Thailand still faces some difficulty with the word spirituality and its translations from English into Thai, not only because of technical aspects but because, as illustrated above, this word and concept are being grounded in a different culture and religion. Western understandings of spirituality are likely to be influenced by their preferred religions, such as Christianity (Sheldrake, 2007), whereas the concept of spirituality to Thai people is influenced by Buddhism in particular (Tongprateep, 2002). At the outset of this study (2005), there was debate at a scholarly level about the concept of spirituality. Some Thai scholars have argued that spirituality is only a consequence of the mind that has been trained because one of the results of training the mind is gaining wisdom or insight (e.g. Phra Dhammapitaka, 2003). This argument is supported by Wasi (2000)
5
Noble Eightfold Path is one truth of the Four Noble Truths. It is the path to guide human beings to be
free from suffering. It consists of the Eightfold Path: right thinking, right mindfulness, right view, right speech, right action, right diligence, right livelihood, and right concentration.
13
who states that spiritual well-being is the well-being that is augmented when people do a good thing or the mind is touched by a good thing such as engaging in, and following, a religious doctrine or following the Dharma (Buddhist teachings).
There was also discussion at governmental levels as Thailand attempted to integrate elements of the World Health Organization (WHO) definition of health into a Thai definition of health. Since 1980, member states of the World Health Organization in the Eastern Mediterranean Region have attempted to include “spiritual health” into the World Health Organization’s (WHO) definition of health (Chokwiwatana, 2008). Finally, in 1997 the Executive Board of the WHO proposed the following amendment of the definition of health as, “Health is a dynamic state of complete physical, mental, spiritual and social well-being and not merely the absence of disease or infirmity”
(Khayat, 1998, p. 5). However, the proposal was not accepted as a resolution at the World Health Assembly. Thus the definition of health remains the same as stated in the preamble of the Constitution of WHO – “the state of complete physical, mental and social well-being and not merely the absence of the disease or infirmity” (Chokwiwatana, 2008, p. 28).
Influenced by discussion at the World Health Assembly and by the writings of Khayat
(1998) an attempt was made in Thailand to create a definition of spirituality for a culture where the Buddhist majority believe that health is the harmony of body and
mind. This attempt brought about strong controversy rooted in some leading Buddhist organisations which rejected the “spiritual dimension” as a concept influenced by a theistic paradigm which is opposite to Buddhism. The first Thai adaptation of the WHO definition of health was “the dynamic state of complete physical, mental (jit), spiritual (jitwinyarn) and social well-being and not merely the absence of disease or infirmity” (Chokwiwatana, 2008, p. 28; The Network of Buddhist Organizations of Thailand, 2003, p. 3). This definition joined two words jit and winyarn that have the same meaning (which is mind in Buddhism) in order to define the term spirituality (jitwinyarn). This definition was disputed on the basis that, from the Buddhist point of view, grouping two words that have the same meaning (in Buddhism) together, appeared to discredit Buddhism (The Network of Buddhist Organizations of Thailand, 2003). Furthermore, the new term to refer to spirituality in Thai words was not familiar to Thais (Bhawilai, 2003). Thus, the Network of Buddhist Organizations of Thailand
14
and other Thai scholars tried to find a new word and definition that were more acceptable for the term spirituality.
In March, 2007, the Health Act 2007 was announced. Finally, consensus had been reached on acceptance of the term “intellectual well-being” as the fourth dimension of health (Chokwiwatana, 2008). This Act included a new definition of health as “the state of human being which is perfect in physical, mental (jit), spiritual (panya) and social aspects all of which are holistic in balance” (Chokwiwatana, 2008, p. 28). It also proposed the Buddhist way of development of the four dimensions of health (Chokwiwatana, 2008). In this, in the Health Act 2007, the term referring to spirituality in the Thai language was changed from jitwinyarn to panya.
Panya, in this definition, refers to a state (of mind) that is able to feel, perceive, understand, and able to identify between the good and the bad, valued and not- valued, and that enhances a state of moral, pleasurable and generous mind that consists of loving-kindness, compassion, and altruistic joy (The National Health Committee, 2007, p. 1).
Therefore, the definition of health in Thailand includes a spiritual dimension that is consistent with the precepts of the WHO. However, from my point of view, the new definition of health which was launched after the commencement of my doctoral research still shows the gap that exists between the perspectives of lay people and academics. The new notion of spirituality was accepted by scholars, the Thai academic community and those at government level only. It was still not fully understood and widely known by many Buddhist and lay Thai people. Furthermore, although in the new definition some words were changed for greater clarity, the words “human being” are used as a central focus which is contrary to the Buddhist emphasis on “life” that is familiar to lay people.
As a consequence, although some healthcare services in Thailand are alert to the need to provide spiritual care – such as providing a prayer (lamad) room for Muslim patients and allowing monks to visit Buddhist patients who are admitted to the hospital – there is no clear picture of how spiritual care ought to be provided in the health care services. Therefore, more knowledge about spirituality in the Thai context is urgently required.
15
In particular, there have been few studies that report what role spirituality plays in overcoming the distress of people living with a life threatening illness such as HIV/AIDS. Also much prior research involves quantitative measures that provide an indication of the relative association of differing variables, but do not provide health professionals with sufficient depth of understanding to enhance their practice. Through more research, this concept could be made more practical and ways developed that could enhance the well-being of people. If all sectors recognise the importance of spirituality and endeavour to make spirituality clearer, this goal could be achieved.