Health and Spirituality A Presentation to Pediatric Integrative Medicine Rounds Edmonton Clinic Health Academy

Health and SpiritualityA Presentation to Pediatric Integrative Medicine RoundsEdmonton Clinic Health Academyby John C Carr, ThM, PhD, RPsych (AB#1035)Associate Faculty, St Stephens College, Edmonton24 March 201512:00 - 12:50 pm

Copyright 2015 - John C. Carr, ThM, PhD, Reg. Psychologist (Alberta 1035)

1

Objectives1.To clarify the differences and similarities between Religion, Spirituality, and Faith2.To focus (briefly) on the interactive process among physical, mental, and relational health3. To offer some thoughts about clinical care that is grounded in an understanding of the relationship between Spirituality/Religion/Faith and Health

2

BIAS

It is important to learn how to hang from the chandelier at the same time as we are engaged in the room when it comes to thinking professionally about religion and spirituality especially when our task is to care for another person.

1. Religion, Spirituality, & FaithWhat comes to mind when you are asked to define or describe Religion? What comes to mind when you are asked to define or describe Spirituality? Are they the same or different? And how are those words related to Faith?

Religionbelief in a god or in a group of godsan organized system of beliefs, ceremonies, and rules used to worship a god or a group of godsan interest, a belief, or an activity that is very important to a person or groupSource: Merriam Websterhttp://www.merriam-webster.com/dictionary/religion

Spiritualitythe quality or state of being concerned with religion or religious mattersthe quality or state of being spiritualof or relating to a person's spiritof or relating to religion or religious beliefshaving similar values and ideasrelated or joined in spiritSource: Merriam Websterhttp://www.merriam-webster.com/dictionary/spiritualityhttp://www.merriam-webster.com/dictionary/spiritual

1

SpiritualityA survey of reviews by McCarroll et al. dealing with the topic of spirituality gave twenty-seven explicit definitions "among which there was little agreement.Source: WikipediaMcCarroll, Pam; O'Connor, Thomas St. James; Meakes, Elizabeth (2005), Assessing plurality in Spirituality Definitions. In: Meier et al, "Spirituality and Health: Multidisciplinary Explorations", pp. 44-59, Wilfrid Laurier Univ. Press2

7

SpiritualityAccording to Waaijman, the traditional meaning of spirituality is that it is a process of re-formation which "aims to recover the original shape of man [sic], the image of God. To accomplish this, the re-formation is oriented at a mold, which represents the original shape: in Judaism the Torah, in Christianity Christ, in Buddhism Buddha, in Islam Muhammad.Source: Wikipedia (Waaijman, Kees (2002),Spirituality: Forms, Foundations, Methods, Peeters Publishers)

3

8

SpiritualityIn modern times the emphasis is on subjective experience.Spirituality may denote almost any kind of meaningful activity or blissful experience.It still denotes a process of transformation, but in a context separate from organized religious institutions, termed "spiritual but not religious." Houtman and Aupers suggest that modern spirituality is a blend of humanistic psychology, mystical and esoteric traditions and eastern religions.Source: WikipediaHoutman, Dick; Aupers, Stef (2007), "The Spiritual Turn and the Decline of Tradition: The Spread of Post-Christian Spirituality in 14 Western Countries, 1981-2000",Journal for the Scientific Study of Religion (2007) 46 (3): 305-3204

SpiritualityWaaijman points out that "spirituality" is only one term of a range of words which denote the praxis of spirituality. Some other terms are "Hasidism, contemplation, kabbala, asceticism, mysticism, perfection, devotion, and piety.Source: WikipediaWaaijman, op. cit., p. 315.5

Faith: A Christian Model is the assurance of things hoped for, the conviction of things not seen Hebrews 11: 1 (New Revised Standard Version of the Christian Scriptures)The verse above is followed by a review of the narrative of the people Israel and of their relationship with Yahweh (God) over more than a millennium of struggle with all that was thrown at them (or that they created for themselves) as they struggled to live out that relationship.1

Faith: A Christian Modelis a combination of relationship with the Divine (God - Jesus Holy Spirit) and assent to a system of beliefs (doctrine) that vary, depending on the persons denomination2

Faith: More Generically strong belief or trust in someone or something belief in the existence of God or of gods, or in idols strong religious feelings or beliefs a system of religious beliefsSource: Merriam Websterhttp://www.merriam-webster.com/dictionary/faith3

Faith: More Genericallyconfidence or trust in a person, thing, deity, view,or in the doctrines or teachings of a religion, as well as confidence based on some degree of warrant [i.e. experience/authority]belief that is not based on proofoften used as a synonym for hope, trust, or beliefSource: Wikipedia4

Religion, Spirituality, & Faith1Although Religion, Spirituality, and Faith have different nuances, the words are often used interchangeably.Often, Spirituality is used as a generic way of speaking about a persons Religion or Faith without narrowing that down to a specific religious tradition.

Religion, Spirituality, & Faith2When the meaning is not clear in the context, it is important to seek clarification about what the other means when they refer to their spirituality e.g. by saying Please tell me what you mean when you describe yourself as spiritual but not religious.

Religion, Spirituality, & Faith3Being spiritual but not religious may mean being anti-religious.Being spiritual but not religious may mean a positive affirmation of a particular spiritual path/praxis.

2. Physical, Mental, and Relational HealthHow do we think about Health?Absence of health: sickness, pathology, disability, threat of deathPresence of wellness: maximum capacity for living and living well

1

Physical, Mental, and Relational HealthThe way in which we think about Health affects whether our effortsare directed towards solving a problem orare focussed on maximizing wellness3

Physical, Mental, and Relational HealthThe way in which we think about Health affectsThe way in which we understand the relationship between Health and Religion-Spirituality-FaithThe way in which we respond to persons who seek the services of a health facility and/or a health professional2

Jrgen MoltmannPre-eminent Christian Theologian of HopeGod weeps with us so that we may one day laugh with him.

Spirituality, Religion & HealthCare: Foundations1Hope is both the earliest and the most indispensable virtue inherent in the state of being alive.If life is to be sustained hope must remain, even where confidence is wounded, trust impaired.Source: The Erik Erikson Reader. (2001) New York: Norton.

Spirituality, Religion & HealthCare: Foundations2"Hope is the enduring belief in the attainability of fervent wishes, in spite of the dark urges and rages which mark the beginning of existence. Hope is the ontogenetic basis [organic origins] of faith, and is nourished by the adult faith which pervades patterns of care.Source: The Erik Erikson Reader. (2001) New York: Norton.

Spirituality, Religion & HealthCare: Foundations3Religion is the institution most involved in restoring a sense of trust through faith, as well as giving a definition to the evil the religion hopes to protect one from.Religion supports trust development. Interestingly, terror management theory purports that when threatened, people will cling to patriotic institutions and the church in an effort to feel protected from evil.Source: www.karencrawfordphd.com/media/edocs/personality_ch_5.doc

Spirituality, Religion & HealthCare1So spirituality/religion/faith can provide a basis for hope and energy for healing.Healing grounded in spirituality/religion/faith may not cause a cure but it sometimes assists the medical/ surgical treatments applied in order to achieve a cure.And sometimes the healing power of spirituality/ religion/faith is the only available explanation for cure.

Spirituality, Religion & HealthCare2Numerous studies, supervised by Northwestern University Social Psychology research methodologist Donald T. Campbell demonstrate the effectiveness of pastoral/spiritual care and prayer in lowering blood pressure, shortening post-surgical hospitalization, etc.While those studies assumed a Christian frame of reference, one can also understand the healing process in terms of such generic spiritual constructs as in-touchness with universal healing energy, etc.

Source: Joint Northwestern University and Garrett-Evangelical Theological College (Evanston, Illinois) PhD Dissertations

3. Clinical Care Grounded in Spiritual SensitivityWill assess the spirituality of the patient and/or of their family as part of the process of Assessment and DiagnosisWill ensure the availability of Spiritual Care appropriate to the spirituality of the patient

Clinical Care Spiritual Assessment Tools1Spiritual assessment tools such as the FICA, the HOPE questions, and the Open Invite provide efficient means of eliciting patients' thoughts on this topic. The spiritual assessment allows physicians to support patients by stressing empathetic listening, documenting spiritual preferences for future visits, incorporating the precepts of patients' faith traditions into treatment plans, and encouraging patients to use the resources of their spiritual traditions and communities for overall wellness.Source: American Family Physician, 2012 Sep 15;86(6):546-550 at http://www.aafp.org/afp/2012/0915/p546.html

Clinical Care Spiritual Assessment Tools2HOPEH: Sources of hope, meaning, comfort, strength, peace, love and connection O: Organized religion P: Personal spirituality and practices E: Effects on medical care and end-of-life issuesSource: Gowri Anandarajah, M.D., and Ellen Hight, M.D., M.P.H Brown University School of Medicine, Providence, Rhode Island athttp://courses.washington.edu/bh518/Articles/hopearticle.pdf

Clinical Care Spiritual Assessment Tools3FICA SPIRITUAL HISTORY TOOLF: Faith or BeliefI: Importance and Influence of Personal SpiritualityC: Community: Importance of Spiritual CommunityA: Address: Interventions to Address Spiritual Needs

Source: Journal of Pain and Symptom Management, 2010, Volume 40, Issue 2, Pages 163173 athttp://www.jpsmjournal.com/article/S0885-3924(10)00325-8/abstract

Clinical Care Spiritual Assessment Tools4

Seven by Seven ModelRush-Presbyterian St. Luke's Medical Center, Chicago, Illinois

Source: Fitchett, G. (1993) Assessing Spiritual Need: A Guide for Caregivers. Minneapolis, Minnesota: Augsburg/Fortress Press.

Clinical Care Spiritual Assessment Tools5Developing a Spiritual Assessment Toolbox: A Discussion of the Strengths and Limitations of Five Different Assessment Methods: This article reviews five complementary assessment approaches that have recently been developed to highlight different facets of clients' spiritual lives. Specifically, one verbal model, spiritual histories, is discussed, along with four diagrammatic approaches: spiritual lifemaps, spiritual genograms, spiritual ecomaps, and spiritual ecograms. An overview of each approach is provided along with a discussion of its relative strengths and limitations. The aim here is to familiarize readers with a repertoire of spiritual assessment tools so that the most appropriate assessment method in a given client-practitioner setting can be selected.Source: Health & Social Work. (2005)Volume 30 Issue 4Pp. 314-323 athttp://hsw.oxfordjournals.org/content/30/4/314.short

Clinical Care Spiritual Assessment Tools6 spirituality in pediatric palliative care has been virtually neglected. The need for guidelines to assess spirituality in this population was identified as a priority issue by members of a subcommittee of the Children's International Project on Children's Palliative/Hospice Services, created under the auspices of the National Hospice Organization. Committee members, based on their clinical, research, and personal experiences, identified several aspects relevant to spirituality in general, and to spirituality in pediatric palliative care in particular, and developed guidelines for clinicians in pediatric palliative care.by Davies B,Brenner P,Orloff S,Sumner L,Worden W (Department of Family Health Care Nursing, School of Nursing, University of California, San Francisco, California, USA) Journal of Palliative Care[2002, 18(1):59-67] at http://europepmc.org/abstract/med/12001404

Spiritually Sensitive Care1Assessment of patient/family spirituality does not involve judging the rightness or wrongness of that spirituality (although potentially negative health effects need to be noted see next slide)Primarily it involves assessing how that spirituality can be enlisted in the healing process andwhether that healing process might involve facilitation of a cure or enhancement of ability to cope with a chronic illness or impending death.

Spiritually Sensitive Care2As noted previously, may occasionally involve a determination that an aspect of the patients/ familys spirituality, or that of their spiritual community, is potentially harmful to healthAnd requires intervention of some kindAnd will involve determining the who and the how of the intervention.

Spiritually Sensitive Care3Will ensure that a spiritual care department is available, with trained and competent chaplains (increasingly called spiritual care practitioners with original formation in a particular religious/spiritual traditions and specialized training in the provision of care across the broad spectrum of religious/spiritual traditions) to assist patients and their families and to be a resource to staff.

Spiritually Sensitive Care4Will ensure access of the patients and/or familys spiritual community through that communitys actual or symbolic presence at the bedside (subject of course to the wishes of the patient/family and to the constraints of the medical-surgical situation).

Spiritually Sensitive Care5Will occasionally require that staff who are not adherents of the religion/spirituality of the patient and/or their family may be called upon to function in innovative ways that meet the needs of the patient/family in unusual and/or emergency situations (e.g. baptism in extremis).

Spiritually Sensitive Care6Will involve systemic thinking at the level of institutional organization and planning concerning how spiritual needs might be met in such a way as to enhance healing and hope for persons seeking care/cure and for those engaged in providing care and doing their best to ensure cure.

Spiritually Sensitive Care7Gauger, Robert W. (2014) The Girl with the Halo. Journal of Pastoral Care & Counseling, Vol 68:2.Jones, Logan C. (2014) A Prayer for Healing Denied, Journal of Pastoral Care & Counseling, Vol 68:3.Eddins, Sharon L., Grogan, Nancy, and Frick, Brandon. (2014) Healing and Belonging: Godly Play in Pediatric Medicine and the Theology of Disability. Journal of Pastoral Care & Counseling, Vol 68:3.Seifter, Julian L. (March, 2014) Correlation or Causation? Our Search for Certainty. Medscape at http://www.medscape.com/viewarticle/840932

40