Daniel P. Sulmasy, MD, PhD
Spirituality and religion are related but conceptually different. I define spirituality as the ways in which a person habitually conducts his or her life in relationship to the question of transcendence. A religion, by contrast, is a set of beliefs, texts, rituals, and other practices that a particular community shares regarding its relationship with the transcendent. Spirituality is thus simultaneously a broader concept than religion and a narrower concept than religion.
It is broader in the sense that all religious and even nonreligious persons confront the question of transcendence, and so the term is compatible with all forms of religious belief and even the rejection of religion. Spirituality is narrower than religion, however, in the sense that, because only persons can engage questions of transcendence, each relationship with the transcendent will always be unique and spirituality ultimately personal. Even within a given religion, there will be as many spiritualities as there are individuals.
Growing numbers of Americans consider themselves “spiritual but not religious.” Although this represents a challenge for organized religion, it is also true that many millions of Americans (more than in most Western nations) are regular practitioners of particular religions and find in their religions sources of meaning and spiritual wisdom.
It is important to note that those who consider themselves spiritual but not religious will also have genuine spiritual needs. And it goes without saying that plenty of people who are “religious but not spiritual,” for whom religious practice does not foster a genuine relationship with the transcendent, may still need to grow spiritually within their faith traditions.
Religious traditions have a great deal of accumulated wisdom to impart regarding the profound spiritual questions that illness and death raise for patients. Patients who are seriously ill, even if estranged from the religions in which they were raised, may still find comfort in some connection to their religious traditions.
The primary spiritual questions that illness raises are about meaning, value, and relationship. Questions about meaning include the “Why me?” questions; questions about the meaning of suffering, life, death, purpose, and afterlife. Questions about value encompass those that illness raises regarding a person’s worth; the value one has (or may not have) when disfigured, dependent, unproductive, or otherwise afflicted in ways that undermine what society typically values.
Questions about relationship encompass those that illness raises about a person’s relationships, the need for reconciliation with those from whom one might be estranged, and the need to know that despite illness or impending death one is connected in important ways to family, friends, community, and possibly beyond.
All these questions engender a series of finite responses that lead one, at the limit, to the brink of transcendence: the lingering meta-question of whether there is a nonfinite answer at the end of each series of finite responses. These questions arise for both patients of all religious persuasions and those who profess no religious beliefs. And these questions are inevitably occasioned by a person’s confrontation with serious illness or injury and the looming possibility of death.