Chapter 11 SPIRITUALITY
DEFINING SPIRITUALITY
All people have a spiritual dimension, but spirituality is an abstract concept and therefore not easily defined. Many authors have reflected on spiritual care in nursing and have presented a range of definitions of spirituality (Greenstreet 2006; O’Brien 2007; McSherry 2006). The concept of spirituality as two dimensional is perhaps the clearest and most easily explained. Moberg and Brusek (1978) first put forward the concept that spirituality has two dimensions — vertical and horizontal. The vertical dimension relates to the way a person reaches out to a personal god, the universe or to something greater than self. The horizontal dimension refers to the way a person reaches out to, and connects with, other people and to a sense of purpose and satisfaction in life that is not entwined with religious meaning. These two dimensions transcend the physical, material world. Each person’s spirituality may be more strongly linked to one of the two dimensions than the other. It may also be that an individual feels connected with only one of the two dimensions.
Either way, to be spiritually healthy, life needs to be invested with purpose and meaning. Seeking purpose and meaning may be a continuous process, sometimes lifelong (Greenstreet 2006). It may be a niggling sense of being unfulfilled that motivates the search. It is not uncommon during times of crisis, such as when facing serious loss or life-threatening illness, that a person’s need to identify purpose and meaning becomes much stronger.
There is no simple answer to the question ‘what is spirituality?’ because a person’s spirituality is intangible — a mysterious thing that cannot be isolated. It is the accumulation of everything a person is — the essence of being. Some might call this essence a person’s soul. However, the word soul tends to be linked to religion, but all people are spiritual and many are spiritual without being religious (Stevens-Barnum 2003; Young & Koopsen 2005).
GENERIC SPIRITUALITY
The term ‘generic spirituality’ is sometimes used when referring to the spirituality of people who find meaning in life and have things in life that are sacred but not necessarily part of a specific religious tradition (Tacey 2003).
SECULAR SPIRITUALITY
The term secular is also used to describe the way people find meaning in life when their spirituality is not based on religion. Secular spirituality means making sense of questions like ‘who or what am I?’ and ‘why am I here?’ without connection to any religious underpinnings. People who have a secular spirituality may hold strong convictions that guide their concepts of right and wrong. It is these convictions rather than religious beliefs that influence the way they live their lives. These convictions encompass views about treating, and being treated by, others as someone of value and with feelings. Interacting in this positive way is viewed as a means of appreciating a person’s worth and thereby acknowledging their spirituality (Smith 2002; Stein-Parbury 2005).
WAYS OF BEING SPIRITUAL
RELIGION
For some people religion is the vehicle that sustains their spirituality. For many it is satisfying because it provides clear rules about morality, a community of like-minded people and a set of rituals and practices to support their spiritual beliefs (Andrews & Boyle 2007).
There are many types of religion. Some religions are monotheistic, whereas some involve the worship of many different gods. People who follow a Christian faith, for example, believe in Jesus of Nazareth being the Messiah, or Christ, while Muslims submit to their god ‘Allah’. New Zealand traditional Māori base their lives on beliefs in many gods that represent the forces of nature; two such gods are Papa tu nuku, the Earth Mother, and Ranginui, the Sky Father (Belich 2001).
Some people, including traditional Māori and Australian Aboriginal people, live a life that is permeated by a religious consciousness. For some Australian Aboriginal people this consciousness envelops a knowledge that there is a life beyond this physical world. This consciousness stems from a belief in the laws of the Dreamtime brought down by the Supreme Intelligence — the Creator. Aboriginal and Māori people have been subjected to the influences of Christianity, some choosing between Christianity and traditional spiritual beliefs, while others have chosen to engage in a mixture of the two (Tracey 2000).
A mixture of beliefs is not unusual in multicultural societies like Australia and New Zealand. Many people select parts of spiritual faiths from a range of religions, the parts of each that feel right for them in their quest to define themselves spiritually and to find meaning in life (Ferrell & Coyle 2006).
For some people religion has no bearing on their spirituality (Saucier-Lundy & Janes 2003). Atheists, for example, do not believe in the existence of God but can be very spiritual, often finding meaning in life through their work, other activities and achievements and their relationships with others.
RITUALISING
Many religions have set rituals (Mauk & Schmidt 2004). Christian denominations, for example, celebrate major life events such as birth, marriage and death, but ritual behaviour also includes many non-religious practices. Non-religious rituals can be metaphorical acts full of symbolic meaning. Setting up a room with personal belongings — things of importance like photographs, paintings and books and other treasures — can be seen as a way of exalting the spirit. When these objects are displayed, an ordinary space becomes special. English (1998) explains this as a spiritual action — a ritualising behaviour that turns the blank space into a sacred place. He suggests that many everyday behaviours, such as wearing particular clothes, getting body parts pierced or getting hair groomed in certain ways, are all rituals that express the inner spirit. He describes other actions such as going through a wedding ceremony or ‘coming out’ as gay as types of rituals that contribute to providing an over-arching meaning to life.
MEDITATION
Meditation is a practice that involves stillness of the body and inward reflection that, with practice, can bring about a corresponding stillness in the mind. It helps to reduce undisciplined thoughts and bring a sense of inner peace. Meditation can lead to a sense of being more in harmony with the laws of nature. It is a means of reducing stress and attaining personal growth and spiritual insights and it is possible for the calmness it induces to help a person deal with suffering and pain (O’Brien 2003; Stevens-Barnum 2003). It is an important component of Eastern culture, where philosophical traditions focus on the person as a spiritual being, with a spiritual goal. While it is predominantly an Eastern cultural practice, interest in meditation as a way to promote spiritual wellbeing is growing in Western culture.
SELF-EXPRESSION
Spiritual health is to do with finding out who you are and being that person. It is also about liking who you are. Writing or playing music, drawing or painting or writing poetry are some ways that help people find out who they are. Feeling spiritually at ease is about being happy with where you are, what you are doing in life and where you are headed (Sherwood 1997). Some people describe various activities as being spiritual. For example, a hang-glider might describe being alone in the air surrounded by beautiful sky and scenery as a spiritual experience. A deep-sea diver might feel the same about being alone in the depths of the ocean. Life experiences that provide moments of ecstasy can have a deep impact on the inner self. It can be said that such experiences are ‘good for the soul’, and soul tends to be viewed by some as synonymous with spirit. It is recommended that student nurses refer to the work of Kliewer and Saultz (2006) who explain differences between the soul and the spirit of a person. They provide insights into the meanings assigned to these facets of the human condition across a range of religious and cultural belief systems.
LOVING AND BEING LOVED
Part of being spiritual is about the ability to love and be loved (Maher 2005). The love can relate to that between people or to love of God. Some, but not all, people have a wonderful capacity to give and receive love. Spiritual health is enhanced when people give and receive love to their maximum capacity (English 1998; Maher 2005). For some people, being spiritual is related to having an intuitive feeling about some infinite source of energy and love.
Thus, spiritual feelings may come about through prayer, meditation, communing with nature, moments of sheer pleasure or through experiences of serious loss, pain and extreme distress. They also evolve from social and cultural influences (Andrews & Boyle 2007; O’Brien 2003).
CULTURE AND SPIRITUALITY
Social norms and cultural practices and beliefs become enmeshed into the spiritual sense of who we are and where we belong, whether or not we are conscious of it. Tradition, folklore, history, national, local and regional customs and education are all powerful influences that contribute to how people construct images of themselves. This image incorporates a spiritual dimension. When this spiritual dimension of personhood is challenged it can be the cause of psychological distress. One clear example is that of Aboriginal people, whose spiritual relationship with the land and way of living has been disrupted by white settlement. Removal from this spiritual dimension of their lives is the root of the psychological distress and social problems Aboriginal people still experience today (refer to Chapters 9 and 10).
In Australia and New Zealand many communities are made up of mixed cultural groups within which there are an assortment of traditions. The population in the communities is not static. The ebb and flow and mixing of people over time sees new ways of life emerge. There can be a blurring of boundaries between old traditions and new ways. The result is a melting pot containing the promise of new customs and cultures. The impact of cultures emerging within cultures is exciting. It has an effect on how people develop and express spiritual meanings in their lives and this will be unique to each person (Maville & Huerta 2001; Smith 2002).
SPIRITUAL HEALTH
Spiritual wellbeing can be defined as inner harmony that stems from a strong sense of satisfaction with self and with life. Spiritual health develops over time; it is a process that begins in childhood and continues throughout life (Hodges & Tod 2007). It is not static and can be challenged and changed by life events (Lewenson & Truglio-Londrigan 2007). Situations that alter a sense of self, such as ageing, grief, bereavement or illness that impacts on functioning or appearance, can disturb inner harmony and contentment (MacKinlay 2003; Shives 2007; Smith 2002). However, major life changes or challenges sometimes help people to grow more spiritual (Clinical Interest Box 11.1).
SPIRITUAL HEALTH AND PSYCHOLOGICAL WELLBEING
There are links between a person’s spiritual health and their psychological wellbeing (Greenstreet 2006: Seaward 2006). The person who has not developed as a mature, psychologically strong person or who encounters significant psychological problems in life is sometimes unable to develop meaningful relationships (Shives 2007; Videbeck 2007). Failure to experience mutual love and concern in relationships can limit the ability to gain inner harmony and a sense of satisfaction with self and life (Videbeck 2007; Watkins 2000).
A lack of mutually caring relationships is often a feature in the lives of people needing mental health care (Videbeck 2007). Many clients in this area suffer a serious lack of inner harmony and are demoralised and dispirited. Enlightened nurses working in mental health recognise that recovery of the spirit is essential to recovery of a sense of wellbeing in these clients. The aim of care therefore encompasses the fostering of supportive relationships as well as nourishing the spirit in a variety of other ways. Some activities promoted by mental health nurses to nourish the spirits of their clients include horticultural therapy, art, music, poetry and drama therapy (Watkins 2000).
SPIRITUAL PAIN
Spiritual pain can occur when people are unable to find meaning in life or when they cannot find sources of hope, love or comfort. It can occur when a person’s inner peace is disturbed, which may be caused by conflict between beliefs and what is happening to them (Olson 1997; Smith 2002).
Any life event causing loss of identity, self-esteem or control over what is happening can result in overwhelming distress or spiritual crisis (O’Brien 2007; Shives 2007; Watkins 2000). Mental illness, getting old, the onset of dementia or any illness that alters appearance or bodily function challenges a person’s sense of identity and can impact negatively on self-esteem (Daniels 2004; Puddner 2000). Feelings of losing control are not uncommon, particularly in clients who suffer chronic pain, are facing unexpected disability or who are faced with a life-threatening illness. Dire circumstances often challenge a client’s religious and spiritual beliefs (Clinical Interest Box 11.2). Sometimes the client’s spiritual pain is clear but sometimes it is difficult to recognise and easily missed or ignored (Loseth 2002).
Recognising spiritual pain
People may experience fear and hopelessness about the future. For example, a client who has hemiplegia and a speech deficit after a cerebrovascular accident (CVA) may fear being able to cope and may have a sense of hopelessness about living with the physical changes. Clients facing terminal illness may have a range of fears about dying and impending death (Ferrell & Coyle 2006).
Some other changes to usual behaviour may also be a sign of spiritual distress. These include:
These changes can indicate psychological or physical distress, but a sad or distressed spirit can be reflected in these ways too (Carpenito-Moyet 2006). This reinforces the need for holistic assessment — all facets of health need to be assessed concurrently.
