More information about text formats
The authors (1) have addressed three major aspects of health related
to physical, mental and social well being as per World Health
Organization's (WHO) definition of health. All these three aspects have
been included very well in the conceptual model developed by the authors.
However, another dimension of health viz. spiritual health has not found a
place in the conceptualization.
According to Puchalski CM (2),...
According to Puchalski CM (2), while patients struggle with the
physical aspects of their disease, they have other pain as well: pain
related to mental and spiritual suffering, to an inability to engage the
deepest questions of life. Patients may be asking questions such as: Why
is this happening to me now? What will happen to me after I die? Will my
family survive my loss? Will I be missed? Will I be remembered? Is there a
God? If so, will he be there for me? Will I have time to finish my life's
work? These questions pertain to the introspection into self, seeking
answers which might lead to his or her inner satisfaction. It is very much
linked with our mental status, physical and social health status.
Thus, one of the challenges physicians face is to help people find
meaning and acceptance in the midst of suffering and chronic illness. Such
circumstances remind us that religion and spirituality form the basis of
meaning and purpose for many people (3). Experiencing life completely and
consciously, even in the midst of great pain and suffering, is the essence
of spiritual health.
Spirituality has been defined in numerous ways which may include: a
belief in a power operating in the universe that is greater than oneself,
a sense of interconnectedness with all living creatures, and an awareness
of the purpose and meaning of life and the development of personal,
absolute values. It's the way one finds meaning, hope, comfort, and inner
peace in life. Spirituality is often associated with religious life, but
many believe that personal spirituality can be developed outside of
religion. Acts of compassion and selflessness, altruism, and the
experience of inner peace are all characteristics of spirituality (4).
Spirituality is recognized as a factor that contributes to health in
many persons. The concept of spirituality is found in all cultures and
societies. It is expressed in an individual's search for ultimate meaning
through participation in religion and/or belief in God, family,
naturalism, rationalism, humanism, and the arts. All of these factors can
influence how patients and health care professionals perceive health and
illness and how they interact with one another (5).
There's no denying the fact that when we feel balanced spiritually we
feel better physically and emotionally. This aspect is extremely helpful
for anyone living with a chronic health condition. It may be difficult to
cure an illness, but the spiritual enrichment can help one feel better,
cope with pain, symptoms, limits and daily challenges, continue to find
meaning and purpose in life and live life more meaningfully. It helps us
live life beyond mundane things and into a different spiritual realm.
Spirituality doesn't always relate to religion. It can be achieved
through various ways. Someone can find it through the practice of
meditation, yoga, breathing exercises, others can find themselves self-
fulfilled through gardening, watching sunset, enjoying nature, art, music,
dance, community work etc. These activities keep oneself engaged both in
body and mind, keeping aloof from the pains of diseases.
Spirituality has been recognized by many authors as an integral
developmental task for those who are dying (6,7). Some observational
studies suggest that people who have regular spiritual practices tend to
live longer (8). Another study points to a possible mechanism which states
that increased levels of Interleukin -6 (IL-6) are associated with an
increased incidence of disease. Koenig et al (9) showed that those who
attended church were half as likely to have elevated levels of IL-6. Thus,
the authors hypothesized that religious commitment may improve stress
control by offering better coping mechanisms, richer social support, and
the strength of personal values and worldview.
It has been observed that spirituality can be measured using quality-
of-life scores. Positive reports on measures such as--a meaningful
personal existence, fulfillment of life goals, and a feeling that life to
that point had been worthwhile-- correlated with a good quality of life
for patients with advanced disease (10).
Thus, considering spirituality as one important aspect of health of
the individual, the conceptual model should also incorporate aspects of it
in the outcome measures.
1. Davies CR, Knuiman M, Wright P, et al.The art of being healthy: a
qualitative study to develop a thematic framework for understanding the
relationship between health and the arts. BMJ Open
2. Puchalski CM. The role of spirituality in health care. BUMC
3. Foglio JP, Brody H. Religion, faith, and family medicine. J Fam
5. Association of American Medical Colleges. Report III: Contemporary
Issues in Medicine: Communication in Medicine, Medical School Objectives
Project. Washington, DC: Association of American Medical Colleges; 1999:25
6. Derrickson BS. The spiritual work of the dying: a framework and
case studies. Hosp J. 1996;11:11-30.
7. Moberg D. Spiritual well-being of the dying. In: Lesnoff-
Caravaglia G, editor. Aging and the Human Condition. New York: Human
Science Press; 1982.
8. Strawbridge WJ, Cohen RD, Shema SJ, Kaplan GA. Frequent attendance
at religious services and mortality over 28 years. Am J Public Health.
9. Koenig HG, Cohen HJ, George LK, Hays JC, Larson DB, Blazer DG.
Attendance at religious services, interleukin-6, and other biological
parameters of immune function in older adults. Int J Psychiatry Med.
10. Cohen SR, Mount BM, Strobel MG, Bui F. The McGill Quality of Life
Questionnaire: a measure of quality of life appropriate for people with
advanced disease. A preliminary study of validity and acceptability.
Palliat Med 1995;9:207-219.
Mongjam Meghachandra Singh
Department of Community Medicine
Maulana Azad Medical College, New Delhi
School of Health Sciences
Indira Gandhi National Open University, New Delhi
Ex-student, Sikkim Manipal Institute of Medical Sciences
Gangtok, Sikkim (India)
Maulana Azad Medical College, New Delhi