Spirituality And Medicine Must Find Common Ground in The New Healthcare Era
Mr. Seidl is senior associate, pastoral care, Catholic Health Association, St. Louis.
Summary
Spiritual health is that aspect of our well-being which organizes the values, the relationships, and the meaning and purpose of our lives. Patients and healthcare professionals alive have experienced a growing recognition of the importance of spiritual health as a foundation for physical health and well-being.
As a reformed healthcare system places greater emphasis on etiology and prevention as opposed to relief of symptoms, creative and holistic partnerships between the medical profession and spiritual care givers can and will emerge. In studying the etiology of illnesses, healthcare providers must examine the underlying social problems of the day: violence, divorce, unemployment, and a host of other factors that lead to disintegrating relationships.
In the past many physicians and nurses refrained from discussing spiritual matters with patients. But given the importance of the relationship between physical and spiritual well-being, providers must make spiritual assessments at the time of any triage. The medical record needs to include references to the patient's spiritual history. And healthcare institutions must seek partnerships with community organizations and leaders to monitor the effects of societal issues that lead to physical and spiritual distress.
In the reformed healthcare system of tomorrow, where all persons have access to healthcare, the care of the poor that currently differentiates Catholic healthcare providers from some others may require less emphasis. As Catholic healthcare enters the next generation of the healing ministry, providers will need to reexamine the mission that drives their work.
An important aspect of the new role of Catholic healthcare providers will be an increased focus on spiritual healing as a precursor to emotional and physical healing. Instead of trying to cure patients after they have been struck by disease or illness—"putting Humpty Dumpty together again"—we will be stretching to the top of the wall to examine the cultural and psychospiritual circumstances that caused him to fall in the first place.
A Spiritual Foundation
The definition of spiritual health is both obvious and elusive. Like health itself, spiritual health can only be defined incompletely. It is often viewed in terms of certain characteristics, such as those listed in "Characterics of Spiritual Health" at the end of this article. In the context of this article, however, I would define spiritual health as that aspect of our well-being which organizes the values, the relationships, and the meaning and purpose of our lives. This well-being motivates individuals to care for themselves and optimize their health so they can serve their community and God.
Patients and healthcare professionals alike have experienced a growing recognition of the importance of spiritual health as a foundation for physical health and emotional well-being. The history of the relationship between spirituality and medicine has been filled with potential but clouded by accusations of superstition, parochialism, and the general conservatism of each discipline. Too much energy has been devoted to naming what belongs to the realm of faith and what belongs to the realm of science. For example, the Index Medicus, the index of articles relating to medicine, has no listings for spirituality, meditation, or religion, despite their recognized value in maintaining health.
As a reformed healthcare system places greater emphasis on etiology and prevention as opposed to relief of symptoms, creative and holistic partnerships between the medical profession and spiritual care givers can and will emerge. The opportunities for fusing the causes of scientific medicine and spiritual enlightenment have never been stronger.
Recent evidence confirms what the ancient Greeks knew 2,000 years ago: A person's well-being is indicative of a cohesive relationship between body, mind, and soul. The Hebrew community referred to these three elements as the material, the relational, and the transcendent. Indeed, the early concepts of holistic care emerged from the Greek and Hebrew cultures. The Greek root of the word "cure" is translated as "repair of the fractured soul," whereas the word "nurse" finds its roots in "a nurturing of the human spirit." In some early cultures the connections between body and spirit were so clear that they viewed illness as a punishment from God for some violation. Unfortunately, this view persists in some circles, particularly with regard to AIDS.
Today, instead of blaming God as the fundamental distributor of illness, many in our society blame individuals for causing their own disease. However, behavior and life-style are just one part of what makes us sick or keeps us well. Many other factors, such as genetic and environmental factors, must also be considered. Regretfully few healthcare professionals have incorporated this balance into their practices. The result—an unchecked sense of guilt for one's own role in an illness—can lead to psychospiritual effects that only add to the patient's suffering, rather than relieving the pain and enabling him or her to move toward wellness.
New Roles and Expectations
In the twenty-first century, as our society better understands the relationship between physical dysfunction and spiritual health, we will begin to create new roles and expectations for a holistically oriented healthcare delivery system. Some advocates of alternative medicine—medical practices that fall outside the traditional delivery system—have pointed to the fractured nature of human existence as the leading cause of illness and death. However, they have had less success in demonstrating the value of spiritual care within a traditional medical model.
At the dawning of a new era of healthcare delivery, the time is ripe to reinvestigate and recommit the healthcare system to a more balanced and holistic approach to treatment. The commitment needs to take place not only among spiritual care givers, but also among boards, administrators, physicians, nurses, and other medical staff.
In studying the etiology of illnesses, healthcare providers must examine the underlying social problems of the day: violence, divorce, unemployment, lack of meaningful time between parents and children, and a host of other factors that lead to disintegrating relationships. Each of these social and family problems will, given time, wind up on the front steps of the nation's emergency rooms and clinics.
Our healthcare system must be prepared to treat those with existential cancer as well as physical cancer. For example, studies have shown that rates of heart disease, cancer, alcoholism, and accidents are remarkably higher in divorced white men than in their married counterparts. Statistics also show increased rates of homicide, suicide, and heart attacks by those recently unemployed. And national statistics continue to reflect the effects of the nuclear family's breakdown: 135,000 American children go to school with a deadly weapon every day, a child runs away from home every 26 seconds, and a teenager has a baby every 120 seconds.
Spiritual Care
The physical heart continues to bear the wounds of a cold and often fatalistic society. Therefore the cure lies not only in treating patients with bandages and drugs but also in helping them understand the meaning of the illness and to make appropriate life-style changes.
In the past many physicians and nurses refrained from discussing spiritual matters with patients because they did not want to get into questions about belief in God and church attendance. But as the scope of spirituality moves beyond religiosity, issues related to spiritual health can be translated into questions such as the following:
- What in your life is important and meaningful?
- What keeps you going when the chips are down?
- What do you still wish to accomplish in life?
For many people, an illness or hospitalization raises grave questions about mortality and the meaning of life. As a result, many persons who become ill are receptive to healthcare providers who can connect their physical symptoms to an underlying spiritual or moral disenfranchisement.
Given the importance of the relationship between physical and spiritual well-being, care givers must ensure that efforts to connect body, mind, and soul do not become only body-mind conversations. Providers must make spiritual assessments at the time of any triage. And the medical record needs to include references to a patient's spiritual history so that physicians, nurses, and social workers can help foster his or her spiritual health. The chaplain's role will be to support these efforts through consultation, training, and direct intervention when necessary.
Furthermore, healthcare institutions must seek partnerships with community organizations and leaders to monitor the effects of societal issues that can lead to spiritual and physical distress. The healthcare community cannot be expected to take full responsibility for all the social and cultural ills of society. On the other hand, they cannot ignore them.
In the near future, we may know enough to list the leading causes of death as lack of meaning, belonging, the will to live, and self-esteem, rather than current causes such as cancer and stroke. These are not physical questions but spiritual issues, and a reformed healthcare system committed to becoming more holistic cannot ignore the spiritual in the process of healing.
Characteristics of Spiritual Health
- Is free of addictive habits
- Finds fulfillment in self, others, work, and leisure
- Accepts the limitations of humanity
- Takes time to meditate or communicate with the Holy
- Finds illness as enabling, not disabling
- Knows mortality to be inescapable yet redeeming
- Investigates and interprets illness within the context of meaning
- Balances dependence and freedom
- Uses health to serve others
- Balances the spiritual with the physical and emotional
- Takes responsibility for health
Lessons for Spiritual Health
As the healthcare system moves from a traditional medical model to a more culturally sensitive and holistic model, several lessons may be critical:
- Illness is often a metaphor for what is out of sync in our lives.
- Often illness is not an event but a process, which likely began months or years before the appearance of physical manifestations of disease.
- Resentment, anger, jealousy, anxiety, and unresolved grief are the silent and relentless precursors to illness.
- Social support, affirmation, and a positive outlook have a beneficial effect on the healing process.
- There is a vital relationship between spirituality and health, well-being, and susceptibility to disease.
- The key element to the healing process often lies within oneself.
Resources for Spiritual Health
Spiritual Assessment Tools
George Fitchett, "Spiritual Assessment in Pastoral Care" (monograph), Journal of Pastoral Care, Decatur, GA, 1993
Sr. Ruth Kerrigan and Joan T. Harkulich, "A Spiritual Tool," Health Progress, May 1993, pp. 46-49
Quality Assurance and Pastoral Care, Catholic Health Association, St. Louis, 1990
Roy B. Nash, Life's Major Spiritual Issues: An Emerging Framework for Spiritual Assessment and Pastoral Diagnosis, Memorial Medical Center, Springfield, IL, 1989
Spirituality and Medicine Books
Justice Blair, Who Gets Sick, Tarcher Publishing, Los Angeles, 1988
Richard Carlson, Healers on Healing, Tarcher Publishing, Los Angeles, 1989
Lawrence Dossey, Recovering the Soul, Bantam Books, New York City, 1989
Thomas Droege, The Faith Factor in Healing, Trinity Press, Philadelphia, 1991
Judith Shelly and Sharon Fish, Spiritual Care: The Nurse's Role, Intervarsity Press, Downer's Grove, IL, 1988