Southern Cross UniversityePublications@SCU

School of Health and Human Sciences

2007

Spirituality, health and the complementarymedicine practitionerAirdre GrantSouthern Cross University

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Publication detailsGrant, A 2007, 'Spirituality, health and the complementary medicine practitioner', Journal of the Australian Traditional-Medicine Society,vol. 13, no. 4, pp. 207-209.The abstract and pdf of the published article reproduced in ePublications@SCU with the permission of Journal of the AustralianTraditional-Medicine Society

Joumal of the Australian Traditional-Medicine SocietyDecember 2007 Volume 13 Issue 4

SPIRITUALITY, HEALTH

A N D THE COMPLEMENTARY

MEDICINE PRACTITIONERAiRDRE GRANT

Abstract

This paper examines the :onceptual relationship between spirituality and health and the philosophical foundations of eom-plementary medicine. These preeepts are evidenced in current educational practice.

Reference

Grant A. Spirituality, health and the complementary medieine practitioner. Journal of the Australian Traditional-MedicineSociety 2007;13(4):207-|209.

Keywords: Complementary medicine; Religion; Spirituality; Education.

Spirituality In Health And Healing

The foundational philosophy of complementary medicineis that health is based on an integration of mind, body

and spirit. Spirituality is a key component of this philosophy,but does current educational practice adequately reflect itsimportance?

Research has shown that a person's spiritual and religiousbeliefs have a great deal to do with their health outlook, theircoping mechanisms, their support networks and so on. Thereis a long (and chequered) relationship between humans andthe divine. The accessing or observance of matters spiritualhas taken different forms historically eg prayer, seance,shamanistie ritual, practices such as placing of symbolictools and objects in the sick room and other less familiarobservanees. It exists as evidence of the human desire to tapinto other sourees for healing, help and succour, particularlyin times of crisis.

The dominance of reductionist biomedieine as the primaryhealthcare system has meant that the value of recognising thespiritual, cultural and social context of a patient has beenmuch diminished in place of positivist protocols. These, byand large, focus on the relief of symptoms and associatedpathologies'". However, there is a shift in this emphasis inhealthcare praetiee. Spirituality, religion and their place inmedicine are currently much discussed, to the point wherethis relationship has been called 'the new frontier'* '̂. What isinteresting is the extent to which complementary medicineeducation and training has incorporated or rejected this vitalaspect of health.

Airdre Grant BA DipEd MECross University, researchication in natural medic,agrantl O@scu. edu. an.

i is a doctoral student at SouthernIg spirituality and healtJi and edu-ne. Telephone (02) 6620 3403.

Current ResearchHistorically the relationship between spirituality, religionand health was a socially constructed one. In earlier times,people lived closer to nature and sought explanation for theirillnesses and imbalanees through the guidance of priests andother similar mediators. They looked to the natural world forhealing, reading signs as divination (this practice is by nomeans extinguished). In the West the signs are more likely tobe test results delivered from a machine and doctors havebeen described as 'secular priests''^'.

In the beginning of the twenty-first century there is a strongresurgence of interest in the role of spirituality in healing andhealth with over 2,000 papers published in medical and nurs-ing literature''". The Handbook of Religion and Health con-tributes to the growing body of research that indicates thereis a positive relationship between spiritual/religious commit-ment and health'^'. This analysis is critical, comprehensiveand systematic; it includes more that 1,200 studies and 400researeh reviews conducted during the twentieth century'^'.

Researeh shows people who are spiritually directed or havea consistent religious practice have greater marital stability,less alcohol and drug use, lower suicide rates, less anxietyand depression'*'. These behaviours are also associated withless eigarette smoking, less stress (especially with medita-tors), lower blood pressure, lower cholesterol, conservativesexual practices and lower sexually transmitted diseases'^'.George reports that data eonsistently shows a positive rela-tionship between religious and spiritual practices and posi-tive health outcomes"*'.

There are obvious links if one lives in a supportive commu-nity. If one's spiritual/religious community promotes fidelityand discourages promiscuity and drug/alcohol abuse, it ismore likely these principles will be embedded in one'smorality and thus refiected in one's health'^'. However, spiri-tuality and religion are not always beneficial to health as

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Joumal of the Australian Traditional-Medicine SocietyDecember 2007 Volume 13 Issue 4

Grant A. Spirituality, Health and the Complementary Medicine Practitioner.

Strict codes and observances can create less than optimalhealth, but what is important is that a practitioner be awareof their patients' embedded belief system.

Why The Interest In SpiritualityAnd Religion In Healthcare?

Astrow et al suggest the reason for the growth of interest inspirituality ha;s been fuelled to a large extent by the domi-nance of a medical model which has been increasingly seenas technology focused, insensitive, economically driven andperceived as disease rather than patient-centered*". Patientsreport fmding medicine as remote, uncaring and with anexperience focused on machines and cold statistics'''.

Thoresen suggests several other factors might contribute tothis trend. It is not unusual to seek meaning when con-fronting death or in an acute life-threatening illness situation,however with the advances in medical treatment people areliving longer lives, often with managed chronic illness. Thisextra 'time' means more time to reflect on the meaning oflife and values that extend beyond material goals***.

Society in the West is increasingly fragmented and techno-logically oriented, creating loneliness and isolation and caus-ing people to experience a laek of 'connectednesses'.Thoresen notes that there is a rise in mental and emotionaldisorders, eonditions that often defy ready solutions. Theselead to a need for a deeper explanation of illness and distur-bance in life. When there is no pathophysiologieal diagnosisthat can account for continued malaise and suffering, therecomes a search for meaning'*'.

There has been a growth in 'spiritual hunger' and this is evi-denced by the rise of interest in religions such as Buddhism,Charismatic Churches and leaders such as the Dalai Lama,along with the popularity of books addressing this need byauthors such as Peek, Moore, Zukav and Komfield""'^'.These best selling books represent a huge market of readersinterested in understanding and deepening their spirituallives. This combination of factors, nominally called a 'spiri-tual void', contribute to the rise in spirituality and religion insociety and one that is present in the treatment room,whether or not the practitioner recognises, acknowledges orfeels able to respond to it<". In May 2007 the MedicalJournal of Australia ran a supplement on the subject of spir-ituality and health, in response to the growing interest.

Influences In Education And TrainingThe pendulum that has taken healing practice into a world ofteehnological efficieneies is swinging baek. Currently 100 of126 medical schools in the United States have included incurricula elective or required courses on religion, spiritualityand medicine**"'. Whilst Australia is largely a secular socie-ty, awareness of spiritual and religious needs of patients isgrowing. In complementary medicine, practice might focuson vitalism and holism as a way of acknowledging the spiri-tuality or religiosity of patients. While this may be seen asrespectful of differing worldviews, it may not be adequate.

Accordingly, attention to and inclusion of the researeh workdone in the field of spirituality, religion and health is appro-priate in the holistic paradigm of healtheare practice. The

philosophieal eommitment to recognition of the spirit as partof the healing process causes problems when different para-digms of healing collide. However, there are definite shifts inhealthcare toward recognition of its importance. Curiously, itis in this realm that westem medieine is outstripping comple-mentary medicine with its burgeoning interest in spirituality,religion and health.

Spiritual AssessmentWilliams and Stemthal report that Australian patients wanttheir practitioners to incorporate spirituality into their assess-ment and treatment protocols*"". But how do practitionersrespond to this need? Spiritual assessment is a tool that prac-titioners can use to establish the context in which theirpatient is located. Spiritual assessment is defined as 'theprocess by which health care providers can identify apatient's spiritual needs pertaining to medical care'*'".

The most common tool for spiritual assessment is likely to befound on the admission forms at a hospital where a patientcan be asked if they have religious affiliation /denominationand this may lead to a visit by the chaplain. D'Souza reportsignoring the spiritual dimension ofa patient may leave themfeeling incomplete, ignored and this has the potential tointerfere with healing'""'.

In considering spiritual assessment Anandarajah and Hightrecommend some important faetors for the practitioner toconsider:

• Their own spiritual and religious beliefs and values asthese may influence their approaeh in a situation thatrequires tolerance and acceptance

The establishment ofa good relationship. All practi-tioner/patient relationships have a critical element oftrust. For a patient to reveal or discuss deeply heldpersonal views there needs to be a good relationship.

• Sensitivity and appropriateness of discussions, so thatthe timing and situation meets the needs of thepatient"".

Tools for assessment have been developed such as HOPE,which comprises questions on the areas of hope(H), organ-ized(O) religion, personal(P) spirituality and practice andeffects(E) on medical care and end of life issues*". Thesetools are about a series of questions that a practitioner canuse to open up the issue of patients' spiritual and religiousaffiliations and obtain some knowledge and insight.Typically they are designed to minimise barriers to conver-sation by having open-ended questions that allow a personroom to express their spiritual and religious understandingswithout feeling confined by expectation or judgment.

However, not all agree that spiritual assessment is a good orworthy activity. Sloan et al suggest that asking patients abouttheir spiritual and religious affiliation is intrusive and maycause harm*"'. Such actions, they suggest, may cause apatient to feel shamed, guilty, offended or even discriminat-ed against. They suggest that some patients still feel that ill-ness is a punishment for 'moral failure'. Accordingly suchquestions may reinforce a negative mind state that eould bedeleterious to health.

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Grant A. Spirituality, Health and the Complementary Medicine Practitioner, Joumal of the Australian Traditional-Medicine SocietyDecember 2007 Volume 13 Issue 4

As is evident, the issue of spiritual assessment is sensitiveand contentious. There is a need for training so that practi-tioners feel confident to approach this aspect of health. Asone student in a complementary medicine clinic noted, 'Weask if they have spiritual and /or religious associations andwe tick the box and that's it. We don't go any further with itand if we did we wouldn't know what to do anyway' (per-sonal comment naturopathic student, 2006),

Conflicts For Practice And PractitionersKnowing that spirituality/religion are important in people'slives doesn't necessarily make it a given, good or easy thingto incorporate into professional practice. There are severalareas of concem. Generally, modem economic modellingrewards technical efficiency, so a consultation that makes adiagnosis and recommends a treatment within a tight framemeans there may be time to do little more than prescribe atreatment program. Such constraints do not allow much timeto get to know the patient, let alone delve into deeper moremysterious/less accessible aspects of disease.

Similarly, practitioners may feel it is not appropriate, nottheir business or that they are trained adequately to deal withthis issue. There are boundary issues, McKee and Chappelpoint out that co-operation between practitioners and pas-toral care workers is desirable^ but may not occur if there areno mechanisms to enable this interaction to happen*'". It ismore likely that there is a simple passing of the baton by wayof referral,

Astrow et al state that 'merely being a believing person doesnot qualify a clinician to dole out spiritual advice'*". As theypoint out, the inherent imbalance of power in the patient/practitioner relationship can invite confusion andspiritual/religious advocacy could be read as coercion.Understanding this only affirms the need for training; tomake sure that consciously or unconsciously there is noproselytising or inappropriate persuasion.

Despite concems, McKee and Chappel affirm the need forpractitioners to take into account a patient's spiritualbeliefs"". When we consider the active interaction betweenthe public and practitioners of complementary medicine, itseems reasonable to conclude that healthcare workers shouldbe trained to incorporate this component of health.

Spirituality and religion belong in the healing paradigm, theyare determinants of health and they are factors in recovery,wellbeing and longevity. Importantly they are one of threecentral pillars of naturopathic philosophy (mind/body/spirit).Research suggests that current educational practice in com-plementary medicine diminishes this aspect of healthcare tothe point where it is taught in a minimal way. This paper sug-gests that while respect, recognition and acknowledgementof spirituality and religion are desirable, conscious and delib-erate teaching programs are required to revitalise the corevalues and philosophy of complementary medicine.

References(1) Puchalski CM, Larson DB, Developing curricula in spirituality and

medicine. Academic Medicine 1998;73(9):970—974,(2) Thoresen J, Spirituality and health: is there a relationship? Joumal

of Health Pyschology 1999;4(3);291—300,

(3) 'Bondi H, Bullock A, East, W (editors). The story of medicine,London: Marshall Cavendish Books, 1969,

(4) Jonas WB, Crawford CC (editors). Healing, intention and energymedicine, Edinburgh: Churchill Livingstone, 2003,

(5) Koenig HG, McCullough ME, Larson DB, Handbook of religionand health, Oxford: Oxford University Press, 2001,

(6) George LK, Larson DB, Koenig HG, McCullough ME, Spiritualityand health: what we know, what we need to know, Joumal of Socialand Clinical Pyschology 2000;9(l):102—116,

(7) Astrow AB, Puchalski CM, Sulmasy DP. Religion, spirituality andhealth care: social, ethical and practical considerations, AmericanJoumal of Medicine 2001 ;110(4):283—287,

(8) Thoresen C, Spirituality, health & science. In: Roth-Roemer S,Kurpuis SER, Carmin CN (editors). The emerging role of coun-selling pyschology in health care. New York: WW Norton, 1998.

(9) Peck MS, The road less travelled: a new psychology of love, tradi-tional values and spiritual growth. London: Arrow Books, 1990,

(10) Moore T, Care of the soul. New York: Harper Perennial, 1992,(11) Zukav G, The seat of the soul. London: Rider & Co., 1990,(12) Kornfield J, After the ecstasy, the laundry, Sydney: Bantam Books,

2000.(13) Peach HG, Religion, spirituality and health: how should Australia's

medical professionals respond? Medical Joumal of Australia2003;178(2):86—88,

(14) Williams DR, Stemthal MJ. Spirituality, religion and health: evi-dence and research directions. Medical Joumal of Australia2007;186(10):47—50,

(15) Anandarajah G, Long R, Smith M, Integrating spirituality into thefamily medieine residency curriculum. Academic Medicine2001;76(5):519—520,

(16) D'Souza R, The importance of spirituality in medicine and itsapplication to clinical practice. Medical Joumal of Australia2007;186(10):57—59,

(17) Anandarajah G Hight E. Spirituality and medical practice: usingthe HOPE questions as a practical tool for spiritual assessment.American Family Physician 2001;63(l):81—88.

(18) Sloan RP, Bagiella E, Vandecreek L, Hover M, Casalone C, HirschTJ et al. Should physicians prescribe religious activities? NewEngland Joumal of Medicine 2000;342(25):1913—1916,

(19) McKee DD, Chappel JN, Spirituality and medical practice, Joumalof Family Practice 1992;35(2):201—205, •

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