The 3 H and BMSEST Models for Spirituality in Multicultural Whole-Person Medicine

Gowri Anandarajah

doi:10.1370/afm.864

Abstract

PURPOSE The explosion of evidence in the last decade supporting the role of spirituality in whole-person patient care has prompted proposals for a move to a biopsychosocial-spiritual model for health. Making this paradigm shift in today’s multicultural societies poses many challenges, however. This article presents 2 theoretical models that provide common ground for further exploration of the role of spirituality in medicine.

METHODS The 3 H model (head, heart, hands) and the BMSEST models (body, mind, spirit, environment, social, transcendent) evolved from the author’s 12-year experience with curricula development regarding spirituality and medicine, 16-year experience as an attending family physician and educator, lived experience with both Hinduism and Christianity since childhood, and a lifetime study of the world’s great spiritual traditions. The models were developed, tested with learners, and refined.

RESULTS The 3 H model offers a multidimensional definition of spirituality, applicable across cultures and belief systems, that provides opportunities for a common vocabulary for spirituality. Therapeutic options, from general spiritual care (compassion, presence, and the healing relationship), to specialized spiritual care (eg, by clinical chaplains), to spiritual self-care are discussed. The BMSEST model provides a conceptual framework for the role of spirituality in the larger health care context, useful for patient care, education, and research. Interactions among the 6 BMSEST components, with references to ongoing research, are proposed.

CONCLUSIONS Including spirituality in whole-person care is a way of furthering our understanding of the complexities of human health and well-being. The 3 H and BMSEST models suggest a multidimensional and multidisciplinary approach based on universal concepts and a foundation in both the art and science of medicine.

Footnotes

Conflicts of interest: none reported
This work has been previously presented in part at the Society of Teachers of Family Medicine (STFM) 19th Conference on Family and Health, March 3–7, 1999, Kiawah Island, South Carolina; the STFM 20th Conference on Families and Health, March 2000, San Diego, California; the 2000 Conference on Spirituality in Healthcare: Issues of Culture & End of Life, September 2000, Dallas, Texas; the STFM Conference on Families and Health, February 2001, Kiawah Island, South Carolina; the Association for Behavioral Science and Medical Education 31st Annual Conference, October 2001, North Falmouth, Massachusetts; the World Organization of Family Doctors (WONCA) World Conference, October 2004, Orlando, Florida; and the Science and Spirituality: East and West Conference at the Center for Indic Studies, University of Massachusetts, June 26, 2004, Dartmouth, Massachusetts.