What medicine keeps getting wrong about spirituality, and what 16,000 papers finally proved

Based on the Harvard Divinity School panel: Spirituality in Serious Illness and Health, featuring Dr Tracy Balboni, Rev Gloria White Hammond, Anna Gosline, Rev Ali Jablonsky and Dr David Rosmarin.

Hello, hello! I’ve been abstaining from my opinions on purpose during this series of articles because I want you to focus on the science of spirituality.

Dr Miller, in my previous article, mentions JAMA. So, I had to visit JAMA and find the damn study the panel presented on YouTube, and it is 100% worth checking out. But I’ll do my best to convey what I’ve learned from it, I promise.

The confession that started the fire

Dr Tracy Balboni (the research presenter) had spent years as a radiation oncologist. She was meticulous and deeply committed to her patients. She checked every scan, every marker, every physical detail with the precision her training demanded.

Then one day, she had to tell a patient his cancer was terminal.

And his response left her without knowing what to do next:
“If I knew it would be like that, I would have shot myself.”

She had spent years focusing on the physical architecture of suffering and, in doing so, had completely missed its main source.

That moment became the question behind one of the most comprehensive studies ever conducted on spirituality and health, published in JAMA, one of the world’s most prestigious medical journals.

Why did this study take so long to exist

Here is something quite shocking to you, my young padawan: spirituality has been part of the World Health Organisation’s definition of health for over two decades!

In 1948, the WHO defined health as a “state of complete physical, mental and social well-being, not merely the absence of disease.”

Spirituality wasn’t named yet, but the door was slowly opening; hold on.

By 2002, the WHO’s definition of palliative care explicitly named spirituality as a key component of care alongside physical and psychological health.

And yet, in most hospitals around the world, nobody speaks about it.

The research existed, but it wasn’t reaching the right journals. It wasn’t being taken seriously in clinical settings. So Tracy and her team of bosses decided to change that.

What 16,000 papers eventually told us about spirituality

The study began with a systematic review of literature from 2020 to 2023, covering spirituality in serious illness and in public health outcomes.

Sixteen f*cking thousand papers!

From those papers, the strongest evidence was reduced to 441 papers on spirituality and serious illness and 276 papers on health outcomes. A Delphi panel (a structured method involving multiple specialists from numerous disciplines) analysed both the qualitative and quantitative data behind that evidence.

What they found were eight strong evidence points for serious illness and eight for health outcomes. And the two sets mirrored each other in ways that were hard to ignore.

The evidence: what happens when spirituality is absent

Patients in serious illness who lacked spiritual support reported:

• Greater psychological distress and despair
• Lower quality of life in their final months
• A sense of profound meaninglessness that no amount of physical care could address
• Feeling unseen, not just by their illness, but by the entire system meant to care for them

The absence of spiritual care was associated with worsened outcomes. But how about when spirituality is taken seriously?

The evidence: what happens when spirituality is present

Patients whose spiritual needs were recognised and supported showed a different scenario:

• Significantly lower rates of major depression
• Greater resilience under physical and emotional stress
• A deeper sense of connection and meaning, even in terminal diagnoses
• Better engagement with their own care and treatment

In my previous article, we saw how Dr Lisa Miller’s neuroimaging research added another layer to this: the spiritual brain is literally structurally different. More developed in the regions responsible for awareness, empathy, perception and resilience.

Spirituality is measurable, babe!

Four voices from the inside

The panel that built this research included chaplains, physicians, psychologists and community leaders who had spent years sitting with people in their most vulnerable moments. And here is what four of them found:

Gloria: The spaces we forgot to build

Rev Gloria White Hammond is a physician and minister, a combination that might seem unusual until you spend five minutes thinking about what illness actually does to people.

She drew attention to something the data confirmed but rarely names directly: the absence of spaces where people of different faiths can express their beliefs and still feel embraced.

Hospitals, for many patients (particularly those from minority communities), are spaces that historically have not seen them, heard them or validated their suffering.

Gloria’s argument was straightforward: if we want spirituality to be part of healthcare, we need to build the infrastructure for it, including physical spaces, cultural competence, and ample room for diversity.

This is not a utopia. It’s a clinical necessity.

Anna: The question nobody asks you in a hospital

Anna Gosline came to the panel with extensive experience in serious illness care. Her observation was simply devastating: almost no clinician will ask you what makes you happy.

They haven’t been trained to see no connection between happiness, purpose and the body lying in the bed in front of them!

So, Anna and her team started asking around. And the responses surprised them big time.

The questions were too abstract at first: “What makes you happy? What gives your life meaning?”

Patients who had spent months being treated as a collection of symptoms simply didn’t know how to answer.

So, the team adapted and got more specific: “What activities do you enjoy? What do you look forward to? What would you want to do when you leave here?”

Then the patients started to answer. And the answers changed how care was given in that space.

Anna also noted that most patients are afraid to disagree with their clinicians because they fear it may affect the quality of their care. Many reported feeling judged for their lifestyle, beliefs, and faith.

And almost every patient from a minority background reported the same thing: “I did not feel seen”. None of those patients was expecting miracles. Or perfect medicine. All they wanted was someone to sit across from them and say, “We will figure this out together.”

Is that asking for too much?

Ali: Spirituality without the label

Rev Ali Jablonsky supervises ICUs and works as a chaplain. She has learned, the hard way, that walking into a room and announcing yourself as a chaplain is sometimes the fastest way to scare people away.

She remembers a young woman waiting for a heart transplant who told her, clearly and unapologetically:

“I am not religious. And if you are coming with the spirituality conversation, I am not spiritual either!”

Ali had to find another way to make it work with patients who didn’t want to have anything to do with the spirituality label.

Her team installed a beauty salon in the hospital. On another occasion, they made a banner of chickens in tutus. They also adopted Bob, a service dog who became, as Ali put it, “a different kind of healthcare provider”.

In a beauty session, a patient asked for rollers in her hair and confessed that getting her hair done had always felt grounding to her, almost like a church. Her husband brought the team a fake plant decorated with rollers on every branch, thanking them for making his wife feel seen for the first time in her long healthcare journey.

Ali also works with patients who come from unsafe religious environments, people for whom the word spirituality carries threat rather than comfort. And for these patients, a dog, a beauty session or a familiar ritual can offer what no scripture can.

As a queer person herself, she knows exactly how dangerous those words can sound.

So, she translates them. Instead of asking about spirituality, she asks:

• Where do you find meaning?
• What are the milestones in your life?
• What do you hope for?
• When and where do you feel safe?
• Where do you turn when you’re scared?
• When are you most yourself?
• When do you feel part of something bigger than yourself?

And she leaves an open space for all answers. To ask those questions well, she says, you need to be able to answer them yourself first.

Dave: Science with a kippah

Dr David Rosmarin is a clinical psychologist and also a proudly observant Jew who wears his kippah every day in the hospital. Which means patients regularly approach him to discuss God, faith, injustice and the very specific rage that serious illness tends to produce.

He didn’t know what to do with this at first. He went to his advisor (an atheist, by the way), who told him, essentially, to figure it out, as the spiritual needs of patients weren’t being met.

So, Dave carefully designed a spirituality-integrated CBT group and brought it to his hospital board. It became one of the most popular groups in the entire programme!

The question he hears most often is one he confesses he cannot answer with precision: Why is God doing this to me?

And Dave doesn’t try to guess the answer. Instead, he sits with it and validates the question, the feeling, and the fury behind it. He creates what he calls psychological security, a space where the most vulnerable version of a person can exist without being fixed, redirected or managed.

His point is delivered with the confidence of someone who has data to back up his science: Humanising treatment is measurably effective.

And it is, as he argues, well past time for care (not money!) to dictate how healthcare actually works.

What they all agreed on

Eight evidence points in serious illness, eight in health outcomes and three clear parallels between them:

• Inclusion – Spirituality must be integrated into the care of seriously ill patients and into community health, not as an optional add-on but as a core component.
• Education – Healthcare teams need training. Not to become chaplains, but to become the kind of practitioners who know how to ask the right questions and sit with the answers.
• Infrastructure – Chaplains should be present in all clinical settings, bringing spirituality recognised as a social determinant of health in public health research, community work and programmes. The systems need to be built for this to happen!
  

The question this leaves you with

Anna asked it best, and I haven’t stopped thinking about it since I first encountered this research:
“What is in our food, water or culture that we just decided it is normal not to care?”

Not caring about patients. About our clinicians. About what makes a person feel like a person, especially when their body is failing them.

We built a healthcare system that is extraordinary at treating the physical. And somewhere along the way, we quietly decided that the rest, the meaning, the fear, the faith, the grief, the identity, the thing that makes someone feel like themselves, is someone else’s problem.

Sixteen thousand papers later, we’re thankfully starting to see the parallels between science and spirituality. After seeing almost 100 professionals and leaving feeling completely hopeless, I appreciate what these distinct scientists are finally doing.