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THEORETICAL PAPER
Spiritual crisis: a concept analysis
Laurie B. Agrimson & Lois B. Taft
Accepted for publication 19 September 2008
Correspondence to L.B. Agrimson:
e-mail: agrimslb@uwec.edu
Laurie B. Agrimson BSN RN
Graduate Student
Department of Nursing, University of
Wisconsin-Eau Claire, USA
Lois B. Taft DNSc RN GCNS-BC
Professor
Department of Nursing, University of
Wisconsin-Eau Claire, USA
Introduction
Although holistic nursing care includes spiritual care, many
nurses skim over spiritual topics or leave them out entirely
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JOURNAL OF ADVANCED NURSING
A G R I M S O N L . B . & T A F T L . B . ( 2 0 0 9 ) Spiritual crisis: a concept analysis. Journal
of Advanced Nursing 65(2), 454–461
doi: 10.1111/j.1365-2648.2008.04869.x
Abstract
Title. Spiritual crisis: a concept analysis.
Aim. This paper is a report of an analysis of the concept of spiritual crisis.
Background. The term spiritual crisis has been used ambiguously in the literature,
resulting in lack of clarity. A holistic approach includes spirituality in nursing care
of the whole person.
Data sources. Papers available online between 1998 and 2007 in the CINAHL,
Medline and PsycInfo databases were retrieved for analysis. The search engine
Google was also used to examine additional references to ‘spiritual crisis’.
Review methods. Spiritual crisis, spiritual emergency and life crisis were the terms
initially used to search each database. The search was expanded to include spiri-
tuality to draw more literature into the review.
Findings. Using Walker and Avant’s method of concept analysis, a definition of
spiritual crisis was identified. Spiritual crisis can be described as a unique form of
grieving or loss, marked by a profound questioning of or lack of meaning in life, in
which an individual or community reaches a turning point, leading to a significant
alteration in the way life is viewed. Possible antecedents include sudden acute illness
and loss of important relationships. Potential consequences may include physical
and emotional responses.
Conclusion. People with terminal illness, depression, and those who are griev-
ing losses may be at special risk of spiritual crisis. The literature suggests
an interdisciplinary approach, nurses’ self-exploration of spirituality, and
refraining from defining spirituality by religious affiliation as part of improving
practice.
Keywords: concept analysis, life crisis, nursing, spiritual crisis, spiritual emer-
gency
(Villagomeza 2005). Philosophies that emphasize the unity of
human beings include the spiritual domain within a unified
whole. Nursing theories that provide direction for holistic
care include Rogers’ Science of Unitary Human Beings, the
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JAN: THEORETICAL PAPER
Neuman Systems Model, Parse’s Theory of Human Becom-
ing, and Newman’s Theory of Expanding Consciousness
(Fawcett 2005).
Typically, in the United States of America, spiritual
assessment in nursing language refers to asking about
religious group membership. In many cultures throughout
the world, religion and spirituality are inseparable and blend
into a unique cultural world view. By understanding individ-
ual and cultural differences in spirituality and religion, it is
possible to reduce barriers to holistic care.
Spiritual crisis is a phenomenon that can affect individuals,
families, and societies. Former U.S. Vice President Al Gore
used the term spiritual crisis in 2007 when he spoke of a ‘new
way of thinking’ to help influence people to combat global
warming. Gore stated that ‘it’s in part a spiritual crisis’ –
‘crisis of our own self-definition – who we are’ (Caputo 2007,
para.3). Maxwell (2003) used the term to describe how
society’s view of the universe as a ‘machine’ tends to cause
individuals to feel fragmented, leading to alienation and
despair, especially in some parts of the world.
Reactions to the death of the United Kingdom’s Princess
Diana were an example of a society that faced a spiritual
crisis in their shared grief. The film The Queen captured the
sense of loss as the whole nation was changed by this crisis.
Another profound example of a society responding to a deep
spiritual crisis is the Peace and Reconciliation Movement in
South Africa.
The word spiritual and its association with religion and
culture are ambiguous. In the literature, spiritual crisis has
generally been used as a ‘catch-all’ phrase which could
encompass many different phenomena. The purpose of this
concept analysis was to clarify and define ‘spiritual crisis’ and
explore the implications for holistic nursing care.
Background
Significance
According to Hermann (2007), their spiritual needs must be
met in order for people to find meaning and purpose in life. All
people are considered naturally spiritual, and so all have
spiritual needs (Walter 2002), including atheists and agnostics
(Carroll 2001). Spiritual needs include: ‘the need for love,
others, and God; the need to find meaning and purpose
in life; the need to find hope for the future; the need for
forgiveness, creativity, continuity with the past; and to serve
and worship God or a higher power’ (McEwen 2005, p. 162).
Galek et al. (2005) described seven domains of spiritual needs:
belonging, meaning, hope, the sacred, morality, beauty and
acceptance of dying.
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Concept analysis of spiritual crisis
Spirituality contributes to the sustenance of life by giving
individuals meaning in their lives and can sometimes keep
them from death by suicide (Wilding et al. 2005). Spirituality
includes cognitive, emotional and behavioural components
(Byrne 2007) and is described as a quality that ‘strives for
inspirations, reverence, awe, meaning and purpose, even in
those who do not believe in God’ (Murray & Zentner 1989,
p. 259). In the words of deVeber, spirituality ‘separates
humans from other beings,’ and ‘is that realm of being that is
concerned with the profound and ultimate questions of
existence’ (deVeber 1995, p.297).
Conceptual models
McSherry and Smith (2007) point out that, to make sense of
life events and cope with various crises, both adults and
children draw on past experiences and beliefs, including
religious and spiritual beliefs. Wright (2005) devised a
conceptual model in which life’s meaning arises from
questioning and exploration of the interaction of suffering,
beliefs and spirituality. The Trinity Model addresses all forms
of human suffering, where suffering is defined as ‘physical,
emotional or spiritual anguish’ (p.129). Individuals who are
experiencing spiritual pain often ask, ‘Why?’ and are search-
ing for meaning (Byrne 2007).
Victor Frankl considered that an individual can find meaning
in life even when challenged by a hopeless situation or immense
suffering; this statement was based on his observations and
experience as a concentration camp victim in World War II.
He suggested that suffering was a personal challenge to an
individual to show courage, to act decently in spite of one’s
situation (Starck 2003) and that a person’s quest for meaning is
the essential motivation in life (Frankl 1984). Frankl’s Theory
of Meaning and Wright’s Trinity Model inform our under-
standing of the concept of spiritual crisis.
Concept analysis process
A concept analysis breaks down concepts into simpler parts
to refine ambiguous elements and improve understanding by
distinguishing what is from what is not included (Walker &
Avant 2005). The steps outlined by Walker and Avant (2005)
are as follows:
• Select a concept.
• Determine the aims or purposes of analysis.
• Identify all uses of the concept that you can discover.
• Determine the defining attributes.
• Identify a model case.
• Identify borderline, related, contrary, invented and
illegitimate cases.
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L.B. Agrimson and L.B. Taft
• Identify antecedents and consequences.
• Define empirical referents.
Data sources
A review of the literature was performed using the terms
‘spiritual crisis’, ‘spiritual emergency’ and ‘life crisis’ in the
electronic databases of Google, Medline, CINAHL, PsychI-
NFO and the Philosophy and Religion database. Papers in
English and published between 1998 and 2007 were retrieved
and analysed. In general, the literature available on these
topics was sparse. The search was limited initially to peer-
reviewed papers, but was later expanded to include non-peer
reviewed papers for the purpose of inclusiveness and under-
standing of terms.
Results
Definitions of terms
In the Merriam-Webster Dictionary (2004, p.692), spiritual is
defined as ‘relating to, consisting of or affecting the spirit,’
where spirit can mean a life-giving force or animating
principle. Other definitions include a person’s mind or
feelings as separate from the body, the soul, a person’s
nature and the true purpose of something as opposed to a
strict interpretation of its words (Oxford American Dictio-
nary, 1980).
Crisis is defined as ‘a turning point for better or worse in an
acute disease or fever,’ or ‘a decisive or critical moment’
(Merriam-Webster, 2004, p.171) or ‘a time of acute difficulty
or danger’ (Oxford American Dictionary, 1980, p.151). A
crisis is, by definition, something for which an individual
cannot prepare, and results in being caught off guard (Spillers
2007). Spiritual distress has been defined by the North
American Nursing Diagnosis Association as ‘the disruption in
the life principle that pervades a person’s entire being and
that integrates and transcends one’s biological and psycho-
social nature’ (Johnson et al. 2001, p.322). Spiritual struggles
have been associated with several negative outcomes such as
feelings of stress, depression, post-traumatic stress disorder,
anxiety, guilt and having thoughts of suicide (Pargament &
Ano 2006).
Uses of the concept
Spiritual crisis is described in the literature on transpersonal
psychology as ‘a turbulent period of spiritual opening and
transformation,’ where ‘a process of spiritual emergence or
awakening becomes unmanageable for the individual’
456  2008 The Authors. Journal compilation  2008 Blackwell Publishing Ltd
(Spiritual Crisis Network: http://www.spiritualcrisisnetwork.
org.uk, para.1–2). Powerful spiritual energies may
affect a person’s body and mind, causing fragmentation of
the self until the energies can be embodied (Cortright
2000). Lukoff et al. (1998) add problems such as loss of
faith, joining a new religious cult and questioning of
religious values to the scope of meaning for spiritual crisis/
emergency.
An individual may have a ‘temporary loss of that connec-
tion with God’ (Penson et al. 2001, p.287), and this may
bring on a powerful spiritual crisis in someone with a strong
faith. Ventegodt et al. (2005) add that spiritual crises may
occur when individuals are not quite true to themselves and
do not lead their lives in accordance with who they really are.
Everything may come to a standstill. Individuals with
religious convictions may also experience internal struggles,
where good and evil may seem to be struggling for
dominance. Some patients may experience profound mean-
inglessness or a death wish, which needs to be attended to
seriously (Ventegodt et al. 2005).
Grof (2007), in an interview with Jeffrey Mishlove,
described the experience of spiritual crisis in this way:
…there is a sense of such hopelessness that you lose the perspective
that this is a lesson and that I’m going to come out of this different. A
lot of times that will happen around what we call the ego death
experience, where everything feels like it’s dying. And what’s
happening in that kind of experience is that all of the old structures,
all of the old ways of being, the unsuccessful ways of being, are
coming to an end, and it feels literally as though, well, this is it…
Again, another irony is that if the person is able to open up to that
experience, to be there with the experience, that just on the other side
of despair and hopelessness and dying is a whole new way of being
(http://www.intuition.org/txt/cgrof2.html).
A spiritual crisis may be a unique form of life crisis, in that
something happens within a person, perhaps after some
stressful event, such as a death of a loved one. Suddenly, the
individual cannot make sense of the world around them;
options seem out of reach, and it is as if the person ‘has hit a
wall and they are unable to move on’ (Ventegodt et al. 2005,
p. 300). A spiritual crisis may also be viewed as an existential
vacuum which is associated with despair, hopelessness, lack
of life’s meaning and feelings of uselessness (Frankl 1969). A
spiritual crisis is a dilemma which can affect anyone. Nagler
(2004) suggests that the universe has tended to be viewed as
consisting of three ontological realms: matter, energy and
consciousness. Science has influenced us to view reality as
primarily related to matter, or what can be seen and
measured, although there is a great hunger for contact with
the spiritual side of life. According to Nagler (2004, p. 3), a
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spiritual crisis occurs when either an individual or a culture is
trapped in an ‘outmoded or suffocating network of values
and conceptions’ in which the old paradigm or worldview is
no longer workable, and a new paradigm has not yet been
born. A shift in worldview must occur in order for the crisis
to pass.
Attributes of spiritual crisis
Several themes were identified in the literature concerning
the attributes of spiritual crisis. The first is that a spiritual
crisis involves profound questioning about the meaning of
one’s life. Conversely, individuals who have developed an
understanding of the meaning of their lives, recognizing the
unpredictability and uncertainty, are able to see through
their own false beliefs and transcend themselves to perceive
reality as it is (McKee & Barber 1999). Life crises tend to
stimulate questions about the meaning of existence (Balk
1999). The questioning of the meaning of life has been
identified as important in understanding essential spiritual
needs (Frankl 1969, McEwen 2005, Villagomeza 2005,
Wilding et al. 2005). Balk (1999) describes how an
individual can also face a crisis when they discover that
they have been fundamentally mistaken about some aspect
of their life.
The second attribute which defines the crisis is grief or a
deep feeling of loss, often as a result of disruption in
a person’s attachment or connection to themselves, others or
a higher power (God). The attachment could also be to a
fundamental belief that has helped to frame the worldview of
an individual. According to Parse (1981), p. 20, without
other people ‘one would not know that one is, or who one is’.
Macmurray (1961) echoes this, noting that identity and
personhood are found by engaging with and encountering
others.
The third defining attribute of spiritual crisis is that it
presents as a critical moment, turning point or juncture in
which a person is changed by the crisis. Balk (1999, p. 485)
writes that, in order for spiritual change to occur, an
individual’s life ‘must forever afterwards be coloured by the
crisis’.
Definition of spiritual crisis
Based on this concept analysis, the following definition of
spiritual crisis is offered: ‘A unique form of grieving or sense
of loss, marked by a profound questioning of or lack of
meaning in life, in which an individual reaches a turning
point or juncture, leading to a significant alteration in the
way oneself and life is viewed.’
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Concept analysis of spiritual crisis
Antecedents and consequences of spiritual crisis
While antecedents are phenomena that must occur prior to
the occurrence of a concept, consequences are the resulting
outcomes (Walker & Avant 2005). Possible antecedents to
spiritual crisis are sudden acute illness, loss of important
relationships, and other similar phenomena. According to
Villagomeza (2005), potential consequences of a spiritual
crisis can be negative or positive, depending on personal
characteristics, spiritual coping mechanisms, and what
support is given. An example of an extreme negative
consequence could be suicide. Conversely, the crisis may
result in self-reorganization which, according to Mishel and
Clayton (2003), occurs when an individual evaluates
uncertainty within their own life, and comes to an
understanding that uncertainty is accepted and part of
the ‘natural rhythm’ of life. A summary of antecedents,
attributes and consequences of spiritual crisis is given in
Table 1.
Empirical referents
Empirical referents are qualities or categories of measurable
phenomena that demonstrate the presence of the concept
(Walker & Avant 2005). Villagomeza (2005) describes 50
separate empirical referents in the conceptual analysis men-
tioned earlier. Examples of referents listed by Villagomeza
are: ‘expresses being separated from usual support system;
feels separated from personal source of comfort and strength;
verbalizes loss of faith; verbalizes that God is unforgiving;
questions meaning of own existence; expresses concern with
meaning of life and death and/or belief systems; verbalizes
profound disharmony’ (p.290).
Model case
Debbie was a 33-year old married woman whose husband
had a history of alcohol use. This was a second marriage for
both of them. Rick had two children from his previous
marriage, and Debbie had a son who was 12 years old.
Debbie was not happily married but remained married
because she was afraid of venturing out on her own. Also,
she had been brought up in a strict church that discouraged
divorce. She was employed as a nurse’s aide, while Rick was
an office manager with a good income.
Debbie’s son, Justin, was involved in a serious car accident
while riding with Rick to a baseball game and was fatally
injured. Debbie was devastated.
After the funeral, she became very depressed and
questioned whether or not she wanted to live, and whether
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Table 1 Antecedents, consequences, and defining attributes of spiritual crisis

Antecedents Defining attributes Consequences

Acute situations that threaten a Grief or a deep feeling of loss Negative:

person’s sense of identity or lead to Profound questioning of the May involve physical symptoms –
an impairment in any one of the meaning of one’s life loss of energy, anxiety, depression,
following areas: A turning point, juncture or chest or abdominal pain, sensitivity to
• sense of trust in God or the world decisive moment in which noise or light, anorexia
• sense of purpose or meaning one’s life will be altered afterwards Loss of control over one’s direction
• sense of inner peace Social withdrawal
• sense of reality Frequent bouts of crying
• feelings of connectedness Decreased attention span
• sense of values Loss of control over emotions or thoughts
• ability to transcend oneself Suicidal ideation
May involve loss of an important person, Feelings of abandonment
belief system or relationship, including with Existential loneliness
oneself, others or one’s higher power Consequences are dependent on the
May involve a sudden, acute or terminal illness individual and multiple factors
Positive:
A sense of renewal or spiritual awakening
Spiritual resilience
Renewal of hope
Self-reorganization
Post-traumatic growth

she could function in her marriage. The prospect of filing

for divorce was difficult to imagine, not having an
adequate income to support herself. She was very anxious
and so went to her physician and obtained a prescription
for lorazepam and sleeping pills. Two months after her
son’s funeral, Debbie’s body was found by her husband at
home, after an apparent overdose. In this case, she had
experienced the three attributes of a spiritual crisis: a major
loss; questioning the meaning of her life and a turning
point that changed her.
Borderline case
Janet was an 80-year old retired teacher with a history of
depression and recent diagnosis of brain cancer. She was
raised as a Catholic and believed in the holy sacraments
and that prayer could heal her. She sincerely believed that
if she only prayed hard enough she would overcome her
illness. Yet, in spite of prayer, her illness did not abate,
and she only got worse. She cried a lot during that period.
Finally, she realized that even though she was not going to
be cured, she was still going to be ‘with God’ and she
accepted that. She died a few days later after receiving last
rites. In this case, Janet exhibited some of the character-
istics of spiritual crisis (grieving the loss of her health and
her connection with God in terms of answered prayer), but
not all of them.
Contrary case
Bill was a 57-year old man admitted to hospital with chest
pain and coronary artery disease. Diagnostic tests including
an angiogram showed a partially-occluded left main coronary
artery and one other affected vessel. Open heart surgery was
performed and Bill was extubated within 6 hours of his
return from surgery. He maintained good spirits during his
immediate recovery and was transferred from intensive care
the following day. He progressed as hoped with cardiac
rehabilitation, and was discharged to home to the care of his
wife on his fourth postoperative day. It did not appear that
Bill exhibited any attributes of spiritual crisis.
Discussion
From a relational and pragmatic approach, no single theory
can hold the absolute truth (Wright & Leahey 2005)
because all knowledge is limited, complex and potentially
fallible. Therefore, all theories must be constantly scruti-
nized for possibly limiting one’s view of knowing. Also,
although concept analysis is a formal exercise, a limitation
is that the product must always be considered tentative.
Two individuals analyzing the same concept may reach
different conclusions, and this is to be expected because of
changes in the meanings of words over time (Walker &
Avant 2005). The topic of spiritual crisis, being positioned

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JAN: THEORETICAL PAPER
What is already known about this topic
• Assessment of spiritual wellness and needs have been
insufficiently taught to nurses.
• Spirituality has many meanings for individuals, which
creates ambiguity and causes reluctance to explore the
topic.
• A greater awareness of spiritual topics and how to
employ spiritual care is crucial to improved patient
care.
What this paper adds
• Spiritual crises can be experienced either at an indi-
vidual level or by a larger community of people who
undergo a paradigm shift in their worldview.
• Nurses can improve their ability to assess and inter-
vene with clients’ spiritual needs through a more open
definition of spirituality and by exploring their own
spiritual needs.
• Spiritual crisis can be described as a unique form of
grieving or sense of loss, marked by a profound ques-
tioning of or lack of meaning in life, in which a person
reaches a turning point, leading to a significant alter-
ation in the way oneself and life is viewed.
Implications for practice and/or policy
• Nurses need to consider every individual or commu-
nity experiencing a significant loss as being at risk for
spiritual crisis.
• An individual’s spirituality should not be defined by
their culture or religious affiliation.
• A more open approach to assessing clients’ spiritual
needs should be encouraged.
within the spiritual dimension, is difficult to quantify. A
diagnosis of spiritual crisis is complex and challenging, and
may be problematic to discern in another individual. An
example of an unnoticed spiritual struggle was brought to
the world’s attention after the death of Mother Teresa. Her
published diary revealed serious personal doubts about
whether she believed God existed, and suggested she
suffered with spiritual pain for over 50 years (Johnston
2002).
A large body of literature on philosophy and/or religion
was excluded from this concept analysis, and the distinction
between spirituality and religion was not specifically
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Concept analysis of spiritual crisis
addressed, although the difference between these is important
in nursing practice.
Implications for nursing
While there has traditionally been a lack of research in this
area of nursing, recent scientific evidence supports the
benefits of spirituality for health (Villagomeza 2005). Spir-
ituality is part of what makes us human, or as Fabry (1991)
asserted, we have a body and a psyche, but we are our spirit.
Simmington (2004) further notes that, in a healthcare
context, clients are viewed as physical beings who happen
to have a soul, rather than as spiritual beings who also have a
physical nature.
In nursing studies, the loneliness of dying people is
described as a type of spiritual distress (Carroll 2001).
Moreover, compassion fatigue (burnout experienced by
nurses torn between the use of technology and the desire to
remain compassionate) has also been identified as a type of
crisis of meaning and termed spiritual crisis (Kelly 2004). If
we examine the concept of spiritual crisis from the perspec-
tive of a response grounded in loss and grieving, it may be
more apparent that the topic is relevant to nursing than if we
merely think of it in terms of religion or belief systems.
There is some criticism in the literature of the attempt in
nursing to try to address spirituality without proper under-
standing of the implications. Many would argue that, as
nurses tend to lack education and understanding in how to
talk to patients about their spirituality, they ought to leave
this to religious professionals. However, Swinton (2006)
stated that nurses need to listen to the critics of spiritual care
in nursing and realize that we must enter into dialogue with
other disciplines if we are to make progress in this area. It is
vital that nurses share information with social workers,
religious professionals and other healthcare professionals
when they become aware that individuals are suffering
spiritually. The questions that nurses ask patients in assess-
ing their spirituality must also be expanded beyond the
typical questions about religious affiliation. Wright (2005)
suggests that the best way to understand suffering is to
examine dialogue between those who suffer and their
nurses. Those who might especially benefit from an
expanded view of spirituality and ability to relate to patients
include those who are depressed or suicidal, those with a
terminal illness, and anyone grieving the death of a loved
one or other losses.
The suggestion that nurses ought to explore their own
spirituality has also been made by many authors, according
to Carroll (2001). Being in touch with one’s own spiritual
dimensions may be the first step in being able to recognize
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L.B. Agrimson and L.B. Taft
and support the spiritual nature of others. Villagomeza
(2005) proposes that assessment of spirituality could be
accomplished not only by direct questioning of patients, but
also by observing them and their behaviour, using assessment
tools focused on spiritual issues, and listening to patients’
stories.
Conclusion
Both Wright’s Trinity Model and Frankl’s Theory of Meaning
could add to the knowledge development of the spiritual
dimension of individuals and communities, through the
concept of spiritual crisis. Framing spiritual crisis as a process
within the realm of suffering or coping may also illuminate
further discussion and research. There has been a lack of
qualitative research in the matter of spiritual distress, but this
would be a desirable area for additional exploration.
Being spiritual is part of what makes us human, and it
should not be defined by boundaries of religion or cultural
background; a more open approach is needed in order to
apply this concept more universally.
Acknowledgement
We would like to thank J. Michael Orange for editorial
comments and suggestions.
Funding
This research received no specific grant from any funding
agency in the public, commercial, or not for-profit sectors.
Author contributions
LBA conducted the concept analysis and drafted the manu-
script with direction and supervision by LBT. LBA and LBT
made critical revisions to the paper.
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