A recent article by a Harvard psychology professor was titled, “Psychologists Shouldn’t Ignore the Soul.” For years, mental health professionals, including psychiatrists, have been discouraged from discussing spiritual and religious matters with patients. This makes some sense since many of the most seriously disturbed mentally ill patients have delusions and confusions about God and religion. Wading into that as a non-theologian, non-chaplain could risk worsening the situation.
However, spirituality shapes how people think and over 80 percent of people in the United States acknowledge having a spiritual belief system. Those suffering emotional or physical health challenges are just those for whom the comfort, structure, rituals and scriptures of their faith can offer a light of hope and practical tools for healing.
Holistic medicine is mind-body-spirit care. However, conventional general medicine also often ignores the spirit part of that triad. Little if anything is systematically taught to medical students on how to address the spiritual needs of their patients, how to take a spiritual history and how to enter into a healing encounter that builds on the patient’s spiritual beliefs and strengths.
The Harvard professor suggests two simple questions to open such a conversation: Do you wish to discuss spirituality with me? If yes, then: How is your spirituality relevant to your symptoms and treatment?
When we developed an interdisciplinary course in Spirituality and Clinical Care at the University of Texas Medical Branch, it was largely seen as irrelevant by many medical students, though nursing students were much more supportive and engaged.
It seems the culture of medicine emphasizes the physical body, gives something of an afterthought to the mind, and refers the spirit out to chaplains and clergy. The problem with that is that clergy are not always available in the hospital room or in the outpatient clinic.
During critical conversations about health and illness, life-altering decisions such as whether or not to go through a challenging chemotherapy program, how to manage advanced directives and end of life decisions, handling an overwhelming depression or other major illness involves the values implicit in a person’s spiritual beliefs and view of life. In assessing patients in our Integrative Oncology consultations, we ask what are their sources of support. Almost invariably they answer their family, friends and faith.
A couple of models guide us how to ask non-intrusively about spirituality and health.
F: Faith — do you have a faith or belief system that helps you cope?
I: Importance — how important is your spiritual outlook in your health care choices?
C: Community — do you have a community that supports you during difficult times?
A: Address — would you like me to address your spiritual beliefs in making health care choices?
H: Sources of hope — what are your sources of hope, strength and comfort?
O: Organized religion — are you part of an organized religion and if so, how does it support you?
P: Personal practices — do you have spiritual beliefs and practices you find helpful?
E: Effects on medical care and end-of-life issues — tell me how your beliefs affect how I can help you during this illness and the how they impact the choices we both need to make.
So yes, spiritual beliefs are important to our health and health care choices. Consider these questions personally, then start the conversation with someone you trust.