By Marilyn Williams
The Affordable Care Act has renewed attention on prevention, wellness, and the continuum of care throughout the life cycle. This discussion also indirectly appeals for healthcare to be holistic, encompassing the whole person — mind, body, and spirit. To date the healthcare chaplain’s voice and leadership has mostly been absent in this dialogue, and in the research underlying wellness and holistic approaches to care. I would suggest that chaplains need to enter into this arena by asking and answering the question, “What is spiritual health?”
Over a half century ago, the World Health Organization defined health “as a complete state of physical, mental, and social being and not merely the absence of disease or infirmity.” However, in the 1970s and 1980s, most people, including health professionals, still thought of health only in terms of the body’s anatomy, physiology, and pathology or the absence of disease or infirmity. In response, some developed a model of total well-being they called “wellness,” while others used “holistic health.” In addition, by the 1990s many became interested in medicine developed outside of the West’s bio-medical model, as well as in specific modalities that became known as alternative, complementary, or more recently as integrative therapies. Some of these modalities would be referred to as mind-body interventions, as research started showing the interconnection between the mind and body. This body of research is sometimes referred to as psychoneuroimmunology. Much of this research would provide fertile ground for the integration of the spiritual dimension into wellness programing. Moreover, these years saw more research regarding the impact of religion and/or spirituality on physical and mental health. Most recently, some health professionals and researchers talk about the bio-psychosocial or bio-psychosocial-spiritual model of healthcare.
The earliest proponents of “wellness,” such as Dr. John W. Travis and his co-author of “The Wellness Workbook,” Regina Sara Ryan, spoke of it as a choice, a way of life, and a process that is never static and has no endpoint. Wellness to them encompassed all dimensions of life including those related to spirituality such as relationships with self, others, and the transcendent and finding meaning. “No matter what is your current state of health,” Travis and Ryan stated in the introduction to their book, “you can begin to appreciate yourself as a growing, changing person and allow yourself to move toward a happier life and positive health.”
In writing this article, I was surprised to discover that many of the wellness principles and mind/body interventions I use with support groups, with stress management programs for patients and staff, and with one-on-one pastoral care, are from publications and conferences of 20 or 30 years ago! However, a quick Internet review leads me to believe that the original work regarding wellness and spiritual care has as much value today as when it first appeared (and may be more useful than some more recent work).
An unfortunate trend of wellness programs is to focus primarily on the physical: exercise, nutrition, weight management, smoking cessation, etc., despite the more expansive vision of the earlier proponents of wellness. While some programs do address stress management and emotional health, and may even include questions addressing spiritual health, the earlier push to integrate all dimensions appears to be mostly lacking.
Should we call this concept of spiritual well-being “spiritual health” or “spiritual wellness”? I have chosen “spiritual health” because the concept of health as encompassing the spiritual dimension is clearly articulated in the Catholic tradition of healthcare as well as implied in the WHO definition. The Ethical and Religious Directives assert: “Since a Catholic health care institution is a community of healing and compassion, the (health) care offered is not limited to the treatment of a disease or bodily ailment but embraces the physical, psychological, social and spiritual dimensions of the human person.” Also, the use of “health” seems to be more consistent for looking at the state of spiritual well-being at any given time if “wellness” is regarded as a journey toward wholeness or complete health.
My guess is that most healthcare chaplains would say they know “spiritual health” when they encounter it, even if they might have trouble describing it. The starting place, thus, may be to identify the signs or indicators of spiritual health. Based on my ministry experience; on a list by Elizabeth Tsang, BCC used in a 2007 presentation; and on’wellness literature, especially “Seeking Your Healthy Balance” by Donald A. and Nancy Loving Tubesing, I would propose the following indicators for discussion and research:
- Knowledge and acceptance of oneself
- Acceptance of one’s current reality
- Resiliency in coping with life’s challenges
- Acceptance of life’s limitations and the ultimate reality of death
- Optimistic and hopeful / has dreams and goals
- Forgiveness of self and others
- Care and concern for others
- Ability to receive love and care from others
- Feeling that life has meaning/purpose or has a commitment to something
- A sense that one’s actions are consistent with personal values/beliefs
- Appreciation and gratitude for something
- Playfulness or the ability to celebrate and experience joy
- Reverence and awe for the mystery of life or awareness of the transcendent
It should be noted that these indicators could apply to those who do not practice any organized religion or even profess any religious or spiritual beliefs.
Finally, we should develop a deeper and explicit spirituality of wellness, as we were challenged to do by Chris Lowney, one of our plenary speakers at the 2014 NACC conference. A spirituality of wellness could challenge us to wake up and pay attention to how we care for our bodies and minds as well as spirits. And thus help us to begin and progress on the journey of wellness, finding better health and more happiness along the way.
Marilyn Williams, BCC, is director of spiritual care at St. Mary’s Health Care System (Trinity Health) in Athens, GA.