James W. Green.

In health care literature, what qualifies as spirituality is diverse and often nebulous. Definitions abound, held to be important as guides for medical research and training, yet running through this same literature is a frequent complaint that no one yet has found a really good definition. Many are proposed and I have chosen several to illustrate the problem. In 1999, the Association of American Medical Colleges declared that: ‘

The concept of spirituality is found in all cultures and societies. It is expressed through an individual’s search for ultimate meaning through participation in religion and/or belief in God, family, naturalism, rationalism, humanism, and the arts.

They argue that spirituality is a feature of all societies and, by implication, a capacity of all human beings. It is a human universal and a cross-cultural fact. Its essence is the search for meaning, a topic often proposed in medical and psychological studies. What anchors this search, however, is open-ended and could be almost anything. This definition lacks enough clarity to be useful as a research or training goal.

A second example comes from a journal I read on family practice: They define spirituality as;

a search for what is sacred or holy in life, coupled with a transcendent (greater than self) relationship with God or a high power or universal energy.

Here a “high power” is paired with “universal energy,” far more abstract and suggesting little in the way of conceptual guidance or clarity.

In one of the larger surveys of the uses of spirituality in medical discourse, a group of scholars led by  Vachon, Fillion, and Achille abstracted from 71 journal articles the dominant conceptual themes occurring over a ten year period. Of eleven identified, five were especially popular.

• First was meaning and purpose, often characterized as a quest or “journey” (a frequent term) to plumb the ultimate significance of one’s time on earth.
• Second, self-transcendence—The dying may arrive at “a sense of connecting authentically with the inner self.”
• Third, transcendence generally, a connection with a “higher being” which for some is God and for others something else. The choice is up to the individual who suffers, and “it refers to a dimension that transcends the physical, social and material world.”
• Fourth is communion and mutuality, the fulfillment of the self in God or in some aspect (perhaps nature) of the grand design of the Universe.

• Fifth is Faith, and what these authors discovered about that is worth noting: it could be God or the Divine but doesn’t have to be. It could be faith “in a higher order system. For instance, beliefs such as believing destiny or believing that each event has a purpose are considered forms of spiritual belief.”

My argument is that these notions of spirituality and their eleven dominant themes, while apparently exhaustive of the literature, do not name any-thing that could be called a valid or even scientific description of reality.

They are rather statements of ideology. They spring from recent and known historical sources; their proponents are invested in a particular way of looking at the world (“post-modern,” perhaps); and the preferred “instruments” of discovery which generate statistical outcomes, descriptively accurate or not, lend a scientific gloss to an implied promise of clinical usefulness.

In staff encounters with sometimes perplexing patients, I suspect these themes have standing because they simplify some of the real complexities of dying in culturally and religiously pluralistic settings.

To push this a little farther, one might even argue that contemporary notions of spirituality are an elitist ideology as well, given their social origins and popularity in communities that are largely white, professional, and dissociated from older, denomination-centered traditions.

In conclusion, I believe that the task of the hospice chaplain is to create opportunities for diverse “religiosities” to be voiced without forcing patients into spiritual versus religious boxes.