health and spirituality

Health and Spirituality

A Presentation to Pediatric

Integrative Medicine Rounds

Edmonton Clinic Health Academy

by John C Carr, ThM, PhD, RPsych (AB#1035)

Associate Faculty, St Stephen’s College, Edmonton

24 March 2015 12:00 - 12:50 pm

Copyright 2015 - John C. Carr, ThM, PhD, Reg. Psychologist (Alberta 1035)

Objectives1. To clarify the differences and similarities

between Religion, Spirituality, and Faith

2. To focus (briefly) on the interactive process among physical, mental, and relational health

3. To offer some thoughts about clinical care that is grounded in an understanding of the

relationship between Spirituality/Religion/Faith and Health

BIAS

It is important to learn how to “hang from the chandelier” at the same

time as we are engaged in the room –when it comes to thinking

professionally about religion and spirituality –

especially when our task is to care for another person.

1. Religion, Spirituality, & Faith

•What comes to mind when you are asked to define or describe “Religion?”

•What comes to mind when you are asked to define or describe “Spirituality?”

• Are they the same or different?

•And how are those words related to “Faith?”

Religion•belief in a god or in a group of gods

•an organized system of beliefs, ceremonies, and rules used to worship a god or a group of gods

•an interest, a belief, or an activity that is very important to a person or group

Source: Merriam Webster

http://www.merriam-webster.com/dictionary/religion

Spirituality• the quality or state of being concerned with religion or

religious matters

• the quality or state of being “spiritual”

• of or relating to a person's spirit

• of or relating to religion or religious beliefs

• having similar values and ideas

• related or joined in spiritSource: Merriam Webster

http://www.merriam-webster.com/dictionary/spirituality

http://www.merriam-webster.com/dictionary/spiritual

1

Spirituality

A survey of reviews by McCarroll et al. dealing with the topic of spirituality gave twenty-seven explicit definitions "among which there was little agreement.”

Source: Wikipedia

McCarroll, Pam; O'Connor, Thomas St. James; Meakes, Elizabeth (2005), Assessing plurality in Spirituality Definitions. In: Meier et al, "Spirituality and Health: Multidisciplinary Explorations", pp. 44-59, Wilfrid Laurier

Univ. Press

2

SpiritualityAccording to Waaijman, the traditional meaning of spirituality is that it is a process of re-formation which "aims to recover the original shape of man [sic], the image of God. To accomplish this, the re-formation is oriented at a mold, which represents the original shape: in Judaism the Torah, in Christianity Christ, in Buddhism Buddha, in Islam Muhammad.”

Source: Wikipedia (Waaijman, Kees (2002), Spirituality: Forms, Foundations, Methods, Peeters Publishers)

3

Spirituality• In modern times the emphasis is on subjective experience.

• Spirituality may denote almost any kind of meaningful activity or blissful experience.

• It still denotes a process of transformation, but in a context separate from organized religious institutions, termed "spiritual but not religious."

• Houtman and Aupers suggest that modern spirituality is a blend of humanistic psychology, mystical and esoteric traditions and eastern religions.

Source: Wikipedia

Houtman, Dick; Aupers, Stef (2007), "The Spiritual Turn and the Decline of Tradition: The Spread of Post-Christian Spirituality in 14 Western Countries, 1981-2000", Journal for the Scientific Study of Religion (2007) 46 (3): 305-320

4

Spirituality

•Waaijman points out that "spirituality" is only one term of a range of words which denote the praxis of spirituality. Some other terms are "Hasidism, contemplation, kabbala, asceticism, mysticism, perfection, devotion, and piety.”

Source: Wikipedia

Waaijman, op. cit., p. 315.

5

Faith: A Christian Model•… is the assurance of things hoped for, the conviction of

things not seen …Hebrews 11: 1 (New Revised Standard Version of the Christian Scriptures)

• The verse above is followed by a review of the narrative of the people Israel and of their relationship with Yahweh (God) over more than a millennium of struggle with all that was thrown at them (or that they created for themselves) as they struggled to live out that relationship.

1

Faith: A Christian Model

•is a combination of relationship with the Divine (God - Jesus – Holy Spirit)

• and assent to a system of beliefs (doctrine) that vary, depending on the person’s “denomination”

2

Faith: More Generically• strong belief or trust in someone or something

• belief in the existence of God [or of gods or in “idols”]

• strong religious feelings or beliefs

• a system of religious beliefsSource: Merriam Webster

http://www.merriam-webster.com/dictionary/faith

3

Faith: More Generically• confidence or trust in a person, thing, deity,

view[point],

•or in the doctrines or teachings of a religion,

• as well as confidence based on some degree of warrant [i.e. experience/authority]

•belief that is not based on proof

•often used as a synonym for hope, trust, or beliefSource: Wikipedia

4

Religion, Spirituality, & Faith 1

•Although “Religion,” “Spirituality,” and “Faith” have different nuances, the words are often used interchangeably.

•Often, “Spirituality” is used as a generic way of speaking about a person’s Religion or Faith without narrowing that down to a specific religious tradition.

Religion, Spirituality, & Faith 2•When the meaning is not clear in the

context, it is important to seek clarification about what the other means when they refer to their “spirituality” – e.g. by saying “Please tell me what you mean when you describe yourself as ‘spiritual but not religious’.”

Religion, Spirituality, & Faith 3

•Being “spiritual but not religious” may mean being anti-religious.

•Being “spiritual but not religious” may mean a positive affirmation of a particular spiritual path/praxis.

2. Physical, Mental, and Relational Health

How do we think about “Health?”

•Absence of health: sickness, pathology, disability, threat of death

•Presence of wellness: maximum capacity for living and living well

1

Physical, Mental, and Relational Health

The way in which we think about “Health” affects whether our efforts

•are directed towards “solving a problem” or

•are focussed on maximizing wellness

3

Physical, Mental, and Relational Health

The way in which we think about “Health” affects

•The way in which we understand the relationship between Health and Religion-Spirituality-Faith

•The way in which we respond to persons who seek the services of a health facility and/or a health professional

2

Jürgen MoltmannPre-eminent Christian Theologian of Hope

“God weeps with us so that we may one day laugh with him.”

See http://www.garrettmedia.net/video500.php?vid_name=special/moltmann09/convocation to listen to a 40-minute lecture by Professor Moltmann at Garrett-Evangelical Theological Seminary,

Evanston, Il, USA - “A Theology of Life, A Life for Theology”.

http://www.garrettmedia.net/video500.php?vid_name=special/moltmann09/convocation

Spirituality, Religion & HealthCare: Foundations 1

•“Hope is both the earliest and the most indispensable virtue inherent in the state of being alive.”

•“If life is to be sustained hope must remain, even where confidence is wounded, trust impaired.”

Source: The Erik Erikson Reader. (2001) New York: Norton.


•"Hope is the enduring belief in the attainability of fervent wishes, in spite of the dark urges and rages which mark the beginning of existence.”

•“Hope is the ontogenetic basis [organic origins] of faith, and is nourished by the adult faith which pervades patterns of care.”

Source: The Erik Erikson Reader. (2001) New York: Norton.


• Religion is the institution most involved in restoring a sense of trust through faith, as well as giving a definition to the evil the religion hopes to protect one from.

• Religion supports trust development. Interestingly, terror management theory purports that when threatened, people will cling to patriotic institutions and the church in an effort to feel protected from evil.

Source: www.karencrawfordphd.com/media/edocs/personality_ch_5.doc

Spirituality, Religion & HealthCare 1

• So spirituality/religion/faith can provide a basis for hope and energy for healing.

•Healing grounded in spirituality/religion/faith may not cause a cure but it sometimes assists the medical/ surgical treatments applied in order to achieve a cure.

•And sometimes the healing power of spirituality/ religion/faith is the only available explanation for cure.

Spirituality, Religion & HealthCare 2

• Numerous studies, supervised by Northwestern Universioty Social Psychology methodologist Donald T. Campbell demonstrate the effectiveness of pastoral/ spiritual care and prayer in lowering blood pressure, shortening post-surgical hospitalization, etc.

• While those studies assumed a Christian frame of reference, one can also understand the healing process in terms of such generic spiritual constructs as in-touchness with universal healing energy, etc. or simply being cared for by a religious / spiritually identified representative of a frame of reference that is larger than ordinary human experience.

Source: Joint Northwestern University and Garrett-Evangelical Theological College (Evanston, Illinois) PhD Dissertations

3. Clinical Care Grounded in “Spiritual Sensitivity”

•Will assess the spirituality of the patient and/or of their family as part of the process of Assessment and Diagnosis•Will ensure the availability of Spiritual Care

appropriate to the spirituality of the patient

Clinical Care Spiritual Assessment Tools 1

“Spiritual assessment tools such as the FICA, the HOPE questions, and the Open Invite provide efficient means of eliciting patients' thoughts on this topic. The spiritual assessment allows physicians to support patients by stressing empathetic listening, documenting spiritual preferences for future visits, incorporating the precepts of patients' faith traditions into treatment plans, and encouraging patients to use the resources of their spiritual traditions and communities for overall wellness. ”

Source: American Family Physician, 2012 Sep 15;86(6):546-550 at http://www.aafp.org/afp/2012/0915/p546.html


HOPE

H: Sources of hope, meaning, comfort, strength, peace, love and connection

O: Organized religion

P: Personal spirituality and practices

E: Effects on medical care and end-of-life issuesSource: Gowri Anandarajah, M.D., and Ellen Hight, M.D., M.P.H Brown University School of Medicine,

Providence, Rhode Island athttp://courses.washington.edu/bh518/Articles/hopearticle.pdf


FICA SPIRITUAL HISTORY TOOL

F: Faith or Belief

I: Importance and Influence of Personal Spirituality

C: Community: Importance of Spiritual Community

A: Address: Interventions to Address Spiritual Needs

Source: Journal of Pain and Symptom Management, 2010, Volume 40, Issue 2, Pages 163–173 athttp://www.jpsmjournal.com/article/S0885-3924(10)00325-8/abstract

Clinical Care Spiritual Assessment Tools 4Seven by Seven Model

Rush-Presbyterian St. Luke's Medical Center, Chicago, Illinois

Source: Fitchett, G. (1993) Assessing Spiritual Need: A Guide for Caregivers. Minneapolis, Minnesota: Augsburg/Fortress Press.

Clinical Care Spiritual Assessment Tools 5Developing a Spiritual Assessment Toolbox: A Discussion of the Strengths and Limitations of Five Different Assessment Methods: This article reviews five complementary assessment approaches that have recently been developed to highlight different facets of clients' spiritual lives. Specifically, one verbal model, spiritual histories, is discussed, along with four diagrammatic approaches: spiritual lifemaps, spiritual genograms, spiritual ecomaps, and spiritual ecograms. An overview of each approach is provided along with a discussion of its relative strengths and limitations. The aim here is to familiarize readers with a repertoire of spiritual assessment tools so that the most appropriate assessment method in a given client-practitioner setting can be selected.

Source: Health & Social Work. (2005)Volume 30 Issue 4Pp. 314-323 athttp://hsw.oxfordjournals.org/content/30/4/314.short


… spirituality in pediatric palliative care has been virtually neglected. The need for guidelines to assess spirituality in this population was identified as a priority issue by members of a subcommittee of the Children's International Project on Children's Palliative/Hospice Services, created under the auspices of the National Hospice Organization. Committee members, based on their clinical, research, and personal experiences, identified several aspects relevant to spirituality in general, and to spirituality in pediatric palliative care in particular, and developed guidelines for clinicians in pediatric palliative care.

by Davies B, Brenner P, Orloff S, Sumner L, Worden W (Department of Family Health Care Nursing, School of Nursing, University of California, San Francisco, California, USA) Journal of

Palliative Care [2002, 18(1):59-67] at http://europepmc.org/abstract/med/12001404

Spiritually Sensitive “Care” 1

•Assessment of patient/family spirituality does not involve “judging” the rightness or wrongness of that spirituality (although potentially negative health effects need to be “noted” – see next slide)

• Primarily it involves assessing how that spirituality can be enlisted in the “healing” process and

•whether that healing process might involve facilitation of a “cure” or enhancement of ability to cope with a chronic illness or impending death.


•As noted previously, may occasionally involve a determination that an aspect of the patient’s/ family’s spirituality, or that of their spiritual community, is potentially harmful to health

•And requires intervention of some kind

•And will involve determining the who and the how of the intervention.


•Will ensure that a spiritual care department is available, with trained and competent chaplains (increasingly called spiritual care practitioners – with original formation in a particular religious/spiritual traditions and specialized training in the provision of care across the broad spectrum of religious/spiritual traditions) to assist patients and their families and to be a resource to staff.


•Will ensure access of the patient’s and/or family’s spiritual community through that community’s actual or symbolic presence at the bedside (subject of course to the wishes of the patient/family and to the constraints of the medical-surgical situation).


•Will occasionally require that staff who are not adherents of the religion/spirituality of the patient and/or their family may be called upon to function in innovative ways that meet the needs of the patient/family in unusual and/or emergency situations (e.g. baptism in extremis).


•Will involve systemic thinking at the level of institutional organization and planning concerning how spiritual needs might be met in such a way as to enhance healing and hope – for persons seeking care/cure and for those engaged in providing “care” and doing their best to ensure “cure.”

Appendix 1: Spiritually Sensitive “Care”Gauger, Robert W. (2014) The Girl with the Halo. Journal of Pastoral Care &

Counseling, Vol 68:2.

Appendix 2: Spiritually Sensitive “Care”Jones, Logan C. (2014) A Prayer for Healing Denied, Journal of Pastoral

Care & Counseling, Vol 68:3.

Appendix 3: Spiritually Sensitive “Care”Eddins, Sharon L., Grogan, Nancy, and Frick, Brandon. (2014) Healing and Belonging: Godly Play in

Pediatric Medicine and the Theology of Disability. Journal of Pastoral Care & Counseling, Vol 68:3.

Appendix 4: Spiritually Sensitive “Care”Seifter, Julian L. (March, 2014) Correlation or Causation? Our Search for

Certainty. Medscape at ttp://www.medscape.com/viewarticle/840932

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