Foolish as the theory of Durkeim may be in confusing what is religious with what is social, it yet contains an element of truth; that is to say that the social feeling is so much like the religious as to be mistaken for it. (Simone Weil, 1951).

Psychiatrists concern themselves with human mental suffering. Behind the consulting room door they reflect with their patients on questions of meaning and existence, issues that concern philosophy and religion as much as psychiatry. It is striking, therefore, that psychiatrists regard spirituality and religion as, at best, cultural noise to be respected but not addressed directly, or at worst pathological thinking that requires modification (Larson et al. 1993).

Despite two millennia of debate we are little nearer a consensus on the meanings of spirituality and religion. The word ‘religion’ has as many definitions as writers. Spirituality and religion are often used interchangeably. Spilka (1985) doubts that a single definition is even possible. Dittes (1969) argues that religion contains so many unrelated variables that it cannot be considered as a unidimensional concept in research. We would argue that religion is the outward practice of a spiritual system of beliefs, values, codes of conduct and rituals (Speck, 1988). Religious groups may function like any other with codes of behaviour, political alliances and ‘in’ and ‘out’ group member ideology (Sherif et al. 1966).

Unfortunately, a concentration on the religious variable has led to a failure to appreciate the broader concept of spiritual and the presumption that if someone does not profess a recognized, religious faith, they have no spiritual discernment or need (Speck, 1988). We propose a definition of ‘spiritual’ as a person's experience of, or a belief in, a power apart from their own existence. It may exist within them but is ultimately apart. It is the sense of relationship or connection with a power or force. It is more specific than a search for meaning or a feeling of unity with others. People may use the word ‘spiritual’ to describe intense emotional pleasure when moved by natural beauty or by an important relationship. Spiritual belief is more specific than that. Some people may use the word ‘God’ to describe this power; others may be less specific. Spirituality differs from belief in other powers, such as nuclear power or magnetism, in its ‘set apart’ quality and the degree to which it is revered and ritualized, the quality which Durkheim (1915) refers to as the sacred.