Applied Evidence

Allowing spirituality into the healing process

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Practice recommendations
  • Research indicates spirituality and religion are a core aspect of life, and patients want physicians to address issues of spirituality in the context of medical care (C).
  • Studies of the effect of patients’ faith on disease outcomes have shown reduced hypertension, better lipid profiles and lower cholesterol levels, and improved immune function (C).
  • An appropriate model for addressing patients’ spiritual concerns should include active-listening skills, identification of spiritual/emotional issues, effective referrals to “spiritual specialists,” and ongoing communication about this aspect of the healing process (C).
  • Remember, it is all about the patient’s spirituality, not the caregiver’s, and about supporting the patient’s spiritual beliefs (unless clearly pathologic) (C).

Most people have a strong awareness of themselves as spiritual beings. For many, their spirituality profoundly impacts, and is impacted by, illness. A review of studies in which spiritual factors are included suggests spirituality influences the process of healing significantly, either positively or negatively. A healthy spirituality can aid in prevention, improve outcomes, and facilitate coping, and should be supported and encouraged. A negative spirituality can hinder the process of healing and should be addressed.

This article considers means by which physicians may enable patients to express their spiritual concerns and find support for them, without stepping over professional boundaries or imposing personal views on those of patients.

Patients’ regard of spirituality and medical care

According to a myriad surveys, most Americans consider spirituality and religion a significant part of who they are.1,2 Although definitions and expressions vary, in general spirituality is defined as a search for what is sacred or holy in life, coupled with a transcendent (greater than self) relationship with God or a higher power or universal energy.3 Religion is seen as focusing more on prescribed beliefs, rituals, and practices as well as social institutional features,4 and on the undertaking of a spiritual search using specific means or methods (ie, rituals or behaviors) within an identifiable group.

Research in the field indicates that spirituality and religion are seen as a core aspect of life, and patients want physicians to address issues of spirituality in the context of medical care.5,6 A public survey done in 1996 by USA Weekend showed that 63% of patients believe doctors should ask about spirituality issues, but only 10% have actually been asked.2 In another study, 77% of patients surveyed said physicians should consider patients’ spiritual needs, and 37% wanted physicians to discuss religious beliefs with them more frequently.7

Intertwining of medicine and spirituality

The relationship of the discipline of medicine with the world of spirituality has been long and varied. The beginning of medicine was deeply imbedded in spirituality with spiritual leaders being some of the earliest “healers.”

A chasm forms

With the advent of the scientific revolution and the emergence of the scientific method in the late 1500s, the relationship between spirituality and science changed dramatically. Since this new experimental method could not be readily or confidently applied to God, or to one’s experiences with God, religion/spirituality was excluded from the realm of science and a chasm emerged between the 2 realms.

The chasm widened given the religious community’s tendency to reject many of the discoveries generated by the scientific method. Distrust, even dislike, of the spiritual by the medical community became widespread. Mandel, in The Psychobiology of Consciousness, calls spirituality a “temporal lobe dysfunction.”8 Perhaps more telling was the use of spirituality in the glossary of technical terms in Diagnostic and Statistical Manual of Mental Disorders, revised 3rd edition (DSM-III-R).9 In that document, all allusions to spirituality were illustrations of psychopathology; 22.2% of all the negative illustrations in the glossary had religious content, while none had sexual, ethnic, racial, or cultural content.

This negativity was exacerbated by an ever-increasing emphasis on the science of medicine, reflecting the exponential growth of scientific knowledge relevant to medical practice, the public’s demand for technologically sophisticated medical care, and an increased emphasis on tools such as evidence-based medicine. Medical practice became centered on the task of choosing treatments proven effective through rigorous study. Aspects of the “art of medicine” that had not undergone rigid empirical evaluation were considered suspect and deemed unworthy of inclusion in medical practice.

Spanning the chasm

However, a new interest in the integration of medicine and spirituality has emerged. One reflection of this interest is the discussion of the topic in both popular and professional journals. A search by Oregon Health and Science University faculty in 1999 of a large public library database of popular magazines using the key words “spirituality and health” revealed only 25 articles from 1990 to 1994, but over 100 articles from 1995 to 1999.

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