Allowing spirituality into the healing process

In some cases it will be clear that the patient is spiritual, and that spirituality is a very positive factor in the effort to find wholeness. What these patients need is support, an affirmation that what they are doing is working. They need permission to bring their spirituality into the exam and treatment space as a powerful resource for wellness.^35,36 If, for example, a patient is coping well and is maintaining a sense of purpose in the face of a debilitating illness, they should be commended for that, and the coping mechanisms that support that stance should be reinforced.

TABLE 3
Emotional continuums used in spiritual assessment

Collaborative intervention

Collaboration begins with the patient. The physician must be clear that this is all about the patient’s spirituality (not their own) and support the spiritual beliefs of the patient, working within the framework of those beliefs (unless clearly pathological). But there are many others who can be brought into the therapeutic process. Providers can collaborate with “spiritual specialists,” such as the patient’s spiritual leader or the hospital chaplains. Other collaborators may include social workers, mental health specialists, or even a group of some sort. Research suggests social support is a key factor that leads to improved outcomes.¹¹

Many options are available for intervention. Connecting the patient with a religious leader or “spiritual specialist” is often very appropriate. In hospital settings, chaplains are a good place to begin. In a community-based setting, the patient’s own spiritual leader or, if the patient is not affiliated with any specific group, a spiritual specialist who is willing to work from the patient’s perspective is often the most viable option. Support groups, study groups, worship experiences all can be a part of this strategy. The use of literature and tapes, prayer (best done with a religious professional if possible) are relatively easy responses to spiritual distress. Appointments with various professional “healers” such as social workers and psychologists may also be helpful, and in some cases necessary.

Follow-up is also critical in working with patients. To bring up such sensitive issues as spiritual matters, and then not show a continued interest in them would be detrimental. The physician should return to the issue(s) in following visits, until it is clear that the patient is moving toward resolution, or until the patient indicates they would like to drop the issue. Communication should continue to take place, if possible, between the physician and others working with the patient. Ongoing dialogue with chaplains, religious leaders, therapists, and others should take place.

Pursuing, not avoiding, integration

We are still early in the process of studying and understanding the complex relationship between spirituality and health. Much more research needs to be done to clarify the benefits and dispel the myths. What is it about spirituality and religious practice that benefits patients? Is it, as some have suggested, merely a matter of lifestyle or compliance? Or is there something deeper and more profound involved? When is religious or spiritual coping positive, and when is it negative?

A continued research agenda focusing on the impact of spirituality on health is needed. There is also a need to look at viable assessment tools, as well as appropriate interventions. Perhaps the issue of intervention is the most difficult challenge. What is appropriate? What can be done given time constraints, the need for boundaries, and limited training? Most research to date has focused on the existing spirituality of patients. Research that looks at the impact of practical spiritual interventions, such as spiritual listening, referral to a spiritual specialist, or prayer is needed to move integration to a new stage.

Careful attention to such issues can move us forward in the task of providing effective and humane care to patients. This task is increasingly important in today’s medical environment. As theologian Martin E. Marty notes, “The modern biomedical enterprise—with its threefold work of knowledge acquisition, technology development, and care delivery—urgently needs the guiding visions and values embodied in the faith traditions. When technological momentum or economic necessity alone guides the health care enterprise, the sustaining impulses of respect, meaning and purpose often fall aside.”³⁷

The process of learning how to integrate medicine and spirituality is not an easy one, nor will it be accomplished without struggle. But it is a process vitally important for modern medicine. The issue truly is one of caring, both when cure is possible, and when it is not. It is a matter of focusing on part of what makes us truly human, and supporting a healing process that often transcends the biomedical agenda.