The 3 H and BMSEST models for spirituality in multicultural whole-person medicine

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.

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.

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.

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.

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.