What is Spirituality?

What is spirituality? Is it something against materialism, money? Is it to renounce the pleasures of matter, of body, of mind?

No.

Spirituality is not any particular practice. It is a certain way of being. You need to do a few things to get there. Just like soil, sunlight and water on its own won’t yield flowers in the garden in your house, similarly you have to cultivate your body, mind, emotions and energies to a certain level of maturity so that something new blossoms within you – that is what is spirituality. When you are immature in your rationale, you doubt everything. When you are mature in your rationale, you see the same things in a completely different light, as it is, without any discrimination. This is viveka.

 

Spirituality is therefore subjectivity, not objectivity.

Everything that you feel or know as an object or identified as an object need not be identified with, need to be discarded. What then finally remains is you, the subject. Pure subjectivity is spirituality. Spirituality is life lived in ultimate depth, subjectively. You are centered at your very being.

It doesn’t mean you cannot live on the circumference, move freely anywhere. You can, you should, but while remaining at the center. Your identity is at the center and not at the peripheral. If you know who you are, then there is no problem if you enjoy food, clothes, house, music, surgery or treating patients. There is no need to renounce it. In fact, the spiritual being is capable of enjoying everything more intensely, more totally than the materialist.

So a person seeped with spirituality lives totally, intensely, burning his torch on both the ends and still remaining aware of his center, the awareness of who he is. Then it doesn’t matter where he is.

What does it mean to be conscious, to be aware? 

If you try to be aware, you cannot be aware. We mistaken mental alertness for awareness. Mental alertness helps you to survive better but that is not awareness. Awareness means right now are you here, right now!

There is a whole change of gestalt.

If you look at a person, a tree or a situation, and  you confront it with your subjectivity – your awareness – with no discrimination, you will be constantly spiritual.

Spirituality in practice

With your patients, if you’re aware who you are, if you’re centered in your subjectivity with mindfulness – then a spontaneous humility, a spontaneous compassion and a spontaneous ethics with your patient sprouts out as naturally as a flower blooms in spring. There is no forced humility, no artificial kindness, no debate on ethics and no facade of ‘mannequin ethics’.

EACH patient is then an object of deep gratitude for you, that he is giving you a chance to touch him, counsel him, and treat him. As you’re centered in your subjectivity with awareness, you feel humbled with each patient that he is coming to you for help. Your behavior in this state of subjectivity is spontaneously compassionate – the more your subjectivity, the more are you compassionate. You  may charge your fixed fees, but you’re lenient to the patient as per his financial status and not as per your fees. You are not only okay to be flexible with your charges, but you don’t have a grudge and meanness and you don’t feel like you’re obliging your patient.

You treat the patient alone as per your knowing and experience, not because you can treat everything and everyone. You are easy with asking help of your colleague where you know there is blind end with your experience. You’re not shy to inform this to the patient and to ask help. You’re not shy to refer to your colleagues where you know you don’t know enough how to treat it. With self awareness, you don’t treat the ‘positive investigation or report’ if the history and examination reveals otherwise. Ethics becomes your very essence.

There is thus a paradigm shift from what is called the “standard market practice” to a “conscious, centered practice with gratitude” to each patient who comes to you and to every chance you get to treat. This subjectivity is spirituality. A doctor practices his medicine in ultimate depth with intensity, with totality with his every patient, with his every treatment.

Obviously it doesn’t mean that such a doctor cannot live his life on the circumference, but he will be constantly conscious and still in his center. His identity is at his center; he realizes it and lives it.

Spirituality and materialism

Many a times there is a debate in the mind that spirituality is to be lived after all aspirations, materialistic needs and luxuries are obtained. Yes, it sounds quite reasonable but to the extent that we surely know when it will be, in which year or decade our all aspirations, our materialistic needs and luxuries will be surely obtained. Does anyone know it? Even if obtained, does anyone realize it that it’s achieved, now take a pause! The answer is clearly no.

Realizing this, initiate yourself as a doctor who is centered in his subjectivity with each patient and every treatment, and simultaneously fulfilling all his aspirations, materialistic needs and luxuries – the objectivities of life, based on his established subjectivity.

Can a tree deepen and strengthen its roots – its subjectivity – after it has borne the fruits and flowers – its objectivity? Obviously no! Can a tree grow simultaneously while it deepens and strengthens its roots? Obviously yes!

Spirituality and religiousness

Similar is the concern in our minds between religiousness and spirituality. Religiousness is the circumference – the periphery, and spirituality is the center. Religiousness has a vagueness of spirituality as a by-product. It is not spirituality, which is the center. Decorating the circumference by cultivating character cannot help. Character is your circumference. It cannot change your center. But if you change the center, the circumference automatically undergoes a transformation.

Spirituality is an inner revolution of your subjectivity. It certainly affects your behavior, but only as a by-product. Because you are more alert, more aware.

Such a type of doctor with an inner revolution in his center and with more alertness is spontaneous in his gratitude, compassionate, ethical, humble and flexible in his fees. These are not forced. His circumference, which is his character and the kind of life he lives with materials and luxuries changes accordingly. He enjoys those too but because he is more alert, more aware, his action is naturally different; his behavior has a different quality and beauty. But vice versa does not hold true.

Spirituality and the patient

 

Serving patients involves spending time with them, holding their hands, and talking about what is important to them. Patients value these experiences with their physicians.

It has been already established that addressing a patient’s spiritual dimension during illness, healing, and at the end of life brings the patient an added benefit that positively links spiritual care and physical and mental well-being, as patients with more developed spirituality cope more resiliently with the challenges they face.^{1 2}It is also established that when the doctor address about the spiritual needs of the patients, they show a positive interest.³

It is also established that a clinician addressing a patient’s spiritual dimension strengthens their relationship and aids consensual decision-making, one of the cornerstones of healthcare.⁴

Knowledge of a patient’s spiritual dimension in terms of values and needs favors adequate holistic care and has become, in practice, an ethical duty.⁵

In 2021, an extensive study was published on this subject.  A whopping  1,414 relevant publications were scrutinized in the three databases (PubMed, Scopus, and CINHAL) and after an extensive full-text analysis, 8 articles were selected that explored the physicians’ perspective on the spiritual dimension in clinical practice. 4 articles were published between 2017 and 2021 and 4 were multicentre studies. Most of the studies were carried out in the area of palliative care, while the other areas covered were oncology, primary care medicine, internal medicine, surgery, gynecology and pediatrics.  3 out of 8 studies had a majority of female samples, and the clinicians in all studies considered themselves to be very or moderately religious.

The main findings of this study are:

Patients want to discuss spiritual issues with their clinicians, and clinicians reported that attending to the spiritual dimension of their patients improved the trusting relationship in clinical practice.

Clinicians considered spiritual care a good practice. 45% clinicians considered themselves capable of addressing it themselves although more than 50% did not address this. Doctors are aware that patient care should involve spirituality, but the most important barrier reported is lack of specific training as it is not yet sufficiently incorporated into professional education, and lack of time and space in providing spiritual care in greater depth. 90% choose to refer to expert providers such as chaplains, counselors, or pastoral agents. There is a growing awareness and sensitivity in the doctors towards spiritual care of the patient, but it is still not given sufficient consideration.

Physicians who consider themselves to be more spiritual and whose own spirituality is more developed are more likely to be more responsive to these needs. 91% think that the influence of religion on health is generally positive. If both – the physician and the patient practiced the same religion, they were more likely to discuss these issues in the clinical relationship.

Studies show that while physicians understand the importance of spirituality in clinical care, the nurses integrate it more into practice. A multidisciplinary approach will favor an environment rich in a truly comprehensive care with spirituality. ⁶

There are no randomized clinical trial studies that specifically explored intervention strategies for physicians in spiritual care for their patients and the outcomes obtained after their implementation.

Dr. Viktor Frankl, an Austrian psychiatrist and Holocaust survivor, who founded logotherapy, a school of psychotherapy, wrote in his 1946 book ‘Man’s Search for Meaning’ of his experiences in a Nazi concentration camp: “Man is not destroyed by suffering; he is destroyed by suffering without meaning”.

One major challenge a physician faces is to help people find meaning and acceptance in the midst of suffering and chronic illness. Religion and spirituality form the basis of meaning and purpose for many people. Not only patients struggle with their physical disease, they have other pain related to an inability to engage the deepest questions of life: Why is this happening to me?

True healing requires answers to this question. Cure is not possible for many illnesses, but there is always a possibility for healing by acceptance of illness and peace with one’s life. This healing is at its core spiritual.⁷Spiritual commitment tends to enhance recovery from illness and surgery.

Specific spiritual practices have been shown to improve health outcomes. In the 1960s, Benson found that 10 to 20 minutes of practiced transcendental meditation twice a day leads to decreased metabolism, decreased heart rate, decreased respiratory rate, and slower brain waves. Further, the meditation was beneficial for the treatment of chronic pain, insomnia, anxiety, hostility, depression, premenstrual syndrome, and infertility and was a useful adjunct to treatment for patients with cancer or HIV. He called this “the relaxation response.” Benson concluded: “To the extent that any disease is caused or made worse by stress, to that extent evoking the relaxation response is effective therapy.”⁸

 

References

1. Jors K., Büssing A., Hvidt N.C., Baumann K. Personal Prayer in Patients Dealing with Chronic Illness: A Review of the Research Literature. Evid.-Based Complement. Altern. Med. 2015;2015:927973. doi: 10.1155/2015/927973.
2. Sankhe A., Dalal K., Save D., Sarve P. Evaluation of the effect of Spiritual care on patients with generalized anxiety and depression: A randomized controlled study. Psychol. Health Med. 2016;22:1186–1191. doi: 10.1080/13548506.2017.1290260.
3. Banin L.B., Suzart N.B., Guimarães F.A., Lucchetti A.L., De Jesus M.A., Lucchetti G. Religious beliefs or physi-cians’ behavior: Whatmakes a patient more prone to accept a physician to address his/her spiritual issues? J. Relig. Health. 2014;53:917–928.
4. Best M., Butow P., Olver I. Doctors discussing religion and spirituality: A systematic literature review. Palliat. Med. 2015;30:327–337.
5. Winslow G.R., Wehtje-Winslow B.J. Ethical boundaries of spiritual care. Med. J. Aust. 2007;186:S63–S66.
6. Spirituality in a Doctor’s Practice: What Are the Issues? Ángela del Carmen López-Tarrida, et all – J Clin Med. 2021 Dec; 10(23): 5612.
7. The role of spirituality in health care – Christina M. Puchalski, MD, MS ^–Proc (Bayl Univ Med Cent) 2001 Oct; 14(4): 352–357.
8. Benson H. The Relaxation Response.reissue ed. New York: Avon; 1990.

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