A Presentation to Pediatric Integrative Medicine Rounds, Edmonton Clinic Health Academy

1. Health and Spirituality
A Presentation to Pediatric
Integrative Medicine Rounds
Edmonton Clinic Health Academy
byJohn C Carr,ThM, PhD, RPsych (AB#1035)
Associate Faculty, St Stephen’s College, Edmonton
24 March 2015 12:00 - 12:50 pm
Copyright 2015 - John C. Carr,ThM, PhD, Reg. Psychologist (Alberta 1035)

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

3. 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.

4. 1. Religion, Spirituality, & Faith
•What 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?”

5. Religion
•belief in a god or in a group of gods
•an organized system of beliefs, ceremonies, and
rules used to worship a god or a group of gods
•an interest, a belief, or an activity that is very
important to a person or group
Source: Merriam Webster
http://www.merriam-webster.com/dictionary/religion

6. Spirituality
• the quality or state of being concerned with religion or
religious matters
• the quality or state of being “spiritual”
• of or relating to a person's spirit
• of or relating to religion or religious beliefs
• having similar values and ideas
• related or joined in spirit
Source: Merriam Webster
http://www.merriam-webster.com/dictionary/spirituality
http://www.merriam-webster.com/dictionary/spiritual
1

7. Spirituality
A 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:Wikipedia
McCarroll, 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. Press
2

8. Spirituality
According toWaaijman, 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 theTorah,
in Christianity Christ, in Buddhism Buddha, in Islam
Muhammad.”
Source:Wikipedia (Waaijman, Kees (2002), Spirituality: Forms, Foundations, Methods, Peeters Publishers)
3

9. Spirituality
• In 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: Wikipedia
Houtman, Dick; Aupers, Stef (2007), "The SpiritualTurn and the Decline ofTradition:The Spread of Post-Christian Spirituality in 14 Western
Countries, 1981-2000", Journal for the Scientific Study of Religion (2007) 46 (3): 305-320
4

10. Spirituality
•Waaijman 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:Wikipedia
Waaijman, op. cit., p. 315.
5

11. Faith: A Christian Model
• … is the assurance of things hoped for, the conviction of
things not seen …
Hebrews 11: 1 (New Revised StandardVersion 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

12. Faith: A Christian Model
•is a combination of relationship with the
Divine (God - Jesus – Holy Spirit)
• and assent to a system of beliefs (doctrine)
that vary, depending on the person’s
“denomination”
2

13. 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 beliefs
Source: MerriamWebster
http://www.merriam-webster.com/dictionary/faith
3

14. Faith: More Generically
•confidence or trust in a person, thing, deity,
view[point],
•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 proof
•often used as a synonym for hope, trust, or belief
Source:Wikipedia
4

15. Religion, Spirituality, & Faith 1
•Although “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 person’s Religion or Faith
without narrowing that down to a specific
religious tradition.

16. Religion, Spirituality, & Faith 2
•When 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’.”

17. Religion, Spirituality, & Faith 3
•Being “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.

18. 2. Physical, Mental, and Relational
Health
How do we think about “Health?”
•Absence of health: sickness, pathology,
disability, threat of death
•Presence of wellness: maximum capacity for
living and living well
1

19. Physical, Mental, and Relational
Health
The way in which we think about “Health”
affects whether our efforts
•are directed towards “solving a problem” or
•are focussed on maximizing wellness
3

20. Physical, Mental, and Relational
Health
The way in which we think about “Health” affects
•The way in which we understand the relationship
between Health and Religion-Spirituality-Faith
•The way in which we respond to persons who seek
the services of a health facility and/or a health
professional
2

21. Jürgen Moltmann
Pre-eminent Christian Theologian of Hope
“God weeps with us so that we may one day laugh with him.”
See http://www.garrettmedia.net/video500.php?vid_name=special/moltmann09/convocation to
listen to a 40-minute lecture by Professor Moltmann at Garrett-EvangelicalTheological Seminary,
Evanston, Il, USA - “ATheology of Life, A Life forTheology”.

22. Spirituality, Religion & HealthCare:
Foundations 1
•“Hope 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) NewYork: Norton.

23. Spirituality, Religion & HealthCare:
Foundations 2
•"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) NewYork: Norton.

24. Spirituality, Religion & HealthCare:
Foundations 3
•Religion 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

25. Spirituality, Religion & HealthCare 1
•So 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.

26. Spirituality, Religion & HealthCare 2
• Numerous studies, supervised by Northwestern Universioty Social
Psychology 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. or
simply being cared for by a religious / spiritually identified
representative of a frame of reference that is larger than ordinary
human experience.
Source: Joint Northwestern University and Garrett-EvangelicalTheological College (Evanston, Illinois) PhD Dissertations

27. 3. Clinical Care Grounded in “Spiritual
Sensitivity”
•Will assess the spirituality of the patient
and/or of their family as part of the process
of Assessment and Diagnosis
•Will ensure the availability of Spiritual Care
appropriate to the spirituality of the
patient

28. Clinical Care Spiritual AssessmentTools 1
“Spiritual 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

29. Clinical Care Spiritual Assessment Tools 2
HOPE
H: 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 issues
Source: Gowri Anandarajah, M.D., and Ellen Hight, M.D., M.P.H Brown University School of Medicine,
Providence, Rhode Island at
http://courses.washington.edu/bh518/Articles/hopearticle.pdf

30. Clinical Care Spiritual Assessment Tools 3
FICA SPIRITUAL HISTORYTOOL
F: Faith or Belief
I: Importance and Influence of Personal Spirituality
C: Community: Importance of Spiritual Community
A: Address: Interventions to Address Spiritual Needs
Source: Journal of Pain and Symptom Management, 2010,Volume 40, Issue 2, Pages 163–173 at
http://www.jpsmjournal.com/article/S0885-3924(10)00325-8/abstract

31. Clinical Care Spiritual Assessment Tools 4
Seven by Seven Model
Rush-Presbyterian St. Luke's Medical Center, Chicago, Illinois
Source: Fitchett, G. (1993) Assessing Spiritual Need: A Guide for Caregivers. Minneapolis,
Minnesota: Augsburg/Fortress Press.

32. Clinical Care Spiritual Assessment Tools 5
Developing a Spiritual AssessmentToolbox: A Discussion of the
Strengths and Limitations of Five DifferentAssessment 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 & SocialWork. (2005)Volume 30 Issue 4Pp. 314-323
athttp://hsw.oxfordjournals.org/content/30/4/314.short

33. Clinical Care Spiritual Assessment Tools 6
… 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,WordenW (Department of Family Health Care
Nursing, School of Nursing, University of California, San Francisco,California, USA) Journal of
PalliativeCare [2002, 18(1):59-67] at http://europepmc.org/abstract/med/12001404

34. Spiritually Sensitive “Care” 1
•Assessment 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 and
•whether that healing process might involve
facilitation of a “cure” or enhancement of ability to
cope with a chronic illness or impending death.

35. Spiritually Sensitive “Care” 2
•As noted previously, may occasionally involve a
determination that an aspect of the patient’s/
family’s spirituality, or that of their spiritual
community, is potentially harmful to health
•And requires intervention of some kind
•And will involve determining the who and the
how of the intervention.

36. Spiritually Sensitive “Care” 3
•Will 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.

37. Spiritually Sensitive “Care” 4
•Will ensure access of the patient’s and/or
family’s spiritual community through that
community’s 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).

38. Spiritually Sensitive “Care” 5
•Will 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).

39. Spiritually Sensitive “Care” 6
•Will 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.”

40. Appendix 1: Spiritually Sensitive “Care”
Gauger, RobertW. (2014)The Girl with the Halo. Journal of Pastoral Care &
Counseling,Vol 68:2.

41. Appendix 2: Spiritually Sensitive “Care”
Jones, Logan C. (2014) A Prayer for Healing Denied, Journal of Pastoral
Care & Counseling,Vol 68:3.

42. Appendix 3: Spiritually Sensitive “Care”
Eddins, Sharon L., Grogan, Nancy, and Frick, Brandon. (2014) Healing and Belonging: Godly Play in
Pediatric Medicine and theTheology of Disability. Journal of Pastoral Care & Counseling,Vol 68:3.

43. Appendix 4: Spiritually Sensitive “Care”
Seifter, Julian L. (March, 2014) Correlation or Causation? Our Search for
Certainty. Medscape at ttp://www.medscape.com/viewarticle/840932