Spirituality

From Pauline usage to the spiritual life

A church historian's account traces the word to the Latin noun spiritualitas, itself tied to the adjective spiritualis and, ultimately, to the Greek pneuma used in the letters of Paul. In that usage a spiritual person was one in whom the Spirit of God dwelt, and the contrast was with the flesh as an attitude to life, not with the body. This moral sense stayed in use in the West until the twelfth century, when scholastic theology began using spiritual to set rational humanity apart from the rest of creation.

The same account reports that in the Middle Ages the noun most often referred to the clerical state, so that the spirituality meant the clergy. It became established as a name for the spiritual life in seventeenth-century France, sometimes pejoratively, then faded from theology until the late nineteenth and early twentieth centuries, and entered English through translations of French writing. After the Second Vatican Council in the early 1960s it began to replace older labels such as ascetical theology and mystical theology, and the author describes it as the dominant term from the 1970s.

Entry into social science and health research

By 1997 a team of psychologists could write that interest in religiousness and spirituality had grown over the previous twenty years and that social scientists were trying to define both terms. They observed that the words had acquired narrower connotations over time, with religiousness increasingly described as narrow and institutional and spirituality as personal and subjective. The World Health Organization (WHO) project that produced its spirituality, religiousness and personal beliefs module ran focus groups with 142 participants in 15 groups, including health professionals, patients, religious persons and atheists, before a pilot of 105 questions at 18 centers worldwide.

Within health care, a consensus conference sponsored by a private foundation met on February 17 and 18, 2009, in Pasadena, California, to set recommendations for spiritual care within palliative medicine. Two further conferences in 2012 and 2013 built on it to propose standards for integrating spiritual care across the whole health care continuum. These were expert consensus processes, and the sources reviewed describe them as such rather than as trials.

The spiritual revolution thesis

A locality study in Kendal, England, led from the late 1990s by sociologists of religion at Lancaster University, produced the 2005 book The Spiritual Revolution. According to the project's page, it asked whether culture was shifting from institutional religion toward personalized spirituality, and it found that the most dramatic claims of change were not supported. Its conclusion was that spiritualities engaging personal experience fared better than religions demanding conformity to a higher truth, which the authors attributed to a subjective turn toward inner experience and personal well-being.

No single agreed definition

The 1997 study by Zinnbauer and colleagues begins from the observation that little consensus exists on what the terms mean, noting that one researcher had called spirituality a fuzzy concept. It cites definitions ranging from a response to a divine call, to a subjective experience of the sacred, to a realm of human potential concerned with ultimate purposes. In their own sample of 346 people from 11 groups, spirituality was most often defined in personal or experiential terms such as a relationship with a higher power, while definitions of religiousness included both personal beliefs and organizational elements.

Hill and Pargament, in a 2003 review, argue that global measures such as church attendance or self-rated religiousness and spirituality do not show how or why either affects health. They point to measures tied more closely to health, such as closeness to God, religious support and religious struggle. Koenig defines religion as beliefs, practices and rituals related to the transcendent, usually within a community, and spirituality as a personal search for sacred meaning, but he treats the two as overlapping and uses them together.

Definitions used in health care and by WHO

The 2009 consensus conference definition, as summarized in the 2014 follow-up report, describes spirituality as the aspect of humanity concerned with how individuals seek and express meaning and purpose, and how they experience connection to the moment, to self, to others, to nature and to the significant or sacred. The WHO instrument does not adopt one definition. Its items use the words spirituality, religion and personal beliefs together, and respondents are asked to answer in terms of their own belief system, whether religious, spiritual or personal.

The WHO questionnaire measures how such beliefs relate to quality of life through items on matters such as faith, awe and inner peace. It is a measurement tool for quality of life and is not itself a definition of spirituality, and a generic English version is not meant to be used without a culturally adapted version.

Spiritual but not religious

Spiritual but not religious is a self-description, and its prevalence depends on how a survey asks. In the 1997 study, 74 percent of respondents chose spiritual and religious, 19 percent spiritual but not religious, 4 percent religious but not spiritual and 3 percent neither, from a sample that was not nationally representative. A 2023 Pew Research Center survey of 11,201 U.S. adults found that 70 percent describe themselves as spiritual in some way and 22 percent as spiritual but not religious, with open-ended answers mixing traditional religious beliefs, connection to something bigger and inner peace.

In palliative and other health care

In the consensus model described in the 2014 report, spiritual care is delivered by an interprofessional team that includes trained chaplains as professional members. Implementation involves spiritual screening or history-taking as part of routine assessment, and all providers are trained in compassionate presence and cultural sensitivity within their scope of practice. The report notes that policies on spiritual care are not always based on evidence or evaluated methodically, although evidence is accumulating.

In wellness and mind-body-spirit settings

The Kendal study described a holistic milieu of mind-body-spirit activities alongside the congregational life of churches. The project's page names practices such as yoga and Reiki as examples of what might compete with churchgoing. A church historian adds that contemporary writing links spirituality to a quest for the sacred and for meaning, to integrating life as a whole, and to thriving, and that many web definitions stress inner experience and personal well-being.

In this encyclopedia the word is used as an umbrella idea for the practices listed under Metaphysical, such as Spiritual Direction, Reiki, Energy Healing, Mindfulness and Shamanic Healing. Each has its own page, and the sources reviewed here do not assess those practices individually.

What the idea is said to offer

Adherents and health-care consensus groups describe spirituality as a source of meaning, purpose and connection. The consensus conferences held that spiritual care is a fundamental component of high-quality palliative care, a belief on which their recommendations rest. Koenig's review lists the outcomes studied in relation to religious and spiritual involvement, including well-being, hope, depression, suicide, substance abuse, heart disease and mortality, and states that he proposes only natural psychological, social and behavioral pathways and does not claim supernatural mechanisms.

Critical views of the claims

The church historian reports that some commentators, among them Jeremy Carrette, regard the present enthusiasm for spirituality as another offshoot of consumerism, and he raises the question of whether spirituality is becoming little more than a comforting form of therapy. Zinnbauer and colleagues warned against polarizing individual spirituality as good and organized religion as bad, since religion in the broad sense covers the personal and the institutional, the helpful and the harmful.

Observational findings and reviews

Koenig's 2012 systematic review of more than 3,300 quantitative studies published between 1872 and 2010 reports that 61 percent of 444 depression studies found lower depression with greater religious or spiritual involvement, 79 percent of 326 well-being studies found a positive association, and 68 percent of 121 mortality studies found longer survival. The same review reports that 6 percent of depression studies and 11 percent of anxiety studies found increases, notes that many anxiety studies were cross-sectional, and states that cross-sectional designs cannot show whether the involvement or the health state came first.

A 2022 systematic review in JAMA screened 8,946 articles on serious illness and 6,485 on health outcomes, kept only studies with validated spirituality measures and low to moderate risk of bias, and used expert Delphi panels to synthesize them. The panels proposed implications such as incorporating spiritual care into care for serious illness and recognizing spirituality as a social factor associated with health. The abstract frames the health-outcome findings mainly around spiritual community, and the conclusions rest on expert consensus about the evidence as well as on the studies themselves.

Intervention studies

A 2017 meta-analysis of eight randomized trials of therapeutic life review in people with terminal or advanced cancer reported small to moderate improvements over usual care in the meaning-of-life domain of spiritual well-being, general distress and overall quality of life. Only the quality-of-life effect remained statistically significant at follow-up of up to three months, and the authors cautioned that the trials were few and methodologically weak. Life review is one specific intervention, and this result should not be carried over to spirituality as a whole.

A 2023 systematic review of non-pharmacological primary care interventions for older patients with palliative care needs found four randomized trials with 268 patients, one of which tested spiritual history taking by nurses and general practitioners. No intervention in the review showed a statistically significant effect on quality of life, and the certainty of the evidence was rated low. The abstract does not report the spiritual history trial separately.

What the sources do not establish

None of the sources reviewed tests whether a spiritual reality exists, and the sources describe no way to do so. Searches of PubMed for spirituality definitions, consensus statements, intervention reviews and spiritual harm were run on October 6, 2026, together with web searches for Cochrane reviews. No Cochrane review specific to spirituality as such was identified, and a search of a second literature index could not be completed because its monthly quota was exhausted. The observational associations above may reflect social support, health behaviors or reverse causation, and Hill and Pargament note that broad measures cannot show why associations arise.

Spiritual struggle and negative religious coping

A meta-analysis of 49 studies and 105 effect sizes found that negative religious coping, such as feeling punished by God or attributing a stressor to the devil, was associated with more depression, anxiety and distress. It did not find the expected link between negative coping and lower positive adjustment, and the authors suggest some such struggles may coexist with growth. The studies were mostly cross-sectional and self-reported, so the direction of effect cannot be established from this meta-analysis alone, although the authors point to longitudinal studies that suggest negative coping may add to distress.

The 2014 consensus report states that negative spiritual and religious beliefs can cause distress and increase the burdens of illness. Hill and Pargament likewise list religious struggle among the dimensions that research on health should measure. The sources reviewed do not give rates of such struggle in the general population.

Spiritual harm and abuse

A 2025 systematic scoping review of literature on clergy sexual abuse in Catholic settings describes spiritual harm as a distinct phenomenon with spiritual, emotional and psychological components. Reported features include a ruptured relationship with God, loss of spiritual coping, distrust of religious communities, difficulty with prayer or sacraments, anxiety, depression, trauma symptoms, and feelings of betrayal and guilt. The review found that the term is not consistently defined and is used interchangeably with others such as spiritual trauma and religious distress.

The review was limited to English-language peer-reviewed articles from 2002 to 2022, concerned one denomination, and included few first-person accounts. The sources reviewed here do not give rates of spiritual abuse across religious or non-religious settings, and they do not address harm in wellness or mind-body-spirit settings specifically.

Care boundaries and training

A 2025 review in the Journal of Nervous and Mental Disease describes an expanded diagnostic category in the fifth edition text revision of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5-TR) titled Moral, Religious, or Spiritual Problem, intended to recognize that such problems can affect mental health. Spiritual belief or practice does not replace assessment or treatment of medical or mental health conditions, and a person in crisis or with new or worsening symptoms is directed by conventional guidance to seek qualified care.

The sources reviewed identify no regulation, protected title or training standard for spirituality as a general term. Chaplains are described as trained professional members of care teams in the consensus model, but their certification systems were not reviewed here.