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Spirituality as sustenance for mental health and meaningful doing: a case illustration

Clare Wilding
Med J Aust 2007; 186 (10): S67. || doi: 10.5694/j.1326-5377.2007.tb01046.x
Published online: 21 May 2007

The relationship between spirituality and health is an area of increasing interest, as evidenced by the plethora of literature devoted to exploration and discussion of this issue.1-4 This interest is equally apparent within the profession of occupational therapy.5-7

Occupational therapy seeks to enhance the health of patients by enabling them to participate in occupations that they want and need to do.8 It is important to recognise that the term “occupation”, as used by occupational therapists, differs from the popular meaning of “work”. Occupation, in this context, embraces all of the meaningful activities that people engage in to occupy themselves,8 including work, self-care, and domestic, leisure and caring activities. The current dearth of research on the relationship between spirituality, health and occupation prompted me to conduct a phenomenological study of this relationship.

There is no consensus in the literature on a definition of spirituality.9,10 Within the study discussed here, an exploratory approach was taken to defining spirituality that included asking each participant what spirituality meant to him or her.

Methods

I approached two community mental health centres in rural Australia and asked case managers to invite patients who were willing to talk about their experiences of spirituality to participate in the study. Six people volunteered to participate — three men and three women, aged between 35 and 55 years. Interviews were conducted between 6 February and 18 October 2001. I did not collect detailed demographic information, as this was not relevant to the exploratory, qualitative design of the study. Participants discussed having diagnoses of one or more of the following conditions: depression; anxiety; drug and alcohol misuse; bipolar disorder; and psychosis. All had had suicidal thoughts at some time.

I interviewed four participants at the community mental health centre they attended and two participants in their own homes, at their request. The unstructured, in-depth interviews aimed to encourage participants to speak freely and comprehensively about their understanding and experiences of spirituality, particularly in relation to their everyday occupations and to living with mental illness. I used open-ended questioning to enable this process.

Each participant was interviewed once for about an hour and a half. The interviews were audiotaped and transcribed, with the transcriptions forming the major dataset. I analysed the data using a Heideggerian phenomenological approach — a qualitative research approach that aims to understand and interpret experiences in order to determine more clearly the essential constituents of the phenomenon under examination.11,12 Through multiple readings of the transcripts, I coded the narrative data and combined them to form “chunks of meaning” that were subsequently compared with each person’s whole story and ultimately collapsed and interpreted into themes. As is consistent with this research paradigm, the findings summarised here represent my own interpretation of the data. More detail about the method has been reported previously.13

My study was approved by the University of South Australia Ethics Committee and the Greater Murray Area Health Service Ethics Committee.

Themes from Bonnie’s story
Spirituality saves from death and provides meaning to life

Bonnie’s sense of spirituality had helped him resolve the question of whether to commit suicide:

At a later point in the interview, Bonnie stated even more bluntly that, without spirituality, he would have suicided. He said that, if he had not developed a strong sense of personally meaningful spirituality,

Not only did spirituality give Bonnie a reason to not die — importantly, it has also given him a reason to live. Bonnie believes

Discussion: implications for clinical practice
Spirituality is an important topic for discussion in health practice

The fact that spirituality saved the participants from suicide and provides them with a reason to live is a compelling argument for health practitioners to explore the issue of spirituality with their patients.14,15 Suicidal thoughts are widespread among people who experience mental illness.16 Thus, it is very heartening to find that, at least for some people who experience mental illness, spirituality can elicit a healthy bond to life. David Webb, an author who has himself experienced mental illness, believes that the question of suicide can be resolved if a person can find a satisfactory answer to the essentially spiritual question, “What does it mean to me that I exist?”17 To take this idea further, if spirituality is so powerful that it can persuade a person who is contemplating suicide to remain alive, then it may even be considered to be a moral imperative that health workers discuss spirituality with their patients. It is possible that, in some cases, connecting to the hope and reassurance that spirituality may provide can give people who are engulfed in despair a reason to live and to move on to a path of hope and healing.

Another important reason for health workers to consider the role that spirituality might play in recovery from illness is my finding that spirituality can help people cope better with mental illness. Spirituality was found to provide emotional support to the participants, especially a feeling of connection to others that helped them feel they were not alone and increased their sense of hope. Other authors have also emphasised the importance of spirituality in recovery from illness.18-20

  • Clare Wilding1

  • School of Community Health, Charles Sturt University, Albury, NSW.


Correspondence: cwilding@csu.edu.au

Acknowledgements: 

I would like to thank the participants in my study for their generosity in sharing their stories and experiences. I would also like to thank Dr Esther May and Dr Eimear Muir-Cochrane of the University of South Australia, who supervised the study.

Competing interests:

None identified.

  • 1. Barker P, Buchanan-Barker P. Spirituality and mental health: breakthrough. London: Whurr, 2004.
  • 2. Gartner J, Larson DB, Allen GA. Religious commitment and mental health: a review of the empirical literature. J Psychol Theol 1991; 19: 6-25.
  • 3. Kilpatrick SD, Weaver AJ, McCullough ME, et al. A review of spiritual and religious measures in nursing research journals: 1995–1999. J Relig Health 2005; 44: 55-66.
  • 4. Miller W, Thoresen C. Spirituality, religion and health: an emerging research field. Am Psychol 2003; 58: 24-35.
  • 5. Burgman I, King A. The presence of child spirituality: surviving in a marginalizing world. In: Kronenberg F, Algado SS, Pollard N, editors. Occupational therapy without borders: learning from the spirit of survivors. Edinburgh: Elsevier Churchill Livingstone, 2005: 152-165.
  • 6. Christiansen C. Acknowledging a spiritual dimension in occupational therapy practice. Am J Occup Ther 1997; 51: 169-172.
  • 7. do Rozario L. Spirituality in the lives of people with disability and chronic illness: a creative paradigm of wholeness and reconstitution. Disabil Rehabil 1997; 19: 427-434.
  • 8. Canadian Association of Occupational Therapists. Enabling occupation: an occupational therapy perspective. Ottawa, Ontario: CAOT, 1997.
  • 9. Tanyi RA. Towards clarification of the meaning of spirituality. J Adv Nurs 2002; 39: 500-509.
  • 10. Unruh AM, Versnel J, Kerr N. Spirituality unplugged: a review of commonalities and contentions, and a resolution. Can J Occup Ther 2002; 69: 5-19.
  • 11. Crotty M. Phenomenology and nursing research. Melbourne: Churchill Livingstone, 1996.
  • 12. Streubert HJ, Carpenter DR. Qualitative research in nursing: advancing the humanistic imperative. Philadelphia: Lippincott, 1995.
  • 13. Wilding C, Whiteford G. Phenomenological research: an exploration of conceptual, theoretical and practical issues. OTJR: Occup Particip Health 2005; 25(3): 1-7.
  • 14. Wilding C, May E, Muir-Cochrane E. Experience of spirituality, mental illness and occupation: a life-sustaining phenomenon. Aust Occup Ther J 2005; 52: 2-9.
  • 15. Wilding C. There’s no life without spiritual life. New Paradigm 2002; Dec: 20-23.
  • 16. Better Health Channel. Victorian Government. Suicide and mental illness explained. http://www.betterhealth.vic.gov.au/bhcv2/bhcarticles.nsf/(Pages)/Suicide_and_mental_illness_explained?OpenDocument (accessed Mar 2007).
  • 17. Webb D. Depression: a psychospiritual perspective. New Paradigm 2002; Feb: 17-23.
  • 18. Hill PC, Pargament KI. Advances in the conceptualization and measurement of religion and spirituality. Implications for physical and mental health research. Am Psychol 2003; 58: 64-74.
  • 19. Pargament KI, Ano GG. Spiritual resources and struggles in coping with medical illness. South Med J 2006; 99: 1161-1162.
  • 20. Pinches A. Spirituality: an afterword for mental health workers. New Paradigm 1998; Aug-Sep: 12-13.
  • 21. Mental Health Foundation. Taken seriously: the Somerset Spirituality Project. London: Mental Health Foundation, 2002.
  • 22. Post SG, Puchalski CM, Larson DB. Physicians and patient spirituality: professional boundaries, competency, and ethics. Ann Intern Med 2000; 132: 578-583.

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