Finding Jesus in the Storm. John Swinton
as a focus on people’s spiritual dimensions is, there are significant problems with this approach.
Spirituality as Self-Actualization
The basic understandings of spirituality in the relevant literature focus on the central features of what people assume spirituality to be: meaning, purpose, hope, value, respect, love, dignity, and (for some people) God.52 Few of these definitions offer a strong philosophical or theological rationale for what spirituality actually is, and why it should be understood in such ways. Instead, many researchers simply create their own definitions of spirituality, which tend to focus on those things the researcher assumes to be most valuable in and, importantly, most absent from current caring practices. Their general assumption is that the content of spirituality emerges from the personal choice of the individual. Some people choose to express their essential spirituality in terms of religion, but others choose different ways of engaging with their spirituality (through nature, art, relationships, sport, and so forth).
Researchers think about spirituality in this way in order to ensure that it is inclusive. Put slightly differently, this is a spirituality designed to cater to people of “all faiths and none.” It is nondenominational, open to the religious and the secular, and above all, individualistic and personal. Spirituality is thus perceived to relate to a series of personal choices that everyone should be given the freedom to develop on their own terms and in their own image. Spirituality relates to my meaning, my purpose, my value, and my choice about whether I believe in God. Viewed in this way, spirituality becomes a mode of self-actualization, a way of meeting personal needs and goals quite apart from others or God. This mode of spirituality fits neatly within the goals of modernity and the expectations of a culture that is deeply individualistic and fundamentally oriented toward personal choice as the moral arbiter.
Thin Spirituality
What we end up with is a very thin mode of spirituality that is terrified of offending anyone. No longer do we have deep, thick descriptions of spirituality, richly narrated spiritual encounters with God, angels, or demons. We have prayer, worship, and sometimes a loose affiliation to religion, but involvement with what God is doing in the world is optional, if it is included at all. Instead, spirituality is thinned down and renarrated in terms of personal choices and practical psychological utility (does it make you feel better?). The efficacy and acceptance of spirituality are gauged by the effect of particular behaviors—prayer, meditation, church attendance—on a person’s well-being, with “well-being,” once again, being viewed primarily in relation to an individual’s hopes and desires. One can choose the God who created the universe and who flung the stars into space, or one can choose a walk in the park. Both are assumed to be pretty much the same thing in terms of spiritual worth.
Practical utility is key. “Does it work?” “What benefits can it bring to people?” “How can it help us feel healthier?” This kind of spirituality is a spirituality from below—a spirituality that may include transcendence, but only as one option among many others. It makes little difference whether God is real. What matters is whether we choose God as a lifestyle option. Rather than introducing something that is radical and new, this mode of spirituality is designed to help certain culturally bound conceptions of spirituality fit in with current practices and assumptions. Instead of transforming mental health-care practices into something radically different from what is available currently, it is deeply shaped and formed by what is already going on in health-care institutions. It is a spirituality from below that takes its shape not from the urgings of the Spirit of God but from the nature and spirituality of health-care institutions.
The Spirituality of the Institution
An examination of the National Health Service (NHS) in the United Kingdom will illustrate this point. The NHS was launched in 1948. It is a system that assumes that good health care should be available to all people regardless of wealth. Health care is thus free at the point of use for all UK residents and is based on clinical need, not ability to pay.
The system is also designed to meet the needs of everyone; this is necessary for it to function effectively and fairly according to its expressed intentions. However, this universality inevitably problematizes and narrows the possible options for the kind of spirituality that might be acceptable within the system. In terms of spirituality, this ensures that the NHS is inevitably secular, because it cannot be connected directly with any one religion. It deals with a very broad range of people, and as such it must meet the needs of people of “all faiths and none.” The particularity of religious traditions becomes problematic within a context that requires generalities in order to function. A general, generic definition of spirituality may be thin, but it is easy to implement.
Health and social care systems such as the NHS require generalities to function effectively. At a pragmatic level, it makes sense to deprioritize the particularities of religion and to develop a general mode of spirituality to which everyone can relate. Treatments—chemotherapy, medication, physiotherapy, pain control—must be universal and applicable across the whole system. You can’t have an antibiotic that works only for one person! So, too, you can’t have a spirituality that works for only one group of people. A system would not work well if each doctor had his or her own way of doing things that might conflict with how other doctors conducted their practice. So, while there is obviously diversity within the system, the principle of generalization is necessary and established.
Within this context, people may think they are acting counterculturally and taking spirituality into the system. However, a deeper reflection indicates that the system itself shapes and forms the spirituality that is acceptable; it silently places boundaries, parameters, and brakes on the activities of spiritual care and our articulations of spirituality and compels us to work with a thin model of spirituality that dovetails neatly with what is already there.
This model of spirituality seems to resonate with the idea of a universal spirituality that everyone shares, something that abounds in the literature. However, when one runs a critical eye across the ways in which people formulate spirituality, it becomes clear that, far from being universal, it is a very Western cultural model, which assumes the primacy of Western values such as individualism, freedom, autonomy, choice, and the right of people to create their own destiny. This is clearly a cultural model of spirituality rather than a universal one. It may raise our consciousness to certain important but overlooked aspects of health care, but by claiming that “everyone has a spirituality” and seeking to make a culturally bound model appear to be universal, we risk “baptizing people behind their backs,” forcing them to accept thin, culturally bound models of spirituality and humanness that may satisfy certain desires and needs but in the end fail to meet those needs that can be discovered only as we engage with thicker descriptions. When this happens, we subliminally engage in precisely the kind of proselytizing behaviors that some consider a central danger of allowing religion to be a part of health care. There is clearly a need for a richer and thicker conversation around spirituality and mental health than is provided by current culturally bound models and approaches. The question is: What might that look like? And how might we go about achieving such a goal?
1. Emily Martin, Bipolar Expeditions: Mania and Depression in American Culture (Princeton: Princeton University Press, 2007), 10.
2. G. E. M. Anscombe, Intention, 2nd ed. (Oxford: Basil Blackwell, 1957).
3. Ian Hacking, The Social Construction of What? (Cambridge, MA: Harvard University Press, 1999), 31.