Integrating spirituality into patient care: An essential element of modern healthcare system

World Health Organisation has already realized the need of the 4th dimension of health, i.e. the spiritual health to be considered as an important element of health. In the words of Derek Yach (World Health Assembly May, 1998):“From the inception, it was felt that the 4th Dimension of health was missing from its definition. The special group of the WHO Executive Board (1998) proposed that the Preamble of the Constitution should be amended as follows”:

“Health is a dynamic state of complete physical, mental, spiritual and social well being and not merely the absence of disease or infirmity.”¹

During one of my lectures on “Life style modification and Health” I was asked to describe spiritual health. Although spiritual health means something different to everyone, below is my response hoping that it might offer some insight in addition to an expanded definition of health beyond diet and exercise. Again, this is my own perspective on spiritual health, which is a dynamic and ever evolving field of learning in medical science and hence not to be considered as absolute truth.

The traditional meaning of spirituality is a process of re-formation which “aims to recover the original shape of man, the image of God”. One can define spiritual health as nothing but peacefulness, simplicity, empathy, compassion to name a few. It might really sound to be true and interesting. It does happen with me too, whenever, I am around a spiritually healthy person, I feel peaceful, inspired, relaxed and safe. It is said, a spiritually healthy person is very much in tune with the present moment and doesn't live in the past or in the future, but instead fully accepts the current moment as the only “real” moment in which to experience and enjoy life in totality.

Interestingly, spirituality and health is a growing field of healthcare. It grew out of courses in spirituality and health developed for medical students in the United States. Research in this area over the last 30 years has also formed an evidence base for spirituality and health. Studies have demonstrated an association between spiritual beliefs of patients and values and a variety of healthcare outcomes. More recent research has also shown a strong desire on the part of patients to have their spirituality addressed as part of their medical care.

Empirical evidence is also available to indicate a direct relation between spirituality and positive health outcomes. Positive values, attitudes, belief and strength that one acquires through spiritual practices contribute to health and happiness. Spiritual practices have a positive correlation with survival, low blood pressure, fewer symptoms of anxiety and depression, less severe medical illness, better quality of life etc. As researchers clearly suggest that spiritual practices enhance the level of self-confidence, assertiveness and such other qualities which help accelerate the process of recovery from illness and surgery in general. One such specific studies of heart transplant patients showed that those who participated in spiritual activities besides complying with suggested medical prescriptions registered faster all round improvement.

In 1992, 3 medical schools offered courses on spirituality and health in America. In 2001, 75 of the 125 schools offered courses. At The George Washington University School of Medicine, spirituality is interwoven with the rest of the curriculum throughout the 4 years of medical school so that the students learn to integrate it into all of their care. Most of the other schools follow this model of integrating spirituality into on-going parts of the medical school curriculum.

Researchers suggest a positive relation between spiritual practices and positive health outcomes, like greater self-confidence, assertiveness and fewer symptoms of anxiety and depression. Evidence shows that spiritual well-being is positively related with self-ratings of physical health and vitality. Physicians do consider such factors in their medical care practice.

Research indicates a close relationship between love for God or feeling of being loved by some Higher Reality with greater self-esteem, higher levels of self-efficacy, sense of mastery, less depression, less physical disability and greater self-rated health. The John Templeton Foundation, USA has invested on more than 24 research studies on forgiveness ‘Unconditional love is the most powerful stimulant of the immune system – the truth is; love heals’.²

For the last two decades, modern system of medicine has started realizing the mind–body axis of the disease and health. Empirical evidence is available to indicate a direct relation between religious involvement, spirituality and positive health outcomes. Positive values, attitudes, beliefs and strength that one acquires through spiritual practices contribute to health and happiness. Spiritual practices have a positive correlation with survival, low blood pressure, less remission time from depression, less number of cigarettes smoked per day per week, less severe medical illness, better quality of life and cooperativeness.

In a cross-sectional study on “Spirituality and health: a knowledge, attitude and practice study among doctors of North India”, found that 65.65% had a strong or very strong belief in the spiritual dimension of health; 55.22% believed in the preventive role of spirituality; 80% believed in the curative role of spirituality and a similar proportion held the view that spirituality has an important role in day-to-day patient care. The most significant finding was that 93.48% of the doctors believe that a spiritual person deals better with stress.³

WHO's quest to integrate spiritual health in the development agenda of United Nations and in the core value system of peoples' life can be easily discerned in the words of Stuckelberger “Addressing the scientific link between religion, spirituality and health has too often been a ‘forgotten subject’ or avoided for irrational, emotional or ‘political’ reasons. It is time for the scientific community to integrate religious and spiritual factors, which have guided human behavior over centuries, into health and human sciences”.^4,5