Significance of spirituality in management of patients in Karachi, Pakistan

HENA JAWAID RIJA AZIZMURAD MOOSA KHANAWAID

Points to emphasize !

Why spirituality?

Why now?

What is the significance in cultural and therapeutic aspects?

What are the global evidences?

Any local research ?

Objectives

To understand concept of spirituality

To know significance of spirituality in medicine

Can we devise bio-psycho-social and spiritual plan for patients’ management?

Outline

Background

Literature review

Objectives of study

Methodology

Results

Discussion

Health Of Mind And Body

Ancient Greek period focused body and mind using two approaches • Materialist - stating matter, or brain • Personalist - central in the person is the core called soul

Unity of soul and mind

Shaman was a religious figure as well as healer

Jesus was a healer of body and spirit

Separation !!

Religiosity - spiritual concerns

Physicians and scientists were dedicated to physical one

Christina M et al., 2001

Rupture of body and spirit- A new healing picture

A torn image of healing

Rene Descartes, 17th C.E, philosopher

believed in mechanical laws

little or no concern to meaning

Ideologies dealt with rupture of body and spirit

Droege TA et al., 1991

Religion and Science

U.S National Academy of Science, 1981

Vision of Machine

New dimensions like –

Neuro - anatomy

Neurophysiology

Micro-biology

Old belief of spiritual highness & intellectual well-being were overshadowed by molecular sciences

Freud et al., 1895

Materialist Approach Only

Our life stories, relationships, meanings & purpose of life

Simply treating a medical diagnosis

Approaching a patient with materialist approach only

Koenig H et al., 2000

Spiritus - the breath

Religion - external functions and apparent code of conduct

Spirituality - esoteric dimensions of personality

- life’s most vital issues and concerns

- spirituality is seen as subjective features of life

Simpson and Weiner, 1991

Emerging definition of health

Ahead of biological functioning, influenced by cultural, social, and philosophical factors, including purpose in life and the quality of

healthy personal relationships

Ryff and Singer 1998

Literature Review

America

Association between intrinsic spirituality and patient’s experience

Assessment of spirituality may be important for family physicians

McBride, J. L., et al. 1998

United kingdom

People who have a spiritual understanding of life in the absence of a religious framework are vulnerable to mental disorder.

King, Michael, et al. 2013

Germany

Multi center cross sectional study 580 Patients The associations between spirituality/religiosity (S/R) ,

positive appraisals. and internal adaptive coping strategies indicate - utilization as an active coping process.

Büssing, A., et al. 2009

Iran

Positive religious coping was assessed to be more in use than negative one to cope up with life difficulties.

Aflakseir, A. et al, 2011

India

Reported improvement in objective clinical psychopathology following a visit or stay at Temple

Raguram, R. at al, 2002

Local FindingsKarachi

Qidwai, W. et al. "Belief in prayers and its role in healing among family practice patients visiting a teaching hospital in Karachi, Pakistan." Pak J Med Sci April-June 25.2 (2009): 182-189.

Qidwai, Waris, and Arsalan Tayyab. "Patients' views about physicians' spiritual role in medical practice." Journal of the College of Physicians and Surgeons--Pakistan: JCPSP 14.8 (2004): 462-465.

Local FindingsLahore

Farooqi, Y. N. et al. "Perception of god among depressives and medical patients." American journal of pastoral counseling 2.4 (1999): 31-43.

Local FindingsKPK

Feder, Adriana, et al. "Coping and PTSD symptoms in Pakistani earthquake survivors: Purpose in life, religious coping and social support." Journal of affective disorders 147.1 (2013): 156-163.

Why Spirituality was Ignored?

(a) It is less central (Bergin, 1991; “Politics of the Professorate,” 1991; Shafranske, 1996)

(b) Outside the scope of scientific study (Thomson, 1996)

(c) Should necessarily move away during an age of rational enlightenment (Barbour, 1990; also see Hill et al., 2000).

Why Spirituality was Ignored?

Two basic assumptions have contributed to the neglect of research in this area:

(a) Spirituality cannot be studied scientifically

(b) neither it Should be studied scientifically

Myths, models, and paradigms

Barbour, I. G. et al 1976

NO to S/R

YES to S/R

Developing Attention

In 1976, the American Psychological Association has established division 36 (Society for the Psychology of Religion and Spirituality) which is dedicated to the psychology of religion, aiming to promote the scientific study of religion and encourage its incorporation in applied settings.

In 1992, three medical schools offered courses on spirituality and health. In 2001, 75 of the 125 schools offered courses.

Developing Attention

The First International Congress on Religion and Mental Health held in Tehran, Islamic Republic of Iran, from 16-19 April 2001. With 242 papers and posters received and 158 selected for presentation

Between the years 2000 and 2002, more than 1,100 additional articles, studies, and reviews involving religion, spirituality, and mental health appeared in psychology literature, compared with 101 articles between 1980 and 1982, suggesting a remarkable increase in attention paid to this area by scientific community.

Journals

The journal of religion and health – 1961

The American journal of Islamic social sciences – 1973

The journal of psychology and Christianity - 1982

The journal of psychology and Judaism – 1990*

The Muslim psychologist – 1997

Study objectives

To determine the importance of spiritual need in treatment plan

to propose bio-psycho-social and spiritual model for evaluation of medical as well as psychiatric illnesses

What is different ?

Bilateral assessment

- Healthcare professionals

- Patients

Different specialties included

Structured assessment tools

Methodology

Written consent will be obtained

Patient will be interviewed from outpatient department of Neurology, Psychiatry, Oncology, Medicine, Family medicine and Rheumatology.

Follow-up patients

Data will be collected by 02 principal investigators

Inter-rater reliability will be established. Confidentiality will be maintained.

SCALES

Al-Yousefi, N. A. (2012). Observations of Muslim physicians regarding the influence of religion on health and their clinical approach. Journal of religion and health, 51(2), 269-280.

SCALES

Puchalski, C. M. (2001). Spirituality and health: the art of compassionate medicine. Hospital Physician, 37(3), 30-36.

SCALES

F—Faith and belief“Do you consider yourself spiritual or religious?” I—Importance“What importance does your faith or belief have in your life? C—Community“Are you a part of a spiritual or religious community? A—Address in care“How would you like me, your healthcare provider, to address these issues in your healthcare?”

Results

Patients view spirituality positively

Want their physicians to discuss spirituality

Strong belief in spirituality helped them cope

Spirituality plays an important part in patients’ illness and its prognosis

Discussion

The American Journal of Psychiatry editorial (Andreasen, 1996) wrote it like, ‘We must practice and preach the fact that psychiatrists are physicians to the soul as well as the body.’

Larson and Matthews (1997) are building hope that the “wall of separation” between medicine and religion will be broken, and emphasize that “future is going to be prayer and Prozac”.

Prayer And Prozac

World Health Organization (1998) quotes health as :

‘a state of complete physical, mental and social well-being, not merely the absence of disease’.

Larson and Matthews [61] are building hope that :

“wall of separation” between medicine and religion will be broken, and emphasize that “future is going to be prayer and Prozac”.