SPIRITUAL DIMENSIONS OF HEALTH

1. SPIRITUAL DIMENSIONS OF HEALTH BY ALLAN R. HANDYSIDES M.B.,Ch.B.. FRCPC, FRCSC, FACOG. DIRECTOR HEALTH MINISTRIES GENERAL CONFERENCE OF SEVENTH-DAY ADVENTISTS

2. SPIRITUALITY? • DEFINITIONS VARY: • ACCORDING TO THE DICTIONARY IT MEANS “RELATING TO THE SPIRIT” • PROBLEMS MAY ARISE BECAUSE THE DEFINITION OF THE SPIRIT IS NOT CLEAR. • TO ADVENTISTS THE SPIRIT IS THE HOLY SPIRIT THIS THEN MEANS SPIRITUALITY=OUR RELATIONSHIP TO GOD

3. HEALTH? • WE REFER TO A WHOLE PERSON • LISTING PHYSICAL MENTAL/EMOTIOAL SOCIAL AND SPIRITUAL COMPONENTS OF A WHOLE PERSON

4. WHAT DO WE MEAN BY SPIRITUAL? • LOOKING FOR SCIENTIFIC STUDY WE ENCOUNTER PROBLEMS BECAUSE OF A LACK OF AGREEMENT ON TERMINOLOGY OF “THE SPIRIT”, “SPIRITUALITY”, AND THE “SPIRITUAL NATURE OF MAN” • THEREFORE MOST OF THE LITERATURE FAILS TO DEFINE “SPIRITUALITY” AND INSTEAD FOCUSES ON “RELIGIOSITY”

5. CONFERENCES MAY END UP CONFUSED • SO ADDRESS RELIGIOSITY; • FAITH IN A HIGHER POWER; BUT THIS MEANS DIFFERENT THINGS TO HINDUS, BUDDISTS, MOSLEMS, CHRISTIANS ETC. • MANY STUDIES INDICATE FAITH IN GOD POSITIVELY INFLUENCES CLINICAL OUTCOMES AS DOES THE USE OF PRAYER

6. JESUS OFTEN STATED • TO THE EFFECT THAT “YOUR FAITH” HAS MADE YOU WHOLE • MANY SEEK TO PROVE THAT IT IS GOD WHO MAKES ONE WHOLE NOT ONES OWN FAITH • OF COURSE THE RESPONSE MIGHT BE IT IS GOD WHO GIVES FAITH • WE NEVERTHELESS HAVE TO BEWARE THE TEMPTATION TO “PROVE GOD”

7. PHILIP YANCEY • WROTE A BOOK • “WHAT GOOD IS GOD?” THE TITLE CONFRONTS THE ISSUE MANY RESEARCHERS SEEK TO DEFINE • THOUGH THE QUESTION SPIRITUALITY AND HEALTH? IS A DIFFERENT ONE. IT LOOKS FOR CORRELATION WITHOUT NECESSARILY SHOWING CAUSATION .

8. MANY STUDIES ARE WEAK • POOR DESIGN • LACK OF CONTROLS • INSUFFICIENT NUMBERS • WOOLY DEFINITIONS

9. HAROLD KOENIGCO AUTHOR HANDBOOK OF RELIGION AND HEALTH • DEFINES SPIRITUALITY AS • “ THE PERSONAL QUEST FOR UNDERSTANDING ANSWERS TO ULTIMATE QUESTIONS ABOUT LIFE, ABOUT MEANING, AND ABOUT RELATIONSHIPS TO THE SACRED OR TRANSCENDANT…”

10. JUSTIFIES USING RELIGION AS AN INDICATOR OF SPIRITUALITY • It suffers from a degree of imprecision and confounding because not all religion and religiosity actually defines the quest for understanding and answers to our ultimate questions (some religiosity never raises such questions)

11. NEED TO EXPLORE • If spirituality is the relationship between the “individual human” and the “individual sacred or transcendent” • We have to examine the nature of EACH to understand SPIRITUALITY • SPIRITUALITY THEN MEANS DIFFERENT THINGS IN DIFFERENT CIRCUMSTANCES

12. “INDIVIDUAL HUMAN” • WE DIFFER AND SOME HAVE ASKED • Is there a God gene? • Are some better “wired” for Spirituality? • Does everyone possess a different degree of “hardwiring”? • In other words is Spirituality innate or acquired? • Are some more SPIRITUAL?

13. “INDIVIDUAL SACRED” • WHAT ARE THE EFFECTS OF THE CHARACTER OF • A TRIUNE GOD? • HINDU GODS? • BUDDAH? • ALLAH ? On the relationship? • Does the nature of GOD influence our Spirituality ? • If so do we have different Spirituality depending upon our religion? • Can we compare between religions as to which is best?

14. ATHEIST? • CAN SPIRITUALITY EXIST WITHOUT A GOD? • THE NEW AGE SEARCH FOR THE AUTHENTIC SELF AND THE QUEST TO TAP THE POWER OF THE HUMAN SPIRIT TO BRING INNER HARMONY! • IS AN ATHEIST CAPABLE OF “SPIRITUALITY” BY MAKING HIMSELF A “GOD”?

15. SUCH DIVERSITY PLAGUES THE STUDY OF SPIRITUALITY HENCE MOST STUDIES ARE DONE ON RELIGIOSITY

16. FOR MANY SPIRITUALITY IS THEIR “SPIRITUAL EXPERIENCE” • Such is an awareness of one’s fundamental yearnings, aspirations, hopes, fears, doubts, anxieties, convictions and beliefs in relationship to the “supreme being or “higher power” • THIS WOULD MEAN SPIRITUALITY IS HIGHLY INDIVIDUAL and INTERNALIZED

17. Such is a very personal experience • UNCLE PAUL • “I asked what is the most important lesson you have learned in life?” • He responded “that God is real” • He here expressed his personal awareness and relationship with God

18. C. S. LEWIS • OFTEN USED HOMEY EARTHY METAPHORS TO ILLUSTRATE HIS WRITING SUCH AS “POACHED EGGS, MUD PIES, AND MOUSE TRAPS” • I WILL TRY ONE TODAY

19. “FROG SPAWN” • THIS TOPIC OF SPIRITUALITY AND HEALTH IS AS DIFFICULT TO GRASP AND GET A HOLD OF AS “FROG SPAWN” • AS A BOY I WOULD COLLECT THE STUFF AND WATCH THE TADPOLES DEVELOP • THOUGH BOTH SPIRITUALITY AND FROG SPAWN ARE DIFFICULT TO GRASP THERE IS A REALITY THAT BOTH ARE PRODUCTIVE

20. MY JAM JAR OF FROG SPAWN • WITHOUT ME UNDERSTANDING HOW GAVE RISE TO A FEW DOZEN TADPOLES • SPIRITUALITY OR SPIRITUAL EXPERIENCE ALSO WITHOUT OUR UNDERSTANDING HOW, GIVES RISE TO MANY ATTRIBUTES IN LIVING ONE OF WHICH IS AN IMPROVEMENT IN OUR HEALTH.

21. RELIGION • DEPENDING ON HOW WE MANIFEST IT CAN AUGMENT OR INHIBIT PROCESSES INVOLVED IN HEALTH • ESPECIALLY THOSE INVOLVED IN THE PSYCHOSOCIAL AND EMOTIONAL AREAS

22. A SURGE IN INTEREST HAS LED TO THE STUDY OF RELIGION AND HEALTH WITH A CONCLUSION SOME 85% OF STUDIES SHOW A POSITIVE CORRELATION WITH RELIGION AND HEALTH • KOENIG ET AL “HANDBOOK OF RELIGION AND HEALTH”

23. POTENTIAL HAZARDS IN SUCH STUDIES • OBSERVER BIAS • METHODOLOGICAL SHORTCOMINGS • IMPRECISE DEFINITIONS OF WHAT IS BEING STUDIED

24. STUDY SUPPORTS THE SDA POSITION OF WHOLE PERSON • WIDER ACCEPTANCE IS NOW APPARENT IN THAT 50% OF AMERICAN MEDICAL SCHOOLS NOW TEACH COURSES ON SPIRITUAL CARE • ADVENTIST HEALTH STUDY 2, IS EXAMINING MANY ASPECTS OF THE CORRELATES

25. APPROPRIATE IN A SOCIETY WHERE • 95% BELIEVE IN A GOD • 94% BELIEVE SPIRITUALITY IS IMPORTANT • 77% WOULD LIKE SPIRITUAL ISSUES CONSIDERED IN THEIR CARE • YET ONLY 18-20% OF PHYSICIANS DISCUSS THEM WITH THEIR PATIENTS ASSUMING THIS IS NOT A CONCERN OR PROJECTING THEIR OWN UNBELIEF

26. WORLD HEALTH ORGANIZATION • RECOGNIZES PHYSICAL, MENTAL, AND EMOTIONAL HEALTH BUT BY REASON OF THEIR CONSTITUENT BASE (NATIONS) HAS STEERED AWAY FROM INCLUDING SPIRITUALITY AS A COMPONENT OF COMPLETE HEALTH

27. WELL BEING AND SPIRITUALITY/RELIGION RELIGIOUS PRACTICE AND BELIEF IS ASSOCIATED WITH REDUCTIONS IN • SUBSTANCE ABUSE, ANXIETY, SUICIDE RATES DEPRESSION • RATES OF CARDIAC DISEASE, CHOLESTEROL LEVELS, BLOOD PRESSURE, AND USE OF TOBACCO. • LOWER DEATH RATES FROM CANCER KOENIG ET AL

28. WELL BEING AND SPIRITUALITY/HEALTH IS ASSOCIATED WITH INCREASES IN, • HOPE AND OPTIMISM, PURPOSE AND MEANING, SOCIAL SUPPORT, MARITAL STABILITY AND SATISFACTION. • IMMUNE SYSTEM FUNCTION, GOOD SLEEP PATTERNS, EXERCISE , RECOVERY FROM HEART ATTACKS KOENIG ET AL

29. CHURCH ATTENDANCE ASSOCIATED WITH • INCREASED LONGEVITY (7YEARS IN WHITES AND 14 YEARS IN BLACKS WITH FEMALES BENEFITTING MORE THAN MALES) KOENIG ET AL

30. NOT ALL RELIGIOSITY IS ASSOCIATED WITH GOOD OUTCOMES • LEGALISTIC OBSESSIVE COMPULSIVE RELIGION BRINGS NEGATIVE OUTCOMES • HARMONIOUS,SUPPORTIVE GROUP ACTIVITY, SHARED VALUES AND THE SENSE OF COMMUNITY ARE ALL SYNERGISTIC AND POSITIVE.

31. RELIGION • INVOLVES THE COMMUNITY OF THE CHURCH • THIS EXTENDS ITS INFLUENCE BEYOND SPIRITUALITY TO SOCIAL EFFECTS • RELATIONSHIPS OF RELIGION ARE BOTH WITH GOD AND WITH OTHERS • BOTH MAY HAVE IMPLICATIONS FOR HEALTH

32. SOME DIVIDE SPIRITUALITY INTO 3 COMPONENTS

33. 1, The intellectual component • This encompasses the philosophical aspects of our spirituality. • It deals with our “world view” • The purpose and meaning of life • The “TRUTH” we hold dear

34. 2. The Experiential Component • Deals with the equanimity or the inner mental harmony. Hope grows in the soil of this experience. • Often rising close to the surface in illness we see the strata on which love, comfort, peace, forgiveness, guilt, and inner strength are founded

35. 3. The behavioral Component • OUR EXTERNAL MANIFESTATION OF THE INNER SPIRITUAL • Sometimes a mask is worn. But just as I would always remove my mask when talking to a patient pre or postoperatively we need to remove our masks in Spiritual dialogue and care.

36. SPIRITUALITY AND ILLNESS • ONE OF THE HAZARDS OF LINKING SPIRITUALITY WITH HEALTH IS THAT WE FALL INTO PHARISAICAL THINKING • “WHO HATH SINNED……THIS MAN OR HIS PARENTS?” • THERE IS TREMENDOUS DANGER OF BECOMING JUDGEMENTAL WHEN CAUSATIVELY LINKING SPIRITUALITY TO HEALTH OR DISEASE.

37. THE QUESTIONS I HAVE BEEN ASKED • SHOULD WE DISFELLOWSHIP A PERSON WHO IS DEPRESSED? • IS A PERSON WITH CANCER NOT SPIRITUAL ENOUGH? • DOES DIABETES INDICATE LACK OF SPIRITUAL CONNECTION ?

38. THINK OF JOB! • “THOUGH HE SLAY ME YET WILL I TRUST HIM” • “I KNOW THAT MY REDEEMER LIVETH “ • “YET IN MY FLESH SHALL I SEE GOD” SPIRITUALITY MORE THAN A DETERMINANT OF DISEASE.. MAY BE MORE A DETERMINANT OF HOW WE COPE WITH IT.

39. THANK YOU

40. APPENDIX FOR HEALTH PROFESSIONALS

41. Spiritual Distress • Many patients will have a past exposure to religion that may lead to EXTREMELY POSITIVE OR NEGATIVE attitudes. • Spiritual distress is present when the sources of MEANING fail. Additionally negative experiences engender even more powerful negative effects, than positive experiences do positive effects.

42. Scuba Diving • When the tank runs out! • Buddy system • Sharing a necessity. We need to recognize different levels of spirituality may be required and to avoid elements of religiosity at the first encounter, just as diving at different levels has different timing requirements before we can reach the surface

43. Learning needs of both patients and care-givers • SPIRITUAL SELF CARE • We cannot minister that which we do not possess. To be patient centered WE must be Spirit Vitalized • All three aspects already covered are important

44. Patient encouraged to seek his/her own spiritual relationships • Identification of the patients progress in the spiritual journey is important • Activities that assist in reaching spiritual relationships may include Family and friends Nature Recreation Spiritual Readings Pastoral interactions

45. Good Patient/Health Professional relationships • Spiritual strength is imparted by truthful, transparent, concerned caring. • “Professionalism” may be an impediment if self serving and based in pride and a sense of superiority • Though we laugh at the doctor who thinks he is God there are many of those who laugh who in reality are no different.

46. Appropriate Timing • Telling a joke requires impressive timing but no more than the sensitivity in broaching spirituality at an appropriate level with a terminally ill patient. • Too soon may be discouraging too late loses the only opportunity

47. THE IMPORTANCE OF HOPE

48. H ope; we need to explore • What are the patients sources of hope, comfort, strength, and peace? • Pertinent questions may include • “I was wondering, what is there in your life that gives you internal support?” • “What are your sources of hope strength comfort and peace?” • “What do you hold on to in difficult times?” • “For some their Religious or Spiritual beliefs give strength .Is this true for you?”

49. When the response is in the NEGATIVE • We could ask “Was it ever, what changed?” • If the response was in the affirmative we then are free to progress to the other letters in HOPE

50. O rganized Religion • “Do you consider yourself part of an organized religion?” • “How important is this to you?” • “What aspects of your religion are most important to you?” • “Are you part of an organized community of faith?” • “Does it help you, how?”