What is spirituality?
Spirituality has been defined in numerous ways, including 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, values. It's the way you find meaning, hope, comfort, and inner peace in your life. Although spirituality is often associated with religion, personal spirituality can also be developed through music, art or a connection with nature. People also find spirituality through acts of compassion and selflessness, altruism, and the experience of inner peace.
Many Americans are becoming interested in the role of spirituality in their health and health care, perhaps because of dissatisfaction with the impersonal nature of our current medical system, and the realization that medical science does not have answers to every question about health and wellness.
What is the history of spirituality and health care?
In most healing traditions, and in the beginnings of Western medicine, concerns of the body and spirit were intertwined. But with the coming of the scientific revolution and enlightenment, these 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 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 10 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 to 66% 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 clinical 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 prone to illness. In a 35 year clinical 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. Another 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. Studies show that a close network of family and friends that lends help and emotional support offers protection against many diseases. Researchers believe that people who experience love and support tend to resist unhealthy behaviors and feel less stressed. In a clinical 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 they believe prayer helps people, and 67% reported praying for a patient. Researchers are also studying 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). 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 there is benefit. Compared to those who were not prayed for, people 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?
Programs with a strong spiritual component, such as Alcoholics Anonymous (AA), show that spiritual disciplines may be especially effective for drug and alcohol addiction. The regular practice of prayer and meditation is strongly associated with recovery and abstinence from drugs.
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.
One clinical study at Duke University found that people who attend regular religious services tend to have better immune function. In another clinical study of 232 older adults undergoing heart surgery, those who were religious were 3 times less likely to die within the 6 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.
What is the future of spirituality in medical practice?
Many 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. Interesting research is also emerging regarding the impact of religion and spirituality (both the child's and the parents') on the health of children and adolescents.
Benson H, Dusek JA, Sherwood JB, et al., Study of the Therapeutic Effects of Intercessory Prayer (STEP) in cardiac bypass patients: a multicenter randomized trial of uncertainty and certainty of receiving intercessory prayer. Am Heart J. 2006;151(4):934-42.
Bormann JE, Smith TL, Becker S, et al., Efficacy of frequent mantram repetition on stress, quality of life, and spiritual well-being in veterans: a pilot study. J Holist Nurs. 2005;23(4):395-414.
Breitbart W. Spirituality and meaning in supportive care: spirituality- and meaning-centered group psychotherapy interventions in advanced cancer. Support Care Cancer. 2002;10(4):272-80.
Cannon AJ, Darrington DL, Reed EC, Loberiza FR. Spirituality, patient's worry, and follow-up health-care utilization among cancer survivors. J Support Oncol. 2011;9(4):141-8.
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.
Efficace F, Marrone R. Spiritual issues and quality of life assessment in cancer care. Death Stud. 2002;26(9):743-56.
Gaudia G. About intercessory prayer: the scientific study of miracles. MedGenMed. 2007;9(1):56.
Guerrero GP, Zago MM, Sawada NO, Pinto MH. Relationship between spirituality and cancer: patient's perspective. Rev Bras Enferm. 2011;64(1):53-9.
Ikedo F, Gangahar DM, Quader MA, Smith LM. The effects of prayer, relaxation technique during general anesthesia on recovery outcomes following cardiac surgery. Complement Ther Clin Pract. 2007;13(2):85-94.
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.
Kashdan TB, Nezlek JB. Whether, when and how is spirituality related to well-being? Moving beyond single occasion questionnaires to understanding daily process. Pers Soc Psychol Bull. 2012;38(11):1523-35.
Kim SS. Spirituality and psychological well-being: testing a theory of family interdependence among family caregivers and their elders. Res Nurs Health. 2011;34(2):103-15.
Lane JD, Seskevich JE, Pieper CF. Brief meditation training can improve perceived stress and negative mood. Altern Ther Health Med. 2007;13(1):38-44.
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.
Lawler-Row KA, Elliott J. The role of religious activity and spirituality in the health and well-being of older adults. J Health Psychol. 2009;14(1):43-52.
Longo DA, Peterson SM. The role of spiritualiy in psychosocial rehabilitation. Psychiatr Rehabil J. 2002;25(4):333-40.
McCaffrey AM, Eisenberg DM, Legedza AT, Davis RB, Phillips RS. Prayer for health concerns: results of a national survey on prevalence and patterns of use. Arch Intern Med. 2004;164(8):858-62.
McSherry W, Ross L. Dilemmas of spiritual assessment: considerations for nursing practice. J Adv Nurs. 2002;38(5):479-88.
McVay MR. Medicine and spirituality: a simple path to restore compassion in medicine. SDJ Med. 2002;55(11):487-91.
Migdal L, MacDonald DA. Clarifying the relation between spirituality and well-being. J Nerv Ment Dis. 2013;201(4):274-80.
Mofidi M, DeVellis RF, DeVellis BM, Blazer DG, Painter AT, Jordan JM. The relationship between spirituality and depressive symptoms: testing psychosocial mechanisms. J Nerv Ment Dis. 2007;195(8):681-8.
Neff JA, Shorkey CT, Windsor LC. Contrasting faith-based and traditional substance abuse treatment programs. J Subst Abuse Treat. 2006;30(1):49-61.
Nelson CJ, Rosenfeld BJ, Breitbart W, Galietta M. Spirituality, religion, and depression in the terminally ill. Psychosomatics. 2002;43(3):213-20.
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.
Palmer RF, Katerndahl D, Morgan-Kidd J. A randomized trial of the effects of remote intercessory prayer: interactions with personal beliefs on problem-specific outcomes and functional status. J Altern Complement Med. 2004;10(3):438-48.
Puchalski CM. Spirituality in the cancer trajectory. Ann Oncol. 2012;32 Suppl 3:49-55.
Rakel, D. Rakel Integrative Medicine. 2nd ed. Philadelphia, PA: Elsevier Saunders; 2007:82.
Sloan RP, Bagiella E. Claims about religious involvement and health outcomes. Ann Behav Med. 2002;24(1):14-21.
Sloan RP, Ramakrishnan R. Science, medicine, and intercessory prayer. Perspect Biol Med. 2006;49(4):504-14.
Sulmasy DP. Spirituality, religion, and clinical care. Chest. 2009;135(6):1634-42.
Tanyi RA, Werner JS. Spirituality in African American and Caucasian women with end-stage renal disease on hemodialysis treatment. Health Care Women Int. 2007;28(2):141-54.
Thoresen CE, Harris AH. Spirituality and health: what's the evidence and what's needed? Ann Behav Med. 2002;24(1):3-13.
Toneatto T, Nguyen L. Does mindfulness meditation improve anxiety and mood symptoms? A review of the controlled research.Can J Psychiatry. 2007;52(4):260-6.
Turner DD. Just another drug? A philosophical assessment of randomised controlled studies on intercessory prayer.J Med Ethics. 2006;32(8):487-90.
Zemore SE. Helping as healing among recovering alcoholics. South Med J. 2007;100(4):447-50.