Spirituality and psychosocial work in emergencies: four commentaries and a response

The commentaries on the next few pages relate to the article ‘Spirituality and mental health in humanitarian contexts: an exploration based on World Vision’s Haiti earthquake response’ by Alison Schafer on page 121-130 of issue 8.2 of Intervention (2010). The author uses the experiences in the aftermath of the Haiti earthquake to substantiate her argument that nongovernmental organisations do not have a clear set of interventions to address the spiritual needs of an affected population, in conjunction with their mental health and psychosocial support needs. The author considers this a gap, given the evidence that spirituality can have beneficial effects on mental wellbeing, and is often an important resource for both coping and coming to terms with the consequences of events. However, as mentioned in the editorial of issue 8.2, blurring the line between psychosocial support and ‘spiritual support’could lead to promoting specific religious values to distressed populations, and may even be seen as proselytising of vulnerable groups. The dilemma surrounding this uneasy relationship between religion and psychosocial work definitely warrants further exploration and discussion. This issue, therefore, contains four commentaries responding to the issues raised in Schafer’s article. Grace Onyango, an experienced psychosocial specialist from Uganda, believes that spiritual approaches are not necessarily at odds with more standardised mental health and psychosocial support interventions. In her experience, providing spiritual nurture is not the same as evangelism and deserves more attention in humanitarian work. Michael Paratharayil, who works with a faith based, nongovernmental organisation, underlines the importance of using (local) religious ritual as part of interventions aimed at improving the psycho-social wellbeing of survivors. He illustrates this with examples from South East Asia. Simon van den Berg, Relinde Reiffers & Leslie Snider, who are staff members of the War Trauma Foundation, acknowledge the need for all humanitarian workers to be sensitive to people’s religious and spiritual beliefs, as they should be for social values and cultural practices, in general, but question whether this warrants the creation of specific ‘psycho-spiritual approaches’ and the development of separate models and guidelines. Cynthia Erikson, a psychologist with the Fuller Theological Seminary, underlines the importance of facilitating both the discussion and practice of what people believe, and to try to understand of how these beliefs relate to the experience of an emergency and its aftermath. She advocates the use of an existing clinical tool, the Cultural Formulation, that can guide clinicians through the various ways that culture (and this could include religion and spirituality) is embedded in diagnosis and treatment, and that this can assist the process of developing appropriate interventions. In her response, Alison Schafer points out that she does not recommend developing tools that narrowly focus only on spiritual nurturance and mental health and psychosocial support, but rather to seek ways to include spiritual nurture more broadly within humanitarian work. A first step is the ongoing consideration of the pervasive in£uence of spirituality on wellbeing, and the ways humanitarian agencies can support all aspects of wellbeing, for the survivors of emergencies.