authors received no specific funding for this work. Introduction Interest in spirituality has grown considerably in a variety of scientific and health disciplines including, but not limited to, psychology, medicine, nursing, social work, counseling, sociology, and organizational management.

But What is Spirituality?

The Need for an Adequate Definition and Taxonomy As a logical starting point, it struck us as important to first overview some of the general definitions of spirituality that are reflective of the better scholarship in the area so as to identify potential commonalities on which to base our own conceptual and methodological approach to the topic. Expressions of Spirituality: Model and measure Motivated to address the problems with definition and measurement seen in the research, MacDonald [ 12 ] completed a series of conjoint exploratory factor analyses using a wide variety of instruments designed to assess spirituality and related concepts available in the literature with data obtained from two large samples of Canadian university students.

Study Design and Hypotheses In order to provide a rigorous evaluation of the cross-cultural generalizability of spirituality as a psychometric construct, we adopted a complex approach to study design that attempted to address to the various shortcomings of the available research. Measures Demographic Survey. Procedure The questionnaires were administered to students at universities in their respective countries. Ethics Statement All data gathering was completed in a manner consistent with standard ethical practices for questionnaire based psychometric research in place at the time of data collection.

Data Analysis The approach to analyzing data for this study was multi-tiered and involved looking at questionnaire scores at both the item and scale level and with the samples combined and separated. Results Prior to beginning any analyses, data were examined for completeness, accuracy, and evidence of response bias e. Download: PPT. Table 1.

Face Validity of the ESI-R Across Country Samples As an initial set of statistics, we focused on the response to item 31 that asks participants to rate the extent to which they perceive the ESI-R as measuring spirituality since it struck us as a good initial indicator of the extent to which spirituality in general and the instrument itself hold up across cultures. Table 2. Table 3. Table 4. Table 5. Table 6.

Associations of ESI-R Dimensions with Age and Sex Product-moment correlations were computed between the ESI-R dimensions for age in years and sex male coded 0 and female coded 1 for the total combined sample and each country sample separately see Table 7. Table 7. Table 8. Table 9. Table Test of Measurement Invariance As the most rigorous test of the ESI-R, we completed a series of CFA analyses wherein a freely estimated five factor model was compared to a model with parameter estimates constrained to equality and the change in goodness of fit evaluated simultaneously across each country sample.

Analyses Involving the Spirituality Adjective List SAL and ESI-R To further evaluate whether or not the findings reported thus far were the product of the type of test used and by association the type of item and test development strategy , exploratory principal component analyses were used to examine the internal structure of the SAL with the American, Indian, and Ugandan samples. Discussion This investigation offers a wealth of information that has substantive ramifications for the cross-cultural study of spirituality.

Limitations Notwithstanding the many key findings, the present study may be seen to suffer from a variety of limitations that need to be kept in mind when critically considering the meaning and generalizability of the results. Conclusions Spirituality is an area of human functioning that has garnered greater attention and legitimatization and will undoubtedly continue to be the focus of research for many years to come. References 1. Psychol Relig Spiritual 1: — View Article Google Scholar 2.

J Relig Health — J Psychosoc Oncol — View Article Google Scholar 5. J Theor Soc Behav 51— View Article Google Scholar 6. Rev Gen Psychol 62— View Article Google Scholar 7. MacDonald DA Studying spirituality scientifically: Reflections, considerations, and recommendations. J Manag Spiritual Relig 8: — View Article Google Scholar 8. Biofeedback 19— View Article Google Scholar 9.

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Psychosis and Spirituality: Consolidating the New Paradigm

Saucier G, Skrzypinska K Spiritual but not religious? Evidence for two independent dispositions. J Pers — J Sci Stud Relig — View Article Google Scholar J Soc Clin Psychol — J Consult Clin Psychol — J Nerv Ment sDis — J Nerv Ment Dis — Psychol Relig Spiritual 5: 90— Psychol Rep — Moberg DO Assessing and measuring spirituality: Confronting dilemmas of universal and particular evaluative criteria. J Adult Dev 9: 47— J Humanist Psychol 7— Psychol Relig Spiritual 1: 3— J Pers Soc Psychol — Behav Brain Sci 61— Piedmont RL Does spirituality represent the sixth factor of personality?

Spiritual transcendence and the five factor model. Kalamazoo, MI: Fetzer Institute. Underwood LG, Teresi JA The Daily Spiritual Experiences Scale: Development, theoretical description, reliability, exploratory factor analysis, and preliminary construct validity using health-related data. Ann Behav Med 22— Res Soc Sci Stud Relig 5: 1— J Clin Psychol — Psychol Relig Spiritual 1: 35— Int J Behav Med 91— Ment Health Relig Culture 89— Am Behav Sci — Counseling across cultures, 6th ed. Thousand Oaks, CA: Sage. Puig A, Fukuyama M A qualitative investigation of multicultural expressions of spirituality: Preliminary findings.

Counseling Spiritual 11— Takahashi M, Ide S Implicit theories of spirituality across three generations: A cross-cultural comparison in the U. J Relig Gerontol 15— Res Aging — J Transpersonal Psychol 41— Stud Psychol — Pac Health Dialog 8: — New York: Routledge. J Cross Cult Psychol — New York: Guilford. Zygon — J Humanist Psychol 5— Pargament KI Spiritually integrated psychotherapy: Understanding and addressing the sacred. Koenig HG Spirituality and mental health. Int J Appl Psychoanal Stud 7: — Helminiak DA The human core of spirituality: Mind as psyche and spirit.

Helminiak DA Religion and the human sciences: An approach via spirituality. Helminiak DA Confounding the divine and the spiritual: Challenges to a psychology of spirituality. Pastor Psychol — Hanfstingl B Ego and spiritual transcendence: Relevance to psychological resilence and the role of age. Evid base Compl Alternative Med. Clarke I, editor Psychosis and spirituality: Exploring the new frontier. London, UK: Whurr Publishers. Clarke I, editor Psychosis and spirituality: Consolidating the new paradigm, 2nd ed. New York: John Wiley and Sons. Grof C, Grof S The stormy search for the self: A guide of personal growth through transformational crisis.

Los Angeles: Jeremy P. Psychopathology — J Humanist Psychol 90— Differentiating religious, spiritual, and transpersonal experiences from psychopathology. J Humanist Psychol — J Transpersonal Psychol 61— Wapnick K Mysticism and schizophrenia. We can easily witness this dilemma occurring within toddlers as they struggle to find a balance between the drive to explore the world and assert their autonomy while still wanting to be unconditionally loved and accepted by their caretakers. And of course this dilemma never fully goes away for most of us. The second dilemma mentioned above is probably a little more difficult for some of us to relate to, especially for us Westerners many practitioners of some of the Eastern traditions such as Buddhism, Taoism, and Advaita Vedanta have thoroughly explored this dilemma.

So, if these existential dilemmas are universal, then why do some individuals become more overwhelmed by them than others, and go on to develop psychosis? The research suggests that there are two main factors that may make someone vulnerable to experiencing one or both of these dilemmas to a very high degree:. With regard to the first dilemma autonomy vs. Attachment research has been exploring and validating this idea for decades. Regarding the second dilemma, recall that this dilemma refers to our need to maintain the sense that we are a relatively secure and stable self living in a relatively secure and stable world, when the reality of our situation is very different than this.

To better understand how someone can be overwhelmed by this dilemma, it will help to first touch on the concept of cognitive constructs. The term cognitive constructs refers to the belief systems and interpretations that each of us has constructed throughout our lives which allow us to make sense of the world. They can act somewhat like a double edged sword for us. They also give us a sense that there is some solid ground beneath our experience — in other words, that we are a secure and stable self living in a relatively secure and stable world.

But on the other hand, our cognitive constructs can close our minds to other perspectives, and they create the illusion that the world and our self are much more stable and secure than they actually are.


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For most of us, our cognitive constructs are fairly solid, changing only slowly over time. Such radical personal paradigm shifting is closely associated with so called delusions and hallucinations — experiences that are generally equated with psychosis. However, even though some people may be more prone to the destabilization of their cognitive constructs, it seems likely that virtually anyone has the potential to experience this if exposed to an overwhelming dilemma, situation, or trauma. The research suggests, then, that both of these factors play an important role in the development of psychosis — an overwhelming existential dilemma and unstable cognitive constructs.

The research also suggests that these two factors are very closely related, in that the experience of such an overwhelming dilemma makes one more susceptible to experiencing unstable cognitive constructs, and vice versa. In other words, how can something as chaotic and as potentially harmful as psychosis act as a strategy to aid someone in transcending an otherwise irresolvable dilemma? To understand this, it helps to use as a metaphor the process of metamorphosis that takes place within the development of a butterfly. In order for a poorly resourced larva to transform into the much more highly resourced butterfly, it must first disintegrate at a very profound level, its entire physical structure becoming little more than amorphous fluid, before it can reintegrate into the fully developed and much more resourced form of a butterfly.

In a similar way, when someone enters a state of psychosis, we can say that prior to the onset of psychosis, for whatever reason, they have arrived at a way of being in the world and experiencing of the world that is no longer sustainable i. As the individual enters into a psychotic process, we can say that their very self, right down to the most fundamental levels of their being, undergoes a process of profound disintegration; and as we have seen in the recovery research, with the proper conditions and support, there is every possibility of their continuing on to profound re integration and eventual reemergence as a renewed self in a significantly changed and more resourced state than that which existed prior to the psychosis.

This idea is well supported in the recovery research in the findings that many people who make full recoveries from psychosis often experience a degree of wellbeing and ability to meet their needs that far exceeds that which existed prior to their psychosis. Arieti, S.

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On schizophrenia, phobias, depression, psychotherapy, and the farther shores of psychiatry. Bassman, R. Beers, C. A mind that found itself. Hagen, B. The greater of two evils? How people with transformative psychotic experiences view psychotropic medications. House, R. Psychopathology, psychosis and the kundalini: Postmodern perspectives on unusual subjective experience. Clarke Ed. London: Whurr Publishers. Karen, R. Becoming attached: First relationships and how they shape our capacity to love.

Karon, B. Psychotherapy of schizophrenia: The treatment of choice. Mahler, M. City shadows: Psychological interventions in psychiatry. New York, NY: Routledge. Modrow, J.