What does spiritual mean?
I was recently having a conversation with someone in my inner circle about spirituality. What it means. How it can be healing and is outside of words such as G-O-D. This person knows my background – heavy in science, focused on ecological systems and human anatomy and function. I have not turned my back on science. In fact, my sense of spirituality unifies many aspects of my life, personal and professional, but I could not effectively put my intuitive sense of what I am experiencing into words. So, I thought – great! Blog post idea. Let me explore this more through writing. What is spirituality? How is spiritual work in fact political? How is it united to science and what we know about healing? Let’s see if we can start to untangle a few of these topics. I am sure I will get things wrong and this post will need editing. But it’s a start.
Spirituality has many definitions, is subjective, can be outside of religious institution and the breadth of definitions make it difficult to study. Spirituality relates to the quest for the sacred, experiencing awe with the universe, and/or personal growth and transformation.
“Spirituality is sometimes associated with philosophical, social, or political movements such as liberalism, feminist theology, and green politics. Some argue (though far from universally accepted—see those who espouse secular humanism) spirituality is intimately linked to resolving mental health issues, managing substance abuse, marital functioning, parenting, and coping.” (https://en.wikipedia.org/wiki/Spirituality)
One of the most perfectly resonant definitions of spirituality I’ve ever read is from Abraham Joshua Heschel:
“Our goal should be to live life in radical amazement. ....get up in the morning and look at the world in a way that takes nothing for granted. Everything is phenomenal; everything is incredible; never treat life casually. To be spiritual is to be amazed.”
Inherently and intuitively, I knew that spirituality is the underlying force of many aspects of my life. It is what gives life meaning and purpose, even the minutiae like managing the never-ending pile of laundry. It is being mindful. It is being kind and seeing the divine, or the depth, of others. It is being compassionate and empathetic. It is also leaving the table when love is no longer being served (Nina Simone; i.e. compassion for one’s self). It is outside of a religious organization or institution. It recognizes the interconnectedness that we have with other humans, that we are biological beings and are connected to and not removed from Earth. It is aiding and transforming yourself and others, participating in healing, seeking to grow. It is rising up – being your best, deepest, fullest self and reaching back to bring that same grace and depth to others. It is about the political, the environment, and social justice. One of my favorite podcasts that explores this issue is On Being - The Spiritual Work of Black Lives Matter: https://onbeing.org/programs/patrisse-cullors-and-robert-ross-the-spiritual-work-of-black-lives-matter-may2017/
“You see the light that comes inside of people to other communities that are like, “I’m going to stand on the side of black lives.” You see people literally transforming. And that’s a different type of work. And for me, that is a spiritual work. It’s a healing work. And human to human, if you take a moment to be with somebody, to understand the pains they’re going through, you get to transform yourself.”
That quote hits me at the bone level.
Spirituality isn’t about being in your head – airy, flighty, and in bliss. I require constant reminders to “show up” at the feet of my children and provide them with what they need, while being kind and not overwhelmed with life. That’s spirituality. It is love (friendship, marriage, parenting) – being present when it is easier not to. I am angry, even ragey, at the pain we cause one another through our actions. That is spirituality. It is mindful, it is reflective, it is earthy/loomy/musty, knee-deep in muck. But it is also action. It is creating connection, community, change, whether that’s as simple as writing a blog , or talking to your neighbor about the heavy topics of politics and social justice, or living more sustainably. It is radical self- love when society tells you that you are less than or unlovable. It can be bigger by facilitating events, and marches, and calling your representatives. It is civic activism. It is Black Lives Matter and protesting at Standing Rock. It is “strategic outrage” (a phrase from the above podcast).
Spirituality and Healing (A reductionist approach)
The National Wellness Institute (NWI) notes that there are 6 dimensions of wellness, including spirituality, and these aspects of wellness interact to help an individual achieve their full potential. According to NWI, spiritual wellness essentially means living in alignment with your values, exploring the meaning of life, and being tolerant of others. (http://www.nationalwellness.org/?page=Six_Dimensions).
But can spirituality, or spiritual practices, be healing?
The National Institutes of Health (NIH) has a center that researches and educates on “alternative” healing modalities, specifically their Center for Complementary, Alternative, and Integrative Health (https://nccih.nih.gov/). Techniques investigated on their website include energy healing and mind/body practices such as meditation, yoga, tai chi, and acupuncture.
I have been practicing yoga for almost 20 years and have been a yoga instructor for over 10 years, so I am personally familiar with the practice. Yoga utilizes breath (pranayama) to shift consciousness, creating a meditative state to access your inner dimension. A common saying in yoga is that the mind follows the breath. Not coincidentally, the word spirit derives from a Latin word for breath. Yoga is a mind/body technique, unifying mind with body and spirit (breath). Yoga then can be a spiritual practice and not just an exercise regimen, allowing the individual time and space to access their inner world, allowing for self-reflection, and allowing an individual to remain present during difficult physical or emotional experiences through meditation and pranayama practice.
What does the research show about yoga (and its close associate, meditation)? In general, the results are positive. Yoga has been shown to help individuals with HIV/AIDS, cancer, multiple sclerosis, arthritis, and fibromyalgia, among other conditions, manage their symptoms. People that practice mind/body techniques, such as yoga, tend to report greater overall wellness (ex. https://nccih.nih.gov/news/press/11042015) . Explore pubmed (https://www.ncbi.nlm.nih.gov/pubmed) to find more specific information on the results and types of healing, but in general, healing was measured through improved quality of life, improved movement or physical function, reduced depression scores, reduced perceptions of pain, etc. Healing is typically a reduction in symptoms and/or improvement in the quality of life, but does not necessarily refer to a “cure”.
Recall that spirituality is subjective and that there is not a specific, agreed-upon definition. My definition is likely more broad than someone else’s. However, with my perspective, is yoga spiritual? – yes. Can yoga provide healing benefits? – yes. Does that mean all spiritual practices can provide healing? – no, but again this is individualistic and subjective. What qualifies as spiritual and even as healing to one individual may differ from another.
Biologically, I suspect that healing results from spiritual practices in stress reduction. The hypothalamic, pituitary, adrenal axis (HPA axis) is a neurological driver of our stress response, existing in a direct feedback loop, and basically increases the release of corticosteroids in response to stress, which modulates or impacts the immune system (and inflammation). Stress is a known component of disease processes. (For a good summaries on stress and disease, see https://en.wikipedia.org/wiki/Hypothalamic–pituitary–adrenal_axis and https://www.psychologytoday.com/blog/evolutionary-psychiatry/201211/stress-the-killer-disease )
Healing from mind/body/spiritual modalities is likely explained by the ‘relaxation response’, described by Herbert Benson, a cardiologist. He examined how stress management impacted blood pressure, by measuring physiological responses to meditation, showing a reduction in blood pressure, a lowering of oxygen consumption (slowed metabolism), and changes in brain wave activity. Benson also wrote of how prayer and meditation could produce similar reductions in stress via the relaxation response (Benson (1993) The Relaxation Response. From Goleman and Gurin. (eds). Mind Body Medicine: How to Use Your Mind for Better Health). More information can be found here: http://www.relaxationresponse.org/
Like the NIH and NWI, other institutes recognize the healing potential of complementary modalities (many of which I would argue are spiritual from my definition). One example is Emory University and their Contemplative Studies Initiative (http://www.emory.edu/religions&humanspirit/Religion%20pages/Contemplative%20Studies.htm). The University of Maryland offers a Center for Integrative Medicine for training of medical professionals and conduction and presentation of research regarding complementary medicine (http://www.cim.umaryland.edu/); under their current studies, they list examining how mindfulness can help reduce problem drinking.
From my perspective, the door is open. There is “something” about mind/body/spiritual practices that allow for healing. Biologically, we have an outline of how that is possible (i.e. relaxation response), though specific mechanisms might require further study in some instances.
Beyond mindfulness (healing in art and nature)
The above demonstrates a biological explanation for healing from mindfulness-type modalities such as yoga. But what about activism type modalities? Or being in nature?
I believe this issue is multifaceted, complex, and layered. Part of the explanation resides in spiritual inquiry (see John Heron, 2006. Spiritual Inquiry: A Handbook of Radical Practice) – that is, living in a self-reflective manner that balances inner and outer worlds. When you have aligned your deepest self with your outer experience and expression, that is a form of healing; this is in opposition to settling for a “safe” or “convenient” lifestyle for example (see also Julia Cameron’s The Artist’s Way). Spiritual inquiry can occur at a larger, cooperative level using action and experience, within groups, and I believe that this is the healing essence experienced in activist movements such as Black Lives Matter. There is a unity within the individual (outward reflection of inner experience and desires) and with others possessing a similar mindset and goals to move humanity toward an improved/better/awakened state.
Being immersed in nature is a larger, conceptual healing modality that is gaining popularity. Biological mechanisms might explain some of the benefits to being in nature (ex. Relaxation response), but there are likely more factors at work. Some forms of healing that have been attributed to nature are: improved attention, reduction in ADHD, faster discharge from hospital (when patients had a view of a greenspace), improved sex lives, greater sense of wellbeing, reduced stress, improved physical function and fitness, just to name a few (Please check out these easy access websites for references, but this list is not exhaustive and research is widely available with a quick search online: https://www.scientificamerican.com/article/nature-that-nurtures/ , http://www.natureandforesttherapy.org/the-science.html , www.nature-rx.org/research/ , http://www.balancedandbarefoot.com/). Human beings are not removed from nature. We are biological, we are animal, we have wild roots. So the healing properties of nature should not be surprising. Being in nature can be spiritual for individuals, beyond just the physical or mental aspect of presence in nature. Nature-based spiritual practices existed at the very beginning of humanity (essentially, this form of spirituality is shamanism), so there is an added layer of spirituality to the healing properties of nature.
Art, or creativity, is also a spiritual act that can be healing. Again, “basic” biological mechanisms such as the relaxation response likely make this healing possible. However, putting biology aside, art requires you to get quiet, to hear your inner voice, to experience your inner world and its emotions; in essence, art requires you to get mindful. Art is the putting of your inner world on paper, on canvas, into sculpture or music, allowing it to flow through your instrument of choice. Expression of your inner world is healing in that it is self-reflective and allows for the birthing, processing, dispersion, or unloading of some of the heavier inner experiences. Sharing art with others is healing through the recognition of what I call “soul truths” – someone else has an inner experience or vision similar to yours, and this resonance allows for healing in the sense that you are not alone. Humans are social creatures, and therefore, connection and shared experience can be healing. Further, someone’s expression or vision of their inner world may cause you to self-reflect or process your experiences in a new way, allowing for a progression on your own mental/emotional/spiritual journey. For more exploration of creativity and spirituality, please refer to Julia Cameron’s The Artist Way series.
Healing with mystery: Placebo and nocebo
I am sure most readers are familiar with the concept of the placebo, that is, individuals benefiting from medical treatments that would have no reason to provide any healing. Placebo demonstrates the difficult to elucidate connection between mind and body. The medical field has several examples of ethically questionable studies that examined placebo. Examples include “sham” knee surgeries which were not significantly different, benefit-wise, from typical surgery for knee arthritis (Moseley et al. 2002, cited by Požgain et al) and even pacemaker surgeries in which patients still benefited from pacemakers that were inserted but turned off (Linde et al. 1999, cited by Požgain et al). It is also noted that drugs with therapeutic rituals are also more effective; an example would be that patients tend to have greater pain relief when they are aware that a pain medication is being administered than without the patient’s awareness. Researchers are even finding that the placebo effect is increasing within their studies, particularly in experiments examining antidepressants. The exact mechanism of the placebo effect remains elusive despite its historic presence in medicine.
Another concept that is likely less familiar to readers is that of the nocebo. With nocebo, negative beliefs and expectations can lead to the worsening of symptoms and health, and these can be the patient/client’s own beliefs as well as a result of the doctor’s/specialist’s words and views. Like placebo, the mechanism remains difficult to decipher; however, research suggests that the HPA axis is involved (ex. Nocebo hyperalgesia or anxiety-induced pain). (For more information on placebo and nocebo, see a detailed review by Požgain et al. 2014 Placebo and Nocebo Effect: A Mini-Review)
Why even bring up placebo and nocebo? What is fascinating to me is that these two phenomena illustrate a component of mind-body interaction that science hasn’t fully grasped yet. Words and expectations of the practitioner/professional and patient/client matter; that is, neurobiology is modified to enhance or denigrate a therapeutic process. This requires pause.
I recall my first full time clinical rotation as a physical therapy student (SPT); it was during this time that I had one of my greatest lessons as an SPT. I had a patient with chronic joint pain, and although I can’t recall specifics, I do remember she benefited from magnets. The research investigating magnets for pain reduction is weaker and limited. I did not comment on the magnets to the patient but asked my clinical instructor what he thought. He said something to the effect of: “if something works for the patient, never tell them it doesn’t or can’t work”. Basically, if a patient or client isn’t being harmed and believes something is helping them, let them believe that. Of course!, and who am I to take that away from them?
I recognize that in the mechanism of placebo and nocebo, there is likely an element of mind-body connection, and that this element, at least in part, explains the healing benefits of mindfulness, meditation, aromatherapy, time in nature, art, journaling, drumming, etc. It is up to the patient/client/person to find what moves them, calls to their “soul truths”, and evolve through those techniques for healing and improved wellness.
Healing vs. a “cure”
Approximately 45 % of Americans have at least 1 chronic disease (Wu S, Green A. Projection of Chronic Illness Prevalence and Cost Inflation. RAND Corporation; 2000). That statistic is staggering. Chronic diseases, by their very nature, typically can be managed but not “cured” in the sense of eliminating the disease entirely. These individuals, of course, can still experience healing. They can minimize signs and symptoms. They can enhance their quality of life and their wellness to enjoy their days to their fullest potential, but they most likely won’t be “cured”.
I finished reading the Alchemy of Illness by Kat Duff. She suffers from a chronic illness and discusses her own experience with the limits of science and physical findings, finally finding a doctor who “believed” her symptoms. Her book explores the healing that comes from illness itself – the transformation and transmutation of spirit and quality of life, how illness can be an initiation into new privilege or responsibility or an education of character (calling the authority and wisdom gained from illness the “lion’s mantle”). It is worth noting, most shamanic paths (a ancient, spiritual practice) recognize an illness or injury initiates a person into shamanic calling, suggesting, again, the transformation, insights, and power that follows illness. The perspective and re-framing of a chronic disease can be healing in itself.
Recall that wellness includes physical, emotional, social, occupational, intellectual, and spiritual components. Quality of life (QOL) measurements typically incorporate aspects of these, such as realizing one’s full potential (ex. Spiritual and intellectual+), satisfaction with relationships (ex. emotional, social, spiritual+), and community engagement (ex. Emotional, social, occupational, intellectual, spiritual+) . (More information on QOL measures https://www.ncbi.nlm.nih.gov/pmc/articles/PMC269997/ and https://www.healthypeople.gov/2020/about/foundation-health-measures/Health-Related-Quality-of-Life-and-Well-Being ). By living well and maximizing the enjoyment of one’s relationships and engagements, there is (again) a re-framing, a healing. That person has become more alive, awake, and resilient in a situation where they could have easily chosen to withdraw, limit their potential, and “suffer”. Further, have a greater quality of life is likely preventative of other sequelae or co-morbidities of disease; for instance, by being active and in the community, one might reduce their participation in a sedentary lifestyle and avoid complications such as increased insulin resistance and risk of heart attack (https://www.nchpad.org/403/2216/Sedentary~Lifestyle~is~Dangerous~to~Your~Health ) Even though individuals may not be “cured” from a disease, they can still live well and experience a fulfilling life. Scientific methods have quantified and validated measures of life satisfaction and fullness; though there may not be a cure, there can be wellness, healing, quality of life, and prevention. Wellness, healing, and quality of life all may include spiritual elements, and together can participate in healing an individual, without “curing” a disease.
Value of the unseen
Science likes concrete evidence; it needs to measure, observe, quantify, validate, repeat to verify that something exists. From my own personal health struggles and those of friends, I can clearly state that just because there isn’t a test for something, doesn’t mean that the something is non-existent or impossible.
There are limitations to the scientific method and scientific worldview. Bias exists in what questions are asked (and paid to be asked), how results are measured, what gets published and where (research studies with null or negative findings are less likely to be published), and repeatability of studies (varies dramatically depending on populations, context, etc). The scientific method cannot be removed from its human-ness, that is, it can only address what we know to ask, with the tools we invented, using the senses and context that we have. Science can be reductionist and mechanistic – desiring to view systems at their smallest and simplest but humans, life systems, and earth are additive and interacting, reflecting not just their parts, but their complex relationships as well. Most beings and systems are 'greater' than the sum of their parts.
This is one reason why there seems to be a dichotomy with the spiritual and the scientific. The spiritual aspects of things typically cannot be measured. How can we measure the spiritual interconnectedness of life? The ephemeral and transient don’t lend themselves easily to capture or to microscopic examination. While far from perfect, we are getting better in the questions we ask that might illuminate the spiritual component of being. That is, an outcome measure being utilized now in healthcare practice is Quality of Life (above). One’s wellbeing and contentedness with life, while partly a mental/emotional/physical component, is also spiritual, as it alludes to one having a meaning-full life.
I’d argue that something being immeasurable is not enough reason to dismiss that “thing”. That “thing” might be a placebo and provide benefit to someone. That “thing” might give a person’s life purpose, depth, and interconnection. The value of that “thing” should not hinge on its scientific rigor, particularly if it appears to help and does not harm. Besides, as we have seen above, that “thing” may actually have scientific mechanisms that support its validity or “proof”, but we haven’t isolated the entire mechanism yet. There is value in the esoteric, in the unseen, despite (or, better yet, because of) its unwillingness to bend to science.
The World I Live In (by Mary Oliver)
"I have refused to live
locked in the orderly house of
reasons and proofs.
The world I live in and believe in
is wider than that. And anyway,
what’s wrong with Maybe?
You wouldn’t believe what once or
twice I have seen. I’ll just
tell you this:
only if there are angels in your head will you
ever, possibly, see one."
I wake up every day in radical amazement with the magic and mystery and science of life. The beauty and complexity leaves me breathless at times. I find comfort at the intersection of the scientific and the mystic, the spiritual and political; I don’t view these topics as being in opposition but as branches off the same tree – all in service to Life.
I hope this information regarding the healing possibilities of spirituality and spiritual practices helps illuminate some of the possibilities in medicine and wellness. My writing is by no means exhaustive on this topic, but will likely stimulate curiosity and your own research into these topics. Good luck, happy exploring, and be well.