Tuesday, May 29, 2012

Spirituality 101 (Part 2 - Religion)


Karl Marx was once quoted as saying that religion...is the opium of the people (Marx, K., 1843-4). Considering the extremely fanatical and persistent religious views of most individuals identified with terrorism in the world today (e.g., Middle East, Afghanistan, & Iraqi - Muslim extremist "suicide bombers," and past Irish - Catholic & Protestant wars, and U.S. abortion clinic bombers, etc.), one might reach the same conclusion - that these individuals must be addicted to something that has abnormally taken control of their minds.

Surveys show however, that despite the few religious extremists mentioned above, religion and spirituality play a central healthy and stabilizing role in the lives of 80% of the world's population (more than 5 Billion people) in human experience today. The religious and spiritual dimensions of culture are repeatedly found to be among the most important factors that structure human experience, beliefs, values, behavior, and illness (Browning et al., 1990; James, 1961; Krippner and Welch, 1992).

Holy War

On September 11, 2001 at 5:30 a.m., (Hawaii- time), I was abruptly woken by an excited radio announcer frantically stating that two airplanes had just attacked the Twin Towers in New York City. Still half asleep, and not sure if this was some kind of sick joke or not, I decided to get up and turn on the TV, instead of hitting my snooze alarm button. After seeing the smoke pouring out of the severely damaged buildings on every major television channel, I was still in shock and disbelief. My wife and I had just a year ago taken a tour in the magnificent twin tours and had walked on the rooftop that I was now watching collapse to the ground in seconds.

Most of us tend to associate the term, "Holy War," with the Muslim religion because of 911. The media has made us aware that Muslims have a religious duty called "Jihad" that requires that their men go to war to defend or spread Islam if the situation warrants it and if they are killed they are guaranteed eternal life in Paradise. Jews, Christians, and many other religious groups have also historically gone to war over religious ideals or as the situation warranted. Religious/ ethnic cleansing "holy wars," or crusades can be read about in Jewish history in the Old Testament, and Christian history (Roman Catholicism), along with Islam's history recorded in the Quran. Mohammad, like King David and many of the Roman Catholic popes were not only the most powerful religious leaders in their cultures, but they were also the military leaders of their religious armies. For example, the Crusades were a group of Holy Wars between Muslims and Christians that was believed by some to be started by Pope Urban in 1905, to recapture Jerusalem from the Muslim Turks.

Our present day global war on terrorism however is not a war against those whose faith is in the common Muslim religion. The individuals that have been thus far identified with the terrorist acts of 911 and throughout the world have all been associated with an extremely rigid, intolerant and militant religious fanatical sect of Islam with similarities to the "Christian" cults started by David Koresh and Jim Jones.

In spite of the fact that we commonly hear the old phrase, "All roads lead to Rome," or all religions lead to God, when some folks attempt to briefly discuss spirituality and religion, it's hard to imagine why we would have six-thousand years of religious wars if it was possible to reconcile the vast complex differences of our world's religions. The one common denominator and maybe the only unifying factor among all of the world's religions is their unanimous view on mankind's fallen condition - that man has not, is not, and will not live in harmony with his God or Gods, unless he is saved from his present (e.g., sinful, ignorant, and/ or unenlightened etc.) condition by either working towards salvation or is saved by some other means of grace or enlightenment. At the great risk of starting another Holy War (just kidding) by attempting to summarize my limited knowledge of all "Spiritual Truth" and simplify a very complex topic for those who can't seem to find the time, energy, or motivation to seek out this knowledge for themselves, I would like to put this comprehensive topic on the shelf for a moment to first address those individuals who are struggling with a much more basic question: Am I presently a believer in anything spiritual/ religious?

Spirituality & Religion (Definitions)

Most individuals have difficulty with defining the meanings and differences of the words - Spirituality and Religion. Walsh, F. (1998), defined spirituality as an overarching construct that involves personal beliefs or values that provide a sense of meaning and unity with nature and the universe. He reported that it often includes a supreme being or force that unifies and guides the universe and that it may be experienced within or outside formal religion. Carlos, P.G., (2002), states that spirituality refers to the unique and intense experience of a reality greater than oneself or an experience of connection with the totality of things and that religion is an organized social structure in which spiritual experiences are shared, ritualized, and passed on to future generations. You don't need to have a spiritual experience to be religious. Likewise, you don't need to be religious to have a spiritual experience and spiritual growth is not dependent upon being a member in a religious organization.

The term "spirituality" has been defined by some authors as that which gives meaning and transcendence to one's life and it often includes many different expressions to include prayer, worship, meditation, interactions with others or nature, and relationship with a higher power or God. Spirituality comes from the root word "spirit," or in Latin - spiritus. The Bible in Genesis chapter 2, verse 7, reports that, "the Lord God formed the man from the dust of the ground and breathed into his nostrils the breath of life, and the man became a living being." The word "spirit" is defined the same in every culture as "breath of life or life giving energy." Spirituality is primarily concerned with whom or what ever is the energy or center of our lives. It is closely related to our values, beliefs, priorities, preoccupations, and goals that give meaning to our existence (Why do we wake up each morning and decide to continue to live on? What lights up our life or what are the "loves" of our life? What are we enthusiastic about?). Strategies must be used to first assist individuals to discover and evaluate their present values and beliefs to determine if their behavior has been in conflict with their spiritual focuses (Where is there spirit focused?), and if not, how well have their spiritual focuses helped them to meet their needs. Spirituality implies a connectedness to humanity and deity through an unconditional love of self and others that ultimately brings peace, wellness, and resiliency in crisis situations. Spirituality deals with the innermost relationships we have with ourselves, others, and God.

When considering a change in our spiritual focuses the existence of a power greater than our selves or "God" must also be contemplated (Who or what is sitting on the throne of your heart and influencing and determining your ultimate decisions in life?). C.S. Lewis - one of the most influential writers of the twentieth century once stated:

"If man is not allowed to worship a king, he will kneel before movie stars, athletes, and even prostitutes. For spiritual nature, like bodily nature will not be denied. Deny it sustenance and it will gobble down poison."

Renewed spirituality provides a new foundation for all of our decisions and relationships that will necessarily help us to develop a new lifestyle, simply because what is most important to us has changed. Kurtz, E. (1992), reports that the benefits of spirituality or spiritual health include humility, inner strength, sense of meaning and purpose in life, acceptance of self and others, sense of harmony and serenity, gratitude, and forgiveness.

Religion on the other hand can be defined as any system of belief that submits itself to one Supreme Being or many deities with adhered to practices (e.g. prayer, meditation, fasting, etc.) typically documented in Holy Scriptures or texts (e.g. Bible, Koran, Torah, etc.) Religion is merely giving worth to what we value the most in life or worth ship or worshiping - typically with others through a more structured organization to express our individual beliefs with actions and others. Religions are organized systems of worship and faith. The fact that religious organizations and institutions have arisen throughout history to meet spiritual needs is evidence that humans have a spiritual dimension that thirst to be filled. Simply put, religion is mans' attempt to reach God through organizations that practice ritualistic codes of worship.

Following are some characteristics that distinguish spirituality from religion:

Spirituality:

1. Individualistic, 2. Subjective, 3. Informal, 4. Emotional, 5. Inward directed, 6. Unaccountable,

7. Spontaneous

Religion:

1. Community Focused, 2. Objective, 3. Systematic, 4. Behavioral, 5. Outward Directed,

6. Authoritarian, 7. Doctrine Oriented

Spirituality and Religious Backgrounds

Sometimes it is helpful to assess where we are spiritually by taking a look at our religious backgrounds. A mature Army Chaplain once told me that part of his work involved assisting soldiers' in making religious/ spiritual assessments. He told me that spiritual fitness is vitally important to soldiers' effectively functioning and sustaining their performance in times of stress, hardship, and tragedy. He stated that spiritual growth develops the personal qualities that form the basis for decision-making, integrity, and character. He reported that most soldiers have religious histories that fall into one of the following three religious background categories:

1. No Religious Preference - These individuals may have had no religious training or exposure to formal religion. Some have never seen the inside of a church, but may have some limited family history of religion. Others may have had some religious teaching as a child, but they do not identify with any religious group or organization at this present time.

2. Positive Religious Background - These individuals' past experiences with spirituality and religion may have left a positive lasting impact upon their lives. They may have spiritually strong parents or parental figures in their lives that have continued as supportive role models. They may have either drifted from their faith as children or have had an adult conversion experience exhibiting real personal faith at present.

3. Negative Religious Background - These individuals may have "spiritually shutdown" as children because of various incidents in which there families forced a rigid, legalistic, and/ or spiritually abusive religion upon them. They may have been physically, sexually, or emotionally abused by members of their church's leadership staff or have known others that were. They may have observed religious groups fighting and have a mindset that all religious people are hypocrites and are poor examples of what they preach. They may feel that God has let them or someone they loved down by not answering their prayers in a time of real need.

This chaplains' primary role was to provide pastoral care to soldiers' and their family members. Part of his work involved helping soldiers' look at religious stumbling blocks to understanding spirituality as a new concept in their life. The category that you find yourself in can give you some guidance as to whether you need to:

1. Start seeing life as three-dimensional: physical, emotional, and spiritual, and develop spirituality as a new concept;

2. Start reinforcing your prior spiritually healthy religious background experiences; and/ or

3. Start reframing your previous spiritually abusive or unhealthy religious background experiences by seeking pastoral counseling and therapy.

This next section is for those that may be seeking out their spiritual dimension for the first time and are curious about how 80% of the world's population practices their religion. Keep in mind that this is a very brief summary of the world's religions and that it is by no means all- inclusive.

Spirituality and Religions of the World

According to David Barrett et al, editors of the "World Christian Encyclopedia: A comparative survey of churches and religions - AD 30 to 2200," there are 19 major world religions. In the year 2000, eight of these major religions had approximately 80% of the world's population adhering to their beliefs. Agnostics and atheists account for approximately 19% of the world's population and the rest of the world's religions including Judaism make up the last 1%.

Christianity - 33%

Islam - 20%

Hinduism - 13%

Buddhism - 6%

Chinese Folk Religion - 4%

New Asian Religion - 2%

Animism - 2%

Agnostics/ No religion - 15%

Atheists - 4%

The Baha'i Faith, Confucianism, Jainism, Judaism, Shaminists, Shinto, Sikhism, Spiritism, Taoism, Wicca, and Zoroastrianism religions make up less than 1% of the world's religious population. There are many, many other significant spiritual/ religious organizations with much fewer members in the world, that could also be included in the last 1%, but they are too numerous to mention in this short summary.

Most of the worlds' religions do not fit neatly into little boxes, however (not counting the atheist and agnostic groups) they can be theoretically divided into six categories:

1. Monotheistic Religions - The doctrine or belief that there is only one God:

(Example: Sikhism and the Abrahamic religions: Christianity, Islam, Judaism, etc.)

2. Polytheistic Religions - The worship of or belief in many Gods or Goddesses: (Example: Hinduism, Shintoism, etc.)

3. Non-theistic Religions - The belief or faith not in God or Gods, but in supreme enlightenment: (Example: Buddhism)

4. Pantheistic Religions - The belief that God and nature are one: (Example: Taoism, Animism, etc.)

5. Dualistic Religions - The belief that there are only two opposing Gods or two interacting forces: (Example: Zoroastrianism/ Taoism Yin/ Yang etc.)

6. Polyreligiousity - Having beliefs in multiple religion simultaneously (Example: Chinese Folk Religion/ New Asian Religions that combine Confucianism/ Buddhism/ Shintoism)

Spiritual/ Religious - Assessment

The need for the evaluation and assessment of our spiritual concerns has been well documented and recognized by many authors (Conrad 1985, Moberg 1982, Byrne 1979, Gartner 1991, Larson 1991, Moberg 1965, Poloma 1991). Despite documented history of research devoted to the psychology of religion, it should be noted that it took the American Psychiatric Association Committee approximately 42-years to recognize spirituality as a human dimension to be assessed for religious / spiritual problems. It wasn't until 1994, that the Diagnostic and Statistical Manuals' Fourth Edition (DSM-IV), included an entry entitled "Religious or Spiritual Problem" (Steinfels, 1994), intended to encourage mental health professionals to view patients' religious experience more seriously. This diagnostic category was proposed for the DSM-IV as "Psycho-religious Problems Not Attributable to Mental Disorder," to delineate those distressing experiences of a religious or spiritual nature that are the focus of psychiatric diagnosis or treatment, but are not attributable to a mental disorder (Lukoff, Lu, & Turner, 1992, p. 677). In the DSM-IV-TR (2000), this entry is listed on page 741, as V62.89, in the chapter entitled, "Other Conditions That May Be a Focus of Clinical Attention." It states, "This category can be used when the focus of clinical attention is a religious or spiritual problem. Examples include distressing experiences that involve loss or questioning of faith, problems associated with conversion to a new faith, or questioning of spiritual values that may not necessarily be related to an organized church or religious institution."

The Joint Commission on the Accreditation of Healthcare Organizations (JCAHO) has also set regulatory requirements for the routine assessment of spiritual needs of all patients (2001). Spiritual concepts, ideas, and relationships are integral to all levels of care, and to a certain degree, even transcend each level of care; nonetheless, they are difficult to define acceptably in objective, behavioral, and measurable terms. Spirituality is implied in all dimensions and is in all levels of care, and certainly is inherent in the Twelve Step philosophy. Likewise, according to the American Society of Addiction Medicine's (ASAM), "Patient Placement Criteria for the Treatment of Substance-Related Disorders, 3rd Edition, 2003," spirituality is absolutely inherent in the comprehensive bio-psychosocial multidimensional assessment, treatment, and continuity of care for substance-related disorders. ASAM's 3rd Edition has set the standard in the field of addiction treatment for recognizing the totality of the individual in his or her life situation. This includes the internal interconnection of multiple dimensions from biomedical to spiritual, as well as external relationships of the individual to the family and larger social groups.

In order to assess the spiritual dimension of man, it is helpful to understand some of the causes of spiritual/ religious problems. Some individuals are just plain confused about what they believe the "truth " to be for them. For others, their spiritual and religious values may be conflicting with their personal goals for success and personal satisfaction. Some struggle with making personal commitments to their beliefs, while others have turned their backs on what they know is true and may feel guilty over their actions. Still others feel deeply committed to their beliefs, but their words and actions are not congruent with their beliefs in that they realize that they do not express a loving attitude toward others. Many believers feel defeated by their inability to change their behaviors due to their internal conflicts and the stressors of everyday life. Some get frustrated because their spiritual growth seems so slow and others are concerned that their prayer and worship activities are performed more out of habit instead of the joy that once motivated them. Many feel that their prayers have gone unanswered because they continue to suffer from chronic sickness, disease, poverty and/ or trauma or have raised their children in the faith only to watch them develop alternative lifestyles.

Spirituality is also one of the key concerns of dying patients that needs to be assessed. It was cited as integral to the dying person's achievement of the developmental task of transcendence and important for health care providers to recognize and foster (Highfield. Mudd, Millson 1992): "The physician will do better to be close by to tune in carefully on what may be transpiring spiritually, both in order to comfort the dying to broaden his or her own understanding of life at its ending"(Leighton 1996). Some spiritual identifiers that one could assess in patients in the last month of life are: 1) is there purpose to their life as they suffer, 2) are they able to transcend their suffering and see something or someone beyond that, 3) are they at peace, 4) are they hopeful or do they despair, 5) what nourishes that sense of value of themselves: prayer, religious commitment, personal faith, relationship with others, 6) do their beliefs help them cope with their anxiety about death, with their pain, and with achieving peace. Finally, one needs to assess how well the patient's spiritual needs are being met: 1) do the health care providers listen to their beliefs, faith, pain, hope or despair, 2) are they able to express or develop their spirituality through prayer, art, writing, reflections, guided imagery, religious or spiritual readings, ritual, or connection to others and God.

So how can we assess the spiritual dimension of man? What resources are available for mental health clinicians? Although there is increasing recognition for the vital role of spirituality in the lives of many clients, there are relatively few quantitative assessment instruments that have been developed.

It appears that the study of spirituality and religion in mental health will continue to blossom in the future as the Joint Commission on the Accreditation of Healthcare Organizations (JCAHO) in 2005, has set regulatory requirements for the routine assessment of spiritual needs of all patients. JCAHO is the feared civilian and military hospital accrediting agency that inspects hospitals and carries the ultimate threat of shutting down hospitals that do not comply with their standards. Per the recent 2005, PC.2.20, EP 4 standards and elements of performance (EPs) found in the "Provision of Care, Treatment, and Services" (PC) chapter in the accreditation manuals, JCAHO requires organizations to include a spiritual assessment as part of the overall assessment of a patient to determine how the patient's spiritual outlook can affect his or her care, treatment, and services, and/ or whether more in-depth assessments are necessary.

Since the Joint Commission on the Accreditation of Healthcare Organizations (JCAHO) has set regulatory requirements for the routine assessment of spiritual needs of all patients (2001), I would also like to propose the following spiritual/ religious screening instrument:

BMIS

This spiritual/ religious screen is a brief set of questions for healthcare providers, clinicians, and those interested in self-help to ask. For quick and easy remembrance, this practical spiritual assessment is based on the acronym - BMIS (referring to Body Mass Index screening - that most primary care physicians are already accustomed to when evaluating overweight and obesity in their patients).

B - Background: What is your spiritual/ religious "background"? Have you had a positive or negative experience with religion? Do you have a spiritual/ religious preference now?

M - Meaning: What gives you the most "meaning" or purpose to your life at this time? (e.g., career, family, school, God, etc.)

I - Importance: How "important" is spirituality and/ or religion to your successful recovery and treatment plan? (e.g., extremely - very - not very - not important at all, etc.)

S - Stress: Are spiritual and/ or religious issues a cause of "stress" and conflict or a "source" of comfort for you? Would you like to talk to a religious counselor and/ or spiritual advisor (e.g., pastor, priest, rabbi, imam, etc.), about these issues?

Qualifying Note: This article was not written and should not be viewed or considered to be a formal theological treatise on spirituality and religion. It is merely a simplistic introduction to these topics to reveal how critical they are to the addiction recovery process with the hope of assisting individuals to reassess their values, and reexamine their priorities to redefine what is really important in their lives. My intent is not to persuade, influence, convince, or convert anyone to my personal beliefs. My goal is to help others to clarify and identify where they presently stand at this point in time, so that they can consider charting a course to get from where they are to where they desire to be someday. After all, you cannot make flight reservations if you don't know what airport you will be departing from.

For further information:

http://www.universal-publishers.com/book.php?method=ISBN&book=1581122101

[http://www.booklocker.com/books/1966.html]

http://www.universal-publishers.com/book.php?method=ISBN&book=1581125399

References: Aday, R. "Belief in Afterlife and Death Anxiety: Correlates and Comparisons," Omega, 1984 18:67-75 Allport, GW and Ross, MJ "Personal Religious Orientation and Prejudice," J of Personality and Social Psych 1967, 5(4):432-443 Batson, CD and Schoenrade, PA. "Measuring Religion as Quest: 1) Validity Concerns," J for The Sci Study of Religion, 1991 30(4):416-429 Batson, CD and Schoenrade, PA "Measuring Religion as Quest: 2) Reliability Concerns," J for The Sci Study of Religion, 1991, 30(4):430-447 Belcher, AR et. al. "Spirituality and Sense of Well-Being in Persons With AIDS," Holistic Nurs. Pract. 1989, 3(4):16-25 Bergin, A. and Jensen, J "Religiousity of Psychotherapists: A National Survey," Psychotherapy, 27:3-7 Burkhardt, M. "Spirituality: An Analysis of The Concept," Holistic Nursing Practice, May 1989 :60-77 Byock IR. Missoula-VITAS Quality of Life Index (version 25S). VITAS Healthcare Corp, 1995. Byrne, JT and Price, JH "In Sickness and In Health: The Effects of Religion," Health Education 1979, 10:6-10. Chambers, LW et. al. "The McMaster Health Index Questionnaire," J Rheumatology 1982, 9:780-784 Clinch, JJ and Schipper, H. "Quality of Life Assessment in Palliative Care," The Challenge of Palliative Med, p. 61-70.




James Slobodzien, Psy.D., CSAC, is a Hawaii licensed psychologist and certified substance abuse counselor who earned his doctorate in Clinical Psychology. He is credentialed by the National Registry of Health Service Providers in Psychology. He has over 20-years of mental health experience primarily working in the fields of alcohol/ substance abuse and behavioral addictions in hospital, prison, and court settings. He is an adjunct professor of Psychology and also maintains a private practice as a mental health consultant.