What is spirituality?
Spirituality has been defined in numerous ways. These include: a belief in a power operating in the universe that is greater than oneself; a sense of interconnectedness with all living creatures; and an awareness of the purpose and meaning of life and the development of personal, absolute values. Although spirituality is often associated with religious life, many believe that personal spirituality can be developed outside of religion. Acts of compassion and selflessness, altruism, and the experience of inner peace are all characteristics of spirituality. Many Americans are becoming interested in the role of spirituality in their health and healthcare. This may be because of dissatisfaction with the impersonal nature of our current medical system, and the realization that medical science does not have answers to all questions about health and wellness.
What is the history of spirituality and healthcare?
In most healing traditions and through generations of healers in the early beginnings of Western medicine, concerns of the body and spirit were intertwined. But with the coming of the scientific revolution and the Enlightenment, non-rational considerations were removed from the medical system. Today, however, a growing number of studies reveal that spirituality may play a bigger role in the healing process than the medical community had previously thought.
How does spirituality influence health?
Spiritual practices tend to improve coping skills and social support, foster feelings of optimism and hope, promote healthy behavior, reduce feelings of depression and anxiety, and encourage a sense of relaxation. By alleviating stressful feelings and promoting healing ones, spirituality can positively influence immune, cardiovascular (heart and blood vessels), hormonal, and nervous systems. An example of a religion that promotes a healthy lifestyle is Seventh Day Adventists. Those who follow this religion, a particularly healthy population, are instructed by their Church not to consume alcohol, eat pork, or smoke tobacco. In a ten-year study of Seventh-Day Adventists in the Netherlands, researchers found that Adventist men lived 8.9 years longer than the national average, and Adventist women lived 3.6 years longer. For both men and women, the chance of dying from cancer or heart disease was 60 and 66 percent less, respectively, than the national average.
Again, the health benefits of religion and spirituality do not stem solely from healthy lifestyles. Many researchers believe that certain beliefs, attitudes, and practices associated with being a spiritual person influence health. In a recent study of people with acquired immune deficiency syndrome (AIDS), those who had faith in God, compassion toward others, a sense of inner peace, and were religious had a better chance of surviving for a long time than those who did not live with such belief systems. Qualities like faith, hope, and forgiveness and the use of social support and prayer seem to have a noticeable effect on health and healing.
- Faith. A person's most deeply held beliefs strongly influence his or her health. Some researchers believe that faith increases the body's resistance to stress. In a 1988 study of women undergoing breast biopsies, the women with the lowest stress hormone levels were those who used their faith and prayer to cope with stress.
- Hope. Without hope—a positive attitude that a person assumes in the face of difficulty—many people become depressed and are more prone to illness. In a 35-year study of Harvard graduates, researchers found that those graduates who expressed hope and optimism lived longer and had fewer illnesses in their lifetime.
- Forgiveness. A practice that is encouraged by many spiritual and religious traditions, forgiveness is a release of hostility and resentment from past hurts. In 1997, a Stanford University study found that college students trained to forgive someone who had hurt them were significantly less angry, more hopeful, and better able to deal with emotions than students not trained to forgive. A more recent survey of 1,400 adults found that willingness to forgive oneself and others and the feeling that one is forgiven by God have beneficial health effects. Some researchers suggest that emotions like anger and resentment cause stress hormones to accumulate in the blood, and that forgiveness reduces this build-up.
- Love and Social Support. A close network of family and friends that lends help and emotional support has been found to offer protection against many diseases. Researchers believe that people who experience love and support tend to resist unhealthy behaviors and feel less stressed. In a study of a close-knit Italian-American community in Pennsylvania, researchers found that the death rate from heart attack was half that of the United States' average. Researchers concluded that the strong social support network helped protect this population from heart disease.
- Prayer. The act of putting oneself in the presence of or conversing with a higher power has been used as a means of healing across all cultures throughout the ages. Today, many Americans believe that prayer is an important part of daily life. In a 1996 poll, one half of doctors reported that they believe prayer helps patients, and 67 percent reported praying for a patient. Intercessory prayer (asking a higher power to intervene on behalf of another either known or unknown to the person praying; also called distance prayer or distance healing) is also being studied. Although it is particularly difficult to study the effect of distance prayer, current research in coronary care units (intensive care units in hospitals devoted to people with severe heart disease, like those who just suffered a heart attack) suggests that there is benefit. Compared to those who were not prayed for, patients who were prayed for showed general improvements in the course of their illness, less complications, and even fewer deaths.
What illnesses and conditions respond well to spirituality?
As programs with a strong spiritual component, such as Alcoholics Anonymous, show, spiritual disciplines may be especially effective for drug and alcohol addiction.
Results from several studies indicate that people with strong religious and spiritual beliefs heal faster from surgery, are less anxious and depressed, have lower blood pressure, and cope better with chronic illnesses such as arthritis, diabetes, heart disease, cancer, and spinal cord injury. In addition, new research is also suggesting that distance healing (see earlier explanation) can help reduce pain, swelling, and tenderness in those with rheumatoid arthritis, improve the outcome for a person who just had a heart attack, and increase pregnancy rates for infertile couples.
One study at Duke University found that people who attend regular religious services tend to have better immune function. In another study of 232 older adults undergoing heart surgery, those who were religious were three times less likely to die within the six months after surgery than those who were not. Not one of the 37 people in this study who described themselves as deeply religious died. Of course, the studies are not comprehensive and many people find help in spiritual resources for numerous conditions.
Can spirituality have a negative impact on health?
Some experts warn that religious beliefs can be harmful when they encourage excessive guilt, fear, and lowered self-worth. Similarly, physicians should avoid advocating for particular spiritual practices; this can be inappropriate, intrusive, and induce a feeling of guilt or even harm if the implication is that ill health is a result of insufficient faith. It is also important to note that spirituality does not guarantee health. Finally, there is the risk that people may substitute prayer for medical care or that spiritual practice could delay the receipt of necessary medical treatment.
How can I receive spiritual counseling when I am in the hospital?
Many hospitals have access to counselors from organized religions. If you would like spiritual counseling or someone to pray with, ask your doctor to refer a counselor.
Where can I find more information on spirituality and health?
To learn more about spirituality's role in health (including the latest research on this topic), call the National Institute for Healthcare Research at 301-984-7162, or visit their
website at www.nihr.org.
What is the future of spirituality in medical practice?
Thus far, more than 30 medical schools in the United States have included spiritual teachings in their curricula. However, what role, if any, a doctor should play in assisting or guiding patients in spiritual matters remains controversial. In addition, given that there appears to be a growing belief in the connection between spirituality and health, scientists in this field feel that research should begin to focus on assessing the validity of this connection, a better understanding of why there is this connection and how it works. There is also interesting research emerging that evaluates the impact of religion and spirituality (both the child's and the parents') on the health of children and adolescents.
Abbot NC, Harkness EF, Stevinson C, Marshall FP, Conn DA, Ernst E. Spiritual healing as a therapy for chronic pain: a randomized, clinical trial. Pain 2001;91(1-2):79-89.
Astin JA, Harkness E, Ernst E. The efficacy of "distant healing": a systematic review of randomized trials. Ann Intern Med. 2000;132(11):903-910.
Aviles JM, Whelan E, Hernke DA, et al. Intercessory prayer and cardiovascular disease progression in a coronary care unit population. a randomized controlled trial. Mayo Clin Proc. 2001;76:1192-1198.
Barnes LL, Plotnikoff GA, Fox K, Pendleton S. Spirituality, religion, and pediatrics: intersecting worlds of healing. Pediatrics. 2000;106(4 Suppl):899-908
Breitbart W. Spirituality and meaning in supportive care: spirituality- and meaning-centered group psychotherapy interventions in advanced cancer. Support Care Cancer. 2002;10(4):272-280.
Byrd RC. Positive therapeutic effects of intercessory prayer in a coronary unit population. South Med J. 1988;81(7):826-829.
Cha KY, Wirth DP, Lobo RA. Does prayer influence the success of in vitro fertilization –embryo transfer? Report of a masked, randomized Trial. J Repro Med.2001;46(9):781-787.
Crowther MR, Parker MW, Achenbaum WA, Larimore WL, Koenig HG. Rowe and Kahn's model of successful aging revisited: positive spirituality--the forgotten factor. Gerontologist.;42(5):613-620.
Davies B, Brenner P, Orloff S, Sumner L, Worden W. Addressing spirituality in pediatric hospice and palliative care. J Palliat Care. 2002;18(1):59-67.
Desai PP, Ng JB, Bryant SG. Care of children and families in the CICU: A focus on their developmental, psychosocial, and spiritual needs. Crit Care Nurs Q. 2002;25(3):88-97.
Dossey L. Healing Words: The Power of Prayer and the Practice of Medicine. San Francisco, Calif: Harper; 1993.
Dunn KS, Horgas AL. The prevalence of prayer as a spiritual self-care modality in elders. J Holist Nurs. 2000;18(4):337-351.
Efficace F, Marrone R. Spiritual issues and quality of life assessment in cancer care. Death Stud. 2002;26(9):743-756.
Ehman JW, Ott BB, Short TH, Ciampa RC, Hansen-Flaschen J. Do patients want physicians to inquire about their spiritual or religious beliefs if they become gravely ill? Arch Intern Med. 1999;159(15):1803-1806.
Gundersen L. Faith and healing [editorial]. Ann Intern Med. 2000;132(2):169-172.
Harris WS, Gowda M, Kolb JW, et al. A randomized, controlled trial of the effects of remote, intercessory prayer on outcomes in patients admitted to the coronary care unit. Arch Intern Med. 1999;159(19):2273-2278.
Ironson G, Solomon GF, Balbin, et al. The Ironson-woods Spirituality/Religiousness Index is associated with long survival, health behaviors, less distress, and low cortisol in people with HIV/AIDS. AnnBehav Med. 2002;24(1):34-48.
Jonas WB. The middle way: realistic randomized controlled trials for the evaluation of spiritual healing. J Comp Alt Med. 2001;7:5-7.
Koenig HG. Religion, spirituality, and medicine: how are they related and what does it mean? Mayo Clin Proc. 2001;76:1189-1191.
Koenig HG. Spiritual healing and prayer. In: Novey DW, ed. Clinician's Complete Reference to Complementary and Alternative Medicine. St. Louis, Mo: Mosby; 2000:130-140.
Koenig HG, McCullough ME, Larson DB. Handbook of Religion and Health. Oxford, England: Oxford University Press; 2001.
Krucoff MW. Mitchell W. Krucoff, MD: the MANTRA study project. Altern Ther Health Med. 1999;5(3):75-82.
Krucoff MW, Crater SW, Green CL, et al. Integrative noetic therapies as adjuncts to percutaneous intervention during unstable coronary syndromes: monitoring and actualization of noetic training (MANTRA) feasibility pilot. Am Heart J. 2001;142(5):760-767.
Larimore WL, Parker M, Crowther M. Should clinicians incorporate positive spirituality into their practices? What does the evidence say? Ann Behav Med.2002;24(1):69-73.
Longo DA, Peterson SM. The role of spiritualiy in psychosocial rehabilitation. Psychiatr Rehabil J. 2002;25(4):333-340.
Masek K, Petrovicky P, Sevcik J, Zidek Z, Frankova D. Past, present and future of psychoneuroimmunology. Toxicology. 2000;142(3):179-188.
Matthews DA. Prayer and spirituality. Rheum Dis Clin North Am. 2000;26(1):177-187.
Matthews DA, Marlowe SM, MacNutt FS. Effects of intercessory prayer on patients with rheumatoid arthritis. South Med J. 2000;93(12):1177-1186.
McSherry W, Ross L. Dilemmas of spiritual assessment: considerations for nursing practice. J Adv Nurs .2002;38(5):479-488.
McVay MR. Medicine and spirituality: a simple path to restore compassion in medicine. SDJ Med. 2002;55(11):487-491.
Nelson CJ, Rosenfeld BJ, Breitbart W, Galietta M. Spirituality, religion, and depression in the terminally ill. Psychosomatics. 2002;43(3):213-220.
Newlin K, Knafl K, Melkus GD. African-American spirituality: a concept analysis. ANS Adv Nurs Sci. 2002;25(2):57-70.
O'Hara DP. Is there a role for prayer and spirituality in health care? Med Clin North Am. 2002 ;86(1):33-46, vi.
Post SG, Puchalski CM, Larson DB. Physicians and patient spirituality: professional boundaries, competency, and ethics. Ann Intern Med. 2000;132(7):578-583.
Rosner F. Religion and medicine [commentary]. Arch Intern Med. 2001;161:1811-1812.
Schuster M, Stein BD, Jaycox L, et al. A national survey of stress reactions after the September 11, 2001, terrorist attacks. NEJM. 2001;345:1507-1512.
Sicher F, Targ E, Moore D II, Smith HS. A randomized double-blind study of the effect of distant healing in a population with advanced AIDS. West J Med. 1998;169(6):356-363.
Sloan RP, Bagiella E. Claims about religious involvement and health outcomes. Ann Behav Med. 2002;24(1):14-21.
Sloan RP, Bagiella E, VandeCreek L, et al. Should physicians prescribe religious activities? N Engl J Med. 2000;342(25):1913-1916.
Sulmasy DP. A biopsychosocial-spiritual model for the care of patients at the end of life.
Gerontologist. 2002;42 Spec No 3:24-33.
Thoresen CE, Harris AH. Spirituality and health: what's the evidence and what's needed? Ann Behav Med. 2002;24(1):3-13.
Toussaint LL. Forgiveness and health: age difference in a US probability sample. J Adult Dev. 2001;8:249-257.