Secular Society, Religion and Spirituality

Most Western societies can be characterised as secular, in the sense that they lack consistent religious practice, belief or interest but generally tolerate diverse religious and cultural groups as part of the society. According to Stammers and Bullivant (17) these societies generate 'secular spiritualities' which make no reference to religion or ideas about God.

Secularism is the term used to refer to philosophical and political doctrines that are reflected in the structures and procedures of institutions. One kind of secularism effectively excludes religion from the public arena and confines it to the private lives of individuals and groups. The other form of secularism, sometimes called 'ecumenical', advocates mutual tolerance between religious groupings and those of no particular religion (17). Nevertheless, there are boundaries that are often difficult to define but which can be crossed. This happened in the case of Caroline Petrie, a National Health Service (NHS) nurse who was suspended (but later reinstated) for offering to pray with a patient (18). It can be argued that the boundaries are not absolute but can be flexed by the mature practitioner sensitive to the patient's own spiritual position. It is interesting it was not Petrie's patient but another member of staff who complained when they heard about the offer. Boundaries also vary between cultures, with practitioners in North America generally being more willing to accept the idea of praying with patients.

The proportion of the population that are 'religious' (across a whole variety of different religions; predominantly Christian, Muslim, Hindu, Jewish and Buddhist in the UK and United States) is higher than many would imagine. It is around 79% in the UK and 84% in the United States (19). The number of fully observant members of their faith groups is much lower. Religion is not the same as spirituality or spiritual well-being, though for many people religion will be an expression of their spirituality and may help them achieve spiritual well-being. We have tried to illustrate the relationship between religion and spirituality in Figure 1.1. In its original meaning (see below) spirituality was considered as wholly contained within religion (Figure 1.1 a). In the post-modern era it seems possible to express spirituality and achieve spiritual well-being without adherence to a formal religion and to be an adherent to formal religion (at least in its 'extrinsic' form) without experiencing spirituality or spiritual well-being. This overlapping relationship between spirituality and religion is expressed in Figure 1.1b.

The term spirituality comes from the Latin spiritus, literally meaning 'breath'. The derivatives of the Latin root include words like inspire and expire (both used in literal and metaphorical senses) respire and, of course, spirit and spirituality. According to McGrath (20), the origins of the modern term spirituality in the English language can be traced to 17th century French. It originally denoted direct knowledge of the divine or supernatural. This would make spirituality almost synonymous with mysticism and place spirituality, in its original English sense, firmly within the bounds of religion (Figure 1.1a). However, over time, the concept has migrated so that spirituality can also denote an 'inner' life without any reference to religion, God or the supernatural (Figure 1.1b).

Harold Koenig and colleagues (21, pp.47-48) argue that in clinical practice it is often best to use the term spirituality rather than religion, precisely because it is so broad and all-encompassing. Swinton and Pattison (22), in the title of their paper, argue for a 'thin, vague and useful understanding of spirituality'. This approach enables the practitioner to start with broad enquiry and follow where the patient leads. However, for research purposes this vagueness and broadness makes it hard to distinguish spirituality and spiritual well-being from existential issues and psychological well-being. This issue is addressed in detail by Koenig et al in Chapter 2 of the Handbook of Religion and Health (21).

Despite the difficulties in measuring spirituality, there have been many attempts to do so. A systematic review by Monod et al (23) identified 35 instruments, classified into measures of general spirituality (N = 22), spiritual well-being (N = 5), spiritual coping (N = 4) and spiritual needs (N = 4). The instruments most frequently used in clinical research were the Functional Assessment of Chronic Illness Therapy — Spiritual Well-Being (FACIT-Sp) (24) and the Spiritual Well-Being Scale (SWBS; 25). Interestingly, both these scales contain subscales that relate to what might broadly be described as religious and existential dimensions. The SWBS specifically incorporates two separate scales for religious well-being (RWB) and

How religion and spirituality relate to each other. (a) Religion 'contains' spirituality. (b) Religion and spirituality overlap but are distinct

Figure 1.1 How religion and spirituality relate to each other. (a) Religion 'contains' spirituality. (b) Religion and spirituality overlap but are distinct.

existential well-being (EWB). When summated these give the overall SWBS score. The two components were designed to reflect 'two commonly recognised components of spirituality'. Items which score in a positive direction in both subscales certainly have face validity; for example, 'I believe that God loves me and cares about me' (RWB) and 'I feel that life is a positive experience' (EWB). The RWB scale (which relates to 'God' or 'a higher power' rather than a specific set of religious beliefs) tends to have a 'ceiling effect' in communities with strong religious beliefs.

There is also the complication that existential well-being appears to be closely related to what the positive psychology movement refers to as sustained or 'eudaimonic' well-being. This focuses on meaning and self-realization in contrast to hedonic well-being, which defines well-being in terms of short-term pleasure attainment and pain avoidance.

So, whilst the various scales may be good for specific research in specific groups, in the end we are thrown back on the realisation that spirituality is understood in different ways by different people. At the practical level, as Gordon et al (26) assert: 'The key to providing spiritual care is to understand what spirituality means to the person you are caring for' (p.5).

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