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September 2002 Article of the Month

This month's article selection is by Chaplain John Ehman, Presbyterian Medical Center, Philadelphia PA


Unruh, A. M., Versnel, J. and Kerr, N. [School of Occupational Therapy, Dalhousie University, Halifax, NS B3H 3J5;]. "Spirituality unplugged: a review of commonalities and contentions, and a resolution." Canadian Journal of Occupational Therapy - Revue Canadienne d'Ergotherapie 69, no. 1 (February 2002): 5-19. 


Comment: In the process of addressing a debate within the Canadian Association of Occupational Therapists concerning the centrality of the concept of spirituality in the Model of Occupational Performance, the authors have collected over a hundred definitions of spirituality in the health care literature and categorized them thematically. The definitions are presented in an extensive appendix to the article, and the themes used to group them are: 1) relationship to God, spiritual being, higher power, a reality greater than the self; 2) not of the self; 3) transcendence or connectedness unrelated to a belief in a higher power; 4) existential, not of the material world; 5) meaning and purpose in life; 6) life force of the person, integrating aspect of the person; and 7) summative [i.e., efforts to combine multiple features of spirituality]. Though spirituality research per se is not the focus of their article, Unruh, Versnel and Kerr point up the wide variety of definitions of spirituality and indicate some commonalities in emerging schools of thought among clinical writers, which are instructive for researchers as well as for pastoral care educators and practitioners.

Over the last ten years, spirituality has become an ascendant term in the health care literature, increasingly distinguished from religion, religiousness, or religiosity, and often displacing those more traditional terms. Clinical writers have relatively quickly created their own authoritative literature on the subject and with rare exception reference only other clinicians (not philosophers, theologians, or pastoral care professionals) when defining spirituality; thus have they created a new and distinct stream of thought about the concept. Reading over the definitions and themes in the present article gives insight into the character of clinical conceptualizations and should raise questions among pastoral educators, caregivers, and researchers about how such definitions play into the training and practice of pastoral care in modern health care institutions and how research on spirituality and health requires critical attention be given to a study's operative definition of spirituality (as a specific concern of concept validity).  

Suggestions for the Use of the Article for Discussion in CPE: 

The appendix listing definitions (pp. 16-19) and the section describing the thematic categories by which the definitions are grouped (pp. 8-9) may serve well to spur discussion about the term/concept of spirituality, which is often used quite ambiguously. Possible questions for group discussion: What definitions in the health care literature seem most in line, or most out of line, with traditional schools of religious thought? What traditional religious language do you find, or not find, in the definitions? How are the definitions theological, and how are they anthropological? Does any particular definition or category of definition have special appeal, and why? What would be your own definition of spirituality?

The article as a whole, in focusing on concerns within occupational therapy, may have too specific a context to interest readers outside of that field. However, it may possibly raise for discussion in a general audience issues of the role of spirituality in health care and the effects of a professional body (e.g., the Canadian Association of Occupational Therapists) formally designating spirituality as a central concept for clinical practice. [Note that the authors ultimately believe that, as a central concept for occupational therapy, spirituality is less well suited than is occupational identity.]  

Related Items of Interest: 

[ADDED 10/3/08]: Anandarajah, G. "The 3 H and BMSEST models for spirituality in multicultural whole-person medicine." Annals of Family Medicine 6, no. 5 (September-October 2008): 448-458. [See our Fall 2008 Newsletter (§5) for a description.]

Anandarajah, G. and Hight, E. "Spirituality and medical practice: using the HOPE questions as a practical tool for spiritual assessment." American Family Physician 63, no. 1 (January 1, 2001): 81-9. [The authors offer a fairly thorough definition of spirituality, and their HOPE assessment is a practical example of how a definition may underlie a clinical tool.]

[ADDED 10/3/08]: Bregman, L. "Spirituality: a glowing and useful term in search of a meaning." Omega: Journal of Death and Dying 53, nos. 1-2 (2006): 5-26.

[ADDED 10/3/08]: Chiu, L., Emblen, J. D., Van Hofwegen, L., Sawatzky, R. and Meyerhoff, H. "An integrative review of the concept of spirituality in the health sciences." Western Journal of Nursing Research 26, no. 4 (June 2004): 405-428. [This is a an analysis of "73 spirituality research articles, which were published in English between January 1990 and September 2000." …"The results identified essential elements of spirituality, current use of operational definitions and instruments, conceptual frameworks used in spirituality research, and cultural aspects of spirituality.". (P. 405, abstract)]

Coyle, J. "Spirituality and health: towards a framework for exploring the relationship between spirituality and health." Journal of Advanced Nursing 37, no. 6 (March 2002): 589-97. [In light of a review of the health care literature from 1999-2000, the author identifies three conceptual approaches to spirituality which constitute a trichotomous conceptual framework she proposes for the further investigation of how spirituality may benefit health. The analysis is creative and the writing erudite, though there are few details of the literature search itself.]

George, L. K., Larson, D. B., Keonig, H. G. and McCullough, M. E. "Spirituality and health: what we know, and what we need to know." Journal of Social and Clinical Psychology 19, no. 1 (Spring 2000): 102-16. [This relatively brief article offers a practical summary of the issue of the definition of spirituality, and goes on to address issues of the relationship between spirituality/religion and health and of research in this area.]

[ADDED 10/3/08]: Hall, D. E., Koenig, H. G. and Meador, K. G. "Conceptualizing ‘religion’: how language shapes and constrains knowledge in the study of religion and health." Perspectives in Biology & Medicine 47, no. 3 (2004): 386-401.

[ADDED 10/3/08]: Hill, P. C. and Pargament, K. I. "Advances in the conceptualization and measurement of religion and spirituality. Implications for physical and mental health research." American Psychologist 58, no. 1 (Jan 2003): 64-74. [See esp. pp. 64-65, and note the authors' inclusion of the concept of "the sacred." This article is featured on our May 2003 Article-of-the-Month page.]

[ADDED 11/19/04]: Hill, P. C., Pargament, K., Hood, R. W., Jr., McCullough, M. E., Swyers, J. P, Larson, D. B. and Zinnbauer, B. J. "Conceptualizing religion and spirituality: points of commonality, points of departure." Journal for the Theory of Social Behaviour 30, no. 1 (March 2000): 51-77. [This is a fine treatment of the topic from some of the leading names in the field of spirituality and health research.]

Hill, P. C., Pargament, K. I., Swyers, J. P., Hill, R. L., McCullough, M. E., Hood, R. W. and Baumeister, R. F. "Definitions of religion and spirituality," in Larson, D. B., Swyers, J. P. and McCullough, M. E., eds., Scientific Research on Spirituality and Health: A Consensus Report (Rockville, Maryland: National Institute for Healthcare Research, 1998): 14-30. [The authors offer a very sensitive overview of the issue of the definition of spirituality for research and provide one of the few definitions that emphasizes the sacred].

[ADDED 10/3/08]: Hufford, D. J. "An analysis of the field of spirituality, religion and health (S/RH)." (Paper) Templeton Advanced Research Program Field Analysis, published online at [--See esp. the definitions and discussion on pp. 10-11].

[ADDED 10/3/08]: Koenig, H. G. "Concerns about measuring ‘spirituality’ in research." Journal of Nervous & Mental Disease 196, no. 5 (May 2008): 349-355.

[ADDED 10/3/08]: Koenig, H. G., McCullough, M. E. and Larson, D. B. "Definitions." Pp. 17-23 in Handbook of Religion and Health. New York: Oxford University Press, 2001.

[ADDED 10/3/08]: McSherry, W. "The principal components model: a model for advancing spirituality and spiritual care within nursing and health care practice." Journal of Clinical Nursing 15, no. 7 (July 2006): 905-917.

[ADDED 10/3/08]: McSherry, W. and Cash, K. "The language of spirituality: an emerging taxonomy." International Journal of Nursing Studies 41, no. 2 (Feb 2004): 151-161.

[ADDED 10/3/08]: McSherry, W., Cash, K. and Ross, L. "Meaning of spirituality: implications for nursing practice." Journal of Clinical Nursing 13, no. 8 (November 2004): 934-941.

Narayanasamy, A. "A review of spirituality as applied to nursing." International Journal of Nursing Studies 36, no. 2 (April 1999): 117-25. [The author surveys the notion of spirituality in the nursing literature, explores how a holistic nursing perspective and Christian theology have shaped the notion, and urges greater attention be given to spirituality's "biological basis."

[ADDED 10/3/08]: Pesut, B. "A conversation on diverse perspectives of spirituality in nursing literature." Nursing Philosophy 9, no. 2 (April 2008): 98-109.

[ADDED 10/20/08]: Pesut, B., Fowler, M., Taylor, E. J, Reimer-Kirkham, S. and Sawatzky, R. "Conceptualising spirituality and religion for healthcare." Journal of Clinical Nursing 17, no. 21 (November 2008): 2803-2810.

[ADDED 10/3/08]: Puchalski, C. and Romer, A. L. "Taking a spiritual history allows clinicians to understand patients more fully." Journal of Palliative Medicine 3, no. 1 (Spring 2000): 129-137. [See esp. the definition/characterization of spirituality on p. 129.]

[ADDED 10/3/08]: Puchalski, C. M., Dorff, R. E. and Hendi, I. Y. "Spirituality, religion, and healing in palliative care." Clinics in Geriatric Medicine 20, no. 4 (November 2004): 689-714, vi-vii. [See esp. pp. 690-691.]

[ADDED 10/3/08]: Sessanna, L., Finnell, D. and Jezewski, M. A. "Spirituality in nursing and health-related literature: a concept analysis." Journal of Holistic Nursing 25, no. 4 (December 2007): 252-262; with discussion on pp. 263-264.

Sheldrake, P. "What is spirituality?" [Chapter 2] in Spirituality and History: Questions of Interpretation and Method (New York: Crossroad, 1992): 32-56. [See esp. pp. 32-3 and 49-53. This is a history of the term/concept of spirituality in the traditional religious (largely Roman Catholic) context, but it provides some broad perspective for the current and particular context of the health care literature.]

Turner, R. P., Lukoff, D., Barnhouse, R. T. and Lu, F. G. "Religious or spiritual problem. A culturally sensitive diagnostic category in the DSM-IV." Journal of Nervous & Mental Disease 183, no. 7 (July 1995): 435-44. [This article offers insight into the process by which the concept of spirituality has begun to be used in the DSM-IV under a new diagnostic category: "Spiritual or Religious Problem."]

Zinnbauer, B. J., Pargament, K. I., Cowell, B. J., Rye, M. and Scott, A. B. "Religion and spirituality: unfuzzing the fuzzy." Journal for the Scientific Study of Religion 36, no. 4 (December 1997): 549-64. [This investigation into how individuals define spirituality and religiousness suggests that scientific research should take into account the ambiguity of the terms at the popular level and variations in meanings according to demographic groups.]

[Added 10/21/08:] For more articles pertinent to the definition and use of the concept of spirituality in the health care literature, see a bibliography (PDF, 1 page) compiled in 2008. Note, though, that there is overlap with the list above.


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