Spirituality

September 28, 2011

Spirituality is not easily defined. By its very nature it is personal and private. Spirituality concerns our human awareness of and relationship to those aspects of life that are intangible. Spirituality involves our awareness of being a part of something greater and more powerful than ourselves, yet something we cannot touch or see. Unlike science, spirituality seeks to know the intangible. It involves a belief in a power outside of our own existence. One definition of spirituality is “my relationship with that which exceeds me utterly.” This definition suggests the relationship of spirituality to the human experience of awe and wonder. It generates our sense of unity with and a reverence for all existence.

Spirituality differs from religion although the two are closely connected. Religion refers to a codified or organized system of beliefs, values, codes of conduct, and rituals. Religious practice is often taken as one indication of the strength of belief or commitment that an individual has to their spiritual life. However, this is found to be an inadequate measure. Spirituality is broader than religious practice and religious practice may sometimes interfere with spiritual awareness.

Current studies suggest that the medical benefits derived from spirituality are directly related to the strength of belief and the intrinsic involvement of the individual in their spiritual commitment. Religious practice in and of itself does not necessarily relate to the depth or strength of one’s faith. Health benefits are derived from the sincerity and importance that the individual attaches to his or her spiritual involvement whatever form this may take.

Spirituality is also concerned with establishing one’s sense of life’s meaning. Meaning derived from spirituality should be differentiated from the philosophical approach to meaning. A philosophical belief finds an existential meaning for a particular life experience. It does not reference any external power or being and is an intellectual understanding. While important, it does not include a spiritual dimension. For many people, spirituality is vital in establishing life’s meaning. More than 70% surveyed reported that religious faith was the most important influence in their lives.

SCIENCE, MEDICINE, AND SPIRITUALITY

The separation of spirituality from health and healing is unique to Western medicine. Throughout time and cultures, spiritual belief and practices were inherently linked with healing practices. The age of enlightenment began the move toward empirical study, which began to dominate much of Western thinking. In the 18th and 19th centuries, science struggled to replace religion as the most appropriate way to understand nature. The scientific method produced discoveries that dramatically changed our lives including our approach to health and illness. While we enjoy the fruits of scientific progress, we are confronted with the negative outcomes from eliminating spirituality from our relationship to nature. This disjuncture is vitally important in the area of health and healing.

In recent years, medical researchers have turned their attention to the role of spirituality in medicine and health care. This burgeoning interest stemmed largely from a small number of studies suggesting that spiritual beliefs and practices improve health, well-being, and responses to medical care. Prior to the 1990s, medical science and religion had become so separate in Western culture that David Larson referred to spirituality as the “forgotten factor” in modern medicine. Medical studies ignored the role of religious or spiritual practices assuming they had no role in health outcome.

It has been suggested that the increasing use of alternative, nontraditional approaches to health care is the public’s response to mainstream medicine’s neglect of spirituality. In two recent national surveys, 70% of patients reported a belief that spiritual faith and prayer could aid in recovery from illness. Another 64% believe that physicians should talk to patients about spiritual issues as a part of their health care and indeed that physicians should pray with patients if the patients requested this.

Although scientific research ignored spirituality and religion, the general U.S. population placed a high value on spiritual and religious beliefs and practices. The Gallup organization conducted scientific polling regarding religious beliefs and practices among Americans over the last four decades. These studies showed that the proportion of Americans who believe in God remained remarkably constant. Ninety-six percent of Americans reported they believed in God in 1944 and ninety-four in 1986. In the general public, 66% considered religion to be the most important or a very important aspect of their lives and 40% reported that they attended services on a weekly basis.

A review of 212 studies examining the effects of religious commitment on health care outcomes found that 75% demonstrated a positive benefit of religious commitment. Of these studies, only 7% demonstrated a negative effect. This is not to suggest, however, that spirituality is a replacement for modern medical care. Rather, it is a potentially important addition. Ralph Snyderman, MD, Chancellor of Health Affairs at Duke University Medical Center, put this very well: “In the health care setting, science without spirituality is incomplete and spirituality without science is ineffective.”

SPIRITUALITY AND PHYSICAL HEALTH

Studies are now available that suggest an active spiritual practice, most often in the form of religious practice, is beneficial to physical health. Other studies further suggest that spiritual practice helps in healing if one does become ill. A study published in 1999 included 21,000 U.S. adults followed over an extended period of time. The researchers found that attending religious services more than once a week correlated with an extended life span of at least 7 years. The impact was even greater for African Americans for whom weekly church attendance correlated with an additional 14 years. Regular, weekly attendance of religious services was the strongest predictor for living longer of all the relevant factors that they could identify. Another large study followed a group for 28 years and found that frequent church attenders were 25% less likely to die than the infrequent attenders.

Cardiovascular disease and hypertension are illnesses most extensively studied in relationship to spirituality and religious practices. Among the studies all but one suggested that religious commitment is associated with lower blood pressure and lower rates of hypertension. One study found that men who placed high importance on religion and had high attendance rates at religious services had mean blood pressure readings (diastolic pressures 5 mm) lower than those who did not place high importance on religious issues. It has been shown that a reduction of a mean blood pressure by as little as 2-4 mm could reduce cardiovascular disease by 10-20%. This reduction could also influence whether or not antihypertension medication is prescribed. Another study reported that people who attended religious study once a week and prayed or studied the Bible at least once a day were 40% less likely to have high blood pressure than those who do so less frequently or not at all.

Older adults were found to be less likely to be hospitalized if they regularly attended religious services. Further, older adults with religious affiliations who are hospitalized had stays that were two and a half times shorter than those without religious affiliations. Another study of 1,718 older adults found that those who attended church regularly had healthier immune systems. A study done at Dartmouth Medical School found that a constant predictor of who survived heart surgery was the strength of a patient’s religious commitment. Elderly heart patients who were socially active and found strength in their religious faith were 14 times less likely to die following surgery. A study of heart transplant patients at the University of Pittsburgh found that those with strong beliefs and who participated in religious activities complied better with their medical regime and had better psychical functioning and emotional well-being at their 12-month follow-ups. Even among smokers, regular church attendance provided some protection from hypertension. Smokers who regularly attended church were four times less likely to have high blood pressure than smokers who did not attend.

A study published in 1984 suggested that spirituality measured as church attendance was important for lowering mortality rates among women. In this study, 2,700 persons were followed for 8-10 years. Only one social factor effectively lowered mortality rates for women and this was increased church attendance. In this study, church attendance was not found to be protective for men. In another study, the risk of dying of atherosclerotic heart disease among women was about twice as high among infrequent church attenders compared to those who attended church weekly or more. This study also found that death rates from pulmonary emphysema and suicide were more than twice as high and death from cirrhosis of the liver was nearly four times as high among women who were infrequent church attenders. It is likely that cirrhosis was the result of higher alcoholism among women who chose not to attend church regularly.

Hip fractures are a serious cause of morbidity among elderly women. A study showed that elderly women recovering from hip fractures revealed that those with the best surgical outcome were those to whom God was a source of strength and comfort, and among those who frequently attended religious services.

In the 1990s, the Temple ton Foundation began awarding grants to medical schools to support the addition of spiritual considerations in their curriculum. This has expanded to support teaching about spirituality in residencies in psychiatry, family practice, internal medicine, and obstetrics and gynecology. Some medical schools are developing programs in alternative medicine following the lead of Andrew Weil at the University of Arizona.

MENTAL HEALTH

The relationship of spirituality to mental health is an interesting one. Studies of the last several years have suggested that spiritual and religious practices support mental health in different ways. Some suggest that spiritual practice helps to improve self-esteem and especially that meditative practice will improve an overall state of greater calm and optimism. Involvement in a spiritual or religious community may also provide a supportive community and the consequent benefits of this.

Traditionally, psychiatry has taken a skeptical, if not a sometimes hostile, attitude toward spirituality or religion. This may relate to the fact that such problems as psychosis, depression, and hysteria were the last areas to be won over from the church as areas more relevant to medical concern. Freud, who dominated psychiatric thinking for the first half of the 20th century, proclaimed his own atheistic orientation and understood religious belief as illusions and generated by deep unacknowledged wishes. Albert Ellis, a psychologist, stated that “religiosity in many respects is equivalent to irrational thinking and emotional disturbance.” Psychiatric clinicians tend to be less religious than the general population. While only 6% of the U.S. population claim to be agnostics or atheists, 21% of psychiatrists and 28% of clinical psychologists claim to be agnostic or atheists.

Despite this history and general difference in attitudes between psychiatric practitioners and the general public, there is an increasing interest in the role of spirituality and religion in mental health and in psychiatric treatment. Four major journals in psychiatry were reviewed between the years of 1978 and 1982. During those 5 years, a religious measure was used in less than 3% of all the quantitative studies. With the increased interest in spirituality and religion, however, this trend is changing. Research involving an assessment of spiritual and religious practice is becoming more sophisticated. Measures of spiritual and religious practice now include an assessment of practices, such as ceremonies, prayer and social support, beliefs involving relations to God or a higher power, attitudes, especially those regarding meaning pertaining to personal purpose, values, and ethics, and others. Assessment tools are now developed in terms of their reliability and validity in measuring different dimensions of spiritual and religious practice. Of these dimensions, a relationship with God or higher power and social support reveal a positive valance correlating with mental health.

Several studies have documented a positive impact of spiritual and religious practice on the overall state of mental well-being. These studies include reactions to life stress as well as a stable sense of well-being. Two large-scale epidemiological studies which examined the overall rate of psychological distress in a general population both found that the religiously committed had less psychological distress than those with less commitment. Studies that assessed religious status and psychological status at different points in time demonstrate improvement in psychological functioning following religious participation. A study published in 1991 of 720 randomly sampled adults found that persons who attended religious services reported lower levels of psychiatric distress than infrequent attenders or non-attenders. This was true regardless of age, education, gender, marital status, or race. In addition to general well-being, they found that as the level of religious attendance increased, the adverse consequences of stress were reduced. Some studies have also indicated that spiritual and religious practices may be important and play a positive role in reducing depression and the rate of suicide. For example, a study published in the American Journal of Psychiatry in 1990 looked at the rate of depression among elderly women recovering from hip fractures. Among the patients with stronger belief and practices, there was less depression and it increased a positive impact on recovery time.

Several studies indicate that spiritual and religious involvement reduces the risk of suicide. One large-scale study found that persons who did not attend church were four times more likely to kill themselves. Another study found that the rate of church attendance predicted suicide rates more effectively than any other factor including unemployment. Other studies have found that religious persons report experiencing fewer suicidal impulses. It has been proposed that religion might help prevent suicide because religious commitment and community provide a unique source of self-esteem, social support, and a moral accountability to a higher power. Groups with higher religious commitment have been found to have a more negative attitude toward suicidal behavior.

Many studies indicate that spirituality and religious practice play an important role in substance abuse. This has been most studied in the area of alcohol abuse where studies reveal that alcohol abusers rarely had strong religious commitment. One study found that 89% of alcoholics had lost interest in religion in their teenage years whereas of the community controlled subjects, 48% had an increased interest in religion and 32% said their interest had remained unchanged. Whether or not the religious tradition specifically teaches against alcohol use, those who are active in a religious group consume substantially less alcohol than those who are not active. Alcoholics Anonymous (AA) has proven to be one of the most effective treatments for alcohol addiction. It is of interest that AA uses religion in the form of invoking a higher power to help alcoholics recover from addiction.

Studies have confirmed that other forms of drug abuse show similar correlations to spiritual and religious commitments. The religious commitment measure of frequency of church attendance was more strongly associated with drug abstinence than other religious variables, such as religious feelings or parental religious commitment. A study of 14,000 young people found that the measure of “importance of religion” to the person was the best predictor in indicating lack of substance abuse. This implies that the controls operating here are deeply internalized values and norms rather than fear or peer pressure. Drug abuse appears to be related to the absence of religion in a person’s life.

Family stability and illogical activities are indirect measures of emotional well-being. Studies have shown that religious and spiritual commitments are important in these areas as well. Persons in long-lasting marriages, in some studies, ranked religion as one of the most important prescriptions for a happy marriage. Another study found that the most important predictor of marital stability was church attendance. These studies raise the concern that divorce rates may be lower among religious people because of constraints against divorce. Studies that look specifically at self-reported marital satisfaction do find that a happy marriage does correlate with religious and spiritual commitment. Indeed, another study reported that very religious women report greater happiness and satisfaction with marital sex than either moderately religious or nonreligious women. Divorce has further implications for mental health; for example, divorced or separated men had four times the risk for outpatient or inpatient psychiatric care, and separated or divorced women had a fivefold increased risk. Personal church attendance has also been found to correlate in a negative way with juvenile delinquency.

Scientists have become interested in the psychological changes brought about by spiritual practices. Early studies looked at changes in cortisol, the stress hormone, and the autonomic nervous system. Advances in neuroscience allow researchers to observe actual changes in the brain from meditation and prayer. In a recent book Why God Won’t Go Away, the authors suggest that the human experience of spirituality is deeply rooted in the brain itself. The work of Jon Kabat-Zinn suggests that spiritual practice may provide treatment. He studied the effect of mindfulness meditation on individuals diagnosed with anxiety disorders. Those who participated in intensive meditation showed marked improvement in their symptoms.

Spirituality is an important aspect of human life. Traditionally all cultures have incorporated spirituality in religious practices. Healing was often incorporated in these practices. Western medicine developed with the scientific method and largely in opposition to religious institutions. Now public consensus and scientific evidence are requiring a reconsideration of this separation. While modern medicine has much to offer to our health and healing, it will be enriched by attending to the spiritual needs of patients.

See Also: Anxiety disorders, Cardiovascular disease, Depression, Hypertension, Meditation, Yoga

Suggested Reading

  • Benson, H. (1975). The relaxation responses. New York: William Morrow.
  • Dossey, L. (1993). Healing words: The power of prayer & the practice of medicine. New York: HarperCollins.
  • Kabat-Zinn, J. (1990). Full catastrophe of living: Using the wisdom of your body and mind to face stress, pain and illness. New York: Delacorte.
  • Newberg, A., D’Aquli, E., & Rause, V. (2002). Why God won’t go away. New York: Ballantine Books.

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