The 3 H and BMSEST Models for Spirituality in Multicultural Whole-Person Medicine

Abstract

PURPOSEThe explosion of evidence in the last decade supporting the role of spirituality in whole-person patient care has prompted proposals for a move to a biopsychosocial-spiritual model for health. Making this paradigm shift in today's multicultural societies poses many challenges, however. This article presents 2 theoretical models that provide common ground for further exploration of the role of spirituality in medicine. METHODSThe 3 H model (head, heart, hands) and the BMSEST models (body, mind, spirit, environment, social, transcendent) evolved from the author's 12-year experience with curricula development regarding spirituality and medicine, 16-year experience as an attending family physician and educator, lived experience with both Hinduism and Christianity since childhood, and a lifetime study of the world's great spiritual traditions. The models were developed, tested with learners, and refi ned. RESULTSThe 3 H model offers a multidimensional defi nition of spirituality, applicable across cultures and belief systems, that provides opportunities for a common vocabulary for spirituality. Therapeutic options, from general spiritual care (compassion, presence, and the healing relationship), to specialized spiritual care (eg, by clinical chaplains), to spiritual self-care are discussed. The BMSEST model provides a conceptual framework for the role of spirituality in the larger health care context, useful for patient care, education, and research. Interactions among the 6 BMSEST components, with references to ongoing research, are proposed.CONCLUSIONS Including spirituality in whole-person care is a way of furthering our understanding of the complexities of human health and well-being. The 3 H and BMSEST models suggest a multidimensional and multidisciplinary approach based on universal concepts and a foundation in both the art and science of medicine. Ann Fam Med 2008;6:448-458. DOI: 10.1370/afm.864. INTRODUCTIONTo cure sometimes, To relieve often, To comfort always.Anonymous, 16th century, France T he ideal of whole-person care has long been espoused by physicians. Many have written about the role of physician as scientist and healer, who uses both objective and subjective methods to bring cure, relief, and comfort to those facing suffering, illness, and death.1,2 Since the time of this 16th century quotation, we have made tremendous advances in the ability to cure. Yet, experienced physicians realize that as we begin the 21st century, with the global burden of disease shifting to chronic illness, 3 we still live in an era in which most of what we can offer consists of providing relief and comfort. Gowri Anandarajah, MD SPIR IT U A LIT Y A ND MULT ICULT UR A L WHOL E-PER S ON C A R EGrowing evidence for the benefi cial role of spirituality in health and well-being suggests promising opportunities for innovation in providing relief and comfort. [4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21] The Association of American Medical Colleges (AAMC), the World Health Organization (W...

In this Issue: Access to Care, Spirituality, and Relevant Research

“…9 An expansive conceptual framework presented by Anandarajah provides both secular and religious pathways for assimilating somatic, mental, spiritual, environmental, social, and transcendent factors into clinical care. 10 An editorialist refl ects on these 3 studies, making a case for studying the biological mechanisms of spiritual phenomenon. This perspective represents the dominant scientifi c paradigm upon which these 3 studies attempt to expand.…”

Where I Practice: On the Spaces of Family Medicine

“…Upon adding a existential dimension (biopsychosocial-existential [BPSE]), 16 I was better able to visualize and grasp the nature of my complex day-to-day tasks than I had previously been able to (based on the family life cycle orientation taught in training 17 ). Having become more cognizant of and more confident in my role as a family physician, I recognized a flip side to the BPSE model.…”

South African Society of Psychiatrists guidelines for the integration of spirituality in the approach to psychiatric practice

“…the original 'split' between religion and psychiatry, and indications of a recent rapprochement [63] • Current inclusion of spirituality in diagnostic systems • Relevant theories and related models such as those by Cloninger, [1] Vaillant, [64] Anandarajah, [65] and Koenig [66] • Psychodynamic and other theories of consciousness [67] • Relevant schools of thought on the philosophy of psychiatry, as well as nosology and phenomenology in psychiatry • Principles of evolutionary psychiatry • Sociological and anthropological views on religion and spirituality [68] • Comparative overview of different faith traditions and belief systems relevant to health and mental health (including monotheist, polytheist and atheist traditions) • Evidence of the saliency of spirituality and religion • The role of spirituality and religion in psychopathology • Bibliographies.…”