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13 February 12

Heythrop College, University of London, Wednesday 9th November 2011

Some of the 15 minute papers presented on the day are summarized here. The summaries are followed by a brief list of conclusions and main themes, and a reflection upon the day by participant Desmond Ryan. Some participants suggested further reading, so we have included a list of suggested titles at the end of the report. See the ‘bios’ document for more information about the speakers.

List of Papers

Orientation and academic perspectives

1. Frank Prochaska: Historical perspective on religion and health in the UK

2. Sara Bhattacharji: Think global, act local: lessons from primary healthcare in India

3. Desmond Ryan: The triumph of scientific medicine: where is religion now?

4. Annelies van Heijst: Care, culture and charity

Practitioner perspectives

5. Jill Olivier: Evidencing the ‘religion’ in religious health assets

6. Jessica Kingsley: Who Cares? And Why They Need To

7. Barry Evans: From Patterns to People: Epidemiology and Theology

8. Andrew Todd: The Changing Role of Chaplaincy

9. Rory Reynolds: Chaplaincy in the Mental Health Setting

10. Gloria Dura Vila: Emotional Distress among Clergy and Contemplative Communities

11. Ijeoma Ajibade:  African Churches, healing and HIV

12. Caroline Hoffman – Other paradigms: complementary medicine

13. Ian Campbell – A relational approach to health and healing

14. Sima Barmania – A Muslim health professional’s perspective

15. Peter Draper – Older people, spirituality and quality of life


1. Frank Prochaska: Historical perspective on religion and health in the UK

It is illuminating to view the ‘health world’ of the UK today from the perspective of what preceded. In late Victorian Britain there were more scripture readers and religious visitors in the population than doctors and nurses; life was ‘physically painful’; medical relief was (by contemporary standards) inaccessible and unsophisticated; religion provided both an explanation for calamity and a treasury of consolation; God was considered as the ‘Great Practitioner’ and Jesus as the ‘physician of the soul’; body and soul, health and religion, were treated together; medical practitioners often accepted a moral responsibility towards patients; the churches accepted a medical responsibility towards parishioners; healing and preaching were linked in the Gospels.  In the 19th century medicine in the hands of Christians passed naturally into ethics while ethics in religious hands took expression in ‘medical philanthropy’.  The challenge of ‘missionary medicine’ was to provide the ‘double cure’: to consecrate medicine to the service of Christ and provide the everlasting remedy. The inability of medicine to restore patients’ bodies or to offer an explanation for death gave strength to religion.  Overall, there was a desperate need for medical care in nineteenth-century Britain, especially in the poorest areas of the country where little relief was on offer beyond making the sick and dying more comfortable, and praying for their souls.  Victorian nursing schools often required nurses to takes courses in theology.  Christianity may have made it more difficult to live, but if we are to believe the many nineteenth-century witnesses to the faith, it made it easier to die.

In the 20th century the introduction of new drugs and painkillers, changes in medical practice, falling mortality rates, the growth of institutional care, and the electrification of hospitals all contributed to the loss of religious influence. State medicine introduced a decisively materialist conception of health.  In the secular medical culture of the NHS, religion seemed out of step with enlarged expectations for healthcare, scientific medicine and egalitarian principles.  In less than a century, the hospitals had been transformed in ideological, professional and administrative terms. There was certainly a price to be paid for this ‘progress’ progress, and it was chiefly paid by Christianity, by charity, and perhaps even by the sick.  Yet most patients felt it was a price worth paying, if medicine could cure their infirmities and eliminate pain. In a culture that rejoiced in earthly gratification, heaven had lost its allure.

2. Sara Bhattacharji: Think global, act local: lessons from primary healthcare in India

In contrast to the modern health situation in the UK outlined by Frank Prochaska, SB highlighted how people in India continue to fall back on religion when they are sick. Spirituality and physical health are still closely linked. She gave examples from her own practice of how religion fosters strength and resilience, and how healing is more than physical treatment. It involves the whole person. It transcends the cure. It restores meaning, purpose and wholeness to the wounded. One of the most challenging questions is still the meaning of poverty: Why was Jesus born poor, and is being poor a blessing or a curse? Whatever answer is given, the key principle for guiding the practice of healing in SB’s own practice is the dignity of every person: seeing dignity in each sick, disabled or vulnerable human being in a country where 70% of the population lives on less than $2 is a duty of every carer. Health and healing can still be understood in spiritual terms: as recognising the pain and darkness of life and death, but nevertheless working to bring light into the darkness.

3. Desmond Ryan: The triumph of scientific medicine: where is religion now?

These days people turn more to medicine than to religion when they are sick, yet it is increasingly clear that the 'functional-modern' (Beyer) paradigm of medicine fails to meet the whole-person needs of the sick/distressed.  Why is this?

My answer has been to identify seven hierarchical levels in an evolutionary-historical spectrum of health-life approaches in the West.  In ascending order of complexity, the levels are: (1) physical-environmental, (2) biological (e.g. pathogens), (3) constitutional (organism), (4) functional (focus on social capacity and instrumental behaviour), (5) socio-ecological (relationships), (6) cultural (7) spiritual.  An illustration: in the 1930s and 40s there was a growing concern with social medicine (Level 5), but it was politically eclipsed by the emerging health-industrial complex, where medical scientists/clinicians and pharmaceutical companies gained large rewards from providing functional services.

It has been their monopoly of key resources (technology, finance, intellectual legitimation, training, credentialling and appointment) that has secured the triumph of Level 4 functional-service organizations, not only in science-based healthcare, but also in education and institutional Christianity.  If we accept Christianity's claim to be a religion of life, this has had the result that, in Western health-life systems, the human concerns of Levels 5, 6 and 7 are currently 'under-actualized evolutionary alternatives' (Laszlo 1987: 49).  Implicitly, both the patient constructed by scientific medicine and the worshipper constructed by organised religion remain Level-4 adapted: compliant, docile, deferential - i.e. the ideals from the 1950s functional systems.  But 'Level-4 clients' are now in short supply, and this 'in-denial system' is breaking down.  Alongside Illich's 'medical nemesis' has emerged a religious nemesis: functional-industrial complexes become counter-productive ('iatrogenic'), both in failing to meet emergent (i.e. whole-person) needs of users, and in malfunctioning internally from over-production of functional goods/services/communications (i.e. that meet producers' needs more than those of users).

Today, in both healthcare and religion, people are thrown back on their own resources - and unsatisfied refugees from both the religious and healthcare industrial complexes end up in the same place: the holistic growth and healing movements.  The Body-Mind-Spirit shelves in the bookshop point to a new reality: complementary/alternative medicine and the new spirituality are a conjoined twin response to a failure to evolve of the Western health-life system.  The hegemonic functional organizations have lost touch with their new human environments.

4. Annelies van Heijst: Care, culture and charity

What place should religion have in modern healthcare? Although it is undoubtedly important it should not dominate healthcare (and certainly no one religion should be exclusively present). Not that long ago 60% of hospitals in the Netherlands were staffed by Roman Catholic nuns – but nuns were often self-sacrificing and overworked. The Christian heritage in this area has positive aspects – and Christian compassionate practices founded today’s healthcare system in the West, but it also has negative and even repressive ones. The current healthcare system is highly functionalistic: it is focused on repair of the body and mind; it views care as a product of a market economy; it has lost the discourse and icons of compassion, comfort, and suffering which Christian religion used to be known for. There is no professional discourse for the pain and distress of the patient, nor for compassion in the carer. AH spoke as a moral theologian, a feminist, and someone who was chronically ill and had experienced the Dutch health care system from within. She remarked on the simmering discontent of many health workers and patients – a theme she addresses in her Professional Loving Care and Models of Charitable.  The concept of ‘professional loving care’ aims to integrate elements from both modern health practice and the Christian heritage. It has been taken up as a slogan by healthworkers in the Netherlands campaigning for change and a new approach to healthcare.


5. Jill Olivier: Evidencing the ‘religion’ in religious health assets

In the 1990s, religion did not feature very strongly on global health and development organizations’ agendas – and those religious institutions and communities working towards improved health were often invisible to broader national and international view. This has changed dramatically over the last decade, with increased interest and activity occurring at many different levels, as well as increased attempts at cross-sectoral and cross-disciplinary dialogue. Currently, there is now considerable concern for the lack of real evidence on the role and impact of religion on different aspects of health. I provide here my top ten ‘soapboxes’ – or prominent issues which frequently emerge as a result of working to evidence the role of religion (or in IRHAP’s language, ‘religious health assets’) for improved public and community health:

(1)    Previously, it was necessary to advocate for the importance of religion to international health and development agendas. Early advocacy, which was often focused on ensuring that religious institutions were ‘at the table’, was (by necessity) based on a very weak and inconsistent evidence-base. As a result, there has been a substantial push-back, and an increased demand for ‘evidence-based’ action and advocacy (of course, the decision over what is ‘evidence’ is highly political).

(2)    There are still substantial evidence gaps – but there is now also more available research than is commonly acknowledged. However, information is often sitting in protected ‘nodes’, and there are substantial divisions (e.g. between  the US and European research streams, between a religion-health and a religion-development focus, between religion-individual-health and religion-public-health, between religion-HIV/AIDS and other concerns).

(3)    A faith-based organization is not a faith-based organization is not a faith-based organization. There are multiple and complex typologies, no common terminology – and no consensus on the basic unit of analysis. The split between NGOs and FBOs is problematic in many contexts (e.g. what about how religion operates in ‘NGOs’?) Many religious health assets do not fit in the frames or typologies in which we seek to force them.

(4)    The use of ‘data’ is currently often advocacy-oriented, and often extremely dated. Given the poor evidence-base, the field has suffered from a lack of critical interrogation of some of the most commonly utilized data (for example, that 30-70% of health care is provided by FBOs in Africa).

(5)    HIV/AIDS has overwhelmed the religion-and-health field of interest. This is an area in which important work has taken place – but there is a critical need to translate or transfer the lessons from the work on religion and HIV/AIDS to other health concerns (so that we do not start from the beginning each time).

(6)    There remains a lack of acknowledgement of previous contributions to the field. For example, questions raised by the Christian Medical Commission (CMC) in the 1960s still have no answers today (for example, what is the meaning of healing? how does faith impact on health care? is religious health provision financially viable?)

(7)    Effective tools for measuring the ‘intangible' religious health assets are most urgently needed. There are huge gaps in the evidence and tools for pursuing questions such as: how does faith motivate? How do religious values impact on both health provision and health decisions?

(8)    It is important to understand how religion fits within complex (health) systems. For example, ‘religion’ needs to be considered how it impacts on macro, meso and micro levels of health systems – on health policy as well as on individual health seeking behaviours.

(9)    Advocacy about the ‘comparative advantages’ of FBOs engaged in health (such as reach, access or trust), is under-researched, unsubstantiated, and frankly often unhelpful.

(10)   Genuine transdisciplinary work at the intersection of religion and health is challenging, long-term, broad, complex, requires constant (re)interrogation and the construction of new theory.

6. Jessica Kingsley: Who Cares? And Why They Need To

JK spoke from the perspective of publishing in the field of health care and well-being. She noted the continuing turn to spirituality and forms of arts therapy in relation to healing and health. Above all, she highlighted the importance of the theme of patients and ‘empowerment’, something that Eastern approaches to health and well-being emphasise strongly in their linking of health with spiritual development. Empowerment in a western health context tends to mean wresting power from a health professional – in eastern practice power is to be found within. In Daoism, for example, bodily practice leads to spiritual development. JK spoke of a new book on spiritual care in end of life work which draws attention to the importance of ‘presence’, ‘hope’, and ‘person-centeredness’.

7. Barry Evans: From Patterns to People: Epidemiology and Theology

BE spoke as a doctor and epidemiologist of many years’ experience, who has recently become involved in pastoral work in a multi-ethnic, multifaith area. He outlined three main domains of public health practice: 1) health improvement – e.g. lifestyles 2) health services – e.g. ‘evidence-based medicine’ (EBM) 3) health protection – e.g. public health approaches including issues such as infectious disease prevention and control, vaccination and accident prevention. He stressed the gains made in public health and treatment as a result of EBM. Very little such evidence existed for most of Complementary and Alternative Medicine (CAM).

He spoke about the rapidly-changing health demands and priorities in the UK today, and highlighted changes such as those brought by migration and by increasing numbers of the elderly – for example, the number of people aged over 85 is due to double over the next 20 years. Other current issues in public health include 1) the ‘globalisation’ or diseases, especially infectious diseases 2) the influence of pharmaceuticals and global pharmaceutical firms 3) the growth of complementary and alternative medicine (CAM).

BE ended by offering reflections, including some arising from his own work and personal commitments, on religion and public health.

- Firstly, he noted that the work of ‘healing’ and treating the whole person has often become the domain of CAM rather than EBM, with EBM's treatment of the disease rather than the person.  He regretted this and considered EBM needed to regain an approach to the whole person.

- Secondly, he discussed the role – if any – of church healing services and discussed the dangers of a ‘God will heal me’ approach which can involve neglect of EBM, with possibly grave consequences not only for the individual but perhaps for the wider community if for instance vaccinations were refused.  But in combination with EBM there may still be a place for the whole person approach which 'healing' services may offer.

- Finally, he reflected on ‘spiritual care’ and ‘spiritual assessment’ in hospital and hospice settings, its nature and adequacy – especially for a diverse population.

Overall, he emphasised that a wedge should not be driven between faith-based healing and scientific medicine, but recognised the difficulty which the latter has in admitting uncertainty and lack of control in the face of the incurable.

8. Andrew Todd: The Changing Role of Chaplaincy

AT explained how rapidly health chaplaincy has been changing, and how new laws and directives are influencing change. Amongst the latter he noted, inter alia, the impact of data protection, equalities legislation and recent moves to establish a statutory basis for chaplaincy. He also noted how, at the same time, chaplaincy is still contested, e.g. recent campaigns against it by the National Secular Society; and how it is vulnerable to cuts in healthcare (like other ‘soft’ services).  There was discussion of the varied models of chaplaincy, both multi-faith and generic. The emphasis of the latter is more on ‘spiritual care’ for all (irrespective of their beliefs), the former connects more with ‘religious’ needs, but the boundaries between them are far from clear. AT noted how ‘religion’ in a healthcare setting is rapidly becoming a subset of ‘spirituality’. A major theme was the pressure on chaplaincy to ‘professionalise’, and all this implies. Negatively it may imply various modes of secularization, and the erection of barriers between professional and patient (does the move from ‘parish priest’ to healthcare professional simply imply a new form of clericalism?). Yet it may also be essential in order to establish healthcare chaplaincy on firmer foundations, building models of accountability that ensure that chaplaincy continues to have a voice in healthcare. Above all, the essential work of seeing and hearing the person must remain central to chaplaincy.

Andrew supervised Layla Welford’s PhD on this topic funded by Religion and Society: http://www.religionandsociety.org.uk/uploads/docs/2011_03/1301491293_Todd_Phase_1_Collaborative_Studentship_Block.pdf

9. Rory Reynolds: Chaplaincy in the Mental Health Setting

Patients in the mental health setting have very limited contact with medical professionals. They are fed and medicated and ‘let out for a smoke’. This can lead to feelings of abandonment and meaninglessness. Often there is simply no-one to talk to who can take one seriously. Chaplaincy ministers in this context. It listens and attempts to bring spiritual insight. It serves as an interface between mental health, psychology and spirituality. There are difficult issues which require experienced chaplaincy: is someone hearing voices having a spiritual experience or schizophrenic? Experienced chaplains try to interpret people’s experience and thereby value it – talking together versus ‘dismissal’.

10. Gloria Dura Vila: Emotional Distress among Clergy and Contemplative Communities

The theme was the ‘medicalisation of sadness’, and alternative (spiritual approaches). GD explained how depression is defined in the DSM, and discussed the growing use of pharmaceuticals to respond to distress, partly as a result of the pharmaceutical industry, and partly because of the costliness of more intensive and personal treatments. She spoke of the resources which religious traditions have for dealing with distress of various kinds, including sadness, disappointment and grief. In particular, she spoke of her research amongst contemplative nuns in Spain, and their use of resources like the Dark Night of the Soul to interpret distress, and reveal its positive indeed ‘healthy’ potentials.  Must we always banish grief? Or can distress sometime be part of serious self-reflection and spiritual growth? Such questions destabilise contemporary medical frames of reference and, at the least, highlight the importance of incorporating existential issues into clinical practice.

11. Ijeoma Ajibade:  African Churches, healing and HIV

IA spoke about the situation in Africa, especially in Nigeria which – like many other non-western countries – is a nation in which religion and faith plays an important role in relation to health. In general, people seek spiritual help to see them through the difficulties and challenges of life.  Nigeria has experienced a growth in new generation churches which are Pentecostal in tradition and are increasingly popular, sometimes supported by TV programs and use of other media, and often with congregations in their thousands. Ije pointed out that these new churches emphasise the power of God, miracles, success, healing and wealth.  In these churches God is immediate and intervenes in daily life in ways that are concrete and physical. People may be encouraged to act on their faith and show that they believe that their prayers have been answered. This in itself is not necessarily a problem, but can become so if it means that you stop taking treatment or medication, even more so when that treatment is for HIV. It is well recognised that HIV is a highly stigmatised condition that can lead to social isolation and alienation. Ije spoke about her involvement in the project run by the Diocese of Southwark and Southwark Council  ‘Being Built Together’ which aims to understand more about the new black churches in Southwark and the communities they serve. She spoke of her work at the African Health Policy Network (AHPN) which developed toolkits on HIV for Christian and Muslim faith communities, of designing a course on HIV for Anglican clergy, and speaking at the House of Lords select Committee on HIV and AIDS. The committee recommended that the Department of Health ensure that they provide sustainable funding for AHPN engaging faith leaders on HIV. Finally, she emphasised the importance of involving people living with HIV to share their experiences of living with the virus and make their voices heard.  This is done through Ffena, which is a group of positive people who are mobilised and supported by the AHPN to influence policy on HIV and other health issues.

12. Caroline Hoffman – Other paradigms: complementary medicine

CH, who offers supportive and complementary treatments at Breast Cancer Haven (‘the Haven’), spoke of ccomplementary medicine (in the sense in which the term is used in Europe and N America) as emerging from a Western context in which many people felt that the deeper parts of the self were not being addressed by a medical paradigm that emphasises the conceptual and the scientific.  People come to complementary medicine hoping for a more holistic approach, which meets people where they are, acknowledging their humanity and engaging with the relationships between body, mind and spirit. There is also an emphasis on reclaiming personal agency rather than seeking help from or deferring to medics, and including the experience of the patient rather than simply the expertise of the practitioner. Some (though not all) religious approaches to health and healing involve putting oneself and one’s wellbeing in the hands of an external force, and emphasising the religious or moral ‘meaning’ of health and healing.  While not specifically religious, complementary medicine has been described as ‘a spirituality of awakening’, drawing on other much older traditions such as herbal medicine and traditional Chinese medicine (TCM).  These offer alternative approaches to the healing of the whole self, such as acupuncture, pulse diagnosis etc. CH’s own work has been in the field of mindfulness-based stress reduction (MBSR), which offers a meditation-based approach to holistic living by focusing on the idea of ‘presence’: of engaging with ourselves in the here and now, and learning to meet our limitations with a loving kindness that extends to ourselves and also to others.  Thus it enables us to move beyond the conceptual limitations of homo sapiens sapiens, and experience ourselves as homo sapiens who is body and spirit as well as mind.

13. Ian Campbell – A relational approach to health and healing

This presentation focused on health issues in the 'developing' world, with cross-over to the economically 'developed' world.  Hospitals can lose their connection to the local community their serve, but local communities (through common sense initiatives that are low cost) can transform health 'provision' toward participation and local ownership in their area.  Case studies of particular people and their initiatives across the globe were used as examples to illustrate the way local (often religiously motivated) communities can seize agency back from paternalistic health systems. Health and healing are approached through a belief that human beings, in community, have a capacity to respond to difficulties in their own lives that may seem insurmountable when looked at from the standpoint of external systems.

The relational approach involves asking a number of questions:

1.      Who are we?    This is a critical question for a health practitioner, focusing on the whole person in the context of community and family.  The human capacity for development and response is fostered by a belief in human strengths of local people and  the value of local action and experience, so that problems are identified and solutions developed in their own context, instead of coming from ‘experts’ outside.

2.      What do we believe? A ‘faith-based organisation’ is one which believes in faith related capacities for stimulating and facilitating care and change. The role of a health professional is to help in unlocking that capacity and in designing what the people can do to help themselves in response to a particular context or situation.  His or her role is not to sit in a hospital or clinic and wait for them to come.

3.      How do we do it? The SALT process is a valuable tool, developed by the Salvation Army and partners for its work in the facilitation of community health and facilitation team development, and increasingly widely used today.  Self-assessment is important, and should include the facilitator.  SALT’s basic concepts are:

  • S : stands for Stimulate, Support
  • A : stands for Appreciate
  • L : stands for Listen, Learn and Link
  • T : stands for Transfer, Team

4.   What then is changing? Health workers and health policy should embed in the belief that local relational community exists, and has strengths enabling a response to critical health issues. They should match that belief with the practice of facilitation, complemented by expert knowledge. A working culture consistent with faith and doctrinal underpinning is the marker for successful transition of tradition.

5.     What are we learning?  This relational approach has implications (including spiritual, social and political ones) for the way we live together.

14. Sima Barmania – A Muslim health professional’s perspective

Islam can be viewed not only as a religion but as a way of life in which practices and cultural norms affect the health and wellbeing of its members. Central beliefs of the faith, such as fasting and pilgrimage illustrate this connection. Fasting is a health issue in that medical advice may be needed to inform the practices of pregnant, diabetic or elderly. Similarly, medical advice is provided during Hajj trips to Mecca to prevent dehydration and to ensure meningitis and other vaccinations are taken. In terms of HIV there is frequent stigma and discrimination attached to those who are infected and many Muslims still have negative attitudes towards the disease which inhibit Muslims from being tested, and prevent those who test positive disclosing their HIV positive status. Given the strong cultural identity associated with Islam in the UK many HIV+ Muslims feel isolated and unsupported. This is where initiatives such as the London-based NAZ Project have been important. The sexual health of Muslims can similarly be influenced by religious attitudes and norms – for example many Somali teenagers in Britain describe how they engage in sexual activity despite the existence of strong moral teaching against sex before marriage in Islam. Because of the lack of sex education and/or the silence regarding safe sex practices, much of this sexual behaviour is high risk. The result is that those most at risk and in need of help cannot access advice and support easily enough. Various other health conditions, such as depression, can be stigmatised by being viewed as ‘Western diseases’ and associated with personal failure or weakness. Certain mental health conditions, such as schizophrenia, are regarded by some as possession by an evil spirit which can prevent or delay timely medical interventions. Elderly relatives suffering from dementia – who tend to live with their extended families – may also find themselves either protected or hidden from the outer world and therefore unable to access the health support they need. This is particularly problematic in cases such as cognitive diseases where early medical interventions can be especially effective. In common with many religious worldviews, Islam also has adherents who maintain that God is the true healer and that this dispenses with the need for medical interventions. Faith healing and other practices remain important.

15. Peter Draper – Older people, spirituality and quality of life

This presentation considered the importance of language in contexts of healing and care and linked this to the concept of spirituality. An underlying observation is that humans modify their speech patterns depending upon how they view the interlocutor (power relations). Speech patterns are therefore revealing of our assumptions, attitudes and values. When this is applied to the context of care for older people in the hospital or care environment, it is possible to note that nurses and other carers might (often unwittingly) use inappropriate language or fail to communicate effectively with those they care for. For example, carers may talk over rather than talk to those cared for. The use of pet terms, overly familiar or condescending language may fail to treat the elderly with the dignity and respect they deserve. This is not a new issue – see Rob Sans Everything (1967). In October 2011 the UK Care Quality Commission published a report on dignity and nutrition among older people in hospitals.  ‘Why has care broken down?’ they asked, ‘when we know how to create a caring environment, and when care and compassion cost nothing?’   The latter assumption is revealing – and erroneous.  Caring for people in hospital is skilled work, and emotionally tiring.  It is generally regarded as ‘women’s work’.  The statement that care and compassion ‘cost nothing’ could be interpreted as meaning that care and compassion are insufficiently important to be worth paying for; consequently, many nurses do not feel they are doing something that is valued. Some staff in the Commission’s survey were found to speak to patients in a condescending and dismissive way, even ignoring basic demands for help with feeding, exercising and the use of toilets.  ‘Spirituality’ provides a vocabulary for discussing the importance of language and the role of the words we use in promoting or undermining the humanity of the other.  Spirituality is a contested term in nursing: the philosopher of health John Paley argues that it is inappropriate to argue for a spiritual basis to care in a secular health service.  By contrast, John Swinton (nurse and theologian) and Stephen Pattison (theologian) suggest that spirituality orientates us to absences and gaps in our provision of health care.  It is time to become more sensitive to the way we talk in health contexts and about them.  PD described one funded project he is involved in that aims at this more attentive approach to the language we use. ‘Taking Care With Words’, based at Hull University, is using the language of poetry to see whether exposure to and practical engagement with more intentional use of language can translate to the more careful use of language – to its meaning and value - among nursing staff in care settings. One way in which this is being tested is through the presence of a poet in residence. The hope is that it can foster not only more thoughtful communication but also nurture the values of care and compassion essential for the health setting.


(These issues should be viewed as pointers towards future research and reflection.)

  1. Can a relational perspective be integrated with ‘evidence-based’ medicine?
  2. Is this new emphasis on ‘EBM’ defensive? In fact little evidence has been gathered in relation to many areas, e.g. surgery
  3. What are the obstacles to integration of the human/spiritual dimension?
  4. What is normal? What is normal health?
  5. How do we deal with the fact that costs are going to go up and the capacity to meet needs will go down in the next decade?  How is this situation to be addressed?
  6. Costs and need for attention rise not necessarily in relation to longevity, but in the last year of life.  How do we take proper account of this fact, including in relation to people who are themselves approaching their final years?
  7. Everyone here is looking for some kind of change: but where might change come from? And how can incompatible approaches to healthcare ever be integrated, especially with the power differential between them.
  8. How can an emphasis on competition take account of the need for greater relationality?
  9. Is it possible/desirable to bring theological or ‘spiritual’ language into the discourse on medical care? The apparent incompatibility of these different discourses.
  10. Where do people experience grace and ‘presence’ in their encounters with health care systems?
  11. How can  community be integrated into the healthsystem, and can we learn from poorer countries about this?
  12. What realignments of primary, secondary and tertiary care are taking place?
  13. Growing crises of ‘social health’ – e.g. obesity – in relation to which the current healthcare system is impotent.
  14. The importance of gender in healthcare systems
  15. Are we seeing the end of the expert – or the opposite? Or both?

A reflection on the colloquium


Desmond Ryan

 '...the primordial task faced by the brain is that of labeling an unlabeled world' (Modell 2003)

Is there an integrating framework or perspective which might guide research and inform practice in the field of religion, spirituality, health and society?  In this colloquium, nearly 20 people each tried to explain what it was they were grasping in their part of the field.  Then all reflected on the experiences of each, trying to turn discrete experiences into a shared understanding. These few paragraphs try to take that reflection forward, even to suggesting that there may be an essence which can be extracted from the set of accounts, a speculative proto-paradigm latent in the presentations.

Every speaker except the historian spoke from personal experience with one or another health-care system: as professional practitioner in either a biomedical or psychospiritual role, as (representative of) carers or patients, as researcher or publisher of findings, as promoters or developers of initiatives.  And virtually all spoke from a committed values base: this was not a detached scientific meeting, but more of a coming together of witnesses.  This is appropriate: as an academic field, spirituality/religion in health has long been under-funded, so it is practitioners and promoters who provide the reports from the front line.  As the historian might have added, the progressive exclusion of Christianity from the state healthcare system has been matched by religion's eclipse in the academy.

Nevertheless, in reporting on their lifeworlds, speakers' concerns were not atomistic and unconnected.  Every one of these worlds was undergoing change, in some cases amounting to a transformation.  This placed common requirements to be addressed by all:

  1. what was the context within which the change was to be understood?
  2. was the complexity of the change-in-context sufficient to warrant an attempt at explanation?
  3. was the change-in-context of a quality that could be evaluated as 'progress'?

At first sight, a focus on context seems unpromising, as every context presented was different.  But within the variety of contexts, a commonality of actors and agencies appeared: traditions and cultures, professions and businesses, religions and ethical systems, disorders and diseases.  In poorer countries, by and large, the context was of a dominant religious system and a restricted biomedical system.  Historically, the religious system was less functionally delimited than in the West, and accounts suggested that in Asia and Africa the 'sacred canopy' of the society still reached over all its members and provided guidance, remedies and support for the ill and unfortunate.  The dominance of religion extended to being a prime supplier of explanatory narratives for sickness and death, much as in Victorian Britain.  The dominance of religion also extended to members of poorer societies who had migrated to richer societies, and whose culture was being reshaped in dialectic with that of the host society, including its healthcare system.  In this dual context, 'explanation' of health and illness often became essentially contested, and politicised, right down to the micro-politics of the family, as with pentecostal Nigerian Christians neglecting their medical treatment out of witness to their faith, or Islamic youth pushed into risky sexual practice by the taboo on discussion in their families.

In the British context more generally, the political dialectic of concern was less between religion and biomedicine than between biomedicine and 'holistic healthcare'.  Most reports from the UK agreed that the emergence in Western culture of a highly developed notion of the 'person' was bringing in its train a powerful surge of demand for new approaches in health and social care, and that the science-based providers had been slow in adapting to this new environment.  Politics was again mentioned:  agencies were always defending territory, professions had material interests as well as scientific ones, and fought to hold on to the privileges voted to them under legislation from the era of biomedical hegemony over legislation and certification, businesses (e.g. pharmaceutical companies) had a huge weight to throw into the scales in asserting their interests.  And explanation of health and illness had now become a site of intense conflict and competition, whether at the micro-level of the individual patient assessing a course of action through an illness episode, or at the macro-level of theology, epidemiology, scientific publishing, national legislation and international policy.  The only surviving meta-narrative is that of the triumphant market, and ideas, discourses, technologies of cure and care, specific remedies - all were competing for buyers.

'Spirituality' was frequently referred to as a phenomenon that figured in these debates.  Chaplains used the term in reporting how their practice had moved from being primarily religious to being primarily humanistic, in the sense of providing person-centred support for whoever needed it in the healthcare system, staff and families as well as patients: this was 'spiritual care' as a clinical practice.  'Feelings' were an important factor which spirituality seemed able to include as integral to its definition of situations, but with which both scientific medicine and credal religion had had little concern.  This was true for all actors in health systems: patients faced suffering and loss of control and needed to be able to find hope; health workers facing depersonalisation and exploitation in outcomes-driven delivery systems needed to recover motivation; CAM practitioners sought to mobilize the patient's emotion and faith in their commitment to self-healing; leaders of communities caught in major transformation found themselves challenged to engage their communities in decisions about matters of life and death which were simultaneously religious, cultural, educational, and scientific.  At the sociological/epidemiological level, a new awareness of spiritual issues as impacting on etiology and outcome of health disorders was pushing research into new and wider questions, and hence towards broader and more cultural methods, whether for AIDS in South London ethnic minorities or possible depression among contemplative nuns in Spain.  Theologians reported that 'spirituality' undermined the conventional functional compartmentalisation of religion in society, chaplains and patients were seeing their new values challenging some mechanistic limitations of the 'evidence-based practice' model currently espoused by professional experts.  A general insight seemed latent here: structurally, the advanced world was in the process of moving towards the traditional.  Confronted by the assertion of 'the person AND their meaning' (cf. von Uexküll) as the new model patient, the functionally delimited, autonomous spheres (à la Luhmann) of religion and health were breaking down.  As in diagnosis, so in therapy, all speakers described an emerging transdisciplinary world.

Taking the long view, and adding a global perspective, we can perhaps propose a kind of natural history of 'biospirituality', of the three-stage kind that the founders of sociology proposed for socio-economic systems.  First, almost universally, societies whose social practices were wholly blended with their metaphysical beliefs so that it was not really possible to discern either a 'religious' or a 'medical' sector: here it was the religious/metaphysical realms which were looked to for explanations and meanings for illness, suffering and death.  A life-meaning harmoniously integrated into the divine will was the norm. Secondly, initially in the West, pari passu with the emergence of specialised functional spheres in the economy, education, technology, the law..., healthcare, led by scientific medicine, became an autonomous system, with a socially recognised, legally guaranteed monopoly over both metaphysical and physical realms of bodily health.  Effectiveness in medical outcome was the dominant norm.  Thirdly, the era we are now living through, in which both metaphysics and the material sciences (e.g. quantum physics) grow beyond the limits of the mechanistic world view and co-create a culture of holism and body-spirit integration.  This emergent culture seeks, not to repudiate the religious meanings and effective physical medicine of the two earlier eras, but to include them in a more complex culture oriented to the achievement of personal development and human fulfilment through a new self-awareness and reclaimed agency.  Once again harmony is the transcendent value, but now it is harmony of a healthcare system with a presumed ideal self, relationally embedded, to be forged and reforged through the vicissitudes of life, always growing, including in illness, even in dying and death. 

Could this be described as 'progress'?  Note how, in this meeting of witnesses, we see something important is under way in the domain of spirituality and health: a recasting of 'the primordial task faced by the brain' from that of 'labeling an unlabeled world' to that of re-labelling a labelled world.  In terms of the western 'socio-cultural brain', the prolonged stand-off between the great cognitive empires of sixteenth-century Christianity and seventeenth-century science is dissolving in the ferment reported here.  The dual epistemological crisis which induced the modern era was a crisis of what to believe to be true.  The crisis of today is more primordial, in two senses: one, in that it is experiential, i.e. concerned with the emergence, roots, constitution and development of whole human beings, rather than with minds/belief systems; two, in that it is a mass cultural experience, inescapably affecting individuals-in-their-contexts all over the world, including those in the major belief systems.  Primordial is personal, but also planetary: spirituality has become evolutionary.  

The transition from belief to experience entails a transition from cognition to imagination.  It has a major consequence.  A crisis in experience is resolved, not by thought, but by action.  Though less than two dozen people, this colloquium is fully representative of the transition, and presents some sample experiences of making meaning by imagination, and of resolution by action.  Globally, in spirituality and health, millions of people are moving beyond the labels, imaginatively building their life-meaning in their life-space, and integrating it into their spiritual universe.  And, in so doing, reaching after a life worth living. 

Should this not be described as progress?


Modell, Arnold H. (2003) Imagination and the meaningful brain Cambridge MA: The MIT Press


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Edmonds, Matt (2010) A Theological Diagnosis: A New Direction on Genetic Therapy, 'Disability' and the Ethics of Healing. London: Jessica Kingsley Publishers

Kabat-Zinn, Jon (2005) Coming to our Senses. New York Hyperion (CH)

Laszlo, E. (1987) Evolution: the grand synthesis London: New Science Library

Mandelstam, Michael (2011), How We Treat the Sick: Neglect and Abuse in our Health Service. London: Jessica Kingsley Publishers

McGuire, Meredith (1988), Ritual Healing in Suburban America. Rutgers University Press (LW)

Nolan, S, Spiritual Care at the End of Life: The Chaplain as a 'Hopeful Presence' (2012) Foreword by Rowan Williams. London, Jessica Kingsley Publishers (JK)

Olivier, J. 2011. “An FB-oh?: mapping the etymology of the religious entity engaged in health." In J.R. Cochrane, B. Schmid & T. Cutts (Eds) When religion and health align: Mobilizing religious health assets for transformation. Pietermaritzburg, South Africa: Cluster Publications. (JO)

Olivier, J., & Wodon, Q. (Eds). 2012. Strengthening faithinspired health engagement in Africa. Washington, DC: The World Bank [forthcoming Jan 2012] (JO)

Paterson, G, (2011) 'Discovering Fire: Changes in International Thinking on Health Care – the Challenge of Religion in J.R. Cochrane, B. Schmid & T. Cutts (Eds) When Religion and Health Align: Mobilising Religious Health Assets for Transformation. Pietermaritzburg, South Africa, Cluster Publications

Prochaska, F, Christianity and Social Service in Modern Britain: The Disinherited Spirit. Oxford, 2006 (suggested by Frank Prochaska)

Simmons, Paul (2008), Faith and Health: Religion, Science, and Public Policy. Macon, GA: Mercer University Press

Swift, Chris (2009). Hospital Chaplaincy in the Twenty-first Century: The crisis of spiritual care on the NHS. Farnham: Ashgate

Swinton J and Pattison S (2010) ‘Moving beyond clarity: towards a thin, vague and useful understanding of spirituality in nursing care’.  Nursing Philosophy: an international journal for healthcare professionals 11 (4) 226-237 (PD)

Todd, Andrew. 2011. ‘Responding to Diversity: Chaplaincy in a Multi-Faith Context’ (2011), in ed. Miranda Threlfall-Holmes & Mark Newitt, Being a Chaplain. London SPCK 89-102

Recommended journal:

The International Journal of Person Centred Medicine (ref. http://www.ijpcm.org).  This journal is edited by Prof Andrew Miles at Imperial College, London

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