Research ArticleTheory

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

Gowri Anandarajah
The Annals of Family Medicine September 2008, 6 (5) 448-458; DOI: https://doi.org/10.1370/afm.864

Article Figures & Data

Figures

  • Figure 1.
    Figure 1.

    BMSEST model at the individual level: the whole person plus external factors.

    BMSEST = body, mind, spirit, environment, social, and transcendent.

    Note: Body = cells, organs, biochemistry, genetics, physiology, possibly energy systems, etc.; mind = thoughts, emotions, cognitive function, etc.; spirit = see Table 1⇓; environment = physical environment, occupational exposure, health care system, etc.; social = family, culture, religious organization, education, economic factors, etc.

    Arrow a = interactions between body and mind.

    Arrow b = interactions between mind and spirit.

    Arrow c = interactions between body and spirit.

    Arrow d = interactions between environmental factors and the individual.

    Arrow e = interactions between social factors and the individual.

  • Figure 2.
    Figure 2.

    Secular version of the BMSEST model for whole-person care: the physician-patient relationship.

    BMSEST = body, mind, spirit, environment, social, and transcendent; PT=physical therapy.

    Arrow a = interactions between body and mind.

    Arrow b = interactions between mind and spirit.

    Arrow c = interactions between body and spirit.

    Arrow d = interactions between environmental factors and the individual.

    Arrow e = interactions between social factors and the individual.

    Arrow f = therapeutic approaches at the body level.

    Arrow g = therapeutic approaches at the mind level.

    Arrow h = therapeutic approaches at the spirit level (specialized spiritual care).

    Arrow i = therapeutic effects at the spirit level (general spiritual care).

  • Figure 3.
    Figure 3.

    Duality version of the BMSEST model for whole-person care.

    BMSEST = body, mind, spirit, environment, social, and transcendent; PT=physical therapy.

    Arrow a = interactions between body and mind.

    Arrow b = interactions between mind and spirit.

    Arrow c = interactions between body and spirit.

    Arrow d = interactions between environmental factors and the individual.

    Arrow e = interactions between social factors and the individual.

    Arrow f = therapeutic approaches at the body level.

    Arrow g = therapeutic approaches at the mind level.

    Arrow h = therapeutic approaches at the spirit level (specialized spiritual care).

    Arrow i = therapeutic effects at the spirit level (general spiritual care).

    Arrow j = interactions between the individual and the Transcendent.

  • Figure 4.
    Figure 4.

    Unity version of the BMSEST model for whole-person care.

    BMSEST = body, mind, spirit, environment, social, and transcendent; PT=physical therapy.

    Arrow a = interactions between body and mind.

    Arrow b = interactions between mind and spirit.

    Arrow c = interactions between body and spirit.

    Arrow d = interactions between environmental factors and the individual.

    Arrow e = interactions between social factors and the individual.

    Arrow f = therapeutic approaches at the body level.

    Arrow g = therapeutic approaches at the mind level.

    Arrow h = therapeutic approaches at the spirit level (specialized spiritual care).

    Arrow i = therapeutic effects at the spirit level (general spiritual care).

    Arrow j = interactions between the individual and the Transcendent.

Tables

  • Table 1.

    The 3 H Dimensions of Spirituality, With Examples of Each Dimension

    Cognitive (Head)Experiential (Heart)Behavioral (Hands)
    BeliefsLoveDuties
    Values    Compassion, altruism, forgivenessDaily behavior
    Ideals    Moral obligations
    MeaningConnection, relationship with:    Choices
    Purpose    Self    Life choices
    Truth    Others, community    Medical choices
    Wisdom    Environment, natureSpecific practices:
    Faith (belief)    The transcendent    Prayer, meditation, yoga, chanting, rituals, diet, nature walks, etc
    Inner energy
 Strength, resilienceParticipation in religious community
    Inner peace, comfort, support
    Hope
    Faith (trust)
    Transcendence

Additional Files

  • The Article in Brief

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

    Gowri Anandarajah

    Background There is growing interest in both whole-person care (which addresses the patient's body, mind, and spirit) and the role of spirituality in patient care. However, there are few comprehensive models of spirituality tailored to daily patient care needs. This article provides a theoretical framework, aimed at clinicians, educators and researchers, addressing how spirituality fits into whole-person health care.

    What This Study Found Two models provide a basis for approaching spirituality in whole-person medicine. The 3 H model of spirituality (head, heart, hands) offers a multidimensional definition of spirituality, which can be applied across cultures and belief systems, with a common vocabulary. The BMSEST (body, mind, Spirit, environment, social, transcendent) models provide a framework for the role of spirituality in the larger health care context, useful for patient care, education, and research.

    Implications

    • Given the complexities of the human condition, the future study of whole-person care will require research methods and approaches from many disciplines, including science, social science, and the humanities.
    • Although challenging, there are many opportunities to find common ground between different world views and ways to provide cure, relief, and comfort to patients.
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