When you are diagnosed with cancer, or blindsided by a stroke, a health crisis can turn into a dark night of the soul.
Many patients torment themselves, asking, "What did I do to make my body turn against me?" And if months of agonizing treatments stretch ahead, with no guarantee of a complete recovery, the burning question may be, "What is the meaning of all this suffering?"
In addition to prescribing medication to help with physical symptoms, health-care professionals are increasingly tuning in to their patients' spiritual needs.
For the past year at Princess Margaret Cancer Centre in Toronto, outpatients have been able to book a 20-minute session of non-denominational support from a spiritual-care provider before or after a chemo treatment. Occupational therapists in Canada have enshrined spiritual care in their guidelines, making it their job to help patients – who may be physically or cognitively impaired – tap into life-affirming sources of personal meaning, such as nature or the arts.
The new approach to spiritual care is not the same as religious counselling or the healing response associated with the placebo effect. Rather, it is based on the idea that everyone has the need for hope, meaning and purpose in life, and that connecting to one's spirit, the essence of the self, can be a powerful motivator in healing.
Researchers in the emerging field of spirituality in medicine argue that science alone cannot meet the needs of aging populations who increasingly suffer from depression, social isolation and chronic diseases such as diabetes and dementia, which tend to worsen over time.
Physicians and nurse practitioners should not only prescribe pills or recommend psychotherapy, researchers say, but also support patients through compassion and mindfulness.
"Patients want much more than a cold doctor," said Dr. Christina Puchalski, a palliative-care physician and founder of the GW Institute for Spirituality and Health at George Washington University in Washington.
In the past two decades, more than 75 per cent of U.S. medical schools have integrated spirituality-related topics into their training.
Puchalski noted that a growing number of health-care workers, including doctors, are participating in group discussions and reflective writing exercises designed to enhance their own self-awareness.
Nurses and physicians may not be qualified to be spiritual guides for patients facing serious illness, but "we are witnesses, we are spiritual companions," Puchalski said.
Some studies suggest that addressing patients' spiritual needs in health-care settings has the potential to improve patient outcomes, and may reduce health-care costs by uncovering some of the underlying causes of stress-related mental and physical illnesses.
Spirituality in hospitals may help reduce health-care workers' stress too, says Marc Doucet, president of the Canadian Association for Spiritual Care. He noted that staff at Princess Margaret are starting to avail themselves of the spiritual-care sessions offered to patients.
Puchalski describes the alignment of health care with spirituality as a movement to reclaim medicine's spiritual roots, which date back to shaman healers and early hospitals founded by religious organizations to promote healing of mind, body and soul.
The difference is that today, belief in God, reincarnation or animal spirit guides isn't part of the prescription. The new approach is not mystical or esoteric – "it's intensely practical," said Melanie Rogers, a nurse practitioner who conducts research on spirituality in health care at the University of Huddersfield in Britain.
For a doctor or nurse, it may take only a few minutes to listen intently, convey a message of hope and ask about sources of meaning in a patient's life, she explained.
Rogers recalls working with a depressed patient who had given up her job to care for her elderly mother. When her mother died, the patient was socially isolated "and felt she didn't have any purpose any more," Rogers said.
She discovered that the patient had an interest in ceramics, and put her in touch with a local pottery group. Before long, the patient was volunteering in community arts projects and building relationships with other ceramicists. "She is just a completely different person," Rogers said.
But is the search for a worthwhile pursuit truly a "spiritual need?"
As "spirituality" becomes a catchphrase in health care, critics argue that the term is too nebulous to mean anything, and that the humanistic side of medicine is a better description of what doctors and nurses can offer – without the religious or new-age undertones.
Par Salander, a professor of social work at Umea University in Sweden, noted that in research papers, the term spirituality has referred to everything from religious beliefs to existential questions, relationships to people, animals or nature, and the abstract notion of "being at peace."
"Spirituality" is being used as a scientific concept, despite the term's lack of conceptual coherence, theoretical rationale and systemic meaning, Salander pointed out. The term "blurs more than clarifies," he wrote in an e-mail.
In health-care settings, however, patients and staff tend to respond favourably to concepts such as spirituality and mindfulness, which has been endorsed by neuroscientists, noted Mike Gartland, head of pastoral and spiritual care at South West Yorkshire Partnership NHS Foundation Trust in Britain.
In general, "people are much happier with the language of spirituality rather than religion," he said.
In British Columbia, the provincial government has replaced the term chaplain with job titles such as spiritual health practitioner to reflect the evolving profession's academic and clinical training requirements, as well as the shift away from traditional faith-based models.
In spiritual care, "the commitment is to the health-care process as opposed to a religious or denominational base," said Philip Crowell, head of the department of spiritual care at the Children's and Women's Health Centre of British Columbia.
The Vancouver-based centre has three spiritual-care professionals on staff to offer round-the-clock services for patients and family members coping with events such as a life-threatening accident or death of a child.
Many are referred by doctors, nurses and social workers who have learned to flag patients in need of spiritual care, Crowell said.
"If this is a spiritual crisis, you don't address it with medical answers. You address what's happening – there may be fear, anxiety, distress, uncertainty, confusion," he explained.
"When we talk about spirituality, it's not so much about beliefs, but about fundamental values – and how you articulate these in times when you are beside yourself," Crowell said.