Date Published: September 26, 2018
Drawing upon faith and spirituality can make you more resilient and able to overcome life challenges. A core belief system, even if it isn’t tied to religion, may help you better cope with stress and lead to a better quality of life.
Deborah Marin, MD, Professor of Psychiatry at the Icahn School of Medicine at Mount Sinai and Director of the Center for Spirituality at Mount Sinai, details how she used faith and spirituality to cope with the death of her parents when she was a young woman.
Welcome Dr. Marin and thank you so much for joining us today. Everyone has a different way of talking about resilience or defining it, but what does resilience mean to you?
Dr. Deborah Marin: 00:39
Resilience to me reflects the capacity to manage or endure stressful events in a way that's a positive thinking kind of manner that one can look at the positive side of things, can draw on their own resources and those of others to combat anything from a death of a loved one, an illness, God forbid, a natural disaster. So it's really managing a stressor in a way that permits them to get through it and even quite frankly grow from it.
Let's talk about your role at Mount Sinai.
Dr. Deborah Marin: 01:15
I am a psychiatrist. I oversee the activities of the chaplains in the different departments with spiritual care. What I've learned through work we've done in clinical observation is that chaplains provide a remarkably important resource for compassionate care. Patients do use their faith to combat illness. They may use their faith in terms of medical decision making. That faith and religiosity has a lot of roles in terms of health outcomes. And when chaplain's work with patients, we found that patients find the experience better in the hospital and meeting spiritual emotional needs is a driver of patient satisfaction.
And you know what chaplains mainly do? They listen, they call it active listening. So unlike us health care providers that often interrupt patients after 18 seconds in an interview, they listen. And it allows the patient to, I think do their own reflection on why they're here, what the illness is about, how it's affecting them and their family. In general, in our health system, we find that chaplains only provide prayer a third of the time. They do other things, a lot of emotional support.
Talk to us about faith and resilience.
Dr. Deborah Marin: 02:29
Well, I also think the whole issue of faith and resilience is very interesting. You know, those who have faith tend to be more resilient with regards to—. Veteran's studies have shown that veterans who are church-goers, who define as more religious or less likely to have post-traumatic stress disorder or substance use, and that's been shown to for church goers by the way, that church goers are less likely to use substances.
Can you give us a specific example of someone where faith and spirituality has helped them become more resilient and it's helped them in the healing process?
Dr. Deborah Marin: 02:58
In my practice, I deal with the Orthodox Jewish population. I have definitely seen that whatever comes the person's way or actually the caregivers way because often family members are so remarkably stressed by taking care of an individual that's sick, particularly someone with Alzheimer's disease that they somehow go, "I know that God has a purpose for this and as a consequence I can endure the pain. I can endure the suffering of my mother because I know that there's a reason this is happening and I know that wherever my mother will go afterwards, she'll be OK." Another example would be I've definitely seen patients who are not very old and who go to do some kind of Bible study and they find that being together with folks of likeminded of their faith and learning the history of, it could be Christianity, it could be Judaism, they find meaning and understanding where they come from. And again, that meaning makes them feel like, I can do this. You know, I understand this and whatever that is out there, there's a reason.
Can you name an instance where faith and spirituality has helped you become more resilient?
Dr. Deborah Marin: 04:09
I do believe in a higher power. I definitely do. It has certainly helped me in my life because my parents died when I was very young. So for me it was like a sense of organization in my thoughts when I was nine when my father died.
So how did you draw on faith and spirituality? Has it shaped your path in life in some sort of way?
Dr. Deborah Marin: 04:29
When you're a kid there's a lot of magical thinking that goes on. When you're nine, you're trying to put the world together in your head. Cognitively, nine year old's are like somewhat formed human beings in terms of their ability to understand the bigger things. So to me it kind of made order in my head. And my mother died when I was in medical school. I felt that my faith in that I did the best I could, that this wasn't a punishment for my mother. In fact, in many ways her death was a good thing for her because she was very, very sick, and that she's somewhere.
Some people call magical thinking, some people call it faith. So for me it gives an order, it gives me a framework or a fabric with which to work. My parents were Holocaust survivors and they grew up being Modern Orthodox Jews in Germany and Hungary, and they continued to be somewhat observant, but very assimilated when they came to the States. I do know that my parents and my aunt and my uncle definitely relied on their own inner faith of some kind to tolerate what they went through. A lot of my parents relatives were killed, a lot of them in front of their eyes, actually, one couple. I would say that I think Holocaust survivors are a mixed bag of their belief in God. I've worked with patients who said, how could there possibly be a God? How could this possibly happen? For my parents it was, I think we're here because of something.
So it's in your DNA to be resilient?
Dr. Deborah Marin: 06:10
I believe that there's a truth to that. I've definitely had my challenges in life, but I can say that my faith, which is connected to my gratitude has definitely done me well. There's no question that all my life I have felt I've been very lucky. All my life, I've been very grateful and definitely since my father died, I felt that there's some higher order, something that's watching over or somehow making me feel I can keep on going. There's no question that has definitely helped me get to where I am and definitely makes me extremely enthusiastic about what I'm doing now.
What have you learned about resilience after going through that hardship?
Dr. Deborah Marin: 06:57
I think what I've learned is that one has to really accept one's weaknesses quite frankly, and figure out how to shore them up and take one's strength, which I think may include faith in something bigger than us. Faith in that there is a reason for why things are the way they are. That has helped me throughout my life way before being a physician. The position I have now, I'm just learning that there's data to prove it and I want to add to the field to understand what that connection is between faith and resilience.
You have a belief system, but not everyone does. What if someone doesn't believe in a higher power or they're reluctant to do so? How do you introduce this concept?
Dr. Deborah Marin: 07:38
I wouldn't. I think that if somebody is an agnostic, atheist, that's their privilege, they may believe in something else outside of themselves. What's very important is meaning-making. So you ask, what are your values? It's a very important component of therapy actually. What are your values? I value my family. I value my health. Okay, well that gives you meaning. So let's see how we can use those values to make you realize you have meaning in your life and meaning making, but I wouldn't say hold on there's a God out there.
So for the people who don't have a tie to religion, they can use meaning making as a guide to resilience to overcome struggles?
Dr. Deborah Marin: 08:18
That's right. Totally. Find what their values are and help them understand what struggles are going through and I do believe that can make somebody more resilient. It has to do with making somebody more able to cope with stress and that is a form of resilience. You know, I have my family, I understand I may be very, very sick, but I do value my family. They value me. We're talking about faith, but I want to actually enlarge it to the term spirituality because spirituality is being connected to something that's transcendent to the person. It could be nature, it could be music. It doesn't have to be God, so the higher power of God is faith. So faith and religion kind of go together. Spirituality, you can be absolutely not religious and be very spiritual. A lot of people, particularly younger individuals, faith is not the defining feature.
And how do you correlate that to resilience?
Dr. Deborah Marin: 09:17
When somebody is spiritual, and they could have a religion, they tend to feel a connectedness to something bigger than them. I think it defines a person's ability to feel more than just within themselves. They're also able to, I think, draw on resources that give them meaning. I think meaning making is very important in terms of faith and spirituality and meaning making is very important for people tolerating the vicissitudes of life. And I think those folks who are resilient have a sense of meaning making in them.
Do you have specific examples that you've encountered with patients or colleagues where spirituality came into play and you saw it at work?
Dr. Deborah Marin: 09:58
In terms of my practice, I have found that my patients who have a sense of meaning, who feel connected to some higher order, there's a sense of that I can count on something bigger than me to tolerate this. There's a purpose and reason why this is happening for me, but the positive value of faith or meaning-making or spirituality is the ability to cope. I have definitely found that.
So would you say that spirituality can be thought of as a therapy?
Dr. Deborah Marin: 10:25
There is literature to show that therapists are using actually spirituality as part of their behavioral therapy for patients. Mindfulness is considered a form of spirituality. You know, being able to be present, think of oneself, connectedness. Let me also talk one thing about meditation. Because meditation is viewed as a spiritual experience by many, many people. If you do it, you can lower your blood pressure. With mindfulness, I think that that can be viewed as a spiritual experience and you know, mindfulness can make people more resilient. You know, there are there ways to become resilient too. I can't explain what it is, but it is the following: People are looking for meaning and people looking for their inner resources to help them cope with everything from burnout, not feeling well.
So when it comes to mindfulness and spirituality, this can actually help doctors build resilience as well and better serve those patients?
Dr. Deborah Marin: 11:20
If patient's think it's important, why wouldn't we think it's important? In terms of what physicians are looking for, given the fact that burnout is such a big issue and physician suicide is such a big issue. Physicians are beginning to think about, what can make them feel more in control, what can make them cope better with the stressors that they're experiencing in this rapidly evolving health care system. I think finding one's inner strength and one's own spirituality could be a very grounding experience and physicians want that. This mindfulness issue is a very big issue. You can't force a person to do wellness, but if you have often the opportunity to think of what may help them, I think that's amazing and this health system is paying attention to it.
In fact, Mount Sinai is using support and spirituality to help doctors and nurses better cope with stress and trauma. There's a new program here called Chi Time™. "Chi" is a word from Chinese philosophy meaning the most important energy a person has. Here's how it works.
Maggie Keogh: 12:30
So I'm Maggie Keogh and I am the Director of the Chi Time™ Program at the Mount Sinai Health System and a chaplain. It started out six years ago when I was working with some nurses and trying to help them learn how to do basic listening skills and I discovered I couldn't even get them in the same room at the same time. They were so stressed and they just didn't want to add one more thing to their plate. So we came up with a solution. Every week we go out and we have, they take our chi cart to different units throughout the hospital and we go into probably a conference room, any kind of room where we can create a safe space and if we can, we dim the lights, and we serve tea and we have aroma therapy we play really, kind of quiet music, sort of trying to reach all of the different senses of the, of the staff. And we serve a very healthy snack. We're there for maybe 40 minutes to an hour. The beauty of it is they can come in when they have five minute break or two minutes to just sit and really be quiet for a time. So it's a really coming and going kind of thing too. And that's the experience, the Chi experience. It's like a community builder when they start coming in, they'll sit there and they'll go, "Oh my God, you've got to go get Mary Beth. She's the one who's been most stressed today." And they'll call her up and bring her in for Chi Time. So it's real community building.
And how can this make people more resilient?
Maggie Keogh: 14:03
Well, because they're getting back to homeostasis, biological term of it, which is stress reduction. It's the relaxation response rather than this stress response. You can really support whatever resilience is in somebody by letting them have lower stress. Because I think you can't be resilient if you're stressed. And when you can be in an environment where it's just like, be here now, it's a stress reducer.
What proof do you have that this works?
Maggie Keogh: 14:33
You know, we did a survey of the staff, what we found, we gave it to the staff that had had the Chi Time at least two times and over a six month period. And we found, I mean, it was over the top with positive results of them feeling that they were able to do their shift in a better way. They were able to feel better about themselves for the rest of the day. That they felt calmer. And that another really amazing one was that they felt that the hospital itself and the administration cared about them and also recognize that their job was stressful. And so I think that was really powerful to see.
Does one story in particular stand out to you? Was one nurse having a particularly or doctor having a particularly difficult day? They come in to Chi Time and it just transforms their day.
Maggie Keogh: 15:22
I've had a couple of things like that. One of the nurses had had a horrible experience I think the day before and it was his first week on the unit as a nurse and he had an unexpected kind of a violent death. This young man was really shaken. He was like, "I don't think I can be a nurse." So, you know, in that Chi Time experience, and I noticed he was there.
And how did that help him?
Maggie Keogh: 15:46
We kind of formed a relationship and I was able to follow up and support him there the next day and we started an email correspondence. I helped him process it.
So here is a man who dealt with trauma. A sudden unexpected trauma. Goes to Chi Time, and ultimately that support system and its form of spirituality helped him become more resilient and get back on the job with confidence.
Maggie Keogh: 16:14
Absolutely. Absolutely. Yes. And I think that everybody that comes in, probably, if you did use the word resilient, that would be what they'd say. They feel more resilient after experiencing Chi Time.
I wanted to see what this Chi Time experience was all about. So I went to a session. And that's where I met Dr. Kaitlin Reilly. She's proof of how effective a program like this can be. Take a listen to her story.
Dr. Kaitlin Reilly: 16:35
So I'm an intensive care physician and I'm also a neurologist. I've had kind of a challenging day today, because we had a number of patients who came in overnight whose injuries were too severe for us to intervene on. Fatal catastrophic hemorrhages. One patient's family who had been struggling with the decision to withdraw care on their mother. Their mother was younger than my mom is. She had a massive stroke that came out of the blue that they weren't expecting. So I think I really identified with them and their struggle and some of their fear and frustration as well. And it's, you know, it's impossible to be with someone going through something like that and not feel some of that yourself.
So Chi Time came on the best day for you?
Dr. Kaitlin Reilly: 17:23
It almost always comes on the best day. So I went into Chi Time, Maggie, who I adore, who we've gone through many cases together, poured me a cup of tea. I put some honey in it. I sat down and I talked to some of the nurses and the nurse practitioners on the team about, not about the cases, not about the medical problems and just had like a moment where we're just people interacting with each other.
So it gave you that critical break?
Dr. Kaitlin Reilly: 17:49
How are you feeling now compared to how you felt before Chi Time?
Dr. Kaitlin Reilly: 17:54
Oh, I feel calmer, definitely. Calmer and sharper.
What difference do you notice in other people on your team after Chi Time?
Dr. Kaitlin Reilly: 18:02
Oh, everyone feels calmer after Chi Time. Everyone feels more focused and ready to get back to work. You know, it can get very harried here as you might imagine. And sometimes frustration can kind of build. But after Chi Time, everyone just kind of calms down and decompresses.
And how does that help you become a better doctor?
Dr. Kaitlin Reilly: 18:19
Well, I think both the taking a step back and not trying to react emotionally. It definitely has improved my performance as a physician, and being able to work well within a team. In addition to having that break, which I think is just so important to anyone who has a stressful job and certainly we would fit that description, but it also makes us feel together, like we're part of a team, that we're supporting each other and that we're being supported by the institution that we work for. I think that's just so important for building and maintaining resilience. You know, when something happens that can feel like a real setback. I think it's important to feel that you're part of a larger group.
And Chi Time, such a simple idea to build resilience can easily be applied beyond the hospital setting. Dr. Marin encourages others to try it out.
Dr. Deborah Marin: 19:07
I have a firm opinion this is something that can be transferred from health care to any other place where there may be stress or not. The idea is to just be there, no proselytizing, no prank. It is highly unusual. And we have shown that staff who get this experience feel more engaged. I think that this whole concept of spirituality, if you cut out the organized religion part of it, there's something when people feel connected to something bigger than them, it makes them spiritual. I used to do triathlons. I never would have gotten through those long rides and those marathons without being part of a community. It also helps me feel connected and pushes you on. It's a congregation of people. There's something about that. There's a lot of work now in the scientific literature about resilience. In terms of here in our health system, We are actually about to better understand how spiritual struggle interfaces with resilience in a positive or negative way. My hypothesis would be that those folks were more resilient, have less spiritual distress and may cope better while they're being very ill, but we're looking into that. We will be looking at, in the intensive care units, how resilience and faith and distress interplay with one another in terms of patient outcomes, including even weaning oneself off the ventilator, which is not an easy experience.
So it seems like right now is a really exciting time for researchers when it comes to resilience. Good luck with this research Dr. Marin, and we have one last question for you. What do you want people to ultimately take away from this topic pf faith and spirituality?
Dr. Deborah Marin: 21:02
I think people should feel, I don't want anybody to think they should feel they should be anything, I think it's very important. One of the worst things I would say to a patient, "you should not be depressed." You should. I think what people need to learn is that there are qualities of being resilient that will really help them deal with everything--from a bad day at work, to a mild illness, to death of a loved one, death of a friend--that if they learn the tools to become resilient, of which I think faith and meaning making are definitely part of it, they may have a better quality of life. That's a big one.
And a better quality of life can certainly be achieved just by taking simple steps. You've been listening to episode 4 of Road to Resilience. You don't want to miss our podcast next month. We have a special guest who's been through significant hardship, starting from the time she was young. She has an exceptional story to tell, and she'll explain how optimism, playing to her strengths, and altruism has helped her overcome incredible obstacles and thrive. You can listen to that starting October 31st. And remember to subscribe, review, and rate us.