Psychologyy

Separating Spirituality From Religiosity: A Hylomorphic Attitudinal Perspective

Carlos M. Del Rio and Lyle J. White Southern Illinois University Carbondale

It is truly a logical question to ask what spirituality is. We sustain this position as we review important corollaries from dualistic and hylomorphic views of human nature. We argue that in 21st century America we ought to be able to think of spirituality separately from religiosity and propose conceptual clarity is necessary to study spirituality. We uphold every person is a substance of two coherent principles, a body and a soul; the nature of which is spirituality. Spirituality’s functions are intellect and volition and their proper ends are truth and goodness. We call on ethicists, theoreticians, researchers, and practitioners in health care disci- plines to focus on the interaction between these aspects of spirituality. We define spirituality as an attitude toward life, making sense of life, relating to others, and seeking unity with the transcendent. We challenge the Diagnostic and Statistical Manual of Mental Disorders (4th ed.; American Psychiatric Association, 1994) codification of spirituality and ask that it be reviewed or removed because spiri- tuality is not equivocal to religiosity, germane to loss of faith, or a factor of cultural diversity. We insist that human individuals are born spiritual, not religious, and present distinctions between these notions at every juncture. We conclude that spirituality must be separated from religiosity if effective epistemic endeavors are to be achieved on either construct. We reject current conflations of “religious- spirituality.”

Keywords: spirituality, individual and systemic clients, dualism, hylomorphism, health care

Several events have contributed to the growing literature on (religious)spirituality in the United States. For example, the codifica- tion of religiosity and (religious)spirituality into the Diagnostic and Statistical Manual of Mental Disorders (4th ed.; DSM–IV; V62.61; American Psychiatric Association, 1994; Lu- koff, Lu, & Turner, 1995) has fomented in- terests to study the relationship between (re- ligious)spirituality and mental health (e.g., Fukuyama & Sevig, 1997; Lukoff, Lu, &

Turner, 1998; Weaver, Pargament, Flannelly, & Oppenheimer, 2006). Other events con- comitant to the DSM–IV codification that have contributed to studies on the relationship between (religious)spirituality and health in- clude: (a) accrediting agencies’ promotion of educational quality and professional account- ability, (b) professional associations’ publica- tion of ethical codes and practice guidelines that recognize the importance of individuals’ and systems’ (religious)spiritual needs, and (c) development of professional competencies for providing (religious)spiritual care.

As research amounts, other publications have attempted to conceptualize spirituality. Com- mon among all publications on (religious)spiri- tuality however, has been a persistent conflation between religiosity and spirituality. This confla- tion has yielded a sort of “religious-spirituality” (as we alluded in our preceding paragraph using the parenthetical adjective “religious”) in pro- fessional publications. Some authors have viewed religious-spirituality as analogous to in-

This article was published Online First March 19, 2012. Carlos M. Del Rio and Lyle J. White, Department of

Educational Psychology and Special Education, Southern Illinois University Carbondale.

Carlos M. Del Rio thanks David G. King, David N. Elkins, Douglas A. MacDonald, and Stephen J. Laumakis for their feedback and critiques.

Correspondence concerning this article should be ad- dressed to Carlos M. Del Rio, Department of Educational Psychology and Special Education, Southern Illinois Uni- versity Carbondale, 20 Applecrest Drive, Carbondale, IL 62903. E-mail: [email protected]

Psychology of Religion and Spirituality © 2012 American Psychological Association 2012, Vol. 4, No. 2, 123–142 1941-1022/12/$12.00 DOI: 10.1037/a0027552

123

trinsic religiosity. However, on closer examina- tion, some possible conjunctive propositions re- veal that religious-spirituality is more equiva- lent to extrinsic religiosity1 (for a distinction between extrinsic and intrinsic religiosity, see Allport & Ross, 1967).

Some authors have advocated that spirituality and religiosity are equivocal. Other authors have argued spirituality and religiosity are un- equivocal (e.g., Burgess, 1997; Elkins, 1995; Ribaudo & Takahashi, 2008; Van Ness, 1996). Still other authors have posited that spirituality subsumes religiosity (Turner, Lukoff, Barn- house, & Lu, 1995). And others have claimed that religiosity’s purpose is to promote spiritu- ality. Yet, the fact remains: Whether authors attempt to join or disjoint these constructs, they use them interchangeably (even within the same publications that advocate contrary concep- tions), and presume their readers understand what these interchangeable conflations mean. The problem with conflating terms’ denotations with their connotative variations leads to logical challenges that in turn lead to fallacious conclu- sions that lack ontological corroboration or con- ceptual clarity. One can reasonably wonder: How can individuals speak or write about con- flated terms, when they have not taken the time to study what they mean separately? On the one hand, conflations truly originate when people make a superficial interpretation of meaning in which one term is thought to signify the other. Regarding religiosity and spirituality, societies have come to view one as the other belying the profound differences that each term entails. On the other hand, denotations refer to terms’ con- gruent meanings without variations or the barest and essential meanings of terms.2 Most impor- tant, here we consider the implications from conflating religiosity and spirituality relative to professions within the health care nomencla- ture, and to the conceptual clarity necessary for frameworks’ development, research practices, and clinical applications to understand spiritu- ality. We also recognize that the prevailing “re- ligious-spirituality” conflation warrants an on- tological examination of human nature.

Our intent is to offer an alternative concep- tion of spirituality: One that allows us to think of spirituality differently and separately from religiosity and intrinsically related to all human- ity by virtue of its own nature. Furthermore, because conventional understanding of reli-

gious-spirituality is conflated and often mis- leading, we must first explain what we mean by spirituality qua spirituality. As we have sur- mised (see below) from Aristotelian hylomor- phism, and scholastic Thomism: Spirituality is the nature of the human soul; it is one’s attitude toward living life, toward making sense of life, and toward seeking for relationships with others and ultimately with that which is transcendent.

One challenge to our discussion is finding the proper language to describe what we mean by the terms we use, in a way that may be under- standable or conciliatory among professions within the health care nomenclature,3 and other related disciplines such as anthropology, his- tory, philology, philosophy, physiology, sci- ence, sociology, theology, and so on. Another challenge we must accept is that the reader’s implicit personal values and denomination (or lack thereof), as well as her discipline’s frame-

1 Some hypothetical conjunctive and disjunctive consid- erations of religiosity, spirituality to consider:

1. If S AND R, then SR (spiritual-religiosity). This means: It is possible that SR is equivocal to intrinsic religiosity.

2. If R AND S, then RS (religious-spirituality). This means: It is possible that RS is equivocal to extrinsic religiosity.

3. If S OR R, then �RS (non-religious–spirituality). This means: It is possible that �RS is simply spirituality.

4. If R OR S, then �SR (non-spiritual-religiosity). This means: It is possible that �SR is simply religiosity.

2 Whereas connotations allow for variable meanings to be assigned to a specific term or construct, denotations stand for what clearly signifies a specific term or construct with- out variations of meaning. Throughout this discussion we mean denotation when we use: conceptual clarity, concep- tual purity, construct purity, and ontological corroboration. Moreover, connotations stand possibly and equally (but not necessarily and identically) for that which they symbolize. Denotations stand necessarily and identically (but not only possibly and equally) for that which they signify. So, con- notations allow for terms’ conflations, whereas denotations distinguish terms. For example, a “denotative separation” of conflated terms will distinguish these given terms by means of what is essentially conceptual to each term.

3 Health care services comprise many professions (coun- seling, medicine, nursing, pastoral counseling, psychiatry, psychology, social work, etc.) and services. We wish our discussion may be useful to all professionals engaged in health care. We also intend to focus on mental health services for both individual and systemic clients who seek help from different professionals.

124 DEL RIO AND WHITE

works will influence how and what she under- stands by what we propose through our terms, regardless of how effectively we may distin- guish them, and how effectively we may en- courage the reader to bear with our key terms’ and phrases’ denotations. Yet another challenge is the topics that we attempt to simplify, which may engender several philosophical interpreta- tions. We recognize we will not be able to exhaust these topics completely, but we hope our positions are welcome as we seek for an- swers in a civil dialogue of mutual discovery. For this reason we ask the reader to keep in mind that whenever we refer to spirituality in this discussion, we intend to distinguish it from its conflation with religiosity. We expect our discussion may advance interdisciplinary dia- logue to obtain a definitive denotative separa- tion between religiosity and spirituality.

Contrast Between Dualism and Hylomorphism

Dualistic Perspective of the Human Person

Ancient Greek dualism postulated that hu- man beings were composed of two substances: a body and a soul. Ancient Greek philosophy certainly has influenced much of Western phi- losophy even to this day. In fact, the mind– body interaction remains an epistemic debate that began in the 5th century BC.4

Plato (circa 424 –348 BC) wrote several works that conveyed the teachings of Socrates (circa 469 –399 BC). Particularly in the Phaedo, Plato (1986) presented several arguments to dis- tinguish the natures of the immortal soul and the corruptible human body. Plato certainly did not explain the purpose of the soul inhabiting the body but emphasized the body imprisoned the soul. These two substances separate at the moment of death, when the soul is liberated from its entrap- ping body, and it goes to the place where the forms (all universal notions or concepts) exist.

During the Axial Age, between 800 BC and 200 BC, several monotheistic religions emerged (Armstrong, 2001, 2004). Doubtless philosoph- ical dualism aided religious dualism to explain not only the good and evil forces in the uni- verse, but also to conventionalize how individ- uals were expected to relate to their experience of the numinous (Armstrong, 2006). For exam- ple, the Manicheans (3rd century AD Iranian

Gnostics) taught that corporal things were not translucent, and hence they were bad; whereas transparent things let light pass through them, and hence they were good (Chadwick, 1993; Pagels, 1989). Somehow, then, immaterial things had to be preserved over material things to achieve a connection with the numinous. Around that time, there was a man who lived a self-avowed questionable moral life, and in seeking rectitude he joined the Manicheans, and eventually converted to early Christianity.5 This impressive man later became a bishop, a saint, and a doctor of the early Christian church; his name was Augustine of Hippo (circa 354-430 AD). St. Augustine remains one of the most influential Christian theologians—incorporating his prevailing dualistic-Manichean views into dogmatic Christian theology.

Augustinian theology taught that moral evil in the world was the result of human free will, and that through asceticism individuals were able to liberate their souls from their bodily concupiscence and to attain intimacy with God. The Augustinian view of human nature postu- lated that people were composed of a corrupt- ible body, and a soul that was “predestined” toward the beatific vision of God. According to some contemporaneous Christians, deification will commence through the final resurrection where all “good” individuals will enter heaven, and all “bad” individuals will enter hell; hence, the necessity of asceticism to control and/or to purge our carnal concupiscence and to preserve the soul’s incorruptibility. In this sense, the beatific vision of God per se applies only to those who enter heaven. However, because God is omnipresent and cannot be bound even by heaven’s boundaries, God’s existence is avail- able in hell as a sense of eternal privation of the Summum Bonum (highest good), and the soul’s awareness of this privation constitutes the na-

4 Mind (nous) eventually replaced soul (psyche) in West- ern cultures.

5 Augustine’s conversion from Manichaeism, and from his lax moral life, perhaps, led him to dismiss the woman who bore him a son. This begs the question whether his concern with his own purification was the reason he aban- doned this woman in Northern Africa during the 4th century AD, where and when because of her gender and her cultural milieu, she was not able to provide for her needs. She remains nameless (see S. Agostino d’Ippona, 1987).

125SEPARATING SPIRITUALITY FROM RELIGIOSITY

ture of hell.6 Most important, Augustinian the- ology continues to influence contemporaneous Christian theology.

In early 17th century Europe, René Descartes (1596 –1650 AD) became the most prominent modern Western philosopher that advanced philosophical and religious Dualisms. Some commentators have asserted that Descartes built on Augustinian dualism (Semonske & Fleming, 1965). Cartesian dualism defined the human soul as immaterial but rational or res cogitans (thinking thing). Descartes argued the essence of a rational mind is thought itself that is not subject to the qualities of extension and motion (which belong to the body), but that the rational mind influences extension and motion in the human body, a material entity (Maher, 1909). In this view, human beings are dualistic aggregates made of a rational soul and a corporeal body. Descartes admitted that the body could only influence the mind through the experience of emotions or passions (see Bennett, 2010).

Descartes’ view of rational human nature was comprised in his Meditations that were more emphatically aimed at proving God’s existence, and providing a firm foundation for all possible knowledge (Descartes, 1901). In Meditation 2, he adduced his famous corollary “cogito, ergo sum.” In Meditation 6, he added that proving God’s existence provided each of us with the assurance that via “introspection” (an intellec- tual act that does need to be spoken, see Hin- tikka, 1965, pp. 50 –74) we are able to deduce not only our existence but the possibility of separation between material (bodies) and imma- terial (souls) entities. This of course applies only to entities with rational minds, human be- ings; not to animals, plants, or other things that have no rational minds.

Cartesian dualism proposed the human body operated like a machine, composed of many material parts to achieve its functions, and the rational mind has control over this kind of body. Thus, mind and body were united only “inci- dentally” in the pineal gland, located at the bottom-center section of the brain (Maher, 1909). Descartes’ understanding of human physiology enabled him to identify the pineal gland as the seat of the soul because of its strategic position (as a gland) in the brain that enabled it to influence bodily functions (Con- nell, 1988; Maher, 1909). Thus, Cartesian dual- ism rendered every human being congruent

with an aggregate; composed of two separate “substances,” a material body and an immaterial rational soul. And the body was further com- posed (as a machine) of many more physical parts (appendages and internal organs) neces- sary to carry out its functions.

As with any other prolific philosopher/author, Descartes’ works pose an interpretative diffi- culty because their key terms are defined in several separate arguments. For example, Des- cartes’ emphasis on human aggregates repre- sents a great challenge to Cartesian dualism. Because human beings are put together of more than one part, they are natural aggregates. How- ever, one can argue that everything in the actual world is either an aggregate or a substance, but human beings are aggregates, thus, they are not substances. Or put in the converse, no aggregate acquires physical properties, but all substances acquire new physical properties (extension, mo- tion, etc.), thus, no substance is an aggregate. However, animals and plants remained nondu- alistic because they have no rational souls. Hence, in a true sense, nonrational living things are substances, excluding only human be- ings—as St. Augustine would have clearly op- posed (Connell, 1988).

Another implication of the corollary cogito, ergo sum is that it is self-invalidating because the mere fact that “cogito” (I think) presumes self-evident existence (I exist first, then I think) it does not require an inference leading to “sum” (because I already exist). To explain, self- evident existence is implicit in “cogito” as it is in “dubito” (I doubt), because either act requires an existing subject. Hence there is no need for the inference (ergo) and the conclusion (sum). Put more simply, Descartes could have used a more succinct expression: either “ego sum,” or “ego existo,” or even just: “ego” would have sufficed (Hintikka, 1965).

Yet a more damaging implication for Carte- sian dualism relative to the human aggregate is the possible separation of its thinking mind (res cogitans) from its body. This could be ex- pressed disjunctively: Either (a) human beings are not physical, or (b) it is possible to deny that

6 A propos, Augustinian-dualistic theology doubtless in- fluenced Durante degli Alighieri’s master poetics (circa 1265 AD–1321 AD), The Divine Comedy, which remain the first descriptions of what heaven, purgatory, or hell may look like (Alighieri, 2007).

126 DEL RIO AND WHITE

the human experience of self guarantees the existence of self. If (b), then (c) humans can no longer remain assured of their existence on the basis of “introspection.” And (d) because cogito is an act of human introspection, then �(c) it is not possible to deny that the human experience of self guarantees existence of the self (which truly means: it is possible to affirm that the human experience of self guarantees the exis- tence of self). This further implies in reference to the original disjunction (either (a) or (b)) that because �(b) it is impossible to affirm that the human experience of self guarantees the exis- tence of self, therefore (a) human beings are not physical (Treanor, 2006). However Descartes affirmed that human beings were composed of a body as well, in fact, he claimed that the seat of the rational soul was in the pineal gland in the brain. So, if �(a) human beings are physical (because of the fact that the mind [res cogitans] inhabits the brain), then (b) it is possible to deny that the human experience of self guarantees the existence of self? This argument disproves Des- cartes’ logic.

In sum, dualism both religious and philo- sophical took hold during the Dark Ages, but some authors contended that it continues to influence contemporaneous religious apologet- ics (e.g., Armstrong, 2001; Lambert, 1999; Pa- gels, 1989). For example, not only Christianity but also Judaism and Islam preserve dualistic views of humanity (Pagels, 1989). As a result, to adherents of religious dualism and of dualis- tic human nature, any claim of spirituality out- side religious systems or cultic practices, is sus- pect of heresy (see no. 3 in footnote 1).7 Most important, a dualistic view of human nature renders human beings as aggregates of two sub- stances. And because human beings are equiv- ocally aggregates, this perspective opens the possibility for multipartite views of human con- stitution. For example, some authors have al- ready introduced tripartite models of human nature comprising body and soul and spirit (e.g., Helminiak, 1996, 1998). Other authors have conceived pentapartite views to integrate hu- man spirituality as akin to the human condition (e.g., Burke & Miranti, 2001). Moreover, be- cause some religious dogmas have accepted these views of human nature, they have given rise to theological positions in which the human person still remains an aggregate. Thus, “dual- istic religious spirituality” (DRS) is the byprod-

uct of these persistent views and conflates reli- giosity and spirituality as one single term.

Hylomorphic Perspective of the Human Person

Aristotle (circa 384 –322 BC) was a scientist- philosopher who made many contributions to science and to several branches of philosophy. Similar to other prolific authors, Aristotle’s works have faced interpretative challenges not only because he developed key terms through- out his works, but also because, as scholars have agreed, there are three periods in which his writings evolved. Each of these periods oc- curred in a different location during his life time. Most of his many works have been lost, and we know about them only from remnants of treatises that allude to them.

Aristotle’s works evince a continuum, from an early Platonic influence, to an emphasis on scientific method, to an independent philosoph- ical position that far exceeded other philosoph- ical perspectives and remains influential to con- temporaneous science and philosophy. Some commentators agreed that Aristotle’s contribu- tions are closer to contemporaneous science and philosophy than some scholars/scientists have been willing to admit (Shields, 2011).

Taken from the ancient Greek words hyle (matter) and morphe (form), Aristotle’s theory of hylomorphism (matter-formism) explains the nature of substances and aggregates in the ac- tual world. We must approach this theory with prudence lest we err as many others have done by oversimplifying or mistaking what Aristotle originally meant. For example, “form” is not simply a “shape” of a thing, nor is it an invisible “substratum” that when all properties are taken away was not there at all. Instead substantial form is a principle of existence that brings about something from a specific stuff (prime mat- ter)—which itself has the capacity to become a particular type of something when it is en- formed by the right type of form (Aveling,

7 One especially egregious example, with foundations in Augustinian thought, that involves human sexuality, views every coital encounter as sinful if it is not oriented toward procreation (Pagels, 1989). As a result, some dualistic- monotheistic doctrines subsume sexual pleasure to faith- based edicts. This position evenly covers married couples, generating a sort of spiritual guilt regarding coital encoun- ters (Eliason, Hanley, & Leventis, 2001).

127SEPARATING SPIRITUALITY FROM RELIGIOSITY

1909, 1911). Differently said, substantial form is what makes something to be what it is (formal cause) and “not-a-thing-else.” Complementary to substantial form is matter or the specific type of stuff out of which something is made (mate- rial cause). Whereas matter is a principle of individuation, form is an existential principle, both of which make a complete substance. Nei- ther principle exists separately. For example, a human soul is the substantial form (that by which human beings are human) of a humanly shaped-human body, and this particular kind of body is the matter of a human soul. These two principles are a singular human person and not- a-thing-else. A humanly shaped-human body is a principle of individuation without which a human person could not exist at all, and its complementary human soul is what makes a living human person to be a living human being. Because if a humanly shaped-human body lies somewhere without its complementary soul, it is not properly a living human person at all, but simply a humanly shaped-human body or a corpse—if its “form” (not shape) that makes it to be what it is (a living human person) is not inhering in the same matter (Royce, 1961). In this sense, material cause (matter) and formal cause (what makes something to be what it is) are intrinsic causes of substances (human be- ings). Their external causes are the efficient cause (the agency that brings something about) or the parents of a human being, and the final cause or the purpose for which something exists at all. Whenever possible, Aristotle used these four causes as sine qua non explanations of changes and generations in the actual world (Connell, 1988).

This Aristotelian notion of soul as a principle of existence for natural bodies that have life potentially in them applies to plants, animals, and human beings. This allows for the consid- eration of three manifestations of soul: nutritive (vegetative) pertaining to plants, perceptive (sensitive) pertaining to animals, and intellec- tual (rational) pertaining to human beings (De Anima; Aristotle, 1996). A unidirectional impli- cation of this categorization follows: any ratio- nal being also has perception, and any percep- tive being has nutrition abilities for growth and reproduction; but not vice versa. This also im- plies that for some human beings (either by natural or unnatural privation; either by congen- ital malformation or mental disability, or by a

car accident, or a coma, or by willful harm, respectively) their souls may manifest any of these characteristics and still remain categori- cally an intellectual soul (Shields, 2011).

Dissimilar to substances, aggregates are two or more juxtaposed substances as a collection of properties—properties exist in a subject as in another and because they inhere in another, they depend on that other to exist at all (for an ample explanation on Categories, see Apostle, 1980a). For example, in the case of substances, a plant is made out of cells different than animal cells. Their substance differs, and so does the substan- tial form that makes plants to be what they are. Animals in turn differ from humans by physio- logical configuration and organic functions; again, their substance differs qualitatively and so does their substantial form—it is not rational. Whereas specific types of matter or stuff cate- gorize substances, function categorizes artefacts (from the Latin “artefactum” or human-made) or aggregates. In the case of aggregates, for example, a pencil is made out of wood and lead (material cause), put together as such by a pen- cil maker (efficient cause), with the definite shape of a pencil (formal cause), and for the purpose or serving as a writing instrument (final cause, for an ample explanation on these four causes, see Apostle, 1980b). However, if a properly made, shaped, produced, pencil is not serving as a writing instrument (its functional purpose for which it exists); it is not properly a pencil— because its ultimate cause is not ful- filled. It simply remains an aggregate of wood and lead, and the shape of a writing instrument. Besides, it requires an external agent who may use it as a writing instrument. That is, it lacks motion from within to fulfill its function on its own.

Relative to substances, form is a principle of existence that renders something to be what it is, and matter is a principle of individuation that renders something to be potentially other things (Aveling, 1909, 1911). For example, by diges- tion food is usually eliminated and human cells are created, and by death a living human body is eliminated and a human corpse is created. In this sense, a human being has two constitutive principles, one by which it is actually a human person, and one by which it is potentially a human corpse. If both principles were “actual” the human person would be two things at once, (as in the case of dualism) and if both principles

128 DEL RIO AND WHITE

were potential, the human person would not be anything at all (as in the case of phenomenalism in which there is no substratum left after prop- erties are removed). So, there must be a princi- ple common to a human person, food, and hu- man corpse (matter); and one principle common to each human stage of existence (form). To illustrate how this relates to aggregates, sand and heat makes bricks, but construction puts together bricks to make a house. Although bricks are separate substances, bricks are only potentially a house, and a house is only a house if it provides shelter by reason of its proper function (Royce, 1961; Shields, 2011). Yet the house that provides shelter, though, is meant to remain static as the pencil in the prior example– neither one has motion from within as sub- stances draw from their substantial form. Mo- tion from within is the fundamental distinction between aggregates and substances, even though Aristotle proposed his four causes to explain generation and transformation of sub- stances and aggregates in the actual world.

According to Aristotle (1996), the human soul not only enlivens the human body (that specifically and irreplaceably complements it) but it also defines the nature of a human soul as human spirituality (De Anima; Aristotle, 1996). And the proper functions of human spirituality are human intellect and human free will or volition—the capacity to choose among alterna- tives. Their proper ends or final causes are truth and goodness, respectively. Contrary to materi- alists and physicalists, Aristotle argued that the human soul does not follow physics or chemis- try because it is able to engage in intellectual and on volitional actions even when separated from its matter.8 To ignore this position is to propose that matter itself is capable of life. Certainly physics and chemistry have proven this alternative proposition false.

Thomas Aquinas (circa 1224 –1275 AD) a philosopher-theologian, a priest, a saint, and doctor of the medieval Christian church built on Aristotle’s theory of hylomorphism (see De Ente et Essentia, Bobik, 1965; Garcia-Valdeca- sas, 2005). Aquinas emphasized that human be- ings were not aggregates within which souls remain imprisoned. Rather, souls make human beings to be what they are: living human per- sons within the category of substances. Conso- nant with Aristotle, Aquinas established apod- ictically the soul’s nature is spirituality, and its

powers or properties are intellect and volition (Coyle, 2002; Garcia-Valdecasas, 2005).

According to Aquinas, human beings’ tele- ological proclivity for unity with that which is transcendent is equivocal with a final causal- ity: A natural proclivity toward the beatific vision of God; and this natural end is avail- able to believers and nonbelievers alike by virtue of being human— because all human beings have souls. To illustrate, if the nature of the human soul is spirituality, and if spir- ituality entails a natural proclivity toward truth and goodness, and these are ontological attributes of God (discoverable by reason), then human beings share a natural proclivity toward unity with God (Royce, 1961). How is this manifested? A natural proclivity is a ten- dency toward something, and a tendency to- ward something is manifested through per- sonal attitudes. Thus, spirituality’s proclivity toward unity with God is a human attitude toward life, making sense of life, relating to others, and seeking unity with God. This is the essence of human spirituality. Yet if a human being is (conventionally) Buddhist, Christian, or Jewish, does this change that same person’s spirituality? The answer is no. That same person remains alive and human by virtue of her soul and her soul’s spirituality. Thus, “hylomorphic attitudinal spirituality” (HAS) comprises conceptually this perspec- tive of the human soul of which spirituality is its essential nature. Because people are di- verse in how they experience and respond to life, it is reasonable that spiritual attitudes may also be diverse.

8 Of course implicit arguments to this assertion (that the soul may continue to act even when separated from its human body) include questions such as: Whether the soul is immortal? Whether the soul is like Plato’s complete sub- stance after the body dies? And so on. We cannot entertain these questions in detail here for the sake of brevity. Let it suffice, however, to mention that St. Thomas Aquinas did entertain these questions, and they can also be explored through logic from Aristotle’s premises. For example, be- cause the soul had a beginning and it belongs to the category of substance, the soul is contingently immortal, but it re- mains incomplete qua substance because its body is defunct (for more explanation on these matters, see Knight, 1920/ 2008).

129SEPARATING SPIRITUALITY FROM RELIGIOSITY

Denotative Separation of Spirituality From Religiosity

Evidence of clinical conflation between re- ligiosity and spirituality. In late 20th cen- tury America, individuals often presented with concerns of religious or spiritual nature in ther- apy. Yet mental health professionals tended to disregard or pathologize these concerns (Lu- koff, Lu, & Turner, 1992). Some authors viewed this tendency as culturally insensitive because, they argued, religiosity and spirituality are cultural elements of human living; and pre- sented to the Task Force preparing the DSM–IV with a new category of “other clinically signif- icant problems that may be the focus of diag- nosis and treatment” (Lukoff et al., 1992; p. 676) to address these concerns. These same authors continued to document the evolution of their proposal into the codification of the Reli- gious or Spiritual Problem (DSM–IV, V 62.89) under the rubric of “issues [that] can be the focus of psychiatric consultation and treatment” (Lukoff et al., 1995, p. 481; see also Turner et al., 1995). Later, these same authors also docu- mented the lack of professional training to dis- cuss these concerns in therapy and argued that from an ethical point of view therapists were responsible to be sensitive to and to recognize religious and spiritual dimensions of human culture (Lukoff et al., 1998). These arguments led several accrediting agencies, and profes- sional associations to require curricular inclu- sion and ethical accountability for acknowledg- ing and treating religious or spiritual problems as elements of cultural diversity.

Even though religion and spirituality were originally defined as separate human phenom- ena,9 their clinical recognition led to their equivocation via loss of faith (Lukoff et al., 1998). As a result, spirituality’s codification into the DSM–IV has raised epistemic difficul- ties: (a) religiosity and spirituality are equivo- cal, (b) “loss of faith” is a spiritual problem, and (c) religiosity and spirituality are elements of cultural diversity.

Are religiosity and spirituality equivocal? It would seem that they are. The perspective that renders human beings as aggregates com- posed of several substances (soul, body, spirit) has influenced some religious thought relative to subsuming what is spiritual to what is reli- gious lest moral evil (from free will) corrupt the

human soul that is created for the beatific vision of God. This position echoes Buddhism, for instance, because detachment from personal de- sires leads to enlightenment—and enlighten- ment may be comparable to the beatific vision for Christians. So it appears that what is essen- tial to religiosity is the preservation of certain customs to satisfy some conventionally estab- lished practices to secure a path for the soul toward what is transcendent. Religiosity, then, is essential to communal living wherein it can potentially assist all individuals within its boundaries by subsuming the spirit (a separate entity of the human person) to preserve the soul’s inclination to unite with the transcendent. In this sense, all spiritual matters are regulated by religious conventions that differ from com- munity to community and from time to time. This position seems to accept tacitly that mat- ters of the human spirit involve intellectual ac- tions and volitional actions (which have poten- tial to bring about moral evil) of which their proper ends are truth and goodness, respec- tively. Perhaps the interest both notions (religi- osity and spirituality) share lies on preserving the soul’s “destiny,” and this is what makes them equivocal. (However, the substance view of human nature would at no point imply that individuals are “predestined” toward the tran- scendent. This would cancel the nature of voli- tion. Rather, human spirituality enables people to pursue or to seek what is transcendent, but they remain free to choose this natural end or to reject it).

If religiosity and spirituality are equivocal, then both notions must conceptually entail (re- quire of necessity) the same essential defini- tional criteria (e.g., terms). Here we turn to the sources for the DSM–IV codification of the Re- ligious or Spiritual Problem that recognized a distinction between these notions: religiosity means adherence to beliefs and practices of a recognized organization, whereas spirituality means a relationship between a person and what is transcendent regardless of religious affiliation (Lukoff et al., 1992). The literature provides

9 Borrowing from other authors, Lukoff and colleagues (1992, 1995, 1998; Turner et al. 1995) constantly empha- sized that religiosity refers to beliefs and practices of an organized community, whereas spirituality refers to a per- sonal relationship with what is transcendent and it is not contingent on religious affiliation.

130 DEL RIO AND WHITE

additional accounts of the difference between these notions. On the one hand, for example, religion embraces traditions, rituals, beliefs, and conventions of meaning (Burke et al., 1999). The key term in this conception is convention. Conventions require communal agreement of what something ought to mean. In this sense, religiosity is “a human invention” (Lorber, 1994, p. 6), a mere convention of religious meaning within a given community. Put differ- ently, religion refers to connections between people and “a specific doctrine or group of people” (Berry, 2005, p. 629). Several other authors have carefully articulated how religios- ity resonates with communal conventions (Eg- bert, Mickley, & Coeling, 2004; Graham, Furr, Flowers, & Burke, 2001; P. C. Hill & Parga- ment, 2003; P. C. Hill et al., 2000; Slater, Hall, & Edwards, 2001; Suyemoto & MacDonald, 1996; Traphagan, 2005). And others have pro- posed that religiosity is indeed “a public mani- festation of communal living” (Hinselwood, 2005, p. 45). Still others have emphasized that religiosity belongs to communities of faith (e.g., Haynes, 2001; J. Hill, 2000; Hodge, 2004; Jo- seph, 1988; Piedmont & Leach, 2002; Stanard, Sandu, & Painter, 2000; Tirri, Nokelainen, & Ubani, 2006)10.

On the other hand, several authors have ar- gued that “spirituality is ‘beyond cultural boundaries’” (Delgado, 2005, p. 157; see also Burke et al., 1999). Others have reported that spirituality is analogous to personal develop- ment, evolution, transformation, and growth; at times thwarted by traditions, rituals, and beliefs. Still others have indicated that spirituality is an individual “human phenomenon” (Elkins, Hed- strom, Hughes, Leaf, & Saunders, 1988, p. 6) that surpasses all cultures and is “integral to each human being, just as the air one breaths” (Benjamin & Looby, 1998, p. 93), and that spirituality is inherent to each human person’s natural constitution (Benjamin & Looby, 1998; Hinterkopf, 1994). Functionally, other authors have defined that spirituality is “how a person makes meaning in their (sic) life” and this in- volves using one’s “attitudes [as] fundamental features of human existence” (van Leeuwen & Cusveller, 2004, p. 235).

There are certainly thousands of additional sources in the health care literature that could be used to identify essential terms for either reli- giosity or spirituality. The forgoing sources,

however, suffice in our view to distinguish some definitional criteria between these two constructs: Whereas religiosity entails commu- nity and convention of belief and ritual, spiritu- ality entails human individuality and making sense of one’s life. That is, conventionally, re- ligiosity defines how a person behaves based on various established belief systems within given milieus, but spirituality seems to be available to individuals of different cultures and different generations. In turn, because religiosity and spirituality do not conceptually entail (require of necessity) the same essential definitional cri- teria (e.g., terms), it follows that religiosity and spirituality are not equivocal.

Moreover, recent empirical research has pro- vided statistical significance that these two con- structs “cannot be collapsed into a single con- struct” (Piedmont, Ciarrochi, Dy-Liacco, & Williams, 2009, p. 170). We must further pro- pose as an implication of our hypothetical ar- gument that whereas religiosity is analogous to communities of faith by virtue of conventional beliefs, spirituality is analogous to the human person by virtue of being human. And to per- petuate the status quo by conflating something private (spirituality) with something public (re- ligiosity) at the same time and in the same respect (a human person’s hylomorphic consti- tution) is an ontological absurdity that hinders spirituality’s research if it remains conflated with religiosity.

Is loss of faith a spiritual problem? It would seem that it is because therapists have classified it as such (Lukoff et al., 1998). This classification originates from the fact that reli- giosity and spirituality have usually been con- flated into a kind of “religious-spirituality,” and people (including health care professionals) tend to use these terms interchangeably without regard of the probable distinctions between them—albeit loss of faith was originally intro- duced as a religious problem (Lukoff et al., 1992).

10 These cited authors and many other works have con- ceptually concurred with the DSM “disjunctive” codifica- tion of religious problems: (a) change in denominational membership or conversion to a new religion, (b) intensifi- cation of adherence to beliefs and practices, (c) loss or questioning or faith, (d) guilt, and (e) cults (Lukoff et al. 1995).

131SEPARATING SPIRITUALITY FROM RELIGIOSITY

If loss of faith is a spiritual problem, then faith is the proper object (purpose) of spiritual- ity for all human beings. Some Christian reli- gious and sectarian dogmatists would argue that human aggregates (composed of body, soul, and spirit) are destined to join God in heaven but only if they follow their established belief sys- tems. For this reason, it is important that reli- gious dogmas regulate spiritual matters to either purge or avoid sin, which has the power to turn people away from God. However to believe in God (and the beatific vision of God) requires intellectual commitment and volition that are spirituality’s functions (which cannot be lost). Commitment to religious belief, however, is the essence of faith (Dubay, 1985). And loss of faith is often labeled as sinful.

However, if all human aggregates are des- tined to believe in and to be with God, accord- ing to some monotheistic religions, then the dogmatic exclusion of persons: Who do not know about God, who know about God but choose not to believe in God, or who believe in God but are excluded from religious communi- ties, are all denied their “natural” purpose to be with God. By and large practicing established belief systems requires human action as in the case of baptism, circumcision, detachment from passions, constant prayer, and so on. One im- plication from lacking baptism, for instance, would send to limbo all unbaptized aborted fetuses, all unbaptized miscarried fetuses, and all unbaptized neonate human infants. Limbo is a permanent theological space in which there is no beatific vision of God because all unbaptized human aggregates come into being in a state of original sin, according to Augustinian theol- ogy.11 If this were the case for all the unbap- tized human aggregates, then their natural con- stitution (their souls in particular) would not reach God, and by implication all the unbap- tized would not properly be human beings. The same exclusionary position of lack of faith vis- à-vis the beatific vision of God would apply to a person who never believed in God and is now in a coma, thus unable to engage in intellectual and volitional actions relative to embracing faith in God, and eventually dies. Or how about nonheterosexuals who believe in God and in the beatific vision of God but who are turned away from their religious communities because at core they are unable to procreate—a very utili- tarian view of human persons—yet they are not

unable to love and to commit to one another. Therefore, some individuals who are naturally spiritually aware (Fenwick & English, 2004) remain excluded from some self-defined reli- gious groups, neither practicing cultic rites nor adhering to conventional religious creeds— sometimes against their wills. Thus, some fun- damental emphasis on religious dogmas im- pacts who is able to be with God and who is not; this is a matter of religious authority as if reli- gious systems were truly able to know God’s intent for all human beings.

Most important, if the aggregate constitution of the human person includes a body, a soul, and a spirit and the spirit seems to serve an auxiliary function to the soul, what happens to the spirit if or when the soul reaches God? Does the spirit decay as the body does at the moment of death, or simply ceases to exist? Better yet, is the spirit able to become a “part” of the soul, and if so, how? Of course this could not happen because both spirit and soul are substances con- stitutive of the human person, and as such they cannot complement each other into one single substance.

In contrast, if the human person is a sub- stance composed of body and soul, and spiritu- ality is the nature of the soul, and spirituality’s functions are intellect and volition of which their proper ends are truth and goodness for all human beings, then faith, which requires intel- lectual commitment and volition to choose something, pertains to all human beings— but the pivotal element here is volition. That is, individuals remain free to believe or not to believe in anything. Does this rejection of faith negate their opportunity to achieve truth and goodness if some individuals choose to (or are de facto rejected from choosing to) believe in God? The answer is no.

The ability to seek unity with what is tran- scendent is already constitutive of the human person naturally, and this does not require (of necessity) a certain belief system. Obviously religious belief systems vary by culture and by time, but God qua God remains the same and cannot be confined to a particular belief system.

11 This article of faith (limbo) is no longer endorsed by the catholic Christian church’s hierarchy but theologians continue to expand on the subject, and the faithful are free to either believe or not to believe in limbo (see for example original sin: 406; in Libreria Editrice Vaticana, 1994).

132 DEL RIO AND WHITE

So, God is not Jewish, Christian, Muslim, Bud- dhist, or limited by any other kind of religion; simply God is available to all who wish to find truth and goodness. And truth and goodness are the proper ends of human spirituality; and, thus, faith as such is not the proper end of all human beings’ spirituality. Therefore, loss of faith is not a spiritual problem.

God’s kindness is available to all human be- ings, but this good news becomes a fallacy when religious dogmas make it a conditional consequent based on specific religious prac- tices. In this sense, a conceptual loss of faith in God (determined by a specific religious belief system) is not a human spiritual problem be- cause God’s beatific vision is available to all human beings whether or not they profess cer- tain religious beliefs and practices.

Are religiosity and spirituality elements of cultural diversity? It would seem that they are because human individuals are born into communities, and communities define what works for them. This conventional aspect of communities influences individuals’ develop- ment (both religious and spiritual), and individ- uals share their spiritual experiences according to religious conventions. So conventional reli- gious meaning of spiritual experiences is a two- fold aspect of cultural diversity.

If religiosity and spirituality are elements of cultural diversity, then both religiosity and spir- ituality must be conventional expressions of communal living for all human beings. The aggregate perspective of human nature would consider a human community to be a collection of human persons. However, this is rather sim- plistic because it begs the question of volition as a human requirement to join or to form a com- munity based on shared purposes. By the same token, communal human living cannot be ex- plained in terms of an infinite regress because at some point in time and place there had to be a couple from whom a community was born. Or to avoid the tacit possibility for incest, perhaps there were a few individuals willing to come together to form a community.

The substance perspective of human nature endorses the principle that communities do not follow an infinite regress of existence. Rather it is from individuals that communities come alive insofar as individuals are willing to commit to communal living and to establish certain rules or expectations for the preservation of their

common good. Then, there is the reciprocal exchange: As new individuals are born into communities, communities influence individual conventions, but equally as new individuals en- ter communities, individuals share their gifts to shape communities’ conventions (Gallaher & Newton, 2009).

We already discussed how religiosity and spirituality are not equivalent aspects of human nature. Rather individuals are to spirituality, what communities are to religiosity. That is to say, spirituality belongs to all human persons by virtue of being human, and religiosity belongs to communities of faith by virtue of human choice. Human beings are not born religious; in contrast, they are born spiritual. It is precisely because human beings are born spiritual that they are able to develop communities of faith within which what is transcendent is perhaps the nexus between these constructs (J. Hill, 2000; Long, 2000).

Human beings are not “by nature” born reli- gious, if this were the case, then there would not be conversions between religious communities, for instance (e.g., Gonsiorek, Richards, Parga- ment, & McMinn, 2009). The antecedent can be exemplified by positing that all persons born within the confines of either Buddhism or Pen- tecostalism would practice either Buddhism or Pentecostalism for the rest of their “natural lives.” However we know this is not the case. For example, some people born into and raised within a religious denomination may remain nominally but not practically religious within the same denomination. In fact, statistically, individuals continue to report more saliently that they are spiritual, but not necessarily reli- gious.12 We believe the converse would be un- reasonable. This also means that those who report to be religious implicitly report to be spiritual. In the case of religious conversions, individuals choose to commit to one denomina- tion over another for a variety of reasons that we will not explore here. Most important, however,

12 For example, a recent national online panel poll pub- lished in a local newspaper revealed that adult Americans (n � 1,051) distinguished spirituality from religiosity, with at least 24% of respondents claiming to be spiritual but not religious (Wicker, 2009). This finding could be interpreted as one out of four adult Americans claims to be spiritual and not religious. The other three presume to be spiritual within the confines of their religious denominations.

133SEPARATING SPIRITUALITY FROM RELIGIOSITY

is to consider that individuals form communi- ties of faith to worship and to seek what is transcendent, thus sharing their spirituality with one another (Gallaher & Newton, 2009).

The substance perspective of human nature supports that (by necessity) spirituality is intrin- sic to the nature of all human beings. However it is not of necessity that all human beings be religious in a natural sense. That is, human beings are able to choose to be religious con- tingently but not necessarily.13 In the same way, human beings may choose to come together to form communities of faith contingently but not necessarily.

Communities of faith share conventional practices that implicitly convey a sense of myth, almost magical. Intercessory prayer, for exam- ple, requests something (at times according to a person’s or community’s wants or needs), ex- pecting that a miracle would occur. Other times, individuals engage in prayer that has an imbed- ded sense of quid pro quo in which a person may offer something in exchange for a particu- lar something from a miraculous source. How- ever, when neither favor is received, sometimes disappointment or doubt in belief may ensue. These are problems of religious nature, as we already discussed.

Spirituality, on the other hand, is substan- tially necessary for the existence of each human being. And being aware of one’s spiritual nature requires simply contemplation and silence. There is much to learn in silence. In fact, some authors believe that in silence individuals com- municate or connect better with what is tran- scendent (Girzone, 2006). In this sense matur- ing spiritually makes one not want what one truly wants, but makes one aware of what one does not truly need.

Substance human beings are gregarious nat- urally. So they build communities, because their lives do not evolve in a social vacuum, neither does their spirituality. They do so by necessity and only contingently regarding communities of faith (otherwise known as religious denomina- tions). For example, there may be communities who choose not to be religious, or not to even believe in a religious conception of God. Or there may be indigenous communities that have never heard about a conventional notion of God, but who are capable to experience what is tran- scendent. Notwithstanding these communal variations, spirituality’s teleological (purposive)

actions do not change by place, nor by time (Casey, 1994). That is individuals from East and West, North and South, from different eras have manifested a sense of intrinsic spirituality (Lu- koff et al., 1995; Turner et al., 1995). This is not the case with religious communities. These, as cultures, are expressions of conventions that vary by place and by time (Sasaki & Kim, 2011). For example, some dogmas of the 4th century Christian church are not upheld in the 21st century (see footnote 9). Furthermore, only religiosity but not spirituality is a cultural ex- pression for some (not all) human beings. Therefore, only religiosity and not spirituality is an element of cultural diversity.

Ethical Necessity for a Denotative Separation of Spirituality From Religiosity

Caring for clients’ spirituality is crucially ethical to health care. This was the message professionals inferred from the DSM–IV codifi- cation of spirituality in 1994. As a result, na- tional accrediting agencies began to require cur- ricular inclusion of competencies for human spirituality to resolve the reported lack of train- ing from professionals to recognize and to care for clients’ spirituality (Burkhart & Hogan, 2008). In tandem, professional associations wrote ethical codes emphasizing the responsi- bility to attend to clients’ spirituality.14

These endeavors would appear to render ther- apeutic spiritual competency a sine qua non of ethical health care. The problem, however, is that all efforts to recognize and to treat spiritu- ality have been built on a conflated religious-

13 All human beings are spiritual by nature whether or not they verbalize their spirituality. In fact, self-declared athe- ists and agnostics have declared to have spiritual needs (Burnard, 1988).

14 For example, the Council for Accreditation of Coun- seling and Related Accredited Programs (2009) requires curricular training to meet clients’ spiritual needs. Other national accrediting health organizations for mental health counseling (Association for Spiritual, Ethical and Religious Values in Counseling, 2009), marriage and family therapy (Nelson et al. 2007), family medicine (Anandarajah & Hight, 2001), nursing (van Leeuwen, Tiesinga, Middel, Post, & Jochemsen, 2009), pastoral counseling (American Association of Pastoral Counselor, 1994), psychology (Ken- kel & Peterson, 2009), psychiatry (American Psychiatric Association, 2009; Joint Reference Committee, 2006; Jo- sephson & Peteet, 2004), and social work (National Asso- ciation of Social Workers, 2007) have identified a similar importance to include spirituality in academic curricula.

134 DEL RIO AND WHITE

spirituality notion and not on separate con- structs (Berthrong, 2004; Dyson, Cobb, & Foreman, 1997; Moberg, 1984, 2002). That is, using religiosity and spirituality interchange- ably has generated ethical discussions on “something” that does not address either con- struct successfully. For example, caring for a person’s spirituality or a person’s spiritual needs, or a person’s spiritual experiences seems untenable because spirituality’s appeal to what is transcendent serves “ideological functions” that use theological associations that are unfal- sifiable and thus, not a proper matter of therapy (Helminiak, 2008). Neither are the list of “spir- itual problems” the DSM–IV has introduced (Lukoff et al., 1998), especially if these “prob- lems” may also be chemically induced halluci- nations, for instance. However we will not ex- plore spiritual problems in this paper for the sake of brevity.

If we agree that competencies relative to hu- man spirituality are ethically necessary, we must also wonder: What are these competen- cies? How do we infuse them into new practi- tioners? Does training itself guarantee ethical competency? Or do we need spirituality com- petencies at all? Obviously skills training and knowledge development and evaluation must follow established academic practices (Gonsi- orek et al., 2009). However, there is no way to ensure that what happens in therapeutic encoun- ters will meet competent criteria or ethical stan- dards. Another problem to consider, if we ac- cept spirituality is intrinsic to human nature, is whether practitioners need to be competent to discuss an intrinsic human component, say for example, nonheterosexual identities, (or spiritu- ality)?

To complicate matters, some authors have questioned what do we call speaking about hu- man spirituality openly, and should we expect remuneration for doing so (Gonsiorek et al., 2009)? The same analogical example of sexual identities serves to illustrate this point. Obvi- ously we do not charge individuals just because they wish to speak about their nonheterosexual identities, neither do we charge heterosexual individuals for discussing how they seek sex- ual pleasure; unless sexual practices cross ethics and law, presenting a potential or ac- tual harm to someone; then, ethical principles must be applied to comply with law expecta- tions regardless of remuneration. We can only

wonder: Could this also be the case with spirituality’s manifestations, and if so, what do they look like? The main point of this analogical comparison is the acceptance of human sexuality as a “normal” topic of health care disciplines, and the hope that one day spirituality be integrated likewise.

Using religiosity and spirituality interchange- ably also obfuscates the development of sound therapies, research studies, and clinical applica- tions. This is a true ethical concern. On the one hand, some authors have argued that spirituality must be recognized as intrinsically human with- out allowing spirituality to become an extension of the transcendent (Helminiak, 2008). On the other hand, other authors have argued that spir- ituality and religiosity must also be separated so that neither term subsumes the other (Kourie, 2006). We have already discussed how they differ notionally and by relation to individuality and to communality, respectively.

We further suggest that unless a definitive distinction between these constructs is achieved, with an emphasis on conceptual clar- ity for each of them, we will remain unable to fully incorporate them into health care disci- plines. Achieving and preserving spirituality’s conceptual clarity (as we have done here) is perhaps the foremost ethical responsibility for disciplines dedicated to health care. Further- more, what remains is a responsibility for de- veloping ethically sound therapies to recognize spirituality’s intrinsic relationship to humanity. And to help individuals understand the differ- ence between spirituality and religiosity lest further conflation (religious-spirituality) pre- vent open conversations about spirituality in therapeutic encounters—particularly in places that are legally government agents. Some critics would certainly argue that this “secularization” of spirituality is detrimental to religion and opens the doors for whatever one wishes to consider as spirituality, while others would ar- gue that educating individuals about human spirituality begs the question about principles of respect and autonomy. However, as scandalous as our position may be perceived, we do not mean to harm religiosity’s role in people’s lives. We only present an alternative view of spiritu- ality and emphasize that we can speak of it separately from religiosity. Nor do we wish to argue that anything goes. For we do not con- sider superstitions, astrology, horoscopes, au-

135SEPARATING SPIRITUALITY FROM RELIGIOSITY

gurs, telepathy, divination, or any other form of “new age” practices to be germane to spiritual- ity. We only suggest that our perspective is an alternative way to view human spirituality “alone,” and that perhaps we ought to educate others as to what this means by building upon our preceding conclusions: (a) religiosity and spirituality are not equivocal; (b) loss of faith is not a spiritual problem; and (c) only religiosity, and not spirituality, is an element of cultural diversity. These suggestions seem consonant with the principles of justice and welfare. Di- lemmas involving juxtaposed ethical principles (as above) may need to be resolved in a new ethics relative to spirituality.

We have taken from Aristotelian and Thomistic philosophies that spirituality’s proper functions are intellect and volition, and these resonate with Bernard Lonergan’s interpretations of spirituali- ty’s functions (Helminiak, 2008). The proper ends (telos) of intellect and volition are truth and good- ness, respectively. Therefore, it is reasonably eth- ical that health care disciplines explore how intel- lect relates to truth and volition to goodness. This also implies that epistemology (to intellect) and ethics (to volition) are central to spirituality (Helminiak, 2008). And studying how these areas interrelate ought to be goals of 21st century ethical health care practices.

We strongly recommend by implication, that a new conception of spirituality in the DSM codifi- cation system must be undertaken: One that does not conflate “spiritual problems” with spirituali- ty’s functions and their proper ends, one that rec- ognizes that spirituality is intrinsic to human na- ture by necessity, one that does not allow a chance for conflation between spirituality and religiosity, either disjunctively or conjunctively (Berry, 2005; Blanch, 2007; Kourie, 2006); and, one that allows for continued dialogue on how to better theorize, research, and practice new frameworks on human spirituality. The converse to these recommenda- tions will only perpetuate the religious limitations imposed on spirituality (Burke & Miranti, 2001; J. Hill, 2000; Lukoff et al., 1998; Prest, Russel, & D’Souza, 1999; Turner et al., 1995; Zinnbauer et al., 1997).

Implications

Theories are born from ideas or constructs. Theories tend explain or predict what is real. Evidence usually proves or disproves theories.

For this reason, precision and conceptual clarity of constructs are fundamental to theoretical de- velopment. This is to prevent theoretical con- ceptions from lacking validity (ontological cor- roboration) regardless of their reliabilities15

(e.g., P. C. Hill & Pargament, 2000, p. 65). In turn, theories require research practices to so- lidify their conceptual speculations (Ribaudo & Takahashi, 2008), and to develop cross- culturally meaningful assessment tools for diag- noses and for treatment plans’ implementations (e.g., Piedmont, 1999, 2001, 2007). These ac- tivities remain ethically predicated on client welfare and advocacy promotion. Hence, it is crucial not only to achieve but also to preserve the conceptual clarity of spirituality (we have adduced) regarding research questions and re- search methods in health care disciplines (Tanyi, 2002).

A decade into the 21st century it is clear that the more conceptualizations of spirituality come to be, based on already existing conflations of religious-spirituality, the more confusion abounds in the development of theories and assessment tools about spirituality and religios- ity. Thus, conceptual clarity about spirituality is crucial if we are to move forward as a species on this planet in terms of understanding and embracing everything our nature entails by ne- cessity. For this reason we have endorsed a hylomorphic attitudinal spirituality perspective (literally a substance-based natural proclivity toward goodness and truth as the nature of every human soul). Existential questions about our or- igin, nature, and purpose have led thinkers throughout history to have introduced a hylomor- phic perspective of human nature. Perhaps we must remain simple and humble and not try to reinvent the wheel, so to speak, but to carry on with the ontological and epistemological conse- quences we have inherited from such a perspec- tive of human nature.

15 Conflated primary constructs (the original constructs used in theory development) render research results ques- tionable regardless of their reliability. Take for example an analogous scale. If this scale measures the same weight every other day for 2 weeks, there is some evidence it is reliable. However, if the scale’s needle does not mark zero every time it weights, it lacks accuracy or construct purity (Rosenthal, 1993). Regarding spirituality, the more defini- tions arise from existing conceptions only adds to its epis- temic conflation (MacDonald 2000; MacDonald, LeClair, Holland, Alter, & Friedman, 1995).

136 DEL RIO AND WHITE

Yet again effective epistemology of contem- porary research relies on the combination of quantitative and qualitative methodologies to achieve conceptual purity (e.g., Greene, 2008). It is at this deeper epistemic level that spiritu- ality’s affirmation becomes evident, as well as its distinction from religiosity. For example, considering spirituality is intrinsic to humanity enables one to operationalize it as “one’s atti- tude toward [emphasis added] . . . by how indi- viduals perceive reality, and how they experi- ence reality by means of personal involvement with reality” (see Del Rio, 2008, p. 13). This threefold axiom allows for the consideration that though spirituality is in each human person, how each person manifests her spirituality may be different within a given relationship or com- munity. For instance, belying the possibility of diverse spirituality’s manifestations would prevent systemic clients from viewing their spiritualities’ complementarities within the relationships they have developed. Put differ- ently, dyadic and familial clients may benefit from discovering not only their spiritual types (spirituality’s manifestations), but also from accepting the complementarities from the dif- ferences they bring to their relationships. In- dividual clients may also benefit from learn- ing that being spiritual is a natural aspect of their humanity; their very attitudes toward experiencing and embracing life’s experi- ences separate from dogmatic systems. We believe only when practitioners perceive spir- ituality as an intrinsic human component, can they engage in genuine spiritual dialogues with their clients (Elkins, 1995). At this level, clients’ spirituality becomes their worldviews about their experiences of life (Benjamin & Looby, 1998). Most fundamental, spirituality is clients’ attitudinal response to life’s expe- riences, and the meaning they make from such experiences. As a principle of existence, spir- ituality contributes to how individuals mature and live their lives. Seeing spirituality in this fashion may help clinicians to include spiri- tuality in therapeutic encounters rather than excluding it because of different religious ad- hesions, negative religious experiences, fear to impose one’s values, or simply making referrals to religious “experts” to avoid dis- cussing this human component.

Conclusions and Recommendations

In this paper, we argued that spirituality be- longs to each person by virtue of being human. Viewing spirituality as a principle of existence and simply as one’s attitude toward life allows for the possibility of its taxonomical assessment (to accept diverse spiritual identities instead of placing spirituality on a linear continuum16 that may imply its “judgmental” or “reductionist” quantification in clinical settings). Our hylo- morphic attitudinal spirituality perspective allows its curricular inclusion, particularly in public higher education institutions (and other government agents); and answers a call for theories’ development to study spirituality separately (e.g., Elkins, 1995; Moberg, 2002). Corresponding frameworks and typological assessment tools are required to help individ- uals learn what being spiritual means. This is similar, for example, to coming to know what it means to be a sexual being (Elkins, 1995).

Our discourse suggests an ontological and epistemological dialogue must continue to fur- ther clarify spirituality’s conceptualization. By and large, such recognition of spirituality and its diverse manifestations may be useful to uncover how complementary one’s spiritual identity is to another, especially in close personal relation- ships. Our spiritual definition leads toward rec- ognition of spiritual diversity in research and therapeutic practices from a forthcoming typo- logical perspective (Del Rio & White, 2011). A hylomorphic attitudinal spirituality’s utility de- taches spirituality from a cumulative continuum in assessment and strategic practices to service both individual and systemic clienteles. In this way, instead of quantifying spirituality, a taxo- nomical perspective opens the path for spiritual types that may be complementary rather than contradictory or mutually exclusive. Denoting spirituality as a principle of existence may en- able health care professionals to acknowledge

16 During gregarious exchanges individuals’ spiritual identities complement one another and cannot be reduced to simplistic quantification on a linear continuum as some assessment tools presume. For this reason, typological in- ventories to assess one’s attitude toward life’s experiences and the meaning that is germane to those experiences re- quires the development of assessment tools that may help identify how spiritual identities differ from or complement one another.

137SEPARATING SPIRITUALITY FROM RELIGIOSITY

the capacity for experiencing life in particular and attitudinal ways. Hence, we conclude that etymologically psyche simply means soul whose nature is spirituality. Some therapeutic strategies to foster hylomorphic attitudinal spir- ituality follow:

1. Encourage the client to define what truth and goodness mean.

2. Encourage the client to make a list of behaviors, thoughts, ideas, or artefacts that help experience truth and goodness.

3. Encourage the client to engage in what helps experience truth and goodness.

4. Encourage the client to write a journal (where the client has been, where the client is currently, or what the client sees in the near future) emphasizing positive events or experiences that counteract negative experiences.

5. Encourage the client to find a comfort- able place and sit quietly and simply practice breathing.

6. Encourage the client to spend time with family, friendships, and/or personal rela- tionships.

7. Encourage the client to make a list of favorite activities, movies, music, books, and so on.

8. Encourage the client to engage in favor- ite, healthy behaviors.

9. Encourage the client to make a list of personal, basic needs.

10. Encourage the client to seek ways to satisfy personal, basic needs.

11. Encourage the client to identify what is lacking in the client’s sense of self-care.

12. Encourage the client to practice self- care.

The foregoing recommendations represent only a small step toward fostering individuals’ awareness of hylomorphic attitudinal spiritual- ity. Recent theoretical and empirical publica- tions have provided support to our proposition that human beings are spiritual by virtue of being humans— because spirituality is truly a human personality factor (Pargament, 2008; Piedmont et al., 2009). The personal and rela- tional natures of the foregoing recommenda- tions obviate we do not specifically address what is transcendent prima facie. We have ex- cluded any allusions to the transcendent pur-

posefully because the converse would lead pro- fessionals and clients to a conflation standpoint in which belief systems and religious adhesions would come to bear on therapeutic conversa- tions at this juncture when our perspective is merely nascent. To explain, if (a) we propose transcendent strategies, then (b) belief systems and religious adhesions would imbue therapeu- tic encounters leading them to face the already existing logical conflation of religious-spiritual- ity. However, �(b) preventing such conse- quent, also �(a) prevents us from suggesting transcendent strategies at this juncture. Alter- natively, if (a) we leave the foregoing recom- mendations to stand, perhaps, as simply rela- tional in nature, this �(b) would prevent re- ligious conventions to imbue therapeutic encounters (but would still foster individuals’ awareness of their attitudinal spirituality). So we decide to (a) leave our recommendations as they are, and our conclusion follows logi- cally �(b) belief systems and religious adhe- sions would not imbue therapeutic encounters leading them to face the already existing log- ical conflation of religious-spirituality.

Finally, we have reiterated time and again that all individuals are spiritual by virtue of being human. It is this spiritual constitution that enables individuals to create or develop communities of faith—religious systems. Hence, spirituality is not only sufficient but also necessary to discover what is transcen- dent, whereas religiosity is only sufficient but not necessary to discover what is transcendent or to foster spirituality qua spirituality. We further premise it is human gregariousness that provides “feelings of oneness with the world or within oneself” (Pargament, 2008, p. 26). It is at this deeper ontological and epis- temic level that the numinous is found, and “once we become aware of it, we find more and more experiences of what is transcendent in relationships, settings, and communities” (Pargament, 2008, p. 26). For these reasons, our suggested strategies are intended to foster such awareness of what is transcendent; one step at a time. A forthcoming discussion (Del Rio & White, 2011) will adduce how these strategies are consonant with a taxonomical theoretical framework, and psychometric properties of a Spiritual Typology Inventory.

138 DEL RIO AND WHITE

References

Alighieri, D. (2007). Dante’s divine comedy: Hell, purgatory, paradise (H. W. Longfellow, Trans.). Edison, NJ: Chartwell Books.

Allport, S. W., & Ross, J. M. (1967). Personal reli- gious orientation and prejudice. Journal of Person- ality and Social Psychology, 5, 432– 443. doi: 10.1037/h0021212

American Association of Pastoral Counselor. (1994). Code of ethics. Retrieved from https://aapc.org/ content/ethics

American Psychiatric Association. (1994). Diagnos- tic and statistical manual of mental disorders (4th ed.).Washington, DC: Author.

American Psychiatric Association. (2009). The prin- ciples of medical ethics with annotations espe- cially applicable to psychiatry. Arlington, VA: Author.

Anandarajah, G., & Hight, E. (2001). Spirituality and medical practice: Using the HOPE questions as a practical tool for spiritual assessment. American Family Physician, 63, 81– 88.

Apostle, H. G. (1980a). Aristotle’s categories and propositions. Grinnell, IA: Peripatetic Press.

Apostle, H. G. (1980b). Aristotle’s physics. Grinnell, IA: Peripatetic Press.

Aristotle. (1996). Aristotle: Introductory readings (T. Irwin & G. Fine, Trans.). Indianapolis, IN: Hack- ett.

Armstrong, K. (2001). Buddha. New York, NY: Pen- guin.

Armstrong, K. (2004). A history of God: The 4000- year quest of Judaism, Christianity and Islam. New York, NY: Gramercy Books.

Armstrong, K. (2006). The great transformation: The world in the time of Buddha, Socrates, Confucius and Jeremiah. New York, NY: Random House.

Association for Spiritual, Ethical and Religious Val- ues in Counseling. (2009). Competencies for ad- dressing spiritual and religious values in counsel- ing. Retrieved from http://www.aservic.org/ competencies/html

Aveling, F. (1909). Form. In K. Knight (Ed.), The catholic encyclopedia (Vol. 6). Retrieved from http://www.newadvent.org/cathen/06137b.htm

Aveling, F. (1911). Matter. In K. Knight (Ed.), The catholic encyclopedia (Vol. 10). Retrieved from http://www.newadvent.org/cathen/10053b.htm

Benjamin, P., & Looby, J. (1998). Defining the nature of spirituality in the context of Maslow’s and Roger’s theories. Counseling and Values, 42(2), 92–100. doi: 10.1002/j.2161-007X.1998.tb00414.x

Bennett, J. (2010). The passions of the soul: Rene Descartes. Retrieved from http://www.earlymodern texts.com/pdf/descpass.pdf

Berry, D. (2005). Methodological pitfalls in the study of religiosity and spirituality. Western Journal of

Nursing Research, 27, 628 – 647. doi:10.1177/ 0193945905275519

Berthrong, J. (2004). Love, lust, and sex: A Christian perspective. Buddhist-Christian Studies, 24, 5–22. doi:10.1353/bcs.2005.0003

Blanch, A. (2007). Integrating religion and spiritual- ity in mental health: The promise and the chal- lenge. Psychiatric Rehabilitation Journal, 30, 251–260. doi:10.295/30.4.2007.251.260

Bobik, J. (1965). De Ente et Essentia: Aquinas on being and essence: A translation and interpreta- tion. Notre Dame, IN: University Press.

Burgess, W. A. (1997). Psychiatric nursing. Stam- ford, CT: Appleton & Lange.

Burke, M. T., Hackney, H., Hudson, P., Miranti, J., Watts, G. A., & Epp, L. (1999). Spirituality, reli- gion, and CACREP curriculum standards. Journal of Counseling and Development, 77, 251–257.

Burke, M. T., & Miranti, J. (2001). The spiritual and religious dimensions of counseling. In D. C. Locke, J. E. Mayers, & E. L. Herr (Eds.), The handbook of counseling (pp. 601– 612). Thousand Oaks, CA: Sage.

Burkhart, L., & Hogan, N. (2008). An experiential theory of spiritual care in nursing practice. Qual- itative Health Research, 18, 928 –938. doi: 10.1177/1049732308318027

Burnard, P. (1988). The spiritual needs of atheists and agnostics. The Professional Nurse, 4, 130 – 132.

Casey, M. (1994). The undivided heart. Petersham, MA: St. Bede’s.

Chadwick, H. (1993). The early church (Rev. ed.). London, England: Clays, St. Ives.

Connell, R. J. (1988). Substance and modern science. Chicago, IL: University of Notre Dame Press.

Council for Accreditation of Counseling & Related Educational Programs. (2009). CACREP standards. Retrieved from www.cacrep.org/2009standards .pdf

Coyle, J. (2002). Nursing theory and concept devel- opment or analysis: Spirituality and health: To- wards a framework for exploring the relationship between spirituality and health. Journal of Ad- vanced Nursing, 37, 589 –597. doi:10.1046/j.1365- 2648.2002.02133.x

Delgado, C. (2005). A discussion on the concept of spirituality. Nursing Science Quarterly, 18, 157– 162. doi:10.1177/0894318405274828

Del Rio, C. M. (2008). Psychometric properties of the Spiritual Typology Inventory. Ann Arbor, MI: ProQuest Information and Learning Company.

Del Rio, C. M., & White, L. J. (2011). Hylomorphic attitudinal spirituality: Development and psycho- metric properties of the Spiritual Typology Inven- tory. Department of Educational Psychology and Special Education, Southern Illinois University Carbondale. Manuscript in preparation.

139SEPARATING SPIRITUALITY FROM RELIGIOSITY

Descartes, R. (1901). Meditations on first philosophy (J. Veitch, Trans.). Retrieved from http://www .filepedia.org/meditations-on-first-philosophy

Dubay, T. (1985). Faith and certitude. San Fran- cisco, CA. Ignatius.

Dyson, J., Cobb, M., & Foreman, D. (1997). The meaning of spirituality: A literature review. Jour- nal of Advanced Nursing, 26, 1183–1188. doi: 10.1111/j.1365-2648.1997.tb00811.x

Egbert, N., Mickley, J., & Coeling, H. (2004). A review and application of social measures of religiosity and spirituality: Assessing a missing component in health communication research. Health Communication, 16, 7–27. doi:10.1207/ S15327027HC1601_2

Eliason, G. T., Hanley, C., & Leventis, M. (2001). The role of spirituality in counseling: Four theo- retical orientations. Pastoral Psychology, 50, 77– 91. doi:0031-2789/01/1100-0077$19.50/0

Elkins, D. N. (1995). Psychotherapy and spiritual- ity: Toward a theory of the soul. Journal of Humanistic Psychology, 35, 78 – 89. doi: 10.1177/00221678950352006

Elkins, D. N., Hedstrom, L. J., Hughes, L. L., Leaf, J. A., & Saunders, C. (1988). Toward a humanis- tic-phenomenological spirituality: Definition, de- scription, and measurement. Journal of Humanis- tic Psychology, 28, 5–18. doi:10.1177/ 0022167888284002

Fenwick, T. J., & English, L. M. (2004). Dimensions of spirituality: A framework for adult educators. The Journal of Adult Theological Education, 1, 49 – 64. doi:10.1558/jate.1.1.49.36052

Fukuyama, M. A., & Sevig, T. D. (1997). Spiritual issues in counseling: A new course. Counselor Education and Supervision, 36, 233–244.

Gallaher, S. K., & Newton, C. (2009). Defining spir- itual growth: Congregations, community, and con- nectedness. Sociology of Religion, 70, 232–261. doi:10.1093/socrel/srp039

Garcia-Valdecasas, M. (2005). Psychology and mind in Aquinas. History of Psychiatry, 16, 291–310. doi:10.1177/0957154X05051920

Girzone, J. F. (2006). My struggle with faith. New York, NY: Doubleday.

Gonsiorek, J. C., Richards, P. S., Pargament, K. I., & McMinn, M. R. (2009). Ethical challenges and opportunities at the edge: Incorporating spirituality and religion into psychotherapy. Professional Psy- chology: Research and Practice, 40, 385–395. doi: 10.1037/a0016488

Graham, S., Furr, S., Flowers, C., & Burke, M. T. (2001). Religion and spirituality in coping with stress. Counseling and Values, 46(1), 2–13.

Greene, J. C. (2008). Is mixed methods social inquiry a distinctive methodology? Journal of Mixed Methods Research, 2, 7–22. doi:10.1177/ 1558689807309969

Haynes, D. T. (2001). Mormonism. In M. Van Hook, B. Hugen, &M. Aguilar (Eds.), Spirituality within religious traditions in social work practice (pp. 251–272). Pacific Grove, CA: Brooks/Cole.

Helminiak, D. A. (1996). The human core of spiri- tuality: Mind as psyche and spirit. Albany: State University of New York Press.

Helminiak, D. A. (1998). Sexuality and spirituality: A humanist account. Pastoral Psychology, 47, 119 –126. doi:10.1023/A:1022909628981

Helminiak, D. A. (2008). Confounding the divine and the spiritual: Challenges to a psychology of spiri- tuality. Pastoral Psychology, 57, 161–182. doi: 10.1007/s11089-008-0163-9

Hill, J. (2000). A rationale for the integration of spirituality in community psychology. Journal of Community Psychology, 28, 139 –149. doi: 10.1002/(SICI)1520-6629(200003)28:2�139:: AID-JCOP3�3.0.CO;2-X

Hill, P. C., & Pargament, K. I. (2003). Advances in the conceptualization and measurement of religion and spirituality: Implications for physical and mental health research. American Psycholo- gist, 58, 64 –74. doi:10.1037/0003-066X.58.1.64

Hill, P. C., Pargament, K. I., Hood, R. W., Jr., McCullough, M. E., Swyers, J. P., Larson, D. B., & Zinnbauer, B. J. (2000). Conceptualizing reli- gion and spirituality: Points of commonality, points of departure. Journal for the Theory of Social Behavior, 30, 51–77. doi:10.1111/1468- 5914.00119

Hinselwood, R. D. (2005). Form, space, body, and emotions. Project Muse Philosophy, Psychiatry, and Psychology, 12, 43– 48. doi:10.1353/ ppp.2005.0025

Hinterkopf, E. (1994). Integrating spiritual experi- ences in counseling. Counseling and Values, 38(3), 98 –111.

Hintikka, J. (1965). Cogito, ergo sum: Inference or performance? In A. Sosenske & N. Fleming (Eds.), Meta-meditations: Studies in Descartes (pp. 50 – 74). Belmont, CA: Wadsworth.

Hodge, D. R. (2004). Why conduct a spiritual assess- ment? A theoretical foundation for assessment. Advances in Social Work, 5, 183–196.

Joint Reference Committee. (2006). Religious/ spiritual commitments and psychiatric practice: Resource document. Retrieved from http:// www.psych.org/Departments/EDU/Library/ APAOfficialDocument

Joseph, M. V. (1988). Religion and social work prac- tice. Social Casework: The Journal of Contempo- rary Social Work, 69, 443– 452.

Josephson, A. M., & Peteet, J. R. (Eds.). (2004). Handbook of spirituality and worldview in clinical practice. Washington, DC: American Psychiatric.

Kenkel, M. B., & Peterson, R. L. (Eds.). (2009). Competency-based education for professional psy-

140 DEL RIO AND WHITE

chology. Washington, DC: American Psychologi- cal Association.

Knight, K. (2008). The summa theologica of St. Thomas Aquinas (Fathers of the English Domini- can Province, Eds. & Trans.), The catholic ency- clopedia (Prima pars, Q 75, 76, 89). Retrieved from http://www.newadvent.org/summa/1.htm (Original work published 1920)

Kourie, C. (2006). The “turn” to spirituality. Acta Theologica Suplementum 8, 19 – 40. Retrieved from http://www.ajol.info/index.php/actat/article/ viewFile/52310/40935

Lambert, Y. (1999). Religion in modernity as a new axial age: Secularization or new religious forms? Sociology of Religion, 60, 303–333. doi:10.2307/ 3711939

Libreria Editrice Vaticana. (1994). Catechism of the Catholic Church for the United States of America. Vatican City: Author.

Long, J. (2000). Spirituality and the idea of transcen- dence. International Journal of Children’s Spiri- tuality, 5, 147–161. doi:10.1080/713670913

Lorber, J. (1994). Paradoxes of gender. Binghamp- ton, NY: Vail-Ballou Press.

Lukoff, D., Lu, F., & Turner, R. (1992). Toward a more culturally sensitive DSM–IV: Psychoreli- gious and psychospiritual problems. The Journal of Nervous and Mental Disease, 180, 673– 682. doi:10.1097/00005053-199211000-00001

Lukoff, D., Lu, F., & Turner, R. (1995). Cultural considerations in the assessment and treatment of religious and spiritual problems. The Psychiatric Clinics of North America, 18, 467– 485.

Lukoff, D., Lu, F., & Turner, R. (1998). From spir- itual emergency to spiritual problem: The transper- sonal roots of the DSM–IV category. Journal of Humanistic Psychology, 38(2), 21–25.

MacDonald, D. A. (2000). Spirituality: Description, measurement, and relation to the five factor model of personality. Journal of Personality, 68, 153– 197. doi:10.1111/1467-6494.t01-1-00094

MacDonald, D. A., LeClair, L., Holland, C. J., Alter, A., & Friedman, H. L. (1995). A survey of mea- sures of transpersonal constructs. The Journal of Transpersonal Psychology, 27, 171–235.

Maher, M. (1909). Dualism. In K. Knight (Ed.), The catholic encyclopedia (Vol. 5). Retri- eved from http://www.newadvent.org/cathen/ 05169a.htm

Moberg, D. O. (1984). Subjective measures of spir- itual well-being. Review of Religious Research, 25, 351–364. doi:10.2307/3511368

Moberg, D. O. (2002). Assessing and measuring spiri- tuality: Confronting dilemmas of universal and par- ticular evaluative criteria. Journal of Adult Develop- ment, 9, 47– 60. doi:1068-0667/02/0100-0047/0

National Association of Social Workers. (2007). In- dicators for the achievement of NASW standards

for cultural competency in social work practice. Washington, DC: Author.

Nelson, T. S., Chenail, R. J., Alexander, J. F., Crane, D. R., Johnson, S. M., & Schwallie, L. (2007). The development of core competencies for the practice of marriage and family therapy. Journal of Marital and Family Therapy, 33, 417– 438. doi:10.1111/ j.1752-0606.2007.00042.x

Pagels, E. (1989). The gnostic gospels. New York, NY: Vintage Books.

Pargament, K. I. (2008). The sacred character of com- munity life. American Journal of Community Psy- chology, 41, 22–34. doi:10.1007/s10464-007-9150-z

Piedmont, R. L. (1999). Does spirituality represent the sixth factor of personality? Spiritual transcendence and the five-factor model, Journal of Personality, 67, 985–1013. doi:10.1111/1467-6494.00080

Piedmont, R. L. (2001). Spiritual transcendence and the scientific study of spirituality. Journal of Re- habilitation, 67, 4 –14.

Piedmont, R. L. (2007). Cross-cultural generaliz- ability of the spiritual transcendence scale to the Philippines: Spirituality as a human universal. Mental Health, Religion & Culture, 10, 89 –107. doi:10.1080/13694670500275494

Piedmont, R. L., Ciarrochi, J. W., Dy-Liacco, G. S., & Williams, J. E. G. (2009). The empirical and conceptual value of the spiritual transcendence and religious involvement scales for personality re- search. Psychology of Religion and Spirituality, 1, 162–179. doi:10.1037/a0015883

Piedmont, R. L., & Leach, M. M. (2002). Cross- cultural generalizability of the spiritual transcen- dence scale in India: Spirituality as a universal aspect of human experience. American Behavi- oral Scientist, 45, 1888 –1901. doi:10.1177/ 0002764202045012011

Plato (1986). Phaedo (R. S. Bluck, Trans.). The dia- logues of Plato (pp. 63–134). New York, NY: Bantam Books.

Prest, L. A., Russel, R., & D’Souza, H. (1999). Spirituality and religion in training, practice and personal development. Journal of Family Ther- apy, 21, 60 –77. doi:10.1111/1467-6427.00104

Ribaudo, A., & Takahashi, M. (2008). Temporal trends in spirituality research: A meta-analysis of journal abstracts between 1944 and 2003. Journal of Religion, Spirituality and Aging, 20, 16 –28. doi:10.1080/155280308801921972

Rosenthal, H. (1993). Encyclopedia of counseling: Master review and tutorial. Bristol, PA: Acceler- ated Development.

Royce, J. E. (1961). Man and his nature: A philo- sophical psychology. New York, NY: McGraw- Hill.

S. Agostino d’Ippona. (1987). Le Confessioni (A. Landi, Trans.). Milan: Italy: Figlie di S. Paolo.

141SEPARATING SPIRITUALITY FROM RELIGIOSITY

Sasaki, J. Y., & Kim, H. S. (2011). At the intersection of culture and religion: A cultural analysis of reli- gion’s implications for secondary control and social affiliation. Journal of Personality and Social Psy- chology, 101, 401– 414. doi:10.1037/a0021849

Semonske, A., & Fleming, N. (Eds.). (1965). Meta- meditations: Studies in Descartes. Belmont, CA: Wadsworth.

Shields, C. (2011). Aristotle’s psychology: The Stan- ford encyclopedia of philosophy E. N. Zalta (Ed.). Retrieved from Http://plato.stanford.edu/entries/ aristotle-psychology/index.html

Slater, W., Hall, T. W., & Edwards, K. J. (2001). Measuring religion and spirituality: Where are we and where are we going? Journal of Psychology and Theology, 29, 4 –21.

Stanard, R. P., Sandhu, D. S., & Painter, L. C. (2000). Assessment of spirituality in counseling. Journal of Counseling and Development, 78, 204 –210.

Suyemoto, K. L., & MacDonald, M. L. (1996). The content and function of religious and spiritual be- liefs. Counseling and Values, 40(2), 143–158.

Tanyi, R. A. (2002). Towards clarification of the meaning of spirituality: Nursing theory and con- cept development or analysis. Journal of Advanced Nursing, 39, 500 –509. doi:10.1046/j.1365-2648 .2002.02315.x

Tirri, K., Nokelainen, P., & Ubani, M. (2006). Conceptual definition and empirical validation of the spiritual sensitivity scale. Journal of Em- pirical Theology, 19, 37– 62. doi:10.1163/ 157092506776901870

Traphagan, J. W. (2005). Multidimensional mea- surement of religiousness/spirituality for use in health research in cross-cultural perspective. Re- search on Aging, 27, 387– 419. doi:10.1177/ 0164027505276049

Treanor, N. (2006). The cogito and the metaphysics of mind. Philosophical Studies, 130, 247–271. doi: 10.1007/s11098-004-4512-y

Turner, R. P., Lukoff, D., Barnhouse, R. T., & Lu, F. G. (1995). Religious or spiritual problem: A culturally sensitive diagnostic category in the DSM–IV. Journal of Nervous and Mental Disease, 183, 435– 444. doi: 10.1097/00005053-199507000-00003

van Leeuwen, R., & Cusveller, B. (2004). Nursing competencies for spiritual care. Journal of Ad- vanced Nursing, 48, 234 –246. doi:10.1111/j.1365- 2648.2004.03192.x

van Leeuwen, R., Tiesinga, L. J., Middel, B., Post, D., & Jochemsen, H. (2009). Issues in nurse edu- cation: The validity and reliability of an instrument to assess nursing competencies in spiritual care. Journal of Clinical Nursing, 18, 2857–2869. doi: 10.1111/j.1365-2702.2008.02594.x

Van Ness, P. H. (1996). Spirituality and the secular quest. London, England: SCM.

Weaver, A. J., Pargament, K. I., Flannelly, K. J., & Oppenheimer, J. E. (2006). Trends in the scientific study of religion, spirituality, and health: 1965– 2000. Journal of Religion and Health, 45, 208 – 214. doi:10.1007/s10943-006-9011-3

Wicker, C. (2009, October 4). Surprising results from an exclusive PARADE poll: How spiritual are we? The Southern Illinoisan PARADE, pp. 4 –5.

Zinnbauer, B. J., Pargament, K. I., Cole, B., Rye, M. S., Butter, E. M., Belavich, T. G., . . . Kadar, J. L. (1997). Religion and spirituality: Unfuzzying the fuzzy. Journal for the Scientific Study of Reli- gion, 36, 549 –564. doi:10.2307/1387689

Received January 14, 2010 Revision received November 14, 2011

Accepted November 28, 2011 �

142 DEL RIO AND WHITE