“Medicine was religion. Religion was society. Society was medicine.”
Framing the Issues and Importance to Providers
From an anthropological viewpoint, spirituality and religion are components of any cultural system, so much so that it is often difficult to clearly separate culture from spirituality and religion as it is practiced in everyday life. For some, it is more than the box they mark on a paper – instead, it is like the “air they breathe.” Others compartmentalize it and see it as very private. Some profess no real sense of spirituality or religion in their lives.
In addition, there is variation within the same faith group across cultures and individual interpretation lends still further ambiguity for any researcher who is interested in research on the relationship of spirituality and religion to health and mental health. Nevertheless, there is no doubt that spiritual and religious beliefs across cultures often include concepts related to prevention, etiology, and treatment of ill-health.
The question remains however, what, if any, is the direct cause and effect of these beliefs to health?
Historically, until the last 200-300 years, the relationship between spirituality, religion, healing, and healers was very close (Koenig 2000). Hufford (page 5) describes the current relationship of spirituality, religion and health as in a “process of reconciliation,” led by “popular demand” rather than by either the religious or medical fields. The debate continues on the relationship with its skeptics, but it is clearly a question that is receiving a great deal of attention in the literature.
Sloan et al. (2000) believe that linking the two fields is not “nearly as well justified or simple as the literature suggests.” Koenig et al. (1999) offer a rebuttal. Koenig offers one the most comprehensive reviews of the relationship of spirituality, religion and health (2001a, 2001b, 2001c, and Koenig, McCullough, and Larson 2001) while at the same time acknowledging the potential negative effects of this relationship (Koenig 2000).
Some of the potential harmful effects may include refusing medical care on religious grounds (e.g. refusing medical transfusions, immunizations for children, or antibiotics); replacing medical treatment with religious practices; or precipitating a greater sense of guilt, shame, or stress if the failure to regain one’s health is seen as the sick person’s fault or because of a lack of faith (Koenig 2000).
At the same time, religious beliefs and practices have been associated with lower suicide rates; less anxiety, substance abuse, and depression; a greater sense of well-being; and more social support in addition to other benefits. (Koenig 2004:1195)
In nursing, there are several approaches to spirituality including the concepts of spiritual distress, spiritual needs, spiritual well-being, (Stoll 1989:13) and more recently, “healing presence.” The latter, referred to as a “complex phenomenon,” by McDonough-Means et al. (2004:S-25) is described as “an interpersonal, intrapersonal, and transpersonal to transcendent phenomenon that leads to a beneficial, therapeutic, and/or positive spiritual change within another individual (healee) and also within the healer.” The goal is to “foster healing at the bio-psycho-social-spiritual levels of the human being.”
The call “to cure sometimes, relieve often, and comfort always” (Gordon 2002 and D’Souza 2007) provides a basis from which to support the “core” of the patient, that which gives his or her life meaning and hope. D’Souza (2007) strongly states that incorporation of spirituality and religion into clinical practice “will not only improve patient care, doctor-patient relationships and patient well-being, but may well come to be seen as the salvation of biomedicine.”
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