Understanding Spiritual Health

17  January 2014


Understanding Spiritual Health


By Dr Ben Bassey,  Psychiatrist




  • Spirituality is a body of knowledge .


  • Data looking at spirituality as an important health index is currently unfolding.


  • We should not deny or deprive ourselves of this increasingly exciting aspect of knowledge


  • Spirituality is a difficult subject to teach or learn. It is easier to experience it than teach!


  • Spirituality as a means of sustaining spiritual health means different things to different people.


  • It is unique or personal to every individual.


  • Everybody experiences practices some aspects of spirituality  even if he or she has no spiritual awareness.  It does not really matter if the person believe in the existence of a supreme being ( God0 or not.


  • In life,  right from birth, everyone fight battles. This could be battle with physical illnesses, mental illnesses, marital disharmony, battle against poverty etc. Spiritual knowledge(power) puts us in  a good stead to win our various life battle.


  • In this write up, the author is only going to scratch the surface of a very hard, difficult, and controversial subject


  • The subject of spirituality has become very topical in recent times! It is note  worthy that no one can completely avoid the subject of spirituality as it pertains to life.





Declaration of Interest:


  • This writer has been very passionate about true spirituality in the light of the Word of Life from childhood. He is a spiritual person and a firm believer in the  Word of Truth and in the integrity of the Holy Bible.




Spirituality As a Health Concept


  • The importance of spirituality to our health is increasingly being realised.


  • Compared with  physical and mental health, our spiritual health is often poorly understood.


  • There is general paucity of research literature with regard to our spiritual health. However, most recently, researchers are showing increasing interest in this area and data are currently unfolding.


  • In the majority of studies, spirituality is noted to promote values such as creativity, patience, perseverance, honesty, kindness, humility, compassion, wisdom, equanimity, hope, optimism, happiness and joy, higher self esteem, life satisfaction, less loneliness , purpose and meaning in life etc all of which support good mental well being.



Two Broad school of Thoughts


  • Some hold that spirituality is independent of religion


  • Others sees it as part of religion—a religious view of life


  • Perhaps, there is the third group that are in between




Separating Spirituality from Religion


  • Using Christian perspective, the differences can  be demonstrated in understanding Jesus Christ, the High Priest, Pharisees and Sadducees as well as Atheist.


  • The High priest, Pharisees, Sadducees were not only religious but legalistic about their religious practices. They were far from being spiritual. They handed over Jesus to be crucified because they felt he was not religious enough!!


  • An atheist can be spiritual, although the source of his empowerment will be limited to the human spirit.


  • Irrespective of one’s faith, beliefs and doctrine, everyone practices some element of spirituality, even if he or she has no spiritual awareness, consciousness or understanding



  • In a deeper sense, spirituality is an internalized concept, unique to individual,  and often make the person visible.


  • The founders of the different religious organizations were to a very large extent spiritual persons or leaders. Some of these include: Judaism (Abraham & Moses), religion of the Jews, recognised in both Christianity and Islam; Jesus Christ (founder of Christianity); Mohammed (founder of Islam); Hinduism (no known founder, not one god; followers are encouraged to seek the truth in their own way); Sidhartha Gautama (founder of Buddaism); Guru Nanak (founder of Sikhism) etc.




Man Exists As trinity

  • It is true that Man  exists at three broad levels: body, soul (mind) and spirit .


  • Our soul or mind is the domain of our Will, Intellect, thoughts, reasoning,  perception, imagination and Emotions. These form the character and the personality of the person.


  • Virtually everything in creation has a spiritual force behind it, be it good  or bad. There is spiritual force at the root of every creation.


  •  Man’s spirit being is very important to the creator, since it is the vital link between man and the creator.


  • Just as we nourish our body with good food /diet; nourish our soul/mind with good/positive thoughts/feelings; we can nourish our spirit man, with ‘spiritual food’: Love, Joy, Peace, Faith, Patience, Humility, Truth, Purity, Righteousness, sincerity, honesty, transparency & Purity etc


  • Thus, man can enjoy optimal health by paying attention to the spiritual aspect of health and balancing  the three broad levels of health: physical, mental and spiritual.




The Three Broad Spiritual Forces Operating in the Universe.


  • Broadly speaking there are three spiritual forces controlling the universe, daily influencing us, whether we have the awareness or not: These spiritual forces are: Goodness(God); Evil (Satan/Devil) and Man, who is comparatively neutral.


  • God as a Spirit is omniscience, omnipresent and omnipotent. He is entirely good, benevolent, kind and perfect.  He very powerful and fully in control of the other two spiritual forces.


  • Satan is malevolent, bad, wicked, evil and destructive spirit. Although he thus have some power, but this is very limited compare with the Spirit of Truth. He is mainly cunning, deceptive, seductive and manipulative. He is under  the control of God.


  • Man is comparatively a neutral spiritual force who has a choice to either fully align with God or with the devil. However, in practice many sit on the fence, with lukewarm attitude with regard to spiritual matters.



 Some Aspects of  Definition/Explanation and Views of Spirituality

Since the beginning of creation until now, man has always shown interest in things of the spirit. The existence of the spirit realm has never been in doubt. Below are how  others view/have viewed the things of the spirit:


  • Holy Bible: ‘God is a Spirit’ (John 4:24)


  • Lao-Tzu (c-604-531 BC)—‘The tao that can be named is not the eternal Tao’. The name that can be named is not the eternal name


  • Jesus Christ: ‘It is the Spirit who gives life; the flesh profits nothing. The words that I speak to you are spirit, and they are life” (John 6:63, NKJV).


  • Victor Frankl (1973): “Man lives in three dimensions: the somatic, the mental, and spiritual. The spiritual dimension cannot be ignored, for it is what makes us human”.


  • Ellison, ( 1983) : suggested that spirituality “enables and motivates us to search for meaning and purpose in life. It is the spirit which synthesize the total personality and provides some sense of energising direction and order. The spiritual dimension does not exist in isolation from the psyche and the soma. It affects and is affected by our physical state, feelings, thoughts and relationships”


  • Professor Swinton, 2001: a well known expert in the field of spirituality and mental health: “the human spirit is the essential life force that under-girds, motivates and vitalises human existence” (Swinton, 2001); Again, (Swinton, 2001) advised: “ Psychiatrists and other mental health professionals need to be bilingual, ‘fluent in… the language of psychiatry and psychology…and the language of spirituality that focuses on issues of meaning, hope, value, and connectedness and transcendence’


  • Cook, (2004a)—“Spirituality is a distinctive, potentially creative and universal dimension of human experience arising both within the inner subjective awareness of individuals and within communities, social groups and traditions. It may be experienced as relationship with that which is intimately ‘inner’, immanent and personal, within the self and others, and /or as relationship with that which is wholly ‘other’, transcendent and beyond the self. It is experienced as being of fundmental or ultimate importance and is thus concerned with matters of meaning and purpose in life, truth and values”


  • Murray et al (2004), in a study of patients with life threatening illness, defined spiritual needs as “needs and expectations which humans have to find meaning, purpose and value in their life. Such needs can be specifically religious but even people who have no religious faith or are not members of an organised religion have belief systems that give their lives meaning and purpose”



  • Athesist: to be atheist is to deny emphatically the existence(even the possibility) of existence of a sacred being, supreme reality, God or other deity



  • Agnostic: to be agnostic is to assert that we cannot truly know about the existence or otherwise of a sacred being, supreme reality, God or other deity


  • Unsure—-to be unsure means the person does not know what he or she believes about a sacred being, supreme reality, God or other deity


  • Religious—to be religious is to believe and have faith in sacred being supreme reality, God or other gods, and/or belong to and practice within an organised religion.


  • Spiritual: to be spiritual is to experience awareness of relationship with a sacred reality, whether or not also belonging to or practicing within an organised religion




The ‘spirit man’ and its Importance based on the Book of Life (Bible).


“It is the Spirit who gives life; the flesh profits nothing. The words that I speak to you are spirit, and they are life”(John 6:63, NKJV).


“A man’s spirit sustains him in sickness, But a broken spirit who can bear”? (Proverbs 18:14, NKJV)


“The spirit of a man is the candle of the Lord” (Prov 20:27 KJV)


As a man “thinketh in his heart so is he” (Prov 23:7, KJV)




Salient Features of Spirituality in General


·         It cuts across all religions


·         Extend across culture & creed


Lack of believe in existence of supreme being does not preclude one from        having a spiritual experience


·         It’s is unique& personal  to individual


·         Atheist  and non believers do practice and experience it


·         It ‘links the deeply personal with universal’


·         It leads to the recognition that helping others is helping oneself ..


·         It leads to recognition that harming others is harming oneself


·         It leads to respect and tolerant of others’ beliefs, cultures and religions ;


·         Above all it leads to recognition that to love others is to love oneself etc



Incorporation of Spirituality into Health:


Historical Aspects:



  • Man’s faith in religion/spirituality is as old as man


  • Mental illnesses and difficult conditions in the beginning were seen as a responsibility of priests and shamans.


  • Priests and physicians were often the same individuals in different civilisations across the world.


  • Spiritual care was very part and parcel of care package patient received in the days of old.


  • Historically, much psychiatric care has been provided within a spiritual or religious context (eg in Europe, the medieval Europe, the shrines of St Mathurin and St Acairus in France. In  1247, the prior of Mary Bethlehem was founded in Kent, England, for the care of insane; now Bethlem Royal Hospital is the oldest hospital in the Uk for people  with mental illness



  • ‘Moral Treatment’..widely practiced 1815-1875 was a system originating in Europe involving compassionate, psychological and spiritual treatment based on idea that insanity was a disruption of both mind and spirit (Taubes, 1998)


  • First established psychiatric care in USA was originally related to spirituality.


  • For most part of 20th century, psychiatry had a somewhat negative view of spirituality, partly because of Freud’s ant-ireligious bias (Peteer, 2007b).


  • From 1908 until his death in 1939, Freud wrote vigorously against religion, and his teachings dramatically changed the views of the following generation of psychiatrist


2Oth Century


The World Health Organization (WHO) in a holistic approach to healthcare later incorporated spirituality .WHO in the 1980s redefined health as ‘a state of physical, mental, social, psychological and spiritual  well being of individuals not just absence of infirmity’. The spirituality aspects of health was initially left out in its original definition in the 1950s.


DSM 1V (1994), American Psychiatric Association (APA), Diagnostic & Statistical Manual of Mental Disorders:


‘V62.89 ‘ Religious Spiritual Problem’: Other  Conditions that May be a Focus of Clinical Attention.  Category can be used when ‘focus of clinical attention is a religious or spiritual problem. Examples include distressing experiences that involve loss or questioning of faith, problems associated with conversion to a new faith or questioning of spiritual values that may not necessarily be related to organised church or religious institution’.



The Royal College of Psychiatrists, UK

Spirituality Interest Group( SIG)


In the UK,  since the 90s, there has been a number of calls for an approach encompassing mend, body and spirit.


The college was urged to by its patron, HRH the Prince of Wales in 1991; Prof Sims raised the issue again in 1993, in his Presidential Valedictory Lecture as did succeeding college presidents.


The Spirituality Special Interest Group(SSIG) was founded in 1999-to provide forum for psychiatrists to explore the influence of the major religions, which shape the cultural values and aspirations of psychiatrist and patient alike.


The spiritual aspirations of person not identifying with any one particular faith are held to be of no less importance,



SIG records the following on its spirituality special interest group  website: ‘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’.



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.



Range of Spiritual Activities  (Religious based/secular)

In practice, spiritual activities range from religious to secular, and  encompasses a wide range of activities identified among others by the. (Royal College of Psychiatrists , UK,website) to include:

  • Engaging  in religious based activities;
    • 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


Spirituality Health and the NHS (UK)


In the United kingdom, it is interesting to observe that the National Health Services has always paid some attention to the spiritual needs of the patients since its inception.


The following comments are worthy of note:


Meeting the varied spiritual needs of patients, staff and visitors is fundamental to the care the NHS provides (DOH, 200a, p.5)

Palliative Medicine—Spirituality is an integral component of palliative care with NICE guidelines clearly given.

Alcoholic Anonymous (AA): Spirituality is an integral component of the AA, which views the 12 steps as a spiritual approach to solving their alcoholism.

Psychotherapy—–‘Mindfulness psychotherapy’ is spiritually oriented, incorporating Buddhist meditative practice.

Dialectical Behavior therapy (DBT) a system of psychotherapy based on cognitive behavioural approach, has been found useful in the treatment of Emotionally unstable personality. It incorporate concepts from Mindfulness awareness largely derived from the Buddhist meditative practice.

Joint Commission (2008) now requires that certain patients in inpatient behavioural health care programs have an assessment that ‘includes the client’s religion and spiritual orientation’ (p. 215)





Elements of Spiritual Care (adapted from Nathan, 1997)


  • An environment fostering hope, joy, and creativity


  • Being valued, and trusted, treated with respect and dignity


  • Sympathetic and confidential listening


  • Help to make sense of, and derive meaning from, illness experiences


  • Receiving permission, encouragement (and sometimes guidance) to develop spiritually




Provision of Spiritual care


IDENTIFIED BENEFITS of Spirituality & Religion

A– (Koenig, 2005; Cook et al 2009)


1-Promote a positive worldview


2—Help to make sense of difficult situations

3 Give purpose an meaning

4—Discourage maladaptive coping

5—Enhance social support

6—Promote ‘other-dierectedness’.

7—Help to release the need for control

8—Provide and encourage forgiveness


9-Encourage forgiveness


10—Provide Hope


Both recognise spirituality and religion can also be deleterious to treatment hence pathological forms of spirituality are recognised.



B—Benefits of Spiritual Care (adapted from Nathan, 1997)


–Healthy grieving of losses enabled (letting go)

-Improved self-esteem and confidence

–Maximisation of personal potential

–Relationships improved (with self, others and with the Absolute/God)

–Renewed sense of meaning and purpose

–Enhance feeling of belonging

Improved capacity for solving problems

–Insoluble problems, continuing distress and disability more easily endured

–Hope renewed



Assessment of Spiritual Needs


The most important objective in psychiatry is to get alongside the patient (Poole & Higgo, 2006: p. 2)


Qualitative Methods—work better!


Taking a Spiritual History(drawn from Americian College of Physicians Lo et al, 1999)


1—Is faith (religion, spirituality) important to you in this illness?

2–has faith (religion, spirituality) been important to you at other times in your life?

3—Do you have some to talk about religions/spiritual matters?

4—Would you like to explore religious/spiritual matters with some?


Such questions should take just couple of minutes (Koenig, 2004



Two Questions in brief history taking –Cook et al 2009

1—What helps you most when things are difficult, when times are hard(such as when you are facing big problems, major losses or other important challenges)?


2—Do you think of yourself as being either religious or spiritual? Eg identifying with any of defined identities



Quantitative Methods—-Spirituality Questionnaires)

1—Royal Free Interview for Religious and Spiritual Beliefs (King et al, 195)


2—The Spiritual Involvement and Beliefs Scales (Hatch etal, 1998)


3—-Multi-dimensional Instrument developed by Fetzer Institute (1999)


4—Hill & Hood’s Measures of Regiosity (1999)



—Failure to capture the subjective nature of human existence (Hodge, 2001a)

–Vital information can be overlooked, as patients are obliged to talor descriptions of their experiences to fit the limited choices of a specific scale and its predetermined understanding of how things are.



Why Assess a Person’s Spiritual Needs? (Cook etal 2009)

1-The very nature of spirituality as a source of vitality, motivation, and a healthy sense of belonging and being valued.


2 The long historical relationship between religion, medicine and mental healthcare.


3—The patients’ wishes as well as those of carers


4—The epidemiology of spirituality/religion and mental health


5 –The influence of spirituality/religion on the attitudes and decisions of psychiatric staff.





Training in Spirituality

Educational programs addressing spirituality have become common in medical schools and residency training programs in USA (Peteet, 2007b)



Relevance of spirituality to psychiatry

Spirituality, including its psychological aspects, is relevant for  all psychiatrists and doctors.



Some Spiritual Values:

Often called ‘Moral Values’ which cut across religions.


  • Justice                         Compassion
  • Fairness                       Holiness
  • Truth                           Humility
  • Love                            Righteousness
  • Tolerance                     Faithfulness
  • Obedience                   Honesty
  • Character                     Integrity
  • Desire for service to Humanity
  • Sacrificial living          Transparency/Openness
  • Diligence(hardwork/capacity for details)
  • Gentleness                   Discipline
  • Patience                       Modesty/Moderation
  • Perseverance               ‘Surrendering of self’
  • Forgiveness                 Mercy
  • Endurance                   Contriteness
  • Peace                           Courage
  • Sincerity                      Wisdom/Knowledge
  • Purity/Sanctification       Hope
  • Goodness/Kindness        Joy
  • Zeal, Desire, passion, Determination for goodness





Importance of truth


Truth very vital to spirituality


Jesus—‘I am the Way, the Truth and the Life (John 14:6)


Isaac Newton—‘Plato is my friend, Aristole is my friend, but my best friend is the truth


Winston Church—‘The truth is incontrovertible, panic may reject it , ignorance may deny it, malice may distrust it, but here it is’.


Close aligned to truth is Honesty, Openness, Transparency, faithfulness, sincerity etc.





Importance of our  thoughts


In spirituality, our predominant daily thoughts are very important.


Our thoughts predispose us to our beliefs, perception, attitude, emotions, imagination etc


As a man thinketh in his heart so is he






Spirituality is good for every one as a means of maintaining mental health stability

Recent studies,   have identified certain values  spirituality promotes including patience, perseverance, kindness, honesty, compassion, wisdom, hope, joy etc  all of  which help to maintain healthy mental health..


There is needs for Spiritual training, research and audits in the field of Mental Health. This should be incorporated into medical training programs.


Our daily predominant thoughts are very important. ‘Whatsoever things are true, whatsoever things are honest, whatsoever things are just, whatsoever things are pure, whatsoever things are lovely, whatsoever things are of good report; if there be any virtue, and if there be any praise, meditate on these things’ .








NICE Guidelines on palliative Care


Royal College of Psychiatrists (2009) .Spirtuality and Psychiatry. Edited by C Cook; A Powell and Andrew Sims


Murray, S., Kendall, M., Boyd, K, et al (2004) Exploring the spiritual needs of people dying of lung cancer or heart failure: a prospective qualitative interview study of patients and their carers. Palliative medicine, 18, 39-45


Koenig, H.G (2004) Taking a spiritual history. Journal of American Medical Association, 291, 2881


Swinton, J. (2001) Spirituality and Mental Health care, Jessica Kingsley