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Spirituality illustration by Anna Maltese

Spirituality illustration by Anna Maltese

What is Spirituality, Anyway?
Is “Spirituality” so Broadly Defined that Testing for it is Meaningless?

There has been an explosion of research addressing spirituality over the past two decades. The use of the term “spirituality” is a staple of our everyday vernacular, whereby many have friends who will identify as spiritual, but not religious. The ubiquity of the “spiritual” label is curious given that a definition of spirituality is rarely discussed. Granted, people are often not required to precisely define concepts that they are discussing, so the fact that spirituality means different things to different people is largely irrelevant in everyday conversation. However, this definitional ambiguity is problematic for researchers who seek to explore the relationship between spirituality and other constructs. In other words, while the average citizen can communicate in imprecise ways and get away with it, scientists and researchers do not have that luxury.

The idea of spirituality is so varied that everyone experiences it differently. If this is the case, how can a measurement of spirituality be valid for everyone?

The current paradigm within the spirituality literature is that higher spirituality has a tendency to be associated with better health. Higher spirituality is allegedly linked to numerous health benefits (e.g., satisfaction with life, better general health 1, less depression2, etc.), and there has been an effort within the literature to promote spiritual diversity in the healthcare system.3 There is also academic interest in how spirituality components relate to quality of life assessments4, as well as movements to incorporate spirituality into clinical practice.5 In short, spirituality is experiencing a prolonged interest from both the academy and the public at large. However, these positive findings are somewhat marred by a fundamental issue within the associated literature, namely what spirituality actually is.

Within the academic literature there does not appear to be an agreed-upon definition of spirituality, while there also appear to be radically different conceptualizations of what “being spiritual” means. One review paper with the express intent of clarifying the definition of spirituality summarized its findings by stating, “Spirituality is an inherent component of being human, and is subjective, intangible, and multidimensional.”6 This statement means that all humans are spiritual although they experience this spirituality differently. However, such a statement is not helpful because it could be used to justify any range of definitions. Offering carte blanche to the spirituality definition does nothing to advance the field of research. If everything can be spiritual then … logically, any measure purporting to measure spirituality is justified.

Surprisingly, while definitions of spirituality are difficult to come by, measures of spirituality are not. In a recent review of various spirituality measures7, a journal article listed close to three dozen measures of spirituality. These measures were classed according to their purpose (e.g., general spirituality, spiritual well-being, spiritual needs, etc.) and were rated on their quality. The purpose of the review article was to organize existing measures of spirituality into a typology that would allow for a better understanding of the measures’ purposes. Within the article, the authors devoted reasonable space to providing evidence that these measures were reliable (i.e., if a participant takes the survey again their score is close to the first time); but there was very little discussion on whether the measures were valid (i.e., whether the measures were actually measuring spirituality). For the purposes of the review article, the working definition of spirituality was, “a sense of transcendence beyond one’s immediate circumstances… purpose and meaning in life, reliance on inner resources, and a sense of withinperson integration or connectedness.” As with the previously quoted definition of spirituality, this definition is less than helpful as it could mean a host of different things.

“In the future, science will be able to explain everything” (Spiritual Involvement and Beliefs Scale8). Oddly, agreement with this statement would result in lower spirituality scores.

How would one go about defining spirituality in a way that is valid; that is, ensuring that a definition is uniquely and exclusively spiritual? Defining terms scientifically is often difficult even with concepts that everyone agrees exist (e.g., intelligence, happiness, hunger). The spirituality literature appears to sidestep this problem by defining a person’s level of spirituality by what he/she may score on spirituality indices. This approach is common within social science research as it provides a meaningful basis of comparison between studies. For example, intelligence can be discussed in a general way that people can understand, and researchers will use a person’s score on “IQ Test X” for comparing people between studies. However, the working definitions of spirituality are extremely varied, occasionally contradictory, and often include abstractions without obvious meaning. A consequence of this variety of definitions is that spirituality can only be meaningfully discussed by scores on specific measures, rather than in a broad conceptual way. While this approach may allow the literature to move forward (in terms of volume of studies), it does nothing to clarify what spirituality actually is.

This problem is exacerbated by the high variability of the items contained within spirituality measures. Spirituality measures will often inquire about concepts that may not be immediately associated with one’s perception of spirituality. Questions for spirituality address topics such as social interaction, meaning in life, environmental consciousness, etc. Contrasted with these are questions about interconnectedness, oneness with the universe, higher powers, benefits of prayer, etc. Some spirituality measures even have items that ostensibly inquire about the limitations of science: “In the future, science will be able to explain everything” (Spiritual Involvement and Beliefs Scale8). Oddly, agreement with this statement would result in lower spirituality scores. Because spirituality is often being defined by the measure used to assess a person’s spirituality score, it is informative to investigate the specific items that are assessing spirituality.

Often, spirituality measures will have items related to social functioning. For example, the Daily Spiritual Experiences Scale contains the items, “I accept others even when they do things that I think are wrong” or “I feel a selfless caring for others.”9 In a similar vein the Spirituality Assessment Scale10 presents items such as “I have a general sense of belonging” or “I feel a kinship to other people.” In addition, the Spiritual Involvement and Beliefs Scale includes items such as “When I wrong someone, I make an effort to apologize” and “I examine my actions to see if they reflect my values.” These questions appear to be addressing how persons interact with other people, and presumably, the better social skills a person has, the healthier he/she is likely to be. However, the answers to these items are counted towards a global spirituality score. Global spirituality scores, which are in part the product of questions about social functioning, are in turn linked to better health outcomes.11 Yet, it is confusing as to why the word spirituality encompasses these characteristics, especially given that other measures (e.g., social support assessments) explicitly investigate these topics.

A different issue plaguing the spirituality literature is whether spirituality is intrinsically linked to a belief in god(s). Nearly all spirituality measures have at least one item that references god(s), higher powers, Creators, etc. (e.g., Spiritual Perspective Scale12, Spiritual Assessment Scale), and numerous spirituality measures have multiple items associated with a god construct (e.g., the Brief Multidimensional Measure of Religiousness/Spirituality13, Spiritual Involvement and Beliefs Scale, Spiritual Health Inventory14). To be fair, these measures will often provide caveats that god(s) is whatever you define him/her/it to be, but this does not change the fact that this question does not apply to everyone. One may argue that deities represent a “power greater than oneself,” but this is a semantic argument. Using a placeholder that is functionally undifferentiated from god(s), but refusing to label it “god(s)” seems to be without benefit to understanding spirituality. Persons who object to “god-related questions” probably do not object to the specific word selection (i.e., “god”), but probably do object to the overarching concept (i.e., “a metaphysical unproven construct”).

The fact that god(s) is a recurring topic within many spirituality measures raises a number of important questions for researchers. Having items on surveys that are only answerable if one assumes the existence of deities seems to be a step away from the idea that spirituality is “an inherent component of being human.” With all other things being equal, persons who do not believe in god(s) (i.e., atheists) will be “penalized” on their spirituality score because of their non-belief. Given the prevalence of questions regarding belief, one could reasonably conclude that spirituality necessarily includes a belief in some form of higher powers. If this is the case, then spirituality is not an inherently human construct, as not all humans can or do believe in deities.

To address this criticism, measures may allow items to be omitted if non-applicable to persons; however, this fix does not address the underlying objection. Either conceptualizations of deities are necessary for an assessment of spirituality (which would exclude atheists), or conceptualizations of deities are not necessary for an assessment of spirituality (which would raise questions about why so many items address deities). In either case, it is clear that spirituality has either substantive definitional issues or substantive measurement issues, or both. Of course, researchers could argue that deities are often a part of many persons’ spirituality, but are not necessary. However, all this demonstrates is that the idea of spirituality is so varied that everyone experiences it differently. If this is the case, how can a measurement of spirituality be valid for everyone?

Skeptic 21.4 (cover)

This article appeared in Skeptic magazine 21.4 (2016).
Buy this issue

It is important to note that these aforementioned spirituality measures have been published in peer-reviewed journals. They are reliable, have convergent validity, and they can be used to predict a variety of health outcomes. These facts are not disputed. However, it must also be made clear that if the items assessing spirituality are about social functioning, life purpose, or emotional maturity, then it is curious as to what makes these items “spiritual”. That these items are related to health outcomes is not surprising given that a bounty of literature has already established this in other fields. If the items assessing spirituality are suspect, then the reliability of the measures is ultimately immaterial to proving the benefits of spirituality. It would be as though “not smoking” was included as an indicator of spirituality, and if researchers then marvelled over the benefits of being spiritual. If spirituality measures do not uniquely predict health outcomes (beyond what is established by other constructs), then researchers should either modify how spirituality is being assessed or critically consider whether items within these surveys unambiguously measure spirituality. Ultimately, much of the investigation into spirituality seems less like research and more like recycling. END

About the Author

Dr. David Speed completed his master’s and doctorate at Memorial University of Newfoundland. His primary field of interest is religion and health, but will research anything that “catches his eye”. He is a member of the Atheist Research Collaborative, which is a non-partisan group that researches atheism and irreligion. When David is not researching, teaching, or working, he is at home with his wife Betsy and his daughters Aliya and Charley.

  1. Dunn, K. S. 2008. “Development and Psychometric Testing of a New Geriatric Spiritual Well-Being Scale.” International Journal of Older People Nursing, 3, pp. 161–169.
  2. Matheis, E. N., Tulsky, D. S., & Matheis, R. J. 2006. “The Relation between Spirituality and Quality of Life Among Individuals with Spinal Cord Injury.” Rehabilitation Psychology, 51, pp. 265–271.
  3. Pesut, B., Fowler, M., Taylor, E., Reimer-Kirkham, S., & Sawatzky, R. 2008. “Conceptualising Spirituality and Religion for Healthcare.” Journal of Clinical Nursing, 17, pp. 2803–2810.
  4. O’Connell, K. A., & Skevington, S. M. 2010. “Spiritual, Religious, and Personal Beliefs are Important and Distinctive to Assessing Quality of Life in Health: A Comparison of Theoretical Models.” British Journal of Health Psychology, 15, pp. 729–748.
  5. Carlson, T., McGeorge, C., & Toomey, R. 2014. “Establishing the Validity of the Spirituality in Clinical Training Scale: Measuring the Level of Integration of Spirituality and Religion in Family Therapy Training.” Contemporary Family Therapy: An International Journal, 36, pp. 310–325.
  6. Tanyi, R. A. 2002. “Towards Clarification of the Meaning of Spirituality.” Journal of Advanced Nursing, 39, pp. 500–509.
  7. Monod, S., Brennan, M., Rochat, E., Martin, E., Rochat, S., & Büla, C. 2011. “Instruments Measuring Spirituality in Clinical Research: A Systematic Review.” Journal of General Internal Medicine, 26, pp. 1345–1357. doi: 10.1007/s11606-011-1769-7
  8. Hatch, R. L., Burg, M., Naberhaus, D. S., & Hellmich, L. K. 1998. “The Spiritual Involvement and Beliefs Scale: Development and Testing of a New Instrument.” Journal of Family Practice, 46, pp. 476–486.
  9. Underwood, L. G., & Teresi, J. A. 2002. “The Daily Spiritual Experience and Scale: Development, Theoretical Description, Reliability, Exploratory Factor Analysis, and Preliminary Construct Validity Using Health-Related Data.” Annals of Behavioral Medicine, 24, 22–33.
  10. Howden, J. 1992. Development and Psychometric Characteristics of the Spirituality Assessment Scale. Texas Women’s University.
  11. Matheis, E. N., Tulsky, D. S., & Matheis, R. J. 2006. “The Relation between Spirituality and Quality of Life Among Individuals with Spinal Cord Injury.” Rehabilitation Psychology, 51, pp. 265–271.
  12. Garner, L. F. 2002. “Spirituality among Baccalaureate Nursing Students at a Private Christian University and a Public State University.” Christian Higher Education, 1, pp. 371–384.
  13. Johnstone, B., McCormack, G., Yoon, D., & Smith, M. 2012. “Convergent/Divergent Validity of the Brief Multidimensional Measure of Religiousness/ Spirituality: Empirical Support for Emotional Connectedness as a ‘Spiritual’ Construct.” Journal of Religion & Health, 51, pp. 529–541.
  14. Korinek, A. W., & Arredondo Jr., R. 2004. “The Spiritual Health Inventory (SHI): Assessment of an Instrument for Measuring Spiritual Health in a Substance Abusing Population.” Alcoholism Treatment Quarterly, 22, pp. 55–66.

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