June 01, 2016

By Nancy Kehoe

I had been leading groups on religious issues at the Metropolitan State Psychiatric Hospital for a year when one woman, Libby, died by suicide. Libby had been in the state hospital for years and was well-known to staff and other patients. Individuals who lived side by side for months or even years often became like family.

Because Libby’s friends were in a locked unit, they could not go to the chapel for her memorial service. I proposed instead that we hold a service in the unit. Some staff were concerned that such a service might prompt others to think of taking their own lives. After much deliberation, they decided that a service could be held, provided that enough staff attended. So I created a ritual. What emerged from that experience was the realization of the vital role rituals can play for individuals and for a community.

A ritual is a religious or solemn ceremony with a series of actions performed according to a prescribed order, using words, objects and possibly music. Ken Pargament wrote in Religion and the Clinical Practice of Psychology,Relatively little attention has been paid to religious rituals by psychiatrists and mental health professionals. However, rituals may offer one way of coping with difficult life situations.”

The day room where I held the ritual did not have the beauty of houses of worship. Worn chairs, yellow walls that hadn’t seen paint in years, patients that wandered in and out of the room, two circles of chairs and staff positioned around the room became the “sacred space.” To create some beauty, I brought a tablecloth, flowers and a candle. I began with some classical music, a poem and a prayer that was from the woman’s religious tradition.

I suggested that people take a moment to remember Libby and what she had meant to them. They shared their experience of Libby with honesty and compassion. At the end of the sharing, I took bread and said that death always leaves us with a sense of emptiness and that cultures and religious traditions, in the face of death, often share food. We then broke the bread and shared it among everyone. That first ritual was an emotional release that allowed attendees to share painful feelings in a safe space.         

“For many people with severe mental illness, disorganization has characterized a great deal of their lives. It is not surprising, then, that rituals associated with religion or spirituality are highly valued by consumers who prize their structure, regularity and predictability,” wrote R. Fallot in Spirituality and Religion in Recovery from Mental Illness. “Many recovery narratives describe the important capacity of such rituals to organize experience, provide meaning, offer trustworthy and safe social engagement and express core beliefs.”

Over the years, I have done countless other rituals, several in the state mental hospital, until it closed, and most in the psychiatric day treatment programs where I have worked for 35 years. What is essential in a ritual is a predictable ceremony. In Religion and Mental Health, J. Jacobs says, “Ritual allows for the recognition of emotional distress in a [social setting] that provides secure boundaries in which to relive and experience emotional pain and suffering.” Individuals often became accustomed to the rituals and counted on them as a way of processing their grief.          

In addition to doing the rituals to grieve a person’s death, I began to create rituals for holidays and special times of the year. When I first began leading the spirituality groups in a psychiatric day treatment program, I suggested that staff have a Passover Seder to honor the experience of going from oppression to freedom. The ritual was valuable because individuals were able to place their journey with mental illness in a larger context.

I created a spring ritual to honor rebirth and renewal. Near a table covered with a lovely cloth, candles, flowers and empty bowls, the community gathered to recall places of new life in themselves. The ritual begins with music and readings from members of the community. Each person is invited to place a flower in the bowl and express a place of new life in themselves or a person who has brought them a sense of new life. This ritual enables participants to honor and recognize growth and fosters hope for recovery.

In December, I created a similar ritual to recognize the power of light at a time when the days grow shorter. This ritual also begins with music and readings. Then each person is invited to place a candle into a wreath and name someone who has been a source of light. After all the candles are lit, attendees sit in silence and gratitude for those who have been a light for us in our darkness.

What has been valuable over the years is to see how the celebration of a ritual has brought the community together. We desire signs of light during the darkness of winter and signs of new life in spring. In creating rituals and celebrating as a community, we have found ways to create and transform a sacred space. In this space, we have mourned, rejoiced and been inspired by the words and actions of all present. 

Nancy is a member of the Religious of the Sacred Heart, a Roman Catholic order of nuns, a licensed clinical psychologist and Assistant Clinical Professor of Psychology at Harvard Medical School, part time.   

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