SPIRITUALITY, TREATMENT AND HEALTH

SPIRITUALITY AND OUTCOME OF MEDICAL TREATMENTS

P. Speck

Faculty of Medicine, University of Southampton, King’s College,London, UK

For many years there has been a research focus on the importance o psychological factors in predicting a variety of symptoms accompanying progressive disease, especially associated with advanced cancer. For example, the experience of pain, the development of depressiv symptoms and anxiety states. Recently, spiritual belief has emerged as a factor that should be taken account of more. This echoes the serie of studies by King, Speck and Thomas in which they concluded that spiritual belief was more predictive of clinical outcome than the usual psychological measures. This trend is to be seen in a growing number of peer reviewed papers from the USA, UK and Europe, which show that belief is of importance to a large proportion of people who enter health care (in the region of 70-80%) but is not always assessed and addressed adequately. A key problem in such studies has been a failure to recognise the distinctiveness, but inter-relatedness, of expressions of belief. A person who has a spiritual belief may or may not be religious, especially if they choose not to express their belief within a religious framework. However, the majority of religious people will have a spiritual belief. Others may choose to express their belief in terms of a philosophical stance. This paper will discuss the importance of these distinctions and review some of the recent studies which appear to indicate that there is a correlation between having a spiritual and/or religious belief and a variety of clinical outcomes, with reference to orthopoedic patients, cardiology patients, bereavement studies and end-of-life care.

ASKING ABOUT RELIGION AND SPIRITUALITY IN PATIENTS RECEIVING PALLIATIVE CARE TREATMENTS

S. Dein

University College of London, UK

The spiritual care of patients is an essential part of palliative care. In this study 105 case notes of hospice patients with cancer were reviewed to assess the information documented by nurses relating to religion and spirituality. Although religious affiliation was recorded 87% of the case notes, only 40% of the notes contained any information about awareness of dying and the use of religion or spirituality in relation to the dying process. The reasons for the nurses’reluctance to discuss spiritual issues are discussed. A teaching programme enabling palliative care professionals to ask about spiritual issues in physical illness is outlined.

SPIRITUAL QUESTIONING AND MENTAL HEALTH IN LATER LIFE

P. G. Coleman

University of Southampton, UK

Erik Erikson’s discussion of the last psychosocial task of life -‘integrity vs. despair’- raises three fundamental issues relating to acceptance. The first, acceptance of the past without bitterness, has received the most attention. The second, acceptance of one’s own death, and especially the third task, acceptance of the society that will continue after one’s own death, have received much less attention. « Questioning » appears to be central to these processes. However, struggle including questioning is not what society normally expects of older people. The expectation of stability and serenity extends also to ministers of religion, who often appear unprepared for the emergence of doubt in the wake of the losses and crises of later life, despite the fact that struggle with despair is a common theme in the lives of saints and spiritual role models. In studies with older people living in congregate housing we have identified a large minority of persons who appear to remain in a chronic state of questioning, unable in particular to integrate their perception of present and past standards of behaviour and their former and present spiritual beliefs. Bereavement appears to be a major trigger of spiritual doubt and questioning. In a recent study following up a sample of bereaved spouses from the first to second anniversary of the death, we found depressive symptoms to be concentrated among those of moderate to weak spiritual belief. Those with strong or no belief were more likely to be free of depression. Our case study format has allowed us to explore these issues at the level of the individual person, to tease out relationships between faith, doubt, personal loss, and contact with religious ministers, and to raise further questions for enquiry. In current studies we have gone on to examine older persons’own expectations of ministers of religion in situations of loss. They illustrate the need for much closer liaison between them and general mental health practitioners.

THE ROLE OF RELIGIOUS LEADERS IN PATHWAYS TO TREATMENT FOR PEOPLE WITH SERIOUS MENTAL ILLNESS

G. Leavey

Barnet, Enfield and Haringey Mental Health NHS Trust, London, UK

In Western societies, medicine and healthcare, of which psychiatry is 3 branch, had much of their evolution within religion-based institutions. However, the growth of the modern liberal state and the dominance of the scientific paradigm have largely eclipsed, and may have removed any real role for religion in the medical treatment of patients. Thus, the view that Western societies are becoming increasingly secularist in nature is fairly persuasive. Nevertheless, to suggest a ‘clean break’ heralding the unrivalled supremacy of scientific medicine would be to underestimate the importance of spiritual and religious beliefs in the consideration of health and illness held by many people. Within some faith communities, health and spirituality are considered as inseparable. Studies in the UK and in the USA indicate that a large proportion of people with psychiatric problems obtain advice and support from people other than psychiatric professionals. Moreover, prior to coming into contact with psychiatry, many psychiatric patients will first seek help from religious leaders. In part this may stem from the highly religious content of some psychotic illness, or from the patient’s religion-based explanatory models of mental illness. Patients and families may simply feel that they have no one else to turn to. Whatever the reason, religious leaders are importantly situated on the pathway to psychiatric treatment for many people and may continue to play an influential role in the course of that treatment. Surprisingly, however, we know very little about how religious leaders from different faith communities conceptualise mental illness and what their role is in the help-seeking process. Are they a helpful resource or a hindrance to appropriate psychiatric care ? This paper will outline the findings of a qualitative, London-based study of the beliefs and attitudes of religious leaders on a range of issues relating to mental illness and psychiatry.

ARE RELIGIOUS AND SPIRITUAL BELIEFS ASSOCIATED WITH BETTER MENTAL HEALTH ? EVIDENCE FROM A NATIONAL SURVEY IN BRITAIN

M. King

Royal Free and University College Medical School, London, UK

This study aimed : a) to compare the prevalence and characteristics of religious and spiritual beliefs in representative samples of the principal ethnic populations in England and b) to examine associations between religious and spiritual beliefs and common mental disorder. The study involved face-to-face interviews with a probabilistic sample of 4281 adults from six ethnic populations living in private households in England. Common mental disorders (CMD) were assessed using the revised Clinical Interview Schedule (CIS-R). Religious and spiritual beliefs were assessed using a brief questionnaire version of the Royal Free Interview for Religious and Spiritual Beliefs. Data were also collected on quality of life, social function and support and psychotic symptoms. 40.3% of people held a religious view of life, 17.9% held a spiritual view but with no religious participation and 41.8%, held neither religious nor spiritual beliefs. South Asian people were more likely to regard themselves as ‘religious’, and less likely as ‘spiritual’ than white, Irish or Black Caribbean people. There was no difference in prevalence of CMD between people who were religious and those who were not. However, people who were not religious but who expressed spiritual beliefs were 1.78 (Cl 1.08, 2.94) times more likely to have CMD than people who held religious beliefs. This association remained statistically significant after adjustment for potential confounders, including physical health status and social support. Thus, lack of religious belief was associated with a higher prevalence of CMD, but only in people who reported having a spiritual life view. This phenomenon may only occur in cultures where religious practice has sharply declined in recent decades.

October 2