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About this book

Spirituality is a multifaceted speciality; anyone who wants to understand it must look across a range of disciplines, which can often make it seem overwhelming and incomplete. This book will act as a reference resource for readers looking to develop their study of spirituality and its relevance to health and social care.

Table of Contents

A

Abstract
The link between ageing and spirituality has long been drawn. This stems from the observation that people become more ‘religious’ or ‘spiritually aware’ and concerned with transcendental issues as they age (Thursby, 1992; Howse, 2004), particularly in the last year of life (Seale and Cartwright, 1994). As the ‘baby-boomer’ generation (those born in the post-war population increase) ages, so attention has turned to a broader understanding of the relationship between spirituality and ageing for people who have experienced a secular rather than religious upbringing (Jewell, 1999; MacKinlay, 2001). Recent work has explored core concepts such as personhood in relation to spirituality, in the context of the demographic shift that has created large numbers of people living into very old age, many with dementia (Swinton, 2007; MacKinlay, 2012). In his ground-breaking work on communicating with people with dementia, Kitwood (1997) insisted that dementia does not render the person less-than-human. In these terms, personhood is a moral concept and the responsibility of carers is to nurture wholeness, and respond to the ‘adapted self’ of the person with dementia, including their innate spirituality.
Steve Nolan, Margaret Holloway

B

Abstract
At its most basic level, a belief is an activity of the mind. To hold a belief means having some understanding of the thing believed in and, also, being convinced, by evidence or trusted authority, that there is no reason why the thing could not exist in reality (that it is ontologically plausible). A belief is a conviction that that which one believes in (a person, a value, a fact) is actually true. Of course, beliefs may be personal — ‘I am a good parent’; they may be wrong — ‘I am going to get better’; and they may be held for reasons that appear very strange, but which have a logic of their own. Beliefs form the basis for behaviour and a person may become very conflicted when they act in ways that are incongruent with their beliefs.
Steve Nolan, Margaret Holloway

C

Abstract
The term spiritual care is used both as an overarching concept to include all aspects of attending to ‘the spiritual’ in healthcare and to specify those interventions that may follow the assessment of spiritual need. However, the boundary between spiritual assessment and spiritual care intervention, between identifying and responding to spiritual need, is very fluid. As Holloway et al. (2011) note in their systematic review of literature dealing with spiritual care at the end of life, ‘even the simple act of acknowledging spiritual needs and the broader spiritual dimension is to respond to that need … many of the interventions identified include assessment as an integral part of the intervention’ (p. 27). Nonetheless, they define ‘spiritual interventions’ (a term imported from US social work literature) as ‘those aspects of spiritual care which … seek to go beyond the assessment of spiritual need by responding to the spiritual issues raised and seeking to meet that need’ (p. 27).
Steve Nolan, Margaret Holloway

D

Abstract
The association between spirituality and death is well established in the literature, first and foremost because existential challenge brings with it a heightened awareness of ‘ultimate’ questions and concerns, and with sources of meaning. Death and spirituality seem intimately connected with the idea of a ‘good death’; and notions of a ‘good death’ have been evolving throughout recorded history. In late-medieval Christian Europe, the miserable realities of poverty, injustice and plague led to manuals on the art of dying, Ars Moriendi, texts illustrated with woodcuts, ‘setting out the protocols and procedures of a good death … according to Christian precepts of the late Middle Ages’ (Fenwick and Fenwick, 2008, p. 213). In this period, a ‘good death’ would be considered one where a person, aware that death was approaching, ‘had the opportunity to prepare themselves for it, both spiritually and in terms of their earthly business’ (Howarth, 2007, p. 20). In such cases, preparation would include saying farewells, disposing of belongings, reviewing one’s life and making confession ‘to absolve personal conscience and prepare for a smooth journey into the afterlife’ (Howarth, 2007, p. 20). In pre-modern Europe, the value of a ‘good death’ lay in being able to prepare for the world to come.
Steve Nolan, Margaret Holloway

E

Abstract
A small but growing literature is beginning to recognize that contemporary spirituality discourse works exclusively from a western paradigm of health and social care practice and, more broadly, the relationship of human beings to the environment. These writers have taken seriously the perspectives of the indigenous peoples of Australia, New Zealand, North America and the far north of Europe, in emphasizing the interconnectedness of people with their environments. Harvey (2012) is keen to emphasize that indigenous spiritualities (and he emphasizes the plural) comprise not traditional beliefs so much as inherited knowledge, — and those who use that knowledge engage with the issues of the present. As he writes: ‘Traditional indigenous knowledges address the present in ways that might have surprised the ancestors who passed them down’ (p. 50).
Steve Nolan, Margaret Holloway

F

Abstract
Having or not having faith is a preoccupation of western culture, if not of Christians, who from New Testament times have been known as ‘believers’. Introductory texts on eastern religions and philosophy (Nakamura, 1964; Smart, 2000; Ram-Prasad, 2005) do not discuss the concept. This is because, in the West, faith is generally thought of as assent to a set of ideas or propositions, often formulated into a statement of faith or a creed and that an individual’s salvation depends upon their belief in these propositions; whereas eastern religions are concerned more with spiritual practice, such as yoga or meditation, than with spiritual beliefs. This is a very generalized observation, because faith also implies a personal commitment to God as the object of faith. The two aspects of faith are expressed in the Catechism of the Catholic Church (1994): ‘Faith is first of all a personal adherence of man to God. At the same time, and inseparably, it is a free assent to the whole truth that God has revealed’ (para 150, emphasis original)
Steve Nolan, Margaret Holloway

G

Abstract
It is difficult to identify when God first appears as an idea informing human culture. The record of God’s origins can only be inferred from the archaeological imprints left by pre-literary humans, the artefacts and monuments, paintings and burial sites they left behind. The burial practices of Neanderthals (around 50,000 to 40,000 years ago), who left ornaments with their dead, hint at the possibility of a nascent religion or belief system, as do the paintings of wild animals in caves at Lascaux, France (from around 15,000 BCE). Some think the primitive art produced by these Neolithic hunter-gathers was part of an early shamanistic ritual (Armstrong, 2010, pp. 14–15), or they may be the product of a form of animism (the belief that aspects of the natural world — plants, animals, the elemental forces of wind, water, fire — are animated by a soul/spirit or anima).
Steve Nolan, Margaret Holloway

H

Abstract
Healing practices have a long association with spirituality and religion. In shamanic traditions, which may continue some of the earliest religious practices, shamans ‘are at once doctors, priests, social workers and mystics’ (Vitebsky, 1995, p. 10). By the time of Hippocrates (460 BCE-370 BCE), the roles of priest and doctor had become separated (Kellehear, 2007), but the Hippocratic Oath, historically taken by all physicians, was still sworn to Apollo, the god of medicine, and associated with the myth of his son, Asclepius. In contemporary practice, the lines of professional demarcation are sharply drawn, but even here there is a sense that healing practices are a responsibility shared between the medical professions and those whose orientation is more spiritual. The desire for healing is a powerful driver that, at times, motives behaviour that may appear quite desperate, even bizarre. It is important that health and social care practitioners understand how religious/spiritual beliefs inform the desire for healing.
Steve Nolan, Margaret Holloway

I

Abstract
Buber’s (1958) division of relationships between the categories of I—It and I—Thou seems immediately understandable and applicable. Everyday relationships are characterized as either I—It relationships, in which I (as subject) treat another person as one more object (It) in my egocentric world (subject—object), or I—Thou relationships, in which I treat other persons with respect and dignity, regarding the other as another subject (Thou) with whom I am connected (subject—subject). The obvious inference is that I—Thou relationships are ethically appropriate to health and social care practice, because they regard others as fully human (see xenophobia).
Steve Nolan, Margaret Holloway

J

Abstract
Journeying is a strong metaphor across the spiritual traditions. Jews look to Father Abraham, ‘a wandering Aramean’ (Deuteronomy 26.5), and regard their origins as a wandering people; for centuries, Christians made pilgrimage to a host of holy sites such as Santiago de Compostela (Spain) and Canterbury (England); the hajj (Arabic: ‘pilgrimage’) is one of the Five Pillars of Islam; and Hindus complete the Char Dham (Four Corners of India pilgrimage) or visit the Kumbh Mela festival. Writing about his experience as a modern Christian pilgrim, Hughes (1986) explains his book is about two journeys:
One, on foot from Weybridge, near London, to Rome in the summer of 1975, lasted for ten weeks. The other journey is spiritual, and still continues. It was to find direction in this second journey that I undertook the first.(xi)
Steve Nolan, Margaret Holloway

K

Abstract
Common to Indian religions (Buddhism, Hinduism, Jainism, Sikhism), karma is a concept that is often referenced and frequently misunderstood by Westerners. For example, the US sitcom My Name Is Earl built on the idea that when something good happens, something bad is ‘waiting round the corner’. The eponymous Earl calls this karma. However, karma (Sanskrit: ‘action’ or ‘deed’) is not a form of bad luck or punishment or fate; rather, it is a universal, usually impersonal, moral or ethical law of cause and effect.
Steve Nolan, Margaret Holloway

L

Abstract
Liberation spiritualities may be considered the motivation for theologies of liberation, also termed political theologies, which emerged in relation to the political and sociocultural upheavals following the Second World War. Although very different in expression, Liberation Theology, Feminist Theology and Black Theology share features in common. They began to appear in the 1960s, they are contextual (i.e. they attempt to address specific peoples in specific contexts, rather than all peoples everywhere) and they express and fuel their desire to be free of oppression by (re)interpreting the symbolism of their religion. Significantly, they tend to be rooted in the experience of the oppressed. Marx (1977) recognized this desire as ‘the sigh of the oppressed creature’ (pp. 63–64); however, liberation spiritualities should not be thought of as pain-numbing opiates but as expressions of the deeply spiritual aspiration to freedom from oppression. Liberation spiritualities and their theologies have been influenced by Bonhoeffer’s writings (1906–1945), whose ideas about ‘religionless Christianity’ (Bonhoeffer, 2001) also informed Martin Luther King Jr. as well as the theologians in the Death of God movement.
Steve Nolan, Margaret Holloway

M

Abstract
Human beings are meaning-seeking creatures. From the first emergence of human society, cave paintings, monolithic monuments, abstract signs and especially stories and myths track our intellectual struggle to make sense. As Armstrong (2005) observes, ‘from the very beginning we invented stories that enabled us to place our lives in a larger setting, that revealed an underlying pattern, and gave us a sense that, against all the depressing and chaotic evidence to the contrary, life had meaning and value’ (p. 2). Barthes (1972), coined the term homo significans to capture the depth of our implication in finding and/or creating meaning.
Steve Nolan, Margaret Holloway

N

Abstract
Although the concept of spiritual need is widely recognized in health and social care, only recently has it been recognized that the term lacks any definition. Taxonomies of need have been developed in other areas. In psychology, Maslow (1943), described humans as ‘a perpetually wanting animal’ (p. 395) and organized a series of basic human needs into a hierarchy. Beginning with physiological needs, as these are satisfied, the individual seeks in turn to satisfy needs for safety, love, esteem and, finally, ‘self-actualization’. Maslow has been criticized on the grounds that his hierarchy is culturally specific and too difficult to operationalize. A more useful taxonomy is that of Bradshaw (1972), who distinguishes four types of social need: normative need is need as defined by experts; felt need is need as the individual perceives it; expressed need is when the felt need is acted upon; and comparative need is need in relation to other individuals with similar needs. As yet, there is no established taxonomy of spiritual need, though McSherry and Cash (2004) have suggested an ‘emerging taxonomy’.
Steve Nolan, Margaret Holloway

O

Abstract
Of all the philosophical terms used in social sciences, ontology is perhaps the most challenging. This is partly because philosophers use it in different ways. Health and social care practitioners are likely to discuss ontology in relation to social research. In this sense, ontology is concerned with how social reality is understood, whether the social world is regarded as being external to and independent of the social beings who live in it, and therefore as an objective reality that can be described and measured like any other object; or whether it is regarded as a construct, a subjective reality that is inseparable from those who live in it.
Steve Nolan, Margaret Holloway

P

Abstract
Even before the term spirituality was used so widely in health and social care services, spiritual pain was a familiar concept. This was largely due to Saunders (1988), who regarded spiritual pain as part of the total pain hospice care sought to relieve. She articulated the nature of spiritual pain:
The realization that life is likely to end soon may well stimulate a desire to put first things first and to reach out to what is seen as true and valuable — and to give rise to feelings of being unable or unworthy to do so. There may be bitter anger at the unfairness of what is happening, and at much of what has gone before, and above all a desolate feeling of meaninglessness. Here lies, I believe, the essence of spiritual pain. (p. 29, emphasis added)
Steve Nolan, Margaret Holloway

Q

Abstract
Judgements about quality of life are unavoidably subjective. What one person considers life-enhancing, another finds utterly repellent; what one person finds unbearable, another regards as comfortably tolerate. Such tensions are the stuff of ordinary life, equally the cause of humour and argument. But in the extraordinary situations that arise in health and social care — situations of human extremes in which decisions must be made about the best interests of vulnerable persons — judgements based on the interpretation of what quality of life might mean have a profound impact.
Steve Nolan, Margaret Holloway

R

Abstract
In discussing the meaning of any new term, writers sometimes assume that the particular word’s etymology (the history of its use and meaning) is enough to clarify its contemporary meaning. The assumption is that the meaning of a word is given in its origins. On this basis, with roots in the classical Latin relegere, ‘to reread’, or legere, ‘to gather’, some take ‘religion’ to be synonymous with traditio. Others dispute the early etymology and Lactantius, a third-century Christian writer, found the origin in religare, ‘to bind up’ or ‘to bind together’, hence the word could be linked with ideas of liturgy, community and the practice of faith (Ward, 2003, p. 2).
Steve Nolan, Margaret Holloway

S

Abstract
The words secular, secularization, secularism derive from the Latin saecularis (‘generation or age’) and have historically been taken to refer ‘the world’ as distinct from the Church. Secular is a neutral adjective: Christians distinguish religious priests, who take the vows of a religious order (e.g. poverty, chastity, obedience), from secular priests, who are obedient to a bishop and who may possess property. Secularization, however, names the process of social, cultural and institutional change in which power and privilege are transferred from religious to non-religious institutions, a classic example being the dissolution of the monasteries, in which Henry VIII sequestrated monastic wealth and power. Secularism is a principled opposition to the separation of religious institutions from the governance of the state. The term was first used by Holyoake in 1851 (Wilson, 1983, p. 533) and may be interpreted as a call, either to exclude religion from public debate, or for the independence of the state from religion.
Steve Nolan, Margaret Holloway

T

Abstract
In simple terms, theology is talk about God. Whether one views God as ‘the Father almighty’, as ‘one of the greatest human ideas of all time’ (Armstrong, 1999, p. 10) or ‘arguably the most unpleasant character in all fiction’ (Dawkins, 2007, p. 51), for those brought up in the West the probability is that we will talk about the God of theism. According to Swinburne (1983), theism is the doctrine that God is ‘a being who is personal, without a body, omnipresent [unlimited in space and time], perfectly free, perfectly good, omnipotent [all-powerful], omniscient [all-knowing], creator and sustainer of the universe, the proper object of human worship and obedience, eternal and necessary’ (p. 562); and it might be added: ‘male’, ‘white’ and ‘European’.
Steve Nolan, Margaret Holloway

U

Abstract
It would be difficult to overestimate the impact Freud’s ‘discovery’ of the unconscious has had on western culture and on the way we think about what it means to be human. He was not the first to think about this subject. Leibniz had postulated a ‘continuum of consciousness, ranging from the clear, distinct, and rational apperceptions through the more mechanical and indistinct perceptions and terminating in what he called minute perceptions’ (Fancher, 1996, p. 69). Similarly, Schopenhauer developed his idea that the Will operates independently of consciousness (Janaway, 2002).
Steve Nolan, Margaret Holloway

V

Abstract
The relationship of values and ethics to spirituality is complex. Values are often distinguished from facts, which are usually regarded as more or less objective descriptions of the way things are in the world; whereas values are strongly held but subjective convictions about what is important; often a conviction about what is ‘good’ and what brings ‘happiness’ (see quality of life). As such, it seems legitimate to speak of spiritual values. Because they are subjective, it can be difficult to give an unbiased account of exactly why one thing is valued over another, and some of the values accepted as self-evident, for example, autonomy or confidentiality, are actually historically contingent and culturally specific. Ethics, on the other hand, is a term related to philosophy, ‘a generic term covering several different ways of examining and understanding the moral life’ (Beauchamp and Childress, 2009, p. 1). As such, it is a term appropriate to robust rational, analytic debate. Whereas values are the convictions that underpin everything and on which our actions are based, ethics is the attempt to formulate moral principles that provide justifiable reasons for taking action.
Steve Nolan, Margaret Holloway

W

Abstract
According to Heelas and Woodhead (2005) contemporary western culture has experienced a ‘massive subjective turn’, the result of which has been the decline of religion and the simultaneous growth of spirituality. Whether or not their interpretation is correct, the current cultural mood appears to dissociate spirituality from religion, as if there was little relationship between the two phenomena (Wong and Vinsky, 2009). However, this view does not stand scrutiny, and, although accusations of oppression are justifiably directed at all religions, equally they have a long and noble tradition of nurturing spirituality.
Steve Nolan, Margaret Holloway

X

Abstract
Humans are social animals. But that short, well-worn phrase glosses over the significance the other has for the humanness of our lives. As babies, we are born into family units, in which the language we acquire primarily to communicate and cooperate with others has the secondary effect of distancing us from those others and of bringing us slowly to consciousness of ourselves as a self-conscious self. The achievement of self-consciousness is possible only in relation to others, the other (see I—It/I—Thou). According to the philosopher Kojève (1969), self-consciousness is achieved when our value as a human being is recognized by another human being. We desire the recognition of the other and our desire of the other’s desire cements society.
Steve Nolan, Margaret Holloway

Y

Abstract
Children and young people are given an important place in the religious traditions. Jesus chided his followers for preventing children coming to him; Muhammad is recorded as playing with children. More significantly, certain religious traditions image their devotional figures as small children: the child Krishna, the baby Buddha and the infant Jesus.
Steve Nolan, Margaret Holloway

Z

Abstract
For many Westerners, Buddhism is either Tibetan or Zen. In fact, both are radically different variations of Buddhism, which share little in common beyond their historic connection to the Buddha. Zen Buddhism developed in Japan from the older Ch’an Buddhism, which emerged in China with the arrival from India of the legendary Buddhist missionary Bodhidharma (around 470–543 CE). Whereas when Buddhism reached Tibet it assimilated aspects of the indigenous shamanistic/animistic Bon religion, in China Ch’an absorbed elements of Daoism, with which it shared a view that ultimate reality is inexpressible. Over time, Ch’an developed into separate Schools, due largely to divergent views about whether enlightenment is an event or a process. In Zen, the main Schools embodying these views are, respectively, Rinzai Zen and Soto Zen. In both cases, enlightenment (satori) ‘is defined as the experience of awakening to the true nature of reality and the realization of the Buddha nature or the Buddha mind … a direct, unmediated awareness of the ultimate nature of reality’ (Netland and Yandell, 2009, p. 61). Buddha nature or Buddha mind is an important teaching in Zen: the assertion that all beings have Buddha nature, which is itself the essential nature of the mind, the possibility to awaken.
Steve Nolan, Margaret Holloway
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