1
Spiritual Heritage of Health Care
Introduction
A study of the historical development of health care reveals that it has a deep rich religious or what could be classified as a ‘spiritual heritage’. Culliford (2002, p.1434) writes: ‘Medicine, once fully bound up with religion, retains a sacred dimension for many.’ It could be argued that health care within many modern societies emerged out of the ethos of the Judeo-Christian principle of charity – caring for those who were less fortunate than oneself or out of a greater humanitarian need to help one’s fellow man, woman. This chapter provides a brief exploration of health care’s historical heritage, indicating that religion and to a lesser degree spirituality has always been present, whether or not there has been a conscious realization of this by contemporary health care theorists. This chapter also introduces some of the growing debate surrounding the effect that technological and medical advancement may have upon the relationship between spirituality and health care practice.
Activity 1.1
Before proceeding with this chapter spend several minutes reflecting upon images associated with the term ‘health care professional’ (I have chosen ‘nurse’ because this is my profession); however, you might want to reflect upon your own profession be it medicine, social work, chaplaincy, radiography, operating department assistant, occupational therapy, etc. Write down any words, thoughts or ideas that come to mind. Pay particular attention to some of the images in general use associated with your group – for example, in my discipline ‘angel of mercy’ – or you may want to reflect upon some of the qualities or virtues that are generic to all health care professions such as patience and kindness.
Symbols and signs
Your reflections may have revealed several terms, phrases or images associated with health care professionals whether this be nursing or your chosen profession (Box 1.1). Some of these may be historical in origin, indicating specific virtues such as patience, kindness or selfless dedication, while others may be related to garments of clothing such as uniforms or hats (for example, in nursing remnants of the nun’s habit and wimple). Modern interpretations may represent comedy as seen on seaside postcards, or the archetypal matron personified by Hatty Jacques, or even an object of desire as represented in the Carry On films by Barbara Windsor. In recent years, there may also be some negativity surrounding specific professional groups. For example, public perception towards medicine has undoubtedly been influenced by the actions and scandals of specific individuals (doctors), bringing to mind the crimes of Harold Shipman which led to the Shipman Inquiry conducted by Dame Janet Smith, whose final report was published in January 2005 (The Shipman Inquiry 2001, www.the-shipman-inquiry.org) and, in social work, the Victoria Climbié Inquiry undertaken by Lord Laming, whose report was published in 2003 (Cm 5730). These cases seem to have eroded public confidence and shattered the caring and trusting views held by many towards medicine and social work. Equally, these cases highlight the importance of all health care professions and social and welfare agencies working collaboratively in providing care. Such events have undoubtedly left a legacy in terms of public opinion leading to reviews as to how some health care professionals are educated and their practice monitored.
By examining both the historical and modern images of health care, it is evident that there has been a dramatic shift in how health care professionals are perceived and portrayed in many Western and Eastern societies. The historical image of health care professionals being morally virtuous has been replaced sadly by images of mistrust, in some instances fuelled by comedy in the mass media, which present doctors as cold-hearted and focusing purely on the physical, whereas nurses seem to be presented as objects of desire and ridicule – for example, the programme titled Nurses on Channel 4. Other professional groups seem immune to ridicule because they are not portrayed frequently in the mass media. It would appear that respect for the sacred and spiritual values inherent in health care have been decayed. A possible explanation for this may be found in how the spiritual heritage of health care is being eroded and replaced by modern, secular, material values. It is suggested that there is a subconscious attempt by Western society to distance health care from its past association with formal religious values and principles. This approach seems very negative and perhaps not representative of all sections in society. However, some of the negative attitudes projected towards health care are continuing to be challenged by television programmes that seek to portray health care professionals in a more ‘professional’ manner – for example, Casualty, Holby City and the Golden Hour on British television and ER across the Atlantic. The remainder of this chapter will address some of these issues in more detail.
Box 1.1 Historical and modern images associated with nursing
Historical
Symbol of virtues, kindness, caring
An angel of mercy
Uniform – remnant of the nun’s habit
Selflessness, vocation
Modern
Comedy – Carry On films, postcards, Channel 4
Barbara Windsor – object of desire, envy, lust
Archetypal matron – control subordination to medical profession
Financial remuneration – career for life
Historical and modern developments
A review of the literature addressing the spiritual dimension reveals that indeed many of the health care professions arise out of a strong historical association with religious and spiritual traditions (Cobb and Robshaw 1998; Cook 2004; Narayanasamy 2001; Rumbold 2002; Whipp 1998). Indeed, Smart (1969, p.10) argues that to understand the developments of any society one must first gain insight into the religions that are found within it:
To understand human history and human life it is necessary to understand religion, and in the contemporary world one must understand other nations’ ideologies and faith in order to grasp the meaning of life as seen from perspectives often very different from our own.
Therefore, when exploring the spiritual heritage of health care, there is a fundamental need to become aware of the religious influences that have shaped and guided health care throughout history. This point is crucial in contemporary society where there is now vast ethnic, racial and cultural diversity. It is imperative that the voices of all groups in a pluralistic society inform any debate on spirituality in health care. The need to engage with and reflect the beliefs and needs of all sections of society is recognized in many of the texts written on spirituality – for example, see Markham (1998), Narayanasamy (2001), Orchard (2001). The outcome of Activity 1.1 reveals that health care does have a strong formal religious and spiritual legacy that has influenced both the individual’s and society’s perceptions; however, this legacy is perhaps mono-cultural in that it reflects Western religious thought. The activity also indicates that some secular values and interpretations are replacing this rich religious/spiritual heritage.
The strong association between mind, body and spirit or soul was recognized by ancient civilizations. This is reflected in, for example, the ‘Hippocratic Oath’ taken by many medical students upon graduation which in the modern version states, ‘I will remember that there is art to medicine as well as science, and that warmth, sympathy, and understanding may outweigh the surgeon’s knife or the chemist’s drug’ (Lasagna 1964). Despite some criticism of the ‘Hippocratic Oath’, the virtues it espouses and the recognition that health care is an intricate blend of art and science have become central to the delivery of all health care practice.
In many Western and Eastern societies, an imbalance in the spirit was believed to manifest itself through physical illness, disease, demonic possession or madness (Holland and Hogg 2001; Narayanasamy 1999). During the Middle Ages, people in Western countries perceived the outbreak of disease or the presence of an illness as a punishment from God. People’s experience of the physical, material world was intimately linked with the awareness of a higher power that controlled the individual’s internal and external world, maintaining equilibrium and restoring order when chaos prevailed.
Tripartite being
Robbins (1991) suggests that the human is a tripartite being composed of mind, body and spirit. Although this illustration is divisive in that it fragments the individual, the analogy does indicate that the spiritual element must be in harmony with the physical and mental for spiritual development to occur. This realization of the importance of the spiritual dimension is reinforced in many religious teachings. It is not possible to provide an insight into the teachings of all world religions; here a brief overview of the Judeo-Christian approach is offered.
Awareness of a higher power
In the Old Testament, the people of Israel awaited deliverance from their suffering and oppression. While in exile and journeying to the Promised Land, their God rescued and delivered them from the hands of their captors. A higher authority had intervened in the destiny of humankind, restoring order and providing a template or code of living that governed and guided the beliefs, values and behaviours of the Jewish people. This awareness of a higher power or divine being intervening in creation and controlling environmental, social, and individual destiny was not just specific to the Judeo-Christian tradition. Historically, people have worshipped or offered sacrifices to the elements, fire, rain, sun and beasts in an attempt to improve their prosperity, indeed their chance of survival. Cupitt (1995, p.90) writes: ‘The god may previously have been a tribal totem or clan divinity in animal form or a fertility figure…’
The realization that a higher authority may control the destiny of humankind resulted in the emergence of different religions and cultures, all with their own forms of expression, beliefs, rituals and guiding principles. Carson (1989) and Bradshaw (1994) reveal how my profession, nursing, has been steeped and fashioned by Christianity, a view shared by Ellis (1980, p.42):
Did not nursing historically develop in a religious milieu in which love of God and mankind was expressed through care, compassion, and charity, to the sick, the poor, the orphans and the outcasts.
Carson (1989) presents an historical overview of the development of nursing which I feel has relevance for many health care professions, since it is not implausible to suggest that some health care professions have their origins from within nursing. She describes one of the most famous of the religious orders, The Knights of Hospitallers of St John, who were responsible for establishing nursing and drew their members from crusaders, monks and religious brothers. This order was founded in the Middle Ages to provide nursing care for the victims of the crusades. Originally, the order was located in Jerusalem but the congregation soon spread throughout the Western world, providing nursing and spiritual care for the sick and dying.
Modernism and secularism
From the argument presented so far, you have probably deduced that we are living in an age that is dominated by things that are material and tangible, and where individuals want immediate results and rewards. Watson (1996, p.39), recognizing the erosion of the spiritual dimension from the heart of nursing, and that this could be extended to include the whole of health care, writes:
May this era between centuries be the turning-point whereby nursing restores and further develops its caring-healing art and spiritual dimensions lest the profession collectively dies of a broken heart.
Watson warns that the spiritual dimension is the most important dimension of nursing in that it provides life to all other aspects of the profession. If health care fails to restore the spiritual dimension to its central position, then it is in danger of being replaced by something dehumanizing and cold. Within the health care literature, the terms ‘modernism’ and ‘secularism’ are used with growing regularity. However, what do these words mean? Moreover, what are the implications of them upon the spiritual dimension of health care?
If we focus upon our own existence and the things that are important to us, it is apparent that there are certain material things in life that are needed for survival such as food, shelter, warmth and water. Deprived of these important elements, we would die. Therefore, by our very physical nature we are dependent upon material things. When the words modernism, materialistic and secular are used in health care, they are often used negatively to suggest that there is a preoccupation with or over-reliance upon them at the expense of other aspects such as the spiritual dimension. Narayanasamy (1997) proposes that the spiritual aspects of individuals will receive less attention in societies that are preoccupied with technological and scientific advancements, and where individuals want immediate result or reward.
Modernism, materialism and secularism are the three main ‘isms’ that, in their extreme, seem to be incompatible with the notion of spirituality (Box 1.2). It is the emergence and subsequent preoccupation with these terms within health care that have resulted in the demise of the spiritual heritage. Moreover, additional forms of extremism are the notion and misconceptions that spirituality equates only with formal, institutional religion, to which many individuals attach little importance, and the danger of making stereotyped assumptions about religious minority groups (Burnard 1988; Gilliat-Ray 2001; Narayanasamy 2001).
Box 1.2 The three main ‘isms’
Modernism
The term used to describe an over-preoccupation with modern technological, medical, scientific advancement.
Secularism
The belief that religious, spiritual principles have been made redundant within modern cultures.
Materialism
An over-reliance with material objects and possessions at the expense of recognizing the transcendent, mysterious aspects of human existence.
Scientific and technological advancement
If one thinks of the recent developments within health care, in particular medical and surgical practices, then one cannot be surprised that these developments and innovations have changed the way in which society perceives health care. These changes are summed up by Donley (1991, p.178): ‘Today, people expect that their diseased organs will be replaced and that disability and death will be postponed.’
It is not surprising that there should be a distrust of science as dehumanising and impersonal, mechanical, hard and cold. And certainly among nursing writers today, it is easy to trace a distrust with western science and what is called the biomedical.
Activity 1.2
Read the above quotation several times and see if you can think of any of your own examples from practice that may support the points that Bradshaw is making.
When reflecting upon the quotation, it is easy to identify and recall examples from your own practice that confirm Bradshaw’s apprehensions. How often does one still hear the phrase, ‘The appendicectomy in bed three’, or, more recently, ‘The lap chole (laparoscopic cholecystectomy) in bed four’, the ‘CABPG (coronary artery bypass graft) in bed five’ or the ‘stroke’ or ‘CVA (cerebrovascular accident) in bed six’, depending upon the specialty? This attitude towards individuals reflects the cold, dehumanizing face of science and a medical model that is not holistic, individualized or patient-centred.
Kearney (1994) and Bradshaw (1996a) suggest that science, religion and the spiritual realm are all seeking answers concerning the nature and mystery of our everyday life. Therefore, science and spirituality, instead of being in opposition, should be seen as different sides of the same coin that are closely united in seeking to find out the truths about our very existence and human condition. Sloan et al. (1999, p.664) highlight the complex and often fraught relationship religion and science share:
It may be that divisions arise because science and spirituality use different methods of enquiry to find out about the nature and structure of individuals. Science seeks to clarify by rigid control, producing evidence from experiments and trials, while spirituality is concerned with the ‘touchy feely’ aspects of our being that are often very mysterious and hard to pin down. It would appear that the argument that there is no place for spirituality within the scientific community is redundant, short-sighted and misguided, since spirituality and science can work in harmony answering questions about our physical and existential world.
Demise of spirituality
The health care literature implies that there has been a gradual demise of the spiritual dimension in the last years of the 20th century. Some contemporary writers on spirituality suggest that the traditional view of health care, in which spirituality was fundamental, has been replaced by a modern – ‘fashionable’ – approach. Bradshaw (1993, p.3) writes:
The long held Judeo-Christian, ethical tradition of caring for the sick as an altruistic calling was now seen as archaic, irrelevant and even a dangerous myth that needed dispelling – the opiate of oppressed nurses.
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