This issue of the Bulletin features photographs from the book When True Simplicity is Gained, by father-son team, Martin and Micah Marty. Using images and textual reflections, the books explore spiritual themes.
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"It is quite clear that there is, palpably, a large and exploding marketplace for spirituality in America." So wrote John A. Coleman, S.J. in a 1997 article in Christian Spirituality Bulletin. Other cultural commentators agree, suggesting that America is moving from a secular culture to a spiritually interested culture. Moreover, this spiritual interest is not confined to churches, synagogues, mosques, and temples. It is emerging in the workplace, in the athletic sphere, in areas of social justice and community organization, and in the ecological and feminist movements. Not surprisingly, then, spiritual interest is also emerging within health care.
In Western society, spirituality and health care have been closely connected. Faith communities founded and sponsored medical endeavors; doctoring and nursing were considered a religious calling; clergy ministered at the sick bed. However, in the 20th century, a sharp division of labor developed. Physicians and nurses focused on the diagnosis and treatment of physical and mental disease, while clergy and pastoral caregivers focused on the state of the soul. Medicine and religion lay side by side with relatively clear boundaries and different professional approaches.
Today a more complex situation is emerging. Spiritual interest and activity are coming to the fore in the practice of medicine, within the organizational life of health care corporations, and as a component of ethical decisions and actions. This widened interest in spirituality also is having effects within pastoral care, the traditional home of spiritual concerns.
Within Medical Practice
In recent medical research, a multitude of studies have connected religion and spirituality to specifically medical goals. These studies have shown that faith has positive effects on physical and mental health. Therefore, religion and spirituality have become variables in the quest for a better understanding of physical disease and health.
When religion and spirituality appear on the medical screen in this way, they do so in terms of medical values. These values prize clear definitions, sharp distinctions, and empirical ways to measure results. Researchers probe how faith contributes to better health in the hope that healthcare practitioners can employ spiritual beliefs. This new appreciation of religion and spirituality moves them from an important but concomitant concern to a potential medical resource in the struggle for health.
This appreciation is influencing how doctors are educated and how medicine is practiced. A growing number of medical schools are finding space in their curriculum for courses on religion and spirituality. Some thinkers are encouraging physicians to support patients' beliefs, whether through spiritual screening, a basic respectfulness, or referrals. Under certain circumstances, physician and patient might even engage in a common religious practice such as prayer.
These developments raise many theological and practical questions. Although spiritual activity may enhance mental and physical health, is that what spirituality is about? Does the spiritual life have to be pursued in terms of its own goals—a deepened relationship to Spirit—and not in terms of its medical effects? While in the immediate past, a physician's faith and spirituality remained in the background to his or her practice, does bringing it to the foreground in a non-coercive way require a new set of skills? What type of religious and spiritual knowledge is necessary in order to be respectful of a patient's faith? If physicians move in this direction, do they enter the arena of symbolic healing, where the inner attitudes and the quality of the relationship between physician and patient are paramount? How are the boundaries of medical disciplines respected as inquiry into spiritual concerns and issues are pursued? Can physicians be sensitive to the spiritual concerns of a patient if they are less spiritual? Do physicians see their practice of medicine as a path of spiritual development for themselves? What ethical and legal questions are involved in this expansion of the physician's role?
Within Organizational Life and Ethics
Health care managers are also interested in spirituality for the bottom-line reason that the market is pushing for more holistic approaches to health care, and thus there has been an increase in the inclusion of alternative and complementary medicines. Because spirituality is a crucial component of holistic care, there is, from a marketing point of view, an increased role for spirituality in health care. A second reason for management interest in spirituality is the need to recognize the pluralistic faiths of people involved in health care. Approaching those faiths from the point of view of spirituality may encourage them without producing tension or proselytizing. Spirituality may be the path of interfaith cooperation without interfaith competition.
Third, recent organizational development theory stresses the need to cultivate soul, or spirit, in the workplace. This inherent dimension of people is particularly necessary in times of change. In order for the overall organization to excel, the organization must nurture the spirit or soul of its people. In faith-based health care, this call for soul in the workplace becomes a way of expressing religious identity.
Interest in spirituality also is emerging within the field of biomedical and organizational ethics. Ethicists are often concerned with relatively abstract matters such as applying principles, implementing values, or sorting out consequences. However, when ethics becomes person-centered, it deals with questions of perception, motivation, and identity. This uncovers the source of ethical decisions and actions in a person and in doing so, ethics enters the realm of spirituality, exploring the deepest grounding of the person who acts. In this understanding, spirituality becomes a crucial component of ethics.
Within Pastoral Care
Although spirituality is the direct concern of pastoral care, the word "spirituality" does not have an established place in many religious traditions. Only fifty years ago the word was largely restricted to select groups in Roman Catholic circles. Today spirituality is a word with high cultural visibility. It is obviously related to words like "religion" and "faith," but it is also distinguished from them. Many people who belong to specific denominations are re-reading their faith traditions in terms of spirituality and are asking for guidance along these lines. Those in pastoral care know that a patient's experience of suffering often becomes an invitation to deeper spiritual realizations, and thus they look for ways to understand and facilitate the development of personal spiritual growth.
This focus on spirituality looks like a promising path for pastoral care: it could both meet contemporary needs and at the same time renew faith traditions. However, it is not a well-trodden path with all the signposts in place. Also, as interest in the spiritual grows within medical practice and organizational life and ethics, pastoral care has to reckon with many new players. The traditional lines of communication between medical personnel, chaplains, managers, and ethicists have a new content—their common yet diverse interest in the spiritual.
A New and Needed Situation
This extension of spiritual interest within health care raises deeper questions of criticism and complementarity. From the health care side, theorists have often complained of a reductionistic medical model, a model that restricted itself to physical and mental disease and treatment. Organizational life and ethics have been criticized in similar ways. Organizations do not allow the "whole person" to come to work, and ethics is a "rational head game" that has little to do with the inner dynamics that generate human action. When spirituality is introduced into these areas, it widens and grounds their concerns in a fuller way. More of the human is present.
From the spirituality side, theologians lament the split that has often developed between the spiritual and physical dimensions. To be spiritual often connotes not to be physical or not to be engaged in the world. A popular notion is that spirituality is otherworldly. When physical, mental, organizational and ethical concerns are connected to spirituality, this distortion is overcome. Spirituality becomes the deep grounding for engaging life in all its complexity. In short, health care needs spirituality to be whole, and spirituality needs health care to be concrete and engaged.
Therefore, this fourfold relationship of spirituality and health care—medical, organizational, ethical and pastoral—is important, and its implications are slowly being worked out. Some features of spirituality have emerged as particularly vital. First, the spiritual as human birthright, a dimension of reality that is present whether it is attended to or not. Second, religious traditions are treasuries of spiritual wisdom and practices that need to be made available. And third, spiritual practices are a way of tapping into inner powers and possibilities, of finding and accessing interior resources.
The Spiritual as a Human Birthright
The spiritual is a birthright, part of the territory of the human. People have described it in various ways: as an inner dimension that connects the person to what is ultimate, or as the power of self-transcendence, or as a movement out of isolation into communion with the whole, or as a sense of being grounded in a mystery beyond space and time. However it is characterized, the fundamental awareness is that the spiritual dimension is there, a given of human existence. Therefore, if health care practitioners are to consider the whole human person, biological, psychological, and social approaches should be complemented by spiritual perspectives.
A crucial implication in this understanding of the spiritual as an essentially human dimension is the possibility of being spiritual without being formally religious, i.e., belonging to a specific religious community and tradition. Although the spiritual and the religious overlap, they can also be distinguished and even separated. Secular spiritualities such as 12-step programs exemplify this possibility, and many contemporary Americans are heard to acknowledge it: "I am spiritual but I am not very religious." This implies that the spiritual is present and active even though the individual doesn't employ explicitly religious language or concepts. In the medical setting, the spiritual is not a separate component but a dimension of all the activities of health care. This is the theoretical foundation for the extension of spiritual concerns into the medical, organizational, and ethical areas.
Religious Traditions as Resources
The traditional home of spiritual concern and exploration is the religious traditions of the world. They have well-developed understandings of spirituality accompanied by theological beliefs and often rooted in revelatory experience. In the religions, spiritual practices are placed within the fullness of the tradition and the ongoing life of a community. Most importantly, what counts as genuine spiritual development and what is counterfeit is thoroughly scrutinized. These traditions may have what the contemporary spiritual interest is lacking.
However, the religious traditions' spiritual wisdom has to be retrieved, which raises difficult issues relating to how past spiritual understandings are interpreted and offered as resources in the contemporary context. Still, a variety of thinkers and practitioners are making creative efforts in this direction, including retrieving and adapting such perspectives as Meister Eckhart's understanding of detachment, the Catholic sacrificial practice of "offering up," the Buddhist conception of compassion, and the Jewish emphasis on hospitality. These efforts develop and nurture the spiritual seeds present in contemporary health care.
Inner Spiritual Resourcing
A common question among spiritually inclined people is, "What is your practice?" In other words, what are you doing that will enhance your spiritual life? The answers may range widely—reading the Bible, reciting the rosary, meditating, attending to breathing, working in a soup kitchen, putting other people first, reading spiritual books, etc. Spirituality often includes a regularly practiced outer exercise. In a wide sense, this outer practice can be labeled a ritual and designated as either traditional or innovative.
However, the outer practice is not to be judged on its own terms. The usual purpose of the outer practice is to bring about a change in the inner state. This inner state, in turn, becomes a resource to respond to what is happening in the outside world. The flow is from outer practice to inner consciousness to outer response.
Obviously, the content of the inner state is related to the specific practices that are performed. Certain practices are geared to generate certain features of consciousness—for example, dependence, peace, or compassion. These practices also are related to the individual performing them. They sit within the ongoing history of that individual and have to be evaluated in that context. Thus, one cannot predict the inner effect of the outer practice on a particular person. There is always a need for personal discernment. However, when spiritual practices are set within the context of suffering and health, a model can be outlined, an inner path can be described, and steps along the way can be demarcated. One series of steps moves from spiritual meaning to resiliency to agency.
However, when spiritual practices are set within the context of suffering and health, some distinct inner resources are often developed. First, people often begin to have a sense of spiritual meaning. They connect what is happening to them to a larger whole. they become aware in a new way of their relationship to the divine source. They are not isolated, but connected. This connectedness to the divine source grounds them, and their practice allows the spiritual to have more and more influence in their minds and hearts. This influence forms perspectives and attitudes that become resources in the ongoing challenge to respond creatively to what is happening in their lives.
In particular, two qualities often emerge within the spiritually connected person. The first is resiliency, the quality that keeps people from being devastated by difficulties. No matter what is befalling them, they know they are made for more: there is something about them that cannot be reduced to their present circumstances. The second quality is agency. In times of physical, mental, and social difficulties, people can become passive and refuse to grapple with the challenges they face. Connectedness to the divine source confers a power to respond, to search out and do what has to be done. Both these qualities—resiliency and agency—reflect the transcendent nature of the person, the spiritual potential that is a dimension of the human.
Where to Go from Here
As the wag puts it, spirituality is an idea whose time has come—again. But there are differences. Spiritual interest is arising in areas that have long been scrupulously secular. Health care practitioners and religious thinkers are exploring religious traditions in terms of their spiritual treasures and evaluating these resources in terms of what they can contribute to physical, mental, social, and ethical life. Many have an intuitive sense that the spiritual is a missing piece, a piece that would bring added value to the health care enterprise. This sense is joined to a commitment to find ways of effectively and appropriately bringing the spiritual into the various areas of health care. The future most likely will continue to be a time of exploration and experimentation in the complex relationship of spirituality and health care.
This article reflects discussions that took place during the two-day colloquium "Spiritual Resources in Health Care." Cosponsored by the Park Ridge Center and the Fetzer Institute, this colloquium will result in the handbook "Spirituality Within Health Care Settings," which will be available from the Park Ridge Center in the second half of 1999.
John Shea, S.T.D., is the Advocate Health Care Senior Scholar at the Park Ridge Center.
