Listening for faith

By Khalid Elzamzamy, MD, MA, Johns Hopkins Medicine  

A missed opportunity 

An adolescent girl, Sarah, sat across from us in the pediatric emergency department after disclosing persistent suicidal thoughts. When asked if she’d ever acted on these thoughts, she shook her head firmly: “No. My faith teaches me life is sacred. Suicide isn’t an option.” 

Sarah named what, for her, was the strongest reason to keep living. Yet the resident caring for her seemed almost uncomfortable lingering there. Instead of exploring what faith meant to her and how it might offer support, he quickly moved on through the checklist of risk and protective factors, asking about substance use, friendships, and family and school stressors. The opportunity to acknowledge and build upon what seemed to be the patient’s deepest source of resilience was quietly passed over. 

That moment highlighted a gap in our medical training. We’re taught to explore biological, psychological, and social contributors to illness, but too often overlook the religious and spiritual dimensions that shape how people see themselves, their struggles, and their futures. 

Faith and flourishing 

The recently launched “Global Flourishing Study” that surveyed more than 200,000 people across 22 countries, offers insight into why faith, religion, and spirituality matter in the clinical care of youth. Findings show that higher religious attendance at age 12 predicts a greater sense of purpose and meaning, greater optimism, forgiveness, charitable giving, volunteering, social trust, and inner peace later in life—factors closely tied, directly or indirectly, to better physical and mental health outcomes. These results echo decades of adult research showing that, for many, religious involvement is associated with positive mental, physical, and social well-being. 

This doesn’t mean that patients’ experiences with religion or spirituality are always protective. At times, they can be entangled with shame, conflict, or struggle. But it does remind us that just like family dynamics or school environment, spiritual life is a powerful influence on health and well-being. 

What I learned in the ER 

During my two years in the pediatric emergency department, I sat with children and families at their most vulnerable moments: a teenager after an impulsive overdose, a child brought in after abuse, a family abandoning their child in the hospital after declaring they could no longer manage the aggressive meltdowns. Some families returned again and again; others, facing similar challenges, managed to stay afloat. 

Our models of care in mental health might help us understand something about illness and suffering. But they rarely ask essential questions: Why are some young people thriving despite adversity? Why do some families, even when battling psychiatric illnesses, still live what looks like a good life? At times, the answer involves deeply held worldviews, practices, and sources of meaning and support that shape resilience.  

Practical tips for healthcare professionals: 

So how do we, as clinicians across specialties, integrate attention to the spiritual into our practice without overstepping? 

1. Ask gently, listen openly.  

A simple question such as “Do you have spiritual beliefs, practices, or values that help you to cope with stress, difficult times, or what you are going through right now?” can be revealing. 

2. Respect the diversity of experiences.  

Not all young people are religious and/or spiritual. For those who are, faith can range from comfort to conflict. 

3. Partner and collaborate.  

When appropriate, consider collaborating with chaplains, clergy, or community mentors, just as you would with teachers or social workers. 

4. Reflect on your own worldview.  

We all have worldviews that shape how we see patients. Awareness of our own stance helps us meet theirs with humility. 

Exceptional care isn’t only about diagnosing and prescribing. It’s also about seeing the whole person. For many youths and families, that includes a rich, complex spiritual life. When we pay attention to it, we not only enhance the therapeutic alliance, but we also help cultivate resilience, hope, and flourishing. 

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This piece expresses the views solely of the author. It does not necessarily represent the views of any organization, including Johns Hopkins Medicine.