GERONE, Lucas Guilherme Teztlaff de 
GERONE, Lucas Guilherme Teztlaff de. Spirituality in the context of health science. Revista Científica Multidisciplinar Núcleo do Conhecimento. Year 05, Ed. 09, Vol. 01, pp. 121-136. September 2020. ISSN: 2448-0959, Access link: https://www.nucleodoconhecimento.com.br/science-of-religion/health-science
Context: Academic research on spirituality and health has been research themes in the areas of health and religion. However, it is not about spirituality from a perspective of the relationship between religion and health professionals. Objectives: This study presents a reflection on spirituality and health. Specifically, it seeks to highlight: a) the relationship between religion and health science; b) the relationship between the Christian religion and health; c) and the Christian tradition and health professionals. Method: A theoretical reference on spirituality in the health context. Results: a) there are etymological associations between spirituality and health; b) religious science has always been aware of the theme of health; c) The ideology of the Christian religion on health extends throughout history; d) there is the influence of the Christian tradition on the practice of care among health professionals. Considerations: a) It is considered that religion is associated and historically with health, b) it is considered that there is a relationship between spirituality and health in the etymological sense and in the practice of health care; c) it is considered that the Christian religion tradition influenced the context in health, such as the practice of care among professionals. Consider the importance of new research on spirituality and health in other religious perspectives, such as spiritism.
Keywords: Spirituality, religion, health, care, health professionals.
The association between spirituality and health is historical, during human and scientific development there is a close relationship between religion and health, such as the practice of care among health professionals. In fact, medicine and religion are areas that have in common the issue of human care, expressed in health care. Many ancient civilizations developed their health service in the figure of a medical priest, such as the divine healing power in the figures of shamans, the shamans of the indigenous tribes, the druids of ancient European civilizations, and the healers and sorcerers of the African tribes and Oceania.
In the Middle Ages (an exponent time of the influence of the Catholic Church) it was common for the physician to perform hospital and religious care, such as prayers in the treatment of the sick. Due to scientific advances in the Modern Age, there was a period of separation between religious and health issues (HEIMANN, 2003). Currently, the influence of religiosity/spirituality in the state of health-disease arouses interest among clinicians and researchers in the health area (MOREIRA-ALMEIDA, 2010). For example, contemporary medicine focuses on physical health care, but also on issues that are relevant to religion, such as looking at health from a perspective of relationality (care in relation to others, with oneself and with transcendence).
There are religious groups that propose to seek health as one of their religious purposes. They are religions that prescribe and proscribe doctrines or teachings about healthy behavior (LEVIN, 2003). In a study, Levin (2003) points out 32 religious groups and faith traditions in the world that have beliefs specific to health events, such as blood and blood products, euthanasia, healing, healing practices, medications, organ donation, questions about the right to die, surgical procedures and receiving visits. Specifically in this study, it is perceived that the Christian religion has an activity in health science. There is an association between the “bodily and spiritual” in the Christian tradition. Currently, the association between body and spirit is part of discourses about humanized health care, because the indiscriminate use of technology, even if it provides body healing, can result in the abandonment, often unintentional, of other respectable human dimensions, such as comfort and control of pain, communication, significant values and, especially, spiritual and religious issues. In this sense, there is “a challenge to health professionals to answer questions about the balance between health and spirituality” (PERES, 2007, p. 86).
1. DEFINITIONS OF TERMINOLOGY: RELIGIOSITY, SPIRITUALITY AND HEALTH
In the academic environment, there is a common association between religiosity and spirituality. For the American physician Harold G. Koenig (2012, p. 12), a world authority in the knowledge of religiosity and health, most studies on these topics use “the term spirituality in the title or discussion of results”. Therefore, in this study, religiosity and spirituality appear united, separated only by a bar (/). However, even though this association exists, religiosity and spirituality cannot be considered as synonyms.
On the one hand, religiosity is a quality of what is part of religion, understood here from its Latin etymology, religare, which means “reconnection” between man and God (DERRIDA, 2000). According to Koenig (2012, p.11), religion is a system of beliefs and practices observed by a group of people who rely on rituals or a set of scriptures and teachings “who recognize, worship, communicate with or approach the Sacred, the Divine, God.”
On the other hand, spirituality is a quality of the nature of the spirit, a factor pertinent to every human being. Spirituality is a domain outside the religious system, and can be present in any human experience — such as in its values, ethics, morals, in love, compassion, art, linked to connection, inner peace, energy, hope, joy, strength, support, friendship, solidarity, humanism, comfort — and, notoriously, in the sense and purpose of life (GERONE, 2015).
For Puchalski (2006, pp. 14-15), a physician and one of the pioneers in the movement to integrate spirituality into health care, spirituality is:
each person’s inherent search for the meaning and ultimate purpose of life. This meaning can be found in religion, but it can often be broader than that, including the relationship with a divine figure or with transcendence, relationships with others, as well as the spirituality found in nature, art, and rational thought. All of these factors can influence how patients and health professionals perceive health and disease and how they interact with each other.
The factors that permeate the notion of spirituality, such as meaning and purpose of life, inner peace, compassion, social support, hope, among others, influence perceptions about the notion of health of patients and health professionals, because these spirituality factors become a positive indicator for health. In this context, spirituality is one of the indicators of the notion of health.
For the Quality of Life Assessment Group of the Mental Health Division of the World Health Organization (WHOQOL GROUP; WHO, 1994), health is related to quality of life, which can be the intuition of the human being about his life condition, according to the cultural context. Furthermore, it is the structure of principles with which the human being relates his goals, expectations, standards and concerns. Therefore, quality of life concerns several health areas: (a) biological and functional, such as health status, functional status and disability; and (b) social and psychological, such as well-being, satisfaction, happiness and economic origin (PANZINI et al, 2007). Therefore, Luz (2009) states that the spiritual dimension has been added to the notion of health, since religiosity/spirituality influences the whole of life — values, behaviors, politics, economy, culture, education — which are directly reflected in the notion of health.
2. RELIGIONS AND HEALTH SCIENCE
There are religious groups that propose to seek health as one of their religious purposes. They are religions that prescribe and proscribe doctrines or teachings about healthy behavior (LEVIN, 2003). In a study, Levin (2003) points out 32 religious groups and faith traditions in the world that have beliefs specific to health events, such as blood and blood products, euthanasia, healing, healing practices, medications, organ donation, questions about the right to die, surgical procedures and receiving visits.
The process of religions prescribing and forscing what is healthy or not significantly impacts the health of their faithful. On the one hand, there are some religions with fundamentalist conducts in relation to the health of their faithful, which are fleeing the traditional medical view, such as the prohibition of certain medicines and treatments. On the other hand, most religious traditions have a positive relationship with their religious beliefs and health, and recommend exercising, maintaining physical fitness, meditating, getting enough sleep, taking vaccines, being willing to undergo a medical examination, undertake a pilgrimage for health reasons, tell the truth about how you feel, have hopes of recovery , combat stress, undergo physical exercise and counseling and be able to deal with resourcefulness with a physical disability (LEVIN, 2003).
In recent years, research in health science has found that religion is a powerful psychological and social factor that greatly influences people’s health (KOENIG, 2012). For Koenig (idem), participating in a religious group can often contribute to improved immune function, endocrine functions, as well as to the production of cytosines, combating metabolic disorders, fighting neurological, cardiovascular, coronary artery disease, or congestive heart failure, hypertension, stroke, infection, helping in wound healing, combating cancer, and dealing with disabilities. It is also a positive factor in view of the rate of depression, anxiety control, the search for well-being, positive emotions, high mood, optimism, hope, longevity, improved life expectancy, quality of life, among others.
Therefore, in fact, religion plays an important role in health and, therefore, for Moreira-Almeida (2010, p. 18), “religiosity and spirituality have been the object of a growing interest among clinicians and researchers in the health area” — for example, epidemiology, an area that studies the frequency and distribution of diseases in the human community, or health problems in numerous groups of people and , sometimes in small groups (ROSSETTO, 2011). Considering that religions are groups of people with something in common about God, epidemiological studies point to a relationship between health and spiritual beliefs and practices, including prayer, attendance at religious services, meditation, faith in God and others. For Levin (2003), social bonding within a religious group also influences human behavior, which in turn influences health.
In psychology science, there are some approaches on religiosity/spirituality and health, among which:
a) Logotherapy — created by the Viennese psychiatrist Viktor Frankl— is a theoretical-practical system that seeks to give meaning to the life and existence of the human being.
By virtue of the self-transcendence of human existence, man is a being in search of meaning. He is dominated by the will of meaning. Today, however, the will of meaning is frustrated. More and more patients return to us psychiatrists complaining of feelings of meaninglessness and emptiness, of a sense of futility and absurdity. They are victims of mass neurosis today (FRANKL, 1989, p. 82).
The lack of meaning is also in the forgetfulness of self-transcendence, which can cause neuroses and sufferings in the patient, and it is up to psychotherapists and/or psychiatrists to help him find his cure through a harmony between the somatic (of body phenomena and physiology), psychological (instincts, conditionings and cognitions) and noetic (from greek nous, which means spirit) (CORREA, 2012).
b) The psychology of religion — is a part of psychology that seeks to study human behavior and its relationship with the transcendent, beliefs, values, motivations, happiness, spiritual life, the knowledge and hunger of God, the desire and meaning of the beyond (FERREIRA, 2002). His view is contrary to that of Sigmund Freud. In Futuro de uma Ilusão, Freud describes that religion caused neurotic symptoms and psychotic symptoms and was therefore not healthy. According to Barros (2000, p. 7), “the psychology of religion can help purify many false or misrepresented images or conceptions of God.” That is, to bring a healthy understanding of human behavior towards God. According to Gomes (2009), within a Jungian view, numerous neuroses are mainly linked to the fact that the religious needs of the soul are no longer taken seriously by psychology.
c) Neurotheology — also known as spiritual neuroscience, is an area of health that seeks to investigate the influence of faith (beliefs, religion) on the human brain, or the “participation of the limbic system in spiritual phenomena” (ALEJANDRO, 2015). The limbic system is the unit responsible for emotions and behaviors, such as attributing sentimental value to emotional experiences: “an example can be the pleasant feeling that exists when someone finishes a prayer or sings to praise” (ALEJANDRO, 2015). For Raul Marino, a neurosurgeon, prayers, praises and meditations are pertinent to the brain area and can be a resource for the patient to accelerate his healing process or adapt to treatment (ALEJANDRO, 2015).
Currently, there are studies in various health sciences, with more constancy in psychology and spiritual neuroscience, which seek to understand how religious and spiritual practices, such as prayers, praises and meditations, can be a resource for healing or coping with situations of suffering, stress and life problems that interfere with physical and mental health. This process of recourse and coping through religious and spiritual practices is called religious/spiritual coping (PANZINI, 2004). Spiritual religious coping can be both positive and negative. As examples of negative spiritual religious coping, we have: to feel abandoned, dissatisfied with God or religion, to attribute the cause of suffering and trouble to sin or demonic act. Positive coping is related to efforts to seek meaning and purpose of life in the midst of adversities, even in the face of different occasions of suffering, stress, etc. (PANZINI, 2004).
For Waldir Souza (2013), in a situation such as suffering, human vulnerability becomes more acute, evoking meanings from strength and weakness, fear and courage, awakening positive and negative emotions in the person. Within this context, religiosity/spirituality can help answer central questions about suffering, such as where it comes from and what it is for or “where I go after death” (ZUBEN, 1993).
It is these questions that unite religiosity/spirituality and health science, as both seek to answer them (SOUZA, 2013). In fact, medical knowledge explains how of diseases, religious sections, already seek to answer why (MONTERO, 1985).
In view of the above, religiosity/spirituality can be a form of contrast with medicine and/or health science, in order to recognize aspects of the disease and reality that would go unnoticed (HAMMES, 2006). While the answer about the question of how a given disease was possible is related to the medical diagnosis, the question about the “why” is sought in the sphere of religiosity/spirituality, as a meaning of life in the face of an illness.
3. THE CHRISTIAN RELIGION AND THE SCIENCE OF HEALTH
The choice for reflection of the Christian religion is the fact that 84% of Brazilians are Christians, as pointed out by ibge 2010 (AZEVEDO, 2012). Another reason is because the Christian religion has an activity in health science. In the early Christian era, Christianity became a medicinal religion with a salus message to mankind. In the patristic tradition, in Ignatius of Antioch, there is a “bodily and spiritual” medical Christ sent to evangelize the poor and heal the contrites of heart (Luke 4:18) (ÁLVAREZ, 2013).
The ideology of the early Christian era extends throughout history, and until the high Middle Ages, there is a strong belief in the miraculous power of the gospel to cure diseases (idem, p. 23). From the 16th century on, with scientific advances and the Enlightenment, which negatively influenced religious reflection on health, there were changes in this perspective. Theologians, such as Rudolf Karl Bultmann (1884–1976), drove religion away from health. Bultmann said that “It is no longer possible […], in case of illness, to make use of modern medicine or current clinical instruments and, at the same time, to continue believing in the world of the spirits and miracles of the New Testament” (GESTEIRA, 1991, p. 254). With this, the miracles of healing began to arouse restlessness, requiring a scientific mentality to explain them.
Another negative factor that has ruled out health religiosity is the valorization of suffering and illness. According to Haring (1981 apud ÁLVAREZ, 2013), some theologians believed that God saved only by the experience of suffering and illness, because “a healthy body is not often a place inhabited by God”. One of the reasons for this is the fact that the science of religion did not understand health as a human experience, something incorporated into consciousness, elaborated, valued and stimulated, but only as a state of absence of disease or disease (idem, p. 28).
Significant progress on the relationship between religion and health takes place in the 1960s, when the World Council of Churches, an ecumenic initiative, highlights a desire of the Christian community to think about the health of individuals and society (idem, p. 29). In this case, in fact there was a genuine religious reflection on health:
[…] European pastoral experts in the world of health wondered how to biblically and theologically base their action. It is no longer enough for the theology of suffering, sickness and death, it was said: it is necessary to add the “health”. In several churches (and this is a significant data), we had stopped talking about “pastoral care of the sick” and we had started to speak of Pastorale de La Santé, PastoraleSanitaria, Pastoral Health Care (ÁLVAREZ, 2013, p. 30).
Another progress on the relationship between religion and health is due to the 20th-century theologian Karl Barth. Barth rescues the view that health is linked to the project of life and salvation of the human being. According to Roccheta (1993), for Barth, every conception of salvation in the Old and New Testaments relates to health, from creation, food, work, rest, sickness, death, and the promise of salvation expected by Israel and realized in Christ.
In the contemporary day, important Christian religious reflections on health emerged. There are several disciplines and theological ememeffects inserted in health:
a) Theobiology. It is the relationship between theology and biology. Since human beings are incorporated organisms, the instruments of psychology, biology and psychophysiology can be used to elucidate the relations between theology, human body and religious experience (PANZINI, 2004).
b) The theology of the body. It gains expressiveness in the pontificate of Pope John Paul II, as a working title for his first catecheses, taught between 1979 and 1984 during the General Audiences. In them, the Pope addressed issues related to Christian life, including health, the relationship of man and woman in the spousal meaning of the human body, the nature and mission of the family, marriage, celibacy, the spiritual struggle of man’s heart and the prophetic language of the human body.
c) Within the theological reflection on the Christian message in action and the Church’s mission in society, practical theology arises, which seeks to practice theological teachings through pastoral actions aimed at people in different situations, such as: immigrants, prisons, children, youth, the elderly and the sick. In the latter, the action of the pastoral care of health is situated. According to the Document of Aparecida, the Pastoral da Saúde seeks to “respond to the great questions of life, such as suffering and death, in the light of the death and resurrection of the Lord”. Its purpose is “to promote, care for, defend and celebrate life, making present in history the liberating and saving gift of Jesus, who came to bring us life and life in abundance” (DURÃES E SOUZA, 2011, p. 11). Within the theological context of health, abundance is to have a sense of living even in the midst of the human condition of the disease. This becomes a liberating act to the extent that it is not limited to health only in having (or not) an illness. Therefore, life in abundance in Jesus is a life that transcends the human condition of illness, that is, it is not just to bring a life with health, but a life of salvation. For Martins (2010), Pastoral da Saúde is the relationship between the Christian community and the various health-related environments, from political bodies, such as local health councils, to solidarity visits to the sick in hospitals and homes.
d) In the 1960s a theology related to the Church’s mission in the liberation of social, political and economic oppression sprees suffered by the Latin American people. Liberation theology drives communities composed of dissatisfied members of the popular classes to fight for housing, transportation, basic sanitation, street lighting, education, daycare and health (ROSSI, 2002).
e) Moral theology. It deals with issues involving human morality and specifically seeks to guide Christians to the reality of life, including various themes on health — such as cybernetics, cloning, human dignity, embryo and foetus, embryonic stem cell research, medical technology, nanotechnology, aging and the elderly, anti-aging interventions, terminal patients and major ethical issues (TRASSFERETTI , 2013).
f) Also noteworthy is the proposal of the theologian Camiliano Francisco Álvarez on a health theology. For Álvarez (2013), a health theology is based on a theological discourse oriented towards Christian and pastoral praxis, in which health is a gift and mission of the Church, manifested in the individual and community experience of faith with the proclamation of God’s saving history, and a dynamic harmony between body, psyche and spirit. Therefore, the science of religion as, health theology needs to seek contrast with psychology and medicine in order to harmonize the proclamation of salvation and health services, such as the practice of hospital care.
4. THE CHRISTIAN TRADITION AND HEALTH PROFESSIONALS
During the history of humanity, health work has always been linked to religiosity/spirituality.
It would be a theoretical improperty to start the characterization of medicine without linking it to religion, since one of the most evident aspects in the advent of medicine is its intimate association with magic and religiosity, which is a constant in all civilizations and times (HEIMANN, 2003, p. 67).
In fact, medicine and religion are areas that have in common the issue of human care, expressed in health care. Contemporary medicine focuses mainly on the care of physical health, while religion looks at health from a spiritual perspective, with emphasis on relationality (care in the relationship with others, with oneself and with transcendence). Many ancient civilizations have developed their health service in the figure of a medical priest, such as the divine healing power in the figures of shamans, shamans of indigenous tribes, druids of ancient European civilizations, and healers and sorcerers of african tribes and Oceania (BOTSARIS, 2011).
Within the Christian tradition there is evidence of the relationship between clerics/religious and the health service. For example, one is among the apostles of Jesus, St Luke, an evangelist physician. According to the historical presentation of Alexsandro Silva (2010), for Justino (ca. 100—165), providing services to the sick was an indispensable condition for being a deacon or participating in the Christian community. The theologian Éfrem (ca. 306—373) built a hospital in Edessa for plague-infected. The Eustácio Bishops of Sebaste (ca. 356—380), Basílio (ca. 360—379) e João Crisóstomo (ca. 347—407) built hospitals for the lepers. São Cesário de Arles (ca. 470—543) founded a hospital next to his cathedral. São Bento (ca. 480—547) practiced inn and infirmary in monasteries and botanical gardens, developing pharmacopoeia. Cassiodoro (ca. 490—581) was one of the first medical monks. São Roque (ca. 1295—1317), considered patron saint of various health-related professions, studied medicine and desired religious life in the cause of the sick. Friar João Gilbert Joffré in 1409 created one of the first psychiatric institutions with occupational therapy, that is, without the treatment of torture. São João de Deus (ca. 1495—1550) e São Camilo de Lellis (ca. 1550—1614), due to their dedications to health services, were declared by Leo XIII (1886) patrons of patients, hospitals and health professionals. São Luís Gonzaga (ca. 1568—1591) died in Rome caring for the sick. O cardeal São Carlos Borromeu (ca. 1538—1584) became so involved in the cause of the sick that he even had a home in the hospital. São Martinho de Porres (ca. 1679—1639) assisted the sick of all ethnicities. São Vicente de Paula (ca. 1581–1660) was a major social activist of the structural causes of poverty and disease. Santa Luisa de Marillac (ca. 1591–1660) founded with Saint Vincent the congregation of the “Daughters of Charity”, which created hospitals and care homes for the sick (SILVA, 2010, pp. 17-22).
Slowly, in the low Middle Ages and at the beginning of modernity, the role of the medical clergyman is diminished due to the advances of medical courses in the universities of Bologna, Paris, Oxford and Salamanca, which now give the medical category a doctor’s degree in the attempt to characterize and oflaw an occupational identity, because before this doctors were seen as healers, a figure that , was sometimes linked to the priesthood (LANDMANN, 1984). The Church itself also noted this need for an occupational identity for the physician, as many clerics lost their religious vocation because they had more medical assignments than ecclesiastical. In this sense, the Council of Clermont, in the 11th century, failed the participation of clerics in medical operations (XAVIER FILHO, 1993). Pope Innocent III (1139) also banned the clergyman in the practice of medicine. Boniface VIII (1302) uprightd this prohibition (ALARCOS, 2006).
However, according to Pitta (1991), only from the 19th century did physicians begin to fulfill their office and occupation without being tied to a religious/spiritual aspect, due to the technological focus and the provision of services from the Industrial Revolution, in which the medical-priest model came to be seen as something artisanal. Then, a technical model of health work emerges, and health professionals assume specific functions, “such as the clinical physician, the laboratory, the nurse, the physiotherapist, the surgeon, the attendants, etc.” (HEIMANN, 2003, p. 37).
In contemporary times, this model based on technical efficiency and the focus on the provision of services is prevalent, having this a positive side when technology helps to cure and treat diseases that in past centuries were incurable, providing better quality of health to humanity. However, the indiscriminate use of technology, although crowded with good intentions, can result in the abandonment, often unintentional, of other respectable human dimensions, such as comfort and pain control, communication, significant values and, especially, spiritual and religious issues. In this sense, there is “a challenge to health professionals to answer questions about the balance between health and spirituality” (PERES, 2007, p. 86). That is, a resumption in integrating religiosity/spirituality as part of the work of health professionals.
1- It is considered that the etymological meanings of spirituality and health are associated in meanings, such as, in the meaning and purpose of life, this influences the science of health and religion, both in the academic meaning of the terms and in the practices of care among health professionals, who currently seek an integral view between the body and the spirit.
2- It is considered that there are religious groups that propose to seek health as one of their religious purposes. They are religions that prescribe and proscribe doctrines or teachings about healthy behavior. In this context, because most of the population was Christian, it used the Christian religion as an example. In this sense, it is pointed out that all religions associate spiritual practice with the state of health-disease (LEVIN, 2003). Therefore, new studies on other religious traditions and their perspectives on health are necessary. Such as spiritism, which understands the notion of health as functioning, interaction, with stability, to which every human being (incarnated) is composed spirit-spirit-matter. Also, studies are needed on groups without religion, which can understand the notion of health as something related to the state of mind, joy and sad, good and bad, rather than religious practices (GERONE, 2015).
3- It is considered that research in the area of health finds that religion is a powerful psychological and social factor, which greatly influences people’s health, practices and healthy behavior, diet, medication and others. In this sense, health science, such as neurology, neuroscience and psychology, can research the psychosocioneurological effect of faith in the disease-health process, such as the impact of religious-spiritual coping on recovery and medical treatment.
4- It is considered that currently there are areas of health inserted in the science of religion, such as the psychology of religion. There are areas of religion inserted in health, such as reflections theologies. In this sense, further studies are needed in both sciences, which have an interdisciplinary view on spirituality and health.
5- It is considered that religion is historically associated with health, especially in this study, realizes that the Christian religion has developed health services over time. It is common to find medical priests, or religious practices in health care. This historical process together with the majority of the population being Christian challenges health professionals in dealing with health and spirituality issues.
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APPENDIX – FOOTNOTE REFERENCE
2. Art and technique of preparing basic medicines, active and supporting ingredients, insums and compounds.
 Master in Theology from PUC/PR. He has a specialization in Organizational Behavior; Specialization in Neuropsychopedagogy; Specialization in Philosophy and Sociology; Specialization in Teaching higher education. MBAs in Administration and Management with emphasis on spirituality and religiosity in companies. Graduated in Commercial Management. Bachelor of Theology. He holds a Degree in Philosophy and a Degree in Pedagogy.
Submitted: August, 2020.
Approved: September, 2020.