Based on her work as a non-religious healthcare chaplain, Madeleine Parkes discusses the role and purpose of spirituality in healthcare.
Since its inception in 1948, the NHS healthcare system in Britain has funded the provision of chaplains, or professional spiritual care givers, in part to ensure patient’s rights under the Human Rights Act (Article 9) and the 2006 Equality Act are met. The NHS is also interested in how a patient’s spirituality is helpful to healing and wellbeing. As a non-religious healthcare chaplain myself whose main responsibility is the provision of spiritual care to non-religious patients, I have faced some challenges when discussing and implementing secular spiritual care in a hospital environment. In the recent blog, Watts argues that scholars of spirituality must make a distinction between the study for spirituality (understanding spirituality’s practical application) and the study of spirituality (describing spirituality in a specific context). One of the challenges I face as a non-religious chaplain is managing both of these approaches to studying spirituality in a secular and medical based institution.
Many people have needs beyond the physical but these do not necessarily have to be religious; they can be existential, concerning life’s ‘big questions’, such as ‘who am I with this diagnosis?’ and ‘what might happen when I die?’ These are legitimate questions patients may have to face, but of course, the answers to these questions heavily depend on the context in which they are asked. For example, a culturally Jewish teenager learning of his cancer diagnosis may have different non-physical needs to an atheist grandmother diagnosed with dementia. Whilst ‘spirituality’ is the term used frequently in healthcare policy and practice to describe the existential quest many human beings embark upon, whether this is partly through religious faith or not, it becomes essential for chaplains to have comprehensive, empirically ground understanding of this term in order to provide sufficient care.
Although defining spirituality exists in many scholarly debates[i], there are only the beginnings about its specific definition (study of) and application (study for) in UK healthcare contexts.[ii] The first comprehensive overview of healthcare in the UK discusses spirituality theoretically in various healthcare contexts but not in depth with empirical evidence. This immediately presents those of us engaged in both research and delivery of spiritual care in healthcare a dilemma, as neither the study of spirituality (definitions) or for spirituality (application) appear to be well developed.
Many scholars in this field have suggested that ‘meaning making’ is central to the definition of spirituality, which any of us who have suffered from an illness, disability or bereavement may be familiar with.[iii] When our lives are shaken by the crisis of an illness the metanarratives we have relied upon to give our lives meaning up to that point may no longer feel helpful or adequate.
During my work as a non-religious hospital chaplain, I have seen time and time again people searching for a new lens of meaning making, a new meta-narrative to subscribe to, in the face of illness, disability or death. What this looks like could be considered the patient’s spirituality. A person’s spirituality, particularly when it is not tied to a religious framework, is usually very personal, subjective and may change many times.[iv] This makes it a difficult concept to define and study from an academic or scientific perspective. In a hospital environment providing good quality research is important in order to justify the offer of an intervention or service. Any medical intervention requires evidence before a hospital will adopt the procedure, and the same requirements are being introduced for all hospital services including spiritual care and chaplaincy. This brings us to a crucial difficulty – how to measure and evaluate an intervention that, by its very nature, is subjective and highly individual.
In my experience, it is not always helpful for chaplains to over-complicate or over-think the definition of spirituality, especially when the primary concern is the practical application for the patient’s wellbeing. Yet as professional spiritual care givers we should be engaged in research into the definition of spirituality, and be able to understand how it applies to a patient and their spiritual and existential struggles. Unfortunately, the resources to conduct this research are limited. For example, the primary goal of the three chaplaincy teams I have worked in was to meet the practical and immediate needs of the patient in the hospital, which takes up considerable time and resource, and the drive to conduct research was a lower priority.
My role as a chaplain is to facilitate the patient to find answers to questions about meaning-making, to enable them to begin a quest or a search for a new lens or metanarrative through which their current situation can be viewed. Due to the subjective nature of one’s spirituality, it is difficult to measure how effective the “spiritual care intervention” I provide is, unlike for example measuring symptom relief when a patient is prescribed medication. Again the study for spirituality and healthcare is difficult as measuring a spiritual care intervention in a meaningful and quantifiable way is problematic. Harold et al. document the relationship between religious practice and health outcomes, although it does not measure non-religious or spiritual practices. There have been some small steps towards conducting quantitative research into the effects of spirituality for patients in specific healthcare contexts.[v] But more needs to be done.
Healthcare chaplains, traditionally representative of a specific religious faith but also highly trained in pastoral care and wider spiritual wellbeing, are well-versed and well-placed to help with a search for spirituality if needed by patients and their families. Increasingly there are more non-religious, humanist or spiritual-not-religious care givers being employed to help non-religious patients along their journey. However, this provision of care also needs to be supported by carefully defined and planned research in order to better understand the role of secular spirituality in healthcare contexts. Both the study for and of spirituality is much needed.
[i] See, for example, King, Ursula. 2009. The Search for Spirituality, London: Canterbury Press Norwich; Tacey, David. 2003. The Spirituality Revolution, Sydney: Harper Collins Publishers.
[ii] For such pioneer studies, see Swinton, John. 2001. Spirituality and Mental Health Care, London: Jessica Kingsley Publishers; Darby, Kathryn, Paul Nash & Sally Nash. 2015. Spiritual Care with Sick Children and Young People, London: Jessica Kingsley Publishers.
[iii] See, for example, Pargament, Kenneth. 2001. The Psychology of Religion and Coping, New York: Guilford Press; Puchalski, C. M. 2002. “Spirituality and end-of-life care: A time for listening and caring”. Journal of Palliative Medicine, 5 (2), 289-294.
[iv] Hay, David. 2006. Something There: The Biology of the Human Spirit, London: Darton, Longman and Todd.
[v] For example, Barber, Joanna, Madeleine Parkes, Helen Parsons & Christopher Cook, 2012 “Importance of spiritual wellbeing in assessment of recovery: The Service user Recovery Evaluation (SeRvE) scale.” The Psychiatrist 36, 444-450.
Madeleine Parkes is a first-year PhD student at Aberdeen University and a part-time hospital chaplain who specialises in spiritual care for non-religious patients. Her PhD is a qualitative study that seeks to understand how hospital chaplains address the needs of non-religious patients.
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The relationship between physical illness and spirituality is interesting to consider. It is evident that, despite their differences in application and study, the spiritual self is integral to medicine and the hospital environment where people are faced with ethical questions, mortality, and other elements that connect physical health to an individual’s spirituality. When considering the value of qualitative and quantitative study of spirituality, context is essential. The secularity of a UK hospital can challenge the nature and abilities of the spiritual services that a non-religious chaplain such as Parkes aims to provide; Parkes is a PhD student evaluating spirituality in hospitals through qualitative study. Galen Watts points to the history, and sometimes perceived lack of tradition, surrounding spirituality as an explanation for the lack of empirical study on spirituality to date.[i] While medicine is most often understood through quantitative study and spirituality in the modern west has been largely understood through qualitative study, it is important to acknowledge that qualitative understanding may be the most effective way to study spirituality, particularly in the context of a hospital.
While other medical hospital services must “justify” their need for intervention through empirical evidence, perhaps it is a requirement unfit for spiritual care. Parkes’s post acknowledges points in favour of allowing spirituality and chaplaincy to remain subjective, but I would like to further explore the notion that quantitative study and requirement is potentially problematic; while it is necessary to have quantitative data in the greater study of spirituality, it may not be of the greatest value in the context of hospital care. Courtney Bender and Ann Ann Taves’ edited collection, What Matters: Ethnographies of Value in a Not-So-Secular Age, references William Connolly, who argues that, in a scholarly setting, spirituality transcends both religion and secularism, as it creates more diverse ideology outside of the religious and secular binary.[ii] What he means by this is that spirituality fills in gaps and expands definitions outside of religion and secularity. Parkes affirms Connolly’s thinking to some degree, and points out that, at least in the context of hospital care, spirituality is more subjective in comparison to religion and secularity, and can evolve for someone over time.
Bender and Taves go on to argue that spirituality has not been “neglected or ignored” in academic discourse, but rather, as the study of religion and secularity evolves, so does the study of spirituality; the growing emphasis on spirituality in the contemporary west creates opportunities for spiritual exploration based on the subjective experience.[iii] If definitions of spirituality within hospitals is to be confined to empirical findings, there would be less freedom and individualism in patients’ experiences with chaplains utilizing spirituality studies scholarship and theory to guide the patients and justify this course of treatment to hospital administration. In this case it could be productive to argue that spirituality is entirely self-defined and that to take an empirical approach in pursuit of spiritual understanding would undermine the truths of the individual and could potentially detract from the quality of their health care.
[i] Watts, Galen. 2017. ““Of” and “For”: Studying Spirituality and the Problems Therein.” Journal for the Study of Spirituality 7 (1): 64-71.
[ii] Taves, Ann, and Courtney Bender. 2011. “Introduction: Things of Value.” In C. Bender and A. Taves (Eds.), What Matters? Ethnographies of Value in a Not So Secular Age, pp. 1-33. New York: Columbia University Press.
[iii] Taves, Ann, and Courtney Bender. 2011. “Introduction: Things of Value.” In C. Bender and A. Taves (Eds.), What Matters? Ethnographies of Value in a Not So Secular Age, pp. 1-33. New York: Columbia University Press.
Faith,
You draw great points and create a very important conversation regarding the relationship between physical illness and individual spirituality. With consideration to the connection between illness and spirituality, it is important to examine the principles of biomedical ethics which creates a connection between physicians and patient spirituality – reflecting on the professional boundaries and competency of patient’s spiritual and religious background. When binding the quantitative study of medicine and the qualitative study of spirituality, we can understand that the two work together to provide individuals with the care that they desire based on their background.
While you bring up a valid argument regarding the value of spirituality in the context of hospital care; the study of bioethics and the integration of religion and spirituality within the realm of hospital care allows for deontological and utilitarian ethics to be considered when dealing with human livelihood. Understanding that “people have needs beyond the physical,” as stated by Lundmark, we can consider the need for a comprehensive overview of healthcare. As Lundmark introduces in her blog, when a crisis arises, individuals often turn to ‘meaning making’ which can be a non-religious notion based on one’s own spirituality. Considering the many spiritual, religious or non-religious perspectives that exist within society – this is the perfect opportunity to integrate the basic principles of bioethics into UK healthcare facilities. By saying this, hospitals can be responsible for providing patients of all backgrounds with a meaningful experience based on their individual belief system.
As Lundmark states, “provision of care needs to be supported by carefully defined and planned research in order to better understand the role of secular spirituality in healthcare contexts. Both the study for and of spirituality is needed.” I believe that rather than interpreting this as a need for a definition of spirituality, therefore causing “less freedom and individualism in patients’ experiences with chaplains” as you stated, that the integration of spirituality can be considered based on the patient themselves. In the study of bioethics, the four basic principles are autonomy, beneficence, non-maleficence and justice [i] – therefore hospital care providers will make it their project to treat each person based on the scale of their personal values and generate universal duties. Principles like this are why the study of bioethics is so important within hospitals and religious studies as a whole. With consideration to these principles, hospital care providers will be able to recognize the faith, insights and experience of each individual who uphold different traditions in their day-to-day lives.
Overall, your reflection as well as Lundmark’s initial post bring up important considerations regarding the purpose of spirituality in healthcare. I believe that incorporating the principles of bioethics will make the integration of spirituality and spiritual education for healthcare providers in British hospitals more personal – and of course ensure that the individual component of spirituality is not eliminated.
[i] Muntada, Mireia. “The Importance of Bioethics”. WorldPress. Retrieved from https://allyouneedisbiology.wordpress.com/2017/06/02/importance-bioethics/ March 11 2018.
Hi Faith and Liana,
You both bring up excellent points in regards to navigating the new field of spiritual care in hospital settings. While examining the principals of bioethics, as Liana argues, is important in maintaining proper care for patients, I think it is also important to take a step back and ask ourselves why there is a growing need for spiritual, as opposed to religious, care in settings such as hospitals? The answer to this question may seem obvious, as many people are aware that Western society is moving away from traditional institutional religion, however, understanding what the new religious landscape looks like in our society is crucially important in understanding what type of care people will need.
As Lundmark explains, ‘meaning making’ is central to understanding spirituality, and providing proper spiritual care. What makes the study of spirituality so unique, as Watts argues, is that there are multitudes of ways to engage in this study, often for different ends.[i] There is no set definition of spirituality, and as Faith points out, it could actually be harmful to the quest of providing spiritual care to provide a specific definition of spirituality, because what makes spirituality so useful to people is their own ability to define what it means to them, individually.
If defining spirituality may actually take us backwards instead of forwards on our quest to understand the growing trend of people defining themselves as spiritual and requesting spiritual care, then how can we understand the type of spiritual care that people need and how can we train hospital care providers to provide this type of care?
As I mentioned earlier, I believe the answer to this question lies in understanding why people are moving away from defining themselves as ‘religious’ and towards more personal definitions of belief such as ‘spiritual’. In understanding the changing religious landscape, Dr. Linda Woodhead provides important research on the growing move away from institutional religion. In her article, “The Rise of ‘No Religion’: Towards an Explanation”, Dr. Woodhead explains that ‘religious nones’ have become the religious majority in Britain.[ii] While the term ‘religious none’ suggests these people have no religious association or belief, what is fascinating from Dr. Woodhead’s study is that many people identifying with the term ‘religious none’ still express belief in things such as an afterlife, or higher powers.[iii] It is clear that ‘religious nones’ are not always non-religious, but rather disagree with defining themselves as a specific institutionalized religion, and would rather understand their beliefs as individual. Another term for these sorts of people is ‘spiritual but not religious’, as these people often still associate themselves with ‘meaning making’, but not traditional forms of religion.
So why do I believe that it is so important for hospital workers to understand the changing religious landscape? Because providing spiritual care does not need to be about specifically defining what spiritual is, or basing research on empirical evidence. Providing spiritual care should be based on understanding why people are choosing to define themselves as spiritual but not religious, and specifically why individual invocation of belief is becoming increasingly important in people’s lives. If we aim to understand why the religious landscape has changed, we can provide support to people based on individual need, and refrain from spending too much time trying to define ‘spiritual’, when really spirituality is different for each person, and that is exactly what makes it so appealing in our modern world.
[i] Watts, Galen. 2017. “”Of” and “For”: Studying Spirituality and the Problems Therein.” Journal for the Study of Spirituality 7 (1): 64-71.
[ii] Woodhead, Linda. 2017. “The Rise of “No Religion”: Towards an Explanation.” Sociology of Religion 78 (3): 247-262.
[iii] Woodhead, Linda. 2017. “The Rise of “No Religion”: Towards an Explanation.” Sociology of Religion 78 (3): 247-262.
Faith, Liana and Emma,
You all bring up many great points regarding the growing need for spiritual care in health care facilities. Emma and Faith, your commentary about the issues with solely focusing on defining spiritualty are mirrored in Galen Watts’ article that the post above references to. Watt’s argues that, “debates over definitions of ‘spirituality’ have distracted attention from the (more consequential) social and ideological shifts – the rise of a ‘Post- Christian spirituality’ – taking place within the wider culture (and the academy).”[i] Thus, Watts highlights the point you are making Emma, regarding the importance of the changing of religious landscape, away from traditional ‘religions’ towards the personalized beliefs of ‘spirituality.’
While it is important to study this shift of beliefs, I feel that in terms of spiritual healthcare it is also important to take a look at the resources already set in place for religion in healthcare settings and how they are established. Why is it that the study of religion in patient care is well-versed and flourishing? In order to answer this, it is critical to consider what falls under the term ‘religion’ and what is considered religious.
Religion, like spirituality, is a difficult term to define, as it too could be personal to the believer. However, religions, especially those considered as ‘traditional world religions’ have structure through the use of doctrines, rituals and practices that provides it rigidity in comparison to the fluidity of spirituality. Though religion can be a means of “meaning-making,” it can also comprise of prayers, church-going, and other quantitative measures, providing the empirical data needed to prove the value of including it in patient care. This is evident through the immense work of research conducted regarding prayer-groups or religious rituals noted in Harold Koenig, Dana King, and Verna B. Carson work, the “Handbook of Religion and Health.”[ii]
In addition, religious beliefs are more recognized and well-known, allowing them to be more public in nature, as opposed to the personal attributes associated with spirituality. This may aid the growth of religion and healthcare, as religious believers may be more open to talk about their beliefs than those who partake in spirituality, leading to the limited research on the effects of spirituality in patient care that the post above argues.
Another potential cause for this lack of substantial research, in regards to spirituality, may be due to the way that the research is conducted. According to Harold G. Koenig book, “Spirituality in Patient Care,” most studies claiming to be measuring the effectiveness of spirituality are actually either measuring religion, using spirituality as a synonym, or are assessing indicators of good mental-health, such as “”forgiveness,” “gratitude,” [and] “existential wellbeing,”” in the name of spirituality.[iii] The first kind of studies provide us with an indication of the effectiveness of religion in healthcare facilities, rather than spirituality, while the second type is a form of tautology, a flawed form of research.
So what could be done to ensure patients are receiving spiritual care as needed? Well, I agree with the Parkes’ affirmation that carefully planned research is required to better understand and further the role of spirituality in terms of healthcare. However, I believe that in order to do so effectively, spirituality must be researched in the absence of religion, to provide effective data. Though religion could be seen as a form of spirituality, including it may cause the research of spirituality to continue on the path it is on presently, and prevent the field the growth needed to aid those in need.
[i] Watts, Galen. 2017. ““Of” and “For”: Studying Spirituality and the Problems Therein.” Journal for the Study of Spirituality 7 (1): 64-71.
[ii] Koenig, Harold G., Dana E. King, and Verna B. Carson. 2012. Handbook of Religion and Health. New York: Oxford University Press.
[iii] Koenig, Harold G. 2007. Spirituality in Patient Care: Why, How, When, and What. 2nd ed. West Conshohocken, Penn.: Templeton Press.