Bert Garssen, PhD
Helen Dowling Institute, Center for Psycho-oncology
Commentary on Reinert K.G. & Koenig H.G. (2013) Re-examining definitions of spirituality in nursing research. Journal of Advanced Nursing 69 (12), 2622–2634. doi: 10.1111/jan.12152
Spirituality questionnaires that contain items referring to spiritual well-being or mental health should not be used to investigate the causal relationship between spirituality and mental health. This concern was expressed before (Migdal & MacDonald 2013) and has been repeated in a recent article in JAN (Reinert & Koenig 2013). Reinert & Koenig (2013) object to using mental health concepts in the definition of spirituality, though in my view their use in spirituality scales seems most problematic.
Reinert & Koenig (2013) plead for a further reduction of the concept by restricting spirituality to religiosity. One of the reasons for preferring this restriction is that many definitions of spirituality have become very broad and include mental health concepts. I agree, if this would refer to terms like well-being and enjoyment. However, I consider terms like “the experience of meaningfulness or purpose in life” of a different category. According to Reinert & Koenig (2013), these terms refer to the core mental symptoms of the DSM-IV diagnosis of major depression. “Worthlessness”, they say, “is one of the nine cardinal symptoms”. However, worthlessness is not simply a lack of meaningfulness or purpose in life. One may experience life in general as meaningful and yet - at least temporarily – experience anxiety or depression. This indicates that there is a distinction between the two concepts. So, in my view there is no decisive reason for the advice of the authors “...that spirituality in research is better served if defined in the context of religious involvement” (Reinert & Koenig 2013).
What to think of people who consider themselves spiritual but not religious, if we would accept the opinion of Reinert & Koenig? Their number cannot be neglected. Zinnbauer et al. (1997) selected people from different churches, New Age groups, students, nursing professionals, and nursing home residents in Pennsylvania and Ohio, and found that 19% defined themselves as spiritual, but not religious. The same number was found in a more recent study among the Dutch general population (Berghuijs et al. 2013).
In fact, there is no decisive logical argument to decide which definition should be accepted, and Reinert & Koenig (2013) also indicate that how one defines spirituality is a matter of personal preference; dependent upon the background and religiosity of the researcher. Nevertheless, I would like to propose some arguments against reducing spirituality to religion. First, non-religious spiritual people describe experiences and attitudes that are also mentioned by religious people, and which both groups find very important in their lives. According to the persons themselves and according to scientists, these are spiritual experiences and attitudes. If so, how can the existence of a non-religious form of spirituality be denied? Experiences that seem essential for both religious people and for non-religious people who consider themselves spiritual are: feeling part of a larger whole, detaching oneself from daily routines and rising above oneself, letting go of the ego focus, experiencing awe for and connectedness with nature (‘God’s creation’ in religious terms), and feeling a deep connection to other people (the congregation or ‘God’s people’ for religious people).
Second, Reinert & Koenig (2013) argue that a definition in religious terms would yield a clearer concept, but even within and among religious traditions is a wide variety in beliefs, experiences, and attitudes. In addition, there presently are definitions of spirituality that are consistent, have not arisen from personal preference, and can be used across international borders, as Reinert & Koenig (2013) prefer. Conceptual analyses (Reed 1992, Chiu et al. 2004) have shown that connectedness is an essential element of spirituality. In nursing research, spirituality is also often defined in terms of connectedness. Reed defined spirituality on the basis of conceptual, empirical, and clinical nursing literature as “the propensity to make meaning through a sense of relatedness to dimensions that transcend the self in such a way that empowers and does not devalue the individual. This relatedness may be experienced intrapersonally (as a connectedness within oneself), interpersonally (in the context of others and the natural environment) and transpersonally (referring to a sense of relatedness to the unseen, God, or power greater than the self and ordinary source)” (Reed 1992, p. 350). Connectedness with oneself is expressed by aspects such as authenticity, inner harmony/ inner peace, consciousness, self-knowledge, and experiencing and searching for meaning in life. Connectedness with others and with nature is related to compassion, caring, gratitude, and wonder. Connectedness with the transcendent includes connectedness with something or someone beyond the human level, such as the universe, transcendent reality, a higher power or God. I am, of course, aware of several other definitions of spirituality. My only aim was to briefly indicate the possibility of presenting a coherent, accepted and usable definition of spirituality that is not (strictly) framed in religious terms.
To summarize, I welcome the warning of Reinert & Koenig (2013) to ban elements of mental health from definitions and operationalizations of spirituality. However, I do not agree with their suggestion that a definition in religious terms would advance the scientific development in this area.
Bert Garssen, PhD
Helen Dowling Institute, Center for Psycho-oncology
The author of the original article has responded to this commentary.
Berghuijs J, Pieper J, and Bakker C (2013) Being 'spiritual' and being 'religious' in Europe: Diverging life orientations, Journal of Contemporary Religion, 28 (1), 15-32.
Chiu L, Emblen JD, van Hofwegen L, Sawatzky R, and Meyerhoff H (2004) An integrative review of the concept of spirituality in the health sciences, Western Journal of Nursing Research, 26, 405-428.
Migdal L and MacDonald DA (2013) Clarifying the Relation Between Spirituality and Well-Being, Journal of Nervous and Mental Disease, 201, 274-280.
Reed P (1992) An emerging paradigm for the investigation of spirituality in nursing, Research in Nursing & Health, 15, 349-357.
Reinert KG and Koenig HG (2013) Re-examining definitions of spirituality in nursing research, Journal of Advanced Nursing, 69 (12), 2622–2634 doi 10/1111/jan.
Zinnbauer BJ, Pargament KI, Cole B, Rye MS, Butter EM, Belavich TG et al. (1997) Religion and spirituality: Unfuzzying the fuzzy, Journal for the Scientific Study of Religion, 36 (4): 549-564.