PREPARED BY DR CHAN KA PO
Published in The Proceedings of The Korean conference on Buddhist studies 2006 (韓國佛教學結集大會論集) Vol 3. No. 2, 1520 -154l . (22nd to 23 rd April 2006)
Spirituality receives much attention in the West in recent few years because of its relationship to health, both physical and mental, of human being. Most literature from the West refers spirituality from a Judaeo-Christian view but spirituality is now considered as different from religiosity. Research on this field in the West is mostly based on Western religion. The topic receives less attention in the East . The relationship between spirituality and health is thought the mind, body, spirit intervention. Mindfulness is one form of intervention from Buddhist origin that receives much attention in the West recently. This kind of intervention is found to have lot of influence on mind, body, spirit of human being. The relationship between Spirituality and Buddhism will be explored in detail. How one complement the others will discuss? Further perspective is a great area for research.
Spirituality receives much attention in the West in recent few years because of its relationship to health, both physical and mental, of human being. Recently spirituality, religion, and person beliefs are regarded as important components of quality of life (WHOQOL SRPB GROUP, 2005). Most literature from the West refers spirituality from a Judaeo-Christian view but spirituality is now considered as different from religiosity (Cawley, 1997; Pargament, 1999; Richards & Bergin, 1997; Thoresen, 1998). Research on this field in the West is mostly based on Western religion (Bradshaw, 1994, Narayanasamy, 1999a and b). The topic receives less attention in the East . The relationship between spirituality and health is thought the mind, body, spirit intervention (Ng et al, 2005). The concept of holistic health is well fit into the practice of Buddhism, which aim at purification of mind, speech and body. Mindfulness is one form of intervention from Buddhist origin that receives much attention in the West recently. This kind of intervention is found to have lot of influence on mind, body, spirit of human being (Leigh et al, 2005; Maaske, 2002). The relationship between Spirituality and Buddhism and its significant in health issue will be explored in detail. Further perspective is a great area for research (Miller et al, 2003).
WHAT IS SPIRITUALITY?
“… when I regard all beings with my Buddha eye, I see that hidden within the klesas [= mental afflictions] of greed, desire, anger, and stupidity, there is seated augustly and unmovingly the tathagata’s [= the Buddha’s] wisdom, the tathagata’s vision, and the tathagata’s body. Good sons, all beings, though they find themselves with all sorts of klesas, have a tathagatagarbha that is eternally unsullied, and that is replete with virtues no different from my own.” (Lopez, 1995:96)
In Mahayana Buddhism, the Tathagatagarbha doctrine (tathāgatagarbha) teaches that each sentient being contains the effulgent Buddhist element or potential to become a Buddha. “Tathagata-garbha” means “Buddha Womb/ Buddha Matrix” or “Buddha Embryo”, the terms “Buddha-nature” (“Buddha-dhatu”) and “Tathagatagarbha” are presented as essentially synonymous.The Buddha-nature is timeless, all encompassing, yet nameless and indescribable but ‘exist’. Spirituality in some way is like ‘Buddha-nature’, difficult to describe, not easy to quantify but does exist. In general, to be “spiritual“, there are four interrelated factors. (1) A relationship with the transcendent, generally seen as both immanent and transcendental. This relationship is focused on trust, surrender and for Sufis, submission. (2) A practice, either regular mediation or some type of prayer (but not prayer where the goal is to ask for particular products or for the train to come quicker). (3) A physical practice to transform or harmonize the body – yoga, tai chi, chi kung, and other similar practices. (4) Social – a relationship with the community, global, or local, a caring for others. This differs from a debate on whose God, or who is true and who is false, to an epistemology of depth and shallow with openness and inclusion toward others (Inayatullah, 2005).
SPIRITUALITY AND RELIGIOSITY
Most literature from the West refers spirituality from a Judaeo-Christian view (Bradshaw, 1994, Narayanasamy, 1999a and b). Very few studies linked spirituality with mainstream religions. Markham (1998) summarizes the concept of spirituality within Islam, Judaism, Buddhism and Hinduism. Each has a different emphasis and he warns against trying to unite the differing accounts of the spiritual, as this would be impossible given the incompatibility of some stances. Although researchers commonly accept the distinction between spirituality and religiosity (Baldacchino & Draper, 2001; Hill & Pargament, 2003; Richards & Bergin, 1997), most of them have not considered religious traditions outside of Christianity. Eastern culture like Chinese is multicultural, influences by Taoism, Confucianism and Buddhism. Very little literature from the East however centers on spirituality. This is an interesting field to study because culture and spirituality are closely related.
Contemplativeness and self-reflectiveness are hallmarks of spirituality. Religion, however, is an institutional (and thus primarily material) phenomenon and unlike spirituality, they are defined by their boundaries. Religions are differentiated by particular beliefs and practices, requirements of membership, and modes of social organization. They are also characterized by other nonspiritual concerns and goals (e.g., cultural, economic, political, social). Thus, religion can be seen as fundamentally a social phenomenon, whereas spirituality (like health and personality) is usually understood at the level of the individual within specific contexts (Richards & Bergin, 1997; Thoresen, 1998). Recent studies have the idea that spirituality is not the same as religiosity. A person can be religious but not leading a spiritual life. On the other hand, a person can be spiritual but not necessarily religious (May, 1982; Shahabi et al., 2002; Woods & Ironson, 1999; Zinnbauer et al., 1997). Spirituality, as compares to religion, may have broader meaning (Cawley, 1997, Nagai-Jacobson & Burkhardt, 1989; Pargament, 1999; Roof, 1993). Recent concept on spirituality is not be biased toward or anchored in a particular religion. Respecting and endeavoring to identify common core values and beliefs across the main philosophical-religious traditions is now the right direction for studying spirituality (Ng et al, 2005).
DEFINITION OF SPIRITUALITY
Achieving what could be considered a comprehensive definition of spirituality has proved difficult for most (Thompson, 2002), if not all, but is of utmost importance especially in research area. According to McSherry (2002), perhaps the greatest dilemma associated with spiritual assessment concerns the definition of spirituality. Actually the word is not bound by a common set of defining characteristics: it can mean different things to different people.
The term spirituality has had a long and diverse character. Spirituality is derived from the Latin word spiritus, spirit, the essential part of the person (Piles, 1990), which ‘controls the mind and the mind controls the body’ (Neuman, 1995:48). Spirituality is defined as the “human quest for personal meaning and mutually fulfilling relationships among people, the nonhuman environment, and, for some, God” (Canda, 1988:243). Simpson and Weiner (1991), in the Oxford English Dictionary, offer a substantial 10 pages of reference material on the concept of spirituality. Two related themes seem to dominate: First is the notion of being concerned with life’s most animating and vital principle or quality, often described as giving life or energy to the material human elements of the person. Second, spirituality includes a broad focus on the immaterial features of life, regarded as not commonly perceptible by the physical senses (e.g., sight, hearing) that are used to understand the material world. According to Thibault et al. (1991), spirituality is defined as an individual’s unique spiritual “style” – the way he or she seeks, finds, or creates; uses; and expands personal meaning in the context of the entire universe. The meaning of spirituality is further complicated by cultural effects. Copsey (1997) discovered people in statutory services were unwilling to acknowledge the existence of religious belief, preferring to use terms such as multicultural, cultural diversity and ethnic diversity. Some view spirituality as primarily relational—a transcendent relationship with that which is sacred in life (Walsh, 2000) or with something divine beyond the self (Emmons, 1999).
The meaning of spirituality is further complicated by having different meaning in different professions and a sort of “approach-avoidance” for research when it comes to religion, spirituality and professionalism (Hill, 2003; Weaver et al, 1998). For example, in the 1995 Encyclopaedia of Social Work, no sections are devoted exclusively to religion or to spirituality (Ellor, 1999: 13). Spirituality is an inherent quality of all humans that drives the search for meaning and purpose in life. This is complex phenomena (Larson et al., 1988; Pargament, 1997) and is not dichotomous. Any attempts to define spirituality as a single linear dimension are greatly oversimplified and often misleading. It involves relationships with oneself, others, and a transcendent dimension (Emmons, 1999; Herman, 2000; Walsh, 2000). That transcendent person or value may take a variety of forms (Bullis, 1996: 2). The definition of spirituality may also reflect its function. Goddard (1995) proposed “spirituality as integrative energy”, served to highlight its importance while at the same time seeking to transform its nature. The concept itself is multidimensional and defies simple clear-cut boundaries (Miller & Thorsen, 2003). It often seems easier to point to what spirituality is not (i.e., something material) than to what it is. In that sense, it shares some problems with latent (and overlapping) constructs such as character, love, well-being, peace, and health (Levin, 2000; Oman & Thoresen, 2002). Although there is no scientific consensus yet exists about these issues, substantial progress has been made within the past few years, and increasing attention (both public and scientific) is being given to the relationship between spirituality and health (Ellison & Levin, 1998; Koenig et al., 2001; Larson et al., 1998; Miller & Thoresen, 1999; Thoresen, 1999). As spirituality is interrelated to the concept of holistic health and mind-body therapy (Ng et al, 2005), a more functional, less vague, more operational and universal definition may be explored in this direction.
SPIRITUALITY AND HEALTH
The World Health Organization (1948) defines health as “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.” Health is powerfully influenced by cultural, social, and philosophical factors, including the existence of meaning and purpose in life and the quality of intimate personal relationships (Ornish, 1999; Ryff & Singer, 1998). Recently the WHOQOL SRPB Group (2005) has present a paper reports on an international study in 18 countries to observe how spirituality, religion and personal beliefs (SRPB) relate to quality of life (QoL). Spirituality encompasses physical, psychological and social components (Henderson, 1967; Colburn, 1990: Neuman, 1995). The concept of holistic health is being in tune with this vital, unifying force of the spiritual dimension. Actually there is lack of distinction between a spiritualized medicine and a medicalized spirituality (Frank, 2005).
A significant number of patients, when asked about how they cope with life stressors and health problems (both physical and psychological); they mention spiritual and religious attitudes, beliefs, and practices. In some parts of the United States, the proportion reaches between 33 percent and 50 percent, according to some surveys, especially among African Americans, women, and the elderly. Furthermore, a surprisingly large number of patients would like their physicians to address religious or spiritual issues in the context of medical visits (Koenig, McCullough, & Larson, 2001, p. 94). George et al. (2000) state that a high priority for future research on spirituality and health is the pursuit of an “epidemiology of spiritual experience” (p. 113) and contend that spiritual experience is the most-ignored dimension of spirituality.
Spirituality and the cultivation of spiritual health can have an influence on physical, mental, and emotional health (Black, 2006; Leigh, 2005; Lindberg, 2005; Thune-Boyle et al, 2006). The impact of spirituality on health may be due in part to the fact that “attitudes, of faith, hope, and commitment imply an internal locus of control, and following an ethical path that involves fulfillment, purpose, and meaning may lead to enhanced self-esteem and a sense of connectedness with self and others”(Waite et al, 1999 ). People with a deep sense of spirituality reported less use of medical services, less minor illness, and more complete recovery from minor illness than the national averages. Those patients with greatest spirituality, even though their illnesses were terminal, showed resilient emotional health (Reed, 1987).
There are more than 100 studies focusing on “spiritual wellness” (Koenig et al, 2001: 214-219). Indeed, there is some evidence that, in general, individuals with internalized spiritual and religious values score higher on measures of mental health than those who do not consider themselves religious, those who only give lip service to religious values, or those whose religious commitment takes the form of adherence to fanatical cults or uncompromising belief systems (Baker, 2003; Wuff, 1991: 504-505, 635). Many systematic reviews and meta-analyses have quantitatively shown that religious involvement is an epidemiologically protective factor (Levin, 1997). It is now recognized that religious/spiritual beliefs may have a role in buffering against the adverse consequences of mental and physical illness (Lee et al, 2005; Rosner, 2001).
Recent studies have showed that spirituality is related to mental health and physical health in general (Baker, 2003; Hill, 2003; Gall et al, 2005; George et al, 2000; Larson et al, 1998; Levin, 1997; Miller, 2003; Plante & Sherman, 2001; Powell et al, 2003; Seeman et al, 2003; Seybold & Hill, 2001; Thoresen, 1999; Thoresen et al, 2001; Waite et al, 1999). Spirituality has been found to be an important and unique component in patients’ ability to cope with serious and chronic illnesses (Brady et al, 1999; Ehman et al, 1999; Pargament, 1997; Roberts et al, 1997). Data suggest that spirituality may be protective against physical and psychological illness as well as important tools for coping with life stressors (Hill, 2003; Miller, 2003). Attention to spirituality may improve the overall health of those in need of care, regardless of their physical condition. This meaning has strong roots in the East ern idea that “mind” can gain control over the body. It puts the emphasis on positive living, growth, and transcendence, rather than on disease and deficits (Ng et al, 2005).
SPIRITUALITY, BUDDHISM AND MIND BODY MEDICINE
Mind is the forerunner of all (evil) conditions.
Mind is their chief, and they are mind-made.
If, with an impure mind, one speaks or acts,
Then suffering follows one
Even as the cart wheel follows the hoof of the ox.
Mind is the forerunner of all (good) conditions.
Mind is their chief, and they are mind-made.
If, with a pure mind, one speaks or acts,
Then happiness follows one
Like a never-departing shadow.
These words, which are the opening lines of the Dhammapada, were spoken by Gotama Buddha 2500 years ago. They illustrate the central theme of Buddhist teaching, the human mind. Buddhism does not deny the reality of material existence, nor does it ignore the very great effect that the physical world has upon us. On the contrary, it refutes the mind-body dichotomy of the Brahmans and says that mind and body are interdependent (Burns, 1994). This entire idea correlates well with the concept of holistic health (Chan et al, 2001; Ng et al, 2005). The National Institutes of Health (NIH) defined mind-body therapies (MBTs) as “interventions that use a variety of techniques designed to facilitate the mind’s capacity to affect bodily function and symptoms”. The way of practice of Buddhism is in line with the definition of Mind body therapy.
Research suggests that spiritual coping strategies were found to help individuals to cope with their ailments (Baldacchino, 2001). The relationship between spirituality and psychotherapy is not new. Historically, in the West, psychological and spiritual issues were largely the domain of the priest-healer until the eighteenth century. Ellenberger (1970: 53) contends that dynamic psychotherapy emerged in 1775 because of the “clash between the physician Mesmer and the exorcist Gassner”. Gassner’s loss symbolized the split of religion from psychotherapy. This denigration was further reinforced by Freud and later by Albert Ellis and others. However there is a changing of attitude recently because of an increasing number of studies that suggest religion and spirituality can positively impact mental health and psychological well-being (McSherry, 2000; Swinton, 2000). Narayanasamy (2004) reports the findings from a qualitative study of spiritual coping mechanism in chronically ill patients suggesting the importance of the spiritual dimension in healing. A survey done by Shafranske (2000) asked psychiatrists if they would use spiritual intervention if it were scientifically proven that these interventions improved patient progress. Thirty-seven percent of the psychiatrists reported they would use the intervention and 57% would recommend the patient consult with a minister or rabbi. Furthermore, 62% would recommend the use of a spiritual intervention such as meditation (Shafranske, 2000). Equally important is that spiritual practices can now be empirically witnessed because of recent advances in brain research. The key point is that spirituality and spiritual empowerment via intervention is brought into the visible world (Conlin, 2004; Conner, 2003). The way of Buddhist practice can be introduced as intervention both for prevention and treatment of mental problem and promotion of mental health.
One of the characteristic of Buddha teaching is that he said relatively little about Nibbana (the ultimate state of enlightenment) and instead directed most of his teachings towards two lesser goals which are empirical realities of readily demonstrable worth. These were, first, the increase, enhancement, and cultivation of positive feelings such as love, compassion, equanimity, mental purity, and the happiness found in bringing happiness to others. Secondly, he advocated the relinquishment and renunciation of greed, hatred, delusion, conceit, agitation, and other negative, unwholesome states (Burns, 1994). The cultivation of positive feelings is going in line with the development of positive psychology (Seligman, 2000) today and in Buddhist’s practice, there are techniques and interventions that we can follow.
In Buddhism, in order to attain the state of enlightenment, one can practice according to the “Noble Eightfold Path”. Williams (2000) describes the Buddhist path as the overcoming of greed, hatred and ignorance through the cultivation of their opposites, non-attachment, compassion, and wisdom, and explains the eight factors of the Noble Eightfold Path as follows:
(a) “Right Speech” is speech that is not false, divisive, hurtful, or merely idle chatter
(b) “Right Action” is refraining from harming living beings, from taking what is not given, and from sexual misconduct
(c) “Right Livelihood” is livelihood not involving the infringement of Right Speech and Right Action
(d) “Right Effort” consists of efforts to prevent the arising of the unwholesome states (e.g. greed, hatred and ignorance) and efforts to develop the arising of the wholesome states (e.g. non-attachment, compassion, and wisdom)
(e) “Right Mindfulness” is constant mindfulness, awareness, with reference to the mind, and to physical and mental processes
(f) “Right Concentration” consists of the mind focusing unwaveringly on a single object, which can be taken to the point where one attains successively deeper levels of meditation
(g) “Right Understanding” is gaining insight into the Four Noble Truths, and into what things actually are rather than what they appear to be (Thera, 1964)
(h) “Right Thought” involves having healthy intentions of benevolence and compassion, and ‘freedom from unhealthy intentions of worldly pleasures, selfishness, and self possessiveness
The Noble Eightfold path can be viewed as a systematic model of cognitive and behavioral based intervention in terms of recent counseling psychology. This is exactly a multidisciplinary approach of psychotherapeutic interventions according to a bio-psycho-socio-spiritual model. Another characteristics of the practice is that everyone can practice the “Noble Eightfold Path” if he wants to even he is not Buddist.
“Meditation” is one of the mind body therapies that many medical practitioners recently have interest (Astin, 2003; Canter, 2003). Recent study by Elkin et al. (2005) found that meditation is one form of complementary and alternative medicine (CAM) used by psychiatric inpatients in United States. Buddhist meditation refers to achieving a positive mental state, and incorporates Right Effort, Right Mindfulness and Right Concentration in the Noble Eightfold Path. Mistakenly, Buddhist meditation is frequently confused with yogic meditation, which often includes physical contortions, autohypnosis, quests for occult powers, and an attempted union with God. None of these are concerns or practices of the Eightfold Path. There are in Buddhism no drugs or stimulants, no secret teachings, and no mystical formulae. Buddhist meditation deals exclusively with the everyday phenomena of human consciousness. In the words of the Venerable Nyanaponika Thera, a renowned Buddhist scholar and monk:
“In its spirit of self-reliance, Satipatthana does not require any elaborate technique or external devices. The daily life is its working material. It has nothing to do with any exotic cults or rites nor does it confer “initiations” or “esoteric knowledge” in any way other than by self-enlightenment.”
Zen Meditation and Mindfulness based meditation have received much attention and have stimulated lots of scientific studies (Kim et al, 2005; Mason et al., 1997; Takahashi et al., 2004). Meditation can help you train your mind in the same way exercise can train your body. Studying Buddhist monks while they meditate in MRI machines has led to startling conclusions, among them that the “monks” meditation practice, which changes their neural physiology, enables them to respond with equanimity to sources of stress. Another study of Buddhists by scientists at the University of California has also found that meditation might tame the amygdala, the part of the brain involved with fear and anger (Conlin, 2004). Richard Davidson, a professor of psychology and psychiatry at the University of Wisconsin at Madison found out that “after a short time meditating, meditation had profound effects not just on how they felt but on their brains and bodies”. Meditation appears to stimulate the left prefrontal lobe, which is related to feelings of well-being and happiness (Conner, 2003). There is also research on the biological concomitants of meditation practice (Davidson et al., 2003; Herzog et al., 1990; Jevning et al., 1996; Lou et al., 1999; Solberg et al, 2004).
Mindfulness is one form of meditation that has acquired numerous researches in the West about its effect on stress reduction (Astin, 1997; Proulx, 2003). It is probably the best understood meditation in clinical field. Historically, mindfulness has been called “the heart” of Buddhist meditation (Thera, 1962). It resides at the core of the teachings of the Buddha (Gunaratana, 1992; Hanh, 1999; Nanamoli & Bodhi, 1995). It does not conflict with patients’ own belief or religion (Thera, 1962). It is basically more spiritual than religious. Mindfulness practice has been used successfully in a range of settings, clinical (Craven, 1989; Roth & Creaser, 1997) and non-clinical including hospitals (Greeson et al., 2001; Reibel et al., 2001; Shapiro et al., 1998) and colleges (Astin, 1997). It has been used as an adjunct in the treatment of conditions like psoriasis (Kabat-Zinn et al., 1998), cancer (Moscoso et al., 2004; Speca et al., 2000), chronic pain (Kabat-Zinn, 1982; Kabat-Zinn et al., 1985) and anxiety disorders (Kabat-Zinn et al., 1997; Kabat-Zinn et al., 1992) besides its prior application in stress reduction. Recent research (Weiss et al., 2005) explored whether MBSR can be used as an adjunct to outpatient psychotherapy, can result in more rapid alleviation of symptoms, increased achievement of therapeutic goals and a decrease in number of therapy sessions sought by clients. Various studies had shown the effect of Mindfulness-based Cognitive Therapy (MBCT) in helping patients with recurring depression (Smith, 2004). MBSR/MBCT also has potential for the treatment of patients with Chronic Fatique Syndrome (Surway et al, 2005).
Recently, increased attention has been given to meditative intervention to improve physical health, mental health and foster spiritual growth (Lindberg, 2005). In 2003, the Society for the Exploration of Psychotherapy Integration celebrated its 20th birthday and at the same time affirms the future goal of psychotherapy integration. Combinations of techniques currently on the cutting edge such as the assimilation of mindfulness methods would be standard (Norcross & Goldfried, 2005). It is the right time for Buddhist to keep open mind and introduce Buddhist practice to health profession and public.