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.
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
As a “meta-theme” of the study, spirituality as experienced by the participants was found to be a life-sustaining phenomenon.14 A more detailed analysis identified eight themes.
- Spirituality is:
- experienced uniquely by each participant.
- a journey that occurs throughout each participant’s life.
- a phenomenon that provides meaning to life.
- that developing mental illness provided the catalyst for the participants’ search for a personally meaningful spirituality.
- that spirituality helped the participants to cope with their mental illness.
- that the participants engaged in spiritual occupations — that is, occupations whose primary purpose is to express and experience spirituality (eg, prayer, meditation, worshipping).
- that spirituality is a form of being that provides the meaning that underpins doing.
- that engaging in shared spiritual occupation was highly valued.
A more detailed comparison and explication of the themes as reflected in the six participants’ narratives has been presented elsewhere.14 Here, one participant’s story is presented as an in-depth illustration of the relationship between spirituality and health. “Bonnie” (a pseudonym chosen by the participant) is a man who, at the time of the interview, reported experiencing chronic anxiety and depression spanning a period of at least 10 years.
Bonnie’s sense of spirituality had helped him resolve the question of whether to commit suicide:
I was always searching for the answer, what’s the meaning of life? . . . When I was depressed, I was always thinking about ending my life. But in actual fact . . . life does not end, it keeps going . . . So that helped me . . . because I started to think, well maybe it doesn’t end anyway, you know, it might end in this physical realm but it won’t end, ultimately anyway. It’ll be eternal. So the point was that I came to believe that to commit suicide or to take my own life was irrelevant.
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,
I’d be dead. I would be, honestly, because that’s what kept . . . that’s what’s saved my life. That’s it, the bottom line, really . . . And I’m fairly confident that I will never take my own life. Now, a few years back . . . I would’ve said I’m fairly confident that sooner or later I’ll take my own life . . . But it’s changed now because of God . . . I honestly believe, 100% guaranteed, that the reason for my existence right now . . . is because I believe in God.
Not only did spirituality give Bonnie a reason to not die — importantly, it has also given him a reason to live. Bonnie believes
I was created for a relationship with God . . . So my life is all about establishing and maintaining a healthy relationship with God . . . It’s the spiritual realm that is what life is all about, [and] that gives life substance. So that’s what’s kept me going . . . I’m living life because of God.
Bonnie believes that, if he asks for help from God, he will receive it.
It’s basic, simple, belief and faith that there is a God and if I communicate, miracles happen . . . Things happened for my benefit that I couldn’t explain, but they happened . . . I found that [I] wouldn’t necessarily get what I wanted but I got what I needed. And it’s a cliché, but that’s the way it works. Things panned out.
Bonnie also believes that his sense of spirituality helps him deal with anxiety by helping him to calm down.
All of a sudden, if I consider God, well then everything’s all right, everything’s okay. Doesn’t matter what’s happening in the world or in my head. Because if I believe and I reconnect and re-establish my relationship with God, well I know that I’ll get led along the right path and I won’t have to worry about the bills or the rent or . . . the job or the friends or the relationship or whatever. Because I know that through God it’ll work out . . . I hand my worries to God.
When Bonnie feels connected to his spirituality and is in tune with God, he engages in ordinary, everyday occupations, which he finds very health-enhancing. He believes that doing these ordinary occupations is good for his soul.
It’s all the simple, basic lifestyle things that make all the difference. You don’t have to go out and make millions of dollars or have the great job or the flash car or the big house or any of that stuff. It’s all just basic simple taking care of yourself . . . feeling well, feeling connected, feeling not isolated. Not helpless, not threatened by the world . . . going for a walk out in the bush and enjoying nature and . . . spending quality time with other people.
Sharing his spirituality with others is another important aspect of Bonnie’s spiritual life. Connecting to other people helps Bonnie connect to God and experience his spirituality.
It works through people. I have friends who I discuss it with . . . I don’t feel too bad because I know that there is somebody there with me. And that makes the difference.
Bonnie has also had negative experiences with others involved in “charismatic” spirituality.
It was good to start with, [but] the most disturbing thing I found . . . was the concept of “pray and be healed” . . . And me with a mental illness getting involved in that regard was quite distressing. Because . . . they believed it was a simple case of pray and be healed. And if I’ve got a mental illness all I have to do is pray and be healed, and if I pray and I’m not healed well that means that I’m doing something wrong. So there’s “right” and “wrong” . . . So you’re getting judged by humans, by people, which just throws the whole thing out of whack . . . it left a bad taste in my mouth, that whole experience of judgement.
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
The concept of spirituality can have good or bad connotations for some people. For example, sharing spiritual practices improved the mental health of some participants in my study by enabling them to feel supported and loved. On the other hand, Bonnie’s experience of charismatic spirituality left him feeling judged by others in a negative way when he was told to “pray and be healed” and did not recover. As spirituality can have either positive or negative associations for people, it is recommended that health practitioners be careful to show sensitivity and acceptance when talking about spirituality with patients who have experienced mental illness.21 Some authors have offered suggestions for how to talk about spirituality with patients.22
Spirituality can provide hope, provide a reason to live, and support a person in his or her life. It can provide the meaning underlying the everyday occupations in which people engage. For these reasons, spirituality can directly affect a person’s health. It may therefore also be a legitimate topic of discussion and exploration for health professionals. Discussions about spirituality with patients should be dealt with cautiously and sensitively.
Abstract
In the past 10–20 years there has been increasing interest in the relationship between spirituality and health.
I interviewed six patients from community mental health centres, using a phenomenological approach to explore how concepts of spirituality, occupation and mental illness/mental health are related. One person’s story is presented to illustrate the issues.
Four main themes were identified:
Spirituality is a phenomenon that provides meaning to life.
Spirituality can help a person cope with mental illness.
Spiritual beliefs can make everyday occupations more meaningful and health-enhancing.
Some people find it valuable to engage in shared occupations that focus on spirituality.
Spirituality is an important and relevant issue to be discussed between patients and health practitioners, provided that practitioners can exercise sensitivity, caution, tolerance and acceptance of values that may differ from their own.