Reflection from a healthcare professional

I recently met Bridget Taumoepeau, a lively and intesting woman who has worked as a psychiatrist for a long time. Bridget kindly shared this piece below. It is very good. Cheers. Richard

Te Taha Wairua – a neglected concept.

In the 1980’s, Professor Sir Mason Durie introduced us to the health model of Te Whare Tapa Wha, in the context of providing relevant assessment in mental health services for Maori.[1] This model has been widely accepted and used in many settings. I note, for example, that a study of smoking cessation in Maori also used Te Whare Tapa Wha[2].

While this model was developed for Maori Mental Health Services, it is also applicable to non-Maori services and to anyone interested in a holistic approach to health and wellbeing.  I know, for example, of Pakeha living in community, who use it as a measure of health of their community and environment[3]. In writing this, I am considering a wide range of settings that require assessment for the purpose of promoting health and healing.

For those unfamiliar with the model – in brief, it describes the principle that for a person (the house or whare) to be healthy, the four walls must be strong.  These ‘walls’ or corner stones are physical health (te taha tinana); mental health (te taha hinegaro); family (te taha whanau) and spiritual health (te taha wairua).

The Government organisation ‘Careers New Zealand’ has published a description of Te Whare Tapa Wha, describing the four aspects of health[4].  Te Taha Wairua is outlined as follows: “This refers to spiritual awareness. It is recognised as the essential requirement for health and wellbeing. It is believed that without spiritual awareness an individual can be lacking in well-being and therefore more prone to ill health. Wairua explores relationships with the environment, people and heritage.  Spiritual awareness is key to making effective career decisions.”[5]  There could hardly be a stronger statement as to the importance of spiritual health.

As with understanding any model of health, we should reflect on how this applies to us as practitioners. How would we ourselves measure up in terms of the four cornerstones of our own health? Do we, in our everyday lives, consider the importance of these four aspects of our lives to our own wellbeing? How often when we have become unwell, have we been told that we are not attending to our physical health, or to our mental health, or giving enough time to our families – a source of strength and support as well as sometimes an anxiety or responsibility?  How often, however, would we consider our spiritual health in making such a self-assessment? Not often, I would suggest. If we are unfamiliar with this aspect of our own wellbeing, how can we incorporate this into our assessment and understanding of others?

First of all, we have to know what spirituality means.  What is the spiritual aspect to our lives? This may vary markedly from person to person, but could be considered to include the idea of our world view; the beliefs or practices that sustain us; an awareness of a life force greater than or outside of ourselves; ways that we make sense of life; what gives meaning and purpose to our lives; spiritual or religious communities that we belong to; how do we feel connected and so on. Such spiritualty may or may not include a traditional religious belief system.

Aside from a possible lack of knowledge about spirituality, we seem to have a reluctance, a shyness, a lack of confidence about asking about this part of people’s lives. With an increasing secularisation of society, an ability to have a relaxed talk of God, a Higher Being or our world view seems to have sunk without trace.  And yet we hear of people who have taken up meditation, attend Buddhist retreats, follow a guru who inspires them, have developed rituals within their families for special occasions, such as the naming of a child, attaining adulthood, death etc. One problem may be that we often conflate spirituality with organised religion.  For those who do not practice the latter they may not recognise that they do have a spiritual aspect to their lives, whereas those who do practise may be reluctant to talk about this as society in general and, perhaps, psychiatry in particular have been dismissive of these beliefs and practices. In addition, saying that one meditates every morning is considered admirable, whereas talking about one’s prayer life and personal relationship with God may be looked upon askance.

As with all aspects of medicine, one’s own experiences may affect the way we practice our skill. Putting this in context, those of us with physical problems may be very sympathetic to a fellow sufferer, be knowledgeable about available services and form a good rapport with the patient.  On the other hand, if their difficulty is minor in contrast to one’s own, it is easy to belittle their distress.  Similarly if we have experienced any aspect of mental illness (and, after all, we are not exempt from the statistics of 1 in 4 or 1 in 5 being likely to have at least an episode of mental distress in our lifetime), this may make us better able to empathise with the person in front of us. But what of spirituality??

If Te Taha Wairua is considered ‘an essential requirement for health and well-being’, than we are being negligent if we ignore this aspect of people’s lives. Encouraging such a conversation may be an opportunity for people to realise the importance of spirituality; to recognise the spiritual side of their lives; to strengthen the way that they develop their beliefs which anchor them in life and link them to others. New Zealand would be one of the most secular societies, yet people are searching for meaning in their lives. Sometimes they don’t know where to look or what to say, yet may already have the answers within themselves, waiting for someone to help them discover this aspect of their lives.

Each doctor, health professional, counsellor, therapist develops their own style of engaging a patient and learning about their concerns and also their strengths.  Such inquiry needs to include getting in touch with the spirituality of the person in front of them.

And so to the practical ways to achieve this – making an inquiry into how much of this is taught in training programmes and what, if anything, needs to be improved; developing ways to ask about this subject, with which we may be unfamiliar – ways that do not upset or alienate people; learning from other professionals who may be more familiar with this area of assessment; committing ourselves to addressing this issue; modelling to younger practitioners that this is part of holistic care; seeking support within our professions from like-minded colleagues – in other words developing this skill as we would any other practical skill in order to treat and heal the best we can.

Bridget Taumoepeau M.B. Ch.B., FRANZCP, B. Theol.

[1] Durie, Mason. ‘Indigenizing mental health services: New Zealand experience’. Transcultural Psychiatry 48(1-2) 24-36.

[2] Glover, Marewa. ‘Analysing Smoking using Te Whare Tapa Wha’, New Zealand Journal of Psychology Vol 34, No.1, March 2005.

[3] Fr. Phil Cody sm, personal communication.


[5] Ibid.

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