Abstract
In the previous chapter, the value of nondirectiveness was shown to be a contested and defining feature of genetic counseling. It was interpreted from the standpoint of the teaching, psychotherapeutic and responsibility models and then respectively applied to Debbie’s case. The responsibility model proposes that genetic counselors need to acknowledge the presence of directiveness and nondirectiveness in both meaning-making and decision-making processes. A key communication skill in genetic counseling –and all health care communication for that matter – is recognizing when directiveness or nondirectiveness is appropriate based on the current conversational score. One area where this skill is difficult to employ involves issues of spirituality and religion.
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- 1.
R. G. Resta and S. Kessler , “Commentary on Robin’s a Smile, and the Need for Counseling Skills in the Clinic,” Am J Med Genet A 126, no. 4 (2004): 437.
- 2.
For empirical studies that show hesitance of genetic counselors to engage in this activity, see L. M. Reis and others, “Spiritual Assessment in Genetic Counseling,” J Genet Couns 16, no. 1 (2007). and P. J. Boyle, “Genetics and Pastoral Counseling: A Special Report,” Second Opin (Chic), no. 11 (2004).
- 3.
One rough indicator of the spate of interest in this area is that 2283 of 2512 medical publications on “spirituality” and “medicine” have occurred in the last 15 years. These numbers are based on a key word search of “spirituality”and“medicine” in Pubmed, a large research database provided by the National Library of Medicine and the National Institutes of Health. An interesting historical and sociological question not pursued here is why there has been such a surge interest. The ethical question of the benefit and harms of the relationship between religion and medicine has been addressed. See Richard P. Sloan, Blind Faith : The Unholy Alliance of Religion and Medicine, 1st ed. (New York: St. Martin’s Press, 2006).
- 4.
A large literature in the humanities addresses the distinction between spirituality and religion . Medical researchers do not pretend to have sorted through the thicket of these conceptual nuances. They have adopted a stipulative definition that serves their purposes. Within the humanistic tradition, I think the biomedical community ’s preference is most compatible with a Hegelian understanding of the distinction that he worked out in Hegel, Miller, and Findlay., and in Georg Wilhelm Friedrich Hegel and Peter Crafts Hodgson, Lectures on the Philosophy of Religion : The Lectures of 1827, one-volume edition. ed. (Berkeley: University of California Press, 1988).
- 5.
To review other definitions of spirituality in the medical literature, see J. Dyson, M. Cobb, and D. Forman, “The Meaning of Spirituality: A Literature Review,” J Adv Nurs 26, no. 6 (1997), A. Moreira-Almeida and H. G. Koenig, “Retaining the Meaning of the Words Religiousness and Spirituality: A Commentary on the Whoqol Srpb Group’s “A Cross-Cultural Study of Spirituality, Religion, and Personal Beliefs as Components of Quality of Life” (62: 6, 2005, 1486–1497),” Soc Sci Med 63, no. 4 (2006).; W. McSherry and K. Cash, “The Language of Spirituality: An Emerging Taxonomy,” Int J Nurs Stud 41, no. 2 (2004).
- 6.
G. Anandarajah and E. Hight, “Spirituality and Medical Practice: Using the Hope Questions as a Practical Tool for Spiritual Assessment,” Am Fam Physician 63, no. 1 (2001): 83.
- 7.
Daniel Sheridan , “Discerning Difference: A Taxonomy of Culture, Spirituality, and Religion,” The Journal of Religion 66, no. 1 (1986): 43.
- 8.
Sheridan ’s proposal is an attempt to resolve the problem of defining religion and culture as different phenomena. When religion is defined broadly, i.e. Geertz ’s religion as cultural system, it becomes difficult to distinguish it from the concept of culture . See Clifford Geertz, The Interpretation of Cultures; Selected Essays (New York,: Basic Books, 1973), 87–125.
- 9.
Sheridan : 40. Sheridan specifies several features of culture : “Underlying this conception of culture are four implied factors: (1) a cosmology, (2) a view of the problematic of the human predicament, (3) a goal of transformation of the predicament, and (4) specific means of transformation of that predicament. The four factors describe a worldview.”
- 10.
Ibid., 44. His reference to plenum suggests spiritualities that are transformed without distinctions such as culture /nature. His “axial spirituality” is an allusion to Karl Jaspers description of the axial period (800–200 B.C.) of pivotal thinkers that transformed humanity’s self-understanding.
- 11.
Ibid., 45. Sheridan ’s taxonomy has some unsatisfactory consequences as do most stances at this level of categorization. The most important has to do with his demarcation of religion . By narrowing it to those modes of culture that look to a transcendent Other for assistance, some phenomena, e.g. most forms of Buddhism , that are traditionally referred to or self-ascribed as religions no longer fall under this mode of culture . Such phenomena would be more likely fall under plenum or axial spiritualities. This change in classification would not put Buddhism or Confucianism outside the purview of scholars of religion . Instead, Sheridan claims that it “obviates the dilemma of trying to show that Confucianism or Nazism is a religion , a quasi-religion , a philosophy of life, or an ideology . On this level of interpretation , the scope of the ‘study of religion ’ is universal both synchronically and diachronically.”(p. 44–45). In other words, ‘religious studies’ would be a form of cultural studies that approaches cultures as consisting of plenum/axial spiritualities and/or religions . The benefits and costs of this approach are related to the large net it casts for students of religion . One benefit is that it permits or invites comparison of cultural modes that seek to transform the human predicament. Relevant to this project, medicine and specific religions could be compared as distinct subcultures that seek to transform human health predicaments. One cost of Sheridan ’s taxonomy is the new set of boundary issues that concern whether a mode of culture actually seeks to ‘transform the human problematic’ or merely, for example, seeks to profit or distract from the human predicament. The complex circumstances and consequences of Sheridan ’s proposal cannot be rehearsed here in their entirety. As a stipulative prospect for understanding religion and religious studies, his taxonomy has promise at certain theoretical levels.
- 12.
Ibid.
- 13.
In informal conversation and unpublished documents, Larry Churchill has used this image of beliefs lodged in emotions .
- 14.
Thomas F. O’Dea, The Sociology of Religion, Foundations of Modern Sociology Series (Englewood Cliffs, N.J.,: Prentice-Hall, 1966). The notion of a limiting condition or its function equivalent has a long history in the sociology of religion . O’Dea’s work provides an example of a functionalist account of religion : “Thus functional theory sees the role of religion as assisting men to adjust to three brute facts of contingency, powerlessness and scarcity (and consequently, frustration and deprivation).”
- 15.
See Vanderbilt Center for Integrative Health, (Vanderbilt University Medical Center, 2007, accessed December 17 2007); available from http://www.vanderbilthealth.com/integrativehealth/.
- 16.
Some studies cited by Anandarajah are J. W. Ehman and others, “Do Patients Want Physicians to Inquire About Their Spiritual or Religious Beliefs If They Become Gravely Ill?,” Arch Intern Med 159, no. 15 (1999), D. E. King and B. Bushwick, “Beliefs and Attitudes of Hospital Inpatients About Faith Healing and Prayer,” J Fam Pract 39, no. 4 (1994).; T. A. Maugans and W. C. Wadland, “Religion and Family Medicine: A Survey of Physicians and Patients,” J Fam Pract 32, no. 2 (1991), O. Oyama and H. G. Koenig, “Religious Beliefs and Practices in Family Medicine,” Arch Fam Med 7, no. 5 (1998).
- 17.
L. C. Kaldjian, J. F. Jekel, and G. Friedland, “End-of-Life Decisions in Hiv-Positive Patients: The Role of Spiritual Beliefs,” Aids 12, no. 1 (1998).
- 18.
King and Bushwick.
- 19.
Ehman and others.
- 20.
Reis and others: 42.
- 21.
Ibid.
- 22.
Ibid.
- 23.
Sloan, 237–38.
- 24.
Ibid., 239.
- 25.
Ibid., 187.
- 26.
Ibid., 206.
- 27.
Ibid., 142.
- 28.
For sample of this literature see: A. Bussing, T. Ostermann, and H. G. Koenig, “Relevance of Religion and Spirituality in German Patients with Chronic Diseases,” Int J Psychiatry Med 37, no. 1 (2007), M. O. Harrison and others, “Religiosity/Spirituality and Pain in Patients with Sickle Cell Disease,” J Nerv Ment Dis 193, no. 4 (2005), H. G. Koenig, “Religion and Medicine Iv: Religion, Physical Health, and Clinical Implications,” Int J Psychiatry Med 31, no. 3 (2001), A. B. Wachholtz, M. J. Pearce, and H. Koenig, “Exploring the Relationship between Spirituality, Coping, and Pain,” J Behav Med 30, no. 4 (2007).
- 29.
Sloan cites several studies that indicate low psychiatric uptake of patients who think prayer worked for mental health conditions. Sloan, 187–89.
- 30.
Reis and others: 45.
- 31.
Ibid., 44.
- 32.
Ibid., 45.
- 33.
Ibid., 47.
- 34.
Ibid.
- 35.
Anandarajah and Hight.
- 36.
This percentage is based on the amount of counselors who found at least three out of four questions relevant in a given section.
- 37.
Reis and others, 48.
- 38.
Ibid.
- 39.
R. Kenen and J. Peters , “The Colored, Eco-Genetic Relationship Map (Cegrm): A Conceptual Approach and Tool for Genetic Counseling Research,” Journal of Genetic Counseling 10, no. 4 (2001): 289.
- 40.
J. A. Peters and others, “Exploratory Study of the Feasibility and Utility of the Colored Eco-Genetic Relationship Map (Cegrm) in Women at High Genetic Risk of Developing Breast Cancer,” Am J Med Genet A 130, no. 3 (2004).
- 41.
J. A. Peters and others, “Evolution of the Colored Eco-Genetic Relationship Map (Cegrm) for Assessing Social Functioning in Women in Hereditary Breast-Ovarian (Hboc) Families,” J Genet Couns 15, no. 6 (2006): 482.
- 42.
Ibid., 480.
- 43.
Ibid.
- 44.
Ibid., 485.
- 45.
Ibid.
- 46.
Two studies they cite are: M. Stefanek, P. G. McDonald, and S. A. Hess, “Religion, Spirituality and Cancer: Current Status and Methodological Challenges,” Psychooncology 14, no. 6 (2005).; E. A. Rippentrop and others, “The Relationship between Religion/Spirituality and Physical Health, Mental Health, and Pain in a Chronic Pain Population,” Pain 116, no. 3 (2005).
- 47.
Peters and others, “Evolution of the Colored Eco-Genetic Relationship Map (Cegrm) for Assessing Social Functioning in Women in Hereditary Breast-Ovarian (Hboc) Families,” 487.
- 48.
Sloan, 238.
- 49.
Ibid., 193.
- 50.
Mary Douglas, Risk and Blame: Essays in Cultural Theory (London; New York: Routledge, 1992), 211. Douglas is using the term to refer to the thought style of a culture but it is appropriate for individuals as well.
- 51.
See studies cited above.
- 52.
Reis and others, 42.
- 53.
Ibid.
- 54.
M. D. Schwartz and others, “Spiritual Faith and Genetic Testing Decisions among High-Risk Breast Cancer Probands,” Cancer Epidemiol Biomarkers Prev 9, no. 4 (2000).
- 55.
For appropriations of Claude Levi Strauss’s notion of ‘bricoleur that have influenced me, see Jeffrey Stout , Ethics after Babel: The Languages of Morals and Their Discontents (Boston: Beacon Press, 1988), 74. and Churchill and Schenck : 401.
- 56.
Sheridan notes that culture is a paradox that generates and transforms certain human predicaments. In this case, generating a risk status creates a new predicament of understanding what that means in practical circumstances.
- 57.
Weil , Psychosocial Genetic Counseling, 52.
- 58.
Ibid.
- 59.
Resta and Kessler , “Commentary on Robin’s a Smile, and the Need for Counseling Skills in the Clinic,” 437.
- 60.
The researchers who are developing the CEGRM have never indicated that it would be used in prenatal genetic counseling for advanced maternal age.
- 61.
Karl Barth’s notion of theonomy stands as the ground of autonomy and heteronomy. Being bound by God’s word (or law) is the very source of the distinction between the latter two terms.
- 62.
Richard Rorty, Philosophy and Social Hope (London, England; New York, N.Y., USA: Penguin, 1999).
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Fanning, J.B. (2016). Genetic Counseling and Spiritual Assessment. In: Normative and Pragmatic Dimensions of Genetic Counseling. Philosophy and Medicine, vol 124. Springer, Cham. https://doi.org/10.1007/978-3-319-44929-6_5
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