The Importance of Spirituality in Mental Health
The subtitle of the book struck me as odd—“My Spiritual Autobiography.” How is a spiritual biography any different from a regular autobiography, I wondered. Twenty years after purchasing the book, I sat down to read it and my wondering turned to wonderment. For in Hannah Whitall Smith’s The Unselfishness of God: My Spiritual Autobiography I gained an appreciation of the importance of spirituality in mental health.
What is spirituality?
Spirituality is a term over which there is the most disagreement and lack of consensus. Maybe this is so because several disciplines have reserved the right to define the term: psychology, theology, ecclesiology, anthropology, music, even.
Today spirituality is a popular expression preferred over religion. Researchers Lucchese and Koenig describe spirituality as “personal, something individuals define for themselves. It is often free of rules, regulations, and responsibilities associated with religion. One can be spiritual, but not religious. In fact, a ‘secular spirituality’ is often emphasized today in circles where religion is in disfavor. Thus, spirituality is seen as non-divisive and common to all, both religious and secular.”
I believe spirituality also describes the awareness that the human person exists not only materially (body, mind) but nonmaterially (soul, spirit). In other words, we were designed to experience life through more than our five senses of sight, smell, hearing, taste, and touch. The attempts we make to go beyond the physical dimension of life to experience the nonmaterial or transcendent life — aka to experience life wholly and fully — is called spirituality. The US Catholic says it this way: “Spirituality is the overriding term that describes engagement in things transcendental. Ultimate aims. Ultimate goals. It has to do with one’s connection with and commitment to ways of engaging transcendence.” The way we choose to identify and engage transcendence—no matter how loosely organized it may be—is called religion.
The human person exists as a “bio-psycho-socio-spiritual being.” As such, a change in one of these dimensions “will usually have ramifications in the other dimensions.” So, when we seek to study, develop or treat the human person, we must focus on the whole being. Mental health is but one dimension of the human person. It affects and is affected by biological and spiritual health.
Are all dimensions equal? Yes, in so far as each dimension is unique in its contribution to health and wellness. And this uniqueness makes it all the more important that all aspects of personhood be considered when treating an individual with mental illness.
Everyone has spiritual needs. There is probably only disagreement on what these needs are.
Howard Clinebell, noted pastoral counselor and psychotherapist, identified seven spiritual needs that, he argued, everyone needs to satisfy in order “to feel whole and fulfilled, making spirituality central to human well-being.” These spiritual needs are:
- All people need to experience regularly the healing and empowerment of love – from others, self, and an ultimate source.
- Everyone needs to experience renewing times of transcendence — moments that expand us beyond the immediate sensory spheres.
- Everybody needs vital beliefs that give some sense of meaning and hope the midst of losses, tragedies, and failures.
- Every person needs to have values, priorities, and life commitments — usually centered in issues of justice, integrity, and love – that guide us in personally and socially responsible living.
- Each human being needs to discover and develop their inner wisdom, creativity and love of their unique transpersonal/spiritual self.
- All people need a deepening awareness of oneness with other people and with the natural world, the wonderful web of all living things.
- Every human being needs spiritual resources to help heal the painful wounds of grief, guilt, resentment, unforgiveness, self-rejection, and shame. We also need spiritual resources to deepen our experiences of trust, self-esteem, hope, joy and love of life.
Spirituality and mental wellness
One of the significant discoveries in the West has been this important role of spirituality in sustaining and regaining mental health, which is outlined in the article Religion, Spirituality, and Health: The Research and Clinical Implications:
Caring for folks with mental health problems had its roots within monasteries and religious communities . In 1247, the Priory of St. Mary of Bethlehem was built in London on the Thames River  to house “distracted people.” This was Europe’s (and perhaps the world’s) ﬁrst mental hospital. In 1547, however, St. Mary’s was torn down and replaced by Bethlehem or Bethlem Hospital . Over the years, as secular authorities took control over the institution, the hospital became famous for its inhumane treatment of the mentally ill, who were often chained , dunked in water, or beaten as necessary to control them. In later years, an admission fee (2 pence) was charged to the general public to observe the patients abusing themselves or other patients . The hospital eventually became known as “bedlam” (from which comes the word used today to indicate a state of confusion and disarray).
Then a rather natural event gave rise to an extraordinary outcome:
In response to the abuses in mental hospitals and precipitated by the death of a Quaker patient in New York asylum in England, an English merchant and devout Quaker named William Tuke began to promote a new form of treatment of the mentally ill called “moral treatment.”
Moral treatment “emphasized religious morals, benevolence and ‘clean living’, in contrast to the somatic therapies of the day (such as bloodletting or purging). Physical restraints were removed from the patients, they were accorded humane and kindly care, and were required to perform useful tasks in the hospital.” Under Tuke’s model, the treatment of mental illness had transitioned from somatic therapies to therapies that embraced the spiritual and psychological needs of the individuals:
In 1796, Tuke and the Quaker community in England established their own asylum known as the York Retreat:
Not long after this, the Quakers brought moral treatment to America where it became the dominant form of psychiatric care . Established in Philadelphia by the Quakers in 1813, “Friends Hospital” (or Friends Asylum) became the ﬁrst private institution in the United States dedicated solely to the care of those with mental illness . Psychiatric hospitals that followed in the footsteps of Friends Asylum were the McLean Hospital (established in 1818 in Boston, and now associated with Harvard), the Bloomingdale Asylum (established in 1821 in New York), and the Hartford Retreat (established in 1824 in Connecticut)—all modeled after the York Retreat and implementing moral treatment as the dominant therapy.
The schism between religion/spirituality and mental health developed in the early twentieth century. While this blog will not survey the history of that schism, suffice it to say that the disconnect persists to this day in one form or another. And this is unfortunate, given the nature of personhood and spiritual needs of the human person. A 2013 study by Fernando Lucchese and Harold Koenig in the Brazilian Journal of Cardiovascular Surgery on “Religion, Spirituality and Cardiovascular Disease: Research, Clinical Implications, and Opportunities in Brazil” has shed light on eight ways in which religion and spirituality (hereafter abbreviated as R/S) influence mental and medical health. The discussion that follows is taken directly from the study:
1. Many patients are R/S and have spiritual needs related to medical or psychiatric illness. Studies of medical and psychiatric patients and those with terminal illnesses report that the vast majority have such needs, and most of those needs currently go unmet [579, 580]. Unmet spiritual needs, especially if they involve R/S struggles, can adversely aﬀect health and may increase mortality independent of mental, physical, or social health .
2. R/S inﬂuences the patient’s ability to cope with illness. In some areas of the country, 90% of hospitalized patients use religion to enable them to cope with their illnesses and over 40% indicate it is their primary coping behavior . Poor coping has adverse eﬀects on medical outcomes, both in terms of lengthening hospital stay and increasing mortality .
3. R/S beliefs aﬀect patients’ medical decisions, may conﬂict with medical treatments, and can inﬂuence compliance with those treatments. Studies have shown that R/S beliefs inﬂuence medical decisions among those with serious medical illness [584,585]and especially among those with advanced cancer  or HIV/AIDS .
4. The physician’s own R/S beliefs often inﬂuence medical decisions they make and aﬀect the type of care they oﬀer to patients, including decisions about use of pain medications , abortion , vaccinations , and contraception. Physician views about such matters and how they inﬂuence the physician’s decisions, however, are usually not discussed with a patient.
5. R/S is associated with both mental and physical health and likely aﬀects medical outcomes. If so, then health professionals need to know about such inﬂuences, just as they need to know if a person smokes cigarette or uses alcohol or drugs. Those who provide health care to the patient need to be aware of all factors that inﬂuence health and health care.
6. R/S inﬂuences the kind of support and care that patients receive once they return home. A supportive faith community may ensure that patients receive medical follow up (by providing rides to doctors’ oﬃces) and comply with their medications. It is important to know whether this is the case or whether the patient will return to an apartment to live alone with little social interaction or support.
7. Research shows that failure to address patients’ spiritual needs increases health care costs, especially toward the end of life .This is a time when patients and families may demand medical care (often very expensive medical care) even when continued treatment is futile. For example, patients or families maybe praying for a miracle. “Giving up” by withdrawing life support or agreeing to hospice care may be viewed as a lack of faith or lack of belief in the healing power of God. If health professionals do not take a spiritual history so that patients/families feel comfortable discussing such issues openly, then situations may go on indeﬁnitely and consume huge amounts of medical resources.
8. Standards set by the Joint Commission for the Accreditation of Hospital Organizations (JCAHO) and by Medicare (in the US) require that providers of health care show respect for patients’ cultural and personal values, beliefs, and preferences (including religious or spiritual beliefs) .
The fifth observation of the Lucchese and Koenig study is best sums up what should be our position with respect to spirituality in the promotion and restoration of health and wellness. “Religion/Spirituality affect medical outcomes. If so, then health professionals need to know about such inﬂuences, just as they need to know if a person smokes cigarette or uses alcohol or drugs. Those who provide health care to the patient need to be aware of all factors that inﬂuence health and health care.” After all, we are biological, psychological, social beings with spiritual needs.
William Tuke’s Work Continues
Today, Intervention Associates (IVA), a care management and guardianship service in Philadelphia, founded on Quaker principles continues to expand the work of William Tuke. They, too, are an exemplary model, caring for those with the most challenging mental, cognitive, emotional and physical issues as whole persons—biopsychosociospiritual beings.