Integrating Spirituality in the Healthcare Setting

A message from Philip J. Boyle (Editor in Chief of the Park Ridge Center Bulletin) 
 

“ I’m not religious, but I am spiritual” is a remark that I—probably just like you—hear with increasing frequency. I’m never sure exactly what the speaker means by the word “spirituality” and I sometimes wonder about those who want to import spirituality into healthcare. What would healthcare look like if spirituality were more explicitly a part of it? Would we all be better off?

Fortunately, the Park Ridge Center was able to explore these and related questions when, in 1998, we collaborated with the Fetzer Institute on the project “Spiritual Resources in the Healthcare Setting”. This issue of the Bulletin emerges from that initiative, an attempt to understand how spirituality is characterized and map its implications—medical, social, and ethical—in fabric of healthcare.

Aside from puzzling over what the term spirituality has meant, what it means now, and what motivates the expanding interest in it, project participants warned that the recent rush to integrate spirituality into health care risks reducing spirituality to one more instrumental good supporting improved health outcomes. For instance, some studies suggest that religious activity can lower blood pressure and fortify the immune system. The danger of such studies is that they may oversimplify the value of spirituality by treating it strictly in terms of its usefulness to health. In contrast, project participants pointed out that spirituality promotes outcomes such as inner resiliency, detachment, and theological creativity, but necessarily cure from physical disease.

The project, and this Bulletin, sketches out some of the moral questions that are embedded in attempts to integrate spirituality into health care. It is a useful thought experiment to imagine this integration through the perspective of the different moral actors who inhabit modern health care. Imagine yourself as a healthcare professional. If you have little interest in spirituality but are faced with patients who seek spiritual help, should you fake a prayer or ritual even though you don’t believe? Is your integrity diminished if you merely go through the motions? On the other hand, if you are a healthcare provider with spiritual interest, should you engage a patient in some spiritual practice if you don’t have sufficient time or ability to deal with it? How far should the healthcare provider go to positive health outcomes, or if the patients have different spiritual practices? Whether you engage in a spiritual practice or not, what re your professional obligations to offer it and be trained in the various spiritualities?

Alternatively, imagine yourself as a healthcare leader, such as an executive or trustee. What should motivate your organization to spend resources spirituality—because the organization must be sensitive to the market, improve employee and patient satisfaction, or fulfill its mission? Are you off the hook if yours is a secular non-religious organization? Should professionals other than pastoral care staff attend to spirituality? How adept should each group be with spirituality and how should the organization go about reaching spirituality to these groups—if it can be done at all? Finally, what institutional safeguards are necessary to avoid coercive practices?

Even if you cannot imagine yourself working within healthcare, as a citizen you might want to imagine what the posture of society ought to be towards spirituality through publicly funded organizations, government regulations, and incentives. Suppose, as our project group conjectured, that spirituality is a basic human good because it helps individuals and societies flourish. What is society’s obligation to promote the good of spirituality, what some philosophers term the “good of religion”? If spirituality is a basic human good like health and education, who ought to promote it?

While these are only first steps into this murky area, the initial lesion is clear. In the rush to integrate spirituality into healthcare setting, the moral questions imbedded in the practice require us to think first so we can honor the value of primum non nocere--Above all, do no harm.

 

The Power of Her Simple Presence

From No Enemies Within By Dawna Markova  

When I was in the hospital, the one person whose presence I welcomed was a woman who came to sweep the floors with a large push broom. She was the only one who didn’t stick things in, take things out, or ask stupid questions. For a few minutes each night, this immense Jamaican woman rested her broom against the wall and sank her body into the turquoise plastic chair in my room. All I heard was the sound of her breath in and out, in and out. It was comforting in a strange way. My own breathing calmed. Of the fifty or so people that made contact with me in any given day, she was the only one who wasn’t trying to change me.

One night she reached out and put her hand on the top of my shoulder. I’m not usually comfortable with casual touch, but her hand felt so natural being there. It happened to be one of the few places in my body that didn’t hurt. I could have sworn she was saying two words with each breath, one on the inhale, one on exhale: “ As . . . Is . . . As . . .Is. . . ?

On her next visit, she looked at me. No evaluation, no trying to figure me out. She just looked and saw me. Then she said simply,” You’re more than the sickness in that body.” I was pretty doped up, so I wasn’t sure I understood her; but my mind was just too thick to ask questions.

I kept mumbling those words to myself throughout the following day, “ I’m more than the sickness in this body. I’m more than the suffering in this body.” I remember her voice clearly. It was rich deep, full, like maple syrup in the spring. I reached out for her hand. It was cool and dry. I knew she wouldn’t let go. She continued, “You’re not the fear in that body. You’re more than that fear. Float on it. Float above it. You’re more than that pain.” I began to breathe a little deeper, as I did when I wanted to float in a lake. I remembered floating in Lake George when I was five, floating in the Atlantic Ocean at Coney island when I was seven, floating in the Indian Ocean off the coast if Africa when I was twenty-eight. Without any instruction from me, this Jamaican guide led me to a source of comfort that was wider and deeper than pain or fear.

It’s been fifteen years since I’ve seen the woman with the broom. I’ve never been able to find her. No one could remember her name; but she touched my soul with her compassionate presence and her fingerprints are there still. 
 

Seeking the Sacred 

How exactly, does one define “spirituality”? In his rich account, The Psychology of Religion and Coping: Theory, Research, Practice, Kenneth Pargament seeks to differentiate religious approaches to critical concerns, matters such as death, tragedy, and inequity, from nonreligious. That distinction becomes clear in his definition of religion: “a process, a search for significance in ways related to the sacred.” Spirituality, for Pargament, is a way of describing the central function of religion—the search for the sacred. In this way, he directly links it to religion, thereby challenging those who define spirituality in individualistic terms, apart from any link to organized religion. Pargament changes that spiritual individualists eliminate the sacred from the definition of spirituality, draining the term of meaning. He asks, “What is it, for example, that makes the values of meaning in life, personal growth, or interconnectedness spiritual unless they are somehow sacrilized? How are practices such as guided imagery or meditation more spiritual than other cognitive and behavioral approaches to change unless they are connected to the sacred? Invoking the label ‘spiritual’ adds luster and legitimacy to any number of values and practices, but the label may ultimately lose meaning and power when it is separated from its sacred core” (fn.1, p. 465). 

Kenneth I. Pargament, the Psychology of Religion and Coping: Theory, Research, Practice (New York: The Guilford Press, 1997).