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The Importance of Our Patients' Spirituality

Op-Med is a collection of original articles contributed by Doximity members.

Most health care professionals are aware that spirituality or religious involvement is now understood to be an evidence-based practice. So why is it that when our clients try to talk to us about their religious life, we end up acting like we are choking on a toothpick? Why is it that we carefully ask our patients about their religious and spiritual histories when we do an intake but then fail to do anything further with that information?

There are, of course, reasons to be cautious when we engage our patients in conversation about religion. Hyper-religiosity is a symptom of mania. The delusional belief that auditory hallucinations are the voice of God or the devil are ideas often seen in acutely ill persons.

However, those concerns lose relevance in outpatient settings where we are helping our patients figure out the management of chronic conditions. Even with this group, many of us find ourselves acting as if we disapprove of any conversation about religious experience. Of course, we share the professional value that we should not impose our personal religious beliefs upon our patients. We also know by experience that some of our clients have pretty odd religious beliefs, and we don’t want to appear to support homophobic, racist, or superstitious assertions. For some of us, our own religious experience has been painful, so we can be antagonistic to organized religion or even the concept of theism. Those may all be legitimate reasons to take care when we engage our clients in conversations about religion, but none trumps the fact that spirituality is a known positive value in the quality of life for chronically ill persons, as well as in maintaining sobriety for those with histories of substance abuse.

My experience has led to the conclusion that it works quite well to engage with patients in conversation about their religious practices. Religious practices, after all, are remarkably similar across the spectrum of major faith groups. To talk in terms of religious practices permits you to reinforce the lessons your clients have already learned about using spirituality to strengthen their recovery, without getting bogged down with questions of belief systems. 

Prayer, and Its Closely Related Cousin, Meditation

Whether your patient prays to the Virgin Mary every morning or sits and tries to be “open to all of creation” as they meditate, you can engage with them about their practice of prayer and/or meditation without getting involved in their belief system. The appropriate clinician skill is to ask questions which honor their experience without getting tangled up in the question of belief or dogma. Questions that generally work well are: who taught you to pray/meditate? What is it about the practice of prayer that results in your continuing to do it regularly? Why do you think the practice of meditation works for you when it doesn’t work for others? How has your practice changed over years of experience? 

Listening to Sermons/Dharma Talks/Radio Preachers

This is a very ancient religious practice. You might ask if the client uses recordings so that he/she can listen over and over to a sermon, or if they listen to these talks by themselves or sitting in a group with other people. Do they think it’s important to know much about the speaker's life, or are they just focused on the message they deliver? Do they talk with friends or coreligionists about the talks, or do they just hold them in their personal awareness? Is this exercise, for them, more about the ideas of the talk or more about the serenity of listening to the message?

Study of the Sacred Documents and Study of Commentaries on the Documents

Focus on such documents would be a hallmark of “organized” religion as opposed to spontaneous spirituality. Reading the “Big Book” in AA can certainly become a religious practice, just as daily reading of the Bible or Quran. Questions about a pattern of reading (daily, early morning, as preparation for bed, etc.) and how they pick which text to read are likely to be more useful than questions about the content of the reading. 

Sacred Objects, Sacred Symbols

These may be simple talismans, like a mustard seed encased in plastic that attaches to a keychain, or more complex and historically rooted objects such as Muslim prayer beads or Catholic rosaries. The person may have religious reminders in a consciously assembled desktop altar or may have objects randomly spotted in their home. Many people have symbols that are tattooed or scarified on the body and are eager to talk about them if we are open to these ideas.

Objects may carry ideas that the person feels are too complex to put into words, so when you ask questions, don’t expect well-developed theological responses. Was there a specific event that led to your decision to hold onto this stone/crystal/carving/icon or get this tattoo/scar? Now that you think back about it, why was it so significant to you at that point in your life? How have you used this object since you first obtained it? What is your relationship to that person now that you have made this object your special token? Have you ever thought about getting rid of this object, and what consideration led you to keep it? For you, does it have to be this specific set of prayer beads/this icon of the Virgin/this pebble from the beach, or is it true for you that any reminder of prayer/the Virgin/nature would work as a practice?

Symbolic Acts

Lighting candles, observing the ban on labor for Sabbath, touching one's forehead in a mark of deference, repeating of a life affirmation daily, uttering a word of blessing before a meal, or burning incense are all examples of symbolic acts. Generally, they serve both as a shorthand way of referencing a whole belief system and as a way of being connected with a larger community of coreligionists. Because modern society is less likely to create symbolic acts, the person who uses such acts is frequently rehearsing their family or cultural tradition. Respectful questions about the acts themselves almost always lead to a conversation about the person’s relationship with their larger religious community.

Public Worship

Public worship integrates multiple religious practices and also requires a lot of social awareness and capacity to manage things like getting to the service on time and dealing with social expectations for appearance and behaviors. The person’s relationship to public worship is often tightly connected to their relationship to the worship leader and, by extension, his/her articulation of belief. Persons who regularly engage in public worship are generally pleased to be able to tell you what congregation they worship with and who is the worship leader. They are open to conversation, such as when you think about your worship practice, what is central for you? The listening to preaching? The reading scriptures? The being with your community? The singing?

A conversation regarding religious practices may sometimes lead to a specific question or request for advice about a religious issue. Keep clear that you are a health professional, not a religious authority. The first response from you needs to honor the legitimacy of the question, for example, by asking why this is an important question or what efforts have already been made to sort out a reply to this question. Avoid giving your position. Institutional chaplains are trained in dealing with this kind of question in a non-denominational manner and are normally more than pleased to get a phone call from you with a referral for a person who has (unusually) gotten to this point in your conversation with them. Your job is to deal thoughtfully with the question, not feel compelled to make an answer.  

If you are drawn to this juncture of health and religion, Kenneth Pargament, PhD has worked to develop an understanding of how religion helps or harms a person's ability to cope with the challenges of life. His standard text is The Psychology of Religious Coping.

Can medicine and religion coexist within your treatments? Share your opinions below.

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