Introduction
Spirituality involves a dimension of human
experience that psychiatrists are increasingly interested in,
because of its potential benefits to mental health.
This leaflet provides guidance for:
- the general public
- people with mental health problems
- carers.
It outlines the relevance of spirituality to
mental health and mental healthcare, and explains some of the
benefits.
It is not necessary to hold formal religious
beliefs, or engage in religious practices, or belong to an
established faith tradition, to experience the spiritual
dimension.
What is spirituality?
In healthcare, spirituality is identified with
experiencing a deep-seated sense of meaning and purpose in life,
together with a sense of belonging. It is about acceptance,
integration and wholeness.
According to one definition, “The spiritual
dimension tries to be in harmony with the universe, strives for
answers about the infinite, and comes especially into focus in
times of emotional stress, physical and mental illness, loss,
bereavement and death.” This desire for wholeness of being is not
an intellectual attainment, for it is no less present in people
with learning disability, but lies in the essence of what it means
to be human.
From the spiritual perspective, a distinction can be made
between cure, or relief of symptoms, and healing of the whole
person. Life is a perpetual journey of discovery and development,
during which maturity is often gained through adversity. The relief
of suffering remains a primary aim of health care, but it is by no
means the whole story.
How is spirituality distinguished from
religion?
Spirituality, described as “linking the deeply
personal with the universal”, is inclusive and unifying. It
naturally leads to the recognition that to harm another is to harm
oneself, and equally that helping others is to help oneself. It
applies to everyone, including those who do not believe in God or a
‘higher being’.
The universality of spirituality extends
across creed and culture; at the same time spirituality is felt as
unique to each and every person.
Religions offer community-based worship, each faith having its
own set of beliefs and sacred traditions. However, when there is a
lack of respect for differences of belief, religion has been used
as a social and political tool leading to intolerance and
divisiveness.
Components of spiritual health care
Surveys of mental health patients have shown
the need for:
- an environment for purposeful activity such
as creative art, structured work and enjoying nature;
- feeling safe and secure. Being treated with
respect and dignity allows you to develop a feeling of belonging,
of being valued and trusted;
- having time to express feelings to
sympathetic and concerned members of staff;
- opportunities and encouragement to make sense
of, and derive meaning from, experiences including illness;
- permission and encouragement to develop a
relationship with God or the Absolute (however the person conceives
whatever is sacred).
People need a time, a place and privacy in which to pray and
worship, the opportunity to explore spiritual (and sometimes
religious) matters, encouragement in deepening faith, feeling
universally connected and perhaps also forgiven.
What are the benefits of paying attention to the spiritual
dimension?
Patients have identified the following
benefits of good quality spiritual care:
- improved self-control, self-esteem and
confidence;
- faster and easier recovery, achieved through
both promoting the healthy grieving of loss and maximising personal
potential;
- improved relationships – with self, others
and with God/creation/nature;
- a new sense of meaning, resulting in
reawakening of hope and peace of mind, enabling people to accept
and live with problems not yet resolved.
Recognising and assessing the religious and spiritual aspects
of a person’s life
A helpful way to begin is simply to ask ‘what
sustains you?’ or ‘what keeps you going in difficult times?’ A
person’s answer to this usually indicates his or her main spiritual
concerns and pursuits.
There are two aspects to look at:
- What helpful inner personal resources can be
encouraged?
- What external supports from the community
and/or faith tradition are available?
A gentle, unhurried approach works best. In
this way, as well as gathering information, the process can have
important therapeutic value.
The following five headings list some additional helpful
questions to ask and consider.
Setting the scene
What is your life all about? Is there anything
that gives you a particular sense of meaning or purpose?
The past Emotional stress usually involves
some kind of loss, or the threat of loss. Have you experienced any
major losses or bereavements? What has been the effect, and what
ways of coping have you tried?
The present
Do you experience a feeling of belonging and
being valued, a sense of safety, respect and dignity? Is there
openness of communication both ways between you and other
people?
Does there seem to be a spiritual aspect to
the current problem? Would it help to involve a chaplain, or
someone from your faith community? What more needs to be
appreciated about your particular religious background?
The future
What does the immediate future seem to hold?
What about the longer term? Is there a concern with death and
dying, or about the possibility of an afterlife? Would it be
helpful to discuss this more? What are your main fears regarding
the future? Do you feel the need for forgiveness about anything?
What, if anything, gives you hope?
Remedies
What kind of support would help you? How can
it be asked for and from whom? Have you considered any
self-help options?
Spiritual practices
These span a wide range, from the religious to
secular:
- belonging to a faith tradition, participating
in associated community-based activities;
- ritual and symbolic practices and other forms
of worship;
- pilgrimage and retreats;
- meditation and prayer;
- reading scripture;
- sacred music (listening to, singing and
playing) including songs, hymns, psalms and devotional chants;
- acts of compassion (including work,
especially teamwork);
- deep reflection (contemplation);
- yoga, Tai Chi and similar disciplined
practices;
- engaging with and enjoying nature;
- contemplative reading (of literature, poetry,
philosophy etc.);
- appreciation of the arts and engaging in
creative activities, including artistic pursuits, cookery,
gardening etc.;
- maintaining stable family relationships and
friendships (especially those involving high levels of trust and
intimacy);
- group or team sports, recreational or other activity
involving a special quality of fellowship.
Spiritual values and skills
Spiritual practices foster an awareness that
serves to identify and promote values such
as creativity, patience, perseverance,
honesty, kindness, compassion, wisdom, equanimity, hope and joy,
all of which support good health care practice.
Spiritual skills include:
- being self-reflective and honest;
- being able to remain focused in the present,
remaining alert, unhurried and attentive;
- being able to rest, relax and create a still,
peaceful state of mind;
- developing greater empathy for others;
- finding courage to witness and endure
distress while sustaining an attitude of hope;
- developing improved discernment, for example
about when to speak or act and when to remain silent;
- learning how to give without feeling
drained;
- being able to grieve and let go.
An important principle of the spiritual
approach to mental healthcare is ‘reciprocity’ – this
means that the giver and receiver both benefit
from the interaction. Provided exhaustion
and ‘burn-out’ are avoided, carers naturally
develop spiritual skills and values over time,
as a result of their devotion to those for
whom they care. Those benefiting from care
are often, in turn, able to give help to others in distress.
The place of chaplaincy/pastoral care
Times have changed since hospital chaplaincy
was thought of as mainly Anglican. It now involves clergy and other
appropriate personnel from many faiths and humanist organisations,
as well as from several Christian denominations. Chaplains, or
spiritual advisors as they are sometimes called, are increasingly
valued as contributors to the work of multi-disciplinary in-patient
and community mental health services.
A properly resourced, modern mental health
chaplaincy or pastoral care department should have access to sacred
space. The chaplains will have made a point of establishing good
relations with local clergy and faith communities, and will provide
information about local religious groups and their traditions and
practices. They will be aware of situations in which an
individual’s understanding of religious beliefs and activities seem
to be unhelpful to them.
Advice should be available on controversial
issues, such as spirit possession and the ministry of deliverance.
Close liaison with the mental health team supports a holistic
approach in which the ‘whole-person’ needs of the individual can be
best understood and met.
Psychiatrists, patients and carers should all be fully
informed of local chaplaincy services.
Education and research
Evidence for the benefits for mental health of
belonging to a faith community, holding
religious or spiritual beliefs, and engaging
in associated practices, is now substantial. On the strength of
this growing body of research, educational initiatives for mental
health
care students and practicing clinicians have
been developed for inclusion in medical and
nursing curricula and Continuing Professional
Development (CPD) options.
About the Spirituality and Psychiatry
Special Interest Group (SIG)
The Spirituality and Psychiatry Special
Interest Group of the Royal College of Psychiatrists (Spirituality
SIG) was founded in 1999 to serve two needs.
- There was no forum available to enable
psychiatrists interested in spirituality to share and explore this
important aspect of mental healthcare.
- Through a number of patient-led surveys,
patients made it clear that they felt deeply the omission of a
spiritual dimension, to the detriment of their quality of
care.
Since its foundation, the Spirituality SIG has
steadily grown, with over 2000 psychiatrists joining the group. An
active programme of one-day events for members is held; also
occasional conferences open to the general public. Information
about these meetings is published in the Spirituality SIG
Newsletter, along with the texts of all talks given, on the
Spirituality SIG website (www.rcpsych.ac.uk/spirit).
Making a spiritual assessment is as important
as all other aspects of medical history taking and examination.
When making a diagnosis, a psychiatrist should be competent in
distinguishing between spiritual crisis and mental illness, and
able to explore areas of overlap and difference between the
two.
Finally, the SIG seeks to promote knowledge of
current research linking spirituality with improved physical and
mental health.
Advice
Spirituality is a deeply personal matter. People are
encouraged to discover ‘what works best for you’. A routine daily
practice involving three elements can be helpful:
a) regular quiet time (for prayer, reflection
or meditation);
b) appropriate study of religious and/or
spiritual material;
c) engaging in supportive friendships with
others sharing similar spiritual and/or religious aims and
aspirations.
It is possible to find advice about spiritual
practices and traditions through the resources of a wide range of
religious organisations (see overleaf). Secular spiritual
activities are increasingly available and popular too. For example,
many complementary therapies have a spiritual or holistic element
that is not defined by any particular religion. The internet,
especially internet bookshops, the local yellow pages, health food
shops and bookstores are all good places to look.
Further reading
Barker, P. & Buchanan-Barker P (Eds).
Spirituality and Mental Health: Breakthrough. Whurr.
Dass, R & Gorman, P. How Can I Help?
Stories and reflections on service. Alfred A Knopf.
Galanter, M. Spirituality and the Healthy
Mind: science, therapy, and the need for personal meaning.
Oxford University Press.
Kabat-Zinn, J. Wherever You Go, There You
Are. Piatkus Books.
Kornfield, J. A Path With Heart.
Rider.
Kowalski, R. The Only Way Out Is In: Yoga,
Ayurveda and Psychology. Jon Carpenter Publishing.
Hanh, T N. Transformation and
Healing. Full Circle Publishing Ltd.
Scott Peck, M. The Road Less
Travelled. Rider.
Swinton, J. Spirituality and Mental Health
Care: Rediscovering a Forgotten Dimension. Jessica
Kingsley.
Whiteside, P. Happiness: The 30-Day Guide
that will last you a lifetime. Rider.
Websites
www.rcpsych.ac.uk/spirit
The Royal College of Psychiatrists’
Spirituality and Psychiatry Special Interest Group.
www.mfghc.com
The Multi-Faith Group for Healthcare
Chaplaincy website has valuable information about traditions,
symbols, teachings and practices of nine world religions.
www.happinesssite.com
Includes a ‘resources’ page with useful
internet links compiled by author Patrick Whiteside.
For additional resources, try typing
‘spirituality and health’, or ‘spirituality and psychiatry’ into an
internet search engine.
References
Murray R & Zentner J. (1989) Nursing
Concepts for Health Promotion. London: Prentice Hall. (Adapted)
Swinton, J. (1999) Building a Church for
Strangers: Theology, Church and Learning Disabilities. Edinburgh:
Contact Pastoral Trust.
Swinton J. (2002) Spirituality and the Lives
of People With Learning Disabilities. The Tizard Learning
Disability Review. 7,4: 29-35.
Culliford L. (2002) Spirituality and Clinical
Care. British Medical Journal. 325:1434-5.
Nathan M. (1997) A study of spiritual care in
mental health practice: patients’ and nurses’ perceptions. MSc
thesis. Enfield: Middlesex University.
Koenig H, McCullough M, & Larson D. (2001)
Handbook of Religion and Health. Oxford: Oxford University
Press.
World Health Organization. (1998) WHOQOL and
Spirituality, Religiousness and Personal Beliefs: Report on WHO
Consultation. Geneva: WHO.
Gilbert P, Nicholls V. (2003) Inspiring Hope:
Recognising the Importance of Spirituality in a Whole Person
Approach to Mental Health. London: National Institute for Mental
Health in England.
Faulkner A. (1997) Knowing our own minds.
London: Mental Health Foundation.
Post S, Puchalski C, Larson D. (2000)
Physicians and Patient Spirituality: Professional Boundaries,
Competency, and Ethics. Annals of Internal Medicine. 132:
578-583.
This leaflet was produced by the Royal College
of Psychiatrists’ Spirituality and Psychiatry Special Interest
Group.
Series Editor: Dr Philip Timms
Expert Review: Dr Larry Culliford and Dr
Andrew Powell
User and carer input: Royal College of
Psychiatrists’ Special Committee of
Patients and Carers
Illustration by Lo Cole/inkshed.co.uk
The Royal College of Psychiatrists is grateful
to the Birthday House Trust for supporting the production of this
leaflet.
The Royal College of Psychiatrists
produces:
A range of materials for carers of people with
mental health problems has also been produced by the ‘Partners in
Care’ campaign. These can be downloaded from www.partnersincare.co.uk.
© 2006 Royal College of Psychiatrists. This
leaflet may be downloaded, printed out, photocopied and distributed
free of charge as long as the Royal College of Psychiatrists is
properly credited and no profit gained from its use. Permission to
reproduce it in any other way must be obtained from the Head of Publications. The College
does not allow reposting of its leaflets on other sites, but allows
them to be linked directly.
For a catalogue of public education materials or copies of our
leaflets contact:
Charity registration number (England and Wales) 228636 and
SC038369.
Please note that we are unable to offer advice on individual cases. Please see our FAQ for advice on getting help.
Please answer the following questions and press 'submit' to send your answers OR
E-mail your responses to dhart@rcpsych.ac.uk
On each line, click on the mark which most closely reflects how you feel about
the statement in the left hand column.
Your answers will help us to make this leaflet more useful - please try to rate
every item.
Did you look at this leaflet because you are a (maximum of 2 categories
please):
Age group (please tick correct box)