International Journal of Integrated Care, 21 December 2006 - ISSN 1568-4156
Book review
Integrating spirituality in health and social care: perspectives and practical approaches
Edited by Greenstreet Wendy
Oxford: Radcliffe Publishing, 2006, pp 177,
ISBN 1 85775 646 0
Nick Goodwin, Senior Lecturer, Health Services Research Unit, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK

There have been many texts over the years examining issues to do with emotional health and well-being, most of which provide a discourse to argue that the practice of healing and the art of medicine have become overly ‘medicalised’ to the detriment of more integrated and holistic responses to people's health and illness. For example, in Janzen's The Social Fabric of Health [1] it was argued how different cultural definitions of health' internationally tended to emphasise the importance of social and behavioural relationships rather than the act of healing or the availability of cures. One such example is the Congolese notion of ‘obusinge’, a local word used in parts of Zaire to reflect the state of an individual's internal spiritual wellbeing and their ability to cope with life events such as births, conflicts, illnesses and bereavements. Whilst individuals in such countries place a mystical interpretation on the attainment of ‘obusinge’, those that have deconstructed the term have shown that it is not just an expression that reflects a state of spiritual wellbeing as a result of being free from illness, but is primarily related to a range of social factors such as peace and friendship between families and the availability of essentials such as land, food, good water, education and freedom from debt [2].

This edited book is a further contribution to this field of work by examining the complex nature of the concept of ‘spiritual care’ and to consider the role that spirituality should play in health and social care. The aim of the book, presented in four sections and across twelve chapters, is to offer readers (particularly professionals) with an introduction to the subject and to challenge them to undertake a ‘discomfort of thought’ by embracing a concept that is somewhat alien to the empirical focus of today's evidence-based professional practice. The secondary aim, rather less well achieved, is in some way to offer practical guidance on how to adopt ‘spiritual care’ in every day practice.

The first section of the book, comprising three chapters written solely by the editor, explores the concept of spirituality and what it means in relation to the health and social care professional. With great academic rigour, the author first takes the reader into a conceptual understanding of the term spirituality by describing how a dual interpretation of the concept has evolved that, on the one hand, emphasises feelings within the inner-self whilst, on the other, is expressed through external relationships or manifest in religious or mystical following. The second chapter expands on the discussion by providing a historical examination of how the term spirituality has been interpreted and how it has evolved, revealing a range of possible descriptors but no set definition. We learn from this that spirituality, like wellbeing, is a ‘holistic’ term open to differing cultural interpretations. The third chapter then examines the relationship between spirituality and wellbeing. This chapter argues that each person has a degree of ‘spiritual need’ (whether or not articulated or believed by the person) the acuteness of which need might be measured along a continuum of ‘spiritual wellbeing’. Since people have variable ‘spiritual needs’, achieving ‘spiritual health’ reflects the degree to which these needs are fulfilled. As with the other opening chapters, the book provides an expert summary of these debates—particularly in a section assessing how such spiritual needs might be measured and assessed in practice. In the conclusion to the first section, it is argued that professionals might use ‘spiritual assessments’—through observational and listening techniques during dialogues with patients—and in so doing identify those spiritual aspects of care that enable wellbeing to be achieved.

The first section of the book is certainly interesting (if rather difficult for the general reader given the nature of the academic language used) and leaves the reader with an understanding of the intrinsic value of spiritual care in improving wellbeing. However, the book offers little in the way of how such care may be conducted and what known additional benefit to ‘traditional’ care might be gained.

It is the second section of the book, again across three Chapters (4–6), that is more practice-focused in examining how spiritual care may be adopted in health and social care settings. These explore the mechanisms of how spiritual care may be conducted and by who (Chapter 4) so emphasising the barriers in medicalised services in gaining access to creative forms of therapy. Chapter 5, on ‘sustaining hope’, begins to examine the importance of mental wellbeing whilst Chapter 6 examines how ‘spirituality’ is also a factor in maintaining a healthy working environment.

However convinced one might be by these chapters, the book fails in its quest to provide any form of ‘practical guide’ for health and social care professionals in integrating the concept into daily routines. There is no real guide for ‘how to’ develop such roles in practice other than to say that the raising of personal and professional awareness of ‘spirituality’ may promote this perspective amongst professionals, and that professionals have a duty to develop and be aware of patients' and clients' spiritual needs. However, the greatest and most surprising omission is that the book does not once examine mental health care services and policies that, for example in the UK, support the development of core competencies amongst mental health workers that focus on the recognition of, and respect and support to, spiritual wellbeing. This is somewhat incredulous since these policies aim at exactly what this book is trying to examine—how to enable individuals to identify and address their personal spiritual needs; to understand people's behaviours through therapies, coping strategies, and independent living skills; and the role of health and social care professionals in facilitating the process.

These deficiencies are revealed in the final two sections of the book. Chapters 7–9 examine the relationship between spirituality, religion, philosophy and culture whilst Chapters 10–12 look at examples in which therapies, art and music can all contribute as alternative forms of spiritual care. Whilst all these chapters have some interest in their own right, they show where the heart of this book lies—not in the practical or institutionalised world of the health and social care professional, but in the conceptual world where spirituality is argued to be the core to good relationships and good health and that alternative approaches to ‘care’ need to be given more prominence within health and social care systems.

Overall, this book provides an interesting read. Whilst it provides an expert analysis on the concept and importance of ‘spirituality’ in promoting good health and wellbeing, it does not in any substantive way provide a guide to how such approaches might be integrated into the daily practice of professionals. For that debate, the reader might be better advised to examine developments in literatures that focus on mental health care or the development of self-care strategies that aim to enable people to live independent, active and healthy lives in communities that support their wider social needs.

Janzen J. The social fabric of health: an introduction to medical anthropology McGraw-Hill: 2001.
Lehmann U, Friedman I, Sanders D. Review of the effectiveness of community-based health workers in Africa, Joint Learning Initiative Working Paper 4-1, February 2004. Available from: URL: